Acupuncture and/or moxibustion for the treatment of lumbar disc herniation: q...LucyPi1
Abstract Objective: In the current systematic review on acupuncture and/or moxibustion for lumbar disc herniation (LDH), we evaluated the methodology and quality of evidence and reports to provide necessary information for accurate clinical decision-making regarding acupuncture and/or moxibustion for LDH. Methods: From databases such as CBM (Chinese biomedical literature database), VIP (China science and technology journal database), CNKI (China national knowledge infrastructure), WF (Wanfang database), Web of Science, Embase, Medline, and Cochrane Library, systematic reviews on acupuncture and/or moxibustion for LDH were retrieved, and the methodological quality of the literature was evaluated according to the assessment of multiple systematic reviews (AMSTAR) list. Furthermore, the grading of recommendations assessment, development and evaluation (GRADE) system was used to grade the quality of evidence and the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement to evaluate the quality of the report. Results: A total of 18 systematic reviews were included, and the conclusion is that acupuncture and/or moxibustion have some advantages in terms of efficacy and safety with regard to LDH treatment. According to the AMSTAR score, there were 4 high-quality studies, 13 moderate-quality studies, and 1 low-quality study. GRADE showed that quality of evidence such as total effective rate of LDH and VAS was low and that of other forms of evidence was lower. The PRISMA statement showed that 8 articles were in line with 20 or more of the 27 items, and 10 articles were in line with 10-19 of the 27 items. Conclusion: At present, acupuncture and/or moxibustion for LDH has a good curative effect. More importantly, its methodological quality was of moderate level and the report quality was generally good and relatively complete. However, the poor quality of the original research results was reflected in the quality of evidence. More studies are needed to make sure whether acupuncture is more effective than other treatment methods
Acupuncture and/or moxibustion for the treatment of lumbar disc herniation: q...LucyPi1
Abstract Objective: In the current systematic review on acupuncture and/or moxibustion for lumbar disc herniation (LDH), we evaluated the methodology and quality of evidence and reports to provide necessary information for accurate clinical decision-making regarding acupuncture and/or moxibustion for LDH. Methods: From databases such as CBM (Chinese biomedical literature database), VIP (China science and technology journal database), CNKI (China national knowledge infrastructure), WF (Wanfang database), Web of Science, Embase, Medline, and Cochrane Library, systematic reviews on acupuncture and/or moxibustion for LDH were retrieved, and the methodological quality of the literature was evaluated according to the assessment of multiple systematic reviews (AMSTAR) list. Furthermore, the grading of recommendations assessment, development and evaluation (GRADE) system was used to grade the quality of evidence and the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement to evaluate the quality of the report. Results: A total of 18 systematic reviews were included, and the conclusion is that acupuncture and/or moxibustion have some advantages in terms of efficacy and safety with regard to LDH treatment. According to the AMSTAR score, there were 4 high-quality studies, 13 moderate-quality studies, and 1 low-quality study. GRADE showed that quality of evidence such as total effective rate of LDH and VAS was low and that of other forms of evidence was lower. The PRISMA statement showed that 8 articles were in line with 20 or more of the 27 items, and 10 articles were in line with 10-19 of the 27 items. Conclusion: At present, acupuncture and/or moxibustion for LDH has a good curative effect. More importantly, its methodological quality was of moderate level and the report quality was generally good and relatively complete. However, the poor quality of the original research results was reflected in the quality of evidence. More studies are needed to make sure whether acupuncture is more effective than other treatment methods
The Effectiveness of Mirror Therapy with Stroke Patients in Producing Improve...CrimsonPublishersTNN
The Effectiveness of Mirror Therapy with Stroke Patients in Producing Improved Motor and Functional Outcomes by Hassan Izzeddin Sarsak in Techniques in Neurosurgery & Neurology
Presentation given by Dr Adnan Saithna, Professor of Orthopedic Surgery at AAOS 2020, on factors influencing outcomes of a validated return to sports test battery after ACL reconstruction
OPEN ACCESS: Prognostic implications of conversion from non-shockable to shoc...Emergency Live
The prognostic significance of conversion from non-shockable to shockable rhythms in patients with initial non-shockable rhythms who experience out-of-hospital cardiac arrest (OHCA) remains unclear. We hypothesized that the neurological outcomes in those patients would improve with subsequent shock delivery following conversion to shockable rhythms, and that the time from initiation of cardiopulmonary resuscitation by emergency medical services personnel to the first defibrillation (shock delivery time) would influence those outcomes. READ MORE HERE: http://ccforum.com/content/18/5/528/abstract#
Water pollution is the contamination of water bodies (e.g. lakes, rivers, oceans, aquifers and groundwater). This form of environmental degradation occurs when pollutants are directly or indirectly discharged into water bodies without adequate treatment to remove harmful compounds.
The Effectiveness of Mirror Therapy with Stroke Patients in Producing Improve...CrimsonPublishersTNN
The Effectiveness of Mirror Therapy with Stroke Patients in Producing Improved Motor and Functional Outcomes by Hassan Izzeddin Sarsak in Techniques in Neurosurgery & Neurology
Presentation given by Dr Adnan Saithna, Professor of Orthopedic Surgery at AAOS 2020, on factors influencing outcomes of a validated return to sports test battery after ACL reconstruction
OPEN ACCESS: Prognostic implications of conversion from non-shockable to shoc...Emergency Live
The prognostic significance of conversion from non-shockable to shockable rhythms in patients with initial non-shockable rhythms who experience out-of-hospital cardiac arrest (OHCA) remains unclear. We hypothesized that the neurological outcomes in those patients would improve with subsequent shock delivery following conversion to shockable rhythms, and that the time from initiation of cardiopulmonary resuscitation by emergency medical services personnel to the first defibrillation (shock delivery time) would influence those outcomes. READ MORE HERE: http://ccforum.com/content/18/5/528/abstract#
Water pollution is the contamination of water bodies (e.g. lakes, rivers, oceans, aquifers and groundwater). This form of environmental degradation occurs when pollutants are directly or indirectly discharged into water bodies without adequate treatment to remove harmful compounds.
We can work together to keep the environment clean so the plants, animals and people who depend on it remain healthy :) Working together, we can make pollution less of a problem and make our world a better place :D :)
Effectiveness of Mirror Therapy on Upper Extremity FunctioniEvonCanales257
Effectiveness of Mirror Therapy on Upper Extremity
Functioning among Stroke Patients
Rohini T. Chaudhari1, Seeta Devi2, Dipali Dumbre3
1MSc Nursing, 2Asst. Professor, 3Tutor, Symbiosis College of Nursing, Symbiosis International
(Deemed University), Pune
ABSTARCT
Background: The prevalence of stroke in the general population varies from 40 to 270 per 1000,000 in
India. Approximately 12% of all strokes occur in those older than 40 years. Stroke may require a variety of
rehabilitation services. One of them Mirror therapy is a simple, inexpensive and most importantly patient
directed treatment that may improve hand function after stroke.
Objective: To assess the effectiveness of mirror therapy on upper extremity functioning among stroke
patients at selected neuro- rehabilitation centres
Method: A quantitative research approach was used in this study. Research design was Quasi-
experimental: pre-test post-test. Sample size was 50 post stroke patients who receive stroke rehabilitation
at Neurorehabilitation centres. The 25 subjects were randomly divided into two groups, experimental group
and control group. The experimental group has received mirror therapy with the conventional therapy for 3
days in a week for 4 weeks. Other side the control group has received only conventional therapy for 4 weeks,
and 3 days in a week. The effectiveness was evaluated by Modified Brunnstrom’s motor function test
Result: An average hand functioning score in pre-test was 8.2 which increased to 12.6 in post-test and 7.6
which increased to 13.4 in post-test for upper extremity functioning among experimental group, following
for the control group as in pre-test an average was 8.3 which increased to 11.2 for hand and 8.1 which
increased to 11.7 of upper extremity.
Conclusion: The findings of the study show that there is significant difference between the scores of
experimental and control group.
Keywords: Mirror Therapy, Upper Extremity Stroke , Neuro Rehabilitation Centre
INTRODUCTION
As human, we move our bodies to explicit our wants,
needs, emotions, thoughts, and ideas. Basically, how
well we move- and how much we move- decides how
well we engage with the world and make our full purpose
in life. Mostly the active movement helps us in function
completely, interact with the world, feel well physically
and emotionally, connect and build relationship with
others, and communicate and express ourselves. Also
the movement helps us recover if our brain is injured
or inflamed. Body movements are comparable important
for smooth and effective day to day activities.1
Nervous system is a one of the system of our body,
which perform all the sensory and motor function
of body. The reason a healthy nervous system is so
important is because it’s what runs everything in our
body. When nervous system is functioning correctly,
body is able to perform all the things it needs to do.
However, when the ...
Exercise Training Recommendation For Individual With Left Ventricular Assisti...Javidsultandar
A left ventricular assist device, or LVAD, is a mechanical pump that is implanted inside a person's chest to help a weakened heart pump blood. Unlike a total artificial heart, the LVAD doesn't replace the heart. It just helps it do its job
The Clinical Pharmacist in Cardiac Rehabilitation Phase I at Sarawak General ...guestaf1e4
A Health Related Quality of Life Study in Patients with Acute Coronary Syndromes: The Cost-Effectiveness of Clinical Pharmacy Service in the Phase I, and Short Course Phase II Cardiac Rehabilitation Program
Authors of proposal: 1, 2 Professor Dr. Sim Kui Hian, 4 Professor Dr. Mohd. Izham Mohd Ibrahim, 1, 2 Dr. Alan Fong Yean Yip, 3 Yanti Nasyuhana Sani, 3 Tiong Lee Len, 3 Bibi Faridha Mohd Salleh, 4 Dr Mohd. Azmi Ahmad Hassali, 4 Prof. Dr Yahaya Hassan, 3 Lawrence Anchah, 5 Karen Tang Siew Lang, 1 Hii Ai Ching,1 Sii Lik Ngoh
1 Dept of Cardiology, Sarawak General Hospital.
2 Clinical Research Centre, Sarawak General Hospital.
3 Dept of Pharmacy, Sarawak General Hospital.
4 School Pharmaceutical Sciences, Universiti Sains Malaysia.
5 Dept of Physiotherapy, Sarawak General Hospital.
NIH Reference No.: (4) dlm.KKM/NIHSEC/08/0804/P07-161, dated 3rd September 2007
Completed 20th Dec 2009
Researcher: Lawrence Anak Ancah, B. Pharm, M. Clinical Pharm, Candidate for Ph.D Cinical Pharmacy in Cardiovascular & HRQoL
Integrative Telerehabilitation Strategy after Acute Coronary SyndromeIgnacio Basagoiti
Poster presentation in e-Cardiology & e-Health Congress Berna 2014 by Ernesto Dalli , Sergio Guillén , Ignacio Basagoiti , Jaime H. Horta , Lourdes Peñalver , José L. Marqués , Clara Bonanad from Department of Cardiology, Hospital Arnau de Vilanova, TSB SA , Departament of Cardiology, Hospital Politécnico Universitario La Fe and Department of Cardiology, Hospital Clínico Universitario, Valencia, Spain.
Effectiveness of Passive Range of Motion Exercises on Hemodynamic parameters ...iosrjce
IOSR Journal of Nursing and health Science is ambitious to disseminate information and experience in education, practice and investigation between medicine, nursing and all the sciences involved in health care. Nursing & Health Sciences focuses on the international exchange of knowledge in nursing and health sciences. The journal publishes peer-reviewed papers on original research, education and clinical practice.
By encouraging scholars from around the world to share their knowledge and expertise, the journal aims to provide the reader with a deeper understanding of the lived experience of nursing and health sciences and the opportunity to enrich their own area of practice. The journal publishes original papers, reviews, special and general articles, case management etc.
Impact of ERAS Protocol on the Post-Operative Complications in Colorectal Sur...semualkaira
The patient experiences post-operative complications after colorectal surgery. To reduce these complications,
the ERAS protocol was developed. The current study assesses the
impact of ERAS on the post-operative complications after colorectal surgery
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
3. treatment (CT) and also examined whether the initial severity
of motor deficits and the treatment intensities of RT interact
to influence the primary outcome.
Methods
Participants
Criteria for study participants were (1) more than 6 months’ onset
from a unilateral stroke; (2) baseline upper extremity score on the
Fugl-Meyer Assessment (FMA) of 26 to 56; (3) no excessive
spasticity in forearm and wrist joints (modified Ashworth scale Ͻ3);
(4) able to follow study instructions and perform study tasks
(Mini-Mental Status Examination Ն22); (5) no upper limb fracture
within 3 months or painful arthritis of the joints; and (6) no severe
neuropsychologic impairments (eg, global aphasia or severe atten-
tion deficits). The Institutional Review Boards of the participating
hospitals approved the study, and all participants provided
informed consent.
Study Procedures
This was a randomized-block controlled trial with pretest, midterm,
and posttest evaluations. Eligible participants were stratified accord-
ing to side of lesion and level of motor deficits and individually
randomized to receive one of the 3 interventions. A random number
table was used to generate randomization assignments, and a
research assistant allocated the patients to an intervention group
accordingly. All clinical measures were administered to the patients
at baseline and immediately after the intervention by the same
blinded rater. The primary outcome measure was also administered
2 weeks after treatment began (midterm).
Interventions
All participants received a duration-matched intervention for 90 to
105 minutes/day, 5 days/week for 4 weeks. The patients in the 2 RT
groups practiced with the Bi-Manu-Track (Reha-Stim Co, Berlin,
Germany; Figure 1), which allows 2 movement patterns: forearm
pronation–supination and wrist flexion–extension.14 Each move-
ment pattern is enabled by 3 computer-controlled modes: passive–
passive (mode 1), active–passive (mode 2), and active–active
mode (mode 3). The parameters of movement and resistance can
be adjusted individually. The robot was equipped with a computer
game to provide instant visual movement feedback and to
increase participation.
Within one training session, the patients in the higher-intensity RT
group practiced 600 to 800 repetitions of modes 1 and 2 for 15 to 20
minutes and 150 to 200 repetitions of mode 3 for 3 to 5 minutes for
bilateral forearm and wrist movements. One repetition indicated one
movement direction. Patients in the higher-intensity RT received
Figure 1. Bi-Manu-Track.
326 Patients with stroke were
assessed for eligibility
54 Underwent randomization
272 Were excluded
232 Did not meet inclusion
criteria
40 Refused to participate
18 Were assigned to
lower-intensity
robot-assisted therapy
18 Were assigned to
control treatment
18 Were assigned to
higher-intensity
robot-assisted therapy
18 Completed study
and 18 were analyzed
18 Completed study
and 18 were analyzed
17 Completed study and
18 were analyzed
1 Drop out
(due to
hydronephrosis)
Figure 2. Flow chart of participant enrollment.
2730 Stroke October 2012
by guest on May 20, 2014http://stroke.ahajournals.org/Downloaded from
4. twice the number of the repetitions per unit of time than patients in
the lower-intensity RT group.15
Before the RT training, 5 minutes of mobilization warm-up were
provided. After the training, the patients received 15 to 20 minutes of
functional activities practice to help them transfer the acquired motor
ability to their performance of daily activities.
The CT group received an intensive therapist-administered control
therapy matched in duration with the RT groups. Occupational
therapy techniques used in the treatment protocols included neuro-
developmental treatment, muscle strengthening, fine-motor training,
and functional task training.
Outcome Measures
The primary outcome was a change in the FMA. The 33 upper
extremity items of the FMA, with scores ranging from 0 to 66, were
used to assess motor impairment.16 The reliability, validity, and
responsiveness of the FMA in patients with stroke have been well
established.16–18
Secondary outcomes included the following assessments: (1) the
Medical Research Council scale, a reliable measurement ranging
from 0 (no contraction) to 5 (normal power), examines muscle power
of the affected arm19; (2) the Motor Activity Log consists of a
30-question interview in which patients rate the amount of use and
quality of movements at the time of using their affected arm to
accomplish daily activities20; and (3) the Stroke Impact Scale (SIS)
3.0 has 4 physical domains—strength, activities of daily living/
instrumental activities of daily living, mobility, and hand function—
that use patient report to evaluate function and quality of life.21
Two common complications after stroke, pain and fatigue,22 were
measured to investigate if intensive rehabilitation causes adverse
effects. The therapist asked the patient to rate the severity of his or
her pain and fatigue during the intervention on a scale of 0 (no pain
and no fatigue) to 10 (unbearable pain and exhaustion).
Statistical Analysis
An intention-to-treat analysis was applied. Two-way repeated-
measures analysis of covariance was used to evaluate efficacy of the
primary outcome among the 3 groups followed by a post hoc analysis
using the Bonferroni test for a significant effect. Analysis of
covariance was used to evaluate treatment efficacy for the secondary
outcomes with baseline scores as the covariates. The t test was used
to examine recovery rates of each week on each outcome (ie,
improved score divided by the number of weeks) between the 2 RT
groups. We also examined whether the initial severity of motor
impairments affected the primary outcome (ie, FMA). Scatterplots
with quadratic curves were used to illustrate the relationship between
the baseline scores and the change scores.
Results
The study enrolled 54 patients. One patient in the CT group
dropped out due to a medical problem unrelated to the study
treatment (Figure 2). The 3 groups did not differ significantly
in baseline characteristics (Pϭ0.40–0.93; Table 1). As de-
termined by the obtained effect size of the primary outcome,
post hoc power was calculated to be 0.80.
Primary Outcome
On the FMA total score, there was a significant groupϫtime
interaction effect (F3.4,83.8ϭ3.95, Pϭ0.01). All 3 groups
showed significant within-group gains on the FMA total
score from baseline to midterm and from baseline to post-
treatment (all PϽ0.05; Table 2). Analysis of covariance
revealed significant differences among the 3 groups at mid-
term (F2,50ϭ6.97, Pϭ0.002) and at posttreatment
(F2,50ϭ4.80, Pϭ0.01). Post hoc analyses showed that the
higher-intensity RT group had significantly greater improve-
ments on the FMA total score than the lower-intensity RT and
CT groups at midterm (Pϭ0.003 and Pϭ0.02) and at post-
treatment (Pϭ0.04 and Pϭ0.02; respectively; Table 2). No
significant differences were found between the lower-
intensity RT and CT groups at midterm and at posttreatment.
A similar effect was also found on the FMA distal score
(Table 2).
Table 1. Baseline Characteristics of the Study Participants by
Group (N)45؍
Characteristics*
Higher-
Intensity RT
(nϭ18)
Lower-
Intensity RT
(nϭ18)
Control
Treatment
(nϭ18) P Value
Age, y 56.51 (10.03) 52.21 (12.20) 54.83 (9.84) 0.49
Time after
stroke, mo
28.67 (13.67) 23.28 (15.37) 22.44 (15.34) 0.40
Sex, no.
Male 11 13 12 0.78
Female 7 5 6
Stroke subtype, no.
Ischemic 12 11 9 0.73
Hemorrhagic 6 7 8
Subarachnoid 0 0 1
Side of stroke, no.
Right 9 9 8 0.93
Left 9 9 10
MMSE score 28.50 (1.98) 28.00 (2.50) 28.28 (2.08) 0.79
FMA score 42.78 (8.86) 43.11 (9.18) 44.61 (11.06) 0.84
RT indicates robot-assisted therapy; MMSE, Mini-Mental State Examination;
FMA, Fugl-Meyer Assessment.
*Continuous data are presented as the mean (SD); categoric data are
presented as indicated.
Table 2. Descriptive Statistics and Group Comparisons on the
Primary Outcome
Outcome
Higher-
Intensity RT
Mean (SD)
Lower-
Intensity RT
Mean (SD)
Control
Treatment
Mean (SD)
FMA total score
Baseline 42.78 (8.86) 43.11 (9.18) 44.61 (11.06)
Midterm 46.06 (8.50)*†‡ 44.50 (9.69)* 46.33 (10.50)*
Posttreatment 48.00 (8.22)*†‡ 46.33 (10.27)* 47.56 (10.50)*
FMA distal score
Baseline 12.56 (6.17) 11.44 (6.81) 13.39 (7.65)
Midterm 14.00 (5.99)*‡ 12.22 (7.14)* 14.06 (7.67)*
Posttreatment 15.17 (5.93)*‡ 13.06 (7.53)* 14.72 (7.51)*
FMA proximal score
Baseline 30.22 (4.01) 31.67 (3.96) 31.22 (4.60)
Midterm 32.06 (3.76)* 32.28 (4.17) 32.28 (4.07)*
Posttreatment 32.83 (3.62)* 33.28 (3.72)* 32.83 (4.25)*
RT indicates robot-assisted therapy; FMA, Fugl-Meyer Assessment.
With-group comparison: *PϽ0.05 when compared with baseline scores.
Between-group comparison: †PϽ0.05 when the higher-intensity RT group
score was greater than the lower-intensity RT group.
‡PϽ0.05, when the higher-intensity RT group score was greater than the
control treatment group.
Hsieh et al Dose–Response of Robot-Assisted Stroke Rehabilitation 2731
by guest on May 20, 2014http://stroke.ahajournals.org/Downloaded from
5. Secondary Outcomes and Adverse Responses
The 3 groups made significant within-group improvements
over time (all PϽ0.05) on the Medical Research Council and
Motor Activity Log; however, the improvements were not
significantly different among the 3 groups on the Medical
Research Council (F2,50ϭ1.41, Pϭ0.25), the Motor Activity
Log quality of movements (F2,50ϭ2.38, Pϭ0.10), or the
Motor Activity Log amount of use (F2,50ϭ1.61, Pϭ0.21).
The higher-intensity RT group reported significant within-
group improvements on the SIS–strength (Pϭ0.002) and SIS
– activities of daily living/instrumental activities of daily
living (Pϭ0.02) assessments. The lower-intensity RT group
had significant within-group improvements on the SIS–
strength assessment (Pϭ0.02). The CT group, however, did
not report significant improvements on the 4 SIS physical
domains (Pϭ0.07–0.29). The between-group comparison did
not show a significant difference among the 3 groups for
gains on the 4 SIS physical domains (F2,50ϭ0.40–1.38,
Pϭ0.26–0.67). The 3 groups showed mild ratings for fatigue
and pain (mean score of Ͻ3 of 10 possible).
Recovery Rates
Recovery rates of the higher-intensity RT group on the FMA
total and distal scores were significantly higher than those of
the lower-intensity RT group at midterm and posttreatment
(all PՅ0.05; Table 3). On the secondary outcomes, differ-
ences in recovery rates between the 2 RT groups were not
significant (Pϭ 0.10–0.86; Table 3); however, the recovery
rate values for the higher-intensity RT group were generally
higher than those for the lower-intensity RT group.
Interaction Between Initial Motor Status and
Treatment Intensity
Figure 3 shows the relationships between patients’ baseline
scores and change scores on the FMA. The data fit a quadratic
function, and the critical point of the fitted curve in the
higher-intensity RT group at posttreatment was calculated to
be 38.41 by differentiating the equation of the curve (Figure
3); that is, patients with an FMA baseline score of approxi-
mately 40 showed the most gains after the higher-intensity
RT. In the lower-intensity RT group, patients with fewer
motor deficits gained more benefits on the FMA; however,
the general gains of this group were lower than the gains in
the higher-intensity RT group. To summarize, the patients
with motor deficits in the middle range (FMA score of
approximately 40) had more improvement in motor ability
after the higher-intensity RT than those with severe or mild
motor deficits.
Discussion
The 3 treatment groups in this trial had significant within-
group gains on the FMA, Medical Research Council, and
Motor Activity Log, indicating that the patients benefited
from the intervention in motor ability, muscle power, and
self-perceived performance in daily activities. The 2 RT
groups also reported significant improvements in the strength
domain of the SIS over time. Between-group comparisons
showed that the patients who received the higher-intensity RT
had significant improvements in primary motor ability at
midterm and posttreatment compared with those who re-
ceived the lower-intensity RT or CT; however, the 2 RT
protocols and the CT demonstrated comparable effects on
improving the secondary outcomes.
When these results were compared with those in the trial
by Hesse et al,14 which used the same robotic device, the
effects on the primary outcome (ie, FMA) were different. The
treatment intensity of RT used in their study was similar to
the lower-intensity RT used in this study. The RT group in the
Hesse et al study, however, had significant benefits compared
with the control group, whereas we did not find a significant
difference between the lower-intensity RT and the CT. The
differing results may be attributable to differences in treat-
ment protocols of the control groups (electric stimulation
versus conventional occupational therapy), stroke phases
(subacute versus chronic), and baseline motor deficits of
patients (severe versus mild to moderate). Moreover, the
higher-intensity RT (twice as many repetitions as in the
lower-intensity RT) of this study led to significant gains in
motor ability compared with the other 2 groups. Our findings
suggest that for patients with chronic stroke with mild to
moderate motor deficits, the treatment intensity of RT using
the Bi-Manu-Track can be higher than the original protocol14
to reach superior effects on motor recovery.
Table 3. Recovery Rates of Each Week at Midterm and
Posttreatment on the Outcomes
Outcome
Higher-
Intensity RT
Mean (SD)
Lower-
Intensity RT
Mean (SD)
P
Value
FMA total score
Midterm 1.64 (1.12) 0.69 (0.52) 0.003
Posttreatment 1.31 (0.65) 0.81 (0.50) 0.01
FMA distal score
Midterm 0.72 (0.43) 0.39 (0.40) 0.02
Posttreatment 0.65 (0.39) 0.40 (0.33) 0.05
FMA proximal score
Midterm 0.92 (0.94) 0.31 (0.52) 0.02
Posttreatment 0.65 (0.46) 0.40 (0.46) 0.11
MRC
Posttreatment 0.07 (0.09) 0.03 (0.05) 0.14
MAL-QOM
Posttreatment 0.11 (0.12) 0.05 (0.09) 0.10
MAL-AOU
Posttreatment 0.10 (0.09) 0.05 (0.09) 0.11
SIS–strength
Posttreatment 2.00 (2.26) 2.17 (3.40) 0.86
SIS–ADL/IADL
Posttreatment 1.17 (1.93) 0.43 (2.45) 0.32
SIS–mobility
Posttreatment 0.62 (2.25) 0.26 (2.29) 0.63
SIS–hand function
Posttreatment 2.67 (5.95) 1.07 (5.29) 0.40
RT indicates robot-assisted therapy; FMA, Fugl-Meyer Assessment; MRC,
Medical Research Council scale; MAL-QOM, Motor Activity Log quality of
movement; AOU, amount of use; SIS, Stroke Impact Scale; ADL/IADL, activities
of daily living/instrumental ADL.
2732 Stroke October 2012
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6. The study results for the functional-based or disability
outcomes are concordant with previous RT studies23,24 that
did not find significant differences between RT and control
groups. Within-group analyses, however, showed that the 2
RT groups had significant gains in self-perceived amount of
use and quality of movement of the affected hand in daily
activities and in the strength domain of the SIS evaluation.
These gains may be attributed to the additional 15 to 20
minutes of functional training per session in our RT proto-
cols. The supplementary functional practice may be necessary
to enhance functional performance but may not be sufficient
for significant between-group differences compared with the
CT. Most robotic devices are designed for the practice of
relatively simple movements, and patients who train on them
have some difficulty in transferring the gained motor ability
to the performance of functional activities.25 Further ap-
proaches may consider the combination of RT and task-
oriented training (eg, constraint-induced therapy) in stroke
rehabilitation to promote motor recovery and functional
improvement.
The recovery rate data suggest a trend for better motor
outcome with the higher-intensity RT at midterm and post-
treatment, indicating a dose–response relationship such that
providing more intense RT may accelerate motor improve-
ment for chronic stroke. Current findings support that highly
intensive therapy tends to accelerate recovery.26 The midterm
evaluation can provide more information about the dynamic
response of patients during the treatment course; however,
whether the intensity effect occurs mainly in the first half or
throughout the entire period of the treatment course needs
further research. For patients who have already reached a
functional plateau at midterm, incorporating or receiving
other interventions after midterm (eg, RT in sequential
combination with constraint-induced therapy) might promote
further improvement.
The initial severity levels of the patients may influence the
treatment effects on the primary outcome. The FMA is
commonly used to identify the severity levels of patients with
stroke.27–29 The relation of FMA baseline scores and change
scores in this study was dependent on the intensity of RT
treatment. As seen in the graph (Figure 3), patients with
moderate motor deficits (ie, FMA score of approximately 40)
showed more motor improvement after the higher-intensity
RT than those with severe or mild deficits. However, there
was a trend that the patients with fewer motor deficits in the
lower-intensity RT group gained more benefits on the FMA.
Further studies may examine the usefulness of the FMA
cutoff score to more accurately stratify patients in RT trials.
Some limitations of the study warrant consideration. Only
one intermediate assessment was conducted during the study
period. To more clearly define dose–response curves of RT,
further investigation of the efficacy of RT on multiple
intermediate data points is warranted. This study did not
evaluate sensory function. Patients with sensory deficits who
receive interactive RT with sensory inputs and feedback may
benefit from RT.30 Further trials should assess the role of
sensory function as a treatment outcome and potential mod-
erator of the outcomes. Another study limitation is that the
participants and the intervention providers were not blinded
to the treatment group, which might have led to some bias.
In conclusion, our study results support that treatment
outcomes, especially in motor improvements, were better
after the higher-intensity RT than after the other 2 interven-
tions. Higher-intensity RT may be feasible in patients with
Figure 3. The relationships of initial values and change scores on the Fugl-Meyer Assessment (FMA) for the 2 robot-assisted therapy
groups. Scatterplots show the distribution of pretreatment and change scores on the FMA. Quadratic function was applied for curve
fitting. The dotted lines show the critical point (38.41) of the fitted curve in the higher-intensity robot-assisted therapy (RT) group at
posttreatment.
Hsieh et al Dose–Response of Robot-Assisted Stroke Rehabilitation 2733
by guest on May 20, 2014http://stroke.ahajournals.org/Downloaded from
7. chronic stroke to accelerate the rate of motor recovery.
Patients with moderate motor deficits tended to have more
motor improvements after the higher-intensity RT than those
with severe or mild motor deficits. The patient’s level of
motor impairment should be considered when planning for
robot-assisted stroke rehabilitation.
Sources of Funding
This project was supported in part by the National Health Research
Institutes (NHRI-EX101-9920PI and NHRI-EX101-10010PI), the
National Science Council (NSC-100-2314-B-002-008-MY3 and
NSC 99-2314-B-182-014-MY3), and the Healthy Ageing Research
Center at Chang Gung University (EMRPD1A0891) in Taiwan.
Disclosures
None.
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