Rehabilitation and Therapy Commons^™

A Randomized, Double-Blind, Placebo-Controlled Trial Of Daxibotulinumtoxina For Injection For The Treatment Of Upper Limb Spasticity In Adults After Stroke Or Traumatic Brain Injury, Atul T Patel, Michael C Munin, Ziyad Ayyoub, Gerard E Francisco, Rashid Kazerooni, Todd M Gross

Faculty, Staff and Student Publications

Background: Intramuscular injection of botulinum toxin type A is a first-line pharmacotherapy for adults with upper limb spasticity (ULS). However, reemergence of symptoms within 12 weeks of treatment is common and longer-lasting treatments are needed.

Objective: To evaluate the efficacy and safety of three doses of DaxibotulinumtoxinA for Injection (DAXI) for treatment of ULS in adults with stroke or traumatic brain injury.

Intervention: Intramuscular injections of placebo (N = 24), DAXI 250 U (N = 22), DAXI 375 U (N = 19), or DAXI 500 U (N = 18) to the suprahypertonic muscle (SMG) and other muscle groups.

Design: Randomized, …

Longitudinal Retrospective Study Of A Wearable Nmes System To Determine The Effects On Arm Usage In Hemiparetic And Hemiplegic Patients, Nipun Chopra, Philip Muccio, Rafik Salama, Josh Schueller, Davis Durrant, Edward Dabrowski

Psychology and Neuroscience Faculty Publications

Brain disorders such as traumatic brain injury (TBI), stroke, cerebral palsy (CP), and surgical interventions can result in aberrant motor function in the contralateral limbs, resulting in paralysis, weakness, and/or spasticity. It is known that, in the short term, neuromuscular electrical stimulation (NMES), the application of low-level electrical currents to motor nerves to induce muscle contractions in paralyzed muscles, can stimulate affected muscle groups and increase arm mobility. However, there remains a paucity of longitudinal evidence examining NMES-mediated improvements of arm usage.

Objective

The aim of this study was to determine the effectiveness of a long-term BioSleeve intervention on the …

Open Doors Rehab: Student-Led Courtesy Occupation-Focused Stroke Rehabilitation Clinic, Caitlin Scully

Entry Level Occupational Therapy Doctoral Capstone Projects Class of 2025

Experiencing a stroke is a life altering event. Effects range from minimal to severe, but nonetheless survivors are put in a position where they need to understand their health and how to move forward (Wolf et. al., 2009). Nagaraja et. al. (2022) draws attention to the issue that survivors who are not eligible for inpatient services are often discharged home with a home exercise program and no clinical or therapy follow- up. This creates a gap in the stroke recovery continuum of care, putting survivors at even more risk for additional health risks and complications. The need for stroke rehabilitative …

The Effectiveness Of Vivistim On Ue Function Post Chronic Ischemic Stroke, Chelsea G. Tucker

Occupational Therapy Doctorate Capstone Posters

The purpose of this capstone project was to learn about a new technology, Vivistim, as it enhances upper extremity function post chronic ischemic stroke through vagus nerve stimulation paired with repetitive task-specific therapy. This project took place at UK Healthcare Outpatient Neurorehabilitation at Cardinal Hill Rehabilitation Hospital in Lexington, Kentucky. The AOTA/ACOTE focus areas for this project included education and clinical practice. Specific goals included to learn about the role of occupational therapy in the outpatient neurorehabilitation setting, research background information for case study including ischemic stroke, motor relearning, vagus nerve stimulation, and Vivistim technology, gather observations for case study, …

Enhancing Stroke Rehabilitation: A Quality Improvement Initiative, Clifford Gordon, Olu Oyesanmi, Marc Kallins, Rahul Mhaskar, Sanjiv Tewari, Lisa Gramong, Kristy Ellison-Snow, Cynthia Koski

West Florida Division GME Research Day 2025

No abstract provided.

Effectiveness Of Immersive Virtual Reality Combined With Task-Specific Training On Hemiplegic Arm Function Following Stroke: A Single Case Series Study, Rahsaan J. Holley

Theses and Dissertations

Motor recovery of the arm following a neurological injury is a common goal of the rehabilitation process for individuals impacted by the condition . Due to the long-term functional implications of impaired arm movement, individuals are often trained to use compensatory strategies to complete functional tasks without incorporating the weakened limb. While compensatory strategies offer stroke survivors the opportunity to regain a level of independence, such approaches fail to directly address the underlying causes of the disability (i.e., limited range of motion, decreased strength, poor coordination, motor planning difficulties) which can unfortunately result in long-term impairment and functional disability.

Motor …

Hemiplegic Shoulder Pain: A Narrative Review, Yeh-Kai Liao, Chueh-Hung Wu, Levent Özçakar

Rehabilitation Practice and Science

Hemiplegic shoulder pain is a common post-stroke complication that negatively affects functional recovery. It is caused by both mechanical and neurological factors. Prevention focuses on proper positioning, patient education, and maintenance of motion. Treatment remains largely conservative; with increasing research surrounding injection therapies, including intra-articular corticosteroid injection, subacromial hyaluronic acid injection, suprascapular nerve blocks, and botulinum toxin injection, all of which have demonstrated improved pain control. Functional electrical stimulation appears to be beneficial, and adjunct therapies such as supportive devices and robotic training may further enhance conventional treatment. Herewith, evidence regarding medications and acupuncture remains limited. Emerging treatments including high-intensity …

Effectiveness Of Using Soft Exosuit In Stroke Case To Improve Walking Speed And Endurance, Aditya Denny Pratama, Rakha Shidqi Widyadhana

Jurnal Fisioterapi Terapan Indonesia

Stroke is a clinically defined syndrome of acute, focal nerve discharge caused by vascular injury (infarction, hemorrhage) of the central nervous system. Punches can cause damage to the brain and affect a person's ability to walk, balance and coordinate movements. Impaired gait is common in stroke cases, often resulting in poor recovery of mobility and inability to carry out daily activities without assistance. One of the interventions that can be used is a soft exosuit. This method can help overcome walking problems in stroke patients where soft exosuits are used to increase walking speed and walking endurance. The purpose of …

The Impact Of Client Education Videos On Stroke Rehabilitation: An Educational Video Series, Sydney Ellis, Lesley Khan-Farooqi Phd, Otd, Otr

Fall 2024 OTD Capstone Symposium

Stroke is one of the leading causes of severe disability and death in the United States. During the initial stage of recovery, clients receive stroke education to learn about what their new reality looks like after discharge; however, many clients feel that the education provided, although appreciated, was not inclusive to all individuals and only occurred one time. This led to difficulties in knowledge retention and acquisition. Although there is a plethora of educational resources available there seems to be a lack of carryover and understanding of information obtained from these resources, this leaves the client wondering how they can …

The Effect Of Phonomotor Treatment In A Telepractice Model: An Experimental Study, Jessica Mulch

Masters Theses & Specialist Projects

This study provides an investigation into the effectiveness of a modified version of Phonomotor Treatment (PMT) for treating apraxia of speech (AOS) in a telepractice model. A single-subject design was utilized to provide treatment to a participant with post-stroke apraxia of speech and aphasia. Treatment occurred two hours a day, five days a week, for four weeks. Targets were selected specifically for the participant after initial probing and testing. Data was taken to measure the chosen targets for acquisition, maintenance, and generalization. The data collected includes pre-treatment (before starting treatment), post-treatment (directly after treatment), and follow-up (10 weeks after the …

African American Patients Have A Higher Probability Of Cognitive Impairment After Incident Stroke: An Analysis Of National Electronic Health Record Data, Alicia Zha, Chenguang Zhang, Gen Zhu, Xinran Huang, Sahar Anjum, Yashar Talebi, Sean Savitz, Hulin Wu

Faculty, Staff and Student Publications

Background: Cognitive impairment (CI) and stroke are diseases with significant disparities in race and geography. Post stroke cognitive impairment (PSCI) can be as high as 15-70 % but few studies have utilized large administrative or electronic health records (EHR) to evaluate trends in PSCI. We utilized an EHR database to evaluate for disparities in PSCI in a large sample of patients after first recorded stroke to evaluate for disparities in race.

Methods: This is a retrospective cohort analysis of Cerner Health Facts® EHR database, which is comprised of EHR data from hundreds of hospitals/clinics in the US from 2009-2018. We …

Reduced Oxygen Desaturation In The Vastus Lateralis Of Chronic Stroke Survivors During Graded Muscle Contractions, Allison S. Hyngstrom, Jennifer N. Nguyen, Spencer A. Murphy, Stephanie C. Raab, Brian D. Schmit, David D. Gutterman, Matthew J. Durand

Physical Therapy Faculty Research and Publications

Background

Few studies have examined changes in skeletal muscle physiology post-stroke. This study examined changes in tissue oxygen saturation (StO₂) of the vastus lateralis (VL) muscle of stroke survivors and age-matched control participants during maximal and submaximal isometric contractions of the knee extensor muscles.

Objectives

We hypothesized that tissue oxygen desaturation (ΔStO₂) during knee extensor muscle contractions would be less in the VL in the paretic vs. the non-paretic and control legs.

Methods

Ten chronic stroke survivors (>6 months post-stroke) with lower extremity muscle weakness and 10 age-matched controls completed this prospective cohort study. Maximum …

Occupational Therapy In Stroke: A Case Study Using The Bobath Frame Of Reference And Task Oriented Approach, Reza Nur Arsyi, Afifah Fadhilah Nursyam, Muhammad Luthfi, Hermito Gidion, Ayleen Alicia Kosasi, Erna Faryza Mohd Poot, Rosilah Wahab, Nur Atiqah Azman

Jurnal Fisioterapi Terapan Indonesia

Stroke is a sudden neurological disorder caused by vascular injury to the brain, leading to significant functional limitations. This case study examines the use of occupational therapy interventions, specifically the Bobath and Task Oriented approaches, for a 43-year-old male with left hemiparesis to enhance independence in motorcycling. The patient experienced various limitations, including vestibular function, range of motion, muscle tone and strength, postural control, and fine motor skills. Using the Ashworth scale and the Canadian Occupational Performance Measure (COPM) for assessment, occupational therapy interventions showed progress in several aspects, although the primary goal has not yet been fully achieved. This …

A Single-Center, Assessor-Blinded, Randomized Controlled Clinical Trial To Test The Safety And Efficacy Of A Novel Brain-Computer Interface Controlled Functional Electrical Stimulation (Bci-Fes) Intervention For Gait Rehabilitation In The Chronic Stroke Population, Piyashi Biswas, Lucy Dodakian, Po T. Wang, Christopher A. Johnson, Jill See, Vicky Chan, Cathy Chou, Wendy Lazouras, Alison L. Mckenzie, David J. Reinkensmeyer, Danh V. Nguyen, Steven C. Cramer, An H. Do, Zoran Nenadic

Physical Therapy Faculty Articles and Research

Background

In the United States, there are over seven million stroke survivors, with many facing gait impairments due to foot drop. This restricts their community ambulation and hinders functional independence, leading to several long-term health complications. Despite the best available physical therapy, gait function is incompletely recovered, and this occurs mainly during the acute phase post-stroke. Therapeutic options are limited currently. Novel therapies based on neurobiological principles have the potential to lead to long-term functional improvements. The Brain-Computer Interface (BCI) controlled Functional Electrical Stimulation (FES) system is one such strategy. It is based on Hebbian principles and has shown promise …

Application Of Intravenous Laser Irradiation Of Blood (Ilib) In Physical Medicine: A Narrative Review, Ya-Chi Chuang, Yuan-Yang Cheng

Rehabilitation Practice and Science

Intravenous laser irradiation of blood (ILIB) involves a type of intravascular treatment which applies a helium-neon laser possessing a wavelength of 632.8nm. Since its first use in 1981 by Russian scientists, it is now widely applied in the treatment of various diseases, including chronic musculoskeletal pain, wound healing, spinal cord injury, stroke, traumatic brain injury, coronary artery disease, type 2 diabetes mellitus, rheumatoid arthritis and acute kidney injury. The underlying mechanism for ILIB may be associated with its anti-oxidative (through regulating the reactive oxygen species systems) and anti-inflammatory effects (by reducing the production of inflammatory cytokines). Moreover, positive effects on …

Neurorehabilitation With Vagus Nerve Stimulation: A Systematic Review, Radha Korupolu, Alyssa Miller, Andrew Park, Nuray Yozbatiran

Faculty, Staff and Student Publications

OBJECTIVE: To systematically review vagus nerve stimulation (VNS) studies to present data on the safety and efficacy on motor recovery following stroke, traumatic brain injury (TBI), and spinal cord injury (SCI).

METHODS: Data sources: PubMed, EMBASE, SCOPUS, and Cochrane.

STUDY SELECTION: Clinical trials of VNS in animal models and humans with TBI and SCI were included to evaluate the effects of pairing VNS with rehabilitation therapy on motor recovery.

DATA EXTRACTION: Two reviewers independently assessed articles according to the evaluation criteria and extracted relevant data electronically.

DATA SYNTHESIS: Twenty-nine studies were included; 11 were animal models of stroke, TBI, and …

Filling The Gap: Educating Caregivers And Patients Post Stroke In An Acute Care Setting, Gabrielle A. Blecke

Occupational Therapy Capstone Presentations

Background: According to the U.S. Department of Health and Human Services (2022), every 40 seconds someone in the United States experiences a cerebrovascular accident (CVA), also known as stroke. A recent study suggests that 63% of these individuals will need informal caregiving from family, friends, or loved-ones throughout their rehabilitation process in order to safely transition home. Research suggests that patients and caregivers post stroke are not receiving enough education to prevent concerns such as caregiver burden, decreased caregiver wellness, and decreased patient outcomes, all which are within the scope of occupational therapy. Methods: Experiences at MyMichigan Midland Hospital drove …

Pain Management Series For Stroke: Identifying Teaching Methods To Increase Clinical Self-Efficacy For Occupational Therapy Doctoral Students, Apasara Jittprasert

UNLV Theses, Dissertations, Professional Papers, and Capstones

Purpose

Post-stroke pain has been identified as a significant challenge for individuals experiencing a stroke. Occupational therapists play a crucial role in the complex treatment of post-stroke pain but often face challenges due to a lack of self-efficacy in implementing treatments for stroke-related pain. This project’s purpose was to,1) to identify which teaching methods are effective for increasing clinical self-efficacy in doctoral occupational therapy students for implementing pain management treatment for individuals’ post-stroke and 2) to increase reported clinical self-efficacy levels among these students following the completion of a pain management educational program for stroke pain.

Methodology

This project recruited …

A Comparison Of Spinal Reflex Function And Morphological Adaptations Of The Achilles Tendon Between Individuals Chronically Post-Stroke And Healthy Controls, Migi Contreras, Mira Seekins, Johanna Mendez, Trevor Diez

UNLV Theses, Dissertations, Professional Papers, and Capstones

Purpose/Hypothesis: The hallmark gait deviation in individuals with post-stroke hemiparesis is slow walking speed. Reduction in gait speed after stroke is influenced by decreased propulsive forces, which may likely be related to impaired spinal circuit function and spasticity of the paretic plantarflexors. Chronic muscle tone maladaptations in paretic ankle plantarflexors can result in altered Achilles tendon (AT) morphology, therefore leading to altered mechanical properties, force transmission capabilities and subsequent insufficient propulsive forces during walking. The purpose of this study is to characterize the chronic maladaptations in both the spinal Ia afferent loop excitability and AT morphology after stroke lesions in …

Alteration In Resting-State Brain Activity In Stroke Survivors After Repetitive Finger Stimulation, Dorothy He, William A Sikora, Shirley A James, Jordan N Williamson, Louis V Lepak, Carolyn F Cheema, Evgeny Sidorov, Sheng Li, Yuan Yang

Faculty, Staff and Student Publications

Objective: This quasi-experimental study examined the effect of repetitive finger stimulation on brain activation in eight stroke and seven control subjects, measured by quantitative electroencephalogram.

Methods: We applied 5 mins of 2-Hz repetitive bilateral index finger transcutaneous electrical nerve stimulation and compared differences pre- and post-transcutaneous electrical nerve stimulation using quantitative electroencephalogram metrics delta/alpha ratio and delta-theta/alpha-beta ratio.

Results: Between-group differences before and after stimulation were significantly different in the delta/alpha ratio ( z = -2.88, P = 0.0040) and the delta-theta/alpha-beta ratio variables ( z = -3.90 with P < 0.0001). Significant decrease in the delta/alpha ratio and delta-theta/alpha-beta ratio variables after the transcutaneous electrical nerve stimulation was detected only in the stroke group (delta/alpha ratio diff = 3.87, P = 0.0211) (delta-theta/alpha-beta ratio diff = 1.19, P = 0.0074).

Conclusions: The decrease in quantitative electroencephalogram metrics in the stroke …

Can Occupational Therapy Take A Hit? A Guide To High-Intensity Training In Stroke Rehabilitation, Jared Demke

UNLV Theses, Dissertations, Professional Papers, and Capstones

Objective: Stroke has been considered a leading cause of functional impairment (Tsao et al., 2022). Recent evidence has supported a treatment approach that increases dosage (Scheets et al., 2021). High-intensity training (HIT) has shown promising evidence for functional recovery poststroke (Crozier et al., 2018). There have been minimal programs related to Occupational therapy (OT) and HIT have been created (Lamoureux, 2023). This doctoral capstone focused on program development of the OT-based HIT program. Theoretical frameworks included the Model of Human Occupation and Motor Learning Theory to provide a foundational structure.

Methods: A needs assessment was performed at the Saint George …

Spatiotemporal Gait Parameter Consistency Across Two Days Of Treadmill Walking In Stroke Survivors, Alejandro Aguirre Ramirez, Samantha N. Jeffcoat, Natalia Sanchez, Andrian Kuch

Student Scholar Symposium Abstracts and Posters

Retraining impaired gait is essential in post-stroke recovery. This project aims to determine between day variability of spatiotemporal gait measures in treadmill walking post-stroke to differentiate between changes due to the intervention and measurement errors due to between day test-retest variability. Six individuals post-stroke performed a two-minute walk test at a self-selected speed (SSS) for two consecutive days. SSS was assessed through the six-minute walk test. Reflective markers were placed on anatomical landmarks (van den Bogert et al. 2013). The heel markers were used for step detection. We calculated spatiotemporal parameters: stride length, stride time, step length, stance time, and …

Respite Care And Relief For Brain Injury Survivors And Their Caregivers, Sydney Bradley

OTD Capstone Projects

This doctoral capstone was completed through a partnership with Neuro Therapy Nashville. Neuro Therapy Nashville (NTN) is an outpatient interdisciplinary clinic that provides services to brain injury survivors including stroke, traumatic brain injury, Parkinson’s, etc. Their mission is work in collaboration with patients to regain as much normal function as possible and return to better, more productive lives through a positive, hopeful and expectant environment. The primary purpose of this project was to create and develop three different programs to provide respite and relief for the brain injury survivors and their caregivers. The process of the project involved collaboration with …

Use Of Medication Management Strategies To Increase Medication Compliance In Person’S Who Have Suffered A Stroke, Mason Pace, Rebecca King

Spring 2024 Virtual OTD Capstone Symposium

The provided research provides education to increased independence in person with stroke for the occupation of medication adherence. Various exercises and education provided in the research to increase independence in persons with stroke.

From Textbooks To Clinical Practice: Selecting And Implementing Outcomes Measures In Stroke Rehabilitation, Stacie Mae Larreau Christensen, Monica Dial

Posters and Presentations: Physical Therapy

No abstract provided.

An Occupational Therapy Approach To Improving Adl/Iadl Performance In Diabetic Adults With Stroke And Upper Extremity Pathologies, Halle Thomas, Cassandra Nelson

Spring 2024 Virtual OTD Capstone Symposium

This capstone presentation depicts the impact of diabetic management with an occupational therapy approach on upper extremity motor function for the adult stroke population. This program utilizes dietary management, a home exercise program, and task modification strategies to improve ADL and IADL performance.

Exploring The Prospects Of Transcranial Electrical Stimulation (Tes) As A Therapeutic Intervention For Post-Stroke Motor Recovery: A Narrative Review, Hao Meng, Michael Houston, Yingchun Zhang, Sheng Li

Faculty, Staff and Student Publications

Introduction: Stroke survivors often have motor impairments and related functional deficits. Transcranial Electrical Stimulation (tES) is a rapidly evolving field that offers a wide range of capabilities for modulating brain function, and it is safe and inexpensive. It has the potential for widespread use for post-stroke motor recovery. Transcranial Direct Current Stimulation (tDCS), Transcranial Alternating Current Stimulation (tACS), and Transcranial Random Noise Stimulation (tRNS) are three recognized tES techniques that have gained substantial attention in recent years but have different mechanisms of action. tDCS has been widely used in stroke motor rehabilitation, while applications of tACS and tRNS are very …

Comprehensive Quality Assessment For Aphasia Rehabilitation After Stroke: Protocol For A Multicentre, Mixed-Methods Study, Sam Harvey, Marissa Stone, Sally Zingelman, David A. Copland, Monique F. Kilkenny, Erin Godecke, Dominique A. Cadilhac, Joosup Kim, Muideen T. Olaiya, Miranda L. Rose, Caterina Breitenstein, Kirstine Shrubsole, Robyn O'Halloran, Annie J. Hill, Deborah Hersh, Kathryn Mainstone, Penelope Mainstone, Carolyn A. Unsworth, Emily Brogan, Kylie J. Short, Clare L. Burns, Caroline Baker, Sarah J. Wallace

Research outputs 2022 to 2026

INTRODUCTION: People with aphasia following stroke experience disproportionally poor outcomes, yet there is no comprehensive approach to measuring the quality of aphasia services. The Meaningful Evaluation of Aphasia SeRvicES (MEASuRES) minimum dataset was developed in partnership with people with lived experience of aphasia, clinicians and researchers to address this gap. It comprises sociodemographic characteristics, quality indicators, treatment descriptors and outcome measurement instruments. We present a protocol to pilot the MEASuRES minimum dataset in clinical practice, describe the factors that hinder or support implementation and determine meaningful thresholds of clinical change for core outcome measurement instruments. METHODS AND ANALYSIS: This research …

Female Enrollment In Rehabilitation Trials: A Systematic Review Of Reporting Sex And Female Participation In Randomized Controlled Trials Of Poststroke Upper Extremity Rehabilitation Over 50 Years, Sarvenaz Mehrabi, Amber Harnett, Marcus Saikaley, Jamie L Fleet, Janice J Eng, Mark Bayley, Robert Teasell

Physical Medicine and Rehabilitation Publications

OBJECTIVE: To systematically assess the reporting of sex and the percentage of female participants in randomized controlled trials (RCTs) examining interventions for the post-stroke rehabilitation of upper extremity (UE) motor disorders.

DATA SOURCES: CINAHL, Embase, PubMed, Scopus and Web of Science were searched from 1960 to April 1, 2021. Additional articles were identified using the Evidence-Based Review of Stroke Rehabilitation.

STUDY SELECTION: Studies were eligible for inclusion if they (1) were RCTs or crossovers published in English, (2) ≥50% of participants were diagnosed and affected by stroke, (3) included adults ≥18 years old, and (4) applied an intervention to the …

What Is Task-Oriented Training? A Scoping Review, Erin Halford, Samantha Jakubiszak, Kassidy Krug, Amanda Umphress

Student Journal of Occupational Therapy

Task-Oriented Training (TOT) is an proven stroke rehabilitation intervention with significant evidence-based research that supports its effectiveness. The absence of a clear definition has led to variability in research reporting and subsequent confusion with practical implementation. A consistent definition seeks to remedy this ambiguity to facilitate knowledge translation. The objective of this study was to determine a comprehensive definition of TOT that encapsulates previous definitions and descriptions in the literature. In order to derive this definition, a two stage scoping review process was conducted across four databases searching for articles on the use of TOT in adult stroke rehabilitation therapy. …