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Bernhardt J, Hayward KS, Dancause N, Lannin NA, Ward NS, Nudo RJ, Farrin A, Churilov L, Boyd LA, Jones TA, Carmichael ST, Corbett D, Cramer SC. A stroke recovery trial development framework: Consensus-based core recommendations from the Second Stroke Recovery and Rehabilitation Roundtable. Int J Stroke 2019; 14:792-802. [DOI: 10.1177/1747493019879657] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
A major goal of the Stroke Recovery and Rehabilitation Roundtable (SRRR) is to accelerate development of effective treatments to enhance stroke recovery beyond that expected to occur spontaneously or with current approaches. In this paper, we describe key issues for the next generation of stroke recovery treatment trials and present the Stroke Recovery and Rehabilitation Roundtable Trials Development Framework (SRRR-TDF). An exemplar (an upper limb recovery trial) is presented to demonstrate the utility of this framework to guide the GO, NO-GO decision-making process in trial development.
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Affiliation(s)
- Julie Bernhardt
- Stroke Theme and NHRMC CRE in Stroke Rehabilitation and Brain Recovery, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Kathryn S Hayward
- Stroke Theme and NHRMC CRE in Stroke Rehabilitation and Brain Recovery, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Numa Dancause
- Département de Neurosciences, Université de Montréal, Montréal, Québec, Canada
| | - Natasha A Lannin
- Department of Clinical Neuroscience, Central Clinical School, Monash University; Alfred Health, Melbourne, Australia
| | - Nick S Ward
- Department of Clinical and Motor Neuroscience, UCL Queen Square Institute of Neurology, London, UK
| | - Randolph J Nudo
- Department of Rehabilitation Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Amanda Farrin
- Leeds Institute of Clinical Trial Research, University of Leeds, Leeds, UK
| | - Leonid Churilov
- Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Lara A Boyd
- Department of Physical Therapy & Centre for Brain Health, University of British Columbia, Vancouver, Canada
| | - Theresa A Jones
- Psychology Department and Institute for Neuroscience, University of Texas at Austin, Austin, TX, USA
| | - S Thomas Carmichael
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Dale Corbett
- Cellular & Molecular Medicine and Canadian Partnership for Stroke Recovery, University of Ottawa, Ottawa, Canada
| | - Steven C Cramer
- Department of Neurology, David Geffen School of Medicine at UCLA; California Rehabilitation Institute, Los Angeles, CA, USA
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102
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Virtual Reality and Noninvasive Brain Stimulation in Stroke: How Effective Is Their Combination for Upper Limb Motor Improvement?-A Meta-Analysis. PM R 2019; 10:1261-1270. [PMID: 30503233 DOI: 10.1016/j.pmrj.2018.10.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 09/06/2018] [Accepted: 10/04/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND Efforts to augment post-stroke upper limb (UL) motor improvement include the use of newer interventions such as noninvasive brain stimulation (NIBS) and task practice in virtual reality environments (VEs). Despite increasing interest in using a combination of these 2 interventions, the effectiveness of this combination to enhance UL motor improvement outcomes has not been examined. OBJECTIVE To evaluate the effectiveness of a combination of NIBS and task practice in a VE to augment post-stroke UL motor improvement. METHODS We conducted a systematic search of the published literature using standard methodology. The Down and Black checklist and the Physiotherapy Evidence Database Research Organization Scale were used to assess study quality. We compared changes in UL impairment and activity levels between active stimulation and sham or other interventions using standardized mean differences and derived a summary effect size. RESULTS We retrieved 5 studies that examined the role of a combination of NIBS and task practice in a VE to optimize UL motor improvement. These 5 studies included 3 randomized controlled trials, 1 cross-sectional study, and 1 crossover study. There was level 1a evidence that the combination was beneficial in subacute stroke. There was level 1b evidence that provision of real stimulation was not superior to sham stimulation in chronic stroke. Effect sizes favoring the combination were moderate for improvements in UL impairment and small for activity levels. CONCLUSIONS Preliminary evidence supports the effectiveness of this combination in subacute stroke. Emergent questions need to be addressed to derive maximum benefit of this combination to augment post-stroke UL motor improvement. LEVEL OF EVIDENCE I.
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103
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Quentin R, Awosika O, Cohen LG. Plasticity and recovery of function. HANDBOOK OF CLINICAL NEUROLOGY 2019; 163:473-483. [PMID: 31590747 DOI: 10.1016/b978-0-12-804281-6.00025-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
The frontal lobe plays a crucial role in human motor behavior. It is one of the last areas of the brain to mature, especially the prefrontal regions. After a brief historical perspective on the perceived dichotomy between the view of the brain as a static organ and that of a plastic, constantly changing structure, we discuss the stability/plasticity dilemma including examples of documented cortical reorganization taking place at multiple spatial and temporal scales. We pose that while plasticity is needed for motor learning, stability of the system is necessary for storage and maintenance of memorized skills. We discuss how this plasticity/stability dilemma is resolved along the life span and after a brain injury. We then examine the main challenges that clinicians have to overcome to promote recovery of function in patients with brain lesions, including attempts to use neurostimulation techniques as adjuvant to training-based customary neurorehabilitation.
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Affiliation(s)
- Romain Quentin
- Human Cortical Physiology and Neurorehabilitation Section, NINDS, Bethesda, MD, United States
| | - Oluwole Awosika
- Human Cortical Physiology and Neurorehabilitation Section, NINDS, Bethesda, MD, United States; University of Cincinnati, College of Medicine, Department of Neurology and Rehabilitation Medicine, Cincinnati, OH, United States
| | - Leonardo G Cohen
- Human Cortical Physiology and Neurorehabilitation Section, NINDS, Bethesda, MD, United States.
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104
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Biofeedback fixation training method for improving eccentric vision in patients with loss of foveal function secondary to different maculopathies. Int Ophthalmol 2019; 40:305-312. [DOI: 10.1007/s10792-019-01180-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 09/19/2019] [Indexed: 11/25/2022]
Abstract
Abstract
Purpose
Fixation stability (FS) of the preferred retinal locus (PRL) may be improved by biofeedback fixation training (BFT) with microperimetry. Such training can be done on the patient’s PRL or in different retinal loci with better functional characteristics. We studied both options and compared the outcomes.
Methods
Sixty-seven consecutive patients with bilateral central vision loss, poor FS and visual acuity (VA) lower than 0.3 LogMAR were recruited for BFT with microperimeter. Patients were assigned into 2 groups. In group A, BFT was performed on the patient’s spontaneous PRL. In group B, PRL was located between 2 adjacent loci with the highest light sensitivity and the lowest distance from the fovea. Two sets of 12 weekly BFT sessions were performed. Primary outcomes were: FS, VA and reading speed.
Results
Outcomes were statistically significantly better in group B. Mean percentage of FS at therapy end improved from 32 to 35% for group A and from 40 to 55% in group B. Mean VA improved from 1 to 0.86 in group A and from 1 to 0.84 in group B. Reading speed (wpm) improved from 56 to 58 in group A and from 63 to 89 in group B.
Conclusions
This study describes a reliable methodology of improving eccentric fixation stability using BFT in microperimetry, when the fixation training locus is individualized as the retinal area with best functional characteristics. Further studies are needed to validate its value in a larger scale of patients, at different stages of the disease, and its persistence over time.
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105
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Proffitt R. Relationships between Occupational Therapy Practitioner Characteristics and Home Exercise Program Prescription for Clients with Neurological Injuries. Occup Ther Health Care 2019; 33:381-393. [PMID: 31411911 PMCID: PMC6868475 DOI: 10.1080/07380577.2019.1649786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 07/23/2019] [Accepted: 07/25/2019] [Indexed: 12/25/2022]
Abstract
There are no guidelines for the prescription of home exercise programs (HEPs) for clients with neurological injuries. However, 95% of occupational therapy practitioners prescribe HEPs. Two thousand anonymous surveys were distributed to occupational therapy practitioners. Data from the 352 returned, usable surveys were analyzed to determine trends in HEP prescription across practice settings and provider demographics. Occupational therapy practitioners in community-based settings tended to use more functional activities and the number of years in practice did not influence HEP dosage. These findings suggest a need for clear guidelines for varying practice settings to guide HEP prescription.
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Affiliation(s)
- Rachel Proffitt
- Department of Occupational Therapy, University of Missouri, Columbia, MO
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106
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Rajagopalan V, Natarajan M, Gorthi SP, Padickaparambil S, Solomon JM. Effectiveness of a multifactorial context-enhancing functional therapy to promote functional arm use and recovery of stroke survivors: study protocol for a clinical trial. BMJ Open 2019; 9:e023963. [PMID: 31530586 PMCID: PMC6756450 DOI: 10.1136/bmjopen-2018-023963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION After a stroke, 55% of survivors do not regain the ability to completely use their arm in daily life functioning. Currently, evidence-based guidelines recommend functional training for improving the affected hand after stroke. However, promoting an optimal quantity and quality of functional training is influenced by personal and environmental contextual factors. Studies that comprehensively target multiple factors regulating arm use are limited. This study compares the effects of functional training to multifactorial context-enhancing functional training program for improving functional arm use and recovery after stroke. METHODS AND ANALYSIS This is a protocol for an observer-blinded, two parallel groups, randomised controlled trial. A total of 126 community-dwelling subacute and chronic stroke survivors will be included in the study. A tailor-made multifactorial context-enhancing intervention-incorporating education, environmental enrichment and behaviour change techniques to reinforce functional training will be provided to the experimental group. The functional training group will be provided with functional exercises. The intervention will be delivered for 2 months. The primary outcomes of functional arm use and recovery will be measured using Motor Activity Log, Goal Attainment Scale and Rating of Everyday Arm-use in the Community and Home scale. The secondary outcomes of arm motor impairment and function will be measured using Fugl-Meyer upper limb score, Action Research Arm Test, ABILHAND questionnaire and Stroke Impact Scale. These will be measured at three points in time: before, after 2 months and after 1-month follow-up. The outcome measures will be analysed using one-way analysis of variance and regression analysis will be performed to identify factors limiting optimal task practice. ETHICS AND DISSEMINATION The study has been approved by the Institutional Ethics Committee of Kasturba Hospital, Manipal, India. Participants will sign a written informed consent prior to participation. The results will be published on completion of the trial and communicated to community-dwelling stroke survivors. TRIAL REGISTRATION NUMBER CTRI/2017/10/010108.
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Affiliation(s)
- Vasanthan Rajagopalan
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Manikandan Natarajan
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
- Centre for Comprehensive Stroke Rehabilitation and Research, Manipal Academy of Higher Education, Manipal, India
| | - Sankar Prasad Gorthi
- Department of Neurology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Sebastian Padickaparambil
- Department of Psychology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - John M Solomon
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
- Centre for Comprehensive Stroke Rehabilitation and Research, Manipal Academy of Higher Education, Manipal, India
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107
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Daly JJ, McCabe JP, Holcomb J, Monkiewicz M, Gansen J, Pundik S. Long-Dose Intensive Therapy Is Necessary for Strong, Clinically Significant, Upper Limb Functional Gains and Retained Gains in Severe/Moderate Chronic Stroke. Neurorehabil Neural Repair 2019; 33:523-537. [PMID: 31131743 PMCID: PMC6625035 DOI: 10.1177/1545968319846120] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background. Effective treatment methods are needed for moderate/severely impairment chronic stroke. Objective. The questions were the following: (1) Is there need for long-dose therapy or is there a mid-treatment plateau? (2) Are the observed gains from the prior-studied protocol retained after treatment? Methods. Single-blind, stratified/randomized design, with 3 applied technology treatment groups, combined with motor learning, for long-duration treatment (300 hours of treatment). Measures were Arm Motor Ability Test time and coordination-function (AMAT-T, AMAT-F, respectively), acquired pre-/posttreatment and 3-month follow-up (3moF/U); Fugl-Meyer (FM), acquired similarly with addition of mid-treatment. Findings. There was no group difference in treatment response (P ≥ .16), therefore data were combined for remaining analyses (n = 31; except for FM pre/mid/post, n = 36). Pre-to-Mid-treatment and Mid-to-Posttreatment gains of FM were statistically and clinically significant (P < .0001; 4.7 points and P < .001; 5.1 points, respectively), indicating no plateau at 150 hours and benefit of second half of treatment. From baseline to 3moF/U: (1) FM gains were twice the clinically significant benchmark, (2) AMAT-F gains were greater than clinically significant benchmark, and (3) there was statistically significant improvement in FM (P < .0001); AMAT-F (P < .0001); AMAT-T (P < .0001). These gains indicate retained clinically and statistically significant gains at 3moFU. From posttreatment to 3moF/U, gains on FM were maintained. There were statistically significant gains in AMAT-F (P = .0379) and AMAT-T P = .003.
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Affiliation(s)
- Janis J. Daly
- Malcom Randall Gainesville DVA Medical
Center, Gainesville, FL, USA
- College of Medicine, University of
Florida, Gainesville, FL, USA
| | | | | | | | - Jennifer Gansen
- Louis Stokes Cleveland VA Medical
Center, Cleveland, OH, USA
| | - Svetlana Pundik
- Louis Stokes Cleveland VA Medical
Center, Cleveland, OH, USA
- Case Western Reserve University School
of Medicine, Cleveland, OH, USA
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108
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Abstract
Background and Purpose- For stroke rehabilitation, task-specific training in animal models and human rehabilitation trials is considered important to modulate neuroplasticity, promote motor learning, and functional recovery. Little is known about what constitutes an effective dosage of therapy. Methods- This is a parallel group, 4 arms, single-blind, phase IIb, randomized controlled trial of 4 dosages of arm therapy delivered in an outpatient setting chronically after stroke. Participants were randomized into groups that varied in duration of scheduled therapy (ie, 0, 15, 30, or 60 hours). Forty-one participants completed the study. Planned primary analyses used linear mixed effects regression to model changes from baseline to postintervention in the Motor Activity Log-Quality of Movement rating and the Wolf Motor Function Test time score over 3 weeks of training as a function of therapy dosage. Results- We observed a dose response for the Motor Activity Log-Quality of Movement: the model that included dose and dose by week interaction significantly better fit the data than the model that included week only (log-likelihood test, P=0.0026). In addition, the greater the dosage of training, the greater the change in Motor Activity Log-Quality of Movement, with the dose by week interaction parameter equal to 0.0045 ( P=0.0016; 95% CI, 0.0018-0.0071). Over the 3 weeks of therapy, there was a gain of 0.92 in Motor Activity Log-Quality of Movement for the 60-hour group compared to the 0-hour group. There was no dose response for the Wolf Motor Function Test. Conclusions- For mild-to-moderately impaired stroke survivors, the dosage of patient-centered, task-specific practice systematically influences the gain in quality of arm use but not functional capacity. We caution that we may have been underpowered for the functional capacity outcome. These findings highlight the importance of recovery outcomes that capture arm use in the natural environment. Clinical Trial Registration- URL: https://www.clinicaltrials.gov . Unique identifier: NCT01749358.
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Affiliation(s)
- Carolee Winstein
- Department of Neurology, Keck School of Medicine (C.W.), University of Southern California, Los Angeles
| | - Bokkyu Kim
- Department of Physical Therapy Education and Department of Neurology, SUNY Upstate Medical University, Syracuse, NY (B.K.)
| | - Sujin Kim
- Department of Physical Therapy, Jeonju University, South Korea (S.K.)
| | - Clarisa Martinez
- From the Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry (N.S., C.M.), University of Southern California, Los Angeles
| | - Nicolas Schweighofer
- From the Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry (N.S., C.M.), University of Southern California, Los Angeles
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109
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Ghai S, Ghai I. Virtual Reality Enhances Gait in Cerebral Palsy: A Training Dose-Response Meta-Analysis. Front Neurol 2019; 10:236. [PMID: 30984095 PMCID: PMC6448032 DOI: 10.3389/fneur.2019.00236] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 02/22/2019] [Indexed: 01/26/2023] Open
Abstract
Virtual-reality-based training can influence gait recovery in children with cerebral palsy. A consensus concerning its influence on spatiotemporal gait parameters and effective training dosage is still warranted. This study analyzes the influence of virtual-reality training (relevant training dosage) on gait recovery in children with cerebral palsy. A search was performed by two reviewers according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines on nine databases: PEDro, EBSCO, PubMed, Cochrane, Web of Science, EMBASE, ICI, Scopus, and PROQUEST. Of 989 records, 16 studies involving a total of 274 children with cerebral palsy met our inclusion criteria. Eighty-eight percent of the studies reported significant enhancements in gait performance after training with virtual reality. Meta-analyses revealed positive effects of virtual-reality training on gait velocity (Hedge's g = 0.68), stride length (0.30), cadence (0.66), and gross motor function measure (0.44). Subgroup analysis reported a training duration of 20–30 min per session, ≤4 times per week across ≥8 weeks to allow maximum enhancements in gait velocity. This study provides preliminary evidence for the beneficial influence of virtual-reality training in gait rehabilitation for children with cerebral palsy.
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Affiliation(s)
- Shashank Ghai
- Institute for Sports Science, Leibniz University Hannover, Hannover, Germany
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110
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First Do No Harm: An Opinion on Bundled Care for Stroke Patients. Arch Phys Med Rehabil 2019; 100:578-580. [DOI: 10.1016/j.apmr.2018.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 08/28/2018] [Accepted: 10/09/2018] [Indexed: 11/19/2022]
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111
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Lewthwaite R, Winstein CJ, Lane CJ, Blanton S, Wagenheim BR, Nelsen MA, Dromerick AW, Wolf SL. Accelerating Stroke Recovery: Body Structures and Functions, Activities, Participation, and Quality of Life Outcomes From a Large Rehabilitation Trial. Neurorehabil Neural Repair 2019; 32:150-165. [PMID: 29554849 DOI: 10.1177/1545968318760726] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Task-oriented therapies have been developed to address significant upper extremity disability that persists after stroke. Yet, the extent of and approach to rehabilitation and recovery remains unsatisfactory to many. OBJECTIVE To compare a skill-directed investigational intervention with usual care treatment for body functions and structures, activities, participation, and quality of life outcomes. METHODS On average, 46 days poststroke, 361 patients were randomized to 1 of 3 outpatient therapy groups: a patient-centered Accelerated Skill Acquisition Program (ASAP), dose-equivalent usual occupational therapy (DEUCC), or usual therapy (UCC). Outcomes were taken at baseline, posttreatment, 6 months, and 1 year after randomization. Longitudinal mixed effect models compared group differences in poststroke improvement during treatment and follow-up phases. RESULTS Across all groups, most improvement occurred during the treatment phase, followed by change more slowly during follow-up. Compared with DEUCC and UCC, ASAP group gains were greater during treatment for Stroke Impact Scale Hand, Strength, Mobility, Physical Function, and Participation scores, self-efficacy, perceived health, reintegration, patient-centeredness, and quality of life outcomes. ASAP participants reported higher Motor Activity Log-28 Quality of Movement than UCC posttreatment and perceived greater study-related improvements in quality of life. By end of study, all groups reached similar levels with only limited group differences. CONCLUSIONS Customized task-oriented training can be implemented to accelerate gains across a full spectrum of patient-reported outcomes. While group differences for most outcomes disappeared at 1 year, ASAP participants achieved these outcomes on average 8 months earlier (ClinicalTrials.gov: Interdisciplinary Comprehensive Arm Rehabilitation Evaluation [ICARE] Stroke Initiative, at www.ClinicalTrials.gov/ClinicalTrials.gov . Identifier: NCT00871715).
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Affiliation(s)
- Rebecca Lewthwaite
- 1 University of Southern California, Los Angeles, CA, USA.,2 Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA
| | | | | | | | - Burl R Wagenheim
- 2 Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA
| | | | - Alexander W Dromerick
- 4 Georgetown University, Washington, DC, USA.,5 MedStar National Rehabilitation Hospital, Washington, DC, USA.,6 VA Medical Center, Washington, DC, USA
| | - Steven L Wolf
- 3 Emory University, Atlanta, GA, USA.,7 VA Center on Visual and Neurocognitive Rehabilitation, Decatur, GA, USA
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112
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Gopaul U, Carey L, Callister R, Nilsson M, van Vliet P. Combined somatosensory and motor training to improve upper limb function following stroke: a systematic scoping review. PHYSICAL THERAPY REVIEWS 2019. [DOI: 10.1080/10833196.2018.1553668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Urvashy Gopaul
- School of Health Sciences, University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Leeanne Carey
- School of Allied Health, La Trobe University, Melbourne, VIC, Australia
- Neurorehabilitation and Recovery, Stroke Division, The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia
| | - Robin Callister
- Hunter Medical Research Institute, Newcastle, NSW, Australia
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia
| | - Michael Nilsson
- Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Paulette van Vliet
- Hunter Medical Research Institute, Newcastle, NSW, Australia
- School of Humanities and Social Sciences, University of Newcastle, Newcastle, NSW, Australia
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113
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Raghavan P. Research in the Acute Rehabilitation Setting: a Bridge Too Far? Curr Neurol Neurosci Rep 2019; 19:4. [DOI: 10.1007/s11910-019-0919-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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114
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Baur K, Schättin A, de Bruin ED, Riener R, Duarte JE, Wolf P. Trends in robot-assisted and virtual reality-assisted neuromuscular therapy: a systematic review of health-related multiplayer games. J Neuroeng Rehabil 2018; 15:107. [PMID: 30454009 PMCID: PMC6245892 DOI: 10.1186/s12984-018-0449-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 10/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multiplayer games have emerged as a promising approach to increase the motivation of patients involved in rehabilitation therapy. In this systematic review, we evaluated recent publications in health-related multiplayer games that involved patients with cognitive and/or motor impairments. The aim was to investigate the effect of multiplayer gaming on game experience and game performance in healthy and non-healthy populations in comparison to individual game play. We further discuss the publications within the context of the theory of flow and the challenge point framework. METHODS A systematic search was conducted through EMBASE, Medline, PubMed, Cochrane, CINAHL and PsycINFO. The search was complemented by recent publications in robot-assisted multiplayer neurorehabilitation. The search was restricted to robot-assisted or virtual reality-based training. RESULTS Thirteen articles met the inclusion criteria. Multiplayer modes used in health-related multiplayer games were: competitive, collaborative and co-active multiplayer modes. Multiplayer modes positively affected game experience in nine studies and game performance in six studies. Two articles reported increased game performance in single-player mode when compared to multiplayer mode. CONCLUSIONS The multiplayer modes of training reviewed improved game experience and game performance compared to single-player modes. However, the methods reviewed were quite heterogeneous and not exhaustive. One important take-away is that adaptation of the game conditions can individualize the difficulty of a game to a player's skill level in competitive multiplayer games. Robotic assistance and virtual reality can enhance individualization by, for example, adapting the haptic conditions, e.g. by increasing haptic support or by providing haptic resistance. The flow theory and the challenge point framework support these results and are used in this review to frame the idea of adapting players' game conditions.
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Affiliation(s)
- Kilian Baur
- Sensory-Motor Systems Lab, Department of Health Sciences and Technology, ETH Zurich, Tannenstrasse 1, Zurich, 8092, Switzerland. .,Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Zurich, Switzerland, Forchstrasse 340, Zurich, 8008, Switzerland.
| | - Alexandra Schättin
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, Swiss Federal Institute of Technology (ETH Zurich), Zurich, Switzerland, Leopold-Ruzicka-Weg 4, Zurich, 8093, Switzerland
| | - Eling D de Bruin
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, Swiss Federal Institute of Technology (ETH Zurich), Zurich, Switzerland, Leopold-Ruzicka-Weg 4, Zurich, 8093, Switzerland.,Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden, Alfred Nobels Alle 23, Huddinge, 141 83, Sweden
| | - Robert Riener
- Sensory-Motor Systems Lab, Department of Health Sciences and Technology, ETH Zurich, Tannenstrasse 1, Zurich, 8092, Switzerland.,Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Zurich, Switzerland, Forchstrasse 340, Zurich, 8008, Switzerland
| | - Jaime E Duarte
- Sensory-Motor Systems Lab, Department of Health Sciences and Technology, ETH Zurich, Tannenstrasse 1, Zurich, 8092, Switzerland.,Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Zurich, Switzerland, Forchstrasse 340, Zurich, 8008, Switzerland.,MyoSwiss AG, Lengghalde 5, Zürich, CH-8008, Switzerland
| | - Peter Wolf
- Sensory-Motor Systems Lab, Department of Health Sciences and Technology, ETH Zurich, Tannenstrasse 1, Zurich, 8092, Switzerland.,Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Zurich, Switzerland, Forchstrasse 340, Zurich, 8008, Switzerland
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115
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Borschmann K, Hayward KS, Raffelt A, Churilov L, Kramer S, Bernhardt J. Rationale for Intervention and Dose Is Lacking in Stroke Recovery Trials: A Systematic Review. Stroke Res Treat 2018; 2018:8087372. [PMID: 30515288 PMCID: PMC6234440 DOI: 10.1155/2018/8087372] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 10/08/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The ineffectiveness of most complex stroke recovery trials may be explained by inadequate intervention design. The primary aim of this review was to explore the rationales given for interventions and dose in stroke rehabilitation randomised controlled trials (RCTs). METHODS We searched the Cochrane Stroke Group library for RCTs that met the following criteria: (1) training based intervention; (2) >50% participants who were stroke survivors; (3) full peer-reviewed text; (4) English language. We extracted data on 16 quality items covering intervention dose (n= 3), trial design (n= 10), and risk of bias (n= 3) and 18 items related to trial method. Logistic regression analyses were performed to determine whether (1) reporting of trial quality items changed over time; (2) reporting of quality items was associated with the likelihood of a positive trial, adjusted for sample size and number of outcomes. RESULTS 27 Cochrane reviews were included, containing 9,044 participants from 194 trials. Publication dates were 1979 to 2013, sample size was median 32 (IQR 20,58), and primary outcome was reported in 49 trials (25%). The median total quality score was 4 (IQR 3,6) and improved significantly each year (OR 1.12, 95% CI 1.07, 1.16, p<0.001). Total quality score was not associated with likelihood of a positive trial, but trials containing a biological rationale for the intervention were more likely to find a difference in patient outcome (OR 2.18, 95% CI 1.14, 4.19, p=0.02). CONCLUSION To develop breakthrough treatments we need to build the rationale for research interventions and testing of intervention dosage. This will be achieved through a collective research agenda to understand the mechanistic principles that drive recovery and identification of clearer targets for clinical trials.
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Affiliation(s)
- Karen Borschmann
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, 245 Burgundy St., Heidelberg 3084, VIC, Australia
- NHMRC CRE Stroke Rehabilitation & Brain Recovery, 245 Burgundy St., Heidelberg 3084, VIC, Australia
| | - Kathryn S. Hayward
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, 245 Burgundy St., Heidelberg 3084, VIC, Australia
- NHMRC CRE Stroke Rehabilitation & Brain Recovery, 245 Burgundy St., Heidelberg 3084, VIC, Australia
- Brain Behaviour Laboratory, Department of Physical Therapy, The University of British Columbia, Koerner Pavilion UBC Hospital, 2211 Wesbrook Mall, Vancouver, BC, Canada V6T2B7
| | - Audrey Raffelt
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, 245 Burgundy St., Heidelberg 3084, VIC, Australia
| | - Leonid Churilov
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, 245 Burgundy St., Heidelberg 3084, VIC, Australia
- NHMRC CRE Stroke Rehabilitation & Brain Recovery, 245 Burgundy St., Heidelberg 3084, VIC, Australia
| | - Sharon Kramer
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, 245 Burgundy St., Heidelberg 3084, VIC, Australia
- NHMRC CRE Stroke Rehabilitation & Brain Recovery, 245 Burgundy St., Heidelberg 3084, VIC, Australia
| | - Julie Bernhardt
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, 245 Burgundy St., Heidelberg 3084, VIC, Australia
- NHMRC CRE Stroke Rehabilitation & Brain Recovery, 245 Burgundy St., Heidelberg 3084, VIC, Australia
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Lin IH, Tsai HT, Wang CY, Hsu CY, Liou TH, Lin YN. Effectiveness and Superiority of Rehabilitative Treatments in Enhancing Motor Recovery Within 6 Months Poststroke: A Systemic Review. Arch Phys Med Rehabil 2018; 100:366-378. [PMID: 30686327 DOI: 10.1016/j.apmr.2018.09.123] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 08/19/2018] [Accepted: 09/21/2018] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To investigate the effects of various rehabilitative interventions aimed at enhancing poststroke motor recovery by assessing their effectiveness when compared with no treatment or placebo and their superiority when compared with conventional training program (CTP). DATA SOURCE A literature search was based on 19 Cochrane reviews and 26 other reviews. We also updated the searches in PubMed up to September 30, 2017. STUDY SELECTION Randomized controlled trials associated with 18 experimented training programs (ETP) were included if they evaluated the effects of the programs on either upper extremity (UE) or lower extremity (LE) motor recovery among adults within 6 months poststroke; included ≥10 participants in each arm; and had an intervention duration of ≥10 consecutive weekdays. DATA EXTRACTION Four reviewers evaluated the eligibility and quality of literature. Methodological quality was assessed using the PEDro scale. DATA SYNTHESIS Among the 178 included studies, 129 including 7450 participants were analyzed in this meta-analysis. Six ETPs were significantly effective in enhancing UE motor recovery, with the standard mean differences (SMDs) and 95% confidence intervals outlined as follow: constraint-induced movement therapy (0.82, 0.45-1.19), electrostimulation (ES)-motor (0.42, 0.22-0.63), mirror therapy (0.71, 0.22-1.20), mixed approach (0.21, 0.01-0.41), robot-assisted training (0.51, 0.22-0.80), and task-oriented training (0.57, 0.16-0.99). Six ETPs were significantly effective in enhancing LE motor recovery: body-weight-supported treadmill training (0.27, 0.01-0.52), caregiver-mediated training (0.64, 0.20-1.08), ES-motor (0.55, 0.27-0.83), mixed approach (0.35, 0.15-0.54), mirror therapy (0.56, 0.13-1.00), and virtual reality (0.60, 0.15-1.05). However, compared with CTPs, almost none of the ETPs exhibited significant SMDs for superiority. CONCLUSIONS Certain experimented interventions were effective in enhancing poststroke motor recovery, but little evidence supported the superiority of experimented interventions over conventional rehabilitation.
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Affiliation(s)
- I-Hsien Lin
- Department of Physical Medicine and Rehabilitation, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Han-Ting Tsai
- Department of Physical Medicine and Rehabilitation, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chien-Yung Wang
- Department of Physical Medicine and Rehabilitation, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chih-Yang Hsu
- Department of Physical Medicine and Rehabilitation, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Yen-Nung Lin
- Department of Physical Medicine and Rehabilitation, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan; Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan.
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The effects of body weight-supported treadmill training on static and dynamic balance in stroke patients: A pilot, single-blind, randomized trial. Turk J Phys Med Rehabil 2018; 64:344-352. [PMID: 31453532 DOI: 10.5606/tftrd.2018.2672] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 06/27/2018] [Indexed: 11/21/2022] Open
Abstract
Objectives This study aims to compare effectiveness of isolated body weight-supported treadmill training (BWSTT) with conventional and combined training on balance, mobility, and fear of falling in stroke patients. Patients and methods Between November 2014 and November 2015, a total of 45 post-stroke patients (32 males, 13 females; mean age 53.1±13.2 years; range, 19 to 73 years) were randomly assigned to combined training group (CombTG), conventional training group (CTG), and BWSTT group (BWSTTG). The CombTG received 45 min conventional therapy for five days a week along with 45 min of BWSTT twice a week. The CTG received only conventional therapy for five days a week. The BWSTTG received only BWSTT twice a week. Training duration was six weeks for all groups. Primary outcome measures were the Berg Balance Scale (BBS), affected and non-affected side Single Leg Stance Test (e-SLST/n-SLST), and Timed Up and Go Test (TUG) results. Secondary outcomes were the Falls Efficacy Scale-International (FES-I), Rivermead Mobility Index (RMI), Comfortable 10-m Walk Test (CWT), and Stair Climbing Test (SCT) results. Results The mean change of outcome measures demonstrated that the improvements between groups were significantly different among the three groups, except for the CWT (p=0.135). In subgroup analysis, except for the RMI and CWT, all primary and secondary outcome measures improved significantly in favor of the CombTG, compared to the CTG and BWSTTG (p<0.016). However, no statistically significant difference was found in the mean change of the CTG and BWSTTG (p>0.05). Conclusion This study demonstrates that combined training has considerable effects on balance, mobility, and fear of falling parameters, while lower frequency of isolated BWSTT is as much effective as higher frequency of conventional training in ambulatory post-stroke patients.
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Büsching I, Sehle A, Stürner J, Liepert J. Using an upper extremity exoskeleton for semi-autonomous exercise during inpatient neurological rehabilitation- a pilot study. J Neuroeng Rehabil 2018; 15:72. [PMID: 30068372 PMCID: PMC6090973 DOI: 10.1186/s12984-018-0415-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 07/12/2018] [Indexed: 11/23/2022] Open
Abstract
Background Motor deficits are the most common symptoms after stroke. There is some evidence that intensity and amount of exercises influence the degree of improvement of functions within the first 6 months after the injury. The purpose of this pilot study was to evaluate the feasibility and acceptance of semi-autonomous exercises with an upper extremity exoskeleton in addition to an inpatient rehabilitation program. In addition, changes of motor functions were examined. Methods Ten stroke patients with a severe upper extremity paresis were included. They were offered to perform a semi-autonomous training with a gravity-supported, computer-enhanced device (Armeo®Spring, Hocoma AG) six times per week for 4 weeks. Feasibility was evaluated by weekly structured interviews with patients and supervisors. Motor functions were assessed before and after the training period using the Wolf Motor Function Test (WMFT). The Wilcoxon Signed Rank Test was used for assessing pre-post differences. The Pearson correlation co-efficient was used for correlating the number of completed sessions with the change in motor function. Acceptance of the device and the level of satisfaction with the training were determined by a questionnaire based on visual analogue scales. Results Neither patients nor supervisors reported side effects. However, one patient had to be excluded from analysis because of transportation difficulties from the ward to the treatment facility. Therefore, analysis was based on nine patients. On average, 13.2 (55%) sessions were realized. WMFT results showed significant improvements of proximal arm functions. The number of sessions correlated with the degree of shoulder force improvement. Patients rated the exercises to be motivating, and enjoyable and would continue using the Armeo®Spring at home if they had the opportunity. Conclusion Using an upper extremity exoskeleton for semi-autonomous training in an inpatient setting is feasible without side effects and is positively rated by the patients. It might further support the recovery of upper extremity function. Trial registration The trial was retrospectively registered. Registration number ISRCTN42633681.
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Affiliation(s)
- Imke Büsching
- Department of Neurorehabilitation, Kliniken Schmieder, Zum Tafelholz 8, D- 78476, Allensbach, Germany.,Reha-Klinik Bellikon, Mutschellenstrasse 2, 5454, Bellikon, Switzerland
| | - Aida Sehle
- Department of Neurorehabilitation, Kliniken Schmieder, Zum Tafelholz 8, D- 78476, Allensbach, Germany
| | - Jana Stürner
- Department of Neurorehabilitation, Kliniken Schmieder, Zum Tafelholz 8, D- 78476, Allensbach, Germany
| | - Joachim Liepert
- Department of Neurorehabilitation, Kliniken Schmieder, Zum Tafelholz 8, D- 78476, Allensbach, Germany.
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Consideration of Dose and Timing When Applying Interventions After Stroke and Spinal Cord Injury. J Neurol Phys Ther 2018. [PMID: 28628593 DOI: 10.1097/npt.0000000000000165] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE Nearly 4 decades of investigation into the plasticity of the nervous system suggest that both timing and dose could matter. This article provides a synopsis of our lectures at the IV STEP meeting, which presented a perspective of current data on the issues of timing and dose for adult stroke and spinal cord injury motor rehabilitation. SUMMARY OF KEY POINTS For stroke, the prevailing evidence suggests that greater amounts of therapy do not result in better outcomes for upper extremity interventions, regardless of timing. Whether or not greater amounts of therapy result in better outcomes for lower extremity and mobility interventions needs to be explicitly tested. For spinal cord injury, there is a complex interaction of timing postinjury, task-specificity, and the microenvironment of the spinal cord. Inflammation appears to be a key determinant of whether or not an intervention will be beneficial or maladaptive, and specific retraining of eccentric control during gait may be necessary. RECOMMENDATIONS FOR CLINICAL PRACTICE To move beyond the limitations of our current interventions and to effectively reach nonresponders, greater precision in task-specific interventions that are well-timed to the cellular environment may hold the key. Neurorehabilitation that ameliorates persistent deficits, attains greater recovery, and reclaims nonresponders will decrease institutionalization, improve quality of life, and prevent multiple secondary complications common after stroke and spinal cord injury.
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120
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McDonald MW, Hayward KS, Rosbergen ICM, Jeffers MS, Corbett D. Is Environmental Enrichment Ready for Clinical Application in Human Post-stroke Rehabilitation? Front Behav Neurosci 2018; 12:135. [PMID: 30050416 PMCID: PMC6050361 DOI: 10.3389/fnbeh.2018.00135] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 06/14/2018] [Indexed: 11/13/2022] Open
Abstract
Environmental enrichment (EE) has been widely used as a means to enhance brain plasticity mechanisms (e.g., increased dendritic branching, synaptogenesis, etc.) and improve behavioral function in both normal and brain-damaged animals. In spite of the demonstrated efficacy of EE for enhancing brain plasticity, it has largely remained a laboratory phenomenon with little translation to the clinical setting. Impediments to the implementation of enrichment as an intervention for human stroke rehabilitation and a lack of clinical translation can be attributed to a number of factors not limited to: (i) concerns that EE is actually the "normal state" for animals, whereas standard housing is a form of impoverishment; (ii) difficulty in standardizing EE conditions across clinical sites; (iii) the exact mechanisms underlying the beneficial actions of enrichment are largely correlative in nature; (iv) a lack of knowledge concerning what aspects of enrichment (e.g., exercise, socialization, cognitive stimulation) represent the critical or active ingredients for enhancing brain plasticity; and (v) the required "dose" of enrichment is unknown, since most laboratory studies employ continuous periods of enrichment, a condition that most clinicians view as impractical. In this review article, we summarize preclinical stroke recovery studies that have successfully utilized EE to promote functional recovery and highlight the potential underlying mechanisms. Subsequently, we discuss how EE is being applied in a clinical setting and address differences in preclinical and clinical EE work to date. It is argued that the best way forward is through the careful alignment of preclinical and clinical rehabilitation research. A combination of both approaches will allow research to fully address gaps in knowledge and facilitate the implementation of EE to the clinical setting.
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Affiliation(s)
- Matthew W McDonald
- Department of Cellular & Molecular Medicine, University of Ottawa, Ottawa, ON, Canada.,Canadian Partnership for Stroke Recovery, Ottawa, ON, Canada
| | - Kathryn S Hayward
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia.,NHMRC Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Heidelberg, VIC, Australia
| | - Ingrid C M Rosbergen
- Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia.,Allied Health Services, Sunshine Coast Hospital and Health Service, Birtinya, QLD, Australia
| | - Matthew S Jeffers
- Department of Cellular & Molecular Medicine, University of Ottawa, Ottawa, ON, Canada.,Canadian Partnership for Stroke Recovery, Ottawa, ON, Canada
| | - Dale Corbett
- Department of Cellular & Molecular Medicine, University of Ottawa, Ottawa, ON, Canada.,Canadian Partnership for Stroke Recovery, Ottawa, ON, Canada
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121
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Abstract
The fields of human motor control, motor learning, and neurorehabilitation have long been linked by the intuition that understanding how we move (and learn to move) leads to better rehabilitation. In reality, these fields have remained largely separate. Our knowledge of the neural control of movement has expanded, but principles that can directly impact rehabilitation efficacy remain somewhat sparse. This raises two important questions: What can basic studies of motor learning really tell us about rehabilitation, and are we asking the right questions to improve the lives of patients? This review aims to contextualize recent advances in computational and behavioral studies of human motor learning within the framework of neurorehabilitation. We also discuss our views of the current challenges facing rehabilitation and outline potential clinical applications from recent theoretical and basic studies of motor learning and control.
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Affiliation(s)
- Ryan T Roemmich
- Center for Movement Studies, The Kennedy Krieger Institute, Baltimore, Maryland 21205, USA.,Department of Physical Medicine and Rehabilitation, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
| | - Amy J Bastian
- Center for Movement Studies, The Kennedy Krieger Institute, Baltimore, Maryland 21205, USA.,Department of Neuroscience, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA;
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122
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On the Reporting of Experimental and Control Therapies in Stroke Rehabilitation Trials: A Systematic Review. Arch Phys Med Rehabil 2018; 99:1424-1432. [DOI: 10.1016/j.apmr.2017.12.024] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 12/07/2017] [Indexed: 11/21/2022]
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123
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Freburger JK, Li D, Johnson AM, Fraher EP. Physical and Occupational Therapy From the Acute to Community Setting After Stroke: Predictors of Use, Continuity of Care, and Timeliness of Care. Arch Phys Med Rehabil 2018; 99:1077-1089.e7. [DOI: 10.1016/j.apmr.2017.03.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 02/08/2017] [Accepted: 03/02/2017] [Indexed: 02/07/2023]
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124
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Hsieh CY, Huang HC, Wu DP, Li CY, Chiu MJ, Sung SF. Effect of Rehabilitation Intensity on Mortality Risk After Stroke. Arch Phys Med Rehabil 2018; 99:1042-1048.e6. [DOI: 10.1016/j.apmr.2017.10.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 10/05/2017] [Accepted: 10/09/2017] [Indexed: 01/21/2023]
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125
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Chen JL. Music-supported therapy for stroke motor recovery: theoretical and practical considerations. Ann N Y Acad Sci 2018; 1423:57-65. [PMID: 29740833 DOI: 10.1111/nyas.13726] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 03/09/2018] [Accepted: 03/20/2018] [Indexed: 11/30/2022]
Abstract
Music may confer benefits for well-being and health. What is the state of knowledge and evidence for a role of music in supporting the rehabilitation of movements after stroke? In this brief perspective, I provide background context and information about stroke recovery in general, in order to spark reflection and discussion for how we think music may impact motor recovery, given the current clinical milieu.
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Affiliation(s)
- Joyce L Chen
- Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Physical Therapy, Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
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126
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Rehabilitation Reduced Readmission and Mortality Risks in Patients With Stroke or Transient Ischemic Attack. Med Care 2018; 56:290-298. [DOI: 10.1097/mlr.0000000000000888] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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127
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Duret C, Mazzoleni S. Upper limb robotics applied to neurorehabilitation: An overview of clinical practice. NeuroRehabilitation 2018; 41:5-15. [PMID: 28505985 DOI: 10.3233/nre-171452] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND During the last two decades, extensive interaction between clinicians and engineers has led to the development of systems that stimulate neural plasticity to optimize motor recovery after neurological lesions. This has resulted in the expansion of the field of robotics for rehabilitation. Studies in patients with stroke-related upper-limb paresis have shown that robotic rehabilitation can improve motor capacity. However, few other applications have been evaluated (e.g. tremor, peripheral nerve injuries or other neurological diseases). PURPOSE This paper presents an overview of the current use of upper limb robotic systems for neurorehabilitation, and highlights the rationale behind their use for the assessment and treatment of common neurological disorders. CONCLUSIONS Rehabilitation robots are little integrated in clinical practice, except after stroke. Although few studies have been carried out to evaluate their effectiveness, evidence from the neurosciences and indications from pilot studies suggests that upper limb robotic rehabilitation can be applied safely in various other neurological conditions. Rehabilitation robots provide an intensity, quality and dose of treatment that exceeds therapist-mediated rehabilitation. Moreover, the use of force fields, multi-sensory environments, feedback etc. renders such rehabilitation engaging and motivating. Future studies should evaluate the effectiveness of rehabilitation robots in neurological pathologies other than stroke.
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Affiliation(s)
- Christophe Duret
- Centre de Rééducation Fonctionnelle Les Trois Soleils, Médecine Physique et de Réadaptation, Unité de Neurorééducation, Boissise-Le-Roi, France.,Centre Hospitalier Sud Francilien, Neurologie, Corbeil-Essonnes, France
| | - Stefano Mazzoleni
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy.,Rehabilitation Bioengineering Laboratory, Volterra, Italy
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Nguyen AV, Ong YLA, Luo CX, Thuraisingam T, Rubino M, Levin MF, Kaizer F, Archambault PS. Virtual reality exergaming as adjunctive therapy in a sub-acute stroke rehabilitation setting: facilitators and barriers. Disabil Rehabil Assist Technol 2018. [DOI: 10.1080/17483107.2018.1447608] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Ai-Vi Nguyen
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Yau-Lok Austin Ong
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Cindy Xin Luo
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Thiviya Thuraisingam
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Michael Rubino
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Mindy F. Levin
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- CISSS Laval, Jewish Rehabilitation Hospital, Laval, Canada
| | - Franceen Kaizer
- CISSS Laval, Jewish Rehabilitation Hospital, Laval, Canada
- Interdisciplinary Research Centre in Rehabilitation (CRIR), Montreal, Canada
| | - Philippe S. Archambault
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- CISSS Laval, Jewish Rehabilitation Hospital, Laval, Canada
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Jeffers MS, Karthikeyan S, Gomez-Smith M, Gasinzigwa S, Achenbach J, Feiten A, Corbett D. Does Stroke Rehabilitation Really Matter? Part B: An Algorithm for Prescribing an Effective Intensity of Rehabilitation. Neurorehabil Neural Repair 2018; 32:73-83. [DOI: 10.1177/1545968317753074] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. The proportional recovery rule suggests that current rehabilitation practices may have limited ability to influence stroke recovery. However, the appropriate intensity of rehabilitation needed to achieve recovery remains unknown. Similarities between rodent and human recovery biomarkers may allow determination of rehabilitation thresholds necessary to activate endogenous biological recovery processes. Objective. We determined the relative influence that clinically relevant biomarkers of stroke recovery exert on functional outcome. These biomarkers were then used to generate an algorithm that prescribes individualized intensities of rehabilitation necessary for recovery of function. Methods. A retrospective cohort of 593 male Sprague-Dawley rats was used to identify biomarkers that best predicted poststroke change in pellet retrieval in the Montoya staircase-reaching task using multiple linear regression. Prospective manipulation of these factors using endothelin-1-induced stroke (n = 49) was used to validate the model. Results. Rehabilitation was necessary to reliably predict recovery across the continuum of stroke severity. As infarct volume and initial impairment increased, more intensive rehabilitation was required to engage recovery. In this model, we prescribed the specific dose of daily rehabilitation required for rats to achieve significant motor recovery using the biomarkers of initial poststroke impairment and infarct volume. Conclusions. Our algorithm demonstrates an individualized approach to stroke rehabilitation, wherein imaging and functional performance measures can be used to develop an optimized rehabilitation paradigm for rats, particularly those with severe impairments. Exploring this approach in human patients could lead to an increase in the proportion of individuals experiencing recovery of lost motor function poststroke.
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Affiliation(s)
- Matthew Strider Jeffers
- University of Ottawa, Ottawa, Ontario, Canada
- Canadian Partnership for Stroke Recovery, Ottawa, Ontario, Canada
| | - Sudhir Karthikeyan
- University of Ottawa, Ottawa, Ontario, Canada
- Canadian Partnership for Stroke Recovery, Ottawa, Ontario, Canada
| | - Mariana Gomez-Smith
- University of Ottawa, Ottawa, Ontario, Canada
- Canadian Partnership for Stroke Recovery, Ottawa, Ontario, Canada
| | | | | | | | - Dale Corbett
- University of Ottawa, Ottawa, Ontario, Canada
- Canadian Partnership for Stroke Recovery, Ottawa, Ontario, Canada
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130
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Influence of skill and exercise training parameters on locomotor recovery during stroke rehabilitation. Curr Opin Neurol 2018; 29:677-683. [PMID: 27748688 DOI: 10.1097/wco.0000000000000397] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE OF REVIEW Research findings from the fields of motor learning and exercise physiology suggest specific training parameters that can be manipulated during physical rehabilitation profoundly influence skilled task performance. This review details the rationale for some of these training variables and their application in selected intervention studies focused on improving walking function in patients poststroke. RECENT FINDINGS Basic and applied studies have shown that the amount, intensity, and variability of specific task practice applied during rehabilitation interventions can affect recovery of walking poststroke. Many studies detailing the effects of conventional, therapist, and mechanically assisted interventions may incorporate some of these training parameters but minimize others, and their relative contributions may influence walking outcomes. Specific patient factors, such as the stroke acuity and degree of impairments, appear to influence the relative contributions of these training variables, and different patient subgroups may benefit from greater emphasis on specific parameters. SUMMARY The present findings suggest these training parameters should be considered when evaluating or implementing physical interventions directed toward improving locomotor function poststroke. More work is needed to understand their optimal combinations to maximize walking outcomes in patients with different levels of impairment poststroke.
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132
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Rosenthal O, Wing AM, Wyatt JL, Punt D, Miall RC. Mapping upper-limb motor performance after stroke - a novel method with utility for individualized motor training. J Neuroeng Rehabil 2017; 14:127. [PMID: 29208020 PMCID: PMC5718133 DOI: 10.1186/s12984-017-0335-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 11/08/2017] [Indexed: 11/27/2022] Open
Abstract
Background Chronic upper limb motor impairment is a common outcome of stroke. Therapeutic training can reduce motor impairment. Recently, a growing interest in evaluating motor training provided by robotic assistive devices has emerged. Robot-assisted therapy is attractive because it provides a means of increasing practice intensity without increasing the workload of physical therapists. However, movements practised through robotic assistive devices are commonly pre-defined and fixed across individuals. More optimal training may result from individualizing the selection of the trained movements based on the individual’s impairment profile. This requires quantitative assessment of the degree of the motor impairment prior to training, in relevant movement tasks. However, standard clinical measures for profiling motor impairment after stroke are often subjective and lack precision. We have developed a novel robot-mediated method for systematic and fine-grained mapping (or profiling) of individual performance across a wide range of planar arm reaching movements. Here we describe and demonstrate this mapping method and its utilization for individualized training. We also present a novel principle for the individualized selection of training movements based on the performance maps. Methods and Results To demonstrate the utility of our method we present examples of 2D performance maps produced from the kinetic and kinematics data of two individuals with stroke-related upper limb hemiparesis. The maps outline distinct regions of high motor impairment. The procedure of map-based selection of training movements and the change in motor performance following training is demonstrated for one participant. Conclusions The performance mapping method is feasible to produce (online or offline). The 2D maps are easy to interpret and to be utilized for selecting individual performance-based training. Different performance maps can be easily compared within and between individuals, which potentially has diagnostic utility. Electronic supplementary material The online version of this article (10.1186/s12984-017-0335-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Orna Rosenthal
- School of Psychology, University of Birmingham, B15 2TT, Birmingham, UK.
| | - Alan M Wing
- School of Psychology, University of Birmingham, B15 2TT, Birmingham, UK
| | - Jeremy L Wyatt
- School of Computer Science, University of Birmingham, B15 2TT, Birmingham, UK
| | - David Punt
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, B15 2TT, Birmingham, UK
| | - R Chris Miall
- School of Psychology, University of Birmingham, B15 2TT, Birmingham, UK
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133
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Barker RN, Hayward KS, Carson RG, Lloyd D, Brauer SG. SMART Arm Training With Outcome-Triggered Electrical Stimulation in Subacute Stroke Survivors With Severe Arm Disability: A Randomized Controlled Trial. Neurorehabil Neural Repair 2017; 31:1005-1016. [DOI: 10.1177/1545968317744276] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background. Stroke survivors with severe upper limb disability need opportunities to engage in task-oriented practice to achieve meaningful recovery. Objective. To compare the effect of SMART Arm training, with or without outcome-triggered electrical stimulation to usual therapy, on arm function for stroke survivors with severe upper limb disability undergoing inpatient rehabilitation. Methods. A prospective, multicenter, randomized controlled trial was conducted with 3 parallel groups, concealed allocation, assessor blinding and intention-to-treat analysis. Fifty inpatients within 4 months of stroke with severe upper limb disability were randomly allocated to 60 min/d, 5 days a week for 4 weeks of (1) SMART Arm with outcome-triggered electrical stimulation and usual therapy, (2) SMART Arm alone and usual therapy, or (3) usual therapy. Assessment occurred at baseline (0 weeks), posttraining (4 weeks), and follow-up (26 and 52 weeks). The primary outcome measure was Motor Assessment Scale item 6 (MAS6) at posttraining. Results. All groups demonstrated a statistically ( P < .001) and clinically significant improvement in arm function at posttraining (MAS6 change ≥1 point) and at 52 weeks (MAS6 change ≥2 points). There were no differences in improvement in arm function between groups (P = .367). There were greater odds of a higher MAS6 score in SMART Arm groups as compared with usual therapy alone posttraining (SMART Arm stimulation generalized odds ratio [GenOR] = 1.47, 95%CI = 1.23-1.71) and at 26 weeks (SMART Arm alone GenOR = 1.31, 95% CI = 1.05-1.57). Conclusion. SMART Arm training supported a clinically significant improvement in arm function, which was similar to usual therapy. All groups maintained gains at 12 months.
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Affiliation(s)
| | - Kathryn S. Hayward
- The University of Queensland, Brisbane, Queensland, Australia
- James Cook University, Mount Isa, Queensland, Australia
| | - Richard G. Carson
- The University of Queensland, Brisbane, Queensland, Australia
- Trinity College Dublin, Dublin, Ireland
- Queen’s University Belfast, Belfast, UK
| | - David Lloyd
- The University of Queensland, Brisbane, Queensland, Australia
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Perez-Marcos D, Chevalley O, Schmidlin T, Garipelli G, Serino A, Vuadens P, Tadi T, Blanke O, Millán JDR. Increasing upper limb training intensity in chronic stroke using embodied virtual reality: a pilot study. J Neuroeng Rehabil 2017; 14:119. [PMID: 29149855 PMCID: PMC5693522 DOI: 10.1186/s12984-017-0328-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 10/31/2017] [Indexed: 01/05/2023] Open
Abstract
Background Technology-mediated neurorehabilitation is suggested to enhance training intensity and therefore functional gains. Here, we used a novel virtual reality (VR) system for task-specific upper extremity training after stroke. The system offers interactive exercises integrating motor priming techniques and embodied visuomotor feedback. In this pilot study, we examined (i) rehabilitation dose and training intensity, (ii) functional improvements, and (iii) safety and tolerance when exposed to intensive VR rehabilitation. Methods Ten outpatient stroke survivors with chronic (>6 months) upper extremity paresis participated in a ten-session VR-based upper limb rehabilitation program (2 sessions/week). Results All participants completed all sessions of the treatment. In total, they received a median of 403 min of upper limb therapy, with 290 min of effective training. Within that time, participants performed a median of 4713 goal-directed movements. Importantly, training intensity increased progressively across sessions from 13.2 to 17.3 movements per minute. Clinical measures show that despite being in the chronic phase, where recovery potential is thought to be limited, participants showed a median improvement rate of 5.3% in motor function (Fugl-Meyer Assessment for Upper Extremity; FMA-UE) post intervention compared to baseline, and of 15.4% at one-month follow-up. For three of them, this improvement was clinically significant. A significant improvement in shoulder active range of motion (AROM) was also observed at follow-up. Participants reported very low levels of pain, stress and fatigue following each session of training, indicating that the intensive VR intervention was well tolerated. No severe adverse events were reported. All participants expressed their interest in continuing the intervention at the hospital or even at home, suggesting high levels of adherence and motivation for the provided intervention. Conclusions This pilot study showed how a dedicated VR system could deliver high rehabilitation doses and, importantly, intensive training in chronic stroke survivors. FMA-UE and AROM results suggest that task-specific VR training may be beneficial for further functional recovery both in the chronic stage of stroke. Longitudinal studies with higher doses and sample sizes are required to confirm the therapy effectiveness. Trial registration This trial was retrospectively registered at ClinicalTrials.gov database (registration number NCT03094650) on 14 March 2017.
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Affiliation(s)
| | - Odile Chevalley
- MindMaze SA, Lausanne, Switzerland.,Laboratory of Cognitive Neuroscience, Brain-Mind Institute, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Thomas Schmidlin
- Center for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | | | - Andrea Serino
- MindMaze SA, Lausanne, Switzerland.,Center for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.,Department of Clinical Neurosciences, University Hospital of Lausanne, Lausanne, Switzerland
| | | | - Tej Tadi
- MindMaze SA, Lausanne, Switzerland
| | - Olaf Blanke
- Laboratory of Cognitive Neuroscience, Brain-Mind Institute, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.,Center for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - José D R Millán
- Center for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.,Chair in Brain-Machine Interface, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
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135
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Brunner I, Skouen JS, Hofstad H, Aßmus J, Becker F, Sanders AM, Pallesen H, Qvist Kristensen L, Michielsen M, Thijs L, Verheyden G. Virtual Reality Training for Upper Extremity in Subacute Stroke (VIRTUES). Neurology 2017; 89:2413-2421. [DOI: 10.1212/wnl.0000000000004744] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 09/18/2017] [Indexed: 11/15/2022] Open
Abstract
Objective:To compare the effectiveness of upper extremity virtual reality rehabilitation training (VR) to time-matched conventional training (CT) in the subacute phase after stroke.Methods:In this randomized, controlled, single-blind phase III multicenter trial, 120 participants with upper extremity motor impairment within 12 weeks after stroke were consecutively included at 5 rehabilitation institutions. Participants were randomized to either VR or CT as an adjunct to standard rehabilitation and stratified according to mild to moderate or severe hand paresis, defined as ≥20 degrees wrist and 10 degrees finger extension or less, respectively. The training comprised a minimum of sixteen 60-minute sessions over 4 weeks. The primary outcome measure was the Action Research Arm Test (ARAT); secondary outcome measures were the Box and Blocks Test and Functional Independence Measure. Patients were assessed at baseline, after intervention, and at the 3-month follow-up.Results:Mean time from stroke onset for the VR group was 35 (SD 21) days and for the CT group was 34 (SD 19) days. There were no between-group differences for any of the outcome measures. Improvement of upper extremity motor function assessed with ARAT was similar at the postintervention (p = 0.714) and follow-up (p = 0.777) assessments. Patients in VR improved 12 (SD 11) points from baseline to the postintervention assessment and 17 (SD 13) points from baseline to follow-up, while patients in CT improved 13 (SD 10) and 17 (SD 13) points, respectively. Improvement was also similar for our subgroup analysis with mild to moderate and severe upper extremity paresis.Conclusions:Additional upper extremity VR training was not superior but equally as effective as additional CT in the subacute phase after stroke. VR may constitute a motivating training alternative as a supplement to standard rehabilitation.ClinicalTrials.gov identifier:NCT02079103.Classification of evidence:This study provides Class I evidence that for patients with upper extremity motor impairment after stroke, compared to conventional training, VR training did not lead to significant differences in upper extremity function improvement.
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136
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Pila O, Duret C, Laborne FX, Gracies JM, Bayle N, Hutin E. Pattern of improvement in upper limb pointing task kinematics after a 3-month training program with robotic assistance in stroke. J Neuroeng Rehabil 2017; 14:105. [PMID: 29029633 PMCID: PMC5640903 DOI: 10.1186/s12984-017-0315-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 10/03/2017] [Indexed: 01/19/2023] Open
Abstract
Background When exploring changes in upper limb kinematics and motor impairment associated with motor recovery in subacute post stroke during intensive therapies involving robot-assisted training, it is not known whether trained joints improve before non-trained joints and whether target reaching capacity improves before movement accuracy. Methods Twenty-two subacute stroke patients (mean delay post-stroke at program onset 63 ± 29 days, M2) underwent 50 ± 17 (mean ± SD) 45-min sessions of robot-assisted (InMotion™) shoulder/elbow training over 3 months, in addition to conventional occupational therapy. Monthly evaluations (M2 to M5) included Fugl-Meyer Assessment (FM), with subscores per joint, and four robot-based kinematic measures: mean target distance covered, mean velocity, direction accuracy (inverse of root mean square error from straight line) and movement smoothness (inverse of mean number of zero-crossings in the velocity profile). We assessed delays to reach statistically significant improvement for each outcome measure. Results At M5, all clinical and kinematic parameters had markedly improved: Fugl-Meyer, +65% (median); distance covered, +87%; mean velocity, +101%; accuracy, +134%; and smoothness, +96%. Delays to reach statistical significance were M3 for the shoulder/elbow Fugl-Meyer subscore (+43%), M4 for the hand (+80%) and M5 for the wrist (+133%) subscores. For kinematic parameters, delays to significant improvements were M3 for distance (+68%), velocity (+65%) and smoothness (+50%), and M5 for accuracy (+134%). Conclusions An intensive rehabilitation program combining robot-assisted shoulder/elbow training and conventional occupational therapy was associated with improvement in shoulder and elbow movements first, which suggests focal behavior-related brain plasticity. Findings also suggested that recovery of movement quantity related parameters (range of motion, velocity and smoothness) might precede that of movement quality (accuracy). Trial registration EudraCT 2016–005121-36. Date of Registration: 2016–12-20. Date of enrolment of the first participant to the trial: 2009–11-24 (retrospective data).
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Affiliation(s)
- Ophélie Pila
- Centre de Rééducation Fonctionnelle Les Trois Soleils, Médecine Physique et de Réadaptation, Unité de Neurorééducation, 19 rue du Château, Boissise-Le-Roi, 77310, France. .,EA 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement (ARM), Université Paris-Est Créteil, Hôpitaux Universitaires Henri Mondor, Assistance Publique - Hôpitaux de Paris, 51 Avenue du Maréchal de Lattre de Tassigny, Créteil, 94010, France.
| | - Christophe Duret
- Centre de Rééducation Fonctionnelle Les Trois Soleils, Médecine Physique et de Réadaptation, Unité de Neurorééducation, 19 rue du Château, Boissise-Le-Roi, 77310, France
| | - François-Xavier Laborne
- SAMU 91, Centre Hospitalier Sud Francilien, 116 Boulevard Jean Jaurès, Corbeil-Essonnes, 91100, France
| | - Jean-Michel Gracies
- EA 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement (ARM), Université Paris-Est Créteil, Hôpitaux Universitaires Henri Mondor, Assistance Publique - Hôpitaux de Paris, 51 Avenue du Maréchal de Lattre de Tassigny, Créteil, 94010, France
| | - Nicolas Bayle
- EA 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement (ARM), Université Paris-Est Créteil, Hôpitaux Universitaires Henri Mondor, Assistance Publique - Hôpitaux de Paris, 51 Avenue du Maréchal de Lattre de Tassigny, Créteil, 94010, France
| | - Emilie Hutin
- EA 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement (ARM), Université Paris-Est Créteil, Hôpitaux Universitaires Henri Mondor, Assistance Publique - Hôpitaux de Paris, 51 Avenue du Maréchal de Lattre de Tassigny, Créteil, 94010, France
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Resquín F, Gonzalez-Vargas J, Ibáñez J, Brunetti F, Dimbwadyo I, Carrasco L, Alves S, Gonzalez-Alted C, Gomez-Blanco A, Pons JL. Adaptive hybrid robotic system for rehabilitation of reaching movement after a brain injury: a usability study. J Neuroeng Rehabil 2017; 14:104. [PMID: 29025427 PMCID: PMC5639749 DOI: 10.1186/s12984-017-0312-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 09/27/2017] [Indexed: 12/11/2022] Open
Abstract
Background Brain injury survivors often present upper-limb motor impairment affecting the execution of functional activities such as reaching. A currently active research line seeking to maximize upper-limb motor recovery after a brain injury, deals with the combined use of functional electrical stimulation (FES) and mechanical supporting devices, in what has been previously termed hybrid robotic systems. This study evaluates from the technical and clinical perspectives the usability of an integrated hybrid robotic system for the rehabilitation of upper-limb reaching movements after a brain lesion affecting the motor function. Methods The presented system is comprised of four main components. The hybrid assistance is given by a passive exoskeleton to support the arm weight against gravity and a functional electrical stimulation device to assist the execution of the reaching task. The feedback error learning (FEL) controller was implemented to adjust the intensity of the electrical stimuli delivered on target muscles according to the performance of the users. This control strategy is based on a proportional-integral-derivative feedback controller and an artificial neural network as the feedforward controller. Two experiments were carried out in this evaluation. First, the technical viability and the performance of the implemented FEL controller was evaluated in healthy subjects (N = 12). Second, a small cohort of patients with a brain injury (N = 4) participated in two experimental session to evaluate the system performance. Also, the overall satisfaction and emotional response of the users after they used the system was assessed. Results In the experiment with healthy subjects, a significant reduction of the tracking error was found during the execution of reaching movements. In the experiment with patients, a decreasing trend of the error trajectory was found together with an increasing trend in the task performance as the movement was repeated. Brain injury patients expressed a great acceptance in using the system as a rehabilitation tool. Conclusions The study demonstrates the technical feasibility of using the hybrid robotic system for reaching rehabilitation. Patients’ reports on the received intervention reveal a great satisfaction and acceptance of the hybrid robotic system. Trial registration Retrospective trial registration in ISRCTN Register with study ID ISRCTN12843006.
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Affiliation(s)
- F Resquín
- Neural Rehabilitation Group, Cajal Institute of the Spanish National Research Council (CSIC), Avda. Doctor Arce, 37, 28002, Madrid, Spain.
| | - J Gonzalez-Vargas
- Neural Rehabilitation Group, Cajal Institute of the Spanish National Research Council (CSIC), Avda. Doctor Arce, 37, 28002, Madrid, Spain
| | - J Ibáñez
- Neural Rehabilitation Group, Cajal Institute of the Spanish National Research Council (CSIC), Avda. Doctor Arce, 37, 28002, Madrid, Spain.,Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, UK
| | - F Brunetti
- Catholic University of Asunción, Asunción, Paraguay
| | - I Dimbwadyo
- Occupational Therapy Department. Occupational Thinks Research Group. Instituto de Neurociencias y Ciencias del Movimiento (INCIMOV), Centro Superior de Estudios Universitarios La Salle. Universidad Autónoma de Madrid, Madrid, Spain
| | - L Carrasco
- Occupational Thinks Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - S Alves
- Centro de Referencia Estatal de Atención al Daño Cerebral (CEADAC), Madrid, Spain
| | - C Gonzalez-Alted
- Centro de Referencia Estatal de Atención al Daño Cerebral (CEADAC), Madrid, Spain
| | - A Gomez-Blanco
- Centro de Referencia Estatal de Atención al Daño Cerebral (CEADAC), Madrid, Spain
| | - J L Pons
- Neural Rehabilitation Group, Cajal Institute of the Spanish National Research Council (CSIC), Avda. Doctor Arce, 37, 28002, Madrid, Spain.,Tecnológico de Monterrey, Monterrey, México
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Tang Y, Lin YH, Ni HY, Dong J, Yuan HJ, Zhang Y, Liang HY, Yao MC, Zhou QG, Wu HY, Chang L, Luo CX, Zhu DY. Inhibiting Histone Deacetylase 2 (HDAC2) Promotes Functional Recovery From Stroke. J Am Heart Assoc 2017; 6:JAHA.117.007236. [PMID: 28982677 PMCID: PMC5721897 DOI: 10.1161/jaha.117.007236] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background Stroke is a leading cause of long‐term disability worldwide. However, current therapies that promote functional recovery from stroke are limited to physical rehabilitation. No pharmacological therapy is available. Thus, understanding the role of histone deacetylase 2 (HDAC2) in the pathophysiological process of stroke‐induced functional loss may provide a novel strategy for stroke recovery. Methods and Results Focal stroke was induced by photothrombosis. LV‐HDAC2‐shRNA‐GFP, LV‐GFP, Ad‐HDAC2‐Flag, or Ad‐inactive‐HDAC2‐Flag was microinjected into the peri‐infarct area immediately after stroke. HDAC inhibitors were microinjected into the peri‐infarct area 4 to 10 days after stroke. Grid‐walking task and cylinder task were conducted to assess motor function. Golgi‐Cox staining, chromatin immunoprecipitation, and electrophysiology were used to reveal the mechanisms underlying stroke recovery. Knockdown or knockout of HDAC2 promoted stroke recovery, whereas overexpression of HDAC2 worsened stroke‐induced functional impairment. More importantly, trichostatin A, a pan‐HDAC inhibitor, promoted functional recovery from stroke in WT mice when used in the delayed phase, but it was ineffective in Hdac2 conditional knockout (Hdac2 CKO) mice. Treatment with suberoylanilide hydroxamic acid, a selective HDAC1 and HDAC2 inhibitor, in the delayed phase of stroke produced sustained functional recovery in mice via epigenetically enhancing neuroplasticity of surviving neurons in the peri‐infarct zone. Conclusions Our novel findings provide evidence that HDAC2 is a crucial target for functional recovery from stroke. As there are clinically available HDAC inhibitors, our findings could be directly translated into clinical research of stroke.
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Affiliation(s)
- Ying Tang
- Institution of Stem Cells and Neuroregeneration, School of Pharmacy, Nanjing Medical University, Nanjing, China.,Department of Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing, China
| | - Yu-Hui Lin
- Institution of Stem Cells and Neuroregeneration, School of Pharmacy, Nanjing Medical University, Nanjing, China.,Department of Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing, China
| | - Huan-Yu Ni
- Institution of Stem Cells and Neuroregeneration, School of Pharmacy, Nanjing Medical University, Nanjing, China.,Department of Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing, China
| | - Jian Dong
- Institution of Stem Cells and Neuroregeneration, School of Pharmacy, Nanjing Medical University, Nanjing, China.,Department of Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing, China
| | - Hong-Jin Yuan
- Institution of Stem Cells and Neuroregeneration, School of Pharmacy, Nanjing Medical University, Nanjing, China.,Department of Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing, China
| | - Yu Zhang
- Institution of Stem Cells and Neuroregeneration, School of Pharmacy, Nanjing Medical University, Nanjing, China.,Department of Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing, China
| | - Hai-Ying Liang
- Institution of Stem Cells and Neuroregeneration, School of Pharmacy, Nanjing Medical University, Nanjing, China.,Department of Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing, China
| | - Meng-Cheng Yao
- Institution of Stem Cells and Neuroregeneration, School of Pharmacy, Nanjing Medical University, Nanjing, China.,Department of Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing, China
| | - Qi-Gang Zhou
- Institution of Stem Cells and Neuroregeneration, School of Pharmacy, Nanjing Medical University, Nanjing, China.,Department of Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing, China
| | - Hai-Yin Wu
- Institution of Stem Cells and Neuroregeneration, School of Pharmacy, Nanjing Medical University, Nanjing, China.,Department of Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing, China
| | - Lei Chang
- Institution of Stem Cells and Neuroregeneration, School of Pharmacy, Nanjing Medical University, Nanjing, China.,Department of Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing, China
| | - Chun-Xia Luo
- Institution of Stem Cells and Neuroregeneration, School of Pharmacy, Nanjing Medical University, Nanjing, China .,Department of Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing, China
| | - Dong-Ya Zhu
- Institution of Stem Cells and Neuroregeneration, School of Pharmacy, Nanjing Medical University, Nanjing, China .,Department of Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing, China.,The Key Laboratory of Precision Medicine of Cardiovascular Disease, Nanjing, China
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Community Use of Physical and Occupational Therapy After Stroke and Risk of Hospital Readmission. Arch Phys Med Rehabil 2017; 99:26-34.e5. [PMID: 28807692 DOI: 10.1016/j.apmr.2017.07.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 06/29/2017] [Accepted: 07/18/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To determine whether receipt of therapy and number and timing of therapy visits decreased hospital readmission risk in stroke survivors discharged home. DESIGN Retrospective cohort analysis of Medicare claims (2010-2013). SETTING Acute care hospital and community. PARTICIPANTS Patients hospitalized for stroke who were discharged home and survived the first 30 days (N=23,413; mean age ± SD, 77.6±7.5y). INTERVENTIONS Physical and occupational therapist use in the home and/or outpatient setting in the first 30 days after discharge (any use, number of visits, and days to first visit). MAIN OUTCOME MEASURES Hospital readmission 30 to 60 days after discharge. Covariates included demographic characteristics, proxy variables for functional status, hospitalization characteristics, comorbidities, and prior health care use. Multivariate logistic regression analyses were conducted to examine the relation between therapist use and readmission. RESULTS During the first 30 days after discharge, 31% of patients saw a therapist in the home, 11% saw a therapist in an outpatient setting, and 59% did not see a therapist. Relative to patients who had no therapist contact, those who saw an outpatient therapist were less likely to be readmitted to the hospital (odds ratio, 0.73; 95% confidence interval, 0.59-0.90). Although the point estimates did not reach statistical significance, there was some suggestion that the greater the number of therapist visits in the home and the sooner the visits started, the lower the risk of hospital readmission. CONCLUSIONS After controlling for observable demographic-, clinical-, and health-related differences, we found that individuals who received outpatient therapy in the first 30 days after discharge home after stroke were less likely to be readmitted to the hospital in the subsequent 30 days, relative to those who received no therapy.
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The Effects of Early Exercise on Motor, Sense, and Memory Recovery in Rats With Stroke. Am J Phys Med Rehabil 2017; 96:e36-e43. [PMID: 27977432 DOI: 10.1097/phm.0000000000000670] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Exercise is an effective, inexpensive, home-based, and accessible intervention strategy for stroke treatment, and early exercise after stroke has attracted a great deal of attention in recent years. However, the effects of early exercise on comprehensive functional recovery remain poorly understood. The present study investigated the effect of early exercise on motor, sense, balance, and spatial memory recovery. DESIGN Adult Sprague-Dawley rats were subjected to unilateral middle cerebral artery occlusion (MCAO) and were randomly divided into early exercise group (EE), non-exercise group (NE), and sham group. EE group received 2 weeks of exercise training initiated at 24 hours after operation. The recovery of motor, sense, and balance function was evaluated every 3 days after MCAO. Spatial memory recovery was detected from 21 to 25 days after MCAO. RESULTS The results showed that early exercise significantly promoted the motor and spatial memory recovery with statistical differences. The rats in EE group have a better recovery in sense and balance function, but there is no statistically significant difference about these results. CONCLUSION Our results showed that early moderate exercise can significantly promote motor and spatial memory recovery, but not the sense and balance functions.
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Grosmaire AG, Duret C. Does assist-as-needed upper limb robotic therapy promote participation in repetitive activity-based motor training in sub-acute stroke patients with severe paresis? NeuroRehabilitation 2017; 41:31-39. [DOI: 10.3233/nre-171454] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Anne-Gaëlle Grosmaire
- Centre de Rééducation Fonctionnelle Les Trois Soleils, Médecine Physique et de Réadaptation, Unité de Neurorééducation, Boissise-Le-Roi, France
| | - Christophe Duret
- Centre de Rééducation Fonctionnelle Les Trois Soleils, Médecine Physique et de Réadaptation, Unité de Neurorééducation, Boissise-Le-Roi, France
- Centre Hospitalier Sud Francilien, Neurologie, Corbeil-Essonnes, France
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Gauthier LV, Kane C, Borstad A, Strahl N, Uswatte G, Taub E, Morris D, Hall A, Arakelian M, Mark V. Video Game Rehabilitation for Outpatient Stroke (VIGoROUS): protocol for a multi-center comparative effectiveness trial of in-home gamified constraint-induced movement therapy for rehabilitation of chronic upper extremity hemiparesis. BMC Neurol 2017; 17:109. [PMID: 28595611 PMCID: PMC5465449 DOI: 10.1186/s12883-017-0888-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 05/26/2017] [Indexed: 11/15/2022] Open
Abstract
Background Constraint-Induced Movement therapy (CI therapy) is shown to reduce disability, increase use of the more affected arm/hand, and promote brain plasticity for individuals with upper extremity hemiparesis post-stroke. Randomized controlled trials consistently demonstrate that CI therapy is superior to other rehabilitation paradigms, yet it is available to only a small minority of the estimated 1.2 million chronic stroke survivors with upper extremity disability. The current study aims to establish the comparative effectiveness of a novel, patient-centered approach to rehabilitation utilizing newly developed, inexpensive, and commercially available gaming technology to disseminate CI therapy to underserved individuals. Video game delivery of CI therapy will be compared against traditional clinic-based CI therapy and standard upper extremity rehabilitation. Additionally, individual factors that differentially influence response to one treatment versus another will be examined. Methods This protocol outlines a multi-site, randomized controlled trial with parallel group design. Two hundred twenty four adults with chronic hemiparesis post-stroke will be recruited at four sites. Participants are randomized to one of four study groups: (1) traditional clinic-based CI therapy, (2) therapist-as-consultant video game CI therapy, (3) therapist-as-consultant video game CI therapy with additional therapist contact via telerehabilitation/video consultation, and (4) standard upper extremity rehabilitation. After 6-month follow-up, individuals assigned to the standard upper extremity rehabilitation condition crossover to stand-alone video game CI therapy preceded by a therapist consultation. All interventions are delivered over a period of three weeks. Primary outcome measures include motor improvement as measured by the Wolf Motor Function Test (WMFT), quality of arm use for daily activities as measured by Motor Activity Log (MAL), and quality of life as measured by the Quality of Life in Neurological Disorders (NeuroQOL). Discussion This multi-site RCT is designed to determine comparative effectiveness of in-home technology-based delivery of CI therapy versus standard upper extremity rehabilitation and in-clinic CI therapy. The study design also enables evaluation of the effect of therapist contact time on treatment outcomes within a therapist-as-consultant model of gaming and technology-based rehabilitation. Trial registration Clinicaltrials.gov, NCT02631850.
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Affiliation(s)
- Lynne V Gauthier
- The Ohio State University, Department of Physical Medicine and Rehabilitation, Division of Rehabilitation Psychology, 480 Medical Center Drive, Columbus, OH, 43210, USA.
| | - Chelsea Kane
- The Ohio State University, Department of Physical Medicine and Rehabilitation, Division of Rehabilitation Psychology, 480 Medical Center Drive, Columbus, OH, 43210, USA
| | - Alexandra Borstad
- Department of Physical Therapy, College of St. Scholastica, 1200 Kenwood Ave, Duluth, MN, 55811, USA
| | - Nancy Strahl
- Providence Medford Medical Center, 1111 Crater Lake Ave, Medford, Oregon, 97504, USA
| | - Gitendra Uswatte
- Department of Psychology; UAB Department of Psychology, University of Alabama at Birmingham, Campbell Hall 415, 1530 3rd Avenue South, Birmingham, AL, 35294-1170, USA
| | - Edward Taub
- Department of Psychology; UAB Department of Psychology, University of Alabama at Birmingham, Campbell Hall 415, 1530 3rd Avenue South, Birmingham, AL, 35294-1170, USA
| | - David Morris
- Department of Physical Therapy; UAB Department of Physical Therapy, University of Alabama at Birmingham, 1720 2nd Avenue South, School of Health Professions Building 360X, Birmingham, AL, 35294-1212, USA
| | - Alli Hall
- The Ohio State University, Department of Physical Medicine and Rehabilitation, Division of Rehabilitation Psychology, 480 Medical Center Drive, Columbus, OH, 43210, USA
| | - Melissa Arakelian
- Providence Medford Medical Center, 1111 Crater Lake Ave, Medford, Oregon, 97504, USA
| | - Victor Mark
- Department of Psychology; UAB Department of Psychology, University of Alabama at Birmingham, Campbell Hall 415, 1530 3rd Avenue South, Birmingham, AL, 35294-1170, USA.,Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294-7330, USA.,Department of Neurology, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
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143
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Opening a New Time Window for Treatment of Stroke by Targeting HDAC2. J Neurosci 2017; 37:6712-6728. [PMID: 28592694 DOI: 10.1523/jneurosci.0341-17.2017] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 05/10/2017] [Accepted: 06/01/2017] [Indexed: 11/21/2022] Open
Abstract
Narrow therapeutic window limits treatments with thrombolysis and neuroprotection for most stroke patients. Widening therapeutic window remains a critical challenge. Understanding the key mechanisms underlying the pathophysiological events in the peri-infarct area where secondary injury coexists with neuroplasticity over days to weeks may offer an opportunity for expanding the therapeutic window. Here we show that ischemia-induced histone deacetylase 2 (HDAC2) upregulation from 5 to 7 d after stroke plays a crucial role. In this window phase, suppressing HDAC2 in the peri-infarct cortex of rodents by HDAC inhibitors, knockdown or knock-out of Hdac2 promoted recovery of motor function from stroke via epigenetically enhancing cells survival and neuroplasticity of surviving neurons as well as reducing neuroinflammation, whereas overexpressing HDAC2 worsened stroke-induced functional impairment of both WT and Hdac2 conditional knock-out mice. More importantly, inhibiting other isoforms of HDACs had no effect. Thus, the intervention by precisely targeting HDAC2 in this window phase is a novel strategy for the functional recovery of stroke survivors.SIGNIFICANCE STATEMENT Narrow time window phase impedes current therapies for stroke patients. Understanding the key mechanisms underlying secondary injury may open a new window for pharmacological interventions to promote recovery from stroke. Our study indicates that ischemia-induced histone deacetylase 2 upregulation from 5 to 7 d after stroke mediates the secondary functional loss by reducing survival and neuroplasticity of peri-infarct neurons as well as augmenting neuroinflammation. Thus, precisely targeting histone deacetylase 2 in the window phase provides a novel therapeutic strategy for stroke recovery.
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144
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Perry BE, Evans EK, Stokic DS. Weight compensation characteristics of Armeo®Spring exoskeleton: implications for clinical practice and research. J Neuroeng Rehabil 2017; 14:14. [PMID: 28212673 PMCID: PMC5316193 DOI: 10.1186/s12984-017-0227-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 02/15/2017] [Indexed: 11/10/2022] Open
Abstract
Background Armeo®Spring exoskeleton is widely used for upper extremity rehabilitation; however, weight compensation provided by the device appears insufficiently characterized to fully utilize it in clinical and research settings. Methods Weight compensation was quantified by measuring static force in the sagittal plane with a load cell attached to the elbow joint of Armeo®Spring. All upper spring settings were examined in 5° increments at the minimum, maximum, and two intermediate upper and lower module length settings, while keeping the lower spring at minimum. The same measurements were made for minimum upper spring setting and maximum lower spring setting at minimum and maximum module lengths. Weight compensation was plotted against upper module angles, and slope was analyzed for each condition. Results The Armeo®Spring design prompted defining the slack angle and exoskeleton balance angle, which, depending on spring and length settings, divide the operating range into different unloading and loading regions. Higher spring tensions and shorter module lengths provided greater unloading (≤6.32 kg of support). Weight compensation slope decreased faster with shorter length settings (minimum length = −0.082 ± 0.002 kg/°; maximum length = −0.046 ± 0.001 kg/°) independent of spring settings. Conclusions Understanding the impact of different settings on the Armeo®Spring weight compensation should help define best clinical practice and improve fidelity of research. Electronic supplementary material The online version of this article (doi:10.1186/s12984-017-0227-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bonnie E Perry
- Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, 1350 East Woodrow Wilson Drive, Jackson, MS, 39216, USA
| | - Emily K Evans
- Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, 1350 East Woodrow Wilson Drive, Jackson, MS, 39216, USA
| | - Dobrivoje S Stokic
- Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, 1350 East Woodrow Wilson Drive, Jackson, MS, 39216, USA.
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145
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Sandler EB, Roach KE, Field-Fote EC. Dose-Response Outcomes Associated with Different Forms of Locomotor Training in Persons with Chronic Motor-Incomplete Spinal Cord Injury. J Neurotrauma 2017; 34:1903-1908. [PMID: 27901413 DOI: 10.1089/neu.2016.4555] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Outcomes of training are thought to be related to the amount of training (training dose). Although various approaches to locomotor training have been used to improve walking function in persons with spinal cord injury (SCI), little is known about the relationship between dose of locomotor training and walking outcomes. This secondary analysis aimed to identify the relationship between training dose and improvement in walking distance and speed associated with locomotor training in participants with chronic motor-incomplete spinal cord injury (MISCI). We compared the dose-response relationships associated with each of four different locomotor training approaches. Participants were randomized to either: treadmill-based training with manual assistance (TM = 17), treadmill-based training with stimulation (TS = 18), overground training with stimulation (OG = 15), and treadmill-based training with locomotor robotic device assistance (LR = 14). Subjects trained 5 days/week for 12 weeks, with a target of 60 training sessions. The distance-dose and time-dose were calculated based on the total distance and total time, respectively, participants engaged in walking over all sessions combined. Primary outcome measures included walking distance (traversed in 2 min) and walking speed (over 10 m). Only OG training showed a good correlation between distance-dose and change in walking distance and speed walked over ground (r = 0.61, p = 0.02; r = 0.62, p = 0.01). None of the treadmill-based training approaches were associated with significant correlations between training dose and improvement of functional walking outcome. The findings suggest that greater distance achieved over the course of OG training is associated with better walking outcomes in the studied population. Further investigation to identify the essential elements that determine outcomes would be valuable for guiding rehabilitation.
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Affiliation(s)
- Evan B Sandler
- 1 Crawford Research Institute , Shepherd Center, Atlanta, Georgia
| | - Kathryn E Roach
- 2 Department of Physical Therapy, Miller School of Medicine, University of Miami , Miami, Florida
| | - Edelle C Field-Fote
- 1 Crawford Research Institute , Shepherd Center, Atlanta, Georgia .,3 Department of Rehabilitation Medicine, School of Medicine, Emory University , Atlanta, Georgia .,4 The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami , Miami, Florida
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146
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Dumas HM, Fragala-Pinkham MA, Rosen EL, Folmar E. Physical Therapy Dosing: Frequency and Type of Intervention in Pediatric Postacute Hospital Care. Pediatr Phys Ther 2017; 29:47-53. [PMID: 27984468 DOI: 10.1097/pep.0000000000000339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To examine differences in physical therapy dosing frequency recommendations based on children's characteristics and to describe types of intervention recommended at postacute hospital admission. METHODS Demographic and clinical information, recommended physical therapy intervention frequency, and intervention types were collected for all admissions from April 1, 2015, to March 1, 2016. Differences across 2 groups, children with recommendations for "less" (≤3x/wk) or "more" (≥4x/wk) frequent therapy, were examined. Types of interventions recommended were described and the measure of association between frequency and type was determined. RESULTS Older children, those with higher admission functional scores, and children with less dependence on medical technology were recommended for "more." Therapeutic exercise was the most common intervention recommended. Greater physical therapy frequency was associated with Functional Training and Motor Function Training. CONCLUSION Children's age, functional level, and technology dependence influence dosing recommendations. Interventions focused on function are associated with greater physical therapy frequency.
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Affiliation(s)
- Helene M Dumas
- Research Center (Drs Dumas and Fragala-Pinkham) and Physical Therapy Department (Dr Rosen), Franciscan Hospital for Children, Boston, Massachusetts; and College of Professional Studies, Northeastern University, Boston, Massachusetts (Dr Folmar)
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Krucoff MO, Rahimpour S, Slutzky MW, Edgerton VR, Turner DA. Enhancing Nervous System Recovery through Neurobiologics, Neural Interface Training, and Neurorehabilitation. Front Neurosci 2016; 10:584. [PMID: 28082858 PMCID: PMC5186786 DOI: 10.3389/fnins.2016.00584] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 12/06/2016] [Indexed: 12/21/2022] Open
Abstract
After an initial period of recovery, human neurological injury has long been thought to be static. In order to improve quality of life for those suffering from stroke, spinal cord injury, or traumatic brain injury, researchers have been working to restore the nervous system and reduce neurological deficits through a number of mechanisms. For example, neurobiologists have been identifying and manipulating components of the intra- and extracellular milieu to alter the regenerative potential of neurons, neuro-engineers have been producing brain-machine and neural interfaces that circumvent lesions to restore functionality, and neurorehabilitation experts have been developing new ways to revitalize the nervous system even in chronic disease. While each of these areas holds promise, their individual paths to clinical relevance remain difficult. Nonetheless, these methods are now able to synergistically enhance recovery of native motor function to levels which were previously believed to be impossible. Furthermore, such recovery can even persist after training, and for the first time there is evidence of functional axonal regrowth and rewiring in the central nervous system of animal models. To attain this type of regeneration, rehabilitation paradigms that pair cortically-based intent with activation of affected circuits and positive neurofeedback appear to be required-a phenomenon which raises new and far reaching questions about the underlying relationship between conscious action and neural repair. For this reason, we argue that multi-modal therapy will be necessary to facilitate a truly robust recovery, and that the success of investigational microscopic techniques may depend on their integration into macroscopic frameworks that include task-based neurorehabilitation. We further identify critical components of future neural repair strategies and explore the most updated knowledge, progress, and challenges in the fields of cellular neuronal repair, neural interfacing, and neurorehabilitation, all with the goal of better understanding neurological injury and how to improve recovery.
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Affiliation(s)
- Max O Krucoff
- Department of Neurosurgery, Duke University Medical Center Durham, NC, USA
| | - Shervin Rahimpour
- Department of Neurosurgery, Duke University Medical Center Durham, NC, USA
| | - Marc W Slutzky
- Department of Physiology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, USA; Department of Neurology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, USA
| | - V Reggie Edgerton
- Department of Integrative Biology and Physiology, University of California, Los Angeles Los Angeles, CA, USA
| | - Dennis A Turner
- Department of Neurosurgery, Duke University Medical CenterDurham, NC, USA; Department of Neurobiology, Duke University Medical CenterDurham, NC, USA; Research and Surgery Services, Durham Veterans Affairs Medical CenterDurham, NC, USA
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Abstract
Advancements in medical care over the last decades have contributed to a continuous decline in immediate post-stroke mortality. The flipside of this development is that patients surviving the initial stroke are forced to live with sometimes extreme functional motor and/or language limitations for the remaining life span. The following overview presents evidence-based neurorehabilitative interventions to promote motor and language recovery in the acute and chronic post-stroke stages. Therapeutic approaches comprise intensive training, neuropharmacological drugs and non-invasive brain stimulation techniques, such as transcranial magnetic stimulation (TMS) or direct current stimulation (tDCS). Additionally, an outlook on promising future interventions for stroke neurorehabilitation is provided.
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149
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Reuter B, Gumbinger C, Sauer T, Wiethölter H, Bruder I, Diehm C, Ringleb PA, Hacke W, Hennerici MG, Kern R. Access, timing and frequency of very early stroke rehabilitation - insights from the Baden-Wuerttemberg stroke registry. BMC Neurol 2016; 16:222. [PMID: 27852229 PMCID: PMC5112693 DOI: 10.1186/s12883-016-0744-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 11/08/2016] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND While the precise timing and intensity of very early rehabilitation (VER) after stroke onset is still under discussion, its beneficial effect on functional disability is generally accepted. The recently published randomized controlled AVERT trial indicated that patients with severe stroke might be more susceptible to harmful side effects of VER, which we hypothesized is contrary to current clinical practice. We analyzed the Baden-Wuerttemberg stroke registry to gain insight into the application of VER in acute ischemic stroke (IS) and intracerebral hemorrhage (ICH) in clinical practice. METHODS 99,753 IS patients and 8824 patients with ICH hospitalized from January 2008 to December 2012 were analyzed. Data on the access to physical therapy (PT), occupational therapy (OT), and speech therapy (ST), the time from admission to first contact with a therapist and the average number of therapy sessions during the first 7 days of admission are reported. Multiple logistic regression models adjusted for patient and treatment characteristics were carried out to investigate the influence of VER on clinical outcome. RESULTS PT was applied in 90/87% (IS/ICH), OT in 63/57%, and ST in 70/65% of the study population. Therapy was mostly initiated within 24 h (PT 87/82%) or 48 h after admission (OT 91/89% and ST 93/90%). Percentages of patients under therapy and also the average number of therapy sessions were highest in those with a discharge modified Rankin Scale score of 2 to 5 and lowest in patients with complete recovery or death during hospitalization. The outcome analyses were fundamentally hindered due to biases by individual decision making regarding the application and frequency of VER. CONCLUSIONS While most patients had access to PT we noticed an undersupply of OT and ST. Only little differences were observed between patients with IS and ICH. The staff decisions for treatment seem to reflect attempts to optimize resources. Patients with either excellent or very unfavorable prognosis were less frequently assigned to VER and, if treated, received a lower average number of therapy sessions. On the contrary, severely disabled patients received VER at high frequency, although potentially harmful according to recent indications from the randomized controlled AVERT trial.
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Affiliation(s)
- Björn Reuter
- Department of Neurology and Neurophysiology, University Hospital Freiburg, Breisacher Straße 64, 79106 Freiburg, Germany
| | - Christoph Gumbinger
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Tamara Sauer
- Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
| | - Horst Wiethölter
- formerly affiliated to Department of Neurology, Bürgerhospital, Stuttgart, Germany
| | - Ingo Bruder
- Office for Quality Assurance in Hospitals (GeQiK), Baden-Wuerttembergische Hospital Association, Stuttgart, Germany
| | - Curt Diehm
- Department of Internal/Vascular Medicine, Max-Grundig-Klinik, Bühl, Germany
| | - Peter A. Ringleb
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Werner Hacke
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael G. Hennerici
- Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
| | - Rolf Kern
- Department of Neurology, Klinikum Kempten-Oberallgaeu, Kempten, Germany
| | - and Stroke Working Group of Baden-Wuerttemberg
- Department of Neurology and Neurophysiology, University Hospital Freiburg, Breisacher Straße 64, 79106 Freiburg, Germany
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
- Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
- formerly affiliated to Department of Neurology, Bürgerhospital, Stuttgart, Germany
- Office for Quality Assurance in Hospitals (GeQiK), Baden-Wuerttembergische Hospital Association, Stuttgart, Germany
- Department of Internal/Vascular Medicine, Max-Grundig-Klinik, Bühl, Germany
- Department of Neurology, Klinikum Kempten-Oberallgaeu, Kempten, Germany
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150
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Is upper limb virtual reality training more intensive than conventional training for patients in the subacute phase after stroke? An analysis of treatment intensity and content. BMC Neurol 2016; 16:219. [PMID: 27835977 PMCID: PMC5106796 DOI: 10.1186/s12883-016-0740-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 11/03/2016] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Virtual reality (VR) training is thought to improve upper limb (UL) motor function after stroke when utilizing intensive training with many repetitions. The purpose of this study was to compare intensity and content of a VR training intervention to a conventional task-oriented intervention (CT). METHODS A random sample of 50 video recordings was analyzed of patients with a broad range of UL motor impairments (mean age 61y, 22 women). Patients took part in the VIRTUES trial and were randomized to either VR or CT and stratified according to severity of paresis. A standardized scoring form was used to analyze intensity, i.e. active use of the affected UL expressed in % of total time, total active time and total duration of a training session in minutes, content of training and feedback. Two raters collected data independently. Linear regression models as well as descriptive and graphical methods were used. RESULTS Patients in the VR group spent significantly more time actively practicing with an activity rate of 77.6 (8.9) % than patients in the CT 67.3 (13.9) %, (p = .003). This difference was attributed to the subgroup of patients with initially severe paresis (n = 22). While in VR severely impaired patients spent 80.7 % (4.4 %) of the session time actively; they reached 60.6 (12.1) % in CT. VR and CT also differed in terms of tasks and feedback provided. CONCLUSION Our results indicate that patients with severely impaired UL motor function spent more time actively in VR training, which may influence recovery. The upcoming results of the VIRTUES trial will show whether this is correlated with an increased effect of VR compared to CT. TRIAL REGISTRATION ClinicalTrials.gov NCT02079103 , February 27, 2014.
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