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Duan X, Huang D, Zhong H, Wu J, Xiao Z, Yang P, Han Y, Jiang H, Zhou P, Liu X. Efficacy of rTMS in treating functional impairment in post-stroke patients: a systematic review and meta-analysis. Neurol Sci 2024:10.1007/s10072-024-07455-2. [PMID: 38512529 DOI: 10.1007/s10072-024-07455-2] [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: 01/15/2024] [Accepted: 03/08/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Most stroke patients suffer from an imbalance in blood supply, which causes severe brain damage leading to functional deficits in motor, sensory, swallowing, cognitive, emotional, and speech functions. Repetitive transcranial magnetic stimulation (rTMS) is thought to restore functions impaired during the stroke process and improve the quality of life of stroke patients. However, the efficacy of rTMS in treating post-stroke function impairment varies significantly. Therefore, we conducted a meta-analysis of the number of patients with effective rTMS in treating post-stroke dysfunction. METHODS The PubMed, Embase, and Cochrane Library databases were searched. Screening and full-text review were performed by three investigators. Single-group rate meta-analysis was performed on the extracted data using a random variable model. Then subgroup analyses were performed at the levels of stroke acuity (acute, chronic, or subacute); post-stroke symptoms (including upper and lower limb motor function, dysphagia, depression, aphasia); rTMS stimulation site (affected side, unaffected side); and whether or not it was a combination therapy. RESULTS We obtained 8955 search records, and finally 33 studies (2682 patients) were included in the meta-analysis. The overall analysis found that effective strength (ES) of rTMS was 0.53. In addition, we found that the ES of rTMS from acute/subacute/chronic post-stroke was 0.69, 0.45, and 0.52. We also found that the ES of rTMS using high-frequency stimulation was 0.56, while the ES of rTMS using low-frequency stimulation was 0.53. From post-stroke symptoms, we found that the ES of rTMS in sensory aspects, upper limb functional aspects, swallowing function, and aphasia was 0.50, 0.52, 0.51, and 0.54. And from the site of rTMS stimulation, we found that the ES of rTMS applied to the affected side was 0.51, while the ES applied to the unaffected side was 0.54. What's more, we found that the ES of rTMS applied alone was 0.53, while the ES of rTMS applied in conjunction with other therapeutic modalities was 0.53. CONCLUSIONS By comparing the results of the data, we recommend rTMS as a treatment option for rehabilitation of functional impairment in patients after stroke. We also recommend that rehabilitation physicians or clinicians use combination therapy as one of the options for patients.
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Affiliation(s)
- Xiaodong Duan
- Department of Rehabilitation Medicine, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Luzhou, 646000, Sichuan, China
- Department of Rehabilitation Medicine, Southwest Medical University, Luzhou, Sichuan, China
- Rehabilitation Medicine and Engineering Key Laboratory of Luzhou, Luzhou, Sichuan, China
| | - Delong Huang
- Clinical Medical College, Southwest Medical University, Luzhou, Sichuan, China
| | - Haoshu Zhong
- Department of Hematology, Huashan Hospital, Fudan University, Shanghai, China
| | - Junhao Wu
- Department of Nuclear Medicine & PET Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhihan Xiao
- Clinical Medical College, Southwest Medical University, Luzhou, Sichuan, China
| | - Peng Yang
- Clinical Medical College, Southwest Medical University, Luzhou, Sichuan, China
| | - Yuanhang Han
- Clinical Medical College, Southwest Medical University, Luzhou, Sichuan, China
| | - Haodong Jiang
- Clinical Medical College, Southwest Medical University, Luzhou, Sichuan, China
| | - Ping Zhou
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Luzhou, 646000, Sichuan, China.
| | - Xi Liu
- Department of Rehabilitation Medicine, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Luzhou, 646000, Sichuan, China.
- Department of Rehabilitation Medicine, Southwest Medical University, Luzhou, Sichuan, China.
- Rehabilitation Medicine and Engineering Key Laboratory of Luzhou, Luzhou, Sichuan, China.
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Yan M, Liu J, Guo Y, Hou Q, Song J, Wang X, Yu W, Lü Y. Comparative efficacy of non-invasive brain stimulation for post-stroke cognitive impairment: a network meta-analysis. Aging Clin Exp Res 2024; 36:37. [PMID: 38345751 PMCID: PMC10861650 DOI: 10.1007/s40520-023-02662-x] [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: 08/08/2023] [Accepted: 11/14/2023] [Indexed: 02/15/2024]
Abstract
BACKGROUND Non-invasive brain stimulation (NIBS) is a burgeoning approach with the potential to significantly enhance cognition and functional abilities in individuals who have undergone a stroke. However, the current evidence lacks robust comparisons and rankings of various NIBS methods concerning the specific stimulation sites and parameters used. To address this knowledge gap, this systematic review and meta-analysis seek to offer conclusive evidence on the efficacy and safety of NIBS in treating post-stroke cognitive impairment. METHODS A systematic review of randomized control trials (RCT) was performed using Bayesian network meta-analysis. We searched RCT in the following databases until June 2022: Cochrane Central Register of Controlled Trials (CENTRAL), PUBMED, and EMBASE. We compared any active NIBS to control in terms of improving cognition function and activities of daily living (ADL) capacity following stroke. RESULTS After reviewing 1577 retrieved citations, a total of 26 RCTs were included. High-frequency (HF)-repetitive transcranial magnetic stimulation (rTMS) (mean difference 2.25 [95% credible interval 0.77, 3.66]) was identified as a recommended approach for alleviating the global severity of cognition. Dual-rTMS (27.61 [25.66, 29.57]) emerged as a favorable technique for enhancing ADL function. In terms of stimulation targets, the dorsolateral prefrontal cortex exhibited a higher ranking in relation to the global severity of cognition. CONCLUSIONS Among various NIBS techniques, HF-rTMS stands out as the most promising intervention for enhancing cognitive function. Meanwhile, Dual-rTMS is highly recommended for improving ADL capacity.
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Affiliation(s)
- Mengyu Yan
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yu Zhong District, , Chongqing, 400016, China
- Institute of Neuroscience, Chongqing Medical University, No. 1 Yixuayuan Road, Yu Zhong District, Chongqing, 400016, China
| | - Jiarui Liu
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yu Zhong District, , Chongqing, 400016, China
| | - Yiming Guo
- Institute of Neuroscience, Chongqing Medical University, No. 1 Yixuayuan Road, Yu Zhong District, Chongqing, 400016, China
| | - Qingtao Hou
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yu Zhong District, , Chongqing, 400016, China
| | - Jiaqi Song
- Institute of Neuroscience, Chongqing Medical University, No. 1 Yixuayuan Road, Yu Zhong District, Chongqing, 400016, China
| | - Xiaoqin Wang
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yu Zhong District, , Chongqing, 400016, China
| | - Weihua Yu
- Institute of Neuroscience, Chongqing Medical University, No. 1 Yixuayuan Road, Yu Zhong District, Chongqing, 400016, China.
| | - Yang Lü
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yu Zhong District, , Chongqing, 400016, China.
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Carter AR, Barrett A. Recent advances in treatment of spatial neglect: networks and neuropsychology. Expert Rev Neurother 2023; 23:587-601. [PMID: 37273197 PMCID: PMC10740348 DOI: 10.1080/14737175.2023.2221788] [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: 03/06/2023] [Accepted: 06/01/2023] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Spatial neglect remains an underdiagnosed and undertreated consequence of stroke that imposes significant disability. A growing appreciation of brain networks involved in spatial cognition is helping us to develop a mechanistic understanding of different therapies under development. AREAS COVERED This review focuses on neuromodulation of brain networks for the treatment of spatial neglect after stroke, using evidence-based approaches including 1) Cognitive strategies that are more likely to impact frontal lobe executive function networks; 2) Visuomotor adaptation, which may depend on the integrity of parietal and parieto- and subcortical-frontal connections and the presence of a particular subtype of neglect labeled Aiming neglect; 3) Non-invasive brain stimulation that may modulate relative levels of activity of the two hemispheres and depend on corpus callosum connectivity; and 4) Pharmacological modulation that may exert its effect primarily via right-lateralized networks more closely involved in arousal. EXPERT OPINION Despite promising results from individual studies, significant methodological heterogeneity between trials weakened conclusions drawn from meta-analyses. Improved classification of spatial neglect subtypes will benefit research and clinical care. Understanding the brain network mechanisms of different treatments and different types of spatial neglect will make possible a precision medicine treatment approach.
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Affiliation(s)
- Alex R. Carter
- Department of Neurology, Department of Orthopedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - A.M. Barrett
- UMass Chan Medical School and UMass Memorial Healthcare, Worcester, MA, USA
- Central Western MA VA Healthcare System, Worcester, MA, USA
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Wang Y, Xu N, Wang R, Zai W. Systematic review and network meta-analysis of effects of noninvasive brain stimulation on post-stroke cognitive impairment. Front Neurosci 2022; 16:1082383. [PMID: 36643019 PMCID: PMC9832390 DOI: 10.3389/fnins.2022.1082383] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 12/05/2022] [Indexed: 12/29/2022] Open
Abstract
Objective To systematically assess the effects of Noninvasive Brain Stimulation (NIBS) on post-stroke cognitive impairment (PSCI) and to compare the efficacy of two different NIBS. Methods Computer searches of PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), Chinese Biomedical literature Service System (SinoMed), and Wanfang Database were conducted using a combination of free words and subject terms. The search was conducted from the database creation date to 27 November 2022. The risk of bias in the included literature was assessed using the Cochrane Risk Assessment Scale. The quality of the included literature was assessed using the physiotherapy evidence database (PEDro) scale. A standard meta-analysis of study data for each outcome indicator was performed using RevMan 5.4 software. Network meta-analysis was performed using State 14.0 according to the Bayesian framework. Results A total of 18 studies involving 809 patients were included. Meta-analysis shows NIBS significantly improved montreal cognitive assessment (MoCA) scores (standardized mean difference [SMD] = 0.76, 95% confidence interval (CI) 0.49-1.02, P < 0.05), mini-mental state examination (MMSE) scores (SMD = 0.72, 95% CI 0.25-1.20, P < 0.05), and modified barthel index (MBI) and functional independence measurement (FIM) scores (SMD = 0.33, 95% CI 0.11-0.54, P < 0.05) in patients with PSCI. The surface under the cumulative ranking curve (SUCRA) of different NIBS in improving MoCA scores were in the order of transcranial direct current stimulation (tDCS) (SUCRA = 92.4%) and transcranial magnetic stimulation (TMS) (SUCRA = 57.6%). The SUCRA of different NIBS in improving MMSE scores were in the order of tDCS (SUCRA = 81.6%) and TMS (SUCRA = 67.3%). The SUCRA of different NIBS in improving MBI and FIM scores were in the order of tDCS (SUCRA = 78.6%) and TMS (SUCRA = 65.3%). Conclusion The available evidence suggests that NIBS improves cognitive impairment. tDCS appeared more effective than TMS for cognitive function and activities of daily living in PSCI patients. Limited by the number of included studies, more large-sample, multicentre, double-blind, high-quality randomized controlled clinical trials are needed to further confirm this study's results. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier: CRD42022372354.
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Choi HS, Lee BM. A Complex Intervention Integrating Prism Adaptation and Neck Vibration for Unilateral Neglect in Patients of Chronic Stroke: A Randomised Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13479. [PMID: 36294062 PMCID: PMC9603544 DOI: 10.3390/ijerph192013479] [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: 09/01/2022] [Revised: 10/06/2022] [Accepted: 10/16/2022] [Indexed: 06/16/2023]
Abstract
Unilateral neglect in patients of chronic stroke reduces the quality of life and interferes with activities of daily living (ADL). This study aimed to investigate the effects of a complex rehabilitative programme that integrates prism adaptation (PA) and neck vibration (NV) for unilateral neglect in patients of chronic stroke. Thirty-six patients were randomised among the PA + NV group (Group A, n = 12), the NV-only group (Group B, n = 12), and the PA-only group (Group C, n = 12). The intervention was performed for 50 min/day, with five sessions per week, for 4 weeks. Albert's test and the Catherine Bergego Scale were used to measure the effects of each intervention on unilateral neglect, whereas the modified Barthel Index was used to assess the effect on ADL. All three groups exhibited a reduction in unilateral neglect and an improvement in activities of daily living after the intervention (p < 0.05). Notably, Group A (PA + NV) exhibited a significantly greater level of reduction in unilateral neglect than the other groups (p < 0.05); however, the improvement in ADL did not significantly vary across the three groups (p > 0.05). This novel complex intervention comprising PA + NV is recommended for the rehabilitation, in the clinical setting, of patients of chronic stroke with unilateral neglect.
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Affiliation(s)
- Hyun-Se Choi
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Bo-Min Lee
- Department of Rehabilitation Science, Inje University Graduate School, Gimhae 50834, Korea
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Bazan R, Fonseca BHDS, Miranda JMDA, Nunes HRDC, Bazan SGZ, Luvizutto GJ. Effect of Robot-Assisted Training on Unilateral Spatial Neglect After Stroke: Systematic Review and Meta-Analysis of Randomized Controlled Trials. Neurorehabil Neural Repair 2022; 36:545-556. [PMID: 35880666 DOI: 10.1177/15459683221110894] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Several studies have shown that robotic devices can effectively improve motor function in stroke patients through limb activation. However, the effects of robot-assisted therapy on perceptual deficits after stroke is unclear. OBJECTIVE This review aimed to evaluate the effectiveness of robotic limb activation in patients with unilateral spatial neglect (USN) after stroke. METHODS In this systematic review, a literature search was performed using MEDLINE, EMBASE, CENTRAL, CINAHL, and LILACS databases without language restrictions. Randomized controlled trials (RCTs) and quasi-RCTs of robot-assisted therapy for USN after stroke were selected. Two reviewers independently assessed the risk of bias and certainty of the evidence of the included studies. RESULTS A total of 630 studies were identified, including five studies for qualitative synthesis and four meta-analyses. The results of RCTs comparing robotic limb activation with a control group suggested an improvement in the degree of USN measured by the line bisection test (standardized mean difference [SMD], -0.64; 95% confidence interval [CI], -1.13 to -0.15; P = .01). There were no differences between the groups in the motor-free visual perception test 3rd edition (SMD, 0.27; 95% CI, -0.25-0.79; P = .31), star cancellation test (SMD, 0.26; 95% CI, -0.42-0.94; P = .54), Albert's test (SMD, -0.67; 95% CI, -2.01-0.66; P = .32), and Catherine Bergego Scale (SMD, -0.81; 95% CI, -2.07-0.45; P = .21). CONCLUSION The study demonstrated that limb activation through robotic therapy can improve midline perception. However, there was no impact on tasks assessing visual scanning, functionality, or activities of daily living.
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Affiliation(s)
- Rodrigo Bazan
- Department of Neurology, Psychology, and Psychiatry at Botucatu Medical School (UNESP), Botucatu, São Paulo, Brazil
| | | | | | | | | | - Gustavo José Luvizutto
- Department of Applied Physical Therapy-Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
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Longley V, Hazelton C, Heal C, Pollock A, Woodward-Nutt K, Mitchell C, Pobric G, Vail A, Bowen A. Non-pharmacological interventions for spatial neglect or inattention following stroke and other non-progressive brain injury. Cochrane Database Syst Rev 2021; 7:CD003586. [PMID: 34196963 PMCID: PMC8247630 DOI: 10.1002/14651858.cd003586.pub4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND People with spatial neglect after stroke or other brain injury have difficulty attending to one side of space. Various rehabilitation interventions have been used, but evidence of their benefit is unclear. OBJECTIVES The main objective was to determine the effects of non-pharmacological interventions for people with spatial neglect after stroke and other adult-acquired non-progressive brain injury. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (last searched October 2020), the Cochrane Central Register of Controlled Trials (CENTRAL; last searched October 2020), MEDLINE (1966 to October 2020), Embase (1980 to October 2020), the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1983 to October 2020), and PsycINFO (1974 to October 2020). We also searched ongoing trials registers and screened reference lists. SELECTION CRITERIA We included randomised controlled trials (RCTs) of any non-pharmacological intervention specifically aimed at spatial neglect. We excluded studies of general rehabilitation and studies with mixed participant groups, unless separate neglect data were available. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Review authors categorised the interventions into eight broad types deemed to be applicable to clinical practice through iterative discussion: visual interventions, prism adaptation, body awareness interventions, mental function interventions, movement interventions, non-invasive brain stimulation, electrical stimulation, and acupuncture. We assessed the quality of evidence for each outcome using the GRADE approach. MAIN RESULTS We included 65 RCTs with 1951 participants, all of which included people with spatial neglect following stroke. Most studies measured outcomes using standardised neglect assessments. Fifty-one studies measured effects on ADL immediately after completion of the intervention period; only 16 reported persisting effects on ADL (our primary outcome). One study (30 participants) reported discharge destination, and one (24 participants) reported depression. No studies reported falls, balance, or quality of life. Only two studies were judged to be entirely at low risk of bias, and all were small, with fewer than 50 participants per group. We found no definitive (phase 3) clinical trials. None of the studies reported any patient or public involvement. Visual interventions versus any control: evidence is very uncertain about the effects of visual interventions for spatial neglect based on measures of persisting functional ability in ADL (2 studies, 55 participants) (standardised mean difference (SMD) -0.04, 95% confidence interval (CI) -0.57 to 0.49); measures of immediate functional ability in ADL; persisting standardised neglect assessments; and immediate neglect assessments. Prism adaptation versus any control: evidence is very uncertain about the effects of prism adaptation for spatial neglect based on measures of persisting functional ability in ADL (2 studies, 39 participants) (SMD -0.29, 95% CI -0.93 to 0.35); measures of immediate functional ability in ADL; persisting standardised neglect assessments; and immediate neglect assessments. Body awareness interventions versus any control: evidence is very uncertain about the effects of body awareness interventions for spatial neglect based on measures of persisting functional ability in ADL (5 studies, 125 participants) (SMD 0.61, 95% CI 0.24 to 0.97); measures of immediate functional ability in ADL; persisting standardised neglect assessments; immediate neglect assessments; and adverse events. Mental function interventions versus any control: we found no trials of mental function interventions for spatial neglect reporting on measures of persisting functional ability in ADL. Evidence is very uncertain about the effects of mental function interventions on spatial neglect based on measures of immediate functional ability in ADL and immediate neglect assessments. Movement interventions versus any control: we found no trials of movement interventions for spatial neglect reporting on measures of persisting functional ability in ADL. Evidence is very uncertain about the effects of body awareness interventions on spatial neglect based on measures of immediate functional ability in ADL and immediate neglect assessments. Non-invasive brain stimulation (NIBS) versus any control: evidence is very uncertain about the effects of NIBS on spatial neglect based on measures of persisting functional ability in ADL (3 studies, 92 participants) (SMD 0.35, 95% CI -0.08 to 0.77); measures of immediate functional ability in ADL; persisting standardised neglect assessments; immediate neglect assessments; and adverse events. Electrical stimulation versus any control: we found no trials of electrical stimulation for spatial neglect reporting on measures of persisting functional ability in ADL. Evidence is very uncertain about the effects of electrical stimulation on spatial neglect based on immediate neglect assessments. Acupuncture versus any control: we found no trials of acupuncture for spatial neglect reporting on measures of persisting functional ability in ADL. Evidence is very uncertain about the effects of acupuncture on spatial neglect based on measures of immediate functional ability in ADL and immediate neglect assessments. AUTHORS' CONCLUSIONS The effectiveness of non-pharmacological interventions for spatial neglect in improving functional ability in ADL and increasing independence remains unproven. Many strategies have been proposed to aid rehabilitation of spatial neglect, but none has yet been sufficiently researched through high-quality fully powered randomised trials to establish potential or adverse effects. As a consequence, no rehabilitation approach can be supported or refuted based on current evidence from RCTs. As recommended by a number of national clinical guidelines, clinicians should continue to provide rehabilitation for neglect that enables people to meet their rehabilitation goals. Clinicians and stroke survivors should have the opportunity, and are strongly encouraged, to participate in research. Future studies need to have appropriate high-quality methodological design, delivery, and reporting to enable appraisal and interpretation of results. Future studies also must evaluate outcomes of importance to patients, such as persisting functional ability in ADL. One way to improve the quality of research is to involve people with experience with the condition in designing and running trials.
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Affiliation(s)
- Verity Longley
- Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
| | - Christine Hazelton
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Calvin Heal
- Centre for Biostatistics, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Alex Pollock
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | | | - Claire Mitchell
- Division of Human Communication, Development & Hearing, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Gorana Pobric
- Geoffrey Jefferson Brain Research Centre, The Manchester Academic Health Science Centre, Northern Care Alliance & University of Manchester, Manchester, UK
| | - Andy Vail
- Centre For Biostatistics, Manchester Academic Health Science Centre, Manchester, UK, University of Manchester, Manchester, UK
| | - Audrey Bowen
- Geoffrey Jefferson Brain Research Centre, The Manchester Academic Health Science Centre, Northern Care Alliance & University of Manchester, Manchester, UK
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Park JH. The effects of robot-assisted left-hand training on hemispatial neglect in older patients with chronic stroke: A pilot and randomized controlled trial. Medicine (Baltimore) 2021; 100:e24781. [PMID: 33655943 PMCID: PMC7939197 DOI: 10.1097/md.0000000000024781] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 01/27/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Even though a variety of rehabilitative technique have been implemented to ameliorate neglect symptoms of patients with stoke, the effects of limb activation using a robotic device are still unknown. The purpose of this study was to investigate the effects of the robot-assisted hand training on hemispatial neglect of older patients with chronic stroke. METHODS The participants were randomly allocated to the experimental group (EG) receiving robot-assisted left-hand training (n = 12) or the control group (CG) receiving conventional treatments for neglect symptoms (n = 12). All participants received 20 sessions for 4-week. To examine the effects on hemispatial neglect, the line bisection test (LBT), the Albert test, and the Catherine Bergego Scale (CBS) were utilized. The outcome measures were analyzed before and after the 20 training sessions. RESULTS After the intervention, improvements in the LBT, the Albert test, and the CBS were found in the EG whereas there were significant improvements in the LBT and the CBS but not the Albert test in the CG. In addition, the EG showed a significantly greater gain in all outcome measures compared to the CG (p < .05). CONCLUSIONS These results indicate that robot-assisted hand training was beneficial to improving the hemispatial neglect of elderly person with chronic stroke compared to the conventional treatments. Robot-assisted limb activation might be useful to ameliorate hemispatial neglect of the elderly with chronic stroke.
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Abstract
There is no consensus about the definition or most effective treatment for neglect syndrome. The aim of this review was therefore to evaluate the results of trials that investigated different treatment methods for neglect syndrome. A systematic literature search in PubMed and Web of Science databases was performed to identify studies that investigated the effects of neglect therapies. Authors followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Studies were selected by two assayers, and disagreement was resolved by a third reviewer. The literature search identified 202 articles: 19 met the inclusion criteria and were included for data extraction. Thirty-five different kinds of assessments were used in these studies, and 17 treatment methods were applied. Successful treatments were reported at least in some parts of the assessments in 12 studies: mirror therapy (in two trials), transcranial magnetic stimulation, street crossing test in virtual reality, smooth pursuit eye movement training, saccadic eye movement therapy, direct current stimulation, eye patching therapy, prism adaptation treatment, socially assistive pet-type therapeutic robot (PARO), Kinesiological Instrument for Normal and Altered Reaching Movement robotic device therapy, transcutaneous electrical nerve stimulation, and optokinetic stimulation (the last two methods in the same trial). No success was shown in seven trials, which contained not only single treatments but combined ones also. Authors concluded that there are no convincing results for or against any of the different therapies used for neglect syndrome. The quality of the trials is questionable, and the numbers of included patients are small in the trials.
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Umeonwuka C, Roos R, Ntsiea V. Current trends in the treatment of patients with post-stroke unilateral spatial neglect: a scoping review. Disabil Rehabil 2020; 44:2158-2185. [DOI: 10.1080/09638288.2020.1824026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Chuka Umeonwuka
- Department of Physiotherapy, Faculty of Health Science, University of Witwatersrand, Johannesburg, South Africa
| | - Ronel Roos
- Department of Physiotherapy, Faculty of Health Science, University of Witwatersrand, Johannesburg, South Africa
- Department of Physiotherapy, The Wits-JBI Centre for Evidenced-Based Practice: A Joanna Briggs Institute Affiliated Group, Johannesburg, South Africa
| | - Veronica Ntsiea
- Department of Physiotherapy, Faculty of Health Science, University of Witwatersrand, Johannesburg, South Africa
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Morone G, Cocchi I, Paolucci S, Iosa M. Robot-assisted therapy for arm recovery for stroke patients: state of the art and clinical implication. Expert Rev Med Devices 2020; 17:223-233. [PMID: 32107946 DOI: 10.1080/17434440.2020.1733408] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Robot-assisted therapy is an emerging approach that performs highly repetitive, intensive, task oriented and quantifiable neuro-rehabilitation. In the last decades, it has been increasingly used in a wide range of neurological central nervous system conditions implying an upper limb paresis. Results from the studies are controversial, for the many types of robots and their features often not accompanied by specific clinical indications about the target functions, fundamental for the individualized neurorehabilitation program.Areas covered: This article reviews the state of the art and perspectives of robotics in post-stroke rehabilitation for upper limb recovery. Classifications and features of robots have been reported in accordance with technological and clinical contents, together with the definition of determinants specific for each patient, that could modify the efficacy of robotic treatments. The possibility of combining robotic intervention with other therapies has also been discussed.Expert commentary: The recent wide diffusion of robots in neurorehabilitation has generated a confusion due to the commingling of technical and clinical aspects not previously clarified. Our critical review provides a possible hypothesis about how to match a robot with subject's upper limb functional abilities, but also highlights the need of organizing a clinical consensus conference about the robotic therapy.
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Affiliation(s)
- Giovanni Morone
- Clinical Laboratory of Experimental Neurorehabilitation, Fondazione Santa Lucia IRCCS, Rome, Italy
| | - Ilaria Cocchi
- Clinical Laboratory of Experimental Neurorehabilitation, Fondazione Santa Lucia IRCCS, Rome, Italy
| | - Stefano Paolucci
- Clinical Laboratory of Experimental Neurorehabilitation, Fondazione Santa Lucia IRCCS, Rome, Italy
| | - Marco Iosa
- Clinical Laboratory of Experimental Neurorehabilitation, Fondazione Santa Lucia IRCCS, Rome, Italy
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