Glove rehabilitation therapy for
post-stroke patients:
rational, application examples, rational, application examples,
effects on motor and visual-
spatial exploration capacities
Valentina Varalta
Neuropsychologist
Neuromotor and Cognitive Rehabilitation Research Center
Neurological Rehabilitation Department
Hospital University of Verona
Right Right brainbrain lesionlesion
SENSORIMOTOR IMPAIRMENTS COGNITIVE IMPAIRMENTS
Unilateral spatial
neglect
Heminattentive
deficit
UnilateralUnilateral SpatialSpatial NeglectNeglect::
SPATIALSPATIAL--MOTORMOTOR--CUEING PARADIGMCUEING PARADIGM
Limb activation contralateral to a cerebral lesion
seems to reduce visual neglect
EXPERIMENTAL TRIALEXPERIMENTAL TRIAL
Heminattentive deficit (sustained attention,
selective attention, reaction time)
Purpose of the study
Spatial Unilateral
Neglect
EFFECTS OF PASSIVE REHABILITATION OF THE CONTRALESIONAL UPPER LIMB:
Sensorimotor impairments (manual dexterity, motricity), spasticity
1)
2)
PatientsInclusion criteria
• Cerebral stroke on the right
hemisphere
• Aged from 18 and 85
• Low level spasticity of the upper
limb (pt<3 Modified Ashworth Scale)
Exclusion criteria
• Other vascular cerebral events in anamnesis and/or
neurological deseases
• Dementia
• Psychiatric disaeses
• Aphasia of medium-high level
• Abuse of alcohol and/or drugs
• Important spasticity (pt≥3 Modified Ashworth Scale)
14 days (10 rehabilitation sessions)
EVALUATION 1
General clinical evaluation
+
Outcome measures
evaluation
EVALUATION 2
Outcome measures
evaluation
EXPERIMENTAL TRIALEXPERIMENTAL TRIAL
T0
(pre-treatment)
T1
(post-treatment)
General clinical evaluation:
• MMSE
• European Stroke Scale
• Modified Ashworth Scale
Outcome measures evaluation:
Cognitive Tests:
� Line Crossing Test
� Bells Test
� Line Bisection Test
� Saccadic Training
� Computerized Test for the
assessment of unilateral stimuli
� Sustained Attention of
Response Task (SART)
Motor Tests:
� Modified Ashworth Scale
� Fugl Meyer Assessment
� Motricity Index
� Nine Hole Peg Test
� Purdue PegBoard Test
Treatment
• 10 rehabilitation sessions of 25 minutes
• 5 sessions per week (for 2 weeks)
EXPERIMENTAL TRIALEXPERIMENTAL TRIAL
Patient Gender Age (years) Education (years) Time from onset (months) Type of lesion MMSE
B.A. F 69 5 13 Ischemic 23,9
B. M. F 66 8 35 Ischemic 25
F. M. F 64 5 4 Hemorrhagyc 24,9
M. S. F 85 7 9 Ischemic 23,8
PATIENTS: Demographic and clinical data
PRE-TREATMENT ASSESSMENT: Neuropsychological tests
Line Bisection Saccadic Training
RESULTSRESULTS
Line Crossing Test Bells Test
Line Bisection
Test SART
Saccadic Training
(Rehacom)
left right left right FA O RT left right
B.A. 12/18 18/18 11/17 17/17 3/9 11/24 17 511 7252 2575
B. M. 18/18 18/18 12/17 13/17 9/9 8/24 31 557 1375 1213
F. M. 6/18 13/18 4/17 15/17 0/9 14/24 34 452 2411 1062
M. S. 10/18 10/18 9/17 11/17 8/9 4/24 140 612 5726 3330
PRE-TREATMENT ASSESSMENT: Motor tests
Purdue Peg Board Test
Nine Hole Peg
Test
Motricity
Index Modified Ashworth Scale
FUGL MEYER - Motor
capacity assessment
left right bimanual assembl. left right shoulder elbow wrist Fingers
B. A. 2 1 0 1 0,08 0,13 73/99 0 0 0 0 99/115
B. M. - 0 2 1 2 43/115
F. M. 4 12 6 4 0,14 0,58 85/99 0 0 0 0 101/115
M. S. - 0 0 1 0 31/115
0
2
4
6
8
10
12
14
16
18
20
sx (18 item) dx (18 item) sx (17 item) dx (17 item)
T0
T1
Lineright left
NEGLECT TEST: Comparison pre/post treatment
B.A.
RESULTSRESULTS
left rightsx (18 item) dx (18 item) sx (17 item) dx (17 item)
Test di Albert (BIT) Test delle Campanelle Bisezione di
linee (BIT)
Line
Bisection
Test
right left
F.M.
0
2
4
6
8
10
12
14
16
18
20
sx (18 item) dx (18 item) sx (17 item) dx (17 item)
Test di Albert (BIT) Test delle Campanelle Bisezione di
linee (BIT)
T0
T1
Line Crossing Test Bells Test
left right
left leftright light
Line Crossing Test Bells Test
Line
Bisection
Test
HEMINATTENTIVE TEST: Comparison pre/post treatment
0
1000
2000
3000
4000
5000
6000
7000
8000
B.A. B. M. F. M. M. S.Re
act
ion
Tim
eC
on
tra
leso
na
lst
imu
li
Saccadic Training
T0
T1
0
100
200
300
400
500
600
700
B.A. B. M. F. M. M. S.
Re
act
ion
Tim
e
SART
T0
T1
RESULTSRESULTS
MANUAL DEXTERITY TEST: Comparison pre/post treatment
Saccadic Training SART
0
2
4
6
8
10
sn dx
bim
an
ua
le
ass
em
bl. sn dx
bim
an
ua
le
ass
em
bl.
B.A. F.M.
Purdue PegBoard Test
bim
an
ua
l
0
0,1
0,2
0,3
0,4
0,5
0,6
0,7
0,8
sn dx sn dx
B.A. F.M.
Nine Hole Peg Test
2535455565758595
105115125
B. A. B. M. F. M. M. S.
Fugl-Meyer
T0
T1
left leftright right
left
rig
ht
left
rig
ht
bim
an
ua
l
1. Effects on visual-spacial and exploration capacities:
1 patient shows an improvement about the performance in all the performed test
1 patient shows unhomogeneous performance
2. Effects on attentive capacities:
All the patients show an improvement about the speed of relevation of contralesional stimuli (Saccadic Training) and a reduction of the reaction time about supported
AFTER PASSIVE MOBILIZATION OF CONTRALESIONAL UPPER LIMB WITH GLOREHA:
CONCLUSIONSCONCLUSIONS
stimuli (Saccadic Training) and a reduction of the reaction time about supported attention (SART)
3. Effects on motor capacities:
We have registered an increase of the capacities of manual dexterity (NHPT; PPBT) and a slight improvement of functional capacities (Fugl-Meyer)
4. Effects on spasticity level:
The patient with spasticity (B.M.) has reduced this affliction (fingers)
INTEGRATION BETWEEN MOTOR REHABILITATION AND COGNITIVE
REHABILITATION THANKS TO ROBOTIC DEVICES LIKE GLOREHA
NICOLA SMANIANICOLA SMANIAGiulia MontemezziGiulia Montemezzi Elisabetta La MarchinaElisabetta La Marchina
Patrizia IanesPatrizia Ianes
Alessandro PicelliAlessandro PicelliMarialuisa GandolfiMarialuisa Gandolfi Daniele MunariDaniele Munari
Christian GeroinChristian Geroin Cristina FonteCristina Fonte ThankThank youyou
forfor youryour attentionattention
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