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Doehner W, Scherbakov N, Schellenberg T, Jankowska EA, Scheitz JF, von Haehling S, Joebges M. Iron deficiency is related to low functional outcome in patients at early rehabilitation after acute stroke. J Cachexia Sarcopenia Muscle 2022; 13:1036-1044. [PMID: 35166066 PMCID: PMC8977949 DOI: 10.1002/jcsm.12927] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/04/2022] [Accepted: 01/07/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Iron deficiency (ID) is a common co-morbidity in patients with cardiovascular disease and contributes to impaired functional capacity. The relevance of ID in patients in recovery after acute stroke is not known. We assessed the prevalence of ID and anaemia in relation to functional capacity and to recovery during early rehabilitation after stroke. METHODS This observational study enrolled consecutively 746 patients with ischaemic or haemorrhagic stroke at in-patient early rehabilitation (age 68 ± 13 years, female 47%, ischaemic stroke 87%). Functional capacity was assessed before and after rehabilitation using Barthel index (reha-BI), motricity index (MI), trunk control test (TCT), and functional ambulatory category (FAC). ID was defined as ferritin <100 μg/L or as transferrin saturation (TSAT) < 20% if ferritin was 100- < 300 μg/L or if CrP > 5 mg/L. Anaemia was defined as Hb < 12 g/dL (women) and <13 g/dL (men). RESULTS The prevalence of ID and anaemia before rehabilitation were 45% and 46%, respectively, and remained high at discharge (after 27 ± 17 days) at 40% and 48%, respectively. Patients with ID had lower functional capacity compared with patients without ID (reha-BI 20 [±86] vs. 40 [±80], MI 64 [±66] vs. 77 [±41], TCT 61 [±76] vs. 100 [±39], FAC 1 [±4] vs. 4 [±4]; median [IQR], all P < 0.001). ID was related to inflammation (OR 2.68 [95% CI 1.98-3.63], P < 0.001), female sex (OR 2.13 [95% CI 1.59-2.85], P < 0.001), haemorrhagic stroke (OR 1.70 [95% CI 1.11-2.61], P = 0.015), initial treatment on stroke unit (OR 3.59 [95% CI 1.08-11.89], P < 0.001), and anaemia (OR 2.94 [95% CI 2.18-3.96], P < 0.001), while age, BMI, and renal function were not related to ID. In adjusted analysis, ID was associated with low functional capacity in all functional scores: reha-BI (OR 1.66 [95% CI 1.08-2.54], P = 0.02), motricity index (OR 1.94 [95% CI 1.36-2.76], P < 0.001), trunk control test (OR 2.34 [95% CI] 1.64-3.32, P < 0.001) and functional ambulatory category (OR 1.77 [95% CI 1.2-2.63], P < 0.02). Functional capacity improved during rehabilitation regardless of presence of ID, but functional outcome remained significantly lower in patients with ID at the end of rehabilitation (rehab BI and MI, both P < 0.001). CONCLUSIONS Iron deficiency and anaemia are common and persistent findings in patients after acute stroke. ID and anaemia are independently related to lower functional capacity after acute stroke and to poor functional outcome after rehabilitation. Regular assessment of iron status may identify patients at risk of low functional recovery.
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Affiliation(s)
- Wolfram Doehner
- BIH Center for Regenerative Therapies (BCRT), Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Cardiology (Virchow Klinikum), Charité Universitätsmedizin Berlin, and German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany.,Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Nadja Scherbakov
- BIH Center for Regenerative Therapies (BCRT), Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Tim Schellenberg
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ewa A Jankowska
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.,Institute of Heart Diseases, University Hospital, Wroclaw, Poland
| | - Jan F Scheitz
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Neurology with Experimental Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center (UMG), Göttingen, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Michael Joebges
- Department of Neurology, Brandenburg Klinik, Bernau, Germany
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202
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Different association between physical activity and physical function according to walking independence in hospital-based rehabilitation program patients with sub-acute stroke. Clin Neurol Neurosurg 2022; 215:107202. [DOI: 10.1016/j.clineuro.2022.107202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 02/27/2022] [Accepted: 03/06/2022] [Indexed: 11/20/2022]
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203
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Chaiwat O, Sathitkarnmanee B, Dajpratham P, Thanakiattiwibun C, Jarungjitaree S, Rattanamung S. The impact of physical medicine and rehabilitation consultation on clinical outcomes in the surgical intensive care unit: A prospective observational cohort study. Medicine (Baltimore) 2022; 101:e28990. [PMID: 35244073 PMCID: PMC8896451 DOI: 10.1097/md.0000000000028990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 02/14/2022] [Indexed: 01/04/2023] Open
Abstract
The impact of a physical medicine and rehabilitation (PM&R) consultation on clinical outcomes in critically ill surgical patients remains unclear. The aim of this study is to examine whether the patients who received PM&R consultation will demonstrate better clinical outcomes in terms of the differences in clinical outcomes including muscle mass and strength, intensive care unit (ICU) length of stay (LOS) and functional outcomes between the PM&R consultation and no PM&R consultation and between early PM&R consultation and late PM&R consultation in critically ill surgical patients.A prospective observational cohort study was undergone in 65-year-old or older patients who were admitted > 24 hours in the surgical intensive care unit (SICU) in a tertiary care hospital. Data collection included patients' characteristic, muscle mass and muscle strength, and clinical outcomes.Ninety surgical patients were enrolled and PM&R was consulted in 37 patients (36.7%). There was no significant difference in muscle mass and function between consulted and no consulted groups. PM&R consulted group showed worse in clinical outcomes including functional outcomes at hospital discharge, longer duration of mechanical ventilation, ICU, and hospital LOS as compared with no PM&R consulted group. The median time of rehabilitation consultation was 6 days and there were no significant differences in clinical outcomes between early (≤ 6 days) and late (> 6 days) consultation.PM&R consultation did not improve muscle mass, functional outcomes at hospital discharge, and ICU LOS in critically ill surgical patients. The key to success might include the PM&R consultation with both intensified physical therapy and early start of mobilization or the rigid mobilization protocol.
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Affiliation(s)
- Onuma Chaiwat
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Integrated Perioperative Geriatric Excellent Research Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Benjaporn Sathitkarnmanee
- Division of Critical Care Medicine, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Piyapat Dajpratham
- Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chayanan Thanakiattiwibun
- Integrated Perioperative Geriatric Excellent Research Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sunit Jarungjitaree
- Integrated Perioperative Geriatric Excellent Research Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Suchera Rattanamung
- Division of Critical Care Medicine, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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204
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Choi JY, Kim H, Jung YI, Chun S, Yoo S, Lim JY, Ko JY, Park K, Kim KI. Factors associated with anticholinergic burden among older patients in long-term care hospitals in Korea. Korean J Intern Med 2022; 37:468-477. [PMID: 35176208 PMCID: PMC8925946 DOI: 10.3904/kjim.2021.457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/10/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Drugs with anticholinergic properties (DAPs) are associated with adverse health outcomes in older patients. The objective of this study was to evaluate the factors that determine the prescribing of more DAPs in long-term care hospitals (LTCHs) in Korea. In addition, the current patterns of DAP prescription were explored using a novel platform, which can collect data from LTCHs. METHODS This was a Health-RESPECT (integrated caRE Systems for elderly PatiEnts using iCT) sub-study, which is a pragmatic, cluster-randomized, controlled trial. The Health-RESPECT platform was used to collect prescribed medication data of 466 patients (aged ≥ 65 years) from seven LTCHs. DAPs were identified using the Korean Anticholinergic Burden Scale (KABS). Physical frailty, cognitive function, functional status, and quality of life were evaluated. RESULTS Among 466 LTCH patients, 88.8% (n = 414) were prescribed DAPs, and the prevalence of high KABS (≥ 3) was 70.4% (n = 328). The drugs that contributed most to the total KABS were quetiapine (20.7%), chlorpheniramine (19.5%), tramadol (9.8%), cimetidine (5.8%), and furosemide (3.6%). Polypharmacy, higher body mass index, less dependence, better communication and cognitive functions, and poorer quality of life were associated with high KABS. CONCLUSION Although the patients with a high burden of DAPs were less dependent and had better cognitive and communication functions, they had poorer quality of life. DAP use in LTCH patients should be monitored carefully, and the risk/ benefit relationship for their use should be considered.
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Affiliation(s)
- Jung-Yeon Choi
- Division of Geriatrics, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Hongsoo Kim
- Department of Public Health Sciences, Graduate School of Public Health, Seoul, Korea
- Institute of Health and Environment, Seoul National University, Seoul, Korea
- Institute on Aging, Seoul National University, Seoul, Korea
| | - Young-il Jung
- Department of Environmental Health, Korea National Open University, Seoul, Korea
| | - Seungyeon Chun
- Department of Public Health Sciences, Graduate School of Public Health, Seoul, Korea
| | - Sooyoung Yoo
- Office of eHealth Research and Businesses, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae-Young Lim
- Institute on Aging, Seoul National University, Seoul, Korea
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Young Ko
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kayoung Park
- Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kwang-il Kim
- Division of Geriatrics, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam,
Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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205
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Long J, Zhang Y, Liu X, Jin X. Effects of sling exercise therapy on post-stroke walking impairment: a systematic review and meta-analysis. Int J Rehabil Res 2022; 45:12-23. [PMID: 34726197 DOI: 10.1097/mrr.0000000000000505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Walking impairment is a common consequence of stroke, resulting in long-term disability. Trunk muscle strength has been proven to be associated with post-stroke walking performance. As a type of trunk training, sling exercise therapy (SET) has been widely used to improve the trunk function in stroke patients. The purpose of this systematic review was to investigate the efficacy of SET on post-stroke walking impairment. Seven databases were systematically searched for eligible studies from their inception to 1 August 2021. Review Manager 5.3 software was used for this meta-analysis. The overall quality of included studies was evaluated by the physiotherapy evidence database scale. Twenty-five randomized controlled trials involving 1504 patients were included (23 in China and two in South Korea). In summary, SET more effectively improved the walking ability of post-stroke patients than conventional physical therapy or trunk training. The pooled analysis demonstrated that SET had positive effects on the 10 m maximum walking speed, integrated electromyography value of rectus femoris, biceps femoris and gastrocnemius, functional ambulation category, timed up and go test, and step length. At least in East Asia, our findings support SET to manage the post-stroke walking impairment.
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Affiliation(s)
- Junzi Long
- School of Rehabilitation Medicine, Henan University of Chinese Medicine, Zhengzhou, Henan, China
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206
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Fukata K, Amimoto K, Inoue M, Sekine D, Fujino Y, Makita S, Takahashi H. Immediate effect of standing and sit-to-stand training on postural vertical for backward disequilibrium following stroke: a case report. Physiother Theory Pract 2022:1-9. [DOI: 10.1080/09593985.2022.2037031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Kazuhiro Fukata
- Department of Rehabilitation Center, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Kazu Amimoto
- Department of Physical Therapy, Faculty of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Masahide Inoue
- Department of Rehabilitation Center, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
- Department of Physical Therapy, Faculty of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Daisuke Sekine
- Department of Rehabilitation Center, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
- Department of Physical Therapy, Faculty of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Yuji Fujino
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan
| | - Shigeru Makita
- Department of Rehabilitation, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Hidetoshi Takahashi
- Department of Rehabilitation, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
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207
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Qu Q, Zhu J, Wang H, Zhang Q, Zhang Y, Yan Z, Fan Q, Wang Y, He Y, Yao L, Xu L, Zhang C, Jia J. Exploring Alternative Measurements of Cardiorespiratory Fitness in Patients With Mild Ischemic Stroke at Acute Phase. Front Neurol 2022; 13:801696. [PMID: 35222244 PMCID: PMC8864240 DOI: 10.3389/fneur.2022.801696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/10/2022] [Indexed: 11/17/2022] Open
Abstract
Background While emerging studies have suggested an association of cardiorespiratory fitness (CRF) with stroke risk and overall health outcomes, little is known regarding the optimum methods of CRF measurement in patients with mild acute ischemic stroke. Objective The aim of this study was to explore the association between the 6-min walk distance (6MWD) and other measurements related to CRF in patients with mild ischemic stroke at the acute stage. Methods A total of 30 patients with stroke and 71 healthy subjects matched for age and grip strength (GS) were prospectively recruited. All patients were within 14 days after stroke onset and presented mild motor impairment (with a full score of Fugl-Meyer Motor Assessment). Demographic data of both groups and clinical information of the stroke group were documented, and the CRF comparison between the two groups was conducted. Each participant underwent a one-time assessment of 6MWD and a series of measurements related to CRF, including GS, 10-m walk test (10mWT), five-times sit-to-stand time (FTSST), functional reaching test (FRT), Berg Balance Scale (BBS), and waistline. Pearson's product-moment correlation coefficient test and multiple linear regression were performed to explore the indicators of CRF. Results Significant moderate correlations (0.3 < r <0.6) were found between 6MWD and GS of left hand (GS-left) (r = 0.573, p = 0.001), GS of right hand (GS-right) (r = 0.524, p = 0.003), FTSST (r = −0.551, p = 0.002), 10mWT (r = 0.554, p = 0.001), and FRT (r = 0.449, p = 0.021) in the patient group. While 6MWD displayed significant moderate correlations with waistline (r = 0.364, p = 0.002), 10mWT (r = 0.512, p < 0.001), FTSST (r = −0.573, p < 0.001), and FRT (r = 0.550, p < 0.001) in the healthy group. All these dependent variables were entered into a stepwise multiple linear regression analysis to evaluate their values in estimating CRF as measured by 6MWD in each group. Analyses suggested that GS-left (p = 0.002) and FTSST (p = 0.003) were the indicators of CRF in the patient group with stroke and explained 51.4% of the variance of 6MWD (R2 = 0.514); FTSST (p < 0.001), 10mWT (p < 0.001), and FRT (p = 0.021) were the indicators of CRF in the healthy group and explained 58.9% of variance of 6MWD (R2 = 0.589). Conclusions Our data confirmed that CRF is impaired in patients with mild ischemic stroke at the acute phase. Moreover, GS-left may be an optional indicator of CRF in patients with mild acute ischemic stroke, but not in healthy people. Clinical Trial Registration www.chictr.org.cn, identifier: ChiCTR2000031379.
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Affiliation(s)
- Qingming Qu
- Department of Rehabilitation Medicine, Fudan University Huashan Hospital, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
| | - Jie Zhu
- Department of Rehabilitation Medicine, Fudan University Huashan Hospital, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
| | - Hewei Wang
- Department of Rehabilitation Medicine, Fudan University Huashan Hospital, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
| | - Qi Zhang
- Department of Rehabilitation Medicine, Fudan University Huashan Hospital, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
| | - Yongli Zhang
- Department of Rehabilitation Medicine, Fudan University Huashan Hospital, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
| | - Zhijie Yan
- Department of Rehabilitation Medicine, Fudan University Huashan Hospital, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
| | - Qiwei Fan
- Department of Rehabilitation Medicine, Fudan University Huashan Hospital, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
| | - Yuanyuan Wang
- Department of Rehabilitation Medicine, The People's Hospital of Jiaozuo City, Jiaozuo, China
| | - Ying He
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Liqing Yao
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Lijuan Xu
- Linping Hospital of Integrated Traditional Chinese and Western Medicine, Linping, China
| | - Chao Zhang
- Hangzhou Xiaoshan Neighborhood United Hospital, Hangzhou, China
| | - Jie Jia
- Department of Rehabilitation Medicine, Fudan University Huashan Hospital, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Fudan University Huashan Hospital, Shanghai, China
- *Correspondence: Jie Jia
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208
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Unilateral non-electric assistive walking device helps neurological and orthopedic patients to improve gait patterns. Gait Posture 2022; 92:294-301. [PMID: 34902658 DOI: 10.1016/j.gaitpost.2021.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 11/04/2021] [Accepted: 11/09/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pathological gait patterns are common in neurological and orthopedic patients. These put them at risk of falling and restrict their autonomy and social participation. Novel assistive walking devices are designed to actively support physiological gait patterns by means of motor guidance and mechanical support of the lower limbs. RESEARCH QUESTION Does a non-electric assistive walking device powered by a cam-spring mechanism (aLQ, Imasen) improve or otherwise affect pathological gait patterns in neurological and orthopedic patients? METHODS A three-dimensional instrumented gait analysis was conducted on a treadmill (quasar, hp cosmos) using spatiotemporal, kinetic, and kinematic data obtained from synchronized motion capturing (Miqus M3, Qualisys), surface EMG (sEMG; Ultium, Noraxon), and pressure distribution measurements (FMD-T, Zebris). Participants with impaired walking were tested in a randomized repeated measures design (assisted/unassisted; at preferred/fast speed) and analyzed with regard to their medical condition (orthopedic or neurological group, n = 20 each). RESULTS In both groups, participants showed a significant increase of step length and decrease of cadence during assisted walking compared to baseline. Immediate kinematic effects included enhanced sagittal hip flexion but reduced extension. On the contrary, knee joint angles and muscle activity of M. gastrocnemius and M. rectus femoris seemed to be unaffected by the aLQ device. SIGNIFICANCE Participants appear to benefit from the assistive walking device regarding gait and movement patterns, which suggests that the tested device may help to improve patients' functional health status and quality of life. Activities of daily living (ADLs) that involve extensive hip flexion like stairs or curb climbing are promising applications. We propose the implementation of an invertible cam-spring that provides an additional resistance training option.
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209
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Inoue S, Otaka Y, Kumagai M, Sugasawa M, Mori N, Kondo K. Effects of Balance Exercise Assist Robot training for patients with hemiparetic stroke: a randomized controlled trial. J Neuroeng Rehabil 2022; 19:12. [PMID: 35090517 PMCID: PMC8796441 DOI: 10.1186/s12984-022-00989-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 01/08/2022] [Indexed: 02/05/2023] Open
Abstract
Background Robot-assisted rehabilitation for patients with stroke is promising. However, it is unclear whether additional balance training using a balance-focused robot combined with conventional rehabilitation programs supplements the balance function in patients with stroke. The purpose of this study was to compare the effects of Balance Exercise Assist Robot (BEAR) training combined with conventional inpatient rehabilitation training to those of conventional inpatient rehabilitation only in patients with hemiparetic stroke. We also aimed to determine whether BEAR training was superior to intensive balance training. Methods This assessor-blinded randomized controlled trial included 60 patients with first-ever hemiparetic stroke, admitted to rehabilitation wards between December 2016 and February 2019. Patients were randomly assigned to one of three groups, robotic balance training and conventional inpatient rehabilitation (BEAR group), intensive balance training and conventional inpatient rehabilitation (IBT group), or conventional inpatient rehabilitation-only (CR group). The intervention duration was 2 weeks, with assessments conducted pre- and post-intervention, and at 2 weeks follow-up. The primary outcome measure was a change in the Mini-Balance Evaluation Systems Test (Mini-BESTest) score from baseline. Results In total, 57 patients completed the intervention, and 48 patients were evaluated at the follow-up. Significant improvements in Mini-BESTest score were observed in the BEAR and IBT groups compared with in the CR group post-intervention and after the 2-week follow-up period (P < 0.05). Conclusions The addition of balance exercises using the BEAR alongside conventional inpatient rehabilitation improved balance in patients with subacute stroke. Trial registration https://www.umin.ac.jp/ctr; Unique Identifier: UMIN000025129. Registered on 2 December 2016.
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210
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Mulder M, Nikamp C, Nijland R, van Wegen E, Prinsen E, Vloothuis J, Buurke J, Kwakkel G. Can telerehabilitation services combined with caregiver-mediated exercises improve early supported discharge services poststroke? A study protocol for a multicentre, observer-blinded, randomized controlled trial. BMC Neurol 2022; 22:29. [PMID: 35039010 PMCID: PMC8762867 DOI: 10.1186/s12883-021-02533-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recovery of walking ability is an important goal for patients poststroke, and a basic level of mobility is critical for an early discharge home. Caregiver-mediated exercises could be a resource-efficient strategy to augment exercise therapy and improve mobility in the first months poststroke. A combination of telerehabilitation and face-to-face support, blended care, may empower patient-caregiver dyads and smoothen the transition from professional support to self-management. The Armed4Stroke study aims to investigate the effects of a caregiver-mediated exercise program using a blended care approach in addition to usual care, on recovery of mobility in the first 6 months poststroke. METHODS A multicentre, observer-blinded randomized clinical trial in which 74 patient-caregiver dyads will be enrolled in the first 3 months poststroke. Dyads are randomly allocated to a caregiver-mediated exercises intervention or to a control group. The primary endpoint is the self-reported mobility domain of the Stroke Impact Scale. Secondary endpoints include care transition preparedness and psychological functioning of dyads, length of inpatient stay, gait-related measures and extended ADL of patients, and caregiver burden. Outcomes are assessed at enrolment, end of treatment and 6 months follow-up. RESULTS During 8 weeks, caregivers are trained to become an exercise coach using a blended care approach. Dyads will receive a tailor-made, progressive training program containing task-specific exercises focusing on gait, balance, physical activity and outdoor activities. Dyads are asked to perform the training program a minimum of 5 times a week for 30 min per session, supported by a web-based telerehabilitation system with instruction videos and a messaging environment to communicate with their physiotherapist. CONCLUSIONS We hypothesize that the Armed4Stroke program will increase self-reported mobility and independence in ADL, facilitating an early discharge poststroke. In addition, we hypothesize that active involvement of caregivers and providing support using blended care, will improve the care transition when professional support tapers off. Therefore, the Armed4Stroke program may complement early supported discharge services. TRIAL REGISTRATION Netherlands Trial Register, NL7422 . Registered 11 December 2018.
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Affiliation(s)
- Marijn Mulder
- Department of Rehabilitation Medicine, Amsterdam University Medical Centre, location VU University Medical Centre, Amsterdam Movement Sciences, PO Box 7057, 1007, MB, Amsterdam, The Netherlands.,Amsterdam Rehabilitation Research Centre
- Reade, Amsterdam, The Netherlands
| | - Corien Nikamp
- Roessingh Research and Development, Enschede, The Netherlands.,Department of Biomedical Signals and Systems, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Rinske Nijland
- Amsterdam Rehabilitation Research Centre
- Reade, Amsterdam, The Netherlands
| | - Erwin van Wegen
- Department of Rehabilitation Medicine, Amsterdam University Medical Centre, location VU University Medical Centre, Amsterdam Movement Sciences, PO Box 7057, 1007, MB, Amsterdam, The Netherlands.,Amsterdam Neuroscience, Vrije Universiteit, Amsterdam, The Netherlands
| | - Erik Prinsen
- Roessingh Research and Development, Enschede, The Netherlands.,Department op Biomechanical Engineering, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Judith Vloothuis
- Amsterdam Rehabilitation Research Centre
- Reade, Amsterdam, The Netherlands
| | - Jaap Buurke
- Roessingh Research and Development, Enschede, The Netherlands.,Department of Biomedical Signals and Systems, Technical Medical Centre, University of Twente, Enschede, the Netherlands.,Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA.,Roessingh, Centre for Rehabilitation, Enschede, The Netherlands
| | - Gert Kwakkel
- Department of Rehabilitation Medicine, Amsterdam University Medical Centre, location VU University Medical Centre, Amsterdam Movement Sciences, PO Box 7057, 1007, MB, Amsterdam, The Netherlands. .,Amsterdam Rehabilitation Research Centre
- Reade, Amsterdam, The Netherlands. .,Amsterdam Neuroscience, Vrije Universiteit, Amsterdam, The Netherlands. .,Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA.
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211
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Mazzoli D, Basini G, Prati P, Galletti M, Mascioli F, Rambelli C, Zerbinati P, Campanini I, Merlo A. Indices of Loading and Propulsive Ability in the Gait of Patients With Chronic Stroke With Equinus Foot Deviation: A Correlation Study. Front Hum Neurosci 2022; 15:771392. [PMID: 35095449 PMCID: PMC8795873 DOI: 10.3389/fnhum.2021.771392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/06/2021] [Indexed: 01/01/2023] Open
Abstract
In literature, indices of overall walking ability that are based on ground reaction forces have been proposed because of their ease of administration with patients. In this study, we analyzed the correlation between the indices of dynamic loading and propulsion ability of 40 chronic hemiparetic post-stroke patients with equinus foot deviation and a set of clinical assessments of ankle joint deviations and walking ability. Ankle passive and active range of motion (ROM) and triceps surae spasticity were considered, along with walking speed and three complementary scales of walking ability focusing respectively on the need for assistance on functional mobility, including balance and transfers, and the limitation in social participation. The correlation between the ground reaction force-based indices and both clinical and functional variables was carried out using the non-parametric Spearman correlation coefficient. Both indices were correlated to 8 of the 10 investigated variables, thus supporting their use. In particular, the dynamic propulsive ability was correlated with all functional scales (rho = 0.5, p < 0.01), and has the advantage of being a continuous variable. Among clinical assessments, limited ankle ROM affected walking ability the most, while spasticity did not. Since the acquisition of ground reaction forces does not require any patient prepping, the derived indices can be used during the rehabilitation period to quickly detect small improvements that, over time, might lead to the broad changes detectable by clinical scales, as well as to immediately highlight the lack of these improvements, thus suggesting adjustments to the ongoing rehabilitation approach.
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Affiliation(s)
- Davide Mazzoli
- Gait and Motion Analysis Laboratory, Sol et Salus Hospital, Rimini, Italy
| | - Giacomo Basini
- Gait and Motion Analysis Laboratory, Sol et Salus Hospital, Rimini, Italy
| | - Paolo Prati
- Gait and Motion Analysis Laboratory, Sol et Salus Hospital, Rimini, Italy
| | - Martina Galletti
- Gait and Motion Analysis Laboratory, Sol et Salus Hospital, Rimini, Italy
| | - Francesca Mascioli
- Gait and Motion Analysis Laboratory, Sol et Salus Hospital, Rimini, Italy
| | - Chiara Rambelli
- Gait and Motion Analysis Laboratory, Sol et Salus Hospital, Rimini, Italy
- Section of Rehabilitation, Department of Neuroscience, University of Padova, Padova, Italy
| | | | - Isabella Campanini
- LAM-Motion Analysis Laboratory, Department of Neuromotor and Rehabilitation, Azienda USL-IRCCS di Reggio Emilia, S. Sebastiano Hospital, Correggio, Italy
| | - Andrea Merlo
- Gait and Motion Analysis Laboratory, Sol et Salus Hospital, Rimini, Italy
- *Correspondence: Andrea Merlo
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212
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Lonini L, Moon Y, Embry K, Cotton RJ, McKenzie K, Jenz S, Jayaraman A. Video-Based Pose Estimation for Gait Analysis in Stroke Survivors during Clinical Assessments: A Proof-of-Concept Study. Digit Biomark 2022; 6:9-18. [PMID: 35224426 PMCID: PMC8832219 DOI: 10.1159/000520732] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/02/2021] [Indexed: 10/10/2023] Open
Abstract
Recent advancements in deep learning have produced significant progress in markerless human pose estimation, making it possible to estimate human kinematics from single camera videos without the need for reflective markers and specialized labs equipped with motion capture systems. Such algorithms have the potential to enable the quantification of clinical metrics from videos recorded with a handheld camera. Here we used DeepLabCut, an open-source framework for markerless pose estimation, to fine-tune a deep network to track 5 body keypoints (hip, knee, ankle, heel, and toe) in 82 below-waist videos of 8 patients with stroke performing overground walking during clinical assessments. We trained the pose estimation model by labeling the keypoints in 2 frames per video and then trained a convolutional neural network to estimate 5 clinically relevant gait parameters (cadence, double support time, swing time, stance time, and walking speed) from the trajectory of these keypoints. These results were then compared to those obtained from a clinical system for gait analysis (GAITRite®, CIR Systems). Absolute accuracy (mean error) and precision (standard deviation of error) for swing, stance, and double support time were within 0.04 ± 0.11 s; Pearson's correlation with the reference system was moderate for swing times (r = 0.4-0.66), but stronger for stance and double support time (r = 0.93-0.95). Cadence mean error was -0.25 steps/min ± 3.9 steps/min (r = 0.97), while walking speed mean error was -0.02 ± 0.11 m/s (r = 0.92). These preliminary results suggest that single camera videos and pose estimation models based on deep networks could be used to quantify clinically relevant gait metrics in individuals poststroke, even while using assistive devices in uncontrolled environments. Such development opens the door to applications for gait analysis both inside and outside of clinical settings, without the need of sophisticated equipment.
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Affiliation(s)
- Luca Lonini
- Shirley Ryan Ability Lab, Chicago, Illinois, USA
- Dept. of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Yaejin Moon
- Shirley Ryan Ability Lab, Chicago, Illinois, USA
| | - Kyle Embry
- Shirley Ryan Ability Lab, Chicago, Illinois, USA
- Dept. of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Chicago, Illinois, USA
| | - R. James Cotton
- Shirley Ryan Ability Lab, Chicago, Illinois, USA
- Dept. of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Sophia Jenz
- Shirley Ryan Ability Lab, Chicago, Illinois, USA
| | - Arun Jayaraman
- Shirley Ryan Ability Lab, Chicago, Illinois, USA
- Dept. of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Chicago, Illinois, USA
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213
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Kerr A, Grealy MA, Kuschmann A, Rutherford R, Rowe P. A Co-creation Centre for Accessible Rehabilitation Technology. FRONTIERS IN REHABILITATION SCIENCES 2022; 2:820929. [PMID: 36188853 PMCID: PMC9397706 DOI: 10.3389/fresc.2021.820929] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 12/13/2021] [Indexed: 12/02/2022]
Abstract
Background: The prevalence of disabling conditions is increasing globally. Rehabilitation improves function and quality of life across many conditions, particularly when applied intensively. The limited workforce, however, cannot deliver evidence-based intensive rehabilitation. By providing individuals with the tools for self- rehabilitation, technology helps bridge the gap between evidence and practise. Few people, however, can access rehabilitation technology. Barriers such as cost, training, education, portability and poor design stand in the way of equitable access. Our group of engineers and researchers have established a centre dedicated to developing accessible technology through close, frequent engagement with users and industry. Methods: The centre employs a co-creation model, coupling engineering and science with user experience and industrial partnerships to develop accessible technology and associated processes. Due to the complexity and size of the challenge the initial focus is stroke. Recruited through a medical charity, participants, with a wide range of disabilities, use prototype and commercial technology during an 8-week rehabilitation programme with supervision from health professionals. The centre includes de-weighting systems, neurostimulation, virtual reality, treadmills, bespoke rehab games, communication apps, powered exercise equipment and gamified resistance equipment. Standard outcome measures (International Classification of Functioning, Disability and Health) are recorded before, during, immediately after, and 3 months after the intervention and used in combination with an interview to design the initial rehabilitation programme, which is reviewed fortnightly. Qualitative methods (surveys and interviews) are used to capture personal experiences of the programme and individual technology and an advisory group of stroke survivors help interpret outcomes to feed into the technology design process. Ethical approval has been granted for a pilot cohort study with stroke survivors, which is currently underway (01/09/2021–31/12/2021) investigating acceptability and feasibility, due to report findings in 2022. Discussion: Through partnerships, research collaborations and a co-creation model a new centre dedicated to the development of accessible rehabilitation technology has been launched and currently undergoing acceptability and feasibility testing with stroke survivors. The centre, through its close engagement with users and industry, has the potential to transform the way rehabilitation technology is developed and help revolutionise the way rehabilitation is delivered.
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Affiliation(s)
- Andy Kerr
- Biomedical Engineering, University of Strathclyde, Glasgow, United Kingdom
- *Correspondence: Andy Kerr
| | - Madeleine Ann Grealy
- Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom
| | - Anja Kuschmann
- Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom
| | | | - Philip Rowe
- Biomedical Engineering, University of Strathclyde, Glasgow, United Kingdom
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214
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Kim JK, Chang MC, Park D. Deep Learning Algorithm Trained on Brain Magnetic Resonance Images and Clinical Data to Predict Motor Outcomes of Patients With Corona Radiata Infarct. Front Neurosci 2022; 15:795553. [PMID: 35046770 PMCID: PMC8763312 DOI: 10.3389/fnins.2021.795553] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/09/2021] [Indexed: 12/21/2022] Open
Abstract
The early and accurate prediction of the extent of long-term motor recovery is important for establishing specific rehabilitation strategies for stroke patients. Using clinical parameters and brain magnetic resonance images as inputs, we developed a deep learning algorithm to increase the prediction accuracy of long-term motor outcomes in patients with corona radiata (CR) infarct. Using brain magnetic resonance images and clinical data obtained soon after CR infarct, we developed an integrated algorithm to predict hand function and ambulatory outcomes of the patient 6 months after onset. To develop and evaluate the algorithm, we retrospectively recruited 221 patients with CR infarct. The area under the curve of the validation set of the integrated modified Brunnstrom classification prediction model was 0.891 with 95% confidence interval (0.814-0.967) and that of the integrated functional ambulatory category prediction model was 0.919, with 95% confidence interval (0.842-0.995). We demonstrated that an integrated algorithm trained using patients' clinical data and brain magnetic resonance images obtained soon after CR infarct can promote the accurate prediction of long-term hand function and ambulatory outcomes. Future efforts will be devoted to finding more appropriate input variables to further increase the accuracy of deep learning models in clinical applications.
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Affiliation(s)
- Jeoung Kun Kim
- Department of Business Administration, School of Business, Yeungnam University, Gyeongsan, South Korea
| | - Min Cheol Chang
- Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Gyeongsan, South Korea
| | - Donghwi Park
- Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
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215
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Rate of torque development of paretic lower limb is an excellent predictor of walking speed in chronic stroke individuals. Clin Biomech (Bristol, Avon) 2022; 91:105527. [PMID: 34915434 DOI: 10.1016/j.clinbiomech.2021.105527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 10/16/2021] [Accepted: 11/09/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Walking speed discriminates levels of functionality in stroke survivors, but its relationship with neuromuscular parameters remains unclear. We aimed to (1) verify relationships between walking speed, peak torque, and rate of torque development in individuals with chronic stroke and (2) investigate whether adjusting the predictive model for assistive device use and lower limb motor function improves its accuracy. METHODS Twenty-nine stroke survivors (time post-stroke ≥6 months) were assessed for walking speed, motor function, torque of knee extensors, and rate of torque development. Hierarchical multiple regression was conducted to infer the contribution of assistive device use and lower limb motor function in the proportion of variance in walking speed explained by neuromuscular parameters. Adequacy of regression models was verified using Shapiro-Wilk test and visual inspection of histograms. FINDINGS Rate of torque development measures presented higher coefficients of determination (R2 = 0.399-0.457) than peak torque (R2 = 0.333). However, no differences were observed between correlation coefficients (P > 0.05). When adjusted for assistive device use and lower limb motor function, coefficients of determination of all neuromuscular parameters were improved (P < 0.05). Regression models showed good adequacy. INTERPRETATION Peak torque and rate of torque development from knee extensors are adequate predictors of walking speed in stroke survivors. Adjusting predictive models for assistive device use and lower limb motor function increases predictive capacity. These findings may have repercussions for assessing chronic stroke individuals and developing treatment strategies.
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216
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Smith MG, Patritti BL. Minimal clinically important difference of the gait assessment and intervention tool for adults with stroke. Gait Posture 2022; 91:212-215. [PMID: 34740058 DOI: 10.1016/j.gaitpost.2021.10.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 10/13/2021] [Accepted: 10/25/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The Gait Assessment and Intervention Tool (GAIT) provides a valid and reliable gait quality measure for adults with stroke, however a minimal clinically important difference (MCID) is yet to be determined. RESEARCH QUESTION What is the GAIT MCID in community dwelling adults with a stroke diagnosis? METHODS The GAIT scores for a consecutive series of 63 adults with stroke, referred for video gait assessment within an outpatient rehabilitation program, were retrospectively identified from a gait laboratory database. Patients were classified by Functional Ambulation Category (FAC) and had walking speed measured, which classified them into one of three walking speed-based ambulatory levels (I.e. household, limited community or community ambulator). Linear regression models were fitted to assess the association between GAIT score and FAC level and GAIT score and ambulatory level. MCIDs were determined based on estimates calculated in the two models RESULTS: The FAC of patients ranged from 3 to 5. GAIT score was negatively correlated with FAC level and ambulatory level (ρ = -0.73, p < 0.001 and ρ =-0.69, p < 0.001, respectively). Pairwise comparisons from the models showed absolute mean differences between estimated GAIT scores of 10.84 (95% confidence interval 7.59-14.09) for changes from FAC level 3-4 and 12.13 (8.90-15.36) for household to limited community ambulator, and 5.90 (3.44-8.37) for changes from FAC level 4-5 and 4.39 (2.01-6.76) for limited community to community ambulator. The proposed MCID for FAC level 3 or household ambulators is 11.48, and for FAC level 4 and 5 or limited community/community ambulators is 5.19. SIGNIFICANCE The proposed MCIDs represent real changes in gait quality measured by the GAIT for adults with stroke who exhibit lower or higher functional mobility levels. The MCIDs will assist clinicians and researchers using the tool to determine if meaningful change in gait quality has taken place for adults with stroke undergoing rehabilitation.
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Affiliation(s)
- Meredith G Smith
- South Australian Movement Analysis Centre, Division of Rehabilitation, Aged and Palliative Care, Flinders Medical Centre, Adelaide, Australia; School of Allied Health Science and Practice, The University of Adelaide, Adelaide, Australia.
| | - Benjamin L Patritti
- South Australian Movement Analysis Centre, Division of Rehabilitation, Aged and Palliative Care, Flinders Medical Centre, Adelaide, Australia; College of Medicine and Public Health, Flinders University, Adelaide, Australia
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217
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Tamura S, Miyata K, Kobayashi S, Takeda R, Iwamoto H. Development of Cut-off Values on the Berg Balance Scale for Predicting Walking Independence in Older Adults with Hip Fracture. Prog Rehabil Med 2022; 7:20220043. [PMID: 36118148 PMCID: PMC9411036 DOI: 10.2490/prm.20220043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 08/03/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives: The aim of the current study was to identify a cut-off value for predicting walking independence at discharge in older adults with hip fracture based on their Berg Balance Scale (BBS) score at admission to a convalescent rehabilitation ward. Methods: This was a retrospective, multicenter, observational study of 187 older adults with hip fractures (mean age 83.7, range 66–97 years). Data was collected on the patients’ age, sex, treatment, and physical function evaluation. An ordinal logistic regression analysis was used to identify predictors associated with the degree of independence in walking at discharge. Receiver operating characteristic curves were used to estimate cut-off values to predict independent and supervised walking at discharge based on the BBS score at admission. The accuracy of the classification was assessed using the area under the curve (AUC). Results: The BBS score at admission was a significant factor predicting the degree of walking independence at discharge (odds ratio = 1.09, 95%CI: 1.06–1.11). The cut-off values of the BBS score at admission for predicting independent walking and supervised walking at discharge were 28 points (AUC = 0.76, 95%CI: 0.69–0.83) and 21 points (AUC = 0.84, 95%CI: 0.77–0.91), respectively. Conclusions: The BBS scores of older adults with hip fracture on admission to a rehabilitation ward are useful for predicting the degree of independence in walking at discharge and can help to structure therapy according to the predicted degree of independence.
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Affiliation(s)
- Shuntaro Tamura
- Department of Rehabilitation, Fujioka General Hospital, Fujioka, Japan
| | - Kazuhiro Miyata
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
| | - Sota Kobayashi
- Department of Rehabilitation, Public Nanokaichi Hospital, Tomioka, Japan
| | - Ren Takeda
- Department of Basic Rehabilitation, Gunma University Graduate School of Health Sciences, Maebashi, Japan
| | - Hiroki Iwamoto
- Department of Rehabilitation, Hidaka Rehabilitation Hospital, Takasaki, Japan
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218
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Silva ECGE, Schmitt ACB, Godoy CGD, Gambeta AC, Carvalho CRFD, Fu C, Tanaka C, Junior CT, Carvalho CRRD, Pompeu JE. Ambulation capacity, age, immunosuppression, and mechanical ventilation are risk factors of in-hospital death in severe COVID-19: a cohort study. Clinics (Sao Paulo) 2022; 77:100075. [PMID: 35863104 PMCID: PMC9250925 DOI: 10.1016/j.clinsp.2022.100075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/22/2022] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE Despite ambulation capacity being associated with a decreased level of physical activity and survival may be influenced by the functional capacity, studies have not addressed the association between ambulation capacity and death in patients hospitalized by COVID-19. OBJECTIVE To verify the functional, clinical, and sociodemographic risk factors associated with in-hospital death in individuals with severe COVID-19. METHODS It is a cohort retrospective study performed at a large tertiary hospital. Patients 18 years of age or more, of both sexes, hospitalized due to severe COVID-19 were included. Cases with dubious medical records and/or missing essential data were excluded. Patients were classified according to their ambulation capacity before the COVID-19 infection. Information regarding sociodemographic characteristics, in-hospital death, total hospital stays, Intensive Care Unit (ICU) stays, and the necessity of Mechanical Ventilation (MV) were collected from medical records and registered in a RedCap database. Multiple logistic regression analysis was used to identify possible factors associated with the in-hospital death rate. RESULTS Data from 1110 participants were included in the statistical analysis. The median age of the patients was 57 (46‒66) years, 58.42% (n = 590) were male, and 61.73% (n = 602) were brown or black. The case fatality rate during hospitalization was 36.0% (n = 363). In-hospital death was associated with ambulation capacity; dependent ambulators (OR = 2.3; CI 95% = 1.2-4.4) and non-functional ambulation (OR = 1.9; CI 95% = 1.1-3.3), age [older adults (OR = 3.0; CI 95% = 1.9‒4.), ICU stays (OR = 1.4; CI 95% = 1.2‒1.4), immunosuppression (OR = 5.5 CI 95% = 2.3‒13.5) and mechanical ventilation (OR = 27.5; CI 95% = 12.0-62.9). CONCLUSION AND RELEVANCE Decreased ambulation capacity, age, length of ICU stay, immunosuppression, and mechanical ventilation was associated with a high risk of in-hospital death due to COVID-19.
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Affiliation(s)
- Erika Christina Gouveia E Silva
- Department of Physical Therapy, Speech Therapy, and Occupational Therapy, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil.
| | - Ana Carolina Basso Schmitt
- Department of Physical Therapy, Speech Therapy, and Occupational Therapy, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
| | - Caroline Gil de Godoy
- Department of Physical Therapy, Speech Therapy, and Occupational Therapy, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
| | - Amislaine Cristina Gambeta
- Department of Physical Therapy, Speech Therapy, and Occupational Therapy, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
| | | | - Carolina Fu
- Department of Physical Therapy, Speech Therapy, and Occupational Therapy, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
| | - Clarice Tanaka
- Department of Physical Therapy, Speech Therapy, and Occupational Therapy, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
| | - Carlos Toufen Junior
- Divisão de Pneumologia, Instituto do Coração (InCor), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, SP, Brazil
| | | | - José Eduardo Pompeu
- Department of Physical Therapy, Speech Therapy, and Occupational Therapy, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
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219
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Almutairi SM, Khalil ME, Almutairi N, Alenazi AM. Effects of Neuromuscular Electrical Stimulation on Plantarflexors Spasticity, Gait Performance, and Self-Reported Health Outcomes in People With Chronic Stroke: A Study Protocol for a Double-Blinded Randomized Clinical Trial. Front Neurol 2021; 12:770784. [PMID: 34925217 PMCID: PMC8672659 DOI: 10.3389/fneur.2021.770784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 10/29/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Rehabilitation approaches have been used for people with stroke to decrease spasticity and improve functions, but little is known about the effect of neuromuscular electrical stimulation (NMES) in this population. Therefore, the primary purpose of this study was to establish a protocol for a double-blinded randomized clinical trial to examine using NMES on plantarflexors spasticity, dorsiflexor muscle strength, physical functions, and self-reported health outcomes in people with chronic stroke in Saudi Arabia. Material and Methods: This randomized clinical trial with two arms and double-blinded registered in ClinicalTrials (NCT04673045) will enroll 44 participants with chronic stroke and randomized them into either the experimental group (EG), including electrical stimulation (ES) with conventional therapy or the control sham group (NMESsham) including placebo electrical stimulation with conventional therapy. The frequency will be set at 80 Hz for 30 min. The intervention will be three times a week for 4 weeks for both groups. Data collection for pre- and post-intervention outcomes will include measurements for the primary outcomes including paretic limb (plantarflexor spasticity, ankle range of motion, and dorsiflexor muscles strength), and gait speed using 10-m walk test (10-MWT). The secondary outcomes including mobility function using Timed Up and Go (TUG), walking endurance using 6 Minutes Walk Test (6-MWT), activity of daily living using the Arabic version of Barthel Index (BI), and self-reported health measures such as quality of life using the Medical Outcomes Survey (Short Form 36, SF-36), physical activity using Rapid Assessment of Physical Activity (RAPA), depression symptoms using Patient Health Questionnaire-9 (PHQ-9), fatigue level using Fatigue Severity Scale (FSS), and risk of fall using Fall Efficacy Scale International (FES-I). An independent t-test will be utilized to examine the effect of the intervention on the outcome measures. Results: The recruitment has started and is ongoing. Conclusions: Using 4 weeks of NMES will provide information about its effect in improving plantarflexor spasticity, dorsiflexor muscles strength, gait speed, mobility functions, and other self-reported health outcomes in people with chronic stroke when compared to NMESsham.
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Affiliation(s)
- Sattam M Almutairi
- Department of Physical Therapy, College of Medical Rehabilitation, Qassim University, Buraydah, Saudi Arabia
| | - Mohamed E Khalil
- Department of Physical Therapy, College of Medical Rehabilitation, Qassim University, Buraydah, Saudi Arabia
| | - Nadiah Almutairi
- Medical Rehabilitation Center, King Fahad Specialist Hospital, Buraydah, Saudi Arabia
| | - Aqeel M Alenazi
- College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-kharj, Saudi Arabia
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220
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Kuo CY, Liu CW, Lai CH, Kang JH, Tseng SH, Su ECY. Prediction of robotic neurorehabilitation functional ambulatory outcome in patients with neurological disorders. J Neuroeng Rehabil 2021; 18:174. [PMID: 34922571 PMCID: PMC8684617 DOI: 10.1186/s12984-021-00965-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/02/2021] [Indexed: 01/01/2023] Open
Abstract
Introduction Conflicting results persist regarding the effectiveness of robotic-assisted gait training (RAGT) for functional gait recovery in post-stroke survivors. We used several machine learning algorithms to construct prediction models for the functional outcomes of robotic neurorehabilitation in adult patients. Methods and materials Data of 139 patients who underwent Lokomat training at Taipei Medical University Hospital were retrospectively collected. After screening for data completeness, records of 91 adult patients with acute or chronic neurological disorders were included in this study. Patient characteristics and quantitative data from Lokomat were incorporated as features to construct prediction models to explore early responses and factors associated with patient recovery. Results Experimental results using the random forest algorithm achieved the best area under the receiver operating characteristic curve of 0.9813 with data extracted from all sessions. Body weight (BW) support played a key role in influencing the progress of functional ambulation categories. The analysis identified negative correlations of BW support, guidance force, and days required to complete 12 Lokomat sessions with the occurrence of progress, while a positive correlation was observed with regard to speed. Conclusions We developed a predictive model for ambulatory outcomes based on patient characteristics and quantitative data on impairment reduction with early-stage robotic neurorehabilitation. RAGT is a customized approach for patients with different conditions to regain walking ability. To obtain a more-precise and clearer predictive model, collecting more RAGT training parameters and analyzing them for each individual disorder is a possible approach to help clinicians achieve a better understanding of the most efficient RAGT parameters for different patients. Trial registration: Retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12984-021-00965-6.
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Affiliation(s)
- Chao-Yang Kuo
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, 172-1, Sec. 2, Keelung Rd., 10675, Taipei City, Taiwan
| | - Chia-Wei Liu
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, 252 Wuxing St, Xinyi District, 11031, Taipei City, Taiwan
| | - Chien-Hung Lai
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, 252 Wuxing St, Xinyi District, 11031, Taipei City, Taiwan.,Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, 250 Wu-Hsing Street, 11031, Taipei City, Taiwan
| | - Jiunn-Horng Kang
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, 252 Wuxing St, Xinyi District, 11031, Taipei City, Taiwan.,Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, 250 Wu-Hsing Street, 11031, Taipei City, Taiwan
| | - Sung-Hui Tseng
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, 252 Wuxing St, Xinyi District, 11031, Taipei City, Taiwan. .,Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, 250 Wu-Hsing Street, 11031, Taipei City, Taiwan.
| | - Emily Chia-Yu Su
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, 172-1, Sec. 2, Keelung Rd., 10675, Taipei City, Taiwan. .,Clinical Big Data Research Center, Taipei Medical University Hospital, 252 Wuxing St, Xinyi District, 11031, Taipei City, Taiwan. .,Research Center for Artificial Intelligence in Medicine, Taipei Medical University, 250 Wu-Hsing Street, 11031, Taipei, Taiwan.
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Garcia-Rodriguez N, Rodriguez S, Tejada PI, Miranda-Artieda ZM, Ridao N, Buxó X, Pérez-Mesquida ME, Beseler MR, Salom JB, Pérez LM, Inzitari M, Otero-Villaverde S, Martin-Mourelle R, Molleda M, Quintana M, Olivé-Gadea M, Penalba A, Rosell A. Functional Recovery and Serum Angiogenin Changes According to Intensity of Rehabilitation Therapy After Stroke. Front Neurol 2021; 12:767484. [PMID: 34899582 PMCID: PMC8655101 DOI: 10.3389/fneur.2021.767484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 10/22/2021] [Indexed: 12/05/2022] Open
Abstract
Background: Rehabilitation is still the only treatment available to improve functional status after the acute phase of stroke. Most clinical guidelines highlight the need to design rehabilitation treatments considering starting time, intensity, and frequency, according to the tolerance of the patient. However, there are no homogeneous protocols and the biological effects are under investigation. Objective: To investigate the impact of rehabilitation intensity (hours) after stroke on functional improvement and serum angiogenin (ANG) in a 6-month follow-up study. Methods: A prospective, observational, longitudinal, and multicenter study with three cohorts: strokes in intensive rehabilitation therapy (IRT, minimum 15 h/week) vs. conventional therapy (NO-IRT, <15 h/week), and controls subjects (without known neurological, malignant, or inflammatory diseases). A total of seven centers participated, with functional evaluations and blood sampling during follow-up. The final cohort includes 62 strokes and 43 controls with demographic, clinical, blood samples, and exhaustive functional monitoring. Results: The median (IQR) number of weekly hours of therapy was different: IRT 15 (15–16) vs. NO-IRT 7.5 (5–9), p < 0.01, with progressive and significant improvements in both groups. However, IRT patients showed earlier improvements (within 1 month) on several scales (CAHAI, FMA, and FAC; p < 0.001) and the earliest community ambulation achievements (0.89 m/s at 3 months). There was a significant difference in ANG temporal profile between the IRT and NO-IRT groups (p < 0.01). Additionally, ANG was elevated at 1 month only in the IRT group (p < 0.05) whereas it decreased in the NO-IRT group (p < 0.05). Conclusions: Our results suggest an association of rehabilitation intensity with early functional improvements, and connect the rehabilitation process with blood biomarkers.
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Affiliation(s)
- Nicolás Garcia-Rodriguez
- Neurovascular Research Laboratory, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain.,Unidad de Rehabilitación Neurológica y Daño Cerebral, Hospital Vall d'Hebron, Barcelona, Spain
| | - Susana Rodriguez
- Unidad de Rehabilitación Neurológica y Daño Cerebral, Hospital Vall d'Hebron, Barcelona, Spain
| | | | | | - Natalia Ridao
- Servei de Medicina Física i Rehabilitació, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Sabadell, Spain
| | - Xavi Buxó
- Unidad de Rehabilitación Neurológica y Daño Cerebral, Hospital Vall d'Hebron, Barcelona, Spain
| | | | - Maria Rosario Beseler
- Servicio de Medicina Física y Rehabilitación, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Juan B Salom
- Unidad Mixta de Investigación Cerebrovascular, Instituto de Investigación Sanitaria La Fe-Universitat de Valencia, Valencia, Spain.,Departamento de Fisiología, Universidad de Valencia, Valencia, Spain
| | - Laura M Pérez
- RE-FiT Barcelona Research Group, Vall d'Hebron Institute of Research, Parc Sanitari Pere Virgili, Barcelona, Spain.,Parc Sanitari Pere Virgili, Area of Intermediate Care, Barcelona, Spain
| | - Marco Inzitari
- RE-FiT Barcelona Research Group, Vall d'Hebron Institute of Research, Parc Sanitari Pere Virgili, Barcelona, Spain.,Universitat Oberta de Catalunya, Barcelona, Spain
| | | | | | | | - Manuel Quintana
- Epilepsy Research Group and Epilepsy Unit, Vall d'Hebron Research Institute and Vall d'Hebron Hospital, Barcelona, Spain
| | | | - Anna Penalba
- Neurovascular Research Laboratory, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anna Rosell
- Neurovascular Research Laboratory, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
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Stage 2: Who Are the Best Candidates for Robotic Gait Training Rehabilitation in Hemiparetic Stroke? J Clin Med 2021; 10:jcm10235715. [PMID: 34884417 PMCID: PMC8658177 DOI: 10.3390/jcm10235715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/30/2021] [Accepted: 12/03/2021] [Indexed: 11/17/2022] Open
Abstract
We aimed to compare the effects of robotic-assisted gait training (RAGT) in patients with FAC < 2 (low initial functional ambulation category [LFAC]) and FAC ≥ 2 (high initial functional ambulation category [HFAC]) on sensorimotor and spasticity, balance and trunk stability, the number of steps and walking distance in subacute hemiparetic stroke. Fifty-seven patients with subacute hemiparetic stroke (mean age, 63.86 ± 12.72 years; 23 women) were assigned to two groups. All patients received a 30-min Walkbot-assisted gait training session, 3 times/week, for 6 weeks. Clinical outcomes included scores obtained on the Fugl-Meyer Assessment (FMA) scale, Modified Ashworth Scale (MAS), Berg Balance Scale (BBS), trunk impairment scale (TIS), and the number of walking steps and walking distance. Analysis of covariance and analysis of variance were conducted at p < 0.05. Significant main effects of time in both groups on number of walking steps and distance (p < 0.05) were observed, but not in MAS (p> 0.05). Significant changes in FMA, BBS, and TIS scores between groups (p < 0.05) were observed. Significant main effects of time on BBS and TIS were demonstrated (p < 0.05). Our study shows that RAGT can maximize improvement in the functional score of FMA, BBS, TIS, steps, and distance during neurorehabilitation of subacute stroke patients regardless of their FAC level.
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223
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Hakakzadeh A, Shariat A, Honarpishe R, Moradi V, Ghannadi S, Sangelaji B, Ansari NN, Hasson S, Ingle L. Concurrent impact of bilateral multiple joint functional electrical stimulation and treadmill walking on gait and spasticity in post-stroke survivors: a pilot study. Physiother Theory Pract 2021; 37:1368-1376. [PMID: 31663796 DOI: 10.1080/09593985.2019.1685035] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 10/09/2019] [Accepted: 10/14/2019] [Indexed: 02/08/2023]
Abstract
Background: Stroke causes multi-joint gait deficits, so a major objective of post-stroke rehabilitation is to regain normal gait function. Design and Setting: A case series completed at a neuroscience institute. Aim: The aim of the study was to determine the concurrent impact of functional electrical stimulation (FES) during treadmill walking on gait speed, knee extensors spasticity and ankle plantar flexors spasticity in post-stroke survivors. Participants: Six post-stroke survivors with altered gait patterns and ankle plantar flexors spasticity (4 = male; age 56.8 ± 4.8 years; Body Mass Index (BMI) 26.2 ± 4.3; since onset of stroke: 30.8 ± 10.4 months; side of hemiplegia [L/R]: 3:3) were recruited. Intervention: Nine treatment sessions using FES bilaterally while walking on a treadmill. Main Outcome Measures: Primary outcome measures included the Modified Modified Ashworth Scale (MMAS), Timed Up and Go test (TUG), 10-m walking test, gait speed, and Functional ambulation category (FAC). Secondary outcome measures included the Step Length Test (SLT), and active range of motion (ROM) of the affected ankle and the knee. Measurements were taken at baseline (T0), at the end of last treatment (T1), and 1 month after the final treatment session (T2). Results: The TUG, 10-m walking test, gait speed, FAC, active ROM, and SLT all significantly improved following treatment (P< .05), while ankle plantar flexors spasticity (P = .135), and knee extensors spasticity (P = .368) did not show any significant decrease. Conclusions: A short duration of bilateral FES in conjugation with treadmill walking contributed to significant improvement in gait speed, functional mobility, functional ambulation, range of motion and step length in post-stroke survivors. In contrast, no significant decreases were identified in the spasticity of the ankle plantar flexors and knee extensors muscles.
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Affiliation(s)
- Azadeh Hakakzadeh
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ardalan Shariat
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Roshanak Honarpishe
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Vahideh Moradi
- Department of Orthotics and Prosthetics, Faculty of Rehabilitation, Iran University of Medical Sciences, Tehran, Iran
| | - Shima Ghannadi
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahram Sangelaji
- Department of Physiotherapy, School of Physiotherapy, Otago University, Dunedin, New Zealand
| | - Noureddin Nakhostin Ansari
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Scott Hasson
- Department of Physical Therapy, Augusta University, Augusta, GA, USA
| | - Lee Ingle
- Department of Sport, Health Exercise Science, University of Hull, Kingston-upon-Hull, UK
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Longatelli V, Pedrocchi A, Guanziroli E, Molteni F, Gandolla M. Robotic Exoskeleton Gait Training in Stroke: An Electromyography-Based Evaluation. Front Neurorobot 2021; 15:733738. [PMID: 34899227 PMCID: PMC8663633 DOI: 10.3389/fnbot.2021.733738] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/08/2021] [Indexed: 11/20/2022] Open
Abstract
The recovery of symmetric and efficient walking is one of the key goals of a rehabilitation program in patients with stroke. The use of overground exoskeletons alongside conventional gait training might help foster rhythmic muscle activation in the gait cycle toward a more efficient gait. About twenty-nine patients with subacute stroke have been recruited and underwent either conventional gait training or experimental training, including overground gait training using a wearable powered exoskeleton alongside conventional therapy. Before and after the rehabilitation treatment, we assessed: (i) gait functionality by means of clinical scales combined to obtain a Capacity Score, and (ii) gait neuromuscular lower limbs pattern using superficial EMG signals. Both groups improved their ability to walk in terms of functional gait, as detected by the Capacity Score. However, only the group treated with the robotic exoskeleton regained a controlled rhythmic neuromuscular pattern in the proximal lower limb muscles, as observed by the muscular activation analysis. Coherence analysis suggested that the control group (CG) improvement was mediated mainly by spinal cord control, while experimental group improvements were mediated by cortical-driven control. In subacute stroke patients, we hypothesize that exoskeleton multijoint powered fine control overground gait training, alongside conventional care, may lead to a more fine-tuned and efficient gait pattern.
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Affiliation(s)
- Valeria Longatelli
- NearLab, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Alessandra Pedrocchi
- NearLab, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | | | - Franco Molteni
- Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Italy
| | - Marta Gandolla
- Department of Mechanical Engineering, Politecnico di Milano, Milan, Italy
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225
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Spina S, Facciorusso S, Botticelli C, Intiso D, Ranieri M, Colamaria A, Fiore P, Ciritella C, Genêt F, Santamato A. Ultrasonographic Evaluation of Three Approaches for Botulinum Toxin Injection into Tibialis Posterior Muscle in Chronic Stroke Patients with Equinovarus Foot: An Observational Study. Toxins (Basel) 2021; 13:829. [PMID: 34822612 PMCID: PMC8622442 DOI: 10.3390/toxins13110829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/11/2021] [Accepted: 11/19/2021] [Indexed: 02/04/2023] Open
Abstract
Spastic equinovarus (SEV) foot deformity is commonly observed in patients with post-stroke spasticity. Tibialis posterior (TP) is a common target for botulinum toxin type-A (BoNT-A) injection, as a first-line treatment in non-fixed SEV deformity. For this deep muscle, ultrasonographic guidance is crucial to achieving maximum accuracy for the BoNT-A injection. In current clinical practice, there are three approaches to target the TP: an anterior, a posteromedial, and a posterior. To date, previous studies have failed to identify the best approach for needle insertion into TP. To explore the ultrasonographic characteristics of these approaches, we investigated affected and unaffected legs of 25 stroke patients with SEV treated with BoNT-A. We evaluated the qualitative (echo intensity) and quantitative (muscle depth, muscle thickness, overlying muscle, subcutaneous tissue, cross-sectional area) ultrasound characteristics of the three approaches for TP injection. In our sample, we observed significant differences among almost all the parameters of the three approaches, except for the safety window. Moreover, our analysis showed significant differences in cross-sectional area between treated and untreated. Advantages and disadvantages of each approach were investigated. Our findings can thus provide a suitable reference for clinical settings, especially for novice operators.
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Affiliation(s)
- Stefania Spina
- Spasticity and Movement Disorders “ReSTaRt” Unit, Physical Medicine and Rehabilitation Section, Policlinico Riuniti Hospital, University of Foggia, 71122 Foggia, Italy; (C.B.); (C.C.)
| | - Salvatore Facciorusso
- Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, 23845 Lecco, Italy;
| | - Chiara Botticelli
- Spasticity and Movement Disorders “ReSTaRt” Unit, Physical Medicine and Rehabilitation Section, Policlinico Riuniti Hospital, University of Foggia, 71122 Foggia, Italy; (C.B.); (C.C.)
| | - Domenico Intiso
- Unit of Neuro-Rehabilitation, and Rehabilitation Medicine, IRCCS “Casa Sollievo della Sofferenza”, San Giovanni Rotondo, 71013 Foggia, Italy;
| | - Maurizio Ranieri
- Department of Basic Sciences, Neuroscience and Sense Organs, Aldo Moro University, 70124 Bari, Italy;
| | - Antonio Colamaria
- Department of Neurosurgery, University of Foggia, 71122 Foggia, Italy;
| | - Pietro Fiore
- Neurorehabilitation Unit, IRCCS Maugeri, 70124 Bari, Italy;
| | - Chiara Ciritella
- Spasticity and Movement Disorders “ReSTaRt” Unit, Physical Medicine and Rehabilitation Section, Policlinico Riuniti Hospital, University of Foggia, 71122 Foggia, Italy; (C.B.); (C.C.)
| | - François Genêt
- UPOH (Unité Péri Opératoire du Handicap, Perioperative Disability Unit), Physical Medicine and Rehabilitathion Department, Raymond-Poincaré Hospital, GHU APHP-Université PARIS SACLAY, 92380 Garches, France;
| | - Andrea Santamato
- Spasticity and Movement Disorders “ReSTaRt” Unit, Physical Medicine and Rehabilitation Section, Policlinico Riuniti Hospital, University of Foggia, 71122 Foggia, Italy; (C.B.); (C.C.)
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226
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Analysis of Gait Characteristics Using Hip-Knee Cyclograms in Patients with Hemiplegic Stroke. SENSORS 2021; 21:s21227685. [PMID: 34833761 PMCID: PMC8621813 DOI: 10.3390/s21227685] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/13/2021] [Accepted: 11/17/2021] [Indexed: 02/02/2023]
Abstract
Gait disturbance is a common sequela of stroke. Conventional gait analysis has limitations in simultaneously assessing multiple joints. Therefore, we investigated the gait characteristics in stroke patients using hip-knee cyclograms, which have the advantage of simultaneously visualizing the gait kinematics of multiple joints. Stroke patients (n = 47) were categorized into two groups according to stroke severity, and healthy controls (n = 32) were recruited. An inertial measurement unit sensor-based gait analysis system, which requires placing seven sensors on the dorsum of both feet, the shafts of both tibias, the middle of both femurs, and the lower abdomen, was used for the gait analysis. Then, the hip-knee cyclogram parameters (range of motion, perimeter, and area) were obtained from the collected data. The coefficient of variance of the cyclogram parameters was obtained to evaluate gait variability. The cyclogram parameters differed between the stroke patients and healthy controls, and differences according to stroke severity were also observed. The gait variability parameters mainly differed in patients with more severe stroke, and specific visualized gait patterns of stroke patients were obtained through cyclograms. In conclusion, the hip-knee cyclograms, which show inter-joint coordination and visualized gait cycle in stroke patients, are clinically significant.
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227
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Luque-Moreno C, Kiper P, Solís-Marcos I, Agostini M, Polli A, Turolla A, Oliva-Pascual-Vaca A. Virtual Reality and Physiotherapy in Post-Stroke Functional Re-Education of the Lower Extremity: A Controlled Clinical Trial on a New Approach. J Pers Med 2021; 11:1210. [PMID: 34834562 PMCID: PMC8622451 DOI: 10.3390/jpm11111210] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/13/2021] [Accepted: 11/15/2021] [Indexed: 01/10/2023] Open
Abstract
Numerous Virtual Reality (VR) systems address post-stroke functional recovery of the lower extremity (LE), most of them with low early applicability due to the gait autonomy they require. The aim of the present study was to evaluate the feasibility of a specific VR treatment and its clinical effect on LE functionality, gait, balance, and trunk control post-stroke. A controlled, prospective, clinical trial was carried out with 20 stroke patients, who were divided into two groups: the first group (VR + CP; n = 10) received combined therapy of 1 h VR and 1 h of conventional physiotherapy (CP) and the second group (CP; n = 10) received 2 h of CP (5 days/week, for 3 weeks). The following pre-post-intervention measuring scales were used: Functional Ambulatory Scale (FAC), Functional Independence Measure (FIM), Fugl-Meyer Assessment (FM), Berg Balance Scale (BBS), and Trunk Control Test (TCT). Only VR + CP showed a significant improvement in FAC. In FIM, CP presented a tendency to significance, whereas VR + CP showed significance. Both groups improved significantly in FM (especially in amplitude/pain in VR + CP and in sensitivity in CP) and in BBS. In TCT, there was a non-significant improvement in both groups. The results indicate that the intervention with VR is a feasible treatment in the post-stroke functional re-education of the LE, with the potential to be an optimal complement of CP.
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Affiliation(s)
- Carlos Luque-Moreno
- Department of Physiotherapy, University of Seville, 41009 Seville, Spain;
- Laboratory of Neurorehabilitation Technologies, San Camillo IRCCS, 30126 Venezia, Italy;
| | - Pawel Kiper
- Physical Medicine and Rehabilitation Unit, Azienda ULSS 3 Serenissima, 30126 Venice, Italy;
| | - Ignacio Solís-Marcos
- Unit of Humans in the Transport System, Swedish National Road and Transport Research Institute (VTI), Linköping University, 58330 Linköping, Sweden;
| | - Michela Agostini
- Department of Neuroscience, Section of Rehabilitation, University-General Hospital of Padova, 35128 Padova, Italy;
| | - Andrea Polli
- Pain in Motion International Research Group, Department of Physiotherapy, Vrije University Brussel, 1050 Brussel, Belgium;
| | - Andrea Turolla
- Laboratory of Neurorehabilitation Technologies, San Camillo IRCCS, 30126 Venezia, Italy;
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228
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Xie YJ, Wei QC, Chen Y, Liao LY, Li BJ, Tan HX, Jiang HH, Guo QF, Gao Q. Cerebellar Theta Burst Stimulation on Walking Function in Stroke Patients: A Randomized Clinical Trial. Front Neurosci 2021; 15:688569. [PMID: 34764848 PMCID: PMC8576464 DOI: 10.3389/fnins.2021.688569] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 10/05/2021] [Indexed: 02/05/2023] Open
Abstract
Objectives: The objective of this study was to explore the efficacy of cerebellar intermittent theta burst stimulation (iTBS) on the walking function of stroke patients. Methods: Stroke patients with walking dysfunction aged 25–80 years who had suffered their first unilateral stroke were included. A total of 36 patients [mean (SD) age, 53 (7.93) years; 10 women (28%)] were enrolled in the study. All participants received the same conventional physical therapy, including transfer, balance, and ambulation training, during admission for 50 min per day during 2 weeks (10 sessions). Every session was preceded by 3 min procedure of cerebellar iTBS applyed over the contralesional cerebellum in the intervention group or by a similar sham iTBS in control group. The groups were formed randomly and the baseline characteristics showed no significant difference. The primary outcome measure was Fugl–Meyer Assessment–Lower Extremity scores. Secondary outcomes included walking performance and corticospinal excitability. Measures were performed before the intervention beginning (T0), after the first (T1) and the second (T2) weeks. Results: The Fugl–Meyer Assessment for lower extremity scores slightly improved with time in both groups with no significant difference between the groups and over the time. The walking performance significantly improved with time and between group. Two-way mixed measures ANOVA showed that there was significant interaction between time and group in comfortable walking time (F2,68 = 6.5242, P = 0.0080, η2partial = 0.276, ε = 0.641), between-group comparisons revealed significant differences at T1 (P = 0.0072) and T2 (P = 0.0133). The statistical analysis of maximum walking time showed that there was significant interaction between time and groups (F2,68 = 5.4354, P = 0.0115, η2partial = 0.198, ε = 0.734). Compared with T0, the differences of maximum walking time between the two groups at T1 (P = 0.0227) and T2 (P = 0.0127) were statistically significant. However, both the Timed up and go test and functional ambulation category scale did not yield significant differences between groups (P > 0.05). Conclusion: Our results revealed that applying iTBS over the contralesional cerebellum paired with physical therapy could improve walking performance in patients after stroke, implying that cerebellar iTBS intervention may be a noninvasive strategy to promote walking function in these patients. This study was registered at ChiCTR, number ChiCTR1900026450.
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Affiliation(s)
- Yun-Juan Xie
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China.,Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Qing-Chuan Wei
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Chen
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Ling-Yi Liao
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China.,Daping Hospital, Third Military Medical University, Chongqing, China
| | - Bao-Jin Li
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Hui-Xin Tan
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Han-Hong Jiang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Qi-Fan Guo
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Qiang Gao
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
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Classification of Limb and Mobility Impairments in Persons With Stroke Using the STREAM. J Neurol Phys Ther 2021; 46:96-102. [PMID: 34775436 DOI: 10.1097/npt.0000000000000384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Classification of functional impairment in persons with stroke can influence treatment planning but this information is missing in the Stroke Rehabilitation Assessment of Movement (STREAM) Scale. This study aimed to establish the classification of limb mobility impairments and item difficulty of the STREAM. METHODS Rasch analysis was conducted on the STREAM scores to examine the person and item reliability, the item difficulty, and level of impairments. A total of 240 participants were evaluated using the STREAM, the Fugl-Meyer Stroke Assessment (FM), and the Functional Ambulation Categories (FAC). The concurrent validity of the STREAM extremity (STREAM-E) category with the FM-motor category and the STREAM mobility (STREAM-M) category with the FAC category was analyzed using the Spearman rank-order correlation. RESULTS Person reliabilities of the STREAM-E and STREAM-M were 0.92 and 0.80, respectively. High-item reliability was observed in both STREAM-E (0.97) and STREAM-M (0.99). The STREAM items "flexes hip and knee in supine" and "rolls onto side" were the easiest items, whereas the "dorsiflexes affected ankle with knee extended" item was the most difficult item. The STREAM-E category demonstrated excellent concurrent validity with the FM-motor category (ρ = 0.83) in classifying individuals with stroke into 5 groups: mild, moderate, moderately severe, severe, and very severe limb impairment. The STREAM-M category showed a moderate correlation with the FAC category (ρ = 0.71) in categorizing persons with stroke into 3 groups: mild, moderate, and severe mobility impairment. DISCUSSION AND CONCLUSIONS Findings can be used in the assessment and treatment planning of persons with stroke.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A373).
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Larsson AC, Palstam A, Persson HC. Physical Function, Cognitive Function, and Daily Activities in Patients Hospitalized Due to COVID-19: A Descriptive Cross-Sectional Study in Sweden. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111600. [PMID: 34770113 PMCID: PMC8582899 DOI: 10.3390/ijerph182111600] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 10/28/2021] [Accepted: 11/03/2021] [Indexed: 12/17/2022]
Abstract
An estimated 14–20% of people infected with COVID-19 require medical care. The aim of the present study was to evaluate physical function, cognitive function, and daily activities in patients hospitalized due to COVID-19, and to investigate differences depending on age and admission to the intensive care unit (ICU). This prospective descriptive cross-sectional study included a consecutive sample of 211 patients (mean age 65.1 years, 67.3% men) hospitalized due to COVID-19 in Sweden. Data regarding physical function and daily activities were collected in hospital from July 2020 to February 2021. The average length of hospital stay was 33.8 days, and 48.8% of the patients were admitted to the ICU. Physical function (grip- and lower body strength) was reduced in both groups, and significantly more in the older group, ≥65 years old, compared to the younger. Furthermore, the older group also had significantly less ability to perform activities in daily life, and had significantly reduced cognitive function as compared to the younger age group. In patients treated in the ICU, physical impairments as well as the activity level were significantly more pronounced compared to patients not treated in the ICU. Patients hospitalized due to COVID-19 are physically impaired, have mild cognitive impairments, and have difficulties performing daily activities. The findings in this study indicate the need for out-patient follow-up and rehabilitation for patients hospitalized due to COVID-19, especially in older patients and patients treated in the ICU.
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Affiliation(s)
- Alexandra C. Larsson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 41345 Gothenburg, Sweden; (A.P.); (H.C.P.)
- Department of Occupational Therapy and Physical Therapy, Sahlgrenska University Hospital, 41346 Gothenburg, Sweden
- Correspondence:
| | - Annie Palstam
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 41345 Gothenburg, Sweden; (A.P.); (H.C.P.)
- Department of Neuro Science, Sahlgrenska University Hospital, 41346 Gothenburg, Sweden
| | - Hanna C. Persson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 41345 Gothenburg, Sweden; (A.P.); (H.C.P.)
- Department of Occupational Therapy and Physical Therapy, Sahlgrenska University Hospital, 41346 Gothenburg, Sweden
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Lamberti N, Manfredini F, Lissom LO, Lavezzi S, Basaglia N, Straudi S. Beneficial Effects of Robot-Assisted Gait Training on Functional Recovery in Women after Stroke: A Cohort Study. Medicina (B Aires) 2021; 57:medicina57111200. [PMID: 34833418 PMCID: PMC8618864 DOI: 10.3390/medicina57111200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/27/2021] [Accepted: 11/02/2021] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: Robot-assisted gait training (RAGT) could be a rehabilitation option for patients after experiencing a stroke. This study aims to determine the sex-related response to robot-assisted gait training in a cohort of subacute stroke patients considering mixed results previously reported. Materials and Methods: In this study, 236 participants (145 males, 91 females) were admitted to a rehabilitation facility after experiencing a stroke and performed RAGT within a multidisciplinary rehabilitation program. Functional Independence Measure (FIM) and Functional Ambulatory Category (FAC) were assessed at admission and discharge to determine sex-related outcomes. Results: At the baseline, no significant difference among sexes was observed. At the end of rehabilitation, both males and females exhibited significant improvements in FIM (71% of males and 80% of females reaching the MCID cut-off value) and FAC (∆score: men 1.9 ± 1.0; women 2.1 ± 1.1). A more remarkable improvement was observed in women of the whole population during the study, but statistical significance was not reached. When analysing the FAC variations with respect to the total number of RAGT sessions, a more significant improvement was observed in women than men (p = 0.025). Conclusion: In conclusion, among subacute stroke patients, benefits were observed following RAGT during a multidisciplinary rehabilitation program in both sexes. A greater significant recovery for women with an ischemic stroke or concerning the number of sessions attended was also highlighted. The use of gait robotics for female patients may favour a selective functional recovery after stroke.
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Affiliation(s)
- Nicola Lamberti
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (F.M.); (N.B.); (S.S.)
- Correspondence: ; Tel.: +39-05-3223-6187
| | - Fabio Manfredini
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (F.M.); (N.B.); (S.S.)
- Unit of Rehabilitation Medicine, University Hospital of Ferrara, 44124 Ferrara, Italy;
| | - Luc Oscar Lissom
- Doctoral Program in Translational Neurosciences and Neurotechnologies, University of Ferrara, 44121 Ferrara, Italy;
| | - Susanna Lavezzi
- Unit of Rehabilitation Medicine, University Hospital of Ferrara, 44124 Ferrara, Italy;
| | - Nino Basaglia
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (F.M.); (N.B.); (S.S.)
| | - Sofia Straudi
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (F.M.); (N.B.); (S.S.)
- Unit of Rehabilitation Medicine, University Hospital of Ferrara, 44124 Ferrara, Italy;
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232
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Simonetti D, Koopman BFJM, Sartori M. Clusterization of multi-channel electromyograms into muscle-specific activations to drive a subject-specific musculoskeletal model: towards fast and accurate clinical decision-making. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:5979-5982. [PMID: 34892480 DOI: 10.1109/embc46164.2021.9631016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Current clinical decision-making is based on rapid and subjective functional tests such as 10 m walking. Moreover, greater accuracy can be achieved at the expense of rapidity and costs. In biomechanical laboratories, advanced technologies and musculoskeletal modeling can quantitatively describe the biomechanical reasons underlying gait disorders. Our work aims to blend clinical rapidity and biomechanical accuracy through multi-channel (MC) electromyography (EMG) clustering and real-time neuro-musculoskeletal (NMS) modeling techniques integrated into a sensorized wearable garment that is quick to set up. Here we present a unique pipeline that goes from MC EMG signals to ankle torque estimation following two steps: (1) non-negative matrix factorization (NNMF)-based EMG clustering for the extraction of muscle-specific activations and (2) subject-specific EMG-driven NMS modeling. The results show the potential of NNMF as an electrode clustering tool, as well as the ability to predict joint torque during movements that were not used for the EMG clustering.
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Utility of the ability for basic movement scale II as a prediction method of ambulation ability in patients after the hip fracture surgery. J Orthop Sci 2021; 26:1025-1028. [PMID: 33288394 DOI: 10.1016/j.jos.2020.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 09/17/2020] [Accepted: 09/18/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND This study was to investigate whether the Ability for Basic Movement Scale II (ABMS II) at admission of the convalescent rehabilitation ward (CRW) could predict the ambulation ability in patients after hip fracture surgery. METHODS The data of the ABMS II and Functional Ambulation Category (FAC) of 118 postsurgical patients with hip fracture who were transferred to the CRW were retrospectively analyzed (mean age 82.7 ± 7.9, female/male: 89/29). Binary logistic regression analysis and receiver operating characteristic (ROC) analysis were used to investigate the predictive value of ABMS II for walking ability at discharge. RESULTS Spearman's correlation analysis showed that there were significantly positive correlations between the ABMS II score at admission and FAC score at discharge (ρ = 0.70, P < 0.05). Logistic regression analysis showed that ABMS II and BMI can be the predictor in both FAC <4 or ≥4 groups. ROC analysis indicated that an optimal cutoff of 24.5 points of ABMS II score predicted independent walking ability (area under the Curve (AUC) 0.87, P < 0.05). CONCLUSIONS The ABMS II at admission in CRW can be a prediction method of ambulation recovery for the patients after hip fracture surgery. STUDY DESIGN Retrospective clinical study.
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234
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Jorge FF, Finkelsztejn A, Rodrigues LP. Motor symptoms and the quality of life of relapsing-remitting multiple sclerosis patients in a specialized center in South of Brazil. ARQUIVOS DE NEURO-PSIQUIATRIA 2021; 79:895-899. [PMID: 34706019 DOI: 10.1590/0004-282x-anp-2020-0315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 11/02/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Spasticity, fatigue, muscle weakness and changes in gait are some of the main motor symptoms of Multiple Sclerosis (MS). These changes can interfere with the patients' quality of life. OBJECTIVE To characterize the motor and quality of life symptoms in patients with relapsing-remitting Multiple Sclerosis at a specialized center. METHODS Fifty five patients at the Neuroimmunology Outpatient Clinic of the Hospital de Clínicas de Porto Alegre were evaluated for fatigue (Fatigue Severity Scale - FSS), walking ability (Functional Ambulation Categories - FAC), impact of MS on walking (Multiple Sclerosis Walking Scale-12 - MSWS-12), walking speed (10-Meter Walk Test - 10MWT and the Times 25-foot Walk test - T25FW), functional independence (Barthel Index - BI), functional mobility (Timed Up and Go - TUG), and quality of life (Multiple Sclerosis Impact Scale - MSIS-29). RESULTS The patients were mostly women (69.1%), with average age of 43.3 (±12.1) years old, with time since diagnosis of 8.2 (±5.3) years, and EDSS average of 4.3 (±1.3). On the BI, the mean was 96.6 (±5.7) points and 80% of the patients had FAC 5. At MSIS-29, patients had a higher average score on the psychological scale (19.5±26.7) than on the physical scale (10.2±23.6). Most patients (69.1%) presented fatigue. CONCLUSION The patients had preserved functional independence and functional walking ability and presence of fatigue. There was minimal impact of MS on patients' quality of life.
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Lee JT, Park E, Jung TD. Machine Learning-Based Classification of Dependence in Ambulation in Stroke Patients Using Smartphone Video Data. J Pers Med 2021; 11:jpm11111080. [PMID: 34834432 PMCID: PMC8623599 DOI: 10.3390/jpm11111080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 01/12/2023] Open
Abstract
The goal of this study was to develop a framework to classify dependence in ambulation by employing a deep model in a 3D convolutional neural network (3D-CNN) using video data recorded by a smartphone during inpatient rehabilitation therapy in stroke patients. Among 2311 video clips, 1218 walk action cases were collected from 206 stroke patients receiving inpatient rehabilitation therapy (63.24 ± 14.36 years old). As ground truth, the dependence in ambulation was assessed and labeled using the functional ambulatory categories (FACs) and Berg balance scale (BBS). The dependent ambulation was defined as a FAC score less than 4 or a BBS score less than 45. We extracted patient-centered video and patient-centered pose of the target from the tracked target’s posture keypoint location information. Then, the extracted patient-centered video was input in the 3D-CNN, and the extracted patient-centered pose was used to measure swing time asymmetry. Finally, we evaluated the classification of dependence in ambulation using video data via fivefold cross-validation. When training the 3D-CNN based on FACs and BBS, the model performed with 86.3% accuracy, 87.4% precision, 94.0% recall, and 90.5% F1 score. When the 3D-CNN based on FACs and BBS was combined with swing time asymmetry, the model exhibited improved performance (88.7% accuracy, 89.1% precision, 95.7% recall, and 92.2% F1 score). The proposed framework for dependence in ambulation can be useful, as it alerts clinicians or caregivers when stroke patients with dependent ambulatory move alone without assistance. In addition, monitoring dependence in ambulation can facilitate the design of individualized rehabilitation strategies for stroke patients with impaired mobility and balance function.
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Affiliation(s)
- Jong Taek Lee
- Artificial Intelligence Application Research Section, Electronics and Telecommunications Research Institute (ETRI), Daegu 42994, Korea;
| | - Eunhee Park
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea;
- Department of Rehabilitation Medicine, Kyungpook National University Chilgok Hospital, Daegu 41404, Korea
| | - Tae-Du Jung
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea;
- Department of Rehabilitation Medicine, Kyungpook National University Chilgok Hospital, Daegu 41404, Korea
- Correspondence: ; Tel.: +82-53-200-2167
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Simondson J, Simondson D, Formby C, Brock K. The Ankle Lunge Test for measurement of dorsiflexion in individuals following stroke; reliability, validity and evaluation of change following intervention for spasticity of the lower limb. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2021; 27:e1925. [PMID: 34644454 DOI: 10.1002/pri.1925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 09/14/2021] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The Ankle Lunge Test (ALT) is a reliable method of measuring weight bearing ankle dorsiflexion range, a key component of gait, in healthy ankles and a range of musculoskeletal conditions. The aim of this study is to evaluate the reliability and concurrent validity of the ALT in people with stroke and investigate whether change in ALT is observed following treatment of spasticity with Botulinum Toxin. METHODOLOGY Repeated Measure Design: Forty stroke survivors were recruited for reliability testing. Twenty three stroke survivors were evaluated with the ALT before and after treatment of the lower limb with Botulinum Toxin. Measurement with the ALT was performed for all participants. For the reliability group, two physiotherapists evaluated the ALT on Day 1 and one therapist re-evaluated the ALT one to 5 days later. For the change evaluation group, the ALT was tested prior to and six to eight weeks after intervention. Other measures evaluated were velocity, the Functional Ambulation Category, Timed Up and Go and the Modified Tardieu Scale. RESULTS Intra-rater, inter-rater and test-retest reliability yielded intra-class correlation coefficients at or above 0.92. Moderate correlations were found between the ALT and velocity r = 0.605 (p < 0.01), the Timed Up and Go r = -0.598 (p < 0.01) and the Functional Ambulation Category r = 0.380 (p < 0.05). Following intervention with Botulinum Toxin, there was significant (p < 0.02) improvement in the ALT; pre-median 20 mm (IQR -25 to 35) to post-median 21 mm (IQR 0 to 40) and the Timed Up and Go; pre-median 21.40 s (IQR 13.43 to 28.82) to post-median 20.08 s (IQR 14.06 to 28.47). CONCLUSION/SIGNIFICANCE The ALT is a reliable and valid measure which may be applied in clinical practice to evaluate change in weight bearing ankle dorsiflexion in people with stroke.
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Affiliation(s)
- Janine Simondson
- Physiotherapy Department, Health Independence Program & Rehabilitation Unit, St Vincent's Hospital Melbourne, St George's Health Service, Kew, Victoria, Australia
| | - David Simondson
- Physiotherapy Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Claire Formby
- Health Independence Program, St Vincent's Hospital Melbourne, St George's Health Service, Kew, Victoria, Australia
| | - Kim Brock
- Physiotherapy Department, Health Independence Program & Rehabilitation Unit, St Vincent's Hospital Melbourne, St George's Health Service, Kew, Victoria, Australia
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Louie DR, Mortenson WB, Durocher M, Schneeberg A, Teasell R, Yao J, Eng JJ. Efficacy of an exoskeleton-based physical therapy program for non-ambulatory patients during subacute stroke rehabilitation: a randomized controlled trial. J Neuroeng Rehabil 2021; 18:149. [PMID: 34629104 PMCID: PMC8502504 DOI: 10.1186/s12984-021-00942-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/27/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Individuals requiring greater physical assistance to practice walking complete fewer steps in physical therapy during subacute stroke rehabilitation. Powered exoskeletons have been developed to allow repetitious overground gait training for individuals with lower limb weakness. The objective of this study was to determine the efficacy of exoskeleton-based physical therapy training during subacute rehabilitation for walking recovery in non-ambulatory patients with stroke. METHODS An assessor-blinded randomized controlled trial was conducted at 3 inpatient rehabilitation hospitals. Patients with subacute stroke (< 3 months) who were unable to walk without substantial assistance (Functional Ambulation Category rating of 0 or 1) were randomly assigned to receive exoskeleton-based or standard physical therapy during rehabilitation, until discharge or a maximum of 8 weeks. The experimental protocol replaced 75% of standard physical therapy sessions with individualized exoskeleton-based sessions to increase standing and stepping repetition, with the possibility of weaning off the device. The primary outcome was walking ability, measured using the Functional Ambulation Category. Secondary outcomes were gait speed, distance walked on the 6-Minute Walk Test, days to achieve unassisted gait, lower extremity motor function (Fugl-Meyer Assessment), Berg Balance Scale, Patient Health Questionnaire, Montreal Cognitive Assessment, and 36-Item Short Form Survey, measured post-intervention and after 6 months. RESULTS Thirty-six patients with stroke (mean 39 days post-stroke) were randomized (Exoskeleton = 19, Usual Care = 17). On intention-to-treat analysis, no significant between-group differences were found in the primary or secondary outcomes at post-intervention or after 6 months. Five participants randomized to the Exoskeleton group did not receive the protocol as planned and thus exploratory as-treated and per-protocol analyses were undertaken. The as-treated analysis found that those adhering to exoskeleton-based physical therapy regained independent walking earlier (p = 0.03) and had greater gait speed (p = 0.04) and 6MWT (p = 0.03) at 6 months; however, these differences were not significant in the per-protocol analysis. No serious adverse events were reported. CONCLUSIONS This study found that exoskeleton-based physical therapy does not result in greater improvements in walking independence than standard care but can be safely administered at no detriment to patient outcomes. Clinical Trial Registration The Exoskeleton for post-Stroke Recovery of Ambulation (ExStRA) trial was registered at ClinicalTrials.gov (NCT02995265, first registered: December 16, 2016).
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Affiliation(s)
- Dennis R Louie
- Department of Physical Therapy, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.,Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - W Ben Mortenson
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Melanie Durocher
- Glenrose Rehabilitation Hospital, Alberta Health Services, Edmonton, AB, Canada
| | - Amy Schneeberg
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Robert Teasell
- Parkwood Institute, St. Joseph's Health Care, London, ON, Canada.,Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Jennifer Yao
- GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, BC, Canada.,Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Janice J Eng
- Department of Physical Therapy, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada. .,Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.
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238
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Perry MK, Peters DM. Neural correlates of walking post-stroke: neuroimaging insights from the past decade. Exp Brain Res 2021; 239:3439-3446. [PMID: 34585257 DOI: 10.1007/s00221-021-06217-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 09/02/2021] [Indexed: 11/25/2022]
Abstract
Walking dysfunction such as slow walking speed and reduced independent mobility are common impairments following stroke. Neural mechanisms of upper limb impairment and motor recovery have been highly studied, while less is known about the neural correlates of walking dysfunction and rehabilitation after stroke. Our objective was to review the literature on neuroimaging correlates of walking and walking recovery post-stroke to provide a more comprehensive picture of neurological regions of interest. We searched the databases PubMed, CINAHL, Web of Science, and Cochrane Trials for articles published in English between January 1, 2010 and November 30, 2020 that assessed walking after stroke through neuroimaging and various clinical measures. The following key words were used: stroke, gait, walking, rehabilitation, brain mapping, neuroimaging, neural control of walking, motor recovery and motor function, and resulted in eighteen articles included in this review. These articles revealed regions of interest associated with lower extremity impairment and walking post-stroke to include the putamen, caudate, insula, pallidum, superior temporal gyrus, internal capsule, superior longitudinal fasciculus, corticospinal tract, corona radiata, and white matter associated with the pedunculopontine nucleus. This information strengthens our understanding of supraspinal control of walking post-stroke. However, future research on lesion location, functional and structural connectivity, and walking deficits is needed to confidently associate specific brain regions and white matter tracts/connectivity with specific impairments. Greater insight into neuromechanisms associated with response to neurorehabilitation post-stroke could improve treatment selection and prediction of motor recovery.
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Affiliation(s)
- McKenna K Perry
- Neuroscience Graduate Program, University of Vermont, 89 Beaumont Avenue, Burlington, VT, 05405, USA.
| | - Denise M Peters
- Department of Rehabilitation and Movement Science, University of Vermont, 106 Carrigan Drive, Burlington, VT, 05405, USA
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Nolan KJ, Karunakaran KK, Roberts P, Tefertiller C, Walter AM, Zhang J, Leslie D, Jayaraman A, Francisco GE. Utilization of Robotic Exoskeleton for Overground Walking in Acute and Chronic Stroke. Front Neurorobot 2021; 15:689363. [PMID: 34539371 PMCID: PMC8442911 DOI: 10.3389/fnbot.2021.689363] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/29/2021] [Indexed: 11/13/2022] Open
Abstract
Stroke commonly results in gait deficits which impacts functional ambulation and quality of life. Robotic exoskeletons (RE) for overground walking are devices that are programmable to provide high dose and movement-impairment specific assistance thus offering new rehabilitation possibilities for recovery progression in individuals post stroke. The purpose of this investigation is to present preliminary utilization data in individuals with acute and chronic stroke after walking overground with an RE. Secondary analysis on a subset of individuals is presented to understand the mechanistic changes due to RE overground walking. Thirty-eight participants with hemiplegia secondary to stroke were enrolled in a clinical trial conducted at eight rehabilitation centers. Data is presented for four sessions of overground walking in the RE over the course of 2 weeks. Participants continued their standard of care if they had any ongoing therapy at the time of study enrollment. Gait speed during the 10 Meter Walk Test, Gait deviations and the Functional Ambulation Category (FAC) data were collected before (baseline) and after (follow-up) the RE walking sessions. Walking speed significantly increased between baseline and follow-up for participants in the chronic (p <0.01) and acute (p < 0.05) stage of stroke recovery. FAC level significantly improved (p < 0.05) and there were significantly fewer (p < 0.05) gait deviations observed for participants in the acute stages of stroke recovery between baseline and follow-up. Secondary analysis on a subset of eight participants indicated that after four sessions of overground walking with the RE, the participants significantly improved their spatial symmetry. The walk time, step count and ratio of walk time to up time increased from first session to the last session for participants in the chronic and acute stages of stroke. The RE was effectively utilized for overground walking for individuals with acute and chronic stroke with varying severity levels. The results demonstrated an increase in walking speed, improvement in FAC and a decrease in gait deviations (from baseline to follow-up) after four sessions of overground walking in the RE for participants. In addition, preliminary data indicated that spatial symmetry and step length also improved after utilization of an RE for overground walking.
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Affiliation(s)
- Karen J Nolan
- Kessler Foundation, Center for Mobility and Engineering Research, West Orange, NJ, United States.,Rutgers-New Jersey Medical School, Department of Physical Medicine and Rehabilitation, Newark, NJ, United States
| | - Kiran K Karunakaran
- Kessler Foundation, Center for Mobility and Engineering Research, West Orange, NJ, United States.,Rutgers-New Jersey Medical School, Department of Physical Medicine and Rehabilitation, Newark, NJ, United States
| | - Pamela Roberts
- Cedars-Sinai Medical Center, Department of Physical Medicine and Rehabilitation, Los Angeles, CA, United States
| | - Candy Tefertiller
- Craig Hospital, Department of Physical Therapy, Englewood, CO, United States
| | - Amber M Walter
- Sheltering Arms Physical Rehabilitation Centers, Mechanicsville, VA, United States
| | - Jun Zhang
- St. Charles Hospital, Port Jefferson, NY, United States
| | | | - Arun Jayaraman
- Shirley Ryan AbilityLab, Max Nader Center for Rehabilitation Technologies and Outcomes Research, Chicago, IL, United States.,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, United States
| | - Gerard E Francisco
- University of Texas at Houston McGovern Medical School, Houston, TX, United States.,TIRR Memorial Hermann, Houston, TX, United States
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Kuwakado S, Kawaguchi K, Sakugawa A, Takahashi M, Oda T, Shimamoto N, Motomura G, Hamai S, Nakashima Y. Factors Affecting the Length of Convalescent Hospital Stay Following Total Hip and Knee Arthroplasty. Prog Rehabil Med 2021; 6:20210033. [PMID: 34514183 PMCID: PMC8385549 DOI: 10.2490/prm.20210033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 08/04/2021] [Indexed: 11/24/2022] Open
Abstract
Objectives : An important role of convalescent rehabilitation wards is the short-term improvement of mobility and activities of daily living (ADL). We aimed to identify predictors associated with the length of stay (LOS) in a convalescent hospital after total hip and knee arthroplasty. Methods : This study included 308 patients hospitalized in a convalescent ward following total hip or total knee arthroplasty. The following factors were examined: age, sex, orthopedic comorbidities, motor component of the functional independence measure (M-FIM), M-FIM gain, pain, 10-m walk test, timed up and go (TUG) test, functional ambulation category (FAC), cognitive function, and nutritional status. LOS was categorized as shorter (≤40 days) or longer (>40 days), based on the national average LOS in a convalescent ward, and was statistically analyzed with predictor variables. Results : In our hospital, the average LOS was 36.9 ± 21.4 days, and the average M-FIM at admission to the convalescent ward and the M-FIM gain were 71.1 ± 7.0 and 16.3 ± 6.9, respectively. In univariate analysis, there was a significant correlation between LOS and M-FIM at admission and M-FIM gain, pain, TUG time, and FAC. Logistic multivariate analysis identified M-FIM at admission (odds ratio [OR] 0.93, 95% confidence interval [CI] 0.88–0.98) and TUG time (OR 1.10, 95% CI 1.03–1.18) as independent predictors of LOS. Conclusions : The M-FIM and TUG test can be used to accurately estimate LOS and to plan rehabilitation treatment in a convalescent rehabilitation ward after lower-limb arthroplasty. Furthermore, preoperative or early postoperative intervention may lead to better quality motor activity and shorter LOS during the convalescent period.
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Affiliation(s)
- So Kuwakado
- Department of Rehabilitation Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Kenichi Kawaguchi
- Department of Rehabilitation Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Akemi Sakugawa
- Department of Rehabilitation Medicine, Fukuoka Mirai Hospital, Fukuoka, Japan
| | - Masanori Takahashi
- Department of Rehabilitation Medicine, Fukuoka Mirai Hospital, Fukuoka, Japan
| | - Taiji Oda
- Department of Rehabilitation Medicine, Fukuoka Mirai Hospital, Fukuoka, Japan
| | - Nobuto Shimamoto
- Department of Rehabilitation Medicine, Fukuoka Mirai Hospital, Fukuoka, Japan
| | - Goro Motomura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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241
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Lundquist CB, Nielsen JF, Brunner IC. Prediction of Upper Limb use Three Months after Stroke: A Prospective Longitudinal Study. J Stroke Cerebrovasc Dis 2021; 30:106025. [PMID: 34464925 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 07/16/2021] [Accepted: 07/25/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND A major goal of upper limb (UL) rehabilitation after stroke is to facilitate the use of the paretic arm in daily life activities. PURPOSE To examine if UL impairment two weeks after stroke can predict real-life UL use at three months. Furthermore, to identify additional factors which contribute to future UL use, and characteristics of patients who do not achieve normal UL use. METHODS This study included patients with stroke ≥ 18 years. UL impairment was assessed by Fugl-Meyer upper extremity motor assessment (FM). Use ratio between affected and unaffected UL was assessed with accelerometers at three months after stroke. The association between FM score and UL use ratio was investigated with linear regression models and adjusted for secondary variables. Non-normal use was examined by a logistic regression. RESULTS Eighty-seven patients were included. FM score two weeks after stroke predicted 38% of the variance in UL use ratio three months after stroke. A multivariate regression model predicted 55%, and the significant predictors were FM, motor-evoked potential (MEP) status, and neglect. Non-normal use could be predicted with a high accuracy based on MEP and/or neglect. In a logistic regression sensitivity for prediction of non-normal use was 0.93 and specificity was 0.75. CONCLUSION Better baseline capacity of the paretic UL predicted increased use of the arm and hand in daily life. Non-normal UL use could be predicted reliably based on the absence of MEPs and/or presence of neglect.
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Affiliation(s)
- Camilla Biering Lundquist
- Research Department, Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark.
| | - Jørgen Feldbæk Nielsen
- Research Department, Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark.
| | - Iris Charlotte Brunner
- Research Department, Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark; Aarhus University, Department of Clinical Medicine, Denmark.
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242
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Tamura S, Miyata K, Kobayashi S, Takeda R, Iwamoto H. Minimal clinically important difference of the Berg Balance Scale score in older adults with hip fractures. Disabil Rehabil 2021; 44:6432-6437. [PMID: 34410873 DOI: 10.1080/09638288.2021.1962993] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE The minimal clinically important difference (MCID) is the smallest clinically significant difference in treatment identified as crucial to the patient. There is no known MCID for the Berg Balance Scale (BBS), which measures balance function in patients with hip fractures. We aimed to calculate the MCID of the BBS in older adults with hip fractures. MATERIALS AND METHODS This is a retrospective multicenter clinical study that included 187 older adults with hip fractures. MCID was calculated using functional ambulation categories (FACs), which were used as anchors for the change in BBS scores between admission and discharge. MCID was calculated as an improvement for more than one point and as a substantial change for improvement for more than two points in the FAC. RESULTS MCID of the BBS was 11.5 points and that of the substantial change was 18.5 points, with an area under the curve of 0.76 and 0.81, respectively. CONCLUSIONS MCID for the BBS was 11.5 points in older adults with hip fractures. In addition, an improvement of more than 18.5 points in BBS can be considered a substantial change. These values may be useful in determining meaningful balance function improvement.Implications for rehabilitationHip fractures are a common injury for the older adults, and improvement in gait function has a bearing on prognosis.The effectiveness of meaningful rehabilitation is possible to determine by clarifying the minimal clinically important difference in balance function, which is important for the acquisition of gait.An improvement of 11.5 points or more on the Berg Balance Scale in an older adult with a hip fracture is considered a meaningful effect.
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Affiliation(s)
- Shuntaro Tamura
- Department of Rehabilitation, Fujioka General Hospital, Fujioka, Japan
| | - Kazuhiro Miyata
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Ami, Japan
| | - Sota Kobayashi
- Department of Rehabilitation, Public Nanokaichi Hospital, Tomioka, Japan.,Department of Basic Rehabilitation, Gunma University Graduate School of Health Sciences, Maebashi, Japan
| | - Ren Takeda
- Department of Basic Rehabilitation, Gunma University Graduate School of Health Sciences, Maebashi, Japan.,Numata Neurosurgery & Heart Disease Hospital, Numata, Japan
| | - Hiroki Iwamoto
- Department of Rehabilitation, Hidaka Rehabilitation Hospital, Takasaki, Japan
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243
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Costa P, De Jesus T, Torriani-Pasin C, Polese J. Functional capacity and walking speed reserve in individuals with chronic stroke: A cross-sectional study. Physiother Theory Pract 2021; 38:2563-2567. [PMID: 34399658 DOI: 10.1080/09593985.2021.1964660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Individuals with stroke experience residual walking disabilities, as the inability to increase walking speed (walking speed reserve - WSR), and frequently present decreasing in functional capacity. The relation between functional capacity and walking ability may contribute to more specific functional management of stroke. OBJECTIVE To investigate the association between WSR and functional capacity in individuals with chronic stroke and compare functional capacity between individuals who can increase walking speed or not. METHODS Cross-sectional study, where functional capacity was assessed with the Duke Activity Status Index (DASI), in metabolic equivalent (METS). WSR was assessed through the difference between fast and self-selected speed (in m/s). The individuals were assigned into two groups: able (WSR ≥ 0.2 m/s) and unable (WSR<0.2 m/s) to increase speed. Pearson's correlation and t test were used for analysis. RESULTS Fifty-five individuals (functional capacity 23 ± 13 METS and WSR 0.3 ± 0.2 m/s) were included. The association between functional capacity and WSR was positive and statistically significant, with moderate magnitude (r = 0.56) (p < .001). Individuals who were unable to increase their walking speed have less functional capacity (17.5 versus 31.3) (p = .003). CONCLUSION Functional capacity has a positive association with WSR in individuals with chronic stroke. The individuals who are unable to increase walking speed present lower functional capacity.
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Affiliation(s)
- Pollyana Costa
- Department Of Physical Therapy, Post Graduate Program Of Health Sciences, Faculdade Ciências Médicas De Minas Gerais, Belo Horizonte, Brazil
| | - Thainá De Jesus
- Department Of Physical Therapy, Post Graduate Program Of Health Sciences, Faculdade Ciências Médicas De Minas Gerais, Belo Horizonte, Brazil
| | - Camila Torriani-Pasin
- School Of Physical Education And Sports, University Of São Paulo. Av. Professor Mello Moraes, São Paulo, Brazil
| | - Janaine Polese
- Department Of Physical Therapy, Post Graduate Program Of Health Sciences, Faculdade Ciências Médicas De Minas Gerais, Belo Horizonte, Brazil
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244
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Song KJ, Chun MH, Lee J, Lee C. The effect of robot-assisted gait training on cortical activation in stroke patients: A functional near-infrared spectroscopy study. NeuroRehabilitation 2021; 49:65-73. [PMID: 33998555 DOI: 10.3233/nre-210034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate the effects of the robot-assisted gait training on cortical activation and functional outcomes in stroke patients. METHODS The patients were randomly assigned: training with Morning Walk® (Morning Walk group; n = 30); conventional physiotherapy (control group; n = 30). Rehabilitation was performed five times a week for 3 weeks. The primary outcome was the cortical activation in the Morning Walk group. The secondary outcomes included gait speed, 10-Meter Walk Test (10MWT), FAC, Motricity Index-Lower (MI-Lower), Modified Barthel Index (MBI), Rivermead Mobility Index (RMI), and Berg Balance Scale (BBS). RESULTS Thirty-six subjects were analyzed, 18 in the Morning Walk group and 18 in the control group. The cortical activation was lower in affected hemisphere than unaffected hemisphere at the beginning of robot rehabilitation. After training, the affected hemisphere achieved a higher increase in cortical activation than the unaffected hemisphere. Consequently, the cortical activation in affected hemisphere was significantly higher than that in unaffected hemisphere (P = 0.036). FAC, MBI, BBS, and RMI scores significantly improved in both groups. The Morning Walk group had significantly greater improvements than the control group in 10MWT (P = 0.017), gait speed (P = 0.043), BBS (P = 0.010), and MI-Lower (P = 0.047) scores. CONCLUSION Robot-assisted gait training not only improved functional outcomes but also increased cortical activation in stroke patients.
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Affiliation(s)
- Kyeong Joo Song
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Min Ho Chun
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Junekyung Lee
- Department of Rehabilitation Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of Korea
| | - Changmin Lee
- BK21-Y-BASE R&E Institute, School of Electrical and Electronic Engineering, Yonsei University, Seoul, Republic of Korea
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245
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Ribeiro TS, Silva EMG, Vasconcellos LS, Souza AA, Lindquist ARR. Are biomechanical strategies to perform functional activities different between individuals with subacute and chronic stroke? NeuroRehabilitation 2021; 49:95-101. [PMID: 33998552 DOI: 10.3233/nre-210027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate if the capacity to perform functional mobility activities change within the first year post-stroke using the Timed "Up and Go" Assessment of Biomechanical Strategies (TUG-ABS). METHODS A cross-sectional study was conducted with thirty-eight stroke individuals. A motion analysis system was used during the Timed "Up and Go" (TUG) test to evaluate the following activities: sit-to-stand, gait, turn, and stand-to-sit. Kinematic variables related to each activity were obtained in addition to TUG-ABS scores. The ability to perform the activities was compared between subacute (up to 3 months post-stroke, n = 21) and chronic participants (4 to 12 months post-stroke, n = 17) using Mann-Whitney U tests (α= 5%). RESULTS Results were expressed as median difference (MD) and 95% confidence intervals (95% CI). TUG-ABS scores: Sit-to-stand (MD = 0, 95% CI = 0.0 to 1), gait (MD = 0, 95% CI = 0.0 to 1), stand-to-sit (MD = 0, 95% CI = 0.0 to 1), and total score (MD = 2.0, 95% CI = 0.0 to 6) were not different between groups. Subacute participants presented significant better scores during turn activity (MD = 2.0, 95% CI 0.0 to 2.0). All kinematic variables were not different between participants. CONCLUSIONS Capacity to perform functional activities was not different within the first year post-stroke, suggesting that biomechanical strategies are developed within the first three months following stroke.
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Affiliation(s)
- Tatiana S Ribeiro
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal-RN, Brazil
| | - Emília M G Silva
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal-RN, Brazil
| | - Liliane S Vasconcellos
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal-RN, Brazil
| | - Aline A Souza
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal-RN, Brazil
| | - Ana Raquel R Lindquist
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal-RN, Brazil
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246
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Hernández-Méndez B, Martín-Silva I, Tapias-Vilanova M, Moreno-Gallo Y, Sanjuan-Menendez E, Lorenzo-Tamayo E, Ramos-González M, Montufo-Rosal M, Zuriguel-Pérez E. Very early mobilization in the stroke unit: Functionality, quality of life and disability at 90 days and 1 year post-stroke. NeuroRehabilitation 2021; 49:403-414. [PMID: 34308915 DOI: 10.3233/nre-210118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The evidence of early mobilization after stroke is conflicting, and the recovery period is an important concern. OBJECTIVE To analyse the functionality, quality of life and disability at 90 days and 1 year post-stroke of patients who received a Very Early Mobilization Protocol (VEMP). METHODS Prospective cohort study in a tertiary stroke unit. Consecutive patients aged≥18 years and without prior significant disability, who presented motor deficit after acute stroke, were included. A symmetry test was performed to compare the changes in the main variables: Barthel Index (BI), Functional Ambulation Category (FAC), modified Rankin Scale (mRS) and EuroQol five-dimensions three-level (EQ-5D-3L) between 90 days and 1 year post-stroke. RESULTS A total of 123 patients were recruited. The BI reflected an improvement at 1 year in transfer to chair/bed in 25.8%(p < 0.01) of patients and in toilet use in 25.8%(p = 0.02). The FAC showed an improvement at 1 year in 44.4%(p < 0.01) of patients and the mRS in 19.1%(p = 0.01). The usual activities dimension of the EQ-5D-3L showed a clinically relevant improvement after 1 year in 15.9%(p = 0.23) of patients. CONCLUSIONS A significant percentage of patients show improvements in some functional areas and in disability between 90 days and 1 year post-stroke.
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Affiliation(s)
- Beatriz Hernández-Méndez
- Rehabilitation Service/Physiotherapy and Occupational Therapy Unit, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, Barcelona, Spain.,Multidisciplinary Nursing Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, Barcelona, Spain
| | - Isabel Martín-Silva
- Rehabilitation Service/Physiotherapy and Occupational Therapy Unit, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, Barcelona, Spain
| | - Martíi Tapias-Vilanova
- Rehabilitation Service/Physiotherapy and Occupational Therapy Unit, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, Barcelona, Spain
| | - Yolanda Moreno-Gallo
- Rehabilitation Service/Physiotherapy and Occupational Therapy Unit, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, Barcelona, Spain
| | - Estela Sanjuan-Menendez
- Neurology Service/Stroke Unit, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, Barcelona, Spain.,Stroke Research, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, Barcelona, Spain
| | - Eva Lorenzo-Tamayo
- Neurology Service/Stroke Unit, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, Barcelona, Spain
| | - Montserrat Ramos-González
- Neurology Service/Stroke Unit, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, Barcelona, Spain
| | - Marina Montufo-Rosal
- Neurology Service/Stroke Unit, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, Barcelona, Spain
| | - Esperanza Zuriguel-Pérez
- Multidisciplinary Nursing Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, Barcelona, Spain
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247
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Miller A, Reisman DS, Billinger SA, Dunning K, Doren S, Ward J, Wright H, Wagner E, Carl D, Gerson M, Awosika O, Khoury J, Kissela B, Boyne P. Moderate-intensity exercise versus high-intensity interval training to recover walking post-stroke: protocol for a randomized controlled trial. Trials 2021; 22:457. [PMID: 34271979 PMCID: PMC8284012 DOI: 10.1186/s13063-021-05419-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 07/02/2021] [Indexed: 12/12/2022] Open
Abstract
Background Stroke results in neurologic impairments and aerobic deconditioning that contribute to limited walking capacity which is a major barrier post-stroke. Current exercise recommendations and stroke rehabilitation guidelines recommend moderate-intensity aerobic training post-stroke. Locomotor high-intensity interval training is a promising new strategy that has shown significantly greater improvements in aerobic fitness and motor performance than moderate-intensity aerobic training in other populations. However, the relative benefits and risks of high-intensity interval training and moderate-intensity aerobic training remain poorly understood following stroke. In this study, we hypothesize that locomotor high-intensity interval training will result in greater improvements in walking capacity than moderate-intensity aerobic training. Methods Using a single-blind, 3-site randomized controlled trial, 50 chronic (> 6 months) stroke survivors are randomly assigned to complete 36 locomotor training sessions of either high-intensity interval training or moderate-intensity aerobic training. Main eligibility criteria are age 40–80 years, single stroke for which the participant received treatment (experienced 6 months to 5 years prior to consent), walking speed ≤ 1.0 m/s, able to walk at least 3 min on the treadmill at ≥ 0.13 m/s (0.3 mph), stable cardiovascular condition (American Heart Association class B), and the ability to walk 10 m overground without continuous physical assistance. The primary outcome (walking capacity) and secondary outcomes (self-selected and fast gait speed, aerobic fitness, and fatigue) are assessed prior to initiating training and after 4 weeks, 8 weeks, and 12 weeks of training. Discussion This study will provide fundamental new knowledge to inform the selection of intensity and duration dosing parameters for gait recovery and optimization of aerobic training interventions in chronic stroke. Data needed to justify and design a subsequent definitive trial will also be obtained. Thus, the results of this study will inform future stroke rehabilitation guidelines on how to optimally improve walking capacity following stroke. Trial registration ClinicalTrials.govNCT03760016. Registered on November 30, 2018.
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Affiliation(s)
- Allison Miller
- Department of Biomechanics and Movement Sciences Program, University of Delaware, Newark, DE, 19713, USA
| | - Darcy S Reisman
- Department of Biomechanics and Movement Sciences Program, University of Delaware, Newark, DE, 19713, USA.,Department of Physical Therapy, University of Delaware, Newark, DE, 19713, USA
| | - Sandra A Billinger
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Kari Dunning
- Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati, 3225 Eden Avenue, Cincinnati, OH, USA
| | - Sarah Doren
- Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati, 3225 Eden Avenue, Cincinnati, OH, USA
| | - Jaimie Ward
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Henry Wright
- Department of Physical Therapy, University of Delaware, Newark, DE, 19713, USA
| | - Erin Wagner
- Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati, 3225 Eden Avenue, Cincinnati, OH, USA
| | - Daniel Carl
- Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati, 3225 Eden Avenue, Cincinnati, OH, USA
| | - Myron Gerson
- Departments of Cardiology and Internal Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Oluwole Awosika
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Jane Khoury
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Brett Kissela
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Pierce Boyne
- Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati, 3225 Eden Avenue, Cincinnati, OH, USA.
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248
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Young R, Broom D, O'Brien R, Sage K, Smith C. Users' experience of community-based power assisted exercise: a transition from NHS to third sector services. Int J Qual Stud Health Well-being 2021; 16:1949899. [PMID: 34252010 PMCID: PMC8276664 DOI: 10.1080/17482631.2021.1949899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
PURPOSE Seated Power Assisted Exercise (PAE) equipment is an accessible exercise mode for people with limited mobility following stroke and is available at a small number of community-based venues. The purpose of this qualitative study was to understand the lived experience of using PAE amongst PwS in a community venue and identify recommendations for the development and advancement of PAE equipment. METHOD Semi-structured interviews were conducted with 8 participants (PwS) attending a community stroke venue where PAE equipment was available. Transcribed data were analysed using interpretative phenomenological analysis. RESULTS Three overarching themes emerged from the analysis; 1) Don't tell me I've plateaued; 2) PAE facilitates the transition into long-term recovery; 3) Reframing the experience of stroke. Participants associated the uptake of PAE alongside venue membership as a turning point in their adjustment to life following stroke. In addition, recommendations for future development of the equipment were identified. CONCLUSION These findings indicate that membership of a stroke venue alongside engagement with PAE facilitated transition from early stroke rehabilitation into longer term recovery. The results of this study have informed the need for future product design and highlighted PAE is an effective mode for continued rehabilitation in third-sector services.
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Affiliation(s)
- Rachel Young
- Department of Allied Health Professions, Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
| | - David Broom
- Academy of Sport and Physical Activity, Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - Rachel O'Brien
- Department of Allied Health Professions, Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
| | - Karen Sage
- Department of Nursing, Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
| | - Christine Smith
- Department of Allied Health Professions, Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
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249
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Tamburella F, Lorusso M, Tagliamonte NL, Bentivoglio F, Bigioni A, Pisotta I, Lancini M, Pasinetti S, Ghidelli M, Masciullo M, Saraceni VM, Molinari M. Load Auditory Feedback Boosts Crutch Usage in Subjects With Central Nervous System Lesions: A Pilot Study. Front Neurol 2021; 12:700472. [PMID: 34295303 PMCID: PMC8290055 DOI: 10.3389/fneur.2021.700472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/09/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Crutches are the most common walking aids prescribed to improve mobility in subjects with central nervous system (CNS) lesions. To increase adherence to the appropriate level of crutch usage, providing load-related auditory feedback (aFB) may be a useful approach. We sensorized forearm crutches and developed a custom software to provide aFB information to both user and physical therapist (PhT). Aim: Evaluate aFB effects on load control during gait by a self-controlled case series trial. Methods: A single experimental session was conducted enrolling 12 CNS lesioned participants. Load on crutch was recorded during 10 Meter Walk Test performed with and without aFB. In both cases, crutch load data, and gait speed were recorded. Usability and satisfaction questionnaires were administered to participants and PhTs involved. Results: Reliable data were obtained from eight participants. Results showed that compared to the no FB condition, aFB yielded a significant reduction in the mean load on the crutches during gait (p = 0.001). The FB did not influence gait speed or fatigue (p > 0.05). The experience questionnaire data indicated a positive experience regarding the use of aFB from both participants' and PhTs' perspectives. Conclusion: aFB significantly improves compliance with crutch use and does not affect gait speed or fatigue by improving the load placed on crutches. The FB is perceived by users as helpful, safe, and easy to learn, and does not interfere with attention or concentration while walking. Furthermore, the PhTs consider the system to be useful, easy to learn and reliable.
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Affiliation(s)
- Federica Tamburella
- Spinal Rehabilitation Laboratory (SPIRE Lab), Neurorehabilitation 1 Department, Santa Lucia Foundation, Rome, Italy.,Laboratory of Robotic Neurorehabilitation (NEUROROBOT Lab), Neurorehabilitation 1 Department, Santa Lucia Foundation, Rome, Italy
| | - Matteo Lorusso
- Spinal Rehabilitation Laboratory (SPIRE Lab), Neurorehabilitation 1 Department, Santa Lucia Foundation, Rome, Italy.,Laboratory of Robotic Neurorehabilitation (NEUROROBOT Lab), Neurorehabilitation 1 Department, Santa Lucia Foundation, Rome, Italy
| | - Nevio Luigi Tagliamonte
- Spinal Rehabilitation Laboratory (SPIRE Lab), Neurorehabilitation 1 Department, Santa Lucia Foundation, Rome, Italy.,Laboratory of Robotic Neurorehabilitation (NEUROROBOT Lab), Neurorehabilitation 1 Department, Santa Lucia Foundation, Rome, Italy.,Advanced Robotics and Human-Centered Technologies Research Unit, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Francesca Bentivoglio
- Advanced Robotics and Human-Centered Technologies Research Unit, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Alessandra Bigioni
- Spinal Rehabilitation Laboratory (SPIRE Lab), Neurorehabilitation 1 Department, Santa Lucia Foundation, Rome, Italy.,Laboratory of Robotic Neurorehabilitation (NEUROROBOT Lab), Neurorehabilitation 1 Department, Santa Lucia Foundation, Rome, Italy
| | - Iolanda Pisotta
- Spinal Rehabilitation Laboratory (SPIRE Lab), Neurorehabilitation 1 Department, Santa Lucia Foundation, Rome, Italy.,Laboratory of Robotic Neurorehabilitation (NEUROROBOT Lab), Neurorehabilitation 1 Department, Santa Lucia Foundation, Rome, Italy
| | - Matteo Lancini
- Deptartment of Mechanical and Industrial Engineering, University of Brescia, Brescia, Italy
| | - Simone Pasinetti
- Deptartment of Mechanical and Industrial Engineering, University of Brescia, Brescia, Italy
| | - Marco Ghidelli
- Deptartment of Mechanical and Industrial Engineering, University of Brescia, Brescia, Italy
| | - Marcella Masciullo
- Spinal Rehabilitation Laboratory (SPIRE Lab), Neurorehabilitation 1 Department, Santa Lucia Foundation, Rome, Italy.,Laboratory of Robotic Neurorehabilitation (NEUROROBOT Lab), Neurorehabilitation 1 Department, Santa Lucia Foundation, Rome, Italy
| | | | - Marco Molinari
- Spinal Rehabilitation Laboratory (SPIRE Lab), Neurorehabilitation 1 Department, Santa Lucia Foundation, Rome, Italy.,Laboratory of Robotic Neurorehabilitation (NEUROROBOT Lab), Neurorehabilitation 1 Department, Santa Lucia Foundation, Rome, Italy
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250
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Aries AM, Pomeroy VM, Sim J, Read S, Hunter SM. Sensory Stimulation of the Foot and Ankle Early Post-stroke: A Pilot and Feasibility Study. Front Neurol 2021; 12:675106. [PMID: 34290663 PMCID: PMC8287025 DOI: 10.3389/fneur.2021.675106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/17/2021] [Indexed: 12/19/2022] Open
Abstract
Background: Somatosensory stimulation of the lower extremity could improve motor recovery and walking post-stroke. This pilot study investigated the feasibility of a subsequent randomized controlled trial (RCT) to determine whether task-specific gait training is more effective following either (a) intensive hands-on somatosensory stimulation or (b) wearing textured insoles. Objectives: Determine recruitment and attrition rates, adherence to intervention, acceptability and viability of interventions and outcome measures, and estimate variance of outcome data to inform sample size for a subsequent RCT. Methods: Design: randomized, single-blinded, mixed-methods pilot study. Setting: In-patient rehabilitation ward and community. Participants: n = 34, 18+years, 42-112 days following anterior or posterior circulation stroke, able to follow simple commands, able to walk independently pre-stroke, and providing informed consent. Intervention: Twenty 30-min sessions of task-specific gait training (TSGT) (delivered over 6 weeks) in addition to either: (a) 30-60 min mobilization and tactile stimulation (MTS); or (b) unlimited textured insole (TI) wearing. Outcomes: Ankle range of movement (electrogoniometer), touch-pressure sensory thresholds (Semmes Weinstein Monofilaments), motor impairment (Lower Extremity Motricity Index), walking ability and speed (Functional Ambulation Category, 5-m walk test, pressure insoles) and function (modified Rivermead Mobility Index), measured before randomization, post-intervention, and 1-month thereafter (follow-up). Adherence to allocated intervention and actual dose delivered (fidelity) were documented in case report forms and daily diaries. Focus groups further explored acceptability of interventions and study experience. Analysis: Recruitment, attrition, and dose adherence rates were calculated as percentages of possible totals. Thematic analysis of daily diaries and focus group data was undertaken. Standard deviations of outcome measures were calculated and used to inform a sample size calculation. Results: Recruitment, attrition, and adherence rates were 48.57, 5.88, and 96.88%, respectively. Focus groups, daily-diaries and case report forms indicated acceptability of interventions and outcome measures to participants. The 5-m walk was selected as primary outcome measure for a future trial [mean (SD) at end of intervention: 16.86 (11.24) MTS group and 21.56 (13.57) TI group]; sample size calculation indicated 60 participants are required per group. Conclusion: Recruitment, attrition and adherence rates and acceptability of interventions and outcomes justify a subsequent powered RCT of MTS+TSGT compared with TI+TSGT.
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Affiliation(s)
- Alison M. Aries
- School of Allied Health Professions, Faculty of Medicine and Health Sciences, Keele University, Keele, United Kingdom
| | - Valerie M. Pomeroy
- Acquired Brain Injury Recovery Alliance (ABIRA), School of Health Sciences, University of East Anglia, Norwich, United Kingdom
- National Institute for Health Research (NIHR) Brain Injury MedTech Co-operative, Cambridge, United Kingdom
| | - Julius Sim
- School of Allied Health Professions, Faculty of Medicine and Health Sciences, Keele University, Keele, United Kingdom
| | - Susan Read
- School of Nursing and Midwifery, Faculty of Medicine and Health Sciences, Keele University, Keele, United Kingdom
| | - Susan M. Hunter
- School of Allied Health Professions, Faculty of Medicine and Health Sciences, Keele University, Keele, United Kingdom
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