Comparison of gait recovery patterns according to the paralyzed side in stroke patients: An observational study based on a retrospective chart review (STROBE compliant)

Neuroplasticity Following Stroke from a Functional Laterality Perspective: A fNIRS Study

To explore alterations of resting-state functional connectivity (rsFC) in sensorimotor cortex following strokes with left or right hemiplegia considering the lateralization and neuroplasticity. Seventy-three resting-state functional near-infrared spectroscopy (fNIRS) files were selected, including 26 from left hemiplegia (LH), 21 from right hemiplegia (RH) and 26 from normal controls (NC) group. Whole-brain analyses matching the Pearson correlation were used for rsFC calculations. For right-handed normal controls, rsFC of motor components (M1 and M2) in the left hemisphere displayed a prominent intensity in comparison with the right hemisphere (p < 0.05), while for stroke groups, this asymmetry has disappeared. Additionally, RH rather than LH showed stronger rsFC between left S1 and left M1 in contrast to normal controls (p < 0.05), which correlated inversely with motor function (r = - 0.53, p < 0.05). Regarding M1, rsFC within ipsi-lesioned M1 has a negative correlation with motor function of the affected limb (r = - 0.60 for the RH group and - 0.43 for the LH group, p < 0.05). The rsFC within contra-lesioned M1 that innervates the normal side was weakened compared with that of normal controls (p < 0.05). Stronger rsFC of motor components in left hemisphere was confirmed by rs-fNIRS as the "secret of dominance" for the first time, while post-stroke hemiplegia broke this cortical asymmetry. Meanwhile, a statistically strengthened rsFC between left S1 and M1 only in right-hemiplegia group may act as a compensation for the impairment of the dominant side. This research has implications for brain-computer interfaces synchronizing sensory feedback with motor performance and transcranial magnetic regulation for cortical excitability to induce cortical plasticity.

Brain Asymmetry and Its Effects on Gait Strategies in Hemiplegic Patients: New Rehabilitative Conceptions

Brain asymmetry is connected with motor performance, suggesting that hemiparetic patients have different gait patterns depending on the side of the lesion. This retrospective cohort study aims to further investigate the difference between right and left hemiplegia in order to assess whether the injured side can influence the patient’s clinical characteristics concerning gait, thus providing insights for new personalized rehabilitation strategies. The data from 33 stroke patients (17 with left and 16 with right hemiplegia) were retrospectively compared with each other and with a control group composed of 20 unaffected age-matched individuals. The 3D gait analysis was used to assess kinematic data and spatio-temporal parameters. Compared to left hemiplegic patients, right hemiplegic patients showed worse spatio-temporal parameters (p < 0.05) and better kinematic parameters (p < 0.05). Both pathological groups were characterized by abnormal gait parameters in comparison with the control group (p < 0.05). These findings show an association between the side of the lesion—right or left—and the different stroke patients’ gait patterns: left hemiplegic patients show better spatio-temporal parameters, whereas right hemiplegic patients show better segmentary motor performances. Therefore, further studies may develop and assess new personalized rehabilitation strategies considering the injured hemisphere and brain asymmetry.

Two-Week Rehabilitation with Auditory Biofeedback Prosthesis Reduces Whole Body Angular Momentum Range during Walking in Stroke Patients with Hemiplegia: A Randomized Controlled Trial

Walking rehabilitation is challenging in stroke patients with sensory impairments. In this study, we examined the two-week effect of an auditory biofeedback prosthesis, Auditory Foot (AF), on the change in the frontal whole body angular momentum (WBAM) range, before and after a two-week walking rehabilitation. We conducted a pilot randomized controlled trial (RCT). We employed statistical Bayesian modeling to understand the mechanism of the rehabilitation effect and predict the expected effect in new patients. The best-performing model indicated that the frontal WBAM range was reduced in the AF group by 12.9–28.7%. This suggests that the use of kinesthetic biofeedback in gait rehabilitation contributes to the suppression of frontal WBAM, resulting in an improved walking balance function in stroke patients.

Minimal clinically Important difference of Gait Assessment and Intervention Tool (G.A.I.T.) in patients with sub-acute stroke

BACKGROUND

The Gait Assessment and Intervention Tool (G.A.I.T.) is a well-accepted tool to determine gait characteristics in neurological patients.

AIM

The aim of this study was to determine the minimal clinically importance difference (MCID) of the G.A.I.T in sub-acute stroke patients.

DESIGN

Prospective study.

SETTING

An in- and out-patient rehabilitation clinic in a university hospital in Thailand.

POPULATION

Patients with sub-acute stroke who had an ongoing rehabilitation between October 2017 to March 2019.

METHODS

We used an anchor-based method to determine change in G.A.I.T. score needed to achieve MCID. Participants were dichotomized to 'no change group' or 'positive change group' based on different anchors of objective and subjective perceived changes in gait function after 4 weeks of rehabilitation. The groups were determined based on whether 1) participants achieved an increase in comfortable gait speed (CGS) of ≥ 0.06 m/s, 2) averaged Global Rating Of Change (GROC) score was ≥ +3 evaluated by two physiatrists 3) GROC score of was ≥ +3 rated by the participants. The best cut-off point was the score which most successfully separated these two groups within the ROC curve.

RESULTS

Thirty-one participants with sub-acute stroke (18 males, 13 female) completed both assessments. Their average age was 60.3 years (SD 11.4). The best cut-off point were a 2.5- and 4-point improvements in G.A.I.T. score based on changes in CGS (AUC 0.76, 95%CI 0.58-0.95) and clinicians' perceived changes (AUC 0.88, 95% CI 0.76-1.00). Additionally, the best cut-off point was 1.5 (AUC 0.71 95% CI 0.31-1.00) when determined by participants' perception. All anchors yielded adequate discriminative ability. The positive likelihood ratio (LR) was in the range of 2.7-5.5 and the negative LR range was 0.1-0.3.

CONCLUSIONS

A change in G.A.I.T. score should exceed 1.5, 2.5 and 4 to be considered MCID based on participants' GROC, CGS and Clinicians' GROC anchors. This information will be useful for the determination of changes after rehabilitation and for tracking sub-acute stroke patients' progress.