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Rand D, Assadi Khalil S, Schaham I, Doron N, Peri S, Zeilig G, Dudkiewicz I, Gross-Nevo RF, Barel H. U-Rate-UE; Measuring Perceived Recovery of the Affected Upper Extremity in Adults Post-stroke. Arch Phys Med Rehabil 2024; 105:1151-1157. [PMID: 38412898 DOI: 10.1016/j.apmr.2024.02.715] [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: 04/14/2023] [Revised: 02/11/2024] [Accepted: 02/14/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVE To establish initial validity of "U-Rate-UE", a single-question scale regarding perceived recovery of the stroke affected upper extremity (UE). DESIGN A retrospective longitudinal study of data collected at rehabilitation admission, 6 weeks, and 6 months since stroke. SETTING Stroke rehabilitation and community-based. PARTICIPANTS A convenience sample of 87 individuals, median (interquartile range) age 71.5 (65-80) years, 15.0 (12-20) days post-stroke. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The affected UE was assessed using the Fugl-Meyer Motor Assessment, grip strength, Action Research Arm Test, the Box and Block Test (BBT), and The Rating of Everyday Arm-Use in the Community and Home. Participants also rated how much they perceive that their affected UE recovered from the stroke using U-Rate-UE; 0-100 (no to full recovery). Longitudinal changes in U-Rate-UE ratings were assessed. In addition, at 6 weeks and 6 months post-stroke, the change in BBT was calculated and participants were grouped into achieved/did not achieve the minimal detectable change (MDC). Correlations between U-Rate-UE to the other UE assessments were assessed at all 3 timepoints. RESULTS Significant changes in U-Rate-UE were seen over time (P<.05). At 6 weeks and 6 months, participants who achieved BBT-MDC rated their recovery significantly higher than participants who did not. U-Rate-UE was moderately-strongly significantly correlated to UE assessments (rho=.61-.85, P<.001). CONCLUSIONS The U-Rate-UE is supported for use with UE assessments contributing to comprehensive clinical understanding of the recovery of the affected UE in adults post-stroke.
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Affiliation(s)
- Debbie Rand
- Department of Occupational Therapy, School of Health Professions, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel.
| | - Samar Assadi Khalil
- Department of Occupational Therapy, School of Health Professions, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Inbar Schaham
- Department of Occupational Therapy, School of Health Professions, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Noa Doron
- Department of Occupational Therapy, School of Health Professions, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel; Beit Rivka Geriatric Rehabilitation Center, Petach Tikva, Israel
| | - Shelly Peri
- Department of Occupational Therapy, School of Health Professions, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Gabriel Zeilig
- Sheba Medical Center, Tel Hashomer, Israel; Faculty of Health Professions, Ono Academic College, Kiryat Ono, Israel; Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Israel Dudkiewicz
- Sheba Medical Center, Tel Hashomer, Israel; Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | | | - Haim Barel
- Bait Balev Rehabilitation Center - Maccabi Health Care Services Group, Bat-Yam, Israel
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Li S, Yan H, Pan Y, Zhang Y. Association of the sarcopenia index with cognitive impairment in a middle-aged to older patients with acute ischemic stroke or transient ischemic attack: A multicenter cohort study. J Nutr Health Aging 2024; 28:100241. [PMID: 38669837 DOI: 10.1016/j.jnha.2024.100241] [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: 11/12/2023] [Revised: 04/08/2024] [Accepted: 04/13/2024] [Indexed: 04/28/2024]
Abstract
OBJECTIVES The sarcopenia (SI) index, defined as the serum creatinine to cystatin C ratio, is considered a predictor of poor muscle health and malnutrition, which is related to major adverse cardiovascular events. However, the effect of the SI index on cognitive function in stroke patients remains unknown. In this study, we aimed to examine the association between the SI and longitudinal cognitive impairment in patients with acute ischemic stroke or transient ischemic attack. RESEARCH DESIGN AND METHODS Participants who met the inclusion criteria in this national, multicenter, prospective cohort study were enrolled from the Impairment of Cognition and Sleep (ICONS) study of the China National Stroke Registry-3 (CNSR-3). They were categorized into four groups according to the quartile of the SI index. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) scale. Multivariable-adjusted logistic regression models were performed to evaluate the association between the SI index and post-stroke cognitive impairment (PSCI) at the 3-month follow-up. Moreover, discrimination tests were used to evaluate the incremental predictive value of the SI index beyond the potential risk factors. Furthermore, we performed subgroup analyses to test interactions. RESULTS Among the enrolled participants, the lower the SI index was, the worse the cognitive performance. At the 3-month follow-up, participants in the lowest SI quartile group exhibited a 42% increase in the risk of cognitive impairment relative to the highest quartile group [OR 0.58 (95% CI 0.37-0.90)]. Moreover, after applying the discrimination test, adding the SI index into the potential risk factors resulted in a slight improvement in predicting the risk of cognitive impairment [NRI 14% (P = 0.01)]. CONCLUSION This study demonstrated that a lower sarcopenia index was positively associated with a higher prevalence of PSCI. Monitoring the SI index in stroke patients and early identification and treatment of individuals with low SI level may be helpful to reduce the risk of cognitive impairment.
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Affiliation(s)
- Siqi Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China; China National Clinical Research Center for Neurological Diseases, Capital Medical University, Beijing 100070, China
| | - Hongyi Yan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China; China National Clinical Research Center for Neurological Diseases, Capital Medical University, Beijing 100070, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China; China National Clinical Research Center for Neurological Diseases, Capital Medical University, Beijing 100070, China
| | - Yumei Zhang
- Department of Rehabilitation Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.
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Alekseeva TM, Topuzova MP, Kulikov VP, Kovzelev PD, Kosenko MG, Tregub PP. Hypercapnic hypoxia as a rehabilitation method for patients after ischemic stroke. Neurol Res 2024:1-11. [PMID: 38643375 DOI: 10.1080/01616412.2024.2343510] [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: 01/24/2024] [Accepted: 04/03/2024] [Indexed: 04/22/2024]
Abstract
INTRODUCTION Experimental studies on animals have demonstrated a higher neuroprotective efficacy of hypercapnic hypoxia compared to normocapnic hypoxia. Respiratory training with hypercapnic hypoxia has shown a positive impact on the functional state of the nervous system in children with cerebral palsy (CP). It can be presumed that the combined effect of moderate hypercapnia and hypoxia will be promising for clinical application within the context of early rehabilitation after ischemic stroke. METHODS A randomized triple-blind placebo-controlled study was conducted on 102 patients with ischemic stroke, aged 63.07 ± 12.1 years. All patients were diagnosed with ischemic stroke based on neuroimaging criteria and/or clinical criteria within the 48-72 hour timeframe. The experimental group (n = 50) underwent daily respiratory training with hypercapnic hypoxia (FetCO2 5-6%, FetO2 15-16%) using the 'Carbonic' device for 7-11 sessions of 20 minutes each day during the treatment process. The control group (placebo, n = 52) underwent training on a similar device modified for breathing atmospheric air. Neurological examinations were conducted on all patients before the study and on the day after completing the training course. RESULTS The standard treatment demonstrated effectiveness in terms of neurological status scales in both groups. Intermittent exposure to hypercapnic hypoxia proved more effective in improving neurological function indicators in patients compared to the placebo group: NIHSS scale scores were 40% lower than in the placebo group (p < 0.001); mRS scale scores were 35% lower (p < 0.001); B-ADL-I and RMI indices were higher by 26% (p < 0.01) and 36% (p < 0.001), respectively; MoCA scale results were 13% higher (p < 0.05); HADS and BDI-II scale scores were lower by 35% (p < 0.05) and 25% (p < 0.05), respectively. The increase in MMSE scale scores in the intervention group was 54% higher (p < 0.001), and MoCA scale scores increased by 25% (p < 0.001). CONCLUSION Respiratory training with hypercapnic hypoxia improves the functional state of the nervous system in patients with ischemic stroke. After conducting further clarifying studies, hypercapnic hypoxia can be considered as an effective method of neurorehabilitation, which can be used as early as 48-72 hours after the onset of stroke.
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Affiliation(s)
- Tatiana M Alekseeva
- Department of Neurology with Clinic, V.A. Almazov National Medical Research Center, Saint-Petersburg, Russia
| | - Maria P Topuzova
- Department of Neurology with Clinic, V.A. Almazov National Medical Research Center, Saint-Petersburg, Russia
| | - Vladimir P Kulikov
- Department of Ultrasound and Functional Diagnostics, Altai State Medical University, Barnaul, Russia
| | - Pavel D Kovzelev
- Department of Neurology with Clinic, Smart Clinic ltd, Saint-Petersburg, Russia
| | - Mark G Kosenko
- Department of Pathophysiology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Pavel P Tregub
- Department of Pathophysiology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- Brain Science Institute, Research Center of Neurology, Moscow, Russia
- Scientific and Educational Resource Center "Innovative Technologies of Immunophenotyping, Digital Spatial Profiling and Ultrastructural Analysis", RUDN University, Moscow, Russia
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Chen J, He XY. Comment on: Effects of virtual reality-based cognitive interventions on cognitive function and activity of daily living among stroke patients: Systematic review and meta-analysis. J Clin Nurs 2024. [PMID: 38616563 DOI: 10.1111/jocn.17167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 04/07/2024] [Indexed: 04/16/2024]
Affiliation(s)
- Jing Chen
- Department of Rehabilitation Medicine, Department of Nursing, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Xu-Ying He
- Department of Rehabilitation Medicine, Department of Nursing, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China
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Lim C, Lim S, Moon SJ, Cho S. Neuroprotective effects of methanolic extract from Chuanxiong Rhizoma in mice with middle cerebral artery occlusion-induced ischemic stroke: suppression of astrocyte- and microglia-related inflammatory response. BMC Complement Med Ther 2024; 24:140. [PMID: 38575941 PMCID: PMC10993527 DOI: 10.1186/s12906-024-04454-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 03/25/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND In traditional Asian medicine, dried rhizomes of Ligusticum chuanxiong Hort. (Chuanxiong Rhizoma [CR]) have long been used to treat pain disorders that affect the head and face such as headaches. Furthermore, they have been used primarily for blood circulation improvement or as an analgesic and anti-inflammatory medicine. This study aimed to investigate the neuroprotective effects of a methanol extract of CR (CRex) on ischemic stroke in mice caused by middle cerebral artery occlusion (MCAO). METHODS C57BL/6 mice were given a 1.5-h transient MCAO (MCAO control and CRex groups); CRex was administered in the mice of the CRex group at 1,000-3,000 mg/kg either once (single dose) or twice (twice dose) before MCAO. The mechanism behind the neuroprotective effects of CRex was examined using the following techniques: brain infarction volume, edema, neurological deficit, novel object recognition test (NORT), forepaw grip strength, and immuno-fluorescence staining. RESULTS Pretreating the mice with CRex once at 1,000 or 3,000 mg/kg and twice at 1,000 mg/kg 1 h before MCAO, brought about a significantly decrease in the infarction volumes. Furthermore, pretreating mice with CRex once at 3,000 mg/kg 1 h before MCAO significantly suppressed the reduction of forepaw grip strength of MCAO-induced mice. In the MCAO-induced group, preadministration of CRex inhibited the reduction in the discrimination ratio brought on by MCAO in a similar manner. CRex exhibited these effects by suppressing the activation of astrocytes and microglia, which regulated the inflammatory response. CONCLUSIONS This study proposes a novel development for the treatment of ischemic stroke and provides evidence favoring the use of L. chuanxiong rhizomes against ischemic stroke.
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Affiliation(s)
- Chiyeon Lim
- College of Medicine, Dongguk University, Goyang, 10326, Republic of Korea
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA
| | - Sehyun Lim
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA
- School of Public Health, Far East University, Eumseong, 27601, Republic of Korea
| | - So-Jung Moon
- College of Science & Industry Convergence, Ewha Womans University, Seoul, 03760, Republic of Korea
| | - Suin Cho
- School of Korean Medicine, Pusan National University, Yangsan, 50612, Republic of Korea.
- Department of Korean Medicine, School of Korean Medicine, Yangsan Campus of Pusan National University, Yangsan, 50612, Republic of Korea.
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Bayazeed A, Almalki G, Alnuaim A, Klem M, Sethi A. Factors Influencing Real-World Use of the More-Affected Upper Limb After Stroke: A Scoping Review. Am J Occup Ther 2024; 78:7802180250. [PMID: 38634670 DOI: 10.5014/ajot.2024.050512] [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: 04/19/2024] Open
Abstract
IMPORTANCE Current interventions are limited in improving use of the more-affected upper limb in real-world daily occupations and functional independence poststroke. A comprehensive understanding of the factors influencing real-world upper limb use is required to develop interventions to improve functional independence poststroke. OBJECTIVE To systematically review the factors that influence real-world use of the more-affected upper limb poststroke. DATA SOURCES We searched MEDLINE, Embase, PsycINFO, and the Physiotherapy Evidence Database for English-language articles from 2012 to 2023. STUDY SELECTION AND DATA COLLECTION Of 774 studies, we included 33 studies that had participants at least age 18 yr who exhibited upper limb impairments poststroke, objectively measured real-world upper limb use using a movement sensor, and measured factors affecting upper limb use. Two reviewers independently screened the abstracts. FINDINGS The results were categorized by International Classification of Functioning, Disability and Health domains. Prominent factors were upper limb impairment; motor ability; functional independence; task type; hand dominance; stroke-related factors, including time since stroke; and perception of use of the more-affected upper limb. CONCLUSIONS AND RELEVANCE Existing interventions primarily focus on upper limb impairments and motor ability. Our findings suggest that interventions should also incorporate other factors: task type (unilateral vs. bilateral), hand dominance, self-efficacy, and perception of more-affected limb use as active ingredients in improving real-world use of the more-affected upper limb poststroke. We also provide recommendations to use behavioral activation theory in designing an occupation-focused intervention to augment self-efficacy and confidence in use of the more-affected upper limb in daily occupations. Plain-Language Summary: In order to develop interventions to improve functional independence poststroke, occupational therapy practitioners must have a comprehensive understanding of the factors that influence real-world more-affected upper limb use. The study findings provide a set of distinct factors that practitioners can target separately or in combination to improve real-world use of the more-affected upper limb poststroke.
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Affiliation(s)
- Anadil Bayazeed
- Anadil Bayazeed, MSOT, is PhD Candidate, Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA, and Teaching Assistant, Occupational Therapy Department, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia;
| | - Ghaleb Almalki
- Ghaleb Almalki, MSOT, is PhD Candidate, Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA, and Teaching Assistant, Occupational Therapy Department, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Amjad Alnuaim
- Amjad Alnuaim, MSc, is Teaching Assistant, Department of Occupational Therapy, King Saud University, Riyadh, Saudi Arabia. At the time of the study, Alnuaim was Master's Student, Occupational Therapy Department, University of Pittsburgh, Pittsburgh, PA
| | - Mary Klem
- Mary Klem, PhD, MLIS, is Assistant Director for Advanced Information Support, Health Sciences Library System, University of Pittsburgh, Pittsburgh, PA
| | - Amit Sethi
- Amit Sethi, PhD, OTR/L, is Associate Professor, Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA
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Segura E, Vilà-Balló A, Mallorquí A, Porto MF, Duarte E, Grau-Sánchez J, Rodríguez-Fornells A. The presence of anhedonia in individuals with subacute and chronic stroke: an exploratory cohort study. Front Aging Neurosci 2024; 16:1253028. [PMID: 38384938 PMCID: PMC10880106 DOI: 10.3389/fnagi.2024.1253028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 01/19/2024] [Indexed: 02/23/2024] Open
Abstract
Background Anhedonia refers to the diminished capacity to experience pleasure. It has been described both as a symptom of depression and an enduring behavioral trait that contributes its development. Specifically, in stroke patients, anhedonia has been closely linked to depression, resulting in reduced sensitivity to everyday pleasures and intrinsic motivation to engage in rehabilitation programs and maintain a healthy active lifestyle. This condition may hinder patients' recovery, diminishing their autonomy, functioning, and quality of life. Objective We aimed to explore the prevalence and level of anhedonia and those variables that might be associated in patients with both ischemic and hemorrhagic stroke at subacute and chronic phases of the disease. Methods We conducted an exploratory cohort study with a sample of 125 patients with subacute and chronic stroke presenting upper-limb motor deficits. We measured participants' level of anhedonia with four items from the Beck Depression Inventory-II that describe the symptoms of this condition: loss of pleasure, loss of interest, loss of energy, and loss of interest in sex. We also collected demographic and clinical information and evaluated motor and cognitive functions as well as levels of depression, apathy, and various mood states. The results were compared to a sample of 71 healthy participants of similar age, sex, and level of education. Results Stroke patients demonstrated a significantly higher prevalence (18.5-19.7%) and level of anhedonia compared to the healthy controls (4.3%), regardless of stroke phase, level of motor impairment, and other clinical variables. Furthermore, post-stroke anhedonia was associated with lower levels of motivation and higher levels of negative mood states such as fatigue and anger in the long term. Importantly, anhedonia level was superior in stroke patients than in healthy controls while controlling for confounding effects of related emotional conditions. Conclusion This study provides novel evidence on the prevalence, level and factors related to anhedonia post-stroke. We emphasize the importance of assessing and treating anhedonia in this population, as well as conducting large-scale cohort and longitudinal studies to test its influence on long-term functional and emotional recovery.
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Affiliation(s)
- Emma Segura
- Cognition and Brain Plasticity Unit, Bellvitge Biomedical Research Institute, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Spain
| | - Adrià Vilà-Balló
- Cognition and Brain Plasticity Unit, Bellvitge Biomedical Research Institute, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Spain
- Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Aida Mallorquí
- Clinical Health Psychology Section, Clinic Institute of Neuroscience, Hospital Clínic, Barcelona, Spain
| | - María F. Porto
- Cognition and Brain Plasticity Unit, Bellvitge Biomedical Research Institute, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Spain
| | - Esther Duarte
- Department of Physical and Rehabilitation Medicine, Hospital del Mar, Barcelona, Spain
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Jennifer Grau-Sánchez
- Cognition and Brain Plasticity Unit, Bellvitge Biomedical Research Institute, L’Hospitalet de Llobregat, Barcelona, Spain
- Research Group on Complex Health Diagnoses and Interventions from Occupation and Care (OCCARE), Escola Universitària d'Infermeria i Teràpia Ocupacional, Autonomous University of Barcelona, Barcelona, Spain
| | - Antoni Rodríguez-Fornells
- Cognition and Brain Plasticity Unit, Bellvitge Biomedical Research Institute, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Spain
- Institute of Neurosciences, University of Barcelona, Barcelona, Spain
- Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
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Arya KN, Pandian S, Pandey D, Agarwal GG, Chaudhary N. Task-based and Magnified Mirror Therapy for Unilateral Spatial Neglect among post-stroke subjects: Study protocol for a randomized controlled trial. PLoS One 2024; 19:e0296276. [PMID: 38265989 PMCID: PMC10807845 DOI: 10.1371/journal.pone.0296276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 12/01/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Unilateral spatial neglect (USN) is a commonly occurring neurocognitive disability after a stroke. The neglect may affect the motor recovery of the upper and lower limbs and functional performances. Mirror therapy, a simple and economical approach has the potential to reduce the USN and related impairments. AIM The primary objective of this study is to determine the effectiveness of task-based and magnified mirror therapy on the USN and on the motor recovery of the post-stroke subjects. The secondary objective is to investigate the effectiveness of the intervention on the function and disability of the subjects. METHODS In this randomized controlled, assessor-blinded trial, 86 post-stroke subjects will be recruited from the neuro-rehabilitation laboratory of a rehabilitation institute, located in northern India. The participants,aged20 to 80 years, with 1 to 36 months of stroke onset, hemiparesis, and the USN, will be considered eligible for the study. In addition to the conventional rehabilitation, the experimental group(n = 43) will receive 40 sessions (8 weeks) of Task-based and MAGnified Mirror Therapy for Unilateral Spatial Neglect (T-MAGUSN). The control group (n = 43) will undergo a dose-matched conventional program only. The participants will be assessed at baseline, post-intervention and 4-week follow-up using primary (Line Bisection Test, Letter Cancellation Test, and Fugl-Myer Assessment) and secondary (Catherine Bergego Scale, Berg Balance Scale, Functional Ambulation Classification, Modified Rankin Scale) outcome measures. DISCUSSION This proposed study will lead to the development of a novel rehabilitation protocol for the management of USN, aiming to enhance motor and functional recovery. The investigation will consider both the upper and lower limbs for the intervention, reducing the impact of cognitive disability in stroke. TRIAL REGISTRATION Clinical Trial Registry of India (CTRI) as CTRI/2023/05/053184 (www.ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=74659).
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Affiliation(s)
- Kamal Narayan Arya
- Department of Occupational Therapy, Pandit Deendayal Upadhyaya National Institute for Persons with Physical Disabilities, New Delhi, India
| | - Shanta Pandian
- Department of Occupational Therapy, Pandit Deendayal Upadhyaya National Institute for Persons with Physical Disabilities, New Delhi, India
| | - Divya Pandey
- Department of Occupational Therapy, Pandit Deendayal Upadhyaya National Institute for Persons with Physical Disabilities, New Delhi, India
| | - G. G. Agarwal
- Department of Statistics, Lucknow University, Lucknow, Uttar Pradesh, India
| | - Neera Chaudhary
- Department of Neurology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
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Su W, Li H, Dang H, Han K, Liu J, Liu T, Liu Y, Tang Z, Lu H, Zhang H. Predictors of Cognitive Functions After Stroke Assessed Using the Wechsler Adult Intelligence Scale: A Retrospective Study. J Alzheimers Dis 2024; 98:109-117. [PMID: 38363609 DOI: 10.3233/jad-230840] [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] [Indexed: 02/17/2024]
Abstract
Background The mechanism(s) of cognitive impairment remains complex, making it difficult to confirm the factors influencing poststroke cognitive impairment (PSCI). Objective This study quantitatively investigated the degree of influence and interactions of clinical indicators of PSCI. Methods Information from 270 patients with PSCI and their Wechsler Adult Intelligence Scale (WAIS-RC) scores, totaling 18 indicators, were retrospectively collected. Correlations between the indicators and WAIS scores were calculated. Multiple linear regression model(MLR), genetic algorithm modified Back-Propagation neural network(GA-BP), logistic regression model (LR), XGBoost model (XGB), and structural equation model were used to analyze the degree of influence of factors on the WAIS and their mediating effects. Results Seven indicators were significantly correlated with the WAIS scores: education, lesion side, aphasia, frontal lobe, temporal lobe, diffuse lesions, and disease course. The MLR showed significant effect of education, lesion side, aphasia, diffuse lesions, and frontal lobe on the WAIS. The GA-BP included five factors: education, aphasia, frontal lobe, temporal lobe, and diffuse lesions. LR predicted that the lesion side contributed more to mild cognitive impairment, while education, lesion side, aphasia, and course of the disease contributed more to severe cognitive impairment. XGB showed that education, side of the lesion, aphasia, and diffuse lesions contributed the most to PSCI. Aphasia plays a significant mediating role in patients with severe PSCI. Conclusions Education, lesion side, aphasia, frontal lobe, and diffuse lesions significantly affected PSCI. Aphasia is a mediating variable between clinical information and the WAIS in patients with severe PSCI.
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Affiliation(s)
- Wenlong Su
- China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing, China
- School of Health and Life Science, University of Health and Rehabilitation Sciences, Qingdao, China
| | - Hui Li
- Cheeloo College of Medicine, Shandong University, Jinan, China
- School of Health and Life Science, University of Health and Rehabilitation Sciences, Qingdao, China
- China Rehabilitation Research Center, Beijing Bo'ai Hospital, Beijing, China
| | - Hui Dang
- Cheeloo College of Medicine, Shandong University, Jinan, China
- School of Health and Life Science, University of Health and Rehabilitation Sciences, Qingdao, China
- China Rehabilitation Research Center, Beijing Bo'ai Hospital, Beijing, China
| | - Kaiyue Han
- China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing, China
- China Rehabilitation Research Center, Beijing Bo'ai Hospital, Beijing, China
| | - Jiajie Liu
- China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing, China
- China Rehabilitation Research Center, Beijing Bo'ai Hospital, Beijing, China
| | - Tianhao Liu
- China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing, China
- China Rehabilitation Research Center, Beijing Bo'ai Hospital, Beijing, China
| | - Ying Liu
- China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing, China
- China Rehabilitation Research Center, Beijing Bo'ai Hospital, Beijing, China
| | - Zhiqing Tang
- China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing, China
- China Rehabilitation Research Center, Beijing Bo'ai Hospital, Beijing, China
| | - Haitao Lu
- China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing, China
- China Rehabilitation Research Center, Beijing Bo'ai Hospital, Beijing, China
| | - Hao Zhang
- China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing, China
- School of Health and Life Science, University of Health and Rehabilitation Sciences, Qingdao, China
- China Rehabilitation Research Center, Beijing Bo'ai Hospital, Beijing, China
- Cheeloo College of Medicine, Shandong University, Jinan, China
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McMahon D, Dixon D, Quinn T, Gallacher KI. The Acceptability of post-stroke cognitive testing through the lens of the theory of acceptability, a qualitative study. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2023; 6:100197. [PMID: 38226361 PMCID: PMC10788191 DOI: 10.1016/j.cccb.2023.100197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 12/09/2023] [Accepted: 12/18/2023] [Indexed: 01/17/2024]
Abstract
Background Cognitive impairment is common after stroke and screening is recommended. However, there is a lack of evidence on the best way to assess cognition after stroke and a tendency to focus on the clinician rather than stroke survivor. The Theoretical Framework of Acceptability (TFA) was developed to better understand the factors that contribute to the acceptability of healthcare interventions from the patient perspective. We aimed to explore the acceptability of post-stroke cognitive assessment from the stroke survivor perspective, using the TFA as a lens. Methods We analysed interviews conducted with people admitted to hospital after stroke. Inclusion criteria: ≥18 years, able to provide informed consent. Semi-structured interviews were conducted 1-3 weeks after discharge from hospital in the participant's home to explore the experience of cognitive assessment in hospital. Interviews were audio recorded and transcribed verbatim. Data were analysed using framework analysis, with a framework underpinned by the TFA. Results Of the 13 participants interviewed, 8 were male, 6 lived in the most deprived SIMD quintile. Ages were 62-84 years. Five themes were identified that describe the factors that influence acceptability of cognitive screening from the patient perspective: (1) participation motives; (2) trust in health professionals; (3) perceived risks of harm; (4) information provision; (5) burden of testing. Conclusion Clinical teams should be confident that stroke survivors expect cognitive testing and understand its rational. However, the provision of information and results of cognitive testing should be person-centred.
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Affiliation(s)
- David McMahon
- Institute of Cardiovascular and Metabolic Health, Glasgow Royal Infirmary, University of Glasgow, G4 OSF, United Kingdom
| | - Diane Dixon
- Napier University, Craiglockhart Campus, Glenlockhart Road, Edinburgh EH14 1D, United Kingdom
| | - Terry Quinn
- Institute of Cardiovascular and Metabolic Health, Glasgow Royal Infirmary, University of Glasgow, G4 OSF, United Kingdom
| | - Katie I Gallacher
- Institute of Health and Welbeing, University of Glasgow, Clarice Pears Building G12 8TB, United Kingdom
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Embrechts E, McGuckian TB, Rogers JM, Dijkerman CH, Steenbergen B, Wilson PH, Nijboer TCW. Cognitive and Motor Therapy After Stroke Is Not Superior to Motor and Cognitive Therapy Alone to Improve Cognitive and Motor Outcomes: New Insights From a Meta-analysis. Arch Phys Med Rehabil 2023; 104:1720-1734. [PMID: 37295704 DOI: 10.1016/j.apmr.2023.05.010] [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: 01/18/2023] [Revised: 04/18/2023] [Accepted: 05/04/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To evaluate whether cognitive and motor therapy (CMT) is more effective than no therapy, motor therapy, or cognitive therapy on motor and/or cognitive outcomes after stroke. Additionally, this study evaluates whether effects are lasting and which CMT approach is most effective. DATA SOURCES AMED, EMBASE, MEDLINE/PubMed, and PsycINFO databases were searched in October 2022. STUDY SELECTION Twenty-six studies fulfilled the inclusion criteria: randomized controlled trials published in peer-reviewed journals since 2010 that investigated adults with stroke, delivered CMT, and included at least 1 motor, cognitive, or cognitive-motor outcome. Two CMT approaches exist: CMT dual-task ("classical" dual-task where the secondary cognitive task has a distinct goal) and CMT integrated (where cognitive components of the task are integrated into the motor task). DATA EXTRACTION Data on study design, participant characteristics, interventions, outcome measures (cognitive/motor/cognitive-motor), results and statistical analysis were extracted. Multilevel random effects meta-analysis was conducted. DATA SYNTHESIS CMT demonstrated positive effects compared with no therapy on motor outcomes (g=0.49; 95% confidence interval [CI], 0.10, 0.88) and cognitive-motor outcomes (g=0.29; 95% CI, 0.03, 0.54). CMT showed no significant effects compared with motor therapy on motor, cognitive, and cognitive-motor outcomes. A small positive effect of CMT compared with cognitive therapy on cognitive outcomes (g=0.18; 95% CI, 0.01, 0.36) was found. CMT demonstrated no follow-up effect compared with motor therapy (g=0.07; 95% CI, -0.04, 0.18). Comparison of CMT dual-task and integrated revealed no significant difference for motor (F1,141=0.80; P=.371) or cognitive outcomes (F1,72=0.61, P=.439). CONCLUSIONS CMT was not superior to monotherapies in improved outcomes after stroke. CMT approaches were equally effective, suggesting that training that enlists a cognitive load per se may benefit outcomes.
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Affiliation(s)
- Elissa Embrechts
- Rehabilitation Sciences and Physical Therapy, Research group MOVANT, University of Antwerp, Belgium; Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands.
| | - Thomas B McGuckian
- Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Jeffrey M Rogers
- Faculty of Health Sciences, University of Sydney, New South Wales, Australia
| | - Chris H Dijkerman
- Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands
| | - Bert Steenbergen
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Peter H Wilson
- Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Tanja C W Nijboer
- Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands; Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands; Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht, The Netherlands
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Bang M, Jang CW, Kim HS, Park JH, Cho HE. Mobile applications for cognitive training: Content analysis and quality review. Internet Interv 2023; 33:100632. [PMID: 37312799 PMCID: PMC10258500 DOI: 10.1016/j.invent.2023.100632] [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] [Received: 07/10/2022] [Revised: 03/31/2023] [Accepted: 05/25/2023] [Indexed: 06/15/2023] Open
Abstract
Background As the number of individuals suffering from cognitive diseases continues to rise, dealing with the diminished cognitive function that comes with age has become a serious public health concern. While the use of mobile applications (apps) as digital treatments for cognitive training shows promise, the analysis of their content and quality remains unclear. Objective The aim of this study was to systematically search and assess cognitive training apps using the multidimensional mobile app rating scale (MARS) to rate objective quality and identify critical points. Methods A search was conducted on the Google Play Store and Apple App Store in February 2022 using the terms "cognitive training" and "cognitive rehabilitation." The cognitive domains provided by each app were analyzed, and the frequency and percentage according to the apps were obtained. The MARS, a mHealth app quality rating tool including multidimensional measures, was used to analyze the quality of the apps. The relationship between the MARS score, the number of reviews, and 5-star ratings were examined. Results Of the 53 apps, 52 (98 %) included memory function, 48 (91 %) included attention function, 24 (45 %) included executive function, and 19 (36 %) included visuospatial function. The mean (SD) scores of MARS, 5-star ratings, and reviews of 53 apps were 3.09 (0.61), 4.33 (0.30), and 62,415.43 (121,578.77). From the between-section comparison, engagement (mean 2.97, SD 0.68) obtained lower scores than functionality (mean 3.18, SD 0.62), aesthetics (mean 3.13, SD 0.72), and information (mean 3.11, SD 0.54). The mean quality score and reviews showed a statistically significant association (r = 0.447 and P = .001*). As the number of domains increased, the mean quality score showed a statistically significant increasing trend (P = .002*). Conclusions Most apps provided training for the memory and attention domains, but few apps included executive function or visuospatial domains. The quality of the apps improved significantly when more domains were provided, and was positively associated with the number of reviews received. These results could be useful for the future development of mobile apps for cognitive training.
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Affiliation(s)
- Myeonghwan Bang
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
- Department of Integrative Medicine, Yonsei University Graduate School, Seoul, Republic of Korea
| | - Chan Woong Jang
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyoung Seop Kim
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Jung Hyun Park
- Department of Integrative Medicine, Yonsei University Graduate School, Seoul, Republic of Korea
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Medical Device Engineering and Management, Yonsei University Graduate School, Seoul, Korea
| | - Han Eol Cho
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Republic of Korea
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de Miguel Fernandez J, Rey-Prieto M, Rio MSD, Lopez-Matas H, Guirao-Cano L, Font-Llagunes JM, Lobo-Prat J. Adapted Assistance and Resistance Training With a Knee Exoskeleton After Stroke. IEEE Trans Neural Syst Rehabil Eng 2023; 31:3265-3274. [PMID: 37556332 DOI: 10.1109/tnsre.2023.3303777] [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: 08/11/2023]
Abstract
Studies on robotic interventions for gait rehabilitation after stroke require: (i) rigorous performance evidence; (ii) systematic procedures to tune the control parameters; and (iii) combination of control modes. In this study, we investigated how stroke individuals responded to training for two weeks with a knee exoskeleton (ABLE-KS) using both Assistance and Resistance training modes together with auditory feedback to train peak knee flexion angle. During the training, the torque provided by the ABLE-KS and the biofeedback were systematically adapted based on the subject's performance and perceived exertion level. We carried out a comprehensive experimental analysis that evaluated a wide range of biomechanical metrics, together with usability and users' perception metrics. We found significant improvements in peak knee flexion ( p = 0.0016 ), minimum knee angle during stance ( p = 0.0053 ), paretic single support time ( p = 0.0087 ) and gait endurance ( p = 0.022 ) when walking without the exoskeleton after the two weeks of training. Participants significantly ( ) improved the knee angle during the stance and swing phases when walking with the exoskeleton powered in the high Assistance mode in comparison to the No Exo and the Unpowered conditions. No clinically relevant differences were found between Assistance and Resistance training sessions. Participants improved their performance with the exoskeleton (24-55 %) for the peak knee flexion angle throughout the training sessions. Moreover, participants showed a high level of acceptability of the ABLE-KS (QUEST 2.0 score: 4.5 ± 0.3 out of 5). Our preliminary findings suggest that the proposed training approach can produce similar or larger improvements in post-stroke individuals than other studies with knee exoskeletons that used higher training intensities.
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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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Oliveri M, Bagnato S, Rizzo S, Imbornone E, Giustiniani A, Catania A, Turriziani P. A novel digital approach for post-stroke cognitive deficits: a pilot study. Restor Neurol Neurosci 2023; 41:103-113. [PMID: 37522228 DOI: 10.3233/rnn-231305] [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] [Indexed: 08/01/2023]
Abstract
BACKGROUND Cognitive dysfunctions after a brain stroke have a huge impact on patients' disability and activities of daily living. Prism adaptation (PA) is currently used in patients with right brain damage to improve lateralized spatial attentional deficits. Recent findings suggest that PA could also be useful for rehabilitation of other cognitive functions. OBJECTIVE In the present study, we tested for the efficacy on cognitive rehabilitation of a novel device in which the procedure of prism adaptation is digitized and followed by cognitive training of attention and executive functions using serious games. METHODS Thirty stroke patients were randomly assigned to two groups: an experimental group of 15 patients, which performed the experimental rehabilitation training using the novel device in 10 consecutive daily sessions; a control group of 15 patients, which performed the routine cognitive training in 10 consecutive daily sessions. Both groups were tested before and after the rehabilitation program on neuropsychological tests (digit and spatial span forward and backward, attentional matrices, Stroop task) and on functional scales (Barthel index and Beck Anxiety Index). RESULTS The main results showed that only patients who received the experimental rehabilitation training improved their scores on tests of digit span forward, spatial span backward, attentional matrices and Stroop. Moreover, patients of the experimental but not of the control group showed a significant correlation between improvement on some tasks (mainly spatial span backward) and improvement on activities of daily living as well as with reduction of anxiety levels. CONCLUSIONS These results suggest that combining digital PA with cognitive training using serious games may be added in clinical settings for cognitive rehabilitation of stroke patients, with beneficial effects extending in promoting independency in activities of daily living and reduction of psychiatric symptoms.
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Affiliation(s)
- Massimiliano Oliveri
- Department of Biomedicine, Neurosciences and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
| | - Sergio Bagnato
- Rehabilitation Department, Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries, Giuseppe Giglio Foundation, Cefalù, Italy
| | - Silvia Rizzo
- Rehabilitation Department, Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries, Giuseppe Giglio Foundation, Cefalù, Italy
| | - Emilia Imbornone
- Rehabilitation Department, Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries, Giuseppe Giglio Foundation, Cefalù, Italy
| | | | - Angela Catania
- Department of Biomedicine, Neurosciences and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
- Laboratory of Neuropsychology, Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
- International School of Advanced Studies, University of Camerino, Camerino, Italy
| | - Patrizia Turriziani
- Laboratory of Neuropsychology, Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
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