Stroke Rehabilitation and Motor Recovery

Early neurological bedside rehabilitation intervention on the recovery of activities of daily living in stroke patients

BACKGROUND

Stroke is a common neurological disorder that leads to severe functional impairments and reduced quality of life. Early bedside rehabilitation plays a crucial role in recovery, but research on its effectiveness is limited.

METHODS

This study aimed to assess the impact of early bedside rehabilitation on stroke patients. A total of 150 patients were randomly assigned to an intervention group (n = 75) and a control group (n = 75). The intervention group received physical therapy, occupational therapy, and speech therapy within 48 h of stroke onset. The control group received standard care. Assessments included activities of daily living (ADL), motor function, cognitive function, and quality of life.

RESULTS

The intervention group showed significantly better outcomes in ADL, motor function, cognitive function, and quality of life compared to the control group. The intervention group had higher Barthel Index, modified Rankin Scale, Fugl-Meyer Assessment, Montreal Cognitive Assessment (MoCA), and Stroke-Specific Quality of Life Scale (SS-QOL) scores (p < 0.001).

CONCLUSION

Early bedside rehabilitation in the neurology department significantly improves stroke patients' recovery, including ADL, motor function, cognitive function, and quality of life. These findings highlight the importance of early rehabilitation and a comprehensive, multidisciplinary approach in stroke care, which can improve recovery outcomes and overall quality of care.

Identification of Facilitators and Barriers to Functional Ability in Elderly Stroke Patients: A Descriptive Qualitative Study

Purpose

Stroke can cause long-term disability in elderly individuals, and improving the functional ability of patients is vital. This study sought to determine the facilitators and barriers to functional ability in elderly stroke patients from the perspective of healthy aging and to provide a theoretical basis for precise interventions.

Patients and Methods

This study was conducted between December 2023 and January 2024. Eleven patients and eight medical staff from a tertiary hospital were selected for semi-structured interviews using purposive sampling. The interview data were analyzed using thematic analysis.

Results

A total of 19 interviewees participated, including 11 patients and eight medical staff members. Among the patients, four had hemorrhagic stroke and seven had ischemic stroke; ages ranged from 60 to 77 years. Among the medical staff, five had bachelor's degrees and three had master's degrees; ages ranged from 30 to 47 years. Five major themes were identified, including 16 sub-themes. Key themes included: medical service factors, health belief factors, patient factors, family factors, and social/environmental factors.

Conclusion

The core elements for improving the functional ability of patients are establishing a service model of multidisciplinary teamwork; guaranteeing the continuity of in-hospital and home rehabilitation; enriching the form and content of health education to improve patient knowledge of the disease; providing psychological support to alleviate patients' negative emotions; and establishing of effective social safeguards and support systems.

Efficacy and safety of using a unilateral lower limb exoskeleton combined with conventional treatment in post-stroke rehabilitation: a randomized controlled trial

INTRODUCTION

The incidence of hemiplegia caused by stroke is high. In particular, lower limb dysfunction affects the daily activities of patients, and lower limb robotic devices have been proposed to provide rehabilitation therapy to improve balance function in this patient population.

OBJECTIVE

To assess the effectiveness of the LiteStepper® unilateral lower limb exoskeleton (ULLE) combined with conventional treatment for balance function training in patients with post-stroke hemiplegia.

METHODS

This multicenter randomized controlled trial, conducted in the convalescent rehabilitation ward of four hospitals, involved 92 patients in their post-stroke phase. Participants were randomized into an experimental group (EG) or a conventional group (CG). The EG adopted the LiteStepper® ULLE combined with conventional treatment for 21 days. The CG underwent a standard daily rehabilitation routine for 21 days. The Berg Balance Scale (BBS), Functional Ambulation Category scale (FAC), 6-min walk test (6MWT), and Barthel Index (Barthel) were used for evaluations before and after 21 days of rehabilitative training.

RESULTS

The BBS scores in EG was significantly elevated compared to CG, exhibiting a profound statistical difference (P< 0.0001). Notably, these disparities persisted at both day 21 (P < 0.0001) and day 14 (P < 0.0047) post-intervention, underscoring the efficacy of the treatment in the EG. The EG demonstrated a markedly greater improvement in BBS scores from pre-rehabilitation to 21 days post-training, significantly outperforming the CG. Furthermore, at both day 14 and day 21, functional assessments including the FAC, 6MWT, and Barthel revealed improvements in both groups. However, the improvements in the EG were statistically significant compared to the CG at both time points: day 14 (FAC, P = 0.0377; 6MWT, P = 0.0494; Barthel, P = 0.0225) and day 21 (FAC, P = 0.0015; 6MWT, P = 0.0005; Barthel, P = 0.0004). These findings highlight the superiority of the intervention in the EG in enhancing functional outcomes. Regarding safety, the analysis revealed a solitary adverse event (AEs) related to the LiteStepper®ULLE device during the study period, affirming the combination therapy's safety profile when administered alongside conventional balance training in post-stroke hemiplegic patients. This underscores the feasibility and potential of incorporating LiteStepper®ULLE into rehabilitation protocols for this patient population.

DISCUSSION AND SIGNIFICANCE

The LiteStepper® ULLE combined with conventional treatment is effective and safe for balance function training in patients with post-stroke hemiplegia.

Vagus Nerve Stimulation Paired With Upper Extremity Rehabilitation for Chronic Ischemic Stroke: Contribution of Dosage Parameters

BACKGROUND

Vagus nerve stimulation (VNS) combined with rehabilitation is a Food and Drug Administration approved intervention for moderate to severe upper extremity deficits in chronic ischemic stroke patients. Previous studies demonstrated that VNS improves upper extremity motor impairments, using the Fugl Meyer Assessment of Upper Extremity (FMA-UE); however, delineating where these improvements occur, and the role of VNS dosage parameters were not reported.

OBJECTIVE

This study explored the relationship between dosing (time over which task repetitions were executed and number of VNS stimulations) and changes within proximal and distal components of the FMA-UE.

METHODS

Participants underwent VNS implantation, with 1 group receiving VNS paired with rehabilitation (Active VNS) and the other group receiving rehabilitation with sham stimulation (Controls). Both groups received 6 weeks of in-clinic therapy followed by a 90-day at-home, self-rehabilitation program. Participants who completed at least 12 of 18 in-clinic sessions were included in the analyses (n = l06). Pearson correlations and analysis of covariance were used to investigate the relationship between dosing and FMA-UE outcome change along with the effect of covariates including baseline severity, time since stroke, age, and paretic side.

RESULTS

Compared to Controls, active VNS favorably influenced distal function with sustained improvement after the home program. Significant improvements were observed in only distal components (FMdist) at both post day-1 (1.80 points, 95% Cl [0.85, 2.73], P < .001) and post-day 90 (1.62 points, 95% CI [0.45, 2.80], P < .007).

CONCLUSIONS

VNS paired with rehabilitation resulted in significant improvements in wrist and hand impairment compared to Controls, despite similar in-clinic dosing across both groups.NCT03131960.

Exercise preference in stroke survivors: a concept analysis

Background

Exercise preference in stroke survivors is related to their adherence to long-term rehabilitation regimen and functional recovery. Although explored recently, the term exercise preference still lacks a clear definition.

Objective

The aim of this study is to conceptualize exercise preference in stroke survivors.

Methods

The Walker and Avant method was applied as a framework for the conceptual analysis of exercise preference. Data from 34 publications were collected using seven databases (PubMed, Web of Science, Embase, CINAHL, CNKI, Wanfang Data, and CBM) and applied in the analysis. The search period was from the inception of the database to April 30, 2023.

Results

Exercise preference in stroke survivors was defined according to four attributes: priority of choice, behavioral tendency, affective priming, and patience in adherence. The common antecedents of the concept of exercise preference in stroke survivors were classified into patient-related, therapy-related, and environmental-related categories and the consequences were classified into three categories: patient-related, rehabilitation provider-related, and rehabilitation service system-related.

Conclusion

Exercise preference in stroke survivors refers to the patient's choice, tendency, affective response, and attitude toward engagement in the recommended rehabilitation regimen. It is beneficial for understanding the essential attributes of exercise preference in stroke survivors by clarifying the concept. In addition, it will facilitate the development of instruments for assessing exercise preference in stroke survivors and the construction of theory-based intervention programs that can improve adherence to exercise rehabilitation.

Therapeutic robots for post-stroke rehabilitation

Stroke is a prevalent, severe, and disabling health-care issue on a global scale, inevitably leading to motor and cognitive deficits. It has become one of the most significant challenges in China, resulting in substantial social and economic burdens. In addition to the medication and surgical interventions during the acute phase, rehabilitation treatment plays a crucial role in stroke care. Robotic technology takes distinct advantages over traditional physical therapy, occupational therapy, and speech therapy, and is increasingly gaining popularity in post-stroke rehabilitation. The use of rehabilitation robots not only alleviates the workload of healthcare professionals but also enhances the prognosis for specific stroke patients. This review presents a concise overview of the application of therapeutic robots in post-stroke rehabilitation, with particular emphasis on the recovery of motor and cognitive function.