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Lee HS, Kim S, Kim H, Baik SM, Kim DH, Chang WH. No Additional Effects of Sequential Facilitatory Cerebral and Cerebellar rTMS in Subacute Stroke Patients. J Pers Med 2024; 14:687. [PMID: 39063941 PMCID: PMC11278256 DOI: 10.3390/jpm14070687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/20/2024] [Accepted: 06/24/2024] [Indexed: 07/28/2024] Open
Abstract
The aim of this study was to investigate the additional effects of cerebellar rTMS on the motor recovery of facilitatory rTMS over affected primary motor cortex (M1) in subacute stroke patients. Twenty-eight subacute stroke patients were recruited in this single-blind, randomized, controlled trial. The Cr-Cbll group received Cr-Cbll rTMS stimulation consisting of high-frequency rTMS over affected M1 (10 min), motor training (10 min), and high-frequency rTMS over contralesional Cbll (10 min). The Cr-sham group received sham rTMS instead of high-frequency rTMS over the cerebellum. Ten daily sessions were performed for 2 weeks. A Fugl-Meyer Assessment (FMA) was measured before (T0), immediately after (T1), and 2 months after the intervention (T2). A total of 20 participants (10 in the Cr-Cbll group and 10 in the Cr-sham group) completed the intervention. There was no significant difference in clinical characteristics between the two groups at T0. FMA was significantly improved after the intervention in both Cr-Cbll and Cr-sham groups (p < 0.05). However, there was no significant interaction in FMA between time and group. In conclusion, these results could not demonstrate that rTMS over the contralesional cerebellum has additional effects to facilitatory rTMS over the affected M1 for improving motor function in subacute stroke patients.
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Affiliation(s)
- Ho Seok Lee
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Sungwon Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Heegoo Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Seung-min Baik
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Dae Hyun Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
- Department of Health Sciences and Technology, Department of Medical Device Management & Research, Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul 06355, Republic of Korea
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Kolbaşı EN, Huseyinsinoglu BE, Ozdemir Z, Bayraktaroglu Z, Soysal A. Effectiveness of Intermittent Theta Burst Stimulation to Enhance Upper Extremity Recovery After Stroke: A Pilot Study. Arch Phys Med Rehabil 2024:S0003-9993(24)01045-1. [PMID: 38862033 DOI: 10.1016/j.apmr.2024.05.025] [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: 12/07/2023] [Revised: 05/09/2024] [Accepted: 05/17/2024] [Indexed: 06/13/2024]
Abstract
OBJECTIVES To first investigate the effectiveness of modified constraint-ınduced movement therapy (mCIMT) in low-functioning patients with stroke (PwS). Second, we aimed to investigate the efficiency of intermittent theta-burst stimulation (iTBS), applied on intermittent days, in addition to the mCIMT in PwS. DESIGN A randomized, sham-controlled, single-blinded study. SETTING Outpatient clinic. PARTICIPANTS Fifteen PwS (age [mean±SD]: 66.3±9.2 years; 53% female) who were in the first 1 to 12 months after the incident were included in the study. INTERVENTIONS PwS were divided into 3 groups: (1) mCIMT alone; (2) mCIMT + sham iTBS; (3) mCIMT + iTBS. Each group received 15 sessions of mCIMT (1 hour/session, 3 sessions/week). iTBS was applied with 600 pulses on impaired M1 before mCIMT. MAIN OUTCOME MEASURES Upper extremity (UE) impairment was assessed with the Fugl-Meyer Test (FMT-UE), whereas the motor function was evaluated with the Wolf-Motor Function Test (WMFT). Motor Activity Log-28 (MAL-28) was used to evaluate the amount of use and how well (How Well Scale) the impaired UE movements. RESULTS With-in-group analysis revealed that all groups had statistically significant improvements based on the FMT-UE and MAL-28 (p<.05). However, the performance time and arm strength variables of WMFT were only increased in the mCIMT + iTBS group (p<.05). The only between-group difference was observed in the intracortical facilitation in favor of the mCIMT + iTBS group (p<.05). The effect size of iTBS was f=0.18. CONCLUSIONS Our findings suggest that mCIMT with and without the application of iTBS has increased the UE motor function in low-functioning PwS. iTBS applied on intermittent days may have additional benefits as an adjunct therapy for facilitating cortical excitability, increasing the speed and strength of the impaired UE as well as decreasing disability.
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Affiliation(s)
- Esma Nur Kolbaşı
- Department of Physiotherapy and Rehabilitation, Istanbul Medeniyet University, Istanbul; Physiotherapy and Rehabilitation Department, Institute of Graduate Studies, Istanbul University-Cerrahpaşa, Istanbul
| | - Burcu Ersoz Huseyinsinoglu
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Marmara University, Istanbul.
| | - Zeynep Ozdemir
- Department of Neurology, Bakırkoy Prof Dr Mazhar Osman Training and Research Hospital for Psychiatric, Neurologic and Neurosurgical Diseases, Istanbul Health Sciences University, Istanbul
| | - Zubeyir Bayraktaroglu
- Department of Physiology, International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Aysun Soysal
- Department of Neurology, Bakırkoy Prof Dr Mazhar Osman Training and Research Hospital for Psychiatric, Neurologic and Neurosurgical Diseases, Istanbul Health Sciences University, Istanbul
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Yang X, Fengyi W, Yi C, Lin Q, Yang L, Xize L, Shaxin L, Yonghong Y. Effects of robot-assisted upper limb training combined with functional electrical stimulation in stroke patients: study protocol for a randomized controlled trial. Trials 2024; 25:355. [PMID: 38835062 PMCID: PMC11149248 DOI: 10.1186/s13063-024-08199-2] [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: 07/06/2023] [Accepted: 05/27/2024] [Indexed: 06/06/2024] Open
Abstract
INTRODUCTION About 17-80% stroke survivors experience the deficit of upper limb function, which strongly influences their independence and quality of life. Robot-assisted training and functional electrical stimulation are commonly used interventions in the rehabilitation of hemiplegia upper extremities, while the effect of their combination remains unclear. The aim of this trial is to explore the effect of robot-assisted upper limb training combined with functional electrical stimulation, in terms of neuromuscular rehabilitation, compared with robot-assisted upper limb training alone. METHODS Individuals (n = 60) with the first onset of stroke (more than 1 week and less than 1 year after stroke onset) will be considered in the recruitment of this single-blinded, three-arm randomized controlled trial. Participants will be allocated into three groups (robot-assisted training combined with functional electrical stimulation group, robot-assisted training group, and conventional rehabilitation therapies group) with a ratio of 1:1:1. All interventions will be executed for 45 min per session, one session per day, 5 sessions per week for 6 weeks. The neuromuscular function of the upper limb (Fugl-Meyer Assessment of upper extremity), ability of daily life (modified Barthel Index), pain (visual analogue scale), and quality of life (EQ-5D-5L) will be assessed at the baseline, at the end of this trial and after 3 months follow-up. Two-way repeated measures analysis of variance will be used to compare the outcomes if the data are normally distributed. Simple effects tests will be used for the further exploration of interaction effects by time and group. Scheirer-Ray-Hare test will be used if the data are not satisfied with normal distribution. DISCUSSION We expect this three-arm randomized controlled trial to explore the effectiveness of robot-assisted training combined with functional electrical stimulation in improving post-stroke upper limb function compared with robot-assisted training alone. TRIAL REGISTRATION Effect of upper limb robot on improving upper limb function after stroke, identifier: ChiCTR2300073279. Registered on 5 July 2023.
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Affiliation(s)
- Xu Yang
- Rehabilitation Medicine Center, Sichuan University West China Hospital, Chengdu, 611135, Sichuan Province, China
- Sichuan University West China School of Medicine, Chengdu, 611135, Sichuan Province, China
| | - Wang Fengyi
- Rehabilitation Medicine Center, Sichuan University West China Hospital, Chengdu, 611135, Sichuan Province, China
- Sichuan University West China School of Medicine, Chengdu, 611135, Sichuan Province, China
| | - Chen Yi
- Rehabilitation Medicine Center, Sichuan University West China Hospital, Chengdu, 611135, Sichuan Province, China
- Sichuan University West China School of Medicine, Chengdu, 611135, Sichuan Province, China
| | - Qiu Lin
- Rehabilitation Medicine Center, Sichuan University West China Hospital, Chengdu, 611135, Sichuan Province, China
| | - Lin Yang
- Rehabilitation Medicine Center, Sichuan University West China Hospital, Chengdu, 611135, Sichuan Province, China
- Sichuan University West China School of Medicine, Chengdu, 611135, Sichuan Province, China
| | - Li Xize
- Rehabilitation Medicine Center, Sichuan University West China Hospital, Chengdu, 611135, Sichuan Province, China
- Sichuan University West China School of Medicine, Chengdu, 611135, Sichuan Province, China
| | - Liu Shaxin
- Rehabilitation Medicine Center, Sichuan University West China Hospital, Chengdu, 611135, Sichuan Province, China.
- Sichuan University West China School of Medicine, Chengdu, 611135, Sichuan Province, China.
| | - Yang Yonghong
- Rehabilitation Medicine Center, Sichuan University West China Hospital, Chengdu, 611135, Sichuan Province, China.
- Sichuan University West China School of Medicine, Chengdu, 611135, Sichuan Province, China.
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Kolbaşı EN, Huseyinsinoglu BE, Ozdemir Z, Bayraktaroglu Z, Soysal A. Priming constraint-induced movement therapy with intermittent theta burst stimulation to enhance upper extremity recovery in patients with stroke: protocol for a randomized controlled study. Acta Neurol Belg 2024; 124:887-893. [PMID: 38329642 DOI: 10.1007/s13760-024-02472-6] [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: 07/28/2023] [Accepted: 01/03/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND The treatments based on motor control and motor learning principles have gained popularity in the last 20 years, as well as non-invasive brain stimulations that enhance neuroplastic changes after stroke. However, the effect of intermittent theta burst stimulation (iTBS) in addition to evidence-based, intensive neurorehabilitation approaches such as modified constraint-induced movement therapy (mCIMT) is yet to be investigated. AIM We aim to establish a protocol for a randomized controlled study investigating the efficiency of mCIMT primed with iTBS after stroke. METHODS In this randomized controlled, single-blind study, patients with stroke (N = 17) will be divided into 3 groups: (a) mCIMT + real iTBS, (b) mCIMT + sham iTBS, and (c) mCIMT alone. 600-pulse iTBS will be delivered to the primary motor cortex on the ipsilesional hemisphere, and then, patients will receive mCIMT for 1 h/session, 3 sessions/week for 5 weeks. Upper extremity recovery will be assessed with Fugl-Meyer Test-Upper Extremity and Wolf Motor Function Test. Electrophysiological assessments, such as Motor-Evoked Potentials, Resting Motor Threshold, Short-Intracortical Inhibition, and Intracortical Facilitation, will also be included. CONCLUSIONS In this study, a protocol of an ongoing intervention study investigating the effectiveness of iTBS on ipsilesional M1 prior to the mCIMT in patients with stroke is proposed. This will be the first study to research priming mCIMT with iTBS and it may have the potential to reveal the true effect of the iTBS when it is added to the high-quality neurorehabilitation approaches. TRIAL REGISTRATION Trial registration number: NCT05308667.
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Affiliation(s)
- Esma Nur Kolbaşı
- Department of Physiotherapy and Rehabilitation, Istanbul Medeniyet University, Istanbul, Turkey
- Institute of Graduate Studies, Physiotherapy and Rehabilitation Department, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Burcu Ersoz Huseyinsinoglu
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Marmara University, Istanbul, Turkey.
| | - Zeynep Ozdemir
- Department of Neurology, Bakırkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatric, Neurologic and Neurosurgical Diseases, University of Health Sciences, Istanbul, Turkey
| | - Zubeyir Bayraktaroglu
- Department of Physiology, International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Aysun Soysal
- Department of Neurology, Bakırkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatric, Neurologic and Neurosurgical Diseases, University of Health Sciences, Istanbul, Turkey
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Hwang S, Min KC, Song CS. Assistive technology on upper extremity function for stroke patients: A systematic review with meta-analysis. J Hand Ther 2024:S0894-1130(23)00202-8. [PMID: 38796397 DOI: 10.1016/j.jht.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 12/22/2023] [Accepted: 12/30/2023] [Indexed: 05/28/2024]
Abstract
BACKGROUND In stroke rehabilitation, the selection of appropriate assistive devices is of paramount importance for patients. Specifically, the choice of device can significantly influence the functional recovery of the upper limb, impacting their overall activities or functional tasks. OBJECTIVES This review aimed to comprehensively analyze and summarize the clinical evidence from randomized controlled trials (RCTs) regarding the therapeutic effects of commonly used assistive devices on upper extremity function in patients with stroke. METHODS To evaluate assistive devices for patients with stroke, we summarized qualitatively throughout synthesis of results, such as therapeutic intervention, intensity, outcome, and summary of results, and examined risk of bias, heterogeneity, mean difference, 95% confidence interval, and I-squared value. To analyze, we used RoB 2 and RevMan 5.4. RESULTS The qualitative synthesis included 31 RCTs. The randomization process and the reporting of results showed minimal bias, but there were issues with bias from intended interventions, and missing outcome data presented some concerns. The quantitative synthesis included 16 RCTs. There was a significant difference in the Fugl-Meyer assessment-upper extremity functioning (FMA-UE) scores between the groups, with a total mean difference (95% confidence interval) of 2.40 (0.21, 4.60), heterogeneity values were Tau2 = 0.32, chi-square = 8.22, degrees of freedom = 8 (p = 0.41), and I2 = 3% for FMA-UE and the test for the overall effect produced Z = 2.14 (p = 0.03) in patients with chronic stroke. However, there was no significant difference in all other outcome measures. CONCLUSIONS Upper-limb robots did not demonstrate significant superiority over conventional treatments in improving function of upper limbs, with the exception of FMA-UE scores for patients with chronic stroke. The mean difference of FMA-UE was also lower than minimally important difference. Nonetheless, the usage of upper-limb robots may contribute to enhanced function for patients with stroke, as those devices support clinicians and enable a greater number of movement repetitions within specific time frames.
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Affiliation(s)
- Sujin Hwang
- Department of Physical Therapy, Division of Health Science, Baekseok University, Cheonan, Republic of Korea; Graduate School of Health Welfare, Baekseok University, Seoul, Republic of Korea
| | - Kyoung-Chul Min
- Department of Occupational Therpay, Wonkwang University, Republic of Korea
| | - Chiang-Soon Song
- Department of Occupational Therapy, College of Natural Science and Public Health and Safety, Chosun University, Gwangju, Republic of Korea.
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Grewal J, Eng JJ, Sakakibara BM, Schmidt J. The use of virtual reality for activities of daily living rehabilitation after brain injury: A scoping review. Aust Occup Ther J 2024. [PMID: 38757659 DOI: 10.1111/1440-1630.12957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 04/11/2024] [Accepted: 04/14/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION Individuals with acquired brain injury (ABI) experience high rates of poor functional outcomes such as inability to complete activities of daily living (ADL). Occupational therapy needs to be customised to the individual's function, goals, and environment to facilitate improvement in ADLs after ABI. Virtual reality (VR) is a novel treatment approach that aims to improve skills within an individualised environment. This study aimed to review the current literature for the use of VR platforms that incorporate ADLs to improve functional outcomes after ABI. METHODS This review followed the six-stage framework by Arksey & O'Malley (2005). Electronic databases were searched for peer-reviewed journal articles based on inclusion and exclusion criteria. RESULTS One thousand and six hundred eighty articles were screened, including 413 full text articles and 13 articles were included for review. Among the 13 articles, six were RCTs and the rest were pre-post intervention studies. Studies largely used non-immersive VR platforms, which incorporated ADLs such as grocery shopping, aiming to improve functional outcomes. CONSUMER AND COMMUNITY CONSULTATION Consumer and community were not involved in executing this study. CONCLUSION This review suggests mixed results if VR is effective at treating upper limb, cognition, and ADL function after ABI. Using their clinical reasoning, occupational therapists can determine the suitability of VR for ADL rehabilitation for specific patient populations and settings. Plain Language Summary Individuals who sustain an acquired brain injury can have difficulty performing their daily activities such as, making a meal or getting dressed, because of limited function (e.g., physical and cognitive problems). To help improve their ability to complete daily activities, occupational therapy needs to be customised to the individual's function, goals, and environment. Virtual reality is a new rehabilitation approach that allows individuals to improve their function in an individualised environment. In this study, we reviewed the current studies that have used virtual reality platforms that incorporate daily activities to improve function after acquired brain injury. We searched databases and screened the titles and abstracts of 1,680 studies. Then, 413 full-text studies were screened, and 13 studies were included. Studies mostly used non-immersive platforms to practise daily activities such as, grocery shopping, aiming to improve function after acquired brain injury. This review suggests mixed results if virtual reality can effectively treat function after acquired brain injury.
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Affiliation(s)
- Jasleen Grewal
- Rehabilitation Sciences Graduate Program, University of British Columbia, Canada
- Rehabilitation Research Program, Centre for Aging SMART at Vancouver Coastal Health, Canada
| | - Janice J Eng
- Rehabilitation Research Program, Centre for Aging SMART at Vancouver Coastal Health, Canada
- Department of Physical Therapy, University of British Columbia, Canada
| | - Brodie M Sakakibara
- Rehabilitation Research Program, Centre for Aging SMART at Vancouver Coastal Health, Canada
- Centre for Chronic Disease Prevention and Management, Canada
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Canada
| | - Julia Schmidt
- Rehabilitation Research Program, Centre for Aging SMART at Vancouver Coastal Health, Canada
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Canada
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Lo YT, Lim MJR, Kok CY, Wang S, Blok SZ, Ang TY, Ng VYP, Rao JP, Chua KSG. Neural Interface-Based Motor Neuroprosthesis in Poststroke Upper Limb Neurorehabilitation: An Individual Patient Data Meta-analysis. Arch Phys Med Rehabil 2024:S0003-9993(24)00910-9. [PMID: 38579958 DOI: 10.1016/j.apmr.2024.04.001] [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: 11/29/2023] [Revised: 03/28/2024] [Accepted: 04/01/2024] [Indexed: 04/07/2024]
Abstract
OBJECTIVE To determine the efficacy of neural interface-based neurorehabilitation, including brain-computer interface, through conventional and individual patient data (IPD) meta-analysis and to assess clinical parameters associated with positive response to neural interface-based neurorehabilitation. DATA SOURCES PubMed, EMBASE, and Cochrane Library databases up to February 2022 were reviewed. STUDY SELECTION Studies using neural interface-controlled physical effectors (functional electrical stimulation and/or powered exoskeletons) and reported Fugl-Meyer Assessment-upper-extremity (FMA-UE) scores were identified. This meta-analysis was prospectively registered on PROSPERO (#CRD42022312428). PRISMA guidelines were followed. DATA EXTRACTION Changes in FMA-UE scores were pooled to estimate the mean effect size. Subgroup analyses were performed on clinical parameters and neural interface parameters with both study-level variables and IPD. DATA SYNTHESIS Forty-six studies containing 617 patients were included. Twenty-nine studies involving 214 patients reported IPD. FMA-UE scores increased by a mean of 5.23 (95% confidence interval [CI]: 3.85-6.61). Systems that used motor attempt resulted in greater FMA-UE gain than motor imagery, as did training lasting >4 vs ≤4 weeks. On IPD analysis, the mean time-to-improvement above minimal clinically important difference (MCID) was 12 weeks (95% CI: 7 to not reached). At 6 months, 58% improved above MCID (95% CI: 41%-70%). Patients with severe impairment (P=.042) and age >50 years (P=.0022) correlated with the failure to improve above the MCID on univariate log-rank tests. However, these factors were only borderline significant on multivariate Cox analysis (hazard ratio [HR] 0.15, P=.08 and HR 0.47, P=.06, respectively). CONCLUSION Neural interface-based motor rehabilitation resulted in significant, although modest, reductions in poststroke impairment and should be considered for wider applications in stroke neurorehabilitation.
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Affiliation(s)
- Yu Tung Lo
- Department of Neurosurgery, National Neuroscience Institute; Duke-NUS Medical School.
| | - Mervyn Jun Rui Lim
- Department of Neurosurgery, National University Hospital; National University of Singapore, Yong Loo Lin School of Medicine
| | - Chun Yen Kok
- Department of Neurosurgery, National Neuroscience Institute
| | - Shilin Wang
- Department of Neurosurgery, National Neuroscience Institute
| | | | - Ting Yao Ang
- Department of Neurosurgery, National Neuroscience Institute
| | | | - Jai Prashanth Rao
- Department of Neurosurgery, National Neuroscience Institute; Duke-NUS Medical School
| | - Karen Sui Geok Chua
- National University of Singapore, Yong Loo Lin School of Medicine; Institute of Rehabilitation Excellence, Tan Tock Seng Hospital Rehabilitation Centre; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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Robinson-Bert K, Woods AB. Effectiveness of synchronous action observation and mental practice on upper extremity motor recovery after stroke. Occup Ther Health Care 2024; 38:196-213. [PMID: 36309807 DOI: 10.1080/07380577.2022.2138675] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 09/02/2022] [Accepted: 10/15/2022] [Indexed: 06/16/2023]
Abstract
The purpose of this quasi-experimental pretest-posttest control group study was to examine the effect of group synchronous action observation/mental practice intervention compared to usual rehabilitation care on upper extremity motor recovery after stroke. The intervention group (n = 25) received usual care, consisting of a minimum of 3 hours of rehabilitation services per day, 5 days a week, plus group synchronous action observation/mental practice sessions 3 times per week and the control group (n = 26) received usual care. Outcome measures included the Kinesthetic and Visual Imagery Questionnaire Short Version (KVIQ-10), the Fugl-Meyer Assessment (FMA-UE) of affected upper extremity motor function only and The Box and Block Test (BBT). Although there were no statistically significant differences in upper extremity motor function between the two groups, a subgroup analysis of the intervention group identified statistically significant (FMA-UE: p < .001; BBT: p = .04) and Minimally Important Clinical Differences on upper extremity motor recovery between patients with behaviors demonstrating more versus less commitment to the intervention. Group synchronous action observation/mental practice is a promising intervention for patients demonstrating commitment to actively participating in the intervention to improve outcomes on upper extremity motor recovery after stroke.
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Affiliation(s)
| | - Anne B Woods
- Graduate Program in Nursing, Messiah University, Mechanicsburg, PA, USA
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Fernández-Solana J, Álvarez-Pardo S, Moreno-Villanueva A, Santamaría-Peláez M, González-Bernal JJ, Vélez-Santamaría R, González-Santos J. Efficacy of a Rehabilitation Program Using Mirror Therapy and Cognitive Therapeutic Exercise on Upper Limb Functionality in Patients with Acute Stroke. Healthcare (Basel) 2024; 12:569. [PMID: 38470680 PMCID: PMC10931296 DOI: 10.3390/healthcare12050569] [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: 12/13/2023] [Revised: 01/26/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
Applying evidence-based therapies in stroke rehabilitation plays a crucial role in this process, as they are supported by studies and results that demonstrate their effectiveness in improving functionality, such as mirror therapy (MT), cognitive therapeutic exercise (CTE), and task-oriented training. The aim of this study was to assess the effectiveness of MT and CTE combined with task-oriented training on the functionality, sensitivity, range, and pain of the affected upper limb in patients with acute stroke. A longitudinal multicenter study recruited a sample of 120 patients with acute stroke randomly and consecutively, meeting specific inclusion and exclusion criteria. They were randomly allocated into three groups: a control group only for task-oriented training (TOT) and two groups undergoing either MT or CTE, both combined with TOT. The overall functionality of the affected upper limb, specific functionality, sensitivity, range of motion, and pain were assessed using the Fugl-Meyer Assessment Upper Extremity (FMA-UE) scale validated for the Spanish population. An initial assessment was conducted before the intervention, a second assessment after completing the 20 sessions, and another three months later. ANCOVA analysis revealed statistically significant differences between the assessments and the experimental groups compared to the control group, indicating significant improvement in the overall functionality of the upper limb in these patients. However, no significant differences were observed between the two experimental groups. The conclusion drawn was that both therapeutic techniques are equally effective in treating functionality, sensitivity, range of motion, and pain in the upper limb following a stroke.
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Affiliation(s)
- Jessica Fernández-Solana
- Department of Health Sciences, University of Burgos, 09001 Burgos, Spain; (J.F.-S.); (M.S.-P.); (J.J.G.-B.); (R.V.-S.); (J.G.-S.)
| | | | - Adrián Moreno-Villanueva
- Faculty of Health Science, University Isabel I, 09003 Burgos, Spain;
- BioVetMed & SportSci Research Group, Department of Physical activity and Sport, Faculty of Sport Sciences, University of Murcia, San Javier, 30720 Murcia, Spain
| | - Mirian Santamaría-Peláez
- Department of Health Sciences, University of Burgos, 09001 Burgos, Spain; (J.F.-S.); (M.S.-P.); (J.J.G.-B.); (R.V.-S.); (J.G.-S.)
| | - Jerónimo J. González-Bernal
- Department of Health Sciences, University of Burgos, 09001 Burgos, Spain; (J.F.-S.); (M.S.-P.); (J.J.G.-B.); (R.V.-S.); (J.G.-S.)
| | - Rodrigo Vélez-Santamaría
- Department of Health Sciences, University of Burgos, 09001 Burgos, Spain; (J.F.-S.); (M.S.-P.); (J.J.G.-B.); (R.V.-S.); (J.G.-S.)
| | - Josefa González-Santos
- Department of Health Sciences, University of Burgos, 09001 Burgos, Spain; (J.F.-S.); (M.S.-P.); (J.J.G.-B.); (R.V.-S.); (J.G.-S.)
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Van Bladel A, De Ridder R, Palmans T, Van der Looven R, Verheyden G, Meyns P, Cambier D. Defining characteristics of independent walking persons after stroke presenting with different arm swing coordination patterns. Hum Mov Sci 2024; 93:103174. [PMID: 38160498 DOI: 10.1016/j.humov.2023.103174] [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: 12/21/2023] [Accepted: 12/23/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Persons after stroke present with an altered arm swing during walking. Given the known influence of the arm swing on gait, it is important to identify the characteristics of persons with stroke with different arm-to-leg coordination patterns during walking. METHODS Twenty-five persons after stroke walked on a self-paced treadmill at comfortable walking speed. The frequency of shoulder movements per stride was detected by Fast Fourier transform analysis on the kinematic data for hemiplegic shoulder movements in the sagittal plane. An independent-sample t-test or Mann-Whitney U test was used to compare clinical and biomechanical parameters between identified subgroups. RESULTS Two earlier described subgroups based on the number of shoulder flexion-extension movements during one stride could be confirmed. Participants in the 1:1 ratio subgroup (one arm swing during one stride, N = 15) presented with a less upper limb impairment and less spasticity of the elbow extensors (p = 0.012) than the participants in the 2:1 ratio subgroup (two arm swings during one stride, N = 9). Although not significant, the participants in the 1:1 subgroup also seemed to have less spasticity of the shoulder internal rotators (p = 0.06) and a less walking variability based on the standard deviation of the step width. Further research on a greater sample should confirm these findings. CONCLUSION Fast Fourier transform analysis was used to identify subgroups based on sagittal shoulder kinematics during walking. The clinical and gait related differences between the identified subgroups can be taken into account in future research investigating post-stroke gait interventions aiming to improve the arm swing.
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Affiliation(s)
- Anke Van Bladel
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium; Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium.
| | - Roel De Ridder
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.
| | - Tanneke Palmans
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.
| | - Ruth Van der Looven
- Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium.
| | - Geert Verheyden
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.
| | - Pieter Meyns
- Rehabilitation Research group (REVAL), Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium.
| | - Dirk Cambier
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.
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Maeda H, Hishikawa N, Sawada K, Sakurai M, Ohashi S, Mikami Y. Wearable Integrated Volitional Control Electrical Stimulation Device as Treatment for Paresis of the Upper Extremity in Early Subacute Stroke Patients: A Randomized Controlled Non-inferiority Trial. Arch Phys Med Rehabil 2024; 105:227-234. [PMID: 37714508 DOI: 10.1016/j.apmr.2023.08.031] [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: 04/25/2023] [Revised: 08/23/2023] [Accepted: 08/25/2023] [Indexed: 09/17/2023]
Abstract
OBJECTIVE To investigate the effect of a wearable integrated volitional control electrical stimulation (WIVES) device that has been developed as more compact and simpler to use in daily life compared with conventional integrated volitional control electrical stimulation (IVES) devices. DESIGN Randomized controlled non-inferiority trial. SETTING Convalescent rehabilitation ward. PARTICIPANTS Patients with paresis of the upper extremity (UE) after early subacute stroke (N=20). INTERVENTIONS Eligible patients were randomized to receive IVES treatment or WIVES treatment for 8 hours per day for 28 days in daily living, in addition to standard rehabilitation treatment. In both groups, the extensor digitorum communis on the affected side was the target muscle for stimulation. MAIN OUTCOME MEASURE Primary outcomes were assessed with Fugl-Meyer Assessment of the UE (FMA-UE) before and after treatment. Non-inferiority was determined with a specified margin of non-inferiority. RESULTS Twenty patients completed the trial (IVES group: n=10, WIVES group: n=10). FMA-UE improved in both groups. The mean change in FMA-UE was 4.7 for the IVES group and 6.0 for the WIVES group (P>.05, 95% confidence interval: -6.73 to 4.13). The mean difference between the groups was 1.3, and the upper 95% confidence interval did not exceed the non-inferiority margin. CONCLUSION The effectiveness of WIVES treatment is non-inferior to that of IVES treatment. As a portable device, IVES may facilitate the use of affected upper extremities in daily living and may help improve paresis of the UE.
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Affiliation(s)
- Hiroshi Maeda
- Department of Rehabilitation Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan; Department of Rehabilitation, Gakusai Hospital, Kyoto Interdisciplinary Institute of Community Medicine, Kyoto, Japan
| | - Norikazu Hishikawa
- Department of Rehabilitation Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Koshiro Sawada
- Department of Rehabilitation Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan; Department of Development of Multidisciplinary Promote for Physical Activity, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Momoko Sakurai
- Department of Rehabilitation Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan; Department of Rehabilitation, Gakusai Hospital, Kyoto Interdisciplinary Institute of Community Medicine, Kyoto, Japan
| | - Suzuyo Ohashi
- Department of Rehabilitation Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yasuo Mikami
- Department of Rehabilitation Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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12
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Tang CW, Zich C, Quinn AJ, Woolrich MW, Hsu SP, Juan CH, Lee IH, Stagg CJ. Post-stroke upper limb recovery is correlated with dynamic resting-state network connectivity. Brain Commun 2024; 6:fcae011. [PMID: 38344655 PMCID: PMC10853981 DOI: 10.1093/braincomms/fcae011] [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: 02/02/2023] [Revised: 11/25/2023] [Accepted: 01/22/2024] [Indexed: 03/02/2024] Open
Abstract
Motor recovery is still limited for people with stroke especially those with greater functional impairments. In order to improve outcome, we need to understand more about the mechanisms underpinning recovery. Task-unbiased, blood flow-independent post-stroke neural activity can be acquired from resting brain electrophysiological recordings and offers substantial promise to investigate physiological mechanisms, but behaviourally relevant features of resting-state sensorimotor network dynamics have not yet been identified. Thirty-seven people with subcortical ischaemic stroke and unilateral hand paresis of any degree were longitudinally evaluated at 3 weeks (early subacute) and 12 weeks (late subacute) after stroke. Resting-state magnetoencephalography and clinical scores of motor function were recorded and compared with matched controls. Magnetoencephalography data were decomposed using a data-driven hidden Markov model into 10 time-varying resting-state networks. People with stroke showed statistically significantly improved Action Research Arm Test and Fugl-Meyer upper extremity scores between 3 weeks and 12 weeks after stroke (both P < 0.001). Hidden Markov model analysis revealed a primarily alpha-band ipsilesional resting-state sensorimotor network which had a significantly increased life-time (the average time elapsed between entering and exiting the network) and fractional occupancy (the occupied percentage among all networks) at 3 weeks after stroke when compared with controls. The life-time of the ipsilesional resting-state sensorimotor network positively correlated with concurrent motor scores in people with stroke who had not fully recovered. Specifically, this relationship was observed only in ipsilesional rather in contralesional sensorimotor network, default mode network or visual network. The ipsilesional sensorimotor network metrics were not significantly different from controls at 12 weeks after stroke. The increased recruitment of alpha-band ipsilesional resting-state sensorimotor network at subacute stroke served as functionally correlated biomarkers exclusively in people with stroke with not fully recovered hand paresis, plausibly reflecting functional motor recovery processes.
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Affiliation(s)
- Chih-Wei Tang
- Institute of Brain Science, Brain Research Center, National Yang Ming Chiao Tung University, Taipei City 112, Taiwan
- Department of Neurology, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan
| | - Catharina Zich
- Nuffield Department of Clinical Neurosciences, Wellcome Centre for Integrative Neuroimaging, FMRIB, University of Oxford, Oxford OX3 9DU, UK
- MRC Brain Network Dynamics Unit, University of Oxford, Oxford, OX1 3TH, UK
| | - Andrew J Quinn
- Nuffield Department of Clinical Neurosciences, Wellcome Centre for Integrative Neuroimaging, FMRIB, University of Oxford, Oxford OX3 9DU, UK
- Department of Psychiatry, Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford OX3 7JX, UK
- Centre for Human Brain Health, School of Psychology, University of Birmingham, Birmingham B15 2TT, UK
| | - Mark W Woolrich
- Nuffield Department of Clinical Neurosciences, Wellcome Centre for Integrative Neuroimaging, FMRIB, University of Oxford, Oxford OX3 9DU, UK
- Department of Psychiatry, Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford OX3 7JX, UK
| | - Shih-Pin Hsu
- Institute of Brain Science, Brain Research Center, National Yang Ming Chiao Tung University, Taipei City 112, Taiwan
| | - Chi-Hung Juan
- Institute of Cognitive Neuroscience, National Central University, Taoyuan City 320, Taiwan
| | - I Hui Lee
- Institute of Brain Science, Brain Research Center, National Yang Ming Chiao Tung University, Taipei City 112, Taiwan
- Division of Cerebrovascular Diseases, Neurological Institute, Taipei Veterans General Hospital, Taipei City 112, Taiwan
| | - Charlotte J Stagg
- Nuffield Department of Clinical Neurosciences, Wellcome Centre for Integrative Neuroimaging, FMRIB, University of Oxford, Oxford OX3 9DU, UK
- MRC Brain Network Dynamics Unit, University of Oxford, Oxford, OX1 3TH, UK
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Broderick M, Burridge J, Demain S, Johnson L, Brereton J, O'Shea R, Bentley P. Multicentre pilot randomised control trial of a self-directed exergaming intervention for poststroke upper limb rehabilitation: research protocol. BMJ Open 2024; 14:e077121. [PMID: 38245014 PMCID: PMC10806628 DOI: 10.1136/bmjopen-2023-077121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 12/21/2023] [Indexed: 01/22/2024] Open
Abstract
INTRODUCTION Technology-facilitated, self-directed upper limb (UL) rehabilitation, as an adjunct to conventional care, could enhance poststroke UL recovery compared with conventional care alone, without imposing additional resource burden. The proposed pilot randomised controlled trial (RCT) aims to assess whether stroke survivors will engage in self-directed UL training, explore factors associated with intervention adherence and evaluate the study design for an RCT testing the efficacy of a self-directed exer-gaming intervention for UL recovery after stroke. METHODS AND ANALYSIS This is a multicentre, internal pilot RCT; parallel design, with nested qualitative methods. The sample will consist of stroke survivors with UL paresis, presenting within the previous 30 days. Participants randomised to the intervention group will be trained to use an exergaming device and will be supported to adopt this as part of their self-directed rehabilitation (ie, without formal support/supervision) for a 3-month period. The primary outcome will be the Fugl Meyer Upper Extremity Assessment (FM-UE) at 6 months poststroke. Secondary outcomes are the Action Research Arm Test (ARAT), the Barthel Index and the Modified Rankin Scale. Assessment time points will be prior to randomisation (0-1 month poststroke), 3 months and 6 months poststroke. A power calculation to inform sample size required for a definitive RCT will be conducted using FM-UE data from the sample across 0-6 months time points. Semistructured qualitative interviews will examine factors associated with intervention adoption. Reflexive thematic analysis will be used to code qualitative interview data and generate key themes associated with intervention adoption. ETHICS AND DISSEMINATION The study protocol (V.1.9) was granted ethical approval by the Health Research Authority, Health and Care Research Wales, and the London- Harrow Research Ethics Committee (ref. 21/LO/0054) on 19 May 2021. Trial results will be submitted for publication in peer-reviewed journals, presented at national and international stroke meetings and conferences and disseminated among stakeholder communities. TRIAL REGISTRATION NUMBER NCT04475692.
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Affiliation(s)
| | - Jane Burridge
- Life Sciences, University of Southampton, Southampton, UK
| | - Sara Demain
- Life Sciences, University of Southampton, Southampton, UK
| | - Louise Johnson
- Life Sciences, University of Southampton, Southampton, UK
- University Hospitals Dorset NHS Foundation Trust, Poole, UK
| | - Joe Brereton
- University Hospitals Dorset NHS Foundation Trust, Poole, UK
| | | | - Paul Bentley
- Brain Sciences, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
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14
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Mishra B, Sudheer P, Agarwal A, Nilima N, Srivastava MVP, Vishnu VY. Minimal Clinically Important Difference of Scales Reported in Stroke Trials: A Review. Brain Sci 2024; 14:80. [PMID: 38248295 PMCID: PMC10813687 DOI: 10.3390/brainsci14010080] [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: 12/15/2023] [Revised: 01/07/2024] [Accepted: 01/10/2024] [Indexed: 01/23/2024] Open
Abstract
There is a growing awareness of the significance of using minimum clinically important differences (MCIDs) in stroke research. An MCID is the smallest change in an outcome measure that is considered clinically meaningful. This review is the first to provide a comprehensive summary of various scales and patient-reported outcome measures (PROMs) used in stroke research and their MCID values reported in the literature, including a concise overview of the concept of and methods for determining MCIDs in stroke research. Despite the controversies and limitations surrounding the estimation of MCIDs, their importance in modern clinical trials cannot be overstated. Anchor-based and distribution-based methods are recommended for estimating MCIDs, with patient self-evaluation being a crucial component in capturing the patient's perspective on their health. A combination of methods can provide a more comprehensive understanding of the clinical relevance of treatment effects, and incorporating the patient's perspective can enhance the care of stroke patients.
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Affiliation(s)
- Biswamohan Mishra
- Department of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India; (B.M.); (P.S.); (A.A.); (M.V.P.S.)
| | - Pachipala Sudheer
- Department of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India; (B.M.); (P.S.); (A.A.); (M.V.P.S.)
| | - Ayush Agarwal
- Department of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India; (B.M.); (P.S.); (A.A.); (M.V.P.S.)
| | - Nilima Nilima
- Department of Biostatics, All India Institute of Medical Sciences, New Delhi 110029, India;
| | | | - Venugopalan Y. Vishnu
- Department of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India; (B.M.); (P.S.); (A.A.); (M.V.P.S.)
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15
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Okamura R, Nakashima A, Moriuchi T, Fujiwara K, Ohno K, Higashi T, Tomori K. Effects of a virtual reality-based mirror therapy system on upper extremity rehabilitation after stroke: a systematic review and meta-analysis of randomized controlled trials. Front Neurol 2024; 14:1298291. [PMID: 38259644 PMCID: PMC10800725 DOI: 10.3389/fneur.2023.1298291] [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: 09/23/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction Virtual reality-based mirror therapy (VRMT) has recently attracted attention as a novel and promising approach for treating upper extremity dysfunction in patients with stroke. However, the clinical efficacy of VRMT has not been investigated. Methods This study aimed to conduct a meta-analysis to evaluate the effects of VRMT on upper extremity dysfunction in patients with stroke. We screened articles published between January 2010 and July 2022 in PubMed, Scopus, MEDLINE, and Cochrane Central Register of Controlled Trials. Our inclusion criteria focused on randomized controlled trials (RCTs) comparing VRMT groups with control groups (e.g., conventional mirror therapy, occupational therapy, physical therapy, or sham therapy). The outcome measures included the Fugl-Meyer assessment upper extremity test (FMA-UE), the box and block test (BBT), and the manual function test (MFT). Risk of bias was assessed using the Cochrane Collaboration risk-of-bias tool 2.0. We calculated the standardized mean differences (SMD) and 95% confidence intervals (95% CI). The experimental protocol was registered in the PROSPERO database (CRD42022345756). Results This study included five RCTs with 148 stroke patients. The meta-analysis showed statistical differences in the results of FMA-UE [SMD = 0.81, 95% CI (0.52, 1.10), p < 0.001], BBT [SMD = 0.48, 95% CI (0.16, 0.80), p = 0.003], and MFT [SMD = 0.72, 95% CI (0.05, 1.40), p = 0.04] between the VRMT and the control groups. Discussion VRMT may play a beneficial role in improving upper extremity dysfunction after stroke, especially when combined with conventional rehabilitation. However, there were differences in the type of VRMT, stage of disease, and severity of upper extremity dysfunction. Multiple reports of high-quality RCTs are needed to clarify the effects of VRMT. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD42022345756.
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Affiliation(s)
- Ryohei Okamura
- Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Akira Nakashima
- Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Takefumi Moriuchi
- Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Kengo Fujiwara
- Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Kanta Ohno
- Major of Occupational Therapy, Department of Rehabilitation, School of Health Science, Tokyo University of Technology, Tokyo, Japan
| | - Toshio Higashi
- Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Kounosuke Tomori
- Major of Occupational Therapy, Department of Rehabilitation, School of Health Science, Tokyo University of Technology, Tokyo, Japan
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16
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Lv Y, Zhang JJ, Wang K, Ju L, Zhang H, Zhao Y, Pan Y, Gong J, Wang X, Fong KNK. Determining the Optimal Stimulation Sessions for TMS-Induced Recovery of Upper Extremity Motor Function Post Stroke: A Randomized Controlled Trial. Brain Sci 2023; 13:1662. [PMID: 38137110 PMCID: PMC10741851 DOI: 10.3390/brainsci13121662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 11/23/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023] Open
Abstract
To find out the optimal treatment sessions of repetitive transcranial magnetic stimulation (TMS) over the primary motor cortex (M1) for upper extremity dysfunction after stroke during the 6-week treatment and to explore its mechanism using motor-evoked potentials (MEPs) and resting-state functional magnetic resonance imaging (rs-fMRI), 72 participants with upper extremity motor dysfunction after ischemic stroke were randomly divided into the control group, 10-session, 20-session, and 30-session rTMS groups. Low-frequency (1 Hz) rTMS over the contralesional M1 was applied in all rTMS groups. The motor function of the upper extremity was assessed before and after treatment. In addition, MEPs and rs-fMRI data were analyzed to detect its effect on brain reorganization. After 6 weeks of treatment, there were significant differences in the Fugl-Meyer Assessment of the upper extremity and the Wolf Motor Function Test scores between the 10-session group and the 30-session group and between the 20- and 30-session groups and the control group, while there was no significant difference between the 20-session group and the 30-session group. Meanwhile, no significant difference was found between the 10-session group and the control group. The 20-session group of rTMS decreased the excitability of the contralesional corticospinal tract represented by the amplitudes of MEPs and enhanced the functional connectivity of the ipsilesional M1 or premotor cortex with the the precentral gyrus, postcentral gyrus, and cingulate gyrus, etc. In conclusion, the 20-session of rTMS protocol is the optimal treatment sessions of TMS for upper extremity dysfunction after stroke during the 6-week treatment. The potential mechanism is related to its influence on the excitability of the corticospinal tract and the remodeling of corticomotor functional networks.
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Affiliation(s)
- Yichen Lv
- School of Rehabilitation Medicine, Binzhou Medical University, Yantai 264000, China
- Department of Rehabilitation Medicine, Clinical Medical College, Yangzhou University, Yangzhou 225001, China
| | - Jack Jiaqi Zhang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Kui Wang
- Department of Rehabilitation Medicine, Clinical Medical College, Yangzhou University, Yangzhou 225001, China
| | - Leilei Ju
- Department of Rehabilitation Medicine, Clinical Medical College, Yangzhou University, Yangzhou 225001, China
| | - Hongying Zhang
- Department of Medical Imaging, Clinical Medical College, Yangzhou University, Yangzhou 225001, China
| | - Yuehan Zhao
- School of Rehabilitation Medicine, Binzhou Medical University, Yantai 264000, China
- Department of Rehabilitation Medicine, Clinical Medical College, Yangzhou University, Yangzhou 225001, China
| | - Yao Pan
- School of Rehabilitation Medicine, Binzhou Medical University, Yantai 264000, China
- Department of Rehabilitation Medicine, Clinical Medical College, Yangzhou University, Yangzhou 225001, China
| | - Jianwei Gong
- School of Rehabilitation Medicine, Binzhou Medical University, Yantai 264000, China
| | - Xin Wang
- Department of Rehabilitation Medicine, Clinical Medical College, Yangzhou University, Yangzhou 225001, China
| | - Kenneth N. K. Fong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
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Gutiérrez-Suárez A, Pérez-Rodríguez M, García-Hernández JJ, Rodríguez-Romero B. A Randomized Controlled Trial to Evaluate the Impact of an Exercise Therapy Program Based on Sports in People with Acquired Brain Injury: Discover Study Protocol. J Clin Med 2023; 12:7068. [PMID: 38002681 PMCID: PMC10671999 DOI: 10.3390/jcm12227068] [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: 09/18/2023] [Revised: 11/03/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
INTRODUCTION Acquired brain injury (ABI) constitutes a significant and growing global public health concern. People with ABI often face a range of physical and psychosocial challenges that span the domains of "body structure and function", "activity", and "participation", as defined by the International Classification of Functioning, Disability, and Health. Multidisciplinary approaches based on exercise therapy with social leisure activities are essential to improve physical recovery and health-related quality of life after injury. METHODS Adults with ABI, aged > 18 years, in the subacute or chronic stage (within more than one month after the injury) will be recruited through a rehabilitation center. Adults will be randomized to receive either a racket sports-based exercise therapy program combined with usual care (sET) or usual care alone (UC) using a random number sequence with a 1:1 allocation ratio. sET intervention consists of an 8-week exercise therapy program focusing on different racket sports skills, 1 h in duration, 2 days/week. It will be delivered by a physiotherapist in tailored, face-to-face, group-based sessions. Primary outcomes will be the health-related quality of life (SF-36) and upper extremity motor function (Fugl-Meyer Assessment-Upper Extremity Scale). DISCUSSION The study proposes an intervention that combines sports-based exercise therapy with usual care. It aims to determine whether this intervention improves the health-related quality of life and upper limb motor function in adults with ABI compared with usual care alone. The results of this study may have clinical implications for the rehabilitation of this population.
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Affiliation(s)
- Andrea Gutiérrez-Suárez
- University of A Coruña, Psychosocial Intervention and Functional Rehabilitation Research Group, Department of Physiotherapy, Medicine and Biomedical Sciences, Faculty of Physiotherapy, Oza, 15071 A Coruña, Spain
| | - Marta Pérez-Rodríguez
- AFIPE Research Group, Faculty of Physical Activity and Sports Sciences, Universidad Politécnica de Madrid, 28040 Madrid, Spain
- Segunda Parte Foundation, 28034 Madrid, Spain
| | - Juan José García-Hernández
- Segunda Parte Foundation, 28034 Madrid, Spain
- Faculty of Health Sciences, Exercise and Sport Sciences, University of Francisco de Vitoria, 28223 Pozuelo de Alarcón, Spain
| | - Beatriz Rodríguez-Romero
- University of A Coruña, Psychosocial Intervention and Functional Rehabilitation Research Group, Department of Physiotherapy, Medicine and Biomedical Sciences, Faculty of Physiotherapy, Oza, 15071 A Coruña, Spain
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Williamson JN, James SA, He D, Li S, Sidorov EV, Yang Y. High-definition transcranial direct current stimulation for upper extremity rehabilitation in moderate-to-severe ischemic stroke: a pilot study. Front Hum Neurosci 2023; 17:1286238. [PMID: 37900725 PMCID: PMC10602806 DOI: 10.3389/fnhum.2023.1286238] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 09/20/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction Previous studies found that post-stroke motor impairments are associated with damage to the lesioned corticospinal tract (CST) and hyperexcitability of the contralesional cortico-reticulospinal tract (CRST). This proof-of-concept study aims to develop a non-invasive brain stimulation protocol that facilitates the lesioned CST and inhibits the contralesional CRST to improve upper extremity rehabilitation in individuals with moderate-to-severe motor impairments post-stroke. Methods Fourteen individuals (minimum 3 months post ischemic stroke) consented. Physician decision of the participants baseline assessment qualified eight to continue in a randomized, double-blind cross-over pilot trial (ClinicalTrials.gov Identifier: NCT05174949) with: (1) anodal high-definition transcranial direct stimulation (HD-tDCS) over the ipsilesional primary motor cortex (M1), (2) cathodal HD-tDCS over contralesional dorsal premotor cortex (PMd), (3) sham stimulation, with a two-week washout period in-between. Subject-specific MR images and computer simulation were used to guide HD-tDCS and verified by Transcranial Magnetic Stimulation (TMS) induced Motor Evoked Potential (MEP). The motor behavior outcome was evaluated by an Fugl-Meyer Upper Extremity score (primary outcome measure) and the excitability of the ipslesoinal CST and contralesional CRST was determined by the change of MEP latencies and amplitude (secondary outcome measures). Results The baseline ipsilesional M1 MEP latency and amplitude were correlated with FM-UE. FM-UE scores were improved post HD-tDCS, in comparison to sham stimulation. Both anodal and cathodal HD-tDCS reduced the latency of the ipsilesional M1 MEP. The contralesional PMd MEP disappeared/delayed after HD-tDCS. Discussion These results suggest that HD-tDCS could improve the function of the lesioned corticospinal tract and reduce the excitability of the contralesional cortico-reticulospinal tract, thus, improving motor function of the upper extremity in more severely impaired individuals.
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Affiliation(s)
- Jordan N. Williamson
- Department of Bioengineering, Grainger College of Engineering, University of Illinois Urbana-Champaign, Urbana, IL, United States
| | - Shirley A. James
- University of Oklahoma Health Sciences Center, Hudson College of Public Health, Oklahoma City, OK, United States
| | - Dorothy He
- University of Oklahoma Health Sciences Center, College of Medicine, Oklahoma City, OK, United States
| | - Sheng Li
- Department of Physical Medicine and Rehabilitation, UT Health Huston, McGovern Medical School, Houston, TX, United States
| | - Evgeny V. Sidorov
- Department of Neurology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Yuan Yang
- Department of Bioengineering, Grainger College of Engineering, University of Illinois Urbana-Champaign, Urbana, IL, United States
- Clinical Imaging Research Center, Stephenson Family Clinical Research Institute, Carle Foundation Hospital, Urbana, IL, United States
- Beckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign, Urbana, IL, United States
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, United States
- Department of Rehabilitation Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Gallogly College of Engineering, Stephenson School of Biomedical Engineering, University of Oklahoma, Oklahoma City, OK, United States
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Bağcıer F, Yurdakul OV, Deniz G, Akbulut A, Çelik Y, Temel MH. Is Dry Needling Treatment an Extra Contribution to Conventional Treatment for Hemiplegic Shoulder Pain? A Prospective, Randomized Controlled Study. Med Acupunct 2023; 35:236-245. [PMID: 37900876 PMCID: PMC10606952 DOI: 10.1089/acu.2023.0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023] Open
Abstract
Objective This research was conducted to evaluate the effect of adding dry needling (DN) treatment to conventional rehabilitation for pain, range of motion (ROM), and functionality in patients with hemiplegic shoulder pain (HSP). Materials and Methods Patients with HSP (n = 38) were divided into 2 groups. A multimodal rehabilitation protocol, including physical therapy and exercise treatments, was given to both groups (5 sessions per week for 15 sessions). In addition to this rehabilitation, 3 sessions of DN therapy were given to one of the 2 groups. Measurements were a visual analogue scale; ROM; and 2 other scales (Quick Disability of the Arm, Shoulder, Hand; and the Fugl-Meyer Assessment Upper Extremity). Evaluations were made before, after, and at the third month after treatment. Results While a statistically significant improvement was seen in both groups in all parameters after their treatments, a statistical superiority was found in the conventional treatment+DN group (P < 0.05). However, the differences were not greater than the minimal clinically important difference values (MCID). At the 3rd month follow-up, there was no difference in pain and functionality parameters between the groups, while flexion and abduction measurements were higher in the conventional treatment+DN group (P < 0.05). Conclusions Adding DN treatment to conventional rehabilitation did not show any difference except in some joint ROM measurements in the subacute time. Although the changes found were statistically significant, they were not clinically significant as they did not reach MCID values.This study was registered prospectively at ClinicalTrials.gov (ref. no: NCT04790071).
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Affiliation(s)
- Fatih Bağcıer
- Clinic of Physical Medicine and Rehabilitation, Çam and Sakura City Hospital, İstanbul, Turkey
| | - Ozan Volkan Yurdakul
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Bezmialem University İstanbul, Turkey
| | - Gamze Deniz
- Department of Physiotherapy and Rehabilitation, Biruni University Physiotherapy High School, Istanbul, Turkey
| | - Ahmet Akbulut
- Department of Physiotherapy and Rehabilitation, Biruni University Physiotherapy High School, Istanbul, Turkey
| | - Yusuf Çelik
- Department of Biostatistics, Biruni University, Faculty of Education, Istanbul, Turkey
| | - Mustafa Hüseyin Temel
- Clinic of Physical Medicine and Rehabilitation, Üsküdar State Hospital, İstanbul, Turkey
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Bargeri S, Scalea S, Agosta F, Banfi G, Corbetta D, Filippi M, Sarasso E, Turolla A, Castellini G, Gianola S. Effectiveness and safety of virtual reality rehabilitation after stroke: an overview of systematic reviews. EClinicalMedicine 2023; 64:102220. [PMID: 37745019 PMCID: PMC10514431 DOI: 10.1016/j.eclinm.2023.102220] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 08/22/2023] [Accepted: 09/01/2023] [Indexed: 09/26/2023] Open
Abstract
Background Virtual reality (VR) is an innovative neurorehabilitation modality that has been variously examined in systematic reviews. We assessed VR effectiveness and safety after cerebral stroke. Methods In this overview of systematic reviews, we searched eleven databases (Cochrane Database of Systematic Reviews, EMBASE, MEDLINE, SCOPUS, ISI Web of Science, CINAHL, PsycINFO, Pedro, Otseeker, Healthevidence.org, Epistemonikos) and grey literature from inception to January 17, 2023. Studies eligible for inclusion were systematic reviews published in English that included adult patients with a clinical diagnosis of stroke (acute to chronic phase) undergoing any kind of immersive, semi-immersive or non-immersive VR intervention with or without conventional therapy versus conventional therapy alone. The primary outcome was motor upper limb function and activity. The secondary outcomes were gait and balance, cognitive and mental function, limitation of activities, participation, and adverse events. We calculated the degree of overlap between reviews based on the corrected covered area (CCA). Methodological quality was assessed using the A MeaSurement Tool to Assess systematic Reviews (AMSTAR 2) and the Certainty of Evidence (CoE) using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. Discordances between results were examined using a conceptual framework based on the Jadad algorithm. This overview is registered with PROSPERO, CRD42022329263. Findings Of the 58 reviews included (n = 345 unique primary studies), 42 (72.4%) had conducted meta-analysis. More than half of the reviews (58.6%) were published between 2020 and 2022 and many (77.6%) were judged critically low in quality by AMSTAR 2. Most reported the Fugl Meyer Assessment scale (FMA-UE) to measure upper limb function and activity. For the primary outcome, there was a moderate overlap of primary studies (CCA 9.0%) with discordant findings. Focusing on upper limb function (FMA-UE), VR with or without conventional therapy seems to be more effective than conventional therapy alone, with low to moderate CoE and probable to definite clinical relevance. For secondary outcomes there was uncertainty about the superiority or no difference between groups due to substantial heterogeneity of measurement scales (eg, methodological choices). A few reviews (n = 6) reported the occurrence of mild adverse events. Interpretation Current evidence suggests that multiple meta-analyses agreed on the superiority of VR with or without conventional therapy over conventional therapy on FME-UE for upper limb. Clinicians may consider embedding VR technologies into their practice as appropriate with patient's goals, abilities, and preferences. However, caution is needed given the poor methodological quality of reviews. Funding Italian Ministry of Health.
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Affiliation(s)
- Silvia Bargeri
- IRCCS Istituto Ortopedico Galeazzi, Unit of Clinical Epidemiology, Milan, Italy
| | | | - Federica Agosta
- Vita-Salute San Raffaele University, Milan, Italy
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Banfi
- Vita-Salute San Raffaele University, Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Davide Corbetta
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Massimo Filippi
- Vita-Salute San Raffaele University, Milan, Italy
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elisabetta Sarasso
- Vita-Salute San Raffaele University, Milan, Italy
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, Genoa, Italy
| | - Andrea Turolla
- Department of Biomedical and Neuromotor Sciences – DIBINEM, Alma Mater Università di Bologna, Bologna, Italy
- Unit of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Greta Castellini
- IRCCS Istituto Ortopedico Galeazzi, Unit of Clinical Epidemiology, Milan, Italy
| | - Silvia Gianola
- IRCCS Istituto Ortopedico Galeazzi, Unit of Clinical Epidemiology, Milan, Italy
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21
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Jo S, Song Y, Lee Y, Heo SH, Jang SJ, Kim Y, Shin JH, Jeong J, Park HS. Functional MRI Assessment of Brain Activity During Hand Rehabilitation with an MR-Compatible Soft Glove in Chronic Stroke Patients: A Preliminary Study. IEEE Int Conf Rehabil Robot 2023; 2023:1-6. [PMID: 37941170 DOI: 10.1109/icorr58425.2023.10304776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
Brain plasticity plays a significant role in functional recovery after stroke, but the specific benefits of hand rehabilitation robot therapy remain unclear. Evaluating the specific effects of hand rehabilitation robot therapy is crucial in understanding how it impacts brain activity and its relationship to rehabilitation outcomes. This study aimed to investigate the brain activity pattern during hand rehabilitation exercise using functional magnetic resonance imaging (fMRI), and to compare it before and after 3-week hand rehabilitation robot training. To evaluate it, an fMRI experimental environment was constructed to facilitate the same hand posture used in rehabilitation robot therapy. Two stroke survivors participated and the conjunction analysis results from fMRI scans showed that patient 1 exhibited a significant improvement in activation profile after hand rehabilitation robot training, indicative of improved motor function in the bilateral motor cortex. However, activation profile of patient 2 exhibited a slight decrease, potentially due to habituation to the rehabilitation task. Clinical results supported these findings, with patient 1 experiencing a greater increase in FMA score than patient 2. These results suggest that hand rehabilitation robot therapy can induce different brain activity patterns in stroke survivors, which may be linked to patient-specific training outcomes. Further studies with larger sample sizes are necessary to confirm these findings.
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22
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Huynh BP, DiCarlo JA, Vora I, Ranford J, Gochyyev P, Lin DJ, Kimberley TJ. Sensitivity to Change and Responsiveness of the Upper Extremity Fugl-Meyer Assessment in Individuals With Moderate to Severe Acute Stroke. Neurorehabil Neural Repair 2023; 37:545-553. [PMID: 37483132 DOI: 10.1177/15459683231186985] [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] [Indexed: 07/25/2023]
Abstract
BACKGROUND The Fugl-Meyer Assessment-Upper Extremity (FMA-UE) is a widely used outcome measure for quantifying motor impairment in stroke recovery. Meaningful change (responsiveness) in the acute to subacute phase of stroke recovery has not been determined. OBJECTIVE Determine responsiveness and sensitivity to change of the FMA-UE from 1-week to 6-weeks (subacute) after stroke in individuals with moderate to severe arm impairment who received standard clinical care. METHODS A total of 51 participants with resulting moderate and severe UE hemiparesis after stroke had FMA-UE assessment at baseline (within 2 weeks of stroke) and 6-weeks later. Sensitivity to change was assessed using Glass's delta, standardized response means (SRM), standard error of measure (SEM), and minimal detectable change (MDC). Responsiveness was assessed with the minimal clinically important difference (MCID), estimated using receiver operating characteristic curve analysis with patient-reported global rating of change scales (GROC) and a provider-reported modified Rankin Scale (mRS) as anchors. RESULTS The MCID estimates were 13, 12, and 9 anchored to the GROC Arm Weakness, GROC Recovery, and mRS. Glass's delta and the SRM revealed large effect sizes, indicating high sensitivity to change, (∆ = 1.24, 95% CI [0.64, 1.82], SRM = 1.10). Results for the SEM and MDC were 2.46 and 6.82, respectively. CONCLUSION The estimated MCID for the FMA-UE for individuals with moderate to severe motor impairment from 1 to 6-weeks after stroke is 13. These estimates will provide clinical context for FMA-UE change scores by helping to identify the change in upper-extremity motor impairment that is both beyond measurement error and clinically meaningful.
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Affiliation(s)
- Baothy P Huynh
- Department of Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA
| | - Julie A DiCarlo
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- VA RR&D Center for Neurorestoration and Neurotechnology, Rehabilitation R&D Service, Department of VA Medical Center, Providence, RI, USA
| | - Isha Vora
- Department of Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA
| | - Jessica Ranford
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Division of Neurocritical Care, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Perman Gochyyev
- Department of Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA
| | - David J Lin
- Department of Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- VA RR&D Center for Neurorestoration and Neurotechnology, Rehabilitation R&D Service, Department of VA Medical Center, Providence, RI, USA
- Division of Neurocritical Care, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Teresa J Kimberley
- Department of Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Physical Therapy, MGH Institute of Health Professions, Boston, MA, USA
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23
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Shou YZ, Wang XH, Yang GF. Verum versus Sham brain-computer interface on upper limb function recovery after stroke: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2023; 102:e34148. [PMID: 37390271 PMCID: PMC10313240 DOI: 10.1097/md.0000000000034148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 06/08/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND Previous clinical trials have reported that the brain-computer interface (BCI) is a useful management tool for upper limb function recovery (ULFR) in stroke. However, there is insufficient evidence regarding this topic. Thus, this study aimed to investigate the effectiveness of verum versus sham BCI on the ULFR in stroke patients. METHODS We comprehensively searched the Cochrane Library, PUBMED, EMBASE, Web of Science, and China National Knowledge Infrastructure databases from their inception to January 1, 2023. Randomized clinical trials (RCTs) assessing the effectiveness and safety of BCI for ULFR after stroke were included. The outcomes were the Fugl-Meyer Assessment for Upper Extremity, Wolf Motor Function Test, Modified Barthel Index, motor activity log, and Action Research Arm Test. The methodological quality of all the included randomized controlled trials was evaluated using the Cochrane risk-of-bias tool. Statistical analysis was performed using RevMan 5.4 software. RESULTS Eleven eligible studies involving 334 patients were included. The results of the meta-analysis showed significant differences in the Fugl-Meyer Assessment for Upper Extremity (mean difference [MD] = 4.78, 95% confidence interval [CI] [1.90, 7.65], I2 = 0%, P = .001) and Modified Barthel Index (MD = 7.37, 95% CI [1.89, 12.84], I2 = 19%, P = .008). However, no significant differences were found on motor activity log (MD = -0.70, 95% CI [-3.17, 1.77]), Action Research Arm Test (MD = 3.05, 95% CI [-8.33, 14.44], I2 = 0%, P = .60), and Wolf Motor Function Test (MD = 4.23, 95% CI [-0.55, 9.01], P = .08). CONCLUSION BCI may be an effective management strategy for ULFR in stroke patients. Future studies with larger sample size and strict design are still needed to warrant the current findings.
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Affiliation(s)
- Yi-zhou Shou
- Department of Rehabilitation, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Xin-hua Wang
- Department of Tuina, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Gui-fen Yang
- Department of Rehabilitation, Tongde Hospital of Zhejiang Province, Hangzhou, China
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24
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Yang SW, Ma SR, Choi JB. The Effect of Kinesio Taping Combined with Virtual-Reality-Based Upper Extremity Training on Upper Extremity Function and Self-Esteem in Stroke Patients. Healthcare (Basel) 2023; 11:1813. [PMID: 37444646 DOI: 10.3390/healthcare11131813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/17/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
(1) Background: The purpose of this study is to investigate the effect of virtual-reality-based hand motion training (VRT) in parallel with the Kinesio Taping (KT) technique on upper extremity function in stroke patients and to present a more effective therapeutic basis for virtual reality training intervention. (2) Methods: First, 43 stroke patients were randomly assigned to two groups: 21 experimental subjects and 22 controls. The experimental group performed Kinesio Taping (KT) on the dorsal part of the hand along with virtual-reality-based hand motion training, and the control group performed only virtual-reality-based hand motion training. The intervention was conducted for a total of 30 sessions over 6 weeks. To evaluate changes in upper extremity function, the Fugl-Meyer Assessment of the Upper Extremity (FMA-UE), the Wolf Motor Function Test (WMFT), and the Motor Activity Log (MAL) (including amount of use (AOU) and quality of movement (QOM)) were evaluated. In addition, the Self-Efficacy Scale (SEF) was evaluated to examine the change in the self-esteem of the study subjects. (3) Results: The experimental group who participated in the virtual reality training in parallel with the KT technique showed statistically significant improvement (** p < 0.01) in the FMA-UE, WMFT, and MAL evaluations that investigate changes in upper extremity function. SEF evaluation also showed a statistically significant improvement (** p < 0.01). A statistically significant difference between the two groups was observed in the evaluation of FMA-UE, WMFT, MAL-QOM, and SEF (†p < 0.05), showing that that combined intervention was more effective at improving upper extremity function than the existing VRT intervention. There was no statistical difference between the two groups in the MAL-AOU item, which is an evaluation of upper extremity function (p > 0.05). There was a statistically significant difference between the two groups in the amount of change in upper limb function (††p < 0.01). (4) Conclusions: It was confirmed that virtual-reality-based hand motion training performed in parallel with the KT technique had a positive effect on the recovery of upper extremity function of stroke patients. The fact that the KT technique provided stability to the wrist by assisting the wrist extensor muscles appears to have improved the upper extremity function more effectively than VRT alone.
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Affiliation(s)
- Seo-Won Yang
- Department of Occupational Therapy, Sangji University, 83 Sangjidae-gil, Wonju-si 26339, Republic of Korea
| | - Sung-Ryong Ma
- Department of Occupational Therapy, Chosun University, 309 Pilmun-daero, Dong-gu, Gwangju 61452, Republic of Korea
| | - Jong-Bae Choi
- Department of Occupational Therapy, Chosun University, 309 Pilmun-daero, Dong-gu, Gwangju 61452, Republic of Korea
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25
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Ko MJ, Chuang YC, Ou-Yang LJ, Cheng YY, Tsai YL, Lee YC. The Application of Soft Robotic Gloves in Stroke Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Brain Sci 2023; 13:900. [PMID: 37371378 DOI: 10.3390/brainsci13060900] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
Wearable robotic devices have been strongly put into use in both the clinical and research fields of stroke rehabilitation over the past decades. This study aimed to explore the effectiveness of soft robotic gloves (SRGs) towards improving the motor recovery and functional abilities in patients with post-stroke hemiparesis. Five major bibliographic databases, PubMed, Embase, Cochrane Library, Web of Science, and the Physiotherapy Evidence Database, were all reviewed for enrollment regarding comparative trials prior to 7 March 2023. We included adults with stroke and compared their rehabilitation using SRGs to conventional rehabilitation (CR) on hand function in terms of the Fugl-Meyer Upper Extremity Motor Assessment (FMA-UE), Fugl-Meyer Distal Upper Extremity Motor Assessment (FMA-distal UE), box and blocks test score, grip strength test, and the Jebsen-Taylor hand function test (JTT). A total of 8 studies, comprising 309 participants, were included in the analysis. Compared to CR, rehabilitation involving SRGs achieved better FMA-UE (MD 6.52, 95% CI: 3.65~9.39), FMA-distal UE (MD 3.27, 95% CI: 1.50~5.04), and JJT (MD 13.34, CI: 5.16~21.53) results. Subgroup analysis showed that stroke latency of more than 6 months and training for more than 30 min offered a better effect as well. In conclusion, for patients with stroke, rehabilitation using SRGs is recommended to promote the functional abilities of the upper extremities.
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Affiliation(s)
- Ming-Jian Ko
- Department of Education, Taichung Veterans General Hospital, Taichung 407219, Taiwan
| | - Ya-Chi Chuang
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung 407219, Taiwan
| | - Liang-Jun Ou-Yang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taoyuan 333423, Taiwan
| | - Yuan-Yang Cheng
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung 407219, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402202, Taiwan
| | - Yu-Lin Tsai
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung 407219, Taiwan
| | - Yu-Chun Lee
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung 407219, Taiwan
- Department of Exercise Health Science, National Taiwan University of Sport, Taichung 404401, Taiwan
- Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung 407224, Taiwan
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Lieb A, Zrenner B, Zrenner C, Kozák G, Martus P, Grefkes C, Ziemann U. Brain-oscillation-synchronized stimulation to enhance motor recovery in early subacute stroke: a randomized controlled double-blind three- arm parallel-group exploratory trial comparing personalized, non- personalized and sham repetitive transcranial magnetic stimulation (Acronym: BOSS-STROKE). BMC Neurol 2023; 23:204. [PMID: 37231390 PMCID: PMC10210305 DOI: 10.1186/s12883-023-03235-1] [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: 02/01/2023] [Accepted: 04/29/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Stroke is a major cause of death and the most frequent cause of permanent disability in western countries. Repetitive transcranial brain stimulation (rTMS) has been used to enhance neuronal plasticity after stroke, yet with only moderate effect sizes. Here we will apply a highly innovative technology that synchronizes rTMS to specific brain states identified by real-time analysis of electroencephalography. METHODS One hundred forty-four patients with early subacute ischemic motor stroke will be included in a multicenter 3-arm parallel, randomized, double-blind, standard rTMS and sham rTMS-controlled exploratory trial in Germany. In the experimental condition, rTMS will be synchronized to the trough of the sensorimotor µ-oscillation, a high-excitability state, over ipsilesional motor cortex. In the standard rTMS control condition the identical protocol will be applied, but non-synchronized to the ongoing µ-oscillation. In the sham condition, the same µ-oscillation-synchronized protocol as in experimental condition will be applied, but with ineffective rTMS, using the sham side of an active/placebo TMS coil. The treatment will be performed over five consecutive work days (1,200 pulses per day, 6,000 pulses total). The primary endpoint will be motor performance after the last treatment session as measured by the Fugl-Meyer Assessment Upper Extremity. DISCUSSION This study investigates, for the first time, the therapeutic efficacy of personalized, brain-state-dependent rTMS. We hypothesize that synchronization of rTMS with a high-excitability state will lead to significantly stronger improvement of paretic upper extremity motor function than standard or sham rTMS. Positive results may catalyze a paradigm-shift towards personalized brain-state-dependent stimulation therapies. TRIAL REGISTRATION This study was registered at ClinicalTrials.gov (NCT05600374) on 10-21-2022.
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Affiliation(s)
- Anne Lieb
- Department of Neurology and Stroke, and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Brigitte Zrenner
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Institute for Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Christoph Zrenner
- Department of Neurology and Stroke, and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Institute for Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Gábor Kozák
- Department of Neurology and Stroke, and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Peter Martus
- Institute for Clinical Epidemiology and Applied Statistics, University of Tübingen, Tübingen, Germany
| | - Christian Grefkes
- Department of Neurology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Ulf Ziemann
- Department of Neurology and Stroke, and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.
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García-Rudolph A, Soriano I, Becerra H, Madai VI, Frey D, Opisso E, Tormos JM, Bernabeu M. Predicting models for arm impairment: External validation of the Scandinavian models and identification of new predictors in post-acute stroke settings. NeuroRehabilitation 2023:NRE220233. [PMID: 37248917 DOI: 10.3233/nre-220233] [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: 05/31/2023]
Abstract
BACKGROUND Post-stroke arm impairment at rehabilitation admission as predictor of discharge arm impairment was consistently reported as extremely useful. Several models for acute prediction exist (e.g. the Scandinavian), though lacking external validation and larger time-window admission assessments. OBJECTIVES (1) use the 33 Fugl-Meyer Assessment-Upper Extremity (FMA-UE) individual items to predict total FMA-UE score at discharge of patients with ischemic stroke admitted to rehabilitation within 90 days post-injury, (2) use eight individual items (seven from the Scandinavian study plus the top predictor item from objective 1) to predict mild impairment (FMA-UE≥48) at discharge and (3) adjust the top three models from objective 2 with known confounders. METHODS This was an observational study including 287 patients (from eight settings) admitted to rehabilitation (2009-2020). We applied regression models to candidate predictors, reporting adjusted R2, odds ratios and ROC-AUC using 10-fold cross-validation. RESULTS We achieved good predictive power for the eight item-level models (AUC: 0.70-0.82) and for the three adjusted models (AUC: 0.85-0.88). We identified finger mass flexion as new item-level top predictor (AUC:0.88) and time to admission (OR = 0.9(0.9;1.0)) as only common significant confounder. CONCLUSION Scandinavian item-level predictors are valid in a different context, finger mass flexion outperformed known predictors, days-to-admission predict discharge mild arm impairment.
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Affiliation(s)
- Alejandro García-Rudolph
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Ignasi Soriano
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Helard Becerra
- School of Computer Science, University College Dublin, Dublin, Ireland
| | - Vince Istvan Madai
- CLAIM Charité Lab for AI in Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
- QUEST Center for Transforming Biomedical Research, Berlin Institute of Health (BIH), Berlin, Germany
- Charité Universitätsmedizin Berlin, Berlin, Germany
- School of Computing and Digital Technology, Faculty of Computing, Engineering and the Built Environment, Birmingham City University, Birmingham, UK
| | - Dietmar Frey
- CLAIM Charité Lab for AI in Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Eloy Opisso
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Josep María Tormos
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Montserrat Bernabeu
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
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Lin C, Arevalo YA, Harvey RL, Prabhakaran S, Martin KD. The minimal clinically important difference of the motricity index score. Top Stroke Rehabil 2023; 30:298-303. [PMID: 35094664 PMCID: PMC9338175 DOI: 10.1080/10749357.2022.2031532] [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: 11/24/2021] [Accepted: 01/15/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The Motricity Index (MI) can predict motor function after rehabilitation, but its minimal clinically important difference (MCID) has not been established. The primary study aim was to estimate the MCID value of the MI arm score. METHODS Between 2017 and 2018, 173 participants hospitalized with confirmed ischemic stroke were recruited into an observational rehabilitation study. Participants with motor weakness as measured by the Fugl-Meyer upper-extremity (FM-UE) and MI with complete baseline and follow-up assessments at 3 months were included in this analysis. The longitudinal recovery of the MI arm score was anchored to having a poor outcome based on the FM-UE recovery (<9) longitudinally. Results reported include the area-under-curve (AUC), along with sensitivity, specificity, and optimal cut-points based on maximizing the Youden statistic. RESULTS Sixty-nine patients (median [IQR] age 70 [18] years; 48% male; 54% white) were included in the final analysis. Mean ± standard deviation outcome scores at 3-months were: MI arm: 83.19 ± 22.80; FM-UE: 53.04 ± 17.26. For the primary results, the MI arm score optimal MCID cutoff for observed recovery was 13 points with a sensitivity of 80% (95% Confidence Interval (CI)(67.6%, 92.4%)) and a specificity of 69.0% (95% CI (52.1, 85.8%)), and the AUC was 0.8082 (0.7007, 0.9157). CONCLUSIONS This was the first study to report the MCID of the MI arm score, as anchored to the FM-UE recovery between acute evaluation and 3-months. The estimated optimal MCID of improvement in the MI arm score was 13 points.
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Affiliation(s)
- Chen Lin
- Department of Neurology, The University of Alabama at Birmingham, Birmingham, AL 35294
| | - Yurany A. Arevalo
- Department of Neurology, The University of Alabama at Birmingham, Birmingham, AL 35294
| | - Richard L Harvey
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL 60611
| | - Shyam Prabhakaran
- Department of Neurology, The University of Chicago, Chicago, IL 60637
| | - Kimberly D. Martin
- Department of Epidemiology, The University of Alabama at Birmingham, Birmingham, AL 35294
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Moskiewicz D, Mraz M, Chamela-Bilińska D. Botulinum Toxin and Dynamic Splint Restore Grasping Function after Stroke: A Case Report. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4873. [PMID: 36981781 PMCID: PMC10049400 DOI: 10.3390/ijerph20064873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/28/2023] [Accepted: 03/07/2023] [Indexed: 06/18/2023]
Abstract
Evidence on the effectiveness of upper extremity rehabilitation post-stroke is inconclusive. We evaluated a tailored therapeutic program with dynamic splint and botulinum toxin injections for the treatment of upper extremity muscle spasticity. A case of a 43-year-old woman with chronic spastic hemiparesis after ischemic stroke with significant mobility impairment in the left upper extremity was described. A 16-week program consisted of three 50-min sessions daily and focused on grasping and releasing with and without the splint. The patient was evaluated before botulinum toxin injection and after 6, 12 and 16 weeks according to the International Classification of Functioning, Disability and Health, and included the following scales: Fugl-Meyer Upper Extremity Assessment (FMA-UE), Modified Ashworth Scale, Numerical Rating Scale (NRS), MyotonPro, Stroke Impact Scale, Box and Blocks. Photographic documentation made before and after the experiment was compared. Motor functions improved by 19.7% on FMA-UE, spasticity was reduced by one degree and pain at rest and during activity decreased by one score on NRS. A reduction in the oscillation frequency of the relaxed muscle and the stiffness of the examined muscles was observed. The patient regained grasping function. Health-related quality of life was systematically improving with a 35% increase at week 16 compared to the baseline. The combination treatment for spasticity based on botulinum toxin and SaeboFlex® dynamic splint in a patient with chronic spastic hemiparesis reduces disability and improves quality of life. However, further research is needed to investigate the treatment results.
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Affiliation(s)
- Denis Moskiewicz
- Department of Physiotherapy, Wroclaw University of Health and Sport Sciences, 51-612 Wrocław, Poland
- Rehabilitation Department, T. Marciniak Lower Silesian Specialist Hospital, Emergency Medicine Center, 54-049 Wrocław, Poland
| | - Małgorzata Mraz
- Department of Physiotherapy, Wroclaw University of Health and Sport Sciences, 51-612 Wrocław, Poland
| | - Dagmara Chamela-Bilińska
- Department of Physiotherapy, Wroclaw University of Health and Sport Sciences, 51-612 Wrocław, Poland
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30
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González-Santos J, Rodríguez-Fernández P, Pardo-Hernández R, González-Bernal JJ, Fernández-Solana J, Santamaría-Peláez M. A Cross-Sectional Study: Determining Factors of Functional Independence and Quality of Life of Patients One Month after Having Suffered a Stroke. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:995. [PMID: 36673749 PMCID: PMC9859177 DOI: 10.3390/ijerph20020995] [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: 10/20/2022] [Revised: 12/29/2022] [Accepted: 01/01/2023] [Indexed: 06/17/2023]
Abstract
(1) Background: loss of quality of life (QoL) and functional independence are two of the most common consequences of suffering a stroke. The main objective of this research is to study which factors are the greatest determinants of functional capacity and QoL a month after suffering a stroke so that they can be considered in early interventions. (2) Methods: a cross-sectional study was conducted which sample consisted of 81 people who had previously suffered a stroke. The study population was recruited at the time of discharge from the Neurology Service and Stroke Unit of the hospitals of Burgos and Córdoba, Spain, through a consecutive sampling. Data were collected one month after participants experienced a stroke, and the main study variables were quality of life, measured with the Stroke-Specific Quality of Life Measure (NEWSQOL), and functional independence, measured with the Functional Independence Measure-Functional Assessment Measure (FIM-FAM). (3) Results: the factors associated with a worse QoL and functional capacity one month after having suffered a stroke were living in a different dwelling than the usual flat or house (p < 0.05), a worse cognitive capacity (p < 0.001) and a worse functional capacity of the affected upper limb (p < 0.001). A higher age was related to a worse functional capacity one month after suffering a stroke (p = 0.048). (4) Conclusions: the type of dwelling, age, cognitive ability and functional capacity of the affected upper limb are determining aspects in functional independence and QoL during the first weeks after a stroke.
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31
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Garrido M M, Álvarez E E, Acevedo P F, Moyano V Á, Castillo N N, Cavada Ch G. Early transcranial direct current stimulation with modified constraint-induced movement therapy for motor and functional upper limb recovery in hospitalized patients with stroke: A randomized, multicentre, double-blind, clinical trial. Brain Stimul 2023; 16:40-47. [PMID: 36584748 DOI: 10.1016/j.brs.2022.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 12/13/2022] [Accepted: 12/18/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Constraint-induced movement therapy (CIMT) and transcranial direct current stimulation (tDCS) are used to reduce interhemispheric imbalance after stroke, which is why the combination of these therapies has been used for neurological recovery, but not in the acute phase. OBJECTIVES To evaluate the effectiveness of combining active or sham bihemispheric tDCS with modified CIMT (mCIMT) for the recovery of the Upper Limb (UL) in hospitalized patients with acute and subacute stroke. METHODS This randomized controlled, double-blind, placebo-controlled, parallel group clinical trial was executed between September 2018 to March 2021 recruited 70 patients. The patients were randomized to one of two groups to receive treatment for 7 consecutive days, which included 20 min of active or sham bihemispheric tDCS daily (anodal ipsilesional and cathodal contralesional), with an mCIMT protocol. The primary outcome was the difference in the evolution of motor and functional upper limb recovery with assessment on days 0, 5, 7, 10 and 90. The secondary outcomes were independence in activities of daily living (ADL) and quality of life. RESULTS The active group presented a statistically significant gap compared to the simulated group throughout the trend in the scores of the FMA (motor function and joint pain) and WMFT (functional ability and weight to box) (p < 0.05) and showed a minimal clinically important difference (FMA: difference between groups of 4.9 points [CI: 0.007- 9.799]; WMFT: difference between groups of 6.54 points [CI: 1.10-14.15]). In the secondary outcomes, there was a significant difference between the groups in ADL independence (Functional Independence Measure: difference of 8.63 [CI: 1.37-18.64]) and perceived recovery of quality of life evaluated at 90 days (p = 0.0176). CONCLUSIONS Combining mCIMT with bihemispheric tDCS in patients hospitalized with acute-subacute stroke allows us to maximize the motor and functional recovery of the paretic upper limb in the early stages and independence in ADL, maintaining the effects over time.
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Affiliation(s)
- Maricel Garrido M
- Servicio de Medicina Física y Rehabilitación, Hospital Clínico Universidad de Chile, Santiago, Chile.
| | - Evelyn Álvarez E
- Facultad de Ciencias de la Salud, Universidad Central de Chile, Santiago, Chile; Departamento de Terapia Ocupacional y Ciencia de la Ocupación, Universidad de Chile, Santiago, Chile.
| | - Fabrizio Acevedo P
- Servicio de Medicina Física y Rehabilitación, Hospital San José, Santiago, Chile.
| | - Álvaro Moyano V
- Servicio de Medicina Física y Rehabilitación, Hospital Clínico Universidad de Chile, Santiago, Chile.
| | - Natalia Castillo N
- Departamento de Terapia Ocupacional y Ciencia de la Ocupación, Universidad de Chile, Santiago, Chile.
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Wolf S, Holm SE, Ingwersen T, Bartling C, Bender G, Birke G, Meyer A, Nolte A, Ottes K, Pade O, Peller M, Steinmetz J, Gerloff C, Thomalla G. Pre-stroke socioeconomic status predicts upper limb motor recovery after inpatient neurorehabilitation. Ann Med 2022; 54:1265-1276. [PMID: 35510813 PMCID: PMC9090381 DOI: 10.1080/07853890.2022.2059557] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Lower socioeconomic status (SES) is associated with higher mortality rates and the likelihood of receiving less evidence-based treatment after stroke. In contrast, little is known about the impact of SES on recovery after discharge from inpatient rehabilitation. The aim of this study was to investigate the influence of SES on long-term recovery after stroke. PATIENTS AND METHODS In a prospective, observational, multicentre study, inpatients were recruited towards the end of rehabilitation. The 12-month follow-up focussed on upper limb motor recovery, measured by the Fugl-Meyer score. A clinically relevant improvement of ≥5.25 points was considered recovery. Patient-centric measures such as the Patient-reported Outcomes Measurement Information System-Physical Health (PROMIS-10 PH) provided secondary outcomes. Information on schooling, vocational training, income and occupational status pre-stroke entered a multidimensional SES index. Multivariate logistic regression models calculating odds ratios (ORs) and corresponding confidence intervals (CIs) were applied. SES was added to an initial model including age, sex and baseline neurological deficit. Additional exploratory analyses examined the association between SES and outpatient treatment. RESULTS One hundred and seventy-six patients were enrolled of whom 98 had SES and long-term recovery data. Model comparisons showed the SES-model superior to the initial model (Akaike information criterion (AIC): 123 vs. 120, Pseudo R2: 0.09 vs. 0.13). The likelihood of motor recovery (OR = 17.12, 95%CI = 1.31; 224.18) and PROMIS-10 PH improvement (OR = 20.76, 95%CI = 1.28; 337.11) were significantly increased with higher SES, along with more frequent use of outpatient therapy (p = .02). CONCLUSIONS Higher pre-stroke SES is associated with better long-term recovery after discharge from rehabilitation. Understanding these factors can improve outpatient long-term stroke care and lead to better recovery.KEY MESSAGEHigher pre-stroke socioeconomic status (SES) is associated with better long-term recovery after discharge from rehabilitation both in terms of motor function and self-reported health status.Higher SES is associated with significantly higher utilization of outpatient therapies.Discharge management of rehabilitation clinics should identify and address socioeconomic factors in order to detect individual needs and to improve outpatient recovery. Article registration: clinicaltrials.gov NCT04119479.
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Affiliation(s)
- S Wolf
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S E Holm
- Department of Neurology, Charité - University Medicine Berlin, Berlin, Germany
| | - T Ingwersen
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C Bartling
- Clinic for Neurological Rehabilitation, MEDICLIN Klinikum Soltau, Soltau, Germany
| | - G Bender
- Department Neurology, RehaCentrum Hamburg, Hamburg, Germany
| | - G Birke
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Meyer
- Clinic for Neurological Rehabilitation, MEDICLIN Klinikum Soltau, Soltau, Germany
| | - A Nolte
- Department Neurology, VAMED Klinik Geesthacht, Geesthacht, Germany
| | - K Ottes
- Department Neurology, RehaCentrum Hamburg, Hamburg, Germany
| | - O Pade
- Clinic for Neurological Rehabilitation, Klinikum Bad Bramstedt, Bad Bramstedt, Germany
| | - M Peller
- Department Neurology, VAMED Rehaklinik Damp, Damp, Germany
| | - J Steinmetz
- Clinic for Neurological Rehabilitation, Klinikum Bad Bramstedt, Bad Bramstedt, Germany
| | - C Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - G Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Kashoo FZ, Al-Baradie RS, Alzahrani M, Alanazi A, Manzar MD, Gugnani A, Sidiq M, Shaphe MA, Sirajudeen MS, Ahmad M, Althumayri B, Aljandal A, Almansour A, Alshewaier SA, Chahal A. Effect of Transcranial Direct Current Stimulation Augmented with Motor Imagery and Upper-Limb Functional Training for Upper-Limb Stroke Rehabilitation: A Prospective Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15199. [PMID: 36429924 PMCID: PMC9690138 DOI: 10.3390/ijerph192215199] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/12/2022] [Accepted: 11/13/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Combining transcranial direct current stimulation (tDCS) with other therapies is reported to produce promising results in patients with stroke. The purpose of the study was to determine the effect of combining tDCS with motor imagery (MI) and upper-limb functional training for upper-limb rehabilitation among patients with chronic stroke. METHODS A single-center, prospective, randomized controlled trial was conducted among 64 patients with chronic stroke. The control group received sham tDCS with MI, while the experimental group received real tDCS with MI. Both groups performed five different upper-limb functional training exercises coupled with tDCS for 30 min, five times per week for two weeks. Fugl-Meyer's scale (FMA) and the Action Research Arm Test (ARAT) were used to measure the outcome measures at baseline and after the completion of the 10th session. RESULTS Analysis of covariance showed significant improvements in the post-test mean scores for FMA (F (414.4) = 35.79, p < 0.001; η2 = 0.37) and ARAT (F (440.09) = 37.46, p < 0.001; η2 = 0.38) in the experimental group compared to the control group while controlling for baseline scores. CONCLUSIONS Anodal tDCS stimulation over the affected primary motor cortex coupled with MI and upper-limb functional training reduces impairment and disability of the upper limbs among patients with chronic stroke.
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Affiliation(s)
- Faizan Zaffar Kashoo
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Al Majmaah 11952, Saudi Arabia
| | - Raid Saleem Al-Baradie
- Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Majmaah University, Al Majmaah 11952, Saudi Arabia
| | - Msaad Alzahrani
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Al Majmaah 11952, Saudi Arabia
| | - Ahmad Alanazi
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Al Majmaah 11952, Saudi Arabia
| | - Md Dilshad Manzar
- Department of Nursing, College of Applied Medical Sciences, Al Majmaah 11952, Saudi Arabia
| | - Anchit Gugnani
- NIMS College of Physiotherapy and Occupational Therapy, NIMS University Jaipur, Jaipur 303121, Rajasthan, India
| | - Mohammad Sidiq
- NIMS College of Physiotherapy and Occupational Therapy, NIMS University Jaipur, Jaipur 303121, Rajasthan, India
| | - Mohammad Abu Shaphe
- Department of Physical Therapy, College of Applied Medical Sciences, Jazan University, Jazan 82511, Saudi Arabia
| | - Mohamed Sherif Sirajudeen
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Al Majmaah 11952, Saudi Arabia
| | - Mehrunnisha Ahmad
- Department of Nursing, College of Applied Medical Sciences, Al Majmaah 11952, Saudi Arabia
| | - Bader Althumayri
- Department of Physical Therapy, Security Forces Hospital, Riyadh 11564, Saudi Arabia
| | - Abdullah Aljandal
- Department of Physical Therapy and Rehabilitation, Al Fayha Club, Al Majmmah 11952, Saudi Arabia
| | - Ahmed Almansour
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Al Majmaah 11952, Saudi Arabia
| | - Shady Abdullah Alshewaier
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Al Majmaah 11952, Saudi Arabia
| | - Aksh Chahal
- Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar, Mullana 133207, Haryana, India
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Weisinger B, Pandey DP, Saver JL, Hochberg A, Bitton A, Doniger GM, Lifshitz A, Vardi O, Shohami E, Segal Y, Reznik Balter S, Djemal Kay Y, Alter A, Prasad A, Bornstein NM. Frequency-tuned electromagnetic field therapy improves post-stroke motor function: A pilot randomized controlled trial. Front Neurol 2022; 13:1004677. [PMID: 36452175 PMCID: PMC9702345 DOI: 10.3389/fneur.2022.1004677] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/05/2022] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND AND PURPOSE Impaired upper extremity (UE) motor function is a common disability after ischemic stroke. Exposure to extremely low frequency and low intensity electromagnetic fields (ELF-EMF) in a frequency-specific manner (Electromagnetic Network Targeting Field therapy; ENTF therapy) is a non-invasive method available to a wide range of patients that may enhance neuroplasticity, potentially facilitating motor recovery. This study seeks to quantify the benefit of the ENTF therapy on UE motor function in a subacute ischemic stroke population. METHODS In a randomized, sham-controlled, double-blind trial, ischemic stroke patients in the subacute phase with moderately to severely impaired UE function were randomly allocated to active or sham treatment with a novel, non-invasive, brain computer interface-based, extremely low frequency and low intensity ENTF therapy (1-100 Hz, < 1 G). Participants received 40 min of active ENTF or sham treatment 5 days/week for 8 weeks; ~three out of the five treatments were accompanied by 10 min of concurrent physical/occupational therapy. Primary efficacy outcome was improvement on the Fugl-Meyer Assessment - Upper Extremity (FMA-UE) from baseline to end of treatment (8 weeks). RESULTS In the per protocol set (13 ENTF and 8 sham participants), mean age was 54.7 years (±15.0), 19% were female, baseline FMA-UE score was 23.7 (±11.0), and median time from stroke onset to first stimulation was 11 days (interquartile range (IQR) 8-15). Greater improvement on the FMA-UE from baseline to week 4 was seen with ENTF compared to sham stimulation, 23.2 ± 14.1 vs. 9.6 ± 9.0, p = 0.007; baseline to week 8 improvement was 31.5 ± 10.7 vs. 23.1 ± 14.1. Similar favorable effects at week 8 were observed for other UE and global disability assessments, including the Action Research Arm Test (Pinch, 13.4 ± 5.6 vs. 5.3 ± 6.5, p = 0.008), Box and Blocks Test (affected hand, 22.5 ± 12.4 vs. 8.5 ± 8.6, p < 0.0001), and modified Rankin Scale (-2.5 ± 0.7 vs. -1.3 ± 0.7, p = 0.0005). No treatment-related adverse events were reported. CONCLUSIONS ENTF stimulation in subacute ischemic stroke patients was associated with improved UE motor function and reduced overall disability, and results support its safe use in the indicated population. These results should be confirmed in larger multicenter studies. CLINICAL TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT04039178, identifier: NCT04039178.
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Affiliation(s)
| | - Dharam P. Pandey
- Manipal Hospital Physiotherapy and Rehabilitation, New Delhi, India
| | - Jeffrey L. Saver
- Department of Neurology, UCLA Comprehensive Stroke and Vascular Neurology Program, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | | | | | | | | | - Ofir Vardi
- BrainQ Technologies, Ltd., Jerusalem, Israel
| | - Esther Shohami
- BrainQ Technologies, Ltd., Jerusalem, Israel
- Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yaron Segal
- BrainQ Technologies, Ltd., Jerusalem, Israel
| | | | | | | | - Atul Prasad
- Department of Neurology, B. L. Kapur Super Specialty Hospital (BLK), National Capital Territory of Delhi, New Delhi, India
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Fernández-Solana J, Pardo-Hernández R, González-Bernal JJ, Sánchez-González E, González-Santos J, Soto-Cámara R, Santamaría-Pelaez M. Psychometric Properties of the Action Research Arm Test (ARAT) Scale in Post-Stroke Patients-Spanish Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14918. [PMID: 36429637 PMCID: PMC9690867 DOI: 10.3390/ijerph192214918] [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: 10/12/2022] [Revised: 11/07/2022] [Accepted: 11/11/2022] [Indexed: 06/16/2023]
Abstract
The validation of measuring instruments in the field of health is a requirement before they can be used safely and reliably. The action research arm test (ARAT) tool is an instrument validated in numerous countries and languages and for different populations, and its use is widespread. The objective of this research was to determine the psychometric properties of ARAT for a sample composed of post-stroke patients. To achieve this, a psychometric analysis was performed, where internal consistency tests were carried out using Cronbach's alpha, correlations between items and item-total and half-level tests to verify their reliability. Regarding validity, criteria validity tests were performed, taking the motor function dimension of the Fugl-Meyer scale as gold standard, and convergent validity tests were performed by correlation with the FIM-FAM, ECVI-38 and Lawton and Brody scales. The results showed very good internal consistency as well as good criterion and convergent validity. In conclusion, the ARAT can be considered a valid and reliable instrument for the evaluation of upper limb function in post-stroke patients.
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Affiliation(s)
| | | | | | | | | | - Raúl Soto-Cámara
- Department of Health Sciences, University of Burgos, 09001 Burgos, Spain
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Jung HT, Kim Y, Lee J, Lee SI, Choe EK. Envisioning the use of in-situ arm movement data in stroke rehabilitation: Stroke survivors' and occupational therapists' perspectives. PLoS One 2022; 17:e0274142. [PMID: 36264782 PMCID: PMC9584451 DOI: 10.1371/journal.pone.0274142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 08/23/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The key for successful stroke upper-limb rehabilitation includes the personalization of therapeutic interventions based on patients' functional ability and performance level. However, therapists often encounter challenges in supporting personalized rehabilitation due to the lack of information about how stroke survivors use their stroke-affected arm outside the clinic. Wearable technologies have been considered as an effective, objective solution to monitor patients' arm use patterns in their naturalistic environments. However, these technologies have remained a proof of concept and have not been adopted as mainstream therapeutic products, and we lack understanding of how key stakeholders perceive the use of wearable technologies in their practice. OBJECTIVE We aim to understand how stroke survivors and therapists perceive and envision the use of wearable sensors and arm activity data in practical settings and how we could design a wearable-based performance monitoring system to better support the needs of the stakeholders. METHODS We conducted semi-structured interviews with four stroke survivors and 15 occupational therapists (OTs) based on real-world arm use data that we collected for contextualization. To situate our participants, we leveraged a pair of finger-worn accelerometers to collect stroke survivors' arm use data in real-world settings, which we used to create study probes for stroke survivors and OTs, respectively. The interview data was analyzed using the thematic approach. RESULTS Our study unveiled a detailed account of (1) the receptiveness of stroke survivors and OTs for using wearable sensors in clinical practice, (2) OTs' envisioned strategies to utilize patient-generated sensor data in the light of providing patients with personalized therapy programs, and (3) practical challenges and design considerations to address for the accelerated integration of wearable systems into their practice. CONCLUSIONS These findings offer promising directions for the design of a wearable solution that supports OTs to develop individually-tailored therapy programs for stroke survivors to improve their affected arm use.
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Affiliation(s)
- Hee-Tae Jung
- Department of BioHealth Informatics, School of Informatics and Computing, Indiana University at IUPUI, Indianapolis, IN, United States of America
| | - Yoojung Kim
- Graduate School of Convergence Science and Technology, Seoul National University, Seoul, S. Korea
| | - Juhyeon Lee
- College of Information and Computer Sciences, University of Massachusetts Amherst, Amherst, MA, United States of America
| | - Sunghoon Ivan Lee
- College of Information and Computer Sciences, University of Massachusetts Amherst, Amherst, MA, United States of America,* E-mail: (EKC); (SIL)
| | - Eun Kyoung Choe
- College of Information Studies, University of Maryland at College Park, College Park, MD, United States of America,* E-mail: (EKC); (SIL)
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Lavi C, Elboim-Gabyzon M, Naveh Y, Kalichman L. A Combination of Long-Duration Electrical Stimulation with External Shoulder Support during Routine Daily Activities in Patients with Post-Hemiplegic Shoulder Subluxation: A Randomized Controlled Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9765. [PMID: 35955118 PMCID: PMC9368353 DOI: 10.3390/ijerph19159765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 07/31/2022] [Accepted: 08/03/2022] [Indexed: 06/15/2023]
Abstract
The study objective was to determine the effect of long-duration neuromuscular electric stimulation (NMES) on shoulder subluxation and upper-extremity function during the acute post-stroke stage. Twenty-eight subjects (mean age ± standard deviation -70.0 ± 14.0 years) were randomly assigned to an experimental or to a control group receiving NMES to the supraspinatus and posterior deltoid muscles or sham treatment for 6 weeks. All the subjects continued standard rehabilitation and external shoulder support (EST). Assessments were conducted pre- and post-intervention and at a 2 week follow-up session by an assessor blind to group allocation. Outcome measures included the degree of shoulder subluxation, Fugl-Meyer assessment-upper extremity (FMA-UE) test, FMA-hand and finger subscales, Functional Independence Measure (FIM), and shoulder pain (using the Numeric Pain Rate Scale). Shoulder subluxation was significantly lower, while the FMA-UE and FMA-hand and finger subscales were significantly improved in the experimental group post-intervention and at follow-up compared to the control group. FIM at follow-up improved more in the experimental group. No change was observed in pain level in both groups. Supplementing NMES to standard rehabilitation and EST is beneficial in reducing shoulder subluxation and improving upper-extremity function. Further research is necessary to determine effect of longer treatment duration and longer follow-up periods.
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Affiliation(s)
- Chen Lavi
- Department of Rehabilitation, Bait-Balev Hospital, Bat-Yam 59315, Israel
| | - Michal Elboim-Gabyzon
- Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa 3498838, Israel
| | - Yuval Naveh
- Department of Rehabilitation, Bait-Balev Hospital, Bat-Yam 59315, Israel
| | - Leonid Kalichman
- Department of Physical Therapy, Recanati School for Community Health Professions, Ben-Gurion University of the Negev, Beer Sheva 8410501, Israel
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Kim H, Shin JH. Assessment of Upper Extremity Function in People With Stroke Based on the Framework of the ICF: A Narrative Review. BRAIN & NEUROREHABILITATION 2022; 15:e16. [PMID: 36743205 PMCID: PMC9833478 DOI: 10.12786/bn.2022.15.e16] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 07/20/2022] [Indexed: 11/08/2022] Open
Abstract
Although there are many assessment tools for upper extremity (UE) function, it is still difficult to select an appropriate outcome measurement for the rehabilitation process of individuals with stroke. This review aims to classify each tool within the International Classification of Functioning, Disability and Health (ICF) framework and provide an overview of UE assessments. Through a comprehensive understanding of assessments based on ICF, health care professionals will be able to choose suitable measurement tools for individuals, facilitating their rehabilitation.
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Affiliation(s)
- Hanna Kim
- Department of Neurorehabilitation, National Rehabilitation Center, Ministry of Health and Welfare, Seoul, Korea
| | - Joon-Ho Shin
- Department of Neurorehabilitation, National Rehabilitation Center, Ministry of Health and Welfare, Seoul, Korea
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Bigoni C, Zandvliet SB, Beanato E, Crema A, Coscia M, Espinosa A, Henneken T, Hervé J, Oflar M, Evangelista GG, Morishita T, Wessel MJ, Bonvin C, Turlan JL, Birbaumer N, Hummel FC. A Novel Patient-Tailored, Cumulative Neurotechnology-Based Therapy for Upper-Limb Rehabilitation in Severely Impaired Chronic Stroke Patients: The AVANCER Study Protocol. Front Neurol 2022; 13:919511. [PMID: 35873764 PMCID: PMC9301337 DOI: 10.3389/fneur.2022.919511] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/10/2022] [Indexed: 11/17/2022] Open
Abstract
Effective, patient-tailored rehabilitation to restore upper-limb motor function in severely impaired stroke patients is still missing. If suitably combined and administered in a personalized fashion, neurotechnologies offer a large potential to assist rehabilitative therapies to enhance individual treatment effects. AVANCER (clinicaltrials.gov NCT04448483) is a two-center proof-of-concept trial with an individual based cumulative longitudinal intervention design aiming at reducing upper-limb motor impairment in severely affected stroke patients with the help of multiple neurotechnologies. AVANCER will determine feasibility, safety, and effectivity of this innovative intervention. Thirty chronic stroke patients with a Fugl-Meyer assessment of the upper limb (FM-UE) <20 will be recruited at two centers. All patients will undergo the cumulative personalized intervention within two phases: the first uses an EEG-based brain-computer interface to trigger a variety of patient-tailored movements supported by multi-channel functional electrical stimulation in combination with a hand exoskeleton. This phase will be continued until patients do not improve anymore according to a quantitative threshold based on the FM-UE. The second interventional phase will add non-invasive brain stimulation by means of anodal transcranial direct current stimulation to the motor cortex to the initial approach. Each phase will last for a minimum of 11 sessions. Clinical and multimodal assessments are longitudinally acquired, before the first interventional phase, at the switch to the second interventional phase and at the end of the second interventional phase. The primary outcome measure is the 66-point FM-UE, a significant improvement of at least four points is hypothesized and considered clinically relevant. Several clinical and system neuroscience secondary outcome measures are additionally evaluated. AVANCER aims to provide evidence for a safe, effective, personalized, adjuvant treatment for patients with severe upper-extremity impairment for whom to date there is no efficient treatment available.
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Affiliation(s)
- Claudia Bigoni
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Clinique Romande de Réadaptation, Sion, Switzerland
| | - Sarah B. Zandvliet
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Clinique Romande de Réadaptation, Sion, Switzerland
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Elena Beanato
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Clinique Romande de Réadaptation, Sion, Switzerland
| | - Andrea Crema
- Clinical Neuroscience, University of Geneva Medical School, Geneva, Switzerland
- Bertarelli Foundation Chair in Translational Neuroengineering, Centre for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Martina Coscia
- Wyss Center for Bio and Neuroengineering, Geneva, Switzerland
- confinis AG, Sursee, Switzerland
| | - Arnau Espinosa
- Wyss Center for Bio and Neuroengineering, Geneva, Switzerland
| | - Tina Henneken
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Clinique Romande de Réadaptation, Sion, Switzerland
| | - Julie Hervé
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Clinique Romande de Réadaptation, Sion, Switzerland
| | - Meltem Oflar
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Clinique Romande de Réadaptation, Sion, Switzerland
| | - Giorgia G. Evangelista
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Clinique Romande de Réadaptation, Sion, Switzerland
| | - Takuya Morishita
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Clinique Romande de Réadaptation, Sion, Switzerland
| | - Maximilian J. Wessel
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Clinique Romande de Réadaptation, Sion, Switzerland
| | | | - Jean-Luc Turlan
- Department of Neurological Rehabilitation, Clinique Romande de Réadaptation Suva, Sion, Switzerland
| | - Niels Birbaumer
- Department of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
| | - Friedhelm C. Hummel
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Clinique Romande de Réadaptation, Sion, Switzerland
- Clinical Neuroscience, University of Geneva Medical School, Geneva, Switzerland
- *Correspondence: Friedhelm C. Hummel
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de Havenon A, Heitsch L, Sunmonu A, Braun R, Lohse KR, Cole JW, Mistry E, Lindgren A, Worrall BB, Cramer SC. Accurate Prediction of Persistent Upper Extremity Impairment in Patients With Ischemic Stroke. Arch Phys Med Rehabil 2022; 103:964-969. [PMID: 34813742 PMCID: PMC9064879 DOI: 10.1016/j.apmr.2021.10.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 09/24/2021] [Accepted: 10/11/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To develop a simple and effective risk score for predicting which stroke patients will have persistent impairment of upper extremity motor function at 90 days. DESIGN Post hoc analysis of clinical trial patients hospitalized with acute ischemic stroke who were followed for 90 days to determine functional outcome. SETTING Patient were hospitalized at facilities across the United States. PARTICIPANTS We created a harmonized cohort of individual patients (N=1653) from the NINDS tPA, ALIAS part 2, IMS-III, DEFUSE 3, and FAST-MAG trials. We split the cohort into balanced derivation and validation samples. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The primary outcome was persistent arm impairment, defined as a National Institutes of Health Stroke Scale (NIHSS) arm domain score of 2 to 4 at 90 days in patients who had a 24-hour NIHSS arm score of 1 or more. We used least absolute shrinkage and selection operator regression to determine the elements of the persistent upper extremity impairment (PUPPI) index, which we validated as a predictive tool. RESULTS We included 1653 patients (827 derivation, 826 validation), of whom 803 (48.6%) had persistent arm impairment. The PUPPI index gives 1 point each for age 55 years or older and NIHSS values of worse arm (4), worse leg (>2), facial palsy (3), and total NIHSS (≥10). The optimal cutpoint for the PUPPI index was 3 or greater, at which the area under the curve was greater than 0.75 for the derivation and validation cohorts and when using NIHSS values from either 24 hours or in a subacute or discharge time window. Results were similar across different levels of stroke severity. CONCLUSION The PUPPI index uses readily available information to accurately predict persistent upper extremity motor impairment at 90 days poststroke. The PUPPI index can be administered in minutes and could be used as inclusion criterion in recovery-related clinical trials or, with additional development, as a prognostic tool for patients, caregivers, and clinicians.
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Affiliation(s)
- Adam de Havenon
- Department of Neurology, University of Utah, Salt Lake City, UT.
| | - Laura Heitsch
- Department of Emergency Medicine, Washington University, St. Louis, MO
| | - Abimbola Sunmonu
- Department of Neurology, University of Virginia, Charlotteville, VA
| | - Robynne Braun
- Department of Neurology, University of Maryland, College Park, MD
| | - Keith R Lohse
- Department of Neurology, University of Utah, Salt Lake City, UT
| | - John W Cole
- Department of Neurology, University of Maryland, College Park, MD
| | - Eva Mistry
- Department of Neurology, Vanderbilt University, Nashville, TN
| | - Arne Lindgren
- Section of Neurology, Skåne University Hospital, Scania, Sweden; Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden
| | | | - Steven C Cramer
- Department of Emergency Medicine, University of California Los Angeles, Los Angeles, CA; California Rehabilitation Institute, Los Angeles, CA
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Gámez Santiago AB, Martínez Cáceres CM, Hernández-Morante JJ. Effectiveness of Intensively Applied Mirror Therapy in Older Patients with Post-Stroke Hemiplegia: A Preliminary Trial. Eur Neurol 2022; 85:291-299. [PMID: 35378544 DOI: 10.1159/000522413] [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: 10/18/2021] [Accepted: 01/30/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The present work was carried out to determine the effectiveness of neuromuscular stimulation triggered by mirror therapy (MT) in older patients with post-stroke hemiplegia by two different intervention protocols, either intensively or spaced. METHODS A preliminary trial conducted on Spanish rehabilitation centres was conducted. Forty older patients (>70 years) with diagnosed post-stroke hemiplegia were randomly distributed to intensive intervention group (5 times/week for 6 weeks) or to spaced intervention group (3 times/week for 10 weeks), which underwent a similar number of MT sessions (n = 30). Muscle strength and activity were measured at baseline and at the end of treatment. Functional ability was also evaluated. RESULTS Although both interventions improved muscle activity parameters, intensive MT showed a significantly and statistically higher intervention effect on electromyographic activity (p < 0.001) and muscle strength (p < 0.001) than the spaced over time protocol. Attending to the Barthel Index scores, the effect on functionality was also greater in the intensive therapy group (p < 0.001), although the functional improvement measured by the Fugl-Meyer test was similar (p = 0.235). The effect of the interventions was independent of age and clinical antecedents. CONCLUSION Intensive MT appears to be more effective than a more spaced over time therapy; therefore, at least in the older adults, this treatment protocol should be recommended in the post-stroke recovery of these patients. Further studies will confirm with certainty whether this treatment is the most suitable guideline for to treat these patients.
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Lamberti N, Manfredini F, Nardi F, Baroni A, Piva G, Crepaldi A, Basaglia N, Casetta I, Straudi S. Cortical Oxygenation during a Motor Task to Evaluate Recovery in Subacute Stroke Patients: A Study with Near-Infrared Spectroscopy. Neurol Int 2022; 14:322-335. [PMID: 35466207 PMCID: PMC9036242 DOI: 10.3390/neurolint14020026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/10/2022] [Accepted: 03/21/2022] [Indexed: 11/16/2022] Open
Abstract
In subacute stroke patients we studied cortical oxygenation changes by near-infrared spectroscopy (NIRS) during a motor task performed with the hemiparetic arm (15 s of reaching and grasping, 45 s of rest, repeated 6 times). Twenty-three subjects were included at baseline, compared with six healthy subjects, and restudied after 6 weeks of rehabilitation. Motor/premotor cortical changes in oxyhemoglobin detected by NIRS were quantified as the area under the curve (AUC) for the total cortex (TOT-AUC) and for both affected (AFF-AUC) and unaffected hemispheres (UN-AUC). The ratio between AUC and the number of task repetitions performed identified the cortical metabolic cost (CMC) or the oxygenation increase for a single movement. Fugl−Meyer assessment of the upper extremity (FMA-UE) was also performed. At baseline, both total and hemispheric CMC were significantly higher in stroke patients than in healthy subjects and inversely correlated with FMA-UE. After rehabilitation, changes in total-CMC and unaffected-CMC, but not Affected-CMC, were inversely correlated with variations in the FMA-UE score. A value > 5000 a.u. for the ratio baseline TOT-CMC/days since stroke was associated with not reaching the clinically important difference for FMA-UE after rehabilitation. In subacute stroke the CMC, a biomarker assessed by NIRS during a motor task with the hemiparetic arm, may describe cortical time/treatment reorganization and favor patient selection for rehabilitation.
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Affiliation(s)
- Nicola Lamberti
- Department of Neuroscience and Rehabilitation, University of Ferrara, Via Luigi Borsari 46, 44121 Ferrara, Italy; (N.L.); (F.N.); (A.C.); (I.C.); (S.S.)
| | - Fabio Manfredini
- Department of Neuroscience and Rehabilitation, University of Ferrara, Via Luigi Borsari 46, 44121 Ferrara, Italy; (N.L.); (F.N.); (A.C.); (I.C.); (S.S.)
- Unit of Rehabilitation Medicine, University Hospital of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy; (A.B.); (N.B.)
- Correspondence: ; Tel.: +39-05322-36187
| | - Francesca Nardi
- Department of Neuroscience and Rehabilitation, University of Ferrara, Via Luigi Borsari 46, 44121 Ferrara, Italy; (N.L.); (F.N.); (A.C.); (I.C.); (S.S.)
| | - Andrea Baroni
- Unit of Rehabilitation Medicine, University Hospital of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy; (A.B.); (N.B.)
| | - Giovanni Piva
- PhD Program in Environmental Sustainability and Wellbeing, University of Ferrara, Via Paradiso 12, 44121 Ferrara, Italy;
| | - Anna Crepaldi
- Department of Neuroscience and Rehabilitation, University of Ferrara, Via Luigi Borsari 46, 44121 Ferrara, Italy; (N.L.); (F.N.); (A.C.); (I.C.); (S.S.)
- PhD Program in Biomedicine, Instituto Maimónides de Investigación Biomédica de Córdoba, 14005 Córdova, Spain
| | - Nino Basaglia
- Unit of Rehabilitation Medicine, University Hospital of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy; (A.B.); (N.B.)
| | - Ilaria Casetta
- Department of Neuroscience and Rehabilitation, University of Ferrara, Via Luigi Borsari 46, 44121 Ferrara, Italy; (N.L.); (F.N.); (A.C.); (I.C.); (S.S.)
- Unit of Clinical Neurology, University Hospital of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy
| | - Sofia Straudi
- Department of Neuroscience and Rehabilitation, University of Ferrara, Via Luigi Borsari 46, 44121 Ferrara, Italy; (N.L.); (F.N.); (A.C.); (I.C.); (S.S.)
- Unit of Rehabilitation Medicine, University Hospital of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy; (A.B.); (N.B.)
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Tomita Y, Hasegawa S, Chida D, Asakura T, Usuda S. Association between self-perceived activity performance and upper limb functioning in subacute stroke. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2022; 27:e1946. [PMID: 35254717 DOI: 10.1002/pri.1946] [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: 09/14/2021] [Revised: 02/02/2022] [Accepted: 02/24/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND PURPOSE This study aimed to investigate to what extent upper limb (UL) motor impairment, trunk compensation, and activity performance are related to self-perception of UL activity performance in subacute stroke. METHODS This was a prospective observational study. Twenty-four adults with subacute stroke (age: 65.4 ± 10.8 years) underwent clinical and kinematic assessments at baseline (33.9 ± 5.2 days after stroke onset) and 4 weeks after the baseline. The clinical assessment included the UL Fugl-Meyer motor assessment (FMA), Simple Test for Evaluating hand Function (STEF), and the performance and satisfaction scores of the Canadian Occupational Performance Measure (COPM). The kinematic measurement was performed using a motion capture system during a standardized reach-to-grasp task. Endpoint performance variables and trunk displacement were calculated as kinematic outcomes. An inpatient rehabilitation program of 3 h/day was provided every day for 4 weeks between the two measurement points. The relationships between COPM scores and clinical/kinematic outcomes were examined by multiple regression analysis. Significance levels of p < 0.05 were used. RESULTS The results of the multiple regression analysis showed that the changes in STEF (β = 0.520, p = 0.005) and trunk compensation (β = -0.398, p = 0.024) were moderately related to the change in the COPM satisfaction (R2 adj = 0.426, p = 0.001), while the change in UL FMA was not. DISCUSSION The changes in activity performance and trunk compensation were related to improved self-perception of UL activity performance. Therapeutic management for activity performance and trunk compensation may be important for improving self-perception of UL activity performance after stroke.
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Affiliation(s)
- Yosuke Tomita
- Department of Physical Therapy, Takasaki University of Health and Welfare, Takasaki, Japan
| | - Satoshi Hasegawa
- Department of Rehabilitation, Public Nanokaichi Hospital, Tomioka, Japan
| | - Daiki Chida
- Department of Rehabilitation, Gunma Rehabilitation Hospital, Maebashi, Japan
| | - Tomoyuki Asakura
- Graduate School of Health Sciences, Gunma University, Maebashi, Japan
| | - Shigeru Usuda
- Graduate School of Health Sciences, Gunma University, Maebashi, Japan
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Babazadeh-Zavieh SS, Ansari NN, Ghotbi N, Naghdi S, Mansouri K, Khanmohammadi M, Haeri SMJ. Effects of dry needling plus exercise therapy on post-stroke spasticity and motor function: A case report. Complement Ther Clin Pract 2022; 46:101520. [PMID: 34875580 DOI: 10.1016/j.ctcp.2021.101520] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 11/14/2021] [Accepted: 11/27/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND PURPOSE The use of dry needling (DN) with other treatments may be more beneficial in managing post-stroke spasticity. We report the effects of DN plus exercise therapy (ET) on wrist flexor spasticity. PATIENT PRESENTATION The patient was a 45-year-old man with an 8-year history of stroke. The outcome measures included the Modified Modified Ashworth Scale (MMAS), Hmax/Mmax ratio, H-reflex latency, Action Research Arm Test (ARAT), Fugl-Meyer Assessment (FMA), and range of motion (ROM) which were assessed before (T1), after (T2), and after 3-week follow-up (T3). CONCLUSION The MMAS was improved at T2 from "3" to "2". The Hmax/Mmax decreased from 0.77 to 0.53 at T3. The H-reflex latency increased from 15.4 ms to 18.5 ms at T3. The wrist active and passive ROM increased ∼30° and ∼20° at T2, respectively. A 4-session DN plus ET may improve spasticity and ROM. No meaningful improvement was observed in function.
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Affiliation(s)
| | - Noureddin Nakhostin Ansari
- Physical Therapy Department, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran; Research Center for War-affected People, Tehran University of Medical Sciences, Tehran, Iran
| | - Nastaran Ghotbi
- Physical Therapy Department, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
| | - Soofia Naghdi
- Physical Therapy Department, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Korosh Mansouri
- Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Khanmohammadi
- Physical Therapy Department, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
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Lee J, Kim H, Kim J, Chang WH, Kim YH. Multimodal Imaging Biomarker-Based Model Using Stratification Strategies for Predicting Upper Extremity Motor Recovery in Severe Stroke Patients. Neurorehabil Neural Repair 2021; 36:217-226. [PMID: 34970925 DOI: 10.1177/15459683211070278] [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. Various prognostic biomarkers for upper extremity (UE) motor recovery after stroke have been reported. However, most have relatively low predictive accuracy in severe stroke patients.Objective. This study suggests an imaging biomarker-based model for effectively predicting UE recovery in severe stroke patients.Methods. Of 104 ischemic stroke patients screened, 42 with severe motor impairment were included. All patients underwent structural, diffusion, and functional magnetic resonance imaging at 2 weeks and underwent motor function assessments at 2 weeks and 3 months after stroke onset. According to motor function recovery at 3 months, patients were divided into good and poor subgroups. The value of multimodal imaging biomarkers of lesion load, lesion volume, white matter integrity, and cortical functional connectivity for motor recovery prediction was investigated in each subgroup.Results. Imaging biomarkers varied depending on recovery pattern. The integrity of the cerebellar tract (P = .005, R2 = .432) was the primary biomarker in the good recovery group. In contrast, the sensory-related corpus callosum tract (P = .026, R2 = .332) and sensory-related functional connectivity (P = .001, R2 = .531) were primary biomarkers in the poor recovery group. A prediction model was proposed by applying each biomarker in the subgroup to patients with different motor evoked potential responses (P < .001, R2 = .853, root mean square error = 5.28).Conclusions. Our results suggest an optimized imaging biomarker model for predicting UE motor recovery after stroke. This model can contribute to individualized management of severe stroke in a clinical setting.
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Affiliation(s)
- Jungsoo Lee
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, 36626Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Heegoo Kim
- Department of Health Sciences and Technology, Department of Medical Device Management and Research, Department of Digital Health, SAIHST, 35017Sungkyunkwan University, Seoul, Republic of Korea
| | - Jinuk Kim
- Department of Health Sciences and Technology, Department of Medical Device Management and Research, Department of Digital Health, SAIHST, 35017Sungkyunkwan University, Seoul, Republic of Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, 36626Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, 36626Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Health Sciences and Technology, Department of Medical Device Management and Research, Department of Digital Health, SAIHST, 35017Sungkyunkwan University, Seoul, Republic of Korea
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Vinehout K, Tynes K, Sotelo MR, Hyngstrom AS, McGuire JR, Schmit BD. Changes in Cortical Activity in Stroke Survivors Undergoing Botulinum Neurotoxin Therapy for Treatment of Focal Spasticity. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:735819. [PMID: 36188774 PMCID: PMC9397708 DOI: 10.3389/fresc.2021.735819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 11/25/2021] [Indexed: 11/24/2022]
Abstract
Background: Botulinum NeuroToxin-A (BoNT-A) relieves muscle spasticity and increases range of motion necessary for stroke rehabilitation. Determining the effects of BoNT-A therapy on brain neuroplasticity could help physicians customize its use and predict its outcome. Objective: The purpose of this study was to investigate the effects of Botulinum Toxin-A therapy for treatment of focal spasticity on brain activation and functional connectivity. Design: We used functional Magnetic Resonance Imaging (fMRI) to track changes in blood oxygen-level dependent (BOLD) activation and functional connectivity associated with BoNT-A therapy in nine chronic stroke participants, and eight age-matched controls. Scans were acquired before BoNT-A injections (W0) and 6 weeks after the injections (W6). The task fMRI scan consisted of a block design of alternating mass finger flexion and extension. The voxel-level changes in BOLD activation, and pairwise changes in functional connectivity were analyzed for BoNT-A treatment (stroke W0 vs. W6). Results: BoNT-A injection therapy resulted in significant increases in brain activation in the contralesional premotor cortex, cingulate gyrus, thalamus, superior cerebellum, and in the ipsilesional sensory integration area. Lastly, cerebellar connectivity correlated with the Fugl-Meyer assessment of motor impairment before injection, while premotor connectivity correlated with the Fugl-Meyer score after injection. Conclusion: BoNT-A therapy for treatment of focal spasticity resulted in increased brain activation in areas associated with motor control, and cerebellar connectivity correlated with motor impairment before injection. These results suggest that neuroplastic effects might take place in response to improvements in focal spasticity.
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Affiliation(s)
- Kaleb Vinehout
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, WI, United States
| | - Kelsey Tynes
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, WI, United States
| | - Miguel R. Sotelo
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, WI, United States
| | - Allison S. Hyngstrom
- Department of Physical Therapy, Marquette University, Milwaukee, WI, United States
| | - John R. McGuire
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Brian D. Schmit
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, WI, United States
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, WI, United States
- *Correspondence: Brian D. Schmit
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Chen J, Black I, Nichols D, Chen T, Sandison M, Casas R, Lum PS. Pilot Test of Dosage Effects in HEXORR II for Robotic Hand Movement Therapy in Individuals With Chronic Stroke. FRONTIERS IN REHABILITATION SCIENCES 2021; 2. [PMID: 35419565 PMCID: PMC9004134 DOI: 10.3389/fresc.2021.728753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Impaired use of the hand in functional tasks remains difficult to overcome in many individuals after a stroke. This often leads to compensation strategies using the less-affected limb, which allows for independence in some aspects of daily activities. However, recovery of hand function remains an important therapeutic goal of many individuals, and is often resistant to conventional therapies. In prior work, we developed HEXORR I, a robotic device that allows practice of finger and thumb movements with robotic assistance. In this study, we describe modifications to the device, now called HEXORR II, and a clinical trial in individuals with chronic stroke. Fifteen individuals with a diagnosis of chronic stroke were randomized to 12 or 24 sessions of robotic therapy. The sessions involved playing several video games using thumb and finger movement. The robot applied assistance to extension movement that was adapted based on task performance. Clinical and motion capture evaluations were performed before and after training and again at a 6-month followup. Fourteen individuals completed the protocol. Fugl-Meyer scores improved significantly at the 6 month time point compared to baseline, indicating reductions in upper extremity impairment. Flexor hypertonia (Modified Ashworth Scale) also decreased significantly due to the intervention. Motion capture found increased finger range of motion and extension ability after the intervention that continued to improve during the followup period. However, there was no change in a functional measure (Action Research Arm Test). At the followup, the high dose group had significant gains in hand displacement during a forward reach task. There were no other significant differences between groups. Future work with HEXORR II should focus on integrating it with functional task practice and incorporating grip and squeezing tasks. Trial Registration:ClinicalTrials.gov, NCT04536987. Registered 3 September 2020 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/record/NCT04536987.
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Affiliation(s)
- Ji Chen
- Department of Mechanical Engineering, University of the District of Columbia, Washington, DC, United States
- Department of Biomedical Engineering, The Catholic University of America, Washington, DC, United States
| | - Iian Black
- MedStar National Rehabilitation Network, Washington, DC, United States
- Biomedical Engineering Department, Florida International University, Miami, FL, United States
| | - Diane Nichols
- MedStar National Rehabilitation Network, Washington, DC, United States
| | - Tianyao Chen
- Department of Biomedical Engineering, The Catholic University of America, Washington, DC, United States
| | - Melissa Sandison
- Department of Biomedical Engineering, The Catholic University of America, Washington, DC, United States
- MedStar National Rehabilitation Network, Washington, DC, United States
| | - Rafael Casas
- Department of Biomedical Engineering, The Catholic University of America, Washington, DC, United States
- MedStar National Rehabilitation Network, Washington, DC, United States
| | - Peter S. Lum
- Department of Biomedical Engineering, The Catholic University of America, Washington, DC, United States
- MedStar National Rehabilitation Network, Washington, DC, United States
- *Correspondence: Peter S. Lum
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Guzik A, Drużbicki M, Perenc L, Wolan-Nieroda A, Turolla A, Kiper P. Establishing the Minimal Clinically Important Differences for Sagittal Hip Range of Motion in Chronic Stroke Patients. Front Neurol 2021; 12:700190. [PMID: 34539552 PMCID: PMC8443407 DOI: 10.3389/fneur.2021.700190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 08/03/2021] [Indexed: 11/13/2022] Open
Abstract
Many researchers have pointed out that decreased sagittal range of motion (ROM) in the affected hip joint is a common consequence of stroke, and it adversely affects walking performance and walking speed. Nevertheless, the minimal clinically important differences (MCID) in hip-related kinematic gait parameters post-stroke have not yet been determined. The present study aimed to define MCID values for hip ROM in the sagittal plane i.e., flexion-extension (FE), for the affected and unaffected sides at a chronic stage post-stroke. Fifty participants with hemiparesis due to stroke were enrolled for the study. Four statistical methods were used to calculate MCID. According to the anchor-based approach, the mean change in hip FE ROM achieved by the MCID group on the affected/unaffected side amounted to 5.81°/2.86° (the first MCID estimate). The distribution-based analyses established that the standard error of measurement in the no-change group amounted to 1.56°/1.04° (the second MCID estimate). Measurements based on the third method established that a change of 4.09°/0.61° in the hip ROM corresponded to a 1.85-point change in the Barthel Index. The optimum cutoff value, based on ROC curve analysis, corresponded to 2.9/2.6° of change in the hip sagittal ROM for the affected/unaffected side (the fourth MCID estimate). To our knowledge, this is the first study to use a comprehensive set of statistical methods to determine the MCID for hip sagittal ROM for the affected and unaffected sides at a chronic stage post-stroke. According to our findings, the MCID of the hip FE ROM for the affected side amounts to 5.81° and for the unaffected side to 2.86°, in patients with chronic stroke. This indicator is extremely important because it allows clinical practitioners to assess the effects of interventions administered to patients, and to interpret the significance of improvements in sagittal kinematic parameters of the hip; ultimately, it may facilitate the process of designing effective gait reeducation programs.
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Affiliation(s)
- Agnieszka Guzik
- Department of Physiotherapy, Institute of Health Sciences, Medical College, University of Rzeszów, Rzeszów, Poland
| | - Mariusz Drużbicki
- Department of Physiotherapy, Institute of Health Sciences, Medical College, University of Rzeszów, Rzeszów, Poland
| | - Lidia Perenc
- Department of Physiotherapy, Institute of Health Sciences, Medical College, University of Rzeszów, Rzeszów, Poland
| | - Andżelina Wolan-Nieroda
- Department of Physiotherapy, Institute of Health Sciences, Medical College, University of Rzeszów, Rzeszów, Poland
| | - Andrea Turolla
- Laboratory of Kinematics and Robotics IRCCS San Camillo Hospital, Venice, Italy
| | - Paweł Kiper
- Azienda Unità Locale Socio Sanitaria 3 Serenissima Physical Medicine and Rehabilitation Unit, Venice, Italy
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Yu M, Wang L, Wang H, Wu H. The effect of early systematic rehabilitation nursing on the quality of life and limb function in elderly patients with stroke sequelae. Am J Transl Res 2021; 13:9639-9646. [PMID: 34540090 PMCID: PMC8430147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 02/19/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To study the effect of early systematic rehabilitation nursing on the quality of life and limb function in elderly patients with stroke sequelae. METHODS This prospective study was conducted in 97 elderly patients with stroke sequelae. These patients were randomly allocated to the control group (n=49) and the experimental group (n=48). Patients in the control group received routine rehabilitation nursing, while those in the experimental group received early systematic rehabilitation nursing. Upper limb motor function (Fugl-Meyer assessment (FMA) score), upper limb sensory function (tactile threshold and two-point discrimination), physiological state (Hamilton anxiety (HAMA) scale and Hamilton depression (HAMD) scale score), ability of daily living (ADL) (the Barthel index score and ability of daily living score), and the quality of life (generic quality of life inventory-74 (GQOLI-74) score) before and 3 months after intervention were compared between the two groups. RESULTS Compared with before intervention, FMA scores in the two groups after intervention were increased, while modified Ashworth scores were decreased (all P<0.05). The changes in the experimental group after intervention were more than those in the control group (both P<0.05). Tactile threshold and two-point discrimination in both groups after intervention were reduced when compared with before intervention (all P<0.05); tactile threshold and two-point discrimination in the experimental group after intervention group were smaller than those in the control group (both P<0.05). HAMA scale and HAMD scale scores in the two groups after intervention were lower than those before intervention (all P<0.05); HAMA scale and HAMD scale score in the experimental group after intervention were reduced when compared with the control group (both P<0.05). The Barthel index scores, ADL scores, and GQOLI-74 scores in both groups after intervention were increased when compared with before intervention (all P<0.05). The Barthel index score, ADL score, and GQOLI-74 score in the experimental group after intervention were higher than those in the control group (all P<0.05). CONCLUSION For elderly patients with stroke sequelae, early systemic rehabilitation nursing is more beneficial for the improvement of upper limb motor and sensory function, alleviation of negative psychology, raise in ability of daily living, and increase of life quality. It is therefore worthy of clinical application.
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Affiliation(s)
- Mingxia Yu
- First Ward, Department of Internal Medicine, Huiqiao Medical Center, Nanfang Hospital, Southern Medical University Guangzhou, Guangdong Province, China
| | - Li Wang
- First Ward, Department of Internal Medicine, Huiqiao Medical Center, Nanfang Hospital, Southern Medical University Guangzhou, Guangdong Province, China
| | - Haiyan Wang
- First Ward, Department of Internal Medicine, Huiqiao Medical Center, Nanfang Hospital, Southern Medical University Guangzhou, Guangdong Province, China
| | - Honglun Wu
- First Ward, Department of Internal Medicine, Huiqiao Medical Center, Nanfang Hospital, Southern Medical University Guangzhou, Guangdong Province, China
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50
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Sánchez-Cuesta FJ, Arroyo-Ferrer A, González-Zamorano Y, Vourvopoulos A, Badia SBI, Figuereido P, Serrano JI, Romero JP. Clinical Effects of Immersive Multimodal BCI-VR Training after Bilateral Neuromodulation with rTMS on Upper Limb Motor Recovery after Stroke. A Study Protocol for a Randomized Controlled Trial. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:736. [PMID: 34440942 PMCID: PMC8401798 DOI: 10.3390/medicina57080736] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 07/19/2021] [Indexed: 01/31/2023]
Abstract
Background and Objectives: The motor sequelae after a stroke are frequently persistent and cause a high degree of disability. Cortical ischemic or hemorrhagic strokes affecting the cortico-spinal pathways are known to cause a reduction of cortical excitability in the lesioned area not only for the local connectivity impairment but also due to a contralateral hemisphere inhibitory action. Non-invasive brain stimulation using high frequency repetitive magnetic transcranial stimulation (rTMS) over the lesioned hemisphere and contralateral cortical inhibition using low-frequency rTMS have been shown to increase the excitability of the lesioned hemisphere. Mental representation techniques, neurofeedback, and virtual reality have also been shown to increase cortical excitability and complement conventional rehabilitation. Materials and Methods: We aim to carry out a single-blind, randomized, controlled trial aiming to study the efficacy of immersive multimodal Brain-Computer Interfacing-Virtual Reality (BCI-VR) training after bilateral neuromodulation with rTMS on upper limb motor recovery after subacute stroke (>3 months) compared to neuromodulation combined with conventional motor imagery tasks. This study will include 42 subjects in a randomized controlled trial design. The main expected outcomes are changes in the Motricity Index of the Arm (MI), dynamometry of the upper limb, score according to Fugl-Meyer for upper limb (FMA-UE), and changes in the Stroke Impact Scale (SIS). The evaluation will be carried out before the intervention, after each intervention and 15 days after the last session. Conclusions: This trial will show the additive value of VR immersive motor imagery as an adjuvant therapy combined with a known effective neuromodulation approach opening new perspectives for clinical rehabilitation protocols.
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Affiliation(s)
- Francisco José Sánchez-Cuesta
- Facultad de Ciencias Experimentales, Universidad Francisco de Vitoria, 28223 Pozuelo de Alarcón, Spain; (F.J.S.-C.); (A.A.-F.)
| | - Aida Arroyo-Ferrer
- Facultad de Ciencias Experimentales, Universidad Francisco de Vitoria, 28223 Pozuelo de Alarcón, Spain; (F.J.S.-C.); (A.A.-F.)
| | - Yeray González-Zamorano
- Escuela Internacional de Doctorado, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28933 Alcorcón, Spain;
| | - Athanasios Vourvopoulos
- Institute for Systems and Robotics-Lisboa, Department of Bioengineering, Instituto Superior Técnico, Universidade de Lisboa, 1049-001 Lisbon, Portugal; (A.V.); (P.F.)
| | - Sergi Bermúdez i Badia
- Faculdade de Ciências Exatas e da Engenharia, Madeira Interactive Technologies Institute, NOVA LINCS, Universidade da Madeira, 9020-105 Funchal, Portugal;
| | - Patricia Figuereido
- Institute for Systems and Robotics-Lisboa, Department of Bioengineering, Instituto Superior Técnico, Universidade de Lisboa, 1049-001 Lisbon, Portugal; (A.V.); (P.F.)
| | - José Ignacio Serrano
- Neural and Cognitive Engineering Group (gNeC), Centre for Automation and Robotics (CAR), Spanish National Research Council (CSIC-UPM), 28500 Arganda del Rey, Spain;
| | - Juan Pablo Romero
- Facultad de Ciencias Experimentales, Universidad Francisco de Vitoria, 28223 Pozuelo de Alarcón, Spain; (F.J.S.-C.); (A.A.-F.)
- Brain Damage Unit, Beata María Ana Hospital, 28007 Madrid, Spain
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