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Gloreha presentation verona 2013

Presentation by Neuropsychologist, Valentina Varalta, University Hospital of Verona, Italy entitled "Glove rehabilitation therapy for post-stroke patients: rationale, application examples,
effects on motor and visualspatial exploration capacities" This is a small but interesting study that supports the interaction between motor rehabilitation gains and cognitive rehabilitation gains when using Gloreha rehabilitation glove.

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Gloreha presentation verona 2013

  1. 1. Glove rehabilitation therapy for post-stroke patients: rational, application examples, effects on motor and visual- spatial exploration capacitiesValentina VaraltaNeuropsychologistNeuromotor and Cognitive Rehabilitation Research CenterNeurological Rehabilitation DepartmentHospital University of Verona
  2. 2. Right brain lesionSENSORIMOTOR IMPAIRMENTS COGNITIVE IMPAIRMENTS Unilateral spatial Heminattentive neglect deficit
  3. 3. Unilateral Spatial Neglect: Neglect: SPATIAL-MOTOR- SPATIAL-MOTOR-CUEING PARADIGMLimb activation contralateral to a cerebral lesion seems to reduce visual neglect
  4. 4. EXPERIMENTAL TRIALPurpose of the studyEFFECTS OF PASSIVE REHABILITATION OF THE CONTRALESIONAL UPPER LIMB: Spatial Unilateral Heminattentive deficit (sustained attention, 1) Neglect selective attention, reaction time) 2) Sensorimotor impairments (manual dexterity, motricity), spasticityPatientsInclusion criteria Exclusion criteria• Cerebral stroke on the right • Other vascular cerebral events in anamnesis and/orhemisphere neurological deseases• Aged from 18 and 85 • Dementia• Low level spasticity of the upper • Psychiatric disaeseslimb (pt<3 Modified Ashworth Scale) • Aphasia of medium-high level • Abuse of alcohol and/or drugs • Important spasticity (pt≥3 Modified Ashworth Scale)
  5. 5. EXPERIMENTAL TRIAL EVALUATION 1 General clinical evaluation EVALUATION 2 + Outcome measures Outcome measures evaluation evaluation 14 days (10 rehabilitation sessions) T0 T1 (pre-treatment) (post-treatment)General clinical evaluation: Outcome measures evaluation:• MMSE• European Stroke Scale Cognitive Tests: Motor Tests:• Modified Ashworth Scale Line Crossing Test Modified Ashworth Scale Bells Test Fugl Meyer Assessment Line Bisection Test Motricity Index Saccadic Training Nine Hole Peg Test Computerized Test for the Purdue PegBoard Test assessment of unilateral stimuli Sustained Attention of Response Task (SART)
  6. 6. EXPERIMENTAL TRIALTreatment• 10 rehabilitation sessions of 25 minutes• 5 sessions per week (for 2 weeks)
  7. 7. RESULTSPATIENTS: Demographic and clinical data 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 23,8PRE-TREATMENT ASSESSMENT: Neuropsychological tests Line Bisection Saccadic Training Line Crossing Test Bells Test Test SART (Rehacom) left right left right FA O RT left rightB.A. 12/18 18/18 11/17 17/17 3/9 11/24 17 511 7252 2575B. M. 18/18 18/18 12/17 13/17 9/9 8/24 31 557 1375 1213F. M. 6/18 13/18 4/17 15/17 0/9 14/24 34 452 2411 1062M. S. 10/18 10/18 9/17 11/17 8/9 4/24 140 612 5726 3330PRE-TREATMENT ASSESSMENT: Motor tests Nine Hole Peg Motricity FUGL MEYER - Motor Purdue Peg Board Test Test Index Modified Ashworth Scale capacity assessment left right bimanual assembl. left right shoulder elbow wrist FingersB. A. 2 1 0 1 0,08 0,13 73/99 0 0 0 0 99/115B. M. - 0 2 1 2 43/115F. M. 4 12 6 4 0,14 0,58 85/99 0 0 0 0 101/115M. S. - 0 0 1 0 31/115
  8. 8. RESULTS NEGLECT TEST: Comparison pre/post treatment 20 18 16 14 12 10 8 T0B.A. 6 T1 4 2 0 left sx (18 item) right left dx (18 item) sx (17 item) right dx (17 item) Line Test di Albert (BIT) Test delle Campanelle Bisection Bisezione di Line Crossing Test Bells Test Test linee (BIT) 20 18 16 14 12 10F.M. 8 T0 6 T1 4 2 0 left sx (18 item) right left dx (18 item) sx (17 item) light dx (17 item) Line Line Crossing(BIT) Test di Albert Test Test delle Campanelle Bells Test Bisection Bisezione di Test linee (BIT)
  9. 9. RESULTS HEMINATTENTIVE TEST: Comparison pre/post treatment 8000 700 Reaction Time Contralesonal stimuli 7000 600 6000 500 Reaction Time 5000 400 4000 T0 300 T0 3000 T1 200 T1 2000 1000 100 0 0 B.A. B. M. F. M. M. S. B.A. B. M. F. M. M. S. Saccadic Training SART MANUAL DEXTERITY TEST: Comparison pre/post treatment10 0,8 125 8 0,7 115 0,6 105 6 95 4 0,5 85 2 0,4 75 0,3 65 0 T0 0,2 55 bimanuale bimanuale rightdx assembl. dx assembl. left sn left sn bimanual bimanual right 0,1 45 T1 0 35 left right left right 25 sn dx sn dx B. A. B. M. F. M. M. S. B.A. F.M. B.A. F.M. Nine Hole Peg Test Fugl-Meyer Purdue PegBoard Test
  10. 10. CONCLUSIONSAFTER PASSIVE MOBILIZATION OF CONTRALESIONAL UPPER LIMB WITH GLOREHA: 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 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
  11. 11. Giulia Montemezzi Elisabetta La Marchina NICOLA SMANIAMarialuisa Gandolfi Alessandro Picelli Daniele Munari Patrizia Ianes Christian Geroin Cristina Fonte Thank you for your attention

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