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