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Sanchez L, Asuncion BM, Tayag KR, Chua C, Escandor SJ, Dones VC. Effectiveness of constraint-induced movement therapy (CIMT)-Telerehabilitation compared to traditional CIMT on upper extremity dysfunction of adult chronic stroke patients-A systematic review and meta-analysis. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2024; 29:e2090. [PMID: 38685678 DOI: 10.1002/pri.2090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/21/2023] [Accepted: 03/31/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND/OBJECTIVE Constraint-induced movement therapy (CIMT), a therapy that encourages the use of the affected upper limb through intensive functional tasks, effectively promotes upper limb function in patients with chronic stroke. This study determined the effectiveness of CIMT using telerehabilitation compared with traditional CIMT in improving mild to moderate upper limb motor function in adult patients with chronic stroke. METHODS Eligible studies were identified by searching electronic databases and scanning the reference lists of articles. Review Manager 5.4 was used to determine the pooled mean effect size of the standardized mean difference and 95% confidence interval for the group comparison. Visual heterogeneity, I2 statistic, and chi-square test were used to measure the heterogeneity between the included studies. We evaluated the quality of evidence using GRADEpro GDT, software for creating evidence summaries and healthcare recommendations. RESULTS Two randomized controlled trials were included in this review. A total of 109 participants (70 male, 39 female) were evaluated. The time since the stroke was ≥6 months in one study and ≥1 year in another study. Improvements in upper limb motor function while performing functional movements were measured using the Wolf Motor Function Test. The evidence for the effectiveness of CIMT using telerehabilitation compared with traditional CIMT in improving the upper extremity function in patients with chronic stroke is of moderate quality. This suggests no significant difference between the groups (mean difference [95% CI]: -0.04 [-0.42, 0.33]). CONCLUSIONS CIMT using telerehabilitation is not superior to traditional CIMT in improving patients' upper extremity motor function with chronic stroke. CIMT using telerehabilitation may improve access to treatment, minimize SARS-CoV-2 risk, and reduce travel in patients with chronic stroke.
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Affiliation(s)
- Leila Sanchez
- The Graduate School, University of Santo Tomas, Manila, Philippines
| | | | | | - Czyrhen Chua
- The Graduate School, University of Santo Tomas, Manila, Philippines
| | | | - Valentin C Dones
- The Graduate School, University of Santo Tomas, Manila, Philippines
- Center for Health Research and Movement Science, College of Rehabilitation Sciences, University of Santo Tomas, Manila, Philippines
- Center for Health Research and Movement Science - a JBI-Affiliated Group, Manila, Philippines
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Gooch HJ, Jarvis KA, Stockley RC. Behavior Change Approaches in Digital Technology-Based Physical Rehabilitation Interventions Following Stroke: Scoping Review. J Med Internet Res 2024; 26:e48725. [PMID: 38656777 PMCID: PMC11079774 DOI: 10.2196/48725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 11/14/2023] [Accepted: 12/26/2023] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Digital health technologies (DHTs) are increasingly used in physical stroke rehabilitation to support individuals in successfully engaging with the frequent, intensive, and lengthy activities required to optimize recovery. Despite this, little is known about behavior change within these interventions. OBJECTIVE This scoping review aimed to identify if and how behavior change approaches (ie, theories, models, frameworks, and techniques to influence behavior) are incorporated within physical stroke rehabilitation interventions that include a DHT. METHODS Databases (Embase, MEDLINE, PsycINFO, CINAHL, Cochrane Library, and AMED) were searched using keywords relating to behavior change, DHT, physical rehabilitation, and stroke. The results were independently screened by 2 reviewers. Sources were included if they reported a completed primary research study in which a behavior change approach could be identified within a physical stroke rehabilitation intervention that included a DHT. Data, including the study design, DHT used, and behavior change approaches, were charted. Specific behavior change techniques were coded to the behavior change technique taxonomy version 1 (BCTTv1). RESULTS From a total of 1973 identified sources, 103 (5%) studies were included for data charting. The most common reason for exclusion at full-text screening was the absence of an explicit approach to behavior change (165/245, 67%). Almost half (45/103, 44%) of the included studies were described as pilot or feasibility studies. Virtual reality was the most frequently identified DHT type (58/103, 56%), and almost two-thirds (65/103, 63%) of studies focused on upper limb rehabilitation. Only a limited number of studies (18/103, 17%) included a theory, model, or framework for behavior change. The most frequently used BCTTv1 clusters were feedback and monitoring (88/103, 85%), reward and threat (56/103, 54%), goals and planning (33/103, 32%), and shaping knowledge (33/103, 32%). Relationships between feedback and monitoring and reward and threat were identified using a relationship map, with prominent use of both of these clusters in interventions that included virtual reality. CONCLUSIONS Despite an assumption that DHTs can promote engagement in rehabilitation, this scoping review demonstrates that very few studies of physical stroke rehabilitation that include a DHT overtly used any form of behavior change approach. From those studies that did consider behavior change, most did not report a robust underpinning theory. Future development and research need to explicitly articulate how including DHTs within an intervention may support the behavior change required for optimal engagement in physical rehabilitation following stroke, as well as establish their effectiveness. This understanding is likely to support the realization of the transformative potential of DHTs in stroke rehabilitation.
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Affiliation(s)
- Helen J Gooch
- Stroke Research Team, School of Nursing and Midwifery, University of Central Lancashire, Preston, United Kingdom
| | - Kathryn A Jarvis
- Stroke Research Team, School of Nursing and Midwifery, University of Central Lancashire, Preston, United Kingdom
| | - Rachel C Stockley
- Stroke Research Team, School of Nursing and Midwifery, University of Central Lancashire, Preston, United Kingdom
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Gauthier LV, Ravi R, DeLuca D, Zhou W. Dose Response to Upper Extremity Stroke Rehabilitation Varies by Individual: Early Indicators of Treatment Response. Stroke 2024; 55:696-704. [PMID: 38406850 PMCID: PMC10896190 DOI: 10.1161/strokeaha.123.045039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/02/2024] [Accepted: 01/11/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Dose response has remained a priority area in motor rehabilitation research for decades, prompting several large randomized trials and meta-analyses. These between-subjects comparisons have revealed equivocal relationships between the duration of motor practice and rehabilitation response. Prior reliance on time-consuming clinical assessments made it infeasible to capture within-subjects dose response, as tracking the dose-response trajectory of an individual requires dozens of repeated administrations. METHODS This secondary observational cohort analysis of existing data from the gaming arms of the VIGoROUS multisite trial (Video Game Rehabilitation for Outpatient Stroke) describes the rehabilitation dose response of 80 participants with mild-moderate chronic stroke. The 3-dimensional joint position data were captured via the Kinect v2 optical sensor as participants completed a prescribed 15 hours of in-home unsupervised game-based motor practice. Kinematic dose response trajectories were fitted from hundreds to thousands of in-game repetitions for 4 separate upper extremity movements for each participant. RESULTS Of 75 participants with sufficient data for dose-response analysis, 85% showed improved motor capacity for at least 1 movement. Dose response was bimodal; 42% required <5 hours of motor practice before reaching a plateau in movement kinematics, whereas 55% required >10 and 34% required >30 hours. We could predict with 93% accuracy whether or not an individual would ultimately respond to game-based motor practice within 5 hours of gameplay. CONCLUSIONS Dose response varies considerably between individuals. About half of chronic stroke patients benefit from higher doses of motor practice than the current standard of care. Individualized dose-response data from motion capture rehabilitation gaming can guide clinical decision-making early on in treatment. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT02631850.
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Affiliation(s)
- Lynne V. Gauthier
- Department of Physical Therapy and Kinesiology (L.V.G.), University of Massachusetts Lowell
| | - Roshan Ravi
- Department of Computer Science (R.R., D.D., W.Z.), University of Massachusetts Lowell
| | - David DeLuca
- Department of Computer Science (R.R., D.D., W.Z.), University of Massachusetts Lowell
| | - Wenjin Zhou
- Department of Computer Science (R.R., D.D., W.Z.), University of Massachusetts Lowell
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Gebreheat G, Goman A, Porter-Armstrong A. The use of home-based digital technology to support post-stroke upper limb rehabilitation: A scoping review. Clin Rehabil 2024; 38:60-71. [PMID: 37469176 PMCID: PMC10631286 DOI: 10.1177/02692155231189257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 07/05/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE To identify, map and synthesize the extent and nature of existing studies on the use of home-based digital technology to support post-stroke upper limb rehabilitation. DATA SOURCES A comprehensive literature search was completed between 30 May 2022 and 05 April 2023, from seven online databases (CINAHL, Cochrane Library, PubMed, ScienceDirect, IEEExplore, Web of Science and PEDro), Google Scholar and the reference lists of already identified articles. METHODS A scoping review was conducted according to Arksey and O'Malley (2005), and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. All English-language studies reporting on the use of home-based digital technology to support upper limb post-stroke rehabilitation were eligible for inclusion. RESULTS The search generated a total of 1895 records, of which 76 articles met the inclusion criteria. Of these, 52 were experimental studies and the rest, qualitative, case series and case studies. Of the overall 2149 participants, 2028 were stroke survivors with upper limb impairment. The majority of studies were aimed at developing, designing and/or assessing the feasibility, acceptability and efficacy of a digital system for poststroke upper limb rehabilitation in home settings. The thematic analysis found six major categories: Tele-rehabilitation (n = 29), games (n = 45), virtual reality (n = 26), sensor (n = 22), mobile technology (n = 22), and robotics (n = 8). CONCLUSION The digital technologies used in post-stroke upper limb rehabilitation were multimodal, and system-based comprising telerehabilitation, gamification, virtual reality, mobile technology, sensors and robotics. Furthermore, future research should focus to determine the effectiveness of these modalities.
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Affiliation(s)
- Gdiom Gebreheat
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Adele Goman
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
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Sharififar S, Ghasemi H, Geis C, Azari H, Adkins L, Speight B, Vincent HK. Telerehabilitation service impact on physical function and adherence compared to face-to-face rehabilitation in patients with stroke: A systematic review and meta-analysis. PM R 2023; 15:1654-1672. [PMID: 37139741 DOI: 10.1002/pmrj.12988] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/27/2023] [Accepted: 04/05/2023] [Indexed: 05/05/2023]
Abstract
OBJECTIVES The purposes of this systematic review and meta-analysis were to (1) appraise the available evidence of telerehabilitation program effects on functional outcomes, adherence, and patient satisfaction compared to face-to-face programs after stroke; and (2) provide direction for future outcome measure selection and development for clinical research purposes. TYPE: Systematic review and meta analysis of randomized controlled trials. LITERATURE SURVEY MEDLINE, CINAHL, Embase, Scopus, Proquest Theses and Dissertations, Physiotherapy Evidence Database (PEDro), and Clinicaltrials.gov were searched for studies published in English from 1964 to the end of April 2022. METHODOLOGY A total of 6450 studies were identified, 13 were included in the systematic review, and 10 with at least 3 reported similar outcomes were included the meta-analysis. Methodological quality of results was evaluated using the PEDro checklist. SYNTHESIS Telerehabilitation demonstrated equivalency in outcomes across several domains and was favored compared to conventional face to face alone or when paired with semisupervised physical therapy on Wolf Motor Function performance score (mean difference [MD] 1.69 points, 95% confidence interval [CI] 0.21-3.17) and time score (MD 2.07 seconds, 95% CI -4.04 to -0.10, Q test = 30.27, p < .001, I2 = 93%), and Functional Mobility Assessment in the upper extremities (MD 3.32 points, 95% CI 0.90-5.74, Q test = 5.60, p = .23, I2 = 29% alone or when paired with semisupervised physical therapy). The Barthel Index participation measures of function demonstrated improvement (MD 4.18 points, 95% CI, 1.79-6.57, Q test = 3.56, p = .31, I2 = 16%). Over half of summarized study ratings were determined to be of good to excellent quality (PEDro score 6.6 ± 2.3 points). Adherence varied in available studies from 75%-100%. Satisfaction levels of telerehabilitation were highly variable. CONCLUSIONS Telerehabilitation can improve functional outcomes and promote therapy adherence after stroke. Therapy protocols and functional assessments need substantial refinement and standardization to improve interpretation and clinical outcomes.
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Affiliation(s)
- Sharareh Sharififar
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Hanieh Ghasemi
- Shahid Sadoughi University of Medical Sciences, School of Medicine, Yazd, Iran
| | - Carolyn Geis
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Hassan Azari
- School of Podiatric Medicine, Barry University, Miami Shores, Florida, USA
| | - Lauren Adkins
- University of Florida Health Science Center Libraries, Gainesville, Florida, USA
| | - Bailey Speight
- College of Health and Human Performance, University of Florida, Gainesville, Florida, USA
| | - Heather K Vincent
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Florida, Gainesville, Florida, USA
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Szabo DA, Neagu N, Teodorescu S, Apostu M, Predescu C, Pârvu C, Veres C. The Role and Importance of Using Sensor-Based Devices in Medical Rehabilitation: A Literature Review on the New Therapeutic Approaches. SENSORS (BASEL, SWITZERLAND) 2023; 23:8950. [PMID: 37960649 PMCID: PMC10648494 DOI: 10.3390/s23218950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/22/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023]
Abstract
Due to the growth of sensor technology, more affordable integrated circuits, and connectivity technologies, the usage of wearable equipment and sensing devices for monitoring physical activities, whether for wellness, sports monitoring, or medical rehabilitation, has exploded. The current literature review was performed between October 2022 and February 2023 using PubMed, Web of Science, and Scopus in accordance with P.R.I.S.M.A. criteria. The screening phase resulted in the exclusion of 69 articles that did not fit the themes developed in all subchapters of the study, 41 articles that dealt exclusively with rehabilitation and orthopaedics, 28 articles whose abstracts were not visible, and 10 articles that dealt exclusively with other sensor-based devices and not medical ones; the inclusion phase resulted in the inclusion of 111 articles. Patients who utilise sensor-based devices have several advantages due to rehabilitating a missing component, which marks the accomplishment of a fundamental goal within the rehabilitation program. As technology moves faster and faster forward, the field of medical rehabilitation has to adapt to the time we live in by using technology and intelligent devices. This means changing every part of rehabilitation and finding the most valuable and helpful gadgets that can be used to regain lost functions, keep people healthy, or prevent diseases.
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Affiliation(s)
- Dan Alexandru Szabo
- Department of Human Movement Sciences, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania;
- Department ME1, Faculty of Medicine in English, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Nicolae Neagu
- Department of Human Movement Sciences, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania;
| | - Silvia Teodorescu
- Department of Doctoral Studies, National University of Physical Education and Sports, 060057 Bucharest, Romania;
| | - Mihaela Apostu
- Department of Special Motor and Rehabilitation Medicine, National University of Physical Education and Sports, 060057 Bucharest, Romania; (M.A.); (C.P.)
| | - Corina Predescu
- Department of Special Motor and Rehabilitation Medicine, National University of Physical Education and Sports, 060057 Bucharest, Romania; (M.A.); (C.P.)
| | - Carmen Pârvu
- Faculty of Physical Education and Sports, “Dunărea de Jos” University, 63-65 Gării Street, 337347 Galati, Romania;
| | - Cristina Veres
- Department of Industrial Engineering and Management, University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania;
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Psychouli P, Mamais I, Anastasiou C. An Exploration of the Effectiveness of Different Intensity Protocols of Modified Constraint-Induced Therapy in Stroke: A Systematic Review. Rehabil Res Pract 2023; 2023:6636987. [PMID: 37854484 PMCID: PMC10581859 DOI: 10.1155/2023/6636987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 09/21/2023] [Accepted: 09/25/2023] [Indexed: 10/20/2023] Open
Abstract
Purpose To examine the effectiveness of different modified Constraint-Inuced Therapy (mCIMT) protocol intensities on upper extremity motor function in adults with hemiplegia. Methods A search was conducted in PubMed, Scopus, EBSCO, and Cochrane Library for articles published between April 2010 and December 2021. Only randomized controlled trials (RCTs) were included. Studies were excluded if they used a sample of less than five, mCIMT in combination with other therapy, and/or if they were not written in English. Methodologic quality was assessed using the Cochrane collaboration risk of bias tool-2. Results Thirty-six RCTs with a total of 721 participants were included. Most researchers followed a moderate to low protocol intensity in terms of total treatment time and moderate to high intensity with regard to restriction time. Almost all of the upper limb motor function measures showed statistically significant improvements (p < .05) after mCIMT, irrespective of the protocol's intensity, but there was lack of high-quality studies. Statistically significant improvements did not always translate to clinical importance. Conclusions Low-intensity CIMT protocols may result in comparable improvements to more intensive ones but caution has to be taken when drawing conclusions due to high risk of bias studies.
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Affiliation(s)
- Pavlina Psychouli
- Occupational Therapy Program, Department of Health Sciences, European University Cyprus, Cyprus
| | - Ioannis Mamais
- Occupational Therapy Program, Department of Health Sciences, European University Cyprus, Cyprus
| | - Charalambos Anastasiou
- Occupational Therapy Program, Department of Health Sciences, European University Cyprus, Cyprus
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Cui Y, Ma N, Liu X, Lian Y, Li Y, Xu G, Zhang J, Li Z. Progress in the clinical application of constraint-induced therapy following stroke since 2014. Front Neurol 2023; 14:1170420. [PMID: 37273704 PMCID: PMC10235632 DOI: 10.3389/fneur.2023.1170420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/02/2023] [Indexed: 06/06/2023] Open
Abstract
Stroke is a group of cerebrovascular diseases with high prevalence and mortality rate. Stroke can induce many impairments, including motor and cognitive dysfunction, aphasia/dysarthria, dysphagia, and mood disorders, which may reduce the quality of life among the patients. Constraint-induced therapy has been proven to be an effective treatment method for stroke rehabilitation. It has been widely used in the recovery of limb motor dysfunction, aphasia, and other impairment like unilateral neglect after stroke. In recent years, constraint-induced therapy can also combine with telehealth and home rehabilitation. In addition, constraint-induced therapy produces significant neuroplastic changes in the central nervous system. Functional magnetic resonance imaging, diffusion tensor imaging, and other imaging/electrophysiology methods have been used to clarify the mechanism and neuroplasticity. However, constraint-induced therapy has some limitations. It can only be used under certain conditions, and the treatment time and effectiveness are controversial. Further research is needed to clarify the mechanism and effectiveness of CI therapy.
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Gauthier LV, Rider JV, Donkers S. Applying Behavior Change Techniques to Support Client Outcomes in Outpatient Neurorehabilitation: A Clinician Guide. Arch Phys Med Rehabil 2023; 104:711-715. [PMID: 36502892 DOI: 10.1016/j.apmr.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/28/2022] [Accepted: 11/01/2022] [Indexed: 12/13/2022]
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Christie LJ, Fearn N, McCluskey A, Lannin NA, Shiner CT, Kilkenny A, Boydell J, Meharg A, Howes E, Churilov L, Faux S, Doussoulin A, Middleton S. Remote constraint induced therapy of the upper extremity (ReCITE): A feasibility study protocol. Front Neurol 2022; 13:1010449. [DOI: 10.3389/fneur.2022.1010449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/24/2022] [Indexed: 11/21/2022] Open
Abstract
BackgroundDifficulty using the upper extremity in everyday activities is common after stroke. Constraint-induced movement therapy (CIMT) has been shown to be effective in both sub-acute and chronic phases of stroke recovery and is recommended in clinical practice guidelines for stroke internationally. Despite reports of equivalence of outcome when stroke rehabilitation interventions are delivered using telehealth, there has been limited evaluation of CIMT when using this mode of delivery. ReCITE will (a) evaluate the feasibility and acceptability of CIMT when delivered via telehealth to stroke survivors (TeleCIMT) and (b) explore therapists' experiences and use of an online support package inclusive of training, mentoring and resources to support TeleCIMT delivery in clinical practice.MethodsA prospective single-group, single blinded, study design with embedded process evaluation will be conducted. The study will be conducted at three outpatient services in Sydney, Australia. A multi-faceted therapist support package, informed by the Capabilities, Opportunity, Motivation- Behaviour model (COM-B), will be used to support occupational therapists to implement TeleCIMT as part of routine care to stroke survivors. Each service will recruit 10 stroke survivor participants (n = 30) with mild to moderate upper extremity impairment. Upper extremity and quality of life outcomes of stroke survivor participants will be collected at baseline, post-intervention and at a 4 week follow-up appointment. Feasibility of TeleCIMT will be evaluated by assessing the number of stroke participants who complete 80% of intensive arm practice prescribed during their 3 week program (i.e., at least 24 h of intensive arm practice). Acceptability will be investigated through qualitative interviews and surveys with stroke survivors, supporter surveys and therapist focus groups. Qualitative interviews with therapists will provide additional data to explore their experiences and use of the online support package.DiscussionThe COVID-19 pandemic resulted in a rapid transition to delivering telehealth. The proposed study will investigate the feasibility and acceptability of delivering a complex intervention via telehealth to stroke survivors at home, and the support that therapists and patients require for delivery. The findings of the study will be used to inform whether a larger, randomized controlled trial is feasible.
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Measured and Perceived Effects of Upper Limb Home-Based Exergaming Interventions on Activity after Stroke: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159112. [PMID: 35897472 PMCID: PMC9329711 DOI: 10.3390/ijerph19159112] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 07/20/2022] [Accepted: 07/24/2022] [Indexed: 01/25/2023]
Abstract
After discharge from the hospital to home, stroke patients may experience weakness and reduced movement in their hemiparetic arms that limits their ability to perform daily activities. Therapists can use exercise games (exergames) to maintain functional abilities and daily use of the arm at home. A systematic review and meta-analysis was conducted to determine the efficiency of upper limb home-based rehabilitation, using exergaming on activity abilities in stroke.&nbsp;Randomized controlled trials were reviewed in the CENTRAL, MEDLINE, CINAHL, EMBASE, and SCOPUS online databases. Clinical measures of observation and self-reporting were studied in post-intervention and follow-up. Nine studies were included in this systematic review (535 participants). The Physiotherapy Evidence Database (PEDro) score was 6.6/10 (SD 1.0, range 5-8), indicating good quality. This systematic review and meta-analysis showed that upper limb home-based exergaming interventions were no more effective in terms of activity than conventional therapy after stroke, according to the observational and subjective assessments in post-intervention and follow-up. Using this same approach, future studies should focus on evaluating home-based exergames through subgroup analysis to be able to propose recommendations.
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Borstad A, Nichols-Larsen D, Uswatte G, Strahl N, Simeo M, Proffitt R, Gauthier L. Tactile Sensation Improves Following Motor Rehabilitation for Chronic Stroke: The VIGoROUS Randomized Controlled Trial. Neurorehabil Neural Repair 2022; 36:525-534. [PMID: 35695197 DOI: 10.1177/15459683221107893] [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: 11/16/2022]
Abstract
Background. Up to 85% of people with chronic stroke experience somatosensory impairment, which contributes to poor sensorimotor control and non-use of the affected limb. Neurophysiological mechanisms suggest motor rehabilitation may improve tactile sense post-stroke, however, somatosensory recovery has rarely been reported in controlled trials. Objective. To compare the effect of four upper limb motor rehabilitation programs on the recovery of tactile sensation in adults with chronic stroke. Methods. Adults with chronic stroke and mild or moderate upper extremity hemiparesis (n = 167) were enrolled in a multi-site randomized controlled trial. Participants completed three weeks of gaming therapy, gaming therapy with additional telerehabilition, Constraint-Induced Movement therapy, or traditional rehabilitation. Here, we report the results of a secondary outcome, tactile sensation, measured with monofilaments, before and after treatment, and 6 months later. Results. A mixed-effects general linear model revealed similar positive change in tactile sensitivity regardless of the type of training. On average, participants were able to detect a stimulus that was 32% and 33% less after training and at 6-month follow-up, respectively. One-third of participants experienced recategorization of their level of somatosensory impairment (e.g., regained protective sensation) following training. Poorer tactile sensation at baseline was associated with greater change. Conclusions. About one-third of individuals with mild/moderate chronic hemiparesis experience sustained improvements in tactile sensation following motor rehabilitation, regardless of the extent of tactile input in the rehabilitation program. Potential for sensory improvement is an additional motivator for those post-stroke. Characteristics of those who improve and mechanisms of improvement are important future questions. Clinicaltrials.gov NCT02631850.
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Affiliation(s)
- Alexandra Borstad
- Department of Physical Therapy, 3031College of St. Scholastica, Duluth, MN, USA
| | | | - Gitendra Uswatte
- Department of Psychology, University of Alabama Birmingham, Birmingham, AL, USA
| | | | | | - Rachel Proffitt
- Department of Occupational Therapy, University of Missouri, Columbia, MO, USA
| | - Lynne Gauthier
- Department Physical Therapy and Kinesiology, 14710University of Massachusetts Lowell, Lowell, MA, USA
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Abstract
This review provides a concise outline of the advances made in the care of patients and to the quality of life after a traumatic spinal cord injury (SCI) over the last century. Despite these improvements reversal of the neurological injury is not yet possible. Instead, current treatment is limited to providing symptomatic relief, avoiding secondary insults and preventing additional sequelae. However, with an ever-advancing technology and deeper understanding of the damaged spinal cord, this appears increasingly conceivable. A brief synopsis of the most prominent challenges facing both clinicians and research scientists in developing functional treatments for a progressively complex injury are presented. Moreover, the multiple mechanisms by which damage propagates many months after the original injury requires a multifaceted approach to ameliorate the human spinal cord. We discuss potential methods to protect the spinal cord from damage, and to manipulate the inherent inhibition of the spinal cord to regeneration and repair. Although acute and chronic SCI share common final pathways resulting in cell death and neurological deficits, the underlying putative mechanisms of chronic SCI and the treatments are not covered in this review.
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Affiliation(s)
- Stuart Stokes
- Spinal Unit, Department of Neurosurgery, Hull Royal Infirmary, Hull, UK
| | - Martin Drozda
- Spinal Unit, Department of Neurosurgery, Hull Royal Infirmary, Hull, UK
| | - Christopher Lee
- Spinal Unit, Department of Neurosurgery, Hull Royal Infirmary, Hull, UK
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Aquino ERDS, Suffert SCI. Telemedicine in neurology: advances and possibilities. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:336-341. [PMID: 35976317 PMCID: PMC9491412 DOI: 10.1590/0004-282x-anp-2022-s127] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Telemedicine develops from technology that offers opportunities for knowledge transfer and information sharing and allows the provision of health services at a distance. OBJECTIVE To evaluate the number of publications on teleneurology in the last two decades in PubMed and the available evidence on the use of this technology in neurological clinical conditions. METHODS A quantitative assessment of publications related to telemedicine and neurology in the last two decades. A search was performed on the PubMed database for the descriptors ("Telemedicine"[Mesh]) AND "Neurology"[Mesh]). A review of the articles retrieved on the topic was carried out to evaluate the innovation processes used and applications in various clinical conditions involving teleneurology. RESULTS The search performed on March 14th 2022 resulted in 229 publications involving the topic of telemedicine and neurology between 1999 and 2022. Since 2000, there has been an increase in publications related to this topic, with a peak of 71 articles published in 2020, the year in which the World Health Organization defined the COVID-19 pandemic status. CONCLUSION In the last two decades, teleneurology has been developing through the expansion of technological resources and the COVID-19 pandemic intensified this process. Different modalities of teleneurology are studied in several neurology subfields and include teleconsultation (between healthcare professionals or between healthcare professionals and patients), telerehabilitation, telemonitoring and tele-education. The advances achieved by teleneurology in this period encouraged technological innovations and health processes that developed opportunities to improve the care provided in a mechanism of constant evolution.
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Affiliation(s)
- Emanuelle Roberta da Silva Aquino
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brazil
- Hospital Sírio-Libanês, São Paulo, SP, Brazil
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