Rehabilitation of Upper Limbs After Stroke

Prior to the study, an assessment of the reliability, reproducibility and validity of the devices among stroke individuals will be carried out.

The research will be conducted among people who have suffered a stroke in the late period.

The subjects will be allocated, by random selection, to two groups:

The study group will complete a conventional rehabilitation program supplemented with biofeedback exercises using the Pablo Tyromotion device.

The control group will participate in conventional rehabilitation without biofeedback exercises.

Patients will undergo ongoing rehabilitation at the Donum Corde Rehabilitation and Medical Care Center (four weeks). The first examination will be performed on the day of admission, the second on the day of discharge, and the third (control) one month after discharge, during a follow-up visit.

Measurements will be performed three times for all participants:

• assessment of hand and finger muscle strength
• calculated body mass index (BMI)
• proprioceptive testing (mirror test, Thumb Location Test)
• rehabilitation outcome assessment
• functional capacity - Barthel Index, ADL
• Ashworth muscle tone (spasticity)
• hand dexterity using the Box and Blocks test
• hand grip function according to the Frenchay scale
• motor function of the hand and upper limb according to the Fugl-Meyer Motor Assessment Scale for Upper Extremity

Evaluation of reliability, repeatability and validity of device Pablo Tyromotion among stroke.

Prior to the study among individuals with stroke, an evaluation of the reliability, repeatability and credibility of the Pablo Tyromotion to be included in the biofeedback rehabilitation.

The evaluation of the Pablo Tyromotion will be carried out by two independent researchers twice.

Rehabilitation program using upper limb function training with the Pablo Tyromotion device and conventional physiotherapy.

In the control group, patients will complete a 3.5-hour daily rehabilitation program. The program will include two hours of individual therapy with a physiotherapist, one hour of verticalization, and 30 minutes of exercises on the Pablo Tyromotion device.

Other: Rehabilitation program using upper limb function training with the Pablo Tyromotion device and conventional physiotherapy.

In the control group, patients will complete a 3.5-hour daily rehabilitation program. The program will include two hours of individual therapy with a physiotherapist, one hour of verticalization, and 30 minutes of upper limb exercises.

Rehabilitation program using upper limb function training with the Pablo Tyromotion device and conventional physiotherapy. The rehabilitation program will last 4 weeks from Monday to Friday.

Time frame: First examination - before the start of the rehabilitation program

It consists of 33 items assessing motor function and reflexes. The patient can score a maximum of 66 points, where each item on the scale is rated as: 0=unable, 1=partially able, or 2=fully able to perform the movement

Time frame: Second examination - at the end of the three-week program

It consists of 33 items assessing motor function and reflexes. The patient can score a maximum of 66 points, where each item on the scale is rated as: 0=unable, 1=partially able, or 2=fully able to perform the movement

Time frame: Third study (flow-up) - month after Rehabilitation Center discharge, during a follow-up visit

It consists of 33 items assessing motor function and reflexes. The patient can score a maximum of 66 points, where each item on the scale is rated as: 0=unable, 1=partially able, or 2=fully able to perform the movement

Time frame: First examination - before the start of the rehabilitation program

measurements to be performed with a dynamometer The dynamometer registers strength lower than up to 90 kg

Time frame: Second examination - at the end of the three-week program

measurements to be performed with a dynamometer The dynamometer registers strength lower than up to 90 kg

Time frame: Third study (flow-up) - month after Rehabilitation Center discharge, during a follow-up visit

measurements to be performed with a dynamometer The dynamometer registers strength lower than up to 90 kg

Time frame: First examination - before the start of the rehabilitation program

measurements to be performed with a pinch meter. The pinch meter registers strength lower than up to 22 kg

Time frame: Second examination - at the end of the three-week program

measurements to be performed with a pinch meter. The pinch meter registers strength lower than up to 22 kg

Time frame: Third study (flow-up) - month after Rehabilitation Center discharge, during a follow-up visit

measurements to be performed with a pinch meter. The pinch meter registers strength lower than up to 22 kg

Time frame: First examination - before the start of the rehabilitation program

Activities of daily living were assessed using Barthel Index. The subjects could score the maximum of 100 points.

A maximum of 100 points can be obtained on the Barthel scale. There are three assessment ranges: getting from 0 to 20 points. means total dependence, from 20 to 80 points. means that to some extent the patient needs help from others, and the assessment in the border is 80 to 100 points. means that with a little help the patient can function alone.

0-20 points patient's condition "light" 21-85 points - "medium-heavy" patient condition 86-100 points - patient condition "very heavy"

Time frame: Second examination - at the end of the three-week program

Activities of daily living were assessed using Barthel Index. The subjects could score the maximum of 100 points.

A maximum of 100 points can be obtained on the Barthel scale. There are three assessment ranges: getting from 0 to 20 points. means total dependence, from 20 to 80 points. means that to some extent the patient needs help from others, and the assessment in the border is 80 to 100 points. means that with a little help the patient can function alone.

0-20 points patient's condition "light" 21-85 points - "medium-heavy" patient condition 86-100 points - patient condition "very heavy"

Time frame: Third study (flow-up) - month after Rehabilitation Center discharge, during a follow-up visit

Activities of daily living were assessed using Barthel Index. The subjects could score the maximum of 100 points.

A maximum of 100 points can be obtained on the Barthel scale. There are three assessment ranges: getting from 0 to 20 points. means total dependence, from 20 to 80 points. means that to some extent the patient needs help from others, and the assessment in the border is 80 to 100 points. means that with a little help the patient can function alone.

0-20 points patient's condition "light" 21-85 points - "medium-heavy" patient condition 86-100 points - patient condition "very heavy"

Time frame: First examination - before the start of the rehabilitation program

The test uses a wooden box, divided into two equal parts by a partition, as well as 150 blocks. The subject moves as many blocks as possible from one part of the box to the other during 60 seconds.

Time frame: Second examination - at the end of the three-week program

The test uses a wooden box, divided into two equal parts by a partition, as well as 150 blocks. The subject moves as many blocks as possible from one part of the box to the other during 60 seconds.

Time frame: Third study (flow-up) - month after Rehabilitation Center discharge, during a follow-up visit

The test uses a wooden box, divided into two equal parts by a partition, as well as 150 blocks. The subject moves as many blocks as possible from one part of the box to the other during 60 seconds.

Time frame: First examination - before the start of the rehabilitation program

Thumb Localizing Test (TLT). (A) positioning of the paretic UE by the examiner. (B) four spaces in which the paretic UE is placed. Distal spaces are not far from the trunk because the reaching limb should be able to reach them without difficulty. (C) rating of positive results

Time frame: Second examination - at the end of the three-week program

Thumb Localizing Test (TLT). (A) positioning of the paretic UE by the examiner. (B) four spaces in which the paretic UE is placed. Distal spaces are not far from the trunk because the reaching limb should be able to reach them without difficulty. (C) rating of positive results

Time frame: Third study (flow-up) - month after Rehabilitation Center discharge, during a follow-up visit

Thumb Localizing Test (TLT). (A) positioning of the paretic UE by the examiner. (B) four spaces in which the paretic UE is placed. Distal spaces are not far from the trunk because the reaching limb should be able to reach them without difficulty. (C) rating of positive results

Time frame: First examination - before the start of the rehabilitation program

Assessments were performed with eyes closed. Proprioception of the elbow joint was assessed in the 60° elbow flexion position using a plastic Jamar goniometer. The initial fixed axis of the goniometer was set at the lateral epicondyle of the humerus, and the mobile axis was set parallel to the radius, in accordance with the methodology of the study of joint position sensation in the elbow

Time frame: Second examination - at the end of the three-week program

Assessments were performed with eyes closed. Proprioception of the elbow joint was assessed in the 60° elbow flexion position using a plastic Jamar goniometer. The initial fixed axis of the goniometer was set at the lateral epicondyle of the humerus, and the mobile axis was set parallel to the radius, in accordance with the methodology of the study of joint position sensation in the elbow

Time frame: Third study (flow-up) - month after Rehabilitation Center discharge, during a follow-up visit

Assessments were performed with eyes closed. Proprioception of the elbow joint was assessed in the 60° elbow flexion position using a plastic Jamar goniometer. The initial fixed axis of the goniometer was set at the lateral epicondyle of the humerus, and the mobile axis was set parallel to the radius, in accordance with the methodology of the study of joint position sensation in the elbow

Time frame: First examination - before the start of the rehabilitation program

The scale consists of 7 tasks (pass/fail grading); the patient is awarded 1 point for each activity performed successfully, or 0 points for a failure to perform. The maximum score of seven points may be achieved for the performance of the tasks. Higher score corresponds to better manual skills. The scale measures the proximal control of the upper limb and the manual skills.

Time frame: Second examination - at the end of the three-week program

The scale consists of 7 tasks (pass/fail grading); the patient is awarded 1 point for each activity performed successfully, or 0 points for a failure to perform. The maximum score of seven points may be achieved for the performance of the tasks. Higher score corresponds to better manual skills. The scale measures the proximal control of the upper limb and the manual skills.

Time frame: Third study (flow-up) - month after Rehabilitation Center discharge, during a follow-up visit

The scale consists of 7 tasks (pass/fail grading); the patient is awarded 1 point for each activity performed successfully, or 0 points for a failure to perform. The maximum score of seven points may be achieved for the performance of the tasks. Higher score corresponds to better manual skills. The scale measures the proximal control of the upper limb and the manual skills.

Time frame: First examination - before the start of the rehabilitation program

Increased muscle tone (spasticity) was examined with modified Ashworth scale. This is a six-point scale modified to include grade 1.

0: No increase in muscle tone

Slight increase in muscle tone, manifested by a catch and release or by minimal resistance at the end of the range of motion when the affected part(s) is moved in flexion or extension 1+: Slight increase in muscle tone, manifested by a catch, followed by minimal resistance throughout the remainder (less than half) of the ROM More marked increase in muscle tone through most of the ROM, but affected part(s) easily moved Considerable increase in muscle tone, passive movement difficult Affected part(s) rigid in flexion or extension

Time frame: First examination - before the start of the rehabilitation program

Assessment of disability using the modified Rankin scale (MRS)

Score Description 0 - No symptoms at all

1- No significant disability despite symptoms; able to carry out all usual duties and activities 2 - Slight disability; unable to carry out all previous activities, but able to look after own affairs without assistance 3 - Moderate disability; requiring some help, but able to walk without assistance 4 - Moderately severe disability; unable to walk without assistance and unable to attend to own bodily needs without assistance 5 - Severe disability; bedridden, incontinent and requiring constant nursing care and attention 6 - Dead TOTAL

Time frame: First examination - before the start of the rehabilitation program

Motor performance (function) of extremities was assessed using Brunnström scale. This is a six-point scale designed to assess performance (function) of paretic extremities

Time frame: First examination - before the start of the rehabilitation program

WHO BMI classification for adults:

\< 18.5 - Underweight (including: \<16.0 starvation, 16.0-16.9 emaciation, 17.0-18.4 underweight) 18.5-24.9 - Normal body weight 25.0-29.9 - Overweight 30.0-34.9 - Class I obesity 35.0-39.9 - Class II obesity (clinical obesity)

≥ 40.0 - Class III obesity (extreme obesity)

Evaluation of the Effects of Upper Limb Rehabilitation Using the Pablo Tyromotion Device in People After Stroke