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Someya A, Tanaka M. The process by which patients become aware of unilateral spatial neglect: A qualitative study. Neuropsychol Rehabil 2022; 32:2370-2391. [PMID: 34212821 DOI: 10.1080/09602011.2021.1946411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Unilateral spatial neglect (USN), which can occur post-stroke, significantly impacts patients' daily lives. We explored the process by which patients become aware of the facets of their USN from the acute to subacute phase using a qualitative method. Participant observations, semi-structured interviews, and medical-record surveys were conducted with eight patients with USN and thirty healthcare professionals. We identified three themes regarding the patients' USN awareness process: inconsistency between present symptoms and perception of the left side, reconsidering the reasons for a vagueness on the left side, and acceptance of neglecting the left side. Additionally, healthcare professionals' support consisted of four strategies: assessing patients' perception of stimuli on their left side, compensating for patients' behaviours, promoting awareness of USN, and promoting activities that involve the use of residual functions after a cerebrovascular accident. Patients with USN gradually became aware of their deficits through interactions with others, and they responded by creating and practicing their own self-developed management strategies. These findings indicate that recovery from USN requires a series of experiences and social interactions. A comprehensive understanding of the process of awareness and adaption to USN from onset to recovery can help provide support for patients with USN.
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Affiliation(s)
- Akira Someya
- Department of Critical and Invasive-Palliative Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan.,Japan Community Healthcare Organization Tokyo Shinjuku Medical Center, Tokyo, Japan
| | - Makoto Tanaka
- Department of Critical and Invasive-Palliative Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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2
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Kaiser AP, Villadsen KW, Samani A, Knoche H, Evald L. Virtual Reality and Eye-Tracking Assessment, and Treatment of Unilateral Spatial Neglect: Systematic Review and Future Prospects. Front Psychol 2022; 13:787382. [PMID: 35391965 PMCID: PMC8982678 DOI: 10.3389/fpsyg.2022.787382] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/26/2022] [Indexed: 11/17/2022] Open
Abstract
Unilateral spatial neglect (USN) is a disorder characterized by the failure to report, respond to, or orient toward the contralateral side of space to a brain lesion. Current assessment methods often fail to discover milder forms, cannot differentiate between unilateral spatial neglect subtypes and lack ecological validity. There is also a need for treatment methods that target subtypes. Immersive virtual reality (VR) systems in combination with eye-tracking (ET) have the potential to overcome these shortcomings, by providing more naturalistic environments and tasks, with sensitive and detailed measures. This systematic review examines the state of the art of research on these technologies as applied in the assessment and treatment of USN. As we found no studies that combined immersive VR and ET, we reviewed these approaches individually. The review of VR included seven articles, the ET review twelve. The reviews revealed promising results. (1) All included studies found significant group-level differences for several USN measures. In addition, several studies found asymmetric behavior in VR and ET tasks for patients who did not show signs of USN in conventional tests. Particularly promising features were multitasking in complex VR environments and detailed eye-movement analysis. (2) No VR and only a few ET studies attempted to differentiate USN subtypes, although the technologies appeared appropriate. One ET study grouped USN participants using individual heatmaps, and another differentiated between subtypes on drawing tasks. Regarding (3) ecological validity, although no studies tested the prognostic validity of their assessment methods, VR and ET studies utilized naturalistic tasks and stimuli reflecting everyday situations. Technological characteristics, such as the field of view and refresh rate of the head-mounted displays, could be improved, though, to improve ecological validity. We found (4) no studies that utilized VR or ET technologies for USN treatment up until the search date of the 26th of February 2020. In conclusion, VR-ET-based systems show great potential for USN assessment. VR-ET holds great promise for treatment, for example, by monitoring behavior and adapting and tailoring to the individual person's needs and abilities. Future research should consider developing methods for individual subtypes and differential diagnostics to inform individual treatment programs.
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Affiliation(s)
- Alexander Pilgaard Kaiser
- Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark,Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
| | - Kristian Westergaard Villadsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark,Aalborg University Hospital, Aalborg University, Aalborg, Denmark
| | - Afshin Samani
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Hendrik Knoche
- Department of Architecture, Design and Media Technology, Aalborg University, Aalborg, Denmark
| | - Lars Evald
- Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark,*Correspondence: Lars Evald,
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Microstructural MRI Correlates of Cognitive Impairment in Multiple Sclerosis: The Role of Deep Gray Matter. Diagnostics (Basel) 2021; 11:diagnostics11061103. [PMID: 34208650 PMCID: PMC8234586 DOI: 10.3390/diagnostics11061103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/07/2021] [Accepted: 06/10/2021] [Indexed: 11/24/2022] Open
Abstract
Although cognitive impairment (CI) is frequently observed in people with multiple sclerosis (pwMS), its pathogenesis is still controversial. Conflicting results emerged concerning the role of microstructural gray matter (GM) damage especially when involving the deep GM structures. In this study, we aimed at evaluating whether differences in cortical and deep GM structures between apparently cognitively normal (ACN) and CI pwMS (36 subjects in total) are present, using an extensive set of diffusion MRI (dMRI) indices and conventional morphometry measures. The results revealed increased anisotropy and restriction over several deep GM structures in CI compared with ACN pwMS, while no changes in volume were present in the same areas. Conversely, reduced anisotropy/restriction values were detected in cortical regions, mostly the pericalcarine cortex and precuneus, combined with reduced thickness of the superior frontal gyrus and insula. Most of the dMRI metrics but none of the morphometric indices correlated with the Symbol Digit Modality Test. These results suggest that deep GM microstructural damage can be a strong anatomical substrate of CI in pwMS and might allow identifying pwMS at higher risk of developing CI.
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Zhang Y, Hua Y, Bai Y. Applications of Functional Magnetic Resonance Imaging in Determining the Pathophysiological Mechanisms and Rehabilitation of Spatial Neglect. Front Neurol 2020; 11:548568. [PMID: 33281698 PMCID: PMC7688780 DOI: 10.3389/fneur.2020.548568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 09/25/2020] [Indexed: 12/16/2022] Open
Abstract
Functional magnetic resonance imaging (fMRI) is a neuroimaging tool which has been applied extensively to explore the pathophysiological mechanisms of neurological disorders. Spatial neglect is considered to be the failure to attend or respond to stimuli on the side of the space or body opposite a cerebral lesion. In this review, we summarize and analyze fMRI studies focused specifically on spatial neglect. Evidence from fMRI studies have highlighted the role of dorsal and ventral attention networks in the pathophysiological mechanisms of spatial neglect, and also support the concept of interhemispheric rivalry as an explanatory model. fMRI studies have shown that several rehabilitation methods can induce activity changes in brain regions implicated in the control of spatial attention. Future investigations with large study cohorts and appropriate subgroup analyses should be conducted to confirm the possibility that fMRI might offer an objective standard for predicting spatial neglect and tracking the response of brain activity to clinical treatment, as well as provide biomarkers to guide rehabilitation for patients with SN.
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Affiliation(s)
- Yuqian Zhang
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yan Hua
- Department of Rehabilitation Medicine, Huashan Hospital North, Fudan University, Shanghai, China
| | - Yulong Bai
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
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Trombini M, Vestito L, Morando M, Mori L, Trompetto C, Bandini F, Dellepiane S. Unilateral spatial neglect rehabilitation supported by a digital solution: two case-studies. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:3670-3675. [PMID: 33018797 DOI: 10.1109/embc44109.2020.9175834] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Digital solutions for unilateral spatial neglect (USN) assessment and treatment are nowadays of great interest, because of both the possibility of combining them with other rehabilitation practices, and the easy-to-understand data and indicators they collect. The ReMoVES platform, developed in DITEN laboratories, is conceived in the Assistive Technologies framework and provides motor and cognitive exergames and activities to be performed in conjunction with traditional rehabilitation. In this work, two case-studies, related to the USN rehabilitation, are presented. The combination of cognitive therapy, delivered by the ReMoVES platform, and transcranial direct-current stimulation (tDCS) technique was used as rehabilitation treatment for both the patients. Data collected at the beginning or at the end of the rehabilitation process, or also during the treatment sessions, are shown and discussed in this paper. This work is a preliminary part of a wider one, that will be conducted involving many different rehabilitation centers, aimed at proving the validity of such an approach to USN treatments.
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Umeonwuka C, Roos R, Ntsiea V. Current trends in the treatment of patients with post-stroke unilateral spatial neglect: a scoping review. Disabil Rehabil 2020; 44:2158-2185. [DOI: 10.1080/09638288.2020.1824026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Chuka Umeonwuka
- Department of Physiotherapy, Faculty of Health Science, University of Witwatersrand, Johannesburg, South Africa
| | - Ronel Roos
- Department of Physiotherapy, Faculty of Health Science, University of Witwatersrand, Johannesburg, South Africa
- Department of Physiotherapy, The Wits-JBI Centre for Evidenced-Based Practice: A Joanna Briggs Institute Affiliated Group, Johannesburg, South Africa
| | - Veronica Ntsiea
- Department of Physiotherapy, Faculty of Health Science, University of Witwatersrand, Johannesburg, South Africa
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Evald L, Wilms I, Nordfang M. Assessment of spatial neglect in clinical practice: A nationwide survey. Neuropsychol Rehabil 2020; 31:1374-1389. [PMID: 32573333 DOI: 10.1080/09602011.2020.1778490] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This study was part of a nationwide, anonymous, open Internet survey conducted amongst healthcare professionals in Denmark on the assessment and treatment of spatial neglect (SN). The objective was to describe knowledge and practices in the assessment of SN in current clinical practice across different healthcare sectors and professions. Data included the perceived prevalence, assessment methods and observations, subtypes and differential diagnostics of SN. A total of 525 professionals participated in the survey. The vast majority (81.5%) reported that assessment of SN was provided by their workplace. The median of perceived prevalence of SN was 35% (IQR 22-51) but major differences were found between professions. Occupational therapists and psychologists appeared to be most involved in assessment, whilst nursing staff and speech therapists were least involved. Subjective observations were the most common assessment method (90%). Conversely, systematic ADL observations, paper-and-pencil tests, confrontational tests and computerized tests were less common. The survey revealed large differences in the assessment methods and awareness of various aspects of SN symptoms (subtypes and differential diagnostics) between different healthcare professions. The results emphasize the need for international multidisciplinary clinical guidelines on how to assess SN and distinguish between different subtypes and differential diagnoses.
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Affiliation(s)
- Lars Evald
- Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark
| | - Inge Wilms
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Maria Nordfang
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Evald L, Wilms IL, Nordfang M. Treatment of spatial neglect in clinical practice: A nationwide survey. Acta Neurol Scand 2020; 141:81-89. [PMID: 31602640 DOI: 10.1111/ane.13179] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/25/2019] [Accepted: 10/03/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Clinical research has documented a range of evidence-based treatment approaches for spatial neglect (SN), but there is a lack of research on the implementation of treatment into clinical practice. The purpose of this study is to describe the current clinical practice of SN treatment across healthcare sectors including involved professions, methods, timing and sources of evidence. MATERIAL AND METHODS This is the second part of a nationwide, anonymous, open Internet survey that was conducted among healthcare professionals in Denmark on assessment and treatment of SN. RESULTS A total of 525 healthcare professionals participated in the survey of which 411 (78.3%) reported that SN treatment was provided at their workplace. Occupational and physiotherapist were most often involved in the treatment, most commonly characterized by training of activities of daily living (ADL), sensoric stimulation and cueing. Less frequently reported were evidence-based methods such as prism adaptation and visual scanning. The overall intensity of the SN treatment varied considerably across sectors and might consequently be inadequate. A minority of the participants consulted clinical research evidence in their choice of SN treatment approaches. CONCLUSIONS There is a profound lack of dissemination and translation of clinical research into current clinical practice, which unarguably leads to an underuse of evidence-based treatment approaches in SN rehabilitation. The results call for international multidisciplinary clinical guidelines for the treatment of SN at different stages of rehabilitation and the tailoring of treatment approaches to the individual patient.
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Affiliation(s)
- Lars Evald
- Hammel Neurorehabilitation Centre and University Research Clinic Hammel Denmark
| | - Inge Linda Wilms
- Department of Psychology University of Copenhagen Copenhagen Denmark
| | - Maria Nordfang
- Department of Neurology Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
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Liu KPY, Hanly J, Fahey P, Fong SSM, Bye R. A Systematic Review and Meta-Analysis of Rehabilitative Interventions for Unilateral Spatial Neglect and Hemianopia Poststroke From 2006 Through 2016. Arch Phys Med Rehabil 2018; 100:956-979. [PMID: 31030733 DOI: 10.1016/j.apmr.2018.05.037] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 05/14/2018] [Accepted: 05/30/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of activity-based, nonactivity-based, and combined activity- and nonactivity-based rehabilitative interventions for individuals presenting with unilateral spatial neglect (USN) and hemianopia. DATA SOURCES We searched CINAHL, Cochrane Library, EMBASE, MEDLINE, and PubMed from 2006 to 2016. STUDY SELECTION Randomized controlled trials (RCTs) with a score of 6 or more in the Physiotherapy Evidence Database Scale that examined the effects of activity-based and nonactivity-based rehabilitation interventions for people with USN or hemianopia. Two reviewers selected studies independently. DATA EXTRACTION Extracted data from the published RCTs. Mean differences (MD) or standardized mean differences (SMD), and 95% confidence intervals (CIs) were calculated. Heterogeneity was assessed using the I2 statistic. DATA SYNTHESIS A total of 20 RCTs for USN and 5 for hemianopia, involving 594 and 206 stroke participants respectively, were identified. Encouraging results were found in relation to activity-based interventions for visual scanning training and compensatory training for hemianopia (MD=5.11; 95% confidence intervals [95% CI], 0.83-9.4; P=.019; I2=25.16% on visual outcomes), and optokinetic stimulation and smooth pursuit training for USN (SMD=0.49; 95% CI, 0.01-0.97; P=.045; I2=49.35%) on functional performance in activities of daily living, (SMD=0.96; 95% CI, 0.09-1.82; P=.031; I2=89.57%) on neglect. CONCLUSIONS Activity-based interventions are effective and commonly used in the treatment of USN and hemianopia. Nonactivity-based and combined approaches, for both impairments, have not been refuted, because more studies are required for substantiated conclusions to be drawn.
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Affiliation(s)
- Karen P Y Liu
- School of Science and Health, Western Sydney University, Penrith, Australia; Translational Health Research Institute, Western Sydney University, Penrith, Australia.
| | - Jessica Hanly
- School of Science and Health, Western Sydney University, Penrith, Australia
| | - Paul Fahey
- School of Science and Health, Western Sydney University, Penrith, Australia; Translational Health Research Institute, Western Sydney University, Penrith, Australia
| | - Shirley S M Fong
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Rosalind Bye
- School of Science and Health, Western Sydney University, Penrith, Australia
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10
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Bjartmarz I, Jónsdóttir H, Hafsteinsdóttir TB. Implementation and feasibility of the stroke nursing guideline in the care of patients with stroke: a mixed methods study. BMC Nurs 2017; 16:72. [PMID: 29213212 PMCID: PMC5709925 DOI: 10.1186/s12912-017-0262-y] [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: 03/20/2017] [Accepted: 11/10/2017] [Indexed: 11/14/2022] Open
Abstract
Background Nurses often have difficulties with using interdisciplinary stroke guidelines for patients with stroke as they do not focus sufficiently on nursing. Therefore, the Stroke Nursing Guideline (SNG) was developed and implemented. The aim of this study was to determine the implementation and feasibility of the SNG in terms of changes in documentation and use of the guideline in the care of stroke patients on Neurological and Rehabilitation wards, barriers and facilitators, and nurses’ and auxiliary nurses’ view of the implementation. Methods A sequential explorative mixed method design was used including pre-test post-test measures and post intervention focus groups interviews. For the quantitative part retrospective electronic record data of nursing care was collected from 78 patients and prospective measures with Barriers and Facilitators Assessment Instrument (BFAI) and Quality Indicator Tool (QIT) from 33 nursing staff including nurses and auxiliary nurses. In the qualitative part focus groups interviews were conducted with nursing staff on usefulness of the SNG and experiences with implementation. Results Improved nursing documentation was found for 23 items (N = 37), which was significant for nine items focusing mobility (p = 0.002, p = 0.024, p = 0.012), pain (p = 0.012), patient teaching (p = 0.001, p = 0.000) and discharge planning (p = 0.000, p = 0.002, p = 0.004). Improved guideline use was found for 20 QIT-items (N = 30), with significant improvement on six items focusing on mobility (p = 0.023), depression (p = 0.033, p = 0.025, p = 0.046, p = 0.046), discharge planning (p = 0.012). Facilitating characteristics for change were significantly less for two of four BFAI-subscales, namely Innovation (p = 0.019) and Context (p = 0.001), whereas no change was found for Professional and Patient subscales. The findings of the focus group interviews showed the SNG to be useful, improving and providing consistency in care. The implementation process was found to be successful as essential components of nursing rehabilitation were defined and integrated into daily care. Conclusion Nursing staff found the SNG feasible and implementation successful. The SNG improved nursing care, with increased consistency and more rigorous functional exercises than before. The SNG provides nurses and auxiliary nurses with an important means for evidence based care for patients with stroke. Several challenges of implementing this complex nursing intervention surfaced which mandates ongoing attention. Electronic supplementary material The online version of this article (10.1186/s12912-017-0262-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ingibjörg Bjartmarz
- Clinical Nurse Specialist, Department of Rehabilitation, Landspítali University Hospital, Reykjavík, Iceland
| | - Helga Jónsdóttir
- Faculty of Nursing, University of Iceland, Reykjavík, Iceland.,Nursing Care for Chronically Ill Adults, Landspítali University Hospital, Reykjavík, Iceland
| | - Thóra B Hafsteinsdóttir
- Faculty of Nursing, University of Iceland, Reykjavík, Iceland.,Julius Center for Health Sciences and Primary Care, Nursing Science Department, University Medical Center Utrecht, Utrecht, The Netherlands
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11
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Jonsdottir JI, Jonsdottir H, Klinke ME. A systematic review of characteristics of couple-based intervention studies addressing sexuality following cancer. J Adv Nurs 2017; 74:760-773. [DOI: 10.1111/jan.13470] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2017] [Indexed: 01/18/2023]
Affiliation(s)
- Jona Ingibjorg Jonsdottir
- Faculty of Nursing; School of Health Sciences; University of Iceland; Reykjavik Iceland
- Landspitali - The National University Hospital of Iceland; Reykjavik Iceland
| | - Helga Jonsdottir
- Faculty of Nursing; School of Health Sciences; University of Iceland; Reykjavik Iceland
- Landspitali - The National University Hospital of Iceland; Reykjavik Iceland
| | - Marianne E. Klinke
- Faculty of Nursing; School of Health Sciences; University of Iceland; Reykjavik Iceland
- Landspitali - The National University Hospital of Iceland; Reykjavik Iceland
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12
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Klinke ME, Hjaltason H, Tryggvadóttir GB, Jónsdóttir H. Hemispatial neglect following right hemisphere stroke: clinical course and sensitivity of diagnostic tasks. Top Stroke Rehabil 2017; 25:120-130. [DOI: 10.1080/10749357.2017.1394632] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Marianne E. Klinke
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Neurological Department, Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
| | - Haukur Hjaltason
- Neurological Department, Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | | | - Helga Jónsdóttir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland
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13
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Chen P, Pitteri M, Gillen G, Ayyala H. Ask the experts how to treat individuals with spatial neglect: a survey study. Disabil Rehabil 2017; 40:2677-2691. [DOI: 10.1080/09638288.2017.1347720] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Peii Chen
- Stroke Rehabilitation Research, Kessler Foundation, West Orange, NJ, USA
- Department of Physical Medicine and Rehabilitation, Rutgers University, Newark, NJ, USA
| | - Marco Pitteri
- Department of Neurosciences Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Glen Gillen
- Department of Regenerative and Rehabilitation Medicine (Occupational Therapy), Columbia University Medical Center, New York, NY, USA
| | - Harsha Ayyala
- New Jersey Medical School, Rutgers University, Newark, NJ, USA
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Fu W, Cao L, Zhang Y, Huo S, Du J, Zhu L, Song W. Continuous theta-burst stimulation may improve visuospatial neglect via modulating the attention network: a randomized controlled study. Top Stroke Rehabil 2017; 24:236-241. [PMID: 28107807 DOI: 10.1080/10749357.2016.1253139] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Wei Fu
- Department of Rehabilitation, Xuanwu Hospital Capital Medical University, Beijing, P.R. China
| | - Lei Cao
- Department of Rehabilitation, Xuanwu Hospital Capital Medical University, Beijing, P.R. China
| | - Yanming Zhang
- Department of Rehabilitation, Xuanwu Hospital Capital Medical University, Beijing, P.R. China
| | - Su Huo
- Department of Rehabilitation, Xuanwu Hospital Capital Medical University, Beijing, P.R. China
| | - JuBao Du
- Department of Rehabilitation, Xuanwu Hospital Capital Medical University, Beijing, P.R. China
| | - Lin Zhu
- Department of Rehabilitation, Xuanwu Hospital Capital Medical University, Beijing, P.R. China
| | - Weiqun Song
- Department of Rehabilitation, Xuanwu Hospital Capital Medical University, Beijing, P.R. China
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15
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Vloothuis JDM, Mulder M, Veerbeek JM, Konijnenbelt M, Visser‐Meily JMA, Ket JCF, Kwakkel G, van Wegen EEH. Caregiver-mediated exercises for improving outcomes after stroke. Cochrane Database Syst Rev 2016; 12:CD011058. [PMID: 28002636 PMCID: PMC6463929 DOI: 10.1002/14651858.cd011058.pub2] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Stroke is a major cause of long-term disability in adults. Several systematic reviews have shown that a higher intensity of training can lead to better functional outcomes after stroke. Currently, the resources in inpatient settings are not always sufficient and innovative methods are necessary to meet these recommendations without increasing healthcare costs. A resource efficient method to augment intensity of training could be to involve caregivers in exercise training. A caregiver-mediated exercise programme has the potential to improve outcomes in terms of body function, activities, and participation in people with stroke. In addition, caregivers are more actively involved in the rehabilitation process, which may increase feelings of empowerment with reduced levels of caregiver burden and could facilitate the transition from rehabilitation facility (in hospital, rehabilitation centre, or nursing home) to home setting. As a consequence, length of stay might be reduced and early supported discharge could be enhanced. OBJECTIVES To determine if caregiver-mediated exercises (CME) improve functional ability and health-related quality of life in people with stroke, and to determine the effect on caregiver burden. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (October 2015), CENTRAL (the Cochrane Library, 2015, Issue 10), MEDLINE (1946 to October 2015), Embase (1980 to December 2015), CINAHL (1982 to December 2015), SPORTDiscus (1985 to December 2015), three additional databases (two in October 2015, one in December 2015), and six additional trial registers (October 2015). We also screened reference lists of relevant publications and contacted authors in the field. SELECTION CRITERIA Randomised controlled trials comparing CME to usual care, no intervention, or another intervention as long as it was not caregiver-mediated, aimed at improving motor function in people who have had a stroke. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials. One review author extracted data, and assessed quality and risk of bias, and a second review author cross-checked these data and assessed quality. We determined the quality of the evidence using GRADE. The small number of included studies limited the pre-planned analyses. MAIN RESULTS We included nine trials about CME, of which six trials with 333 patient-caregiver couples were included in the meta-analysis. The small number of studies, participants, and a variety of outcome measures rendered summarising and combining of data in meta-analysis difficult. In addition, in some studies, CME was the only intervention (CME-core), whereas in other studies, caregivers provided another, existing intervention, such as constraint-induced movement therapy. For trials in the latter category, it was difficult to separate the effects of CME from the effects of the other intervention.We found no significant effect of CME on basic ADL when pooling all trial data post intervention (4 studies; standardised mean difference (SMD) 0.21, 95% confidence interval (CI) -0.02 to 0.44; P = 0.07; moderate-quality evidence) or at follow-up (2 studies; mean difference (MD) 2.69, 95% CI -8.18 to 13.55; P = 0.63; low-quality evidence). In addition, we found no significant effects of CME on extended ADL at post intervention (two studies; SMD 0.07, 95% CI -0.21 to 0.35; P = 0.64; low-quality evidence) or at follow-up (2 studies; SMD 0.11, 95% CI -0.17 to 0.39; P = 0.45; low-quality evidence).Caregiver burden did not increase at the end of the intervention (2 studies; SMD -0.04, 95% CI -0.45 to 0.37; P = 0.86; moderate-quality evidence) or at follow-up (1 study; MD 0.60, 95% CI -0.71 to 1.91; P = 0.37; very low-quality evidence).At the end of intervention, CME significantly improved the secondary outcomes of standing balance (3 studies; SMD 0.53, 95% CI 0.19 to 0.87; P = 0.002; low-quality evidence) and quality of life (1 study; physical functioning: MD 12.40, 95% CI 1.67 to 23.13; P = 0.02; mobility: MD 18.20, 95% CI 7.54 to 28.86; P = 0.0008; general recovery: MD 15.10, 95% CI 8.44 to 21.76; P < 0.00001; very low-quality evidence). At follow-up, we found a significant effect in favour of CME for Six-Minute Walking Test distance (1 study; MD 109.50 m, 95% CI 17.12 to 201.88; P = 0.02; very low-quality evidence). We also found a significant effect in favour of the control group at the end of intervention, regarding performance time on the Wolf Motor Function test (2 studies; MD -1.72, 95% CI -2.23 to -1.21; P < 0.00001; low-quality evidence). We found no significant effects for the other secondary outcomes (i.e. PATIENT motor impairment, upper limb function, mood, fatigue, length of stay and adverse events; caregiver: mood and quality of life).In contrast to the primary analysis, sensitivity analysis of CME-core showed a significant effect of CME on basic ADL post intervention (2 studies; MD 9.45, 95% CI 2.11 to 16.78; P = 0.01; moderate-quality evidence).The methodological quality of the included trials and variability in interventions (e.g. content, timing, and duration), affected the validity and generalisability of these observed results. AUTHORS' CONCLUSIONS There is very low- to moderate-quality evidence that CME may be a valuable intervention to augment the pallet of therapeutic options for stroke rehabilitation. Included studies were small, heterogeneous, and some trials had an unclear or high risk of bias. Future high-quality research should determine whether CME interventions are (cost-)effective.
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Affiliation(s)
- Judith DM Vloothuis
- Amsterdam Rehabilitation Research Centre, ReadeDepartment of NeurorehabilitationOvertoom 283PO Box 58271AmsterdamNetherlands1054 HW
| | - Marijn Mulder
- VU University Medical CenterDepartment of Rehabilitation Medicine, MOVE Research Institute AmsterdamAmsterdamNetherlands
| | - Janne M Veerbeek
- VU University Medical CenterDepartment of Rehabilitation Medicine, MOVE Research Institute AmsterdamAmsterdamNetherlands
- VU University Medical CenterDepartment of Rehabilitation Medicine, Physical TherapyDe Boelelaan 1118AmsterdamNoor‐HollandNetherlands1007 MB
| | - Manin Konijnenbelt
- Amsterdam Rehabilitation Research Centre, ReadeDepartment of NeurorehabilitationOvertoom 283PO Box 58271AmsterdamNetherlands1054 HW
| | - Johanna MA Visser‐Meily
- University Medical Center Utrecht and De HoogstraatBrain Center Rudolf MagnusHeidelberglaan 100PO Box 85500UtrechtNetherlands3508 GA
| | - Johannes CF Ket
- Vrije Universiteit AmsterdamMedical LibraryDe Boelelaan 1117AmsterdamNetherlands1081 HV
| | - Gert Kwakkel
- VU University Medical CenterDepartment of Rehabilitation Medicine, MOVE Research Institute Amsterdam, Amsterdam NeurosciencesDe Boelelaan 1118AmsterdamNetherlands1007 MB
| | - Erwin EH van Wegen
- Amsterdam Neurosciences, VU University Medical CenterDepartment of Rehabilitation Medicine, MOVE Research Institute AmsterdamPO Box 7057AmsterdamNetherlands1007 MB
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Klinke ME, Hjaltason H, Hafsteinsdóttir TB, Jónsdóttir H. Spatial neglect in stroke patients after discharge from rehabilitation to own home: a mixed method study. Disabil Rehabil 2016; 38:2429-44. [DOI: 10.3109/09638288.2015.1130176] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Marianne E. Klinke
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Neurological Department, Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
| | - Haukur Hjaltason
- Neurological Department, Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Thóra B. Hafsteinsdóttir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Department of Rehabilitation, Nursing Science and Sport, Rudolf Magnus Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Helga Jónsdóttir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland
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