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Rikhof CJH, Feenstra Y, Fleuren JFM, Buurke JH, Prinsen EC, Rietman JS, Prange-Lasonder GB. Robot-assisted support combined with electrical stimulation for the lower extremity in stroke patients: a systematic review. J Neural Eng 2024; 21:021001. [PMID: 38527367 DOI: 10.1088/1741-2552/ad377c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 03/25/2024] [Indexed: 03/27/2024]
Abstract
Objective. The incidence of stroke rising, leading to an increased demand for rehabilitation services. Literature has consistently shown that early and intensive rehabilitation is beneficial for stroke patients. Robot-assisted devices have been extensively studied in this context, as they have the potential to increase the frequency of therapy sessions and thereby the intensity. Robot-assisted systems can be combined with electrical stimulation (ES) to further enhance muscle activation and patient compliance. The objective of this study was to review the effectiveness of ES combined with all types of robot-assisted technology for lower extremity rehabilitation in stroke patients.Approach. A thorough search of peer-reviewed articles was conducted. The quality of the included studies was assessed using a modified version of the Downs and Black checklist. Relevant information regarding the interventions, devices, study populations, and more was extracted from the selected articles.Main results. A total of 26 articles were included in the review, with 23 of them scoring at least fair on the methodological quality. The analyzed devices could be categorized into two main groups: cycling combined with ES and robots combined with ES. Overall, all the studies demonstrated improvements in body function and structure, as well as activity level, as per the International Classification of Functioning, Disability, and Health model. Half of the studies in this review showed superiority of training with the combination of robot and ES over robot training alone or over conventional treatment.Significance. The combination of robot-assisted technology with ES is gaining increasing interest in stroke rehabilitation. However, the studies identified in this review present challenges in terms of comparability due to variations in outcome measures and intervention protocols. Future research should focus on actively involving and engaging patients in executing movements and strive for standardization in outcome values and intervention protocols.
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Affiliation(s)
- C J H Rikhof
- Roessingh Research and Development, Roessinghsbleekweg 33b, Enschede 7522AH, The Netherlands
- Biomechanical Engineering, University of Twente, Drienerlolaan 5, Enschede 7522NB, The Netherlands
| | - Y Feenstra
- Roessingh Centre of Rehabilitation, Roessinghsbleekweg 33, Enschede 7522AH, The Netherlands
| | - J F M Fleuren
- Roessingh Research and Development, Roessinghsbleekweg 33b, Enschede 7522AH, The Netherlands
- Roessingh Centre of Rehabilitation, Roessinghsbleekweg 33, Enschede 7522AH, The Netherlands
| | - J H Buurke
- Roessingh Research and Development, Roessinghsbleekweg 33b, Enschede 7522AH, The Netherlands
- Biomedical Signals and systems, University of Twente, Drienerlolaan 5, Enschede 7522NB, The Netherlands
| | - E C Prinsen
- Roessingh Research and Development, Roessinghsbleekweg 33b, Enschede 7522AH, The Netherlands
- Biomechanical Engineering, University of Twente, Drienerlolaan 5, Enschede 7522NB, The Netherlands
| | - J S Rietman
- Roessingh Research and Development, Roessinghsbleekweg 33b, Enschede 7522AH, The Netherlands
- Biomechanical Engineering, University of Twente, Drienerlolaan 5, Enschede 7522NB, The Netherlands
- Roessingh Centre of Rehabilitation, Roessinghsbleekweg 33, Enschede 7522AH, The Netherlands
| | - G B Prange-Lasonder
- Roessingh Research and Development, Roessinghsbleekweg 33b, Enschede 7522AH, The Netherlands
- Biomechanical Engineering, University of Twente, Drienerlolaan 5, Enschede 7522NB, The Netherlands
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Kim S, Jang S, Lee O. Single fiber curvature for muscle impairment assessment: Phase contrast imaging of stroke-induced animals. Microsc Res Tech 2024; 87:705-715. [PMID: 37983687 DOI: 10.1002/jemt.24459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 10/15/2023] [Accepted: 11/05/2023] [Indexed: 11/22/2023]
Abstract
There are technical challenges in imaging studies that can three-dimensionally (3D) analyze a single fiber (SF) to observe the functionality of the entire muscle after stroke. This study proposes a 3D assessment technique that only segments the SF of the right stroke-induced soleus muscle of a gerbil using synchrotron radiation x-ray microcomputed tomography (SR-μCT), which is capable of muscle structure analysis. Curvature damage in the SF of the left soleus muscle (impaired) progressed at 7-day intervals after the stroke in the control; particularly on the 7 days (1 week) and 14 days (2 weeks), as observed through visualization analysis. At 2 weeks, the SF volume was significantly reduced in the control impaired group (p = .033), and was significantly less than that in the non-impaired group (p = .009). We expect that animal post-stroke studies will improve the basic field of rehabilitation therapy by diagnosing the degree of SF curvature. RESEARCH HIGHLIGHTS: Muscle evaluation after ischemic stroke using synchrotron radiation x-ray microcomputed tomography (SR-μCT). Curvature is measured by segmenting a single fiber (SF) in the muscle. Structural changes in the SF of impaired gerbils at 7-day intervals were assessed.
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Affiliation(s)
- Subok Kim
- Department of Software Convergence, Graduate School, Soonchunhyang University, Asan, Republic of Korea
| | - Sanghun Jang
- Department of Physical Therapy, College of Health and Life Sciences, Korea National University of Transportation, Jeungpyeong-gun, Republic of Korea
| | - Onseok Lee
- Department of Software Convergence, Graduate School, Soonchunhyang University, Asan, Republic of Korea
- Department of Medical IT Engineering, College of Medical Sciences, Soonchunhyang University, Asan, Republic of Korea
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Wei X, Sun S, Zhang M, Zhao Z. A systematic review and meta-analysis of clinical efficacy of early and late rehabilitation interventions for ischemic stroke. BMC Neurol 2024; 24:91. [PMID: 38459477 PMCID: PMC10921695 DOI: 10.1186/s12883-024-03565-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 02/12/2024] [Indexed: 03/10/2024] Open
Abstract
INTRODUCTION At present, stroke has become the first cause of death and disability among Chinese adults. With the coming of the aging population in China, the disease burden brought by stroke will be increasingly aggravated. And stroke is a leading cause of disability. There is a golden plastic period after stroke, during which timely and safe intervention and rehabilitation therapy can effectively improve the disability status. However, there is still controversy about the duration of interventional rehabilitation after stroke. This study conducted a meta-analysis on the influence of intervention in early and late ischemic stroke rehabilitation. METHOD Chinese language databases such as CNKI, Wanfang, and VIP, and English language databases such as Embase, PubMed, Web of Science, and The Cochrane Library were searched, and RCT related to early and late rehabilitation of ischemic stroke from the establishment of the database to October 2023 was collected. Review Manager 5.4.1 was used for relevant analysis. The main outcomes were Barthel Index or Modified Barthel Index, Fugl-Meyer Assessment scale, NIHSS, China Stroke Scale. Standardized Mean Difference (SMD) was used as an effective indicator of continuity variables, and the estimated interval was expressed by 95% confidence interval (CI). RESULTS A total of 1908 patients were included in 16 studies. The results showed that, compared with late rehabilitation, early rehabilitation improved clinical efficacy. Barthel Index or Modified Barthel Index score was [SMD = 1.40, 95%CI(1.16,1.63), p < 0.001]; the score of Fugl-Meyer Assessment Scale was [SMD = 1.18, 95%Cl (0.85, 1.52), P < 0.001]; the score of NIHSS was [SMD= -0.44, 95% CI(-0.65, -0.24), P < 0.001]; the result of China Stroke Scale score was [SMD= -0.37, 95%CI(-0.56, -0.18), P < 0.001]. CONCLUSION In comparison with late rehabilitation, early rehabilitation can significantly improve self-care abilities, daily activities, and neurological functions of ischemic stroke patients. TRIAL REGISTRATION This meta-analysis has been registered with Prospero, and the registration number is CRD42022309911. The registration period is March 22, 2022.
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Affiliation(s)
- Xufang Wei
- Hainan Medical University International School of Public Health and One Health, Haikou, Hainan, China
| | - Shengtong Sun
- Hainan Medical University International School of Public Health and One Health, Haikou, Hainan, China
| | - Manyu Zhang
- Department of Neurology, First Affiliated Hospital, Hainan Medical University, Haikou, Hainan, China
| | - Zhenqiang Zhao
- Department of Neurology, First Affiliated Hospital, Hainan Medical University, Haikou, Hainan, China.
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Vaquero-Rodríguez A, Ortuzar N, Lafuente JV, Bengoetxea H. Enriched environment as a nonpharmacological neuroprotective strategy. Exp Biol Med (Maywood) 2023; 248:553-560. [PMID: 37309729 PMCID: PMC10350798 DOI: 10.1177/15353702231171915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Abstract
The structure and functions of the central nervous system are influenced by environmental stimuli, which also play an important role in brain diseases. Enriched environment (EE) consists of producing modifications in the environment of standard laboratory animals to induce an improvement in their biological conditions. This paradigm promotes transcriptional and translational effects that result in ameliorated motor, sensory, and cognitive stimulation. EE has been shown to enhance experience-dependent cellular plasticity and cognitive performance in animals housed under these conditions compared with animals housed under standard conditions. In addition, several studies claim that EE induces nerve repair by restoring functional activities through morphological, cellular, and molecular adaptations in the brain that have clinical relevance in neurological and psychiatric disorders. In fact, the effects of EE have been studied in different animal models of psychiatric and neurological diseases, such as Alzheimer's disease, Parkinson's disease, schizophrenia, ischemic brain injury, or traumatic brain injury, delaying the onset and progression of a wide variety of symptoms of these disorders. In this review, we analyze the action of EE focused on diseases of the central nervous system and the translation to humans to develop a bridge to its application.
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Affiliation(s)
- Andrea Vaquero-Rodríguez
- Department of Neurosciences, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), 48940 Leioa, Spain
- Neurodegenerative Diseases Group, Biocruces Bizkaia Health Research Institute, 48903 Barakaldo, Spain
| | - Naiara Ortuzar
- Department of Neurosciences, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), 48940 Leioa, Spain
- Neurodegenerative Diseases Group, Biocruces Bizkaia Health Research Institute, 48903 Barakaldo, Spain
| | - José Vicente Lafuente
- Department of Neurosciences, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), 48940 Leioa, Spain
- Neurodegenerative Diseases Group, Biocruces Bizkaia Health Research Institute, 48903 Barakaldo, Spain
| | - Harkaitz Bengoetxea
- Department of Neurosciences, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), 48940 Leioa, Spain
- Neurodegenerative Diseases Group, Biocruces Bizkaia Health Research Institute, 48903 Barakaldo, Spain
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Muacevic A, Adler JR. Effect of Late-Onset Stroke Rehabilitation on Medical Morbidities and Functional Recovery: A Single-Center Observational Study. Cureus 2022; 14:e33002. [PMID: 36712731 PMCID: PMC9879282 DOI: 10.7759/cureus.33002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2022] [Indexed: 12/28/2022] Open
Abstract
Background The concept of focused rehabilitative care and a dedicated rehabilitation setup is fairly less known among the people of developing countries. The main objective of the study is to assess the effect of late-onset stroke rehabilitation on its overall prognosis and to see whether and how the late initiation of rehabilitation would pose a significant effect on functional recovery and adverse medical outcomes Methods A single-center, prospective observational study was conducted in a tertiary rehabilitation center for a duration of one and a half years. The subjects admitted to the Department of Physical Medicine and Rehabilitation were divided into three groups with respect to the onset to admission interval (OAI). Patients who got admitted within 30 days (OAI≤ 30 days) were considered the early rehabilitation group. OAI between 31 and 150 days was the late rehabilitation group and OAI of 151 days or more was the very late rehabilitation group. Barthel Index (BI), Modified Rankin Score (MRS), and 6-minute walk test (6MWT) were used as functional outcome measures at admission and discharge from indoors. Results Maximum complications were observed in the late rehabilitation group, i.e. 2.75±2.74, with an overall mean of 2.02±2.04 (p=0.003). Functional recovery assessed using BI shows a significant difference between the early (35.79±8.86) and late (40.62±10.5) rehabilitation groups (p= 0.0005). 6MWT at discharge showed significant improvement in the early rehabilitation group (p=0.005). Conclusion Early onset of rehabilitation showed better functional recovery and fewer adverse medical outcomes in stroke patients. A longer length of hospital stay (LOHS), with a mean duration of 88 ±2 days was needed for patients with higher OAIs.
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Shao Y, Yang Y, Sun YX, Xu AH. Different frequencies of repetitive transcranial magnetic stimulation combined with local injection of botulinum toxin type A for post-stroke lower limb spasticity: study protocol for a prospective, single-center, non-randomized, controlled clinical trial. Neural Regen Res 2022; 17:2491-2496. [PMID: 35535901 PMCID: PMC9120707 DOI: 10.4103/1673-5374.339011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
No definite consensus has currently been reached regarding the safety and efficacy of low- or high-frequency repetitive transcranial magnetic stimulation in the treatment of post-stroke muscle spasticity. The latest research indicates that when combined with local injections of botulinum toxin type A, it is more effective on post-stroke muscle spasticity than local injections of botulinum toxin type A alone. We designed a prospective, single-center, non-randomized, controlled clinical trial to investigate the safety and efficacy of different frequencies of repetitive transcranial magnetic stimulation combined with local injections of botulinum toxin type A in treating post-stroke lower limb muscle spasticity to determine an optimal therapeutic regimen. This trial will enroll 150 patients with post-stroke muscle spasticity admitted to the Department of Rehabilitation Medicine at the First Affiliated Hospital of China Medical University. All enrolled patients will undergo routine rehabilitation training and will be divided into five groups (n = 30 per group) according to the particular area of cerebral infarction and treatment methods. Group A: Patients with massive cerebral infarction will be given local injections of botulinum toxin type A and low-frequency (1 Hz) repetitive transcranial magnetic stimulation on the contralateral side; Group B: Patients with non-massive cerebral infarction will be given local injections of botulinum toxin type A and high-frequency (10–20 Hz) repetitive transcranial magnetic stimulation on the affected side; Group C: Patients with massive/non-massive cerebral infarction will be given local injections of botulinum toxin type A; Group D: Patients with massive cerebral infarction will be given low-frequency (1 Hz) repetitive transcranial magnetic stimulation on the contralateral side; and Group E: Patients with non-massive cerebral infarction will be given high-frequency (10–20 Hz) repetitive transcranial magnetic stimulation on the affected side. The primary outcome measure of this trial is a modified Ashworth scale score from 1 day before treatment to 12 months after treatment. Secondary outcome measures include Fugl-Meyer Assessment of Lower Extremity, Visual Analogue Scale, modified Barthel index, and Berg Balance Scale scores for the same time as specified for primary outcome measures. The safety indicator is the incidence of adverse events at 3–12 months after treatment. We hope to draw a definite conclusion on whether there are differences in the safety and efficacy of low- or high-frequency repetitive transcranial magnetic stimulation combined with botulinum toxin type A injections in the treatment of patients with post-stroke lower limb spasticity under strict grouping and standardized operation, thereby screening out the optimal therapeutic regimen. The study protocol was approved by the Medical Ethics Committee of the First Affiliated Hospital of China Medical University (approval No. [2021] 2021-333-3) on August 19, 2021. The trial was registered with the Chinese Clinical Trial Registry (Registration No. ChiCTR2100052180) on October 21, 2021. The protocol version is 1.1.
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Affiliation(s)
- Yang Shao
- Department of Rehabilitation Medicine, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Yang Yang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Yong-Xin Sun
- Department of Rehabilitation Medicine, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Ai-Hua Xu
- Department of Rehabilitation Medicine, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
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Response to the letter to the editor by Yun Liao. J Stroke Cerebrovasc Dis 2022; 31:106745. [PMID: 36117078 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Liao Y. Letter to the editor regarding "endovascular thrombectomy reduces risk of poor functional outcomes in patients presenting within 0-6 hours with large ischemic core volumes on computed tomography perfusion". J Stroke Cerebrovasc Dis 2022; 31:106743. [PMID: 36055951 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 08/20/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Yun Liao
- Department of Radiology, Hechi People's Hospital, Guangxi Zhuang Autonomous Region, Guangxi, China..
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Cindy J H R, Prange-Lasonder GB, Prinsen EC, Buurke JH, Rietman JS. Detection thresholds for electrostimulation combined with robotic leg support in sub-acute stroke patients. IEEE Int Conf Rehabil Robot 2022; 2022:1-5. [PMID: 36176097 DOI: 10.1109/icorr55369.2022.9896576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Stroke is one of the leading causes of disability in adults in the European Union. It often leads to motor impairments, such as a hemiparetic lower extremity. Research indicates that early task-specific and intensive training promotes neuroplasticity and leads to recovery and/or compensation. One way to provide intensive training early after a stroke is via robot-supported training. A rehabilitation robot was designed by Life Science Robotics (Aalborg, Denmark) that can provide continuous repetitive movements of the hip, knee, and/or ankle in e.g., a lying position. In order to emphasize active contribution by the patient, actively triggered electrical stimulation (via muscle activation) can be combined with robotic assistance. The current study aims to compare different threshold estimation methods for detection of movement intention from muscle activity for actively triggered electrical stimulation during robot-supported leg movement in stroke patients. Three sub-acute stroke patients were included for a single measurement session. They performed knee extension and/or ankle dorsal flexion with four different threshold estimation methods to assess the intention detection threshold to initiate electrostimulation. The thresholds were based on the resting level of muscle activity (of m. rectus femoris or m. tibialis anterior) plus two or three times the standard deviation of the average resting value, or the resting level plus 5% or 10% of the peak muscle activity during a maximal voluntary contraction. The results showed that the method based on the resting muscle activity plus two times the standard deviation was the most stable across the three included stroke patients. This method had a detection success rate of 86.7% and was experienced as moderately comfortable. In conclusion, performing knee extension and/or ankle dorsal flexion with electromyography triggered electrostimulation is feasible in sub-acute stroke patients. Muscle activity-triggered electrostimulation combined with robotic support based on a threshold of resting levels plus two times the standard deviation seems to detect movement initiation most consistently in this small sample of sub-acute stroke patients.
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Lin H, Liu H, Dai Y, Yin X, Li Z, Yang L, Tao J, Liu W, Chen L. Effect of Physical Activity on Cognitive Impairment in Patients With Cerebrovascular Diseases: A Systematic Review and Meta-Analysis. Front Neurol 2022; 13:854158. [PMID: 35599737 PMCID: PMC9120585 DOI: 10.3389/fneur.2022.854158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose This study investigates the effect of physical activity (PA) on cognition in patients with cerebrovascular disease and explored the maximum benefit of different PA characteristics. Methods Databases, such as Pubmed, Web of Science, Embase, and Cochrane Library, were searched from their inception to May 31, 2021. Standardized mean difference (SMD) and 95% confidence intervals (CIs) were calculated to generate a forest plot. In addition, subgroup analysis, moderation analysis, and regression analysis were performed to explore the possible adjustment factors. Results In total, 22 studies that met the criteria were included, demonstrating data from 1,601 participants. The results indicated that PA produced a positive effect on the global cognition for patients with cerebrovascular disease (SMD: 0.20 [95% CI: 0.12-0.27]), at the same time, PA training prominently improved executive function (SMD: 0.09 [95% CI: 0.00-0.17]) and working memory (SMD: 0.25 [95% CI: 0.10-0.40]). Furthermore, patients with baseline cognitive impairment received the greater benefit of PA on cognition (SMD: 0.24 [95% CI: 0.14-0.34]) than those without cognitive impairment before intervention (SMD: 0.15 [95% CI: 0.04-0.26]). For patients in the acute stage (≤ 3 months), PA did not rescue impairment dysfunction significantly (SMD: 0.08 [95% CI: -0.04-0.21]) and remarkable cognitive gains were detected in the chronic stage of participants (>3 months) (SMD: 0.25 [95% CI: 0.16-0.35]). Moderate intensity PA showed a larger pooled effect size (SMD: 0.23 [95% CI: 0.11-0.36]) than low intensity (SMD: -0.01 [95% CI: -0.44-0.43]) and high intensity (SMD: 0.16 [95% CI: 0.03-0.29]). However, the different types, duration, and frequency of PA resulted in no differences in the improvement of cognitive function. Further regression analysis demonstrated that the beneficial effects of PA on cognition are negatively correlated with age (p < 0.05). Conclusions This study revealed that PA can prominently improve the cognitive ability in patients with cerebrovascular diseases and strengthened the evidence that PA held promise as a widely accessible and effective non-drug therapy for vascular cognitive impairment (VCI).
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Affiliation(s)
- Huawei Lin
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - HuanHuan Liu
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Yaling Dai
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Xiaolong Yin
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Zuanfang Li
- National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Lei Yang
- National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Jing Tao
- The Academy of Rehabilitation Industry, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Weilin Liu
- The Academy of Rehabilitation Industry, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Lidian Chen
- The Academy of Rehabilitation Industry, Fujian University of Traditional Chinese Medicine, Fuzhou, China
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Braakhuis HEM, Berger MAM, Regterschot RGRH, van Wegen EEH, Selles RW, Ribbers GM, Bussmann JBJ. Physical activity dimensions after stroke: patterns and relation with lower limb motor function. J Neuroeng Rehabil 2021; 18:171. [PMID: 34895265 PMCID: PMC8666008 DOI: 10.1186/s12984-021-00960-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 11/19/2021] [Indexed: 11/17/2022] Open
Abstract
Background Stroke survivors show deteriorated physical functioning and physical activity levels. Physical activity levels of stroke survivors are generally low. It is increasingly recognized that physical activity is a multidimensional construct that cannot be captured in a single outcome. In-depth insight into multidimensional physical activity patterns may guide the development and timing of targeted rehabilitation interventions. This longitudinal cohort study explored how multidimensional physical activity outcomes develop during recovery in the subacute phase after stroke and if changes in physical activity were correlated to recovery of lower limb motor function. Methods Patients were recruited during inpatient rehabilitation. At 3, 12, and 26 weeks post-onset, motor function was measured by the Fugl-Meyer Lower Extremity Assessment (FMA-LE). Physical activity was measured with the Activ8 accelerometer in multiple outcomes: counts per minute during walking (CPMwalking; a measure of Intensity), number of active bouts (Frequency), mean length of active bouts (Distribution) and % of waking time in upright positions (Duration). Generalized estimating equations (GEE) were used to study changes in physical activity over time and the relation with the change in lower limb motor recovery. Results Thirty-nine patients (age 56 ± 9, 77% male, 89% ischemic stroke) were included. GEE models showed a significant main effect of time for PA Intensity (+ 13%, p = 0.007) and Duration (+ 64%, p = 0.012) between 3 and 12 weeks. Motor function did not show a significant effect in all PA models across the 3 timepoints (p > 0.020). A significant interaction effect of time × motor function was observed (p < 0.001). Conclusions Patterns of PA recovery depend on the PA dimensions: PA Intensity and Duration increased mostly between 3 and 12 weeks post-stroke, whereas Frequency and Distribution did not show substantial changes. Further, no strong associations with motor recovery and high inter-individual variability were documented, which underlies the need to consider factors specific to the disease, the individual patient and the context.
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Affiliation(s)
- Hanneke E M Braakhuis
- Department of Rehabilitation Medicine and Physical Therapy, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands. .,Rijndam Rehabilitation, Rotterdam, The Netherlands. .,Faculty of Health, Nutrition and Sport, The Hague University of Applied Sciences, The Hague, The Netherlands.
| | - Monique A M Berger
- Faculty of Health, Nutrition and Sport, The Hague University of Applied Sciences, The Hague, The Netherlands
| | - Ruben G R H Regterschot
- Department of Rehabilitation Medicine and Physical Therapy, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Biomedical Signals and Systems, University of Twente, Enschede, The Netherlands
| | - Erwin E H van Wegen
- Department of Rehabilitation Medicine, Amsterdam Neuroscience and Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ruud W Selles
- Department of Rehabilitation Medicine and Physical Therapy, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Plastic and Reconstructive Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Gerard M Ribbers
- Department of Rehabilitation Medicine and Physical Therapy, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Rijndam Rehabilitation, Rotterdam, The Netherlands
| | - Johannes B J Bussmann
- Department of Rehabilitation Medicine and Physical Therapy, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Rijndam Rehabilitation, Rotterdam, The Netherlands
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Peruzzi M, Sanasi E, Pingitore A, Marullo AG, Carnevale R, Sciarretta S, Sciarra L, Frati G, Cavarretta E. An overview of cycling as active transportation and as benefit for health. Minerva Cardioangiol 2021; 68:81-97. [PMID: 32429627 DOI: 10.23736/s0026-4725.20.05182-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Active transportation is defined as travelling on foot, by bicycle or other non-motorized means, sometimes in combination with other forms of public transportation, in contrast with the use of motor vehicles. The prevalence of sedentary lifestyle and physical inactivity is a growing epidemic in most developed countries that spread over the last three decades; active transportation may be a promising approach to increase physical activity and reduce the risk of non-communicable diseases improving cardiorespiratory fitness and cardiometabolic health. The health benefits of physical activity in reducing mortality and morbidity have been proved by several publications. Cardiorespiratory fitness can be improved by regular physical activity with an amelioration of insulin sensitivity, blood lipid profile, body composition, inflammation, and blood pressure. Active transportation as a daily physical activity is less expensive compared to motor vehicle use. The advantages are remarkable in terms of contrasting obesity and sedentary lifestyle, decrease motor traffic congestion and mitigate climate change. Massive investments in policies and interventions aimed to increase active transportation are not generally promoted and there are differences in the prevalence of active transportation in the daily routine among different areas. As in the literature several studies as randomized trials or observational studies have been published, with different end-points, in order to investigate if active commuting may be the right answer to improve cardiorespiratory fitness and cardiometabolic health, we aimed to review the available evidences of cycling as an active transportation and to consider its benefits on health.
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Affiliation(s)
| | - Elena Sanasi
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
| | | | - Antonino G Marullo
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
| | - Roberto Carnevale
- Mediterranea Cardiocentro, Naples, Italy.,Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
| | - Sebastiano Sciarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy.,Department of Angio-Cardio-Neurology, IRCCS NeuroMed, Pozzilli, Isernia, Italy
| | - Luigi Sciarra
- Division of Cardiology, Policlinico Casilino, Rome, Italy
| | - Giacomo Frati
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy.,Department of Angio-Cardio-Neurology, IRCCS NeuroMed, Pozzilli, Isernia, Italy
| | - Elena Cavarretta
- Mediterranea Cardiocentro, Naples, Italy - .,Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
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13
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Dalton EJ, Churilov L, Lannin NA, Corbett D, Campbell BCV, Hayward KS. Early-phase dose articulation trials are underutilized for post-stroke motor recovery: A systematic scoping review. Ann Phys Rehabil Med 2021; 65:101487. [PMID: 33429089 DOI: 10.1016/j.rehab.2021.101487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 11/27/2020] [Accepted: 11/30/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND To enable development of effective interventions, there is a need to complete systematic early-phase dose articulation research. This scoping review aimed to synthesize dose articulation research of behavioral motor interventions for stroke recovery. METHODS MEDLINE and EMBASE were systematically searched for dose articulation studies. Preclinical experiments and adult clinical trials were classified based on the discovery pipeline and analyzed to determine which dose dimensions were articulated (time, scheduling or intensity) and how they were investigated (unidimensional vs multidimensional approach). Reporting of dose, safety and efficacy outcomes were summarized. The intervention description, risk of bias, and quality was appraised. RESULTS We included 41 studies: 3 of preclinical dose preparation (93 rodents), 2 Phase I dose ranging (21 participants), 9 Phase IIA dose screening (198 participants), and 27 Phase IIB dose finding (1879 participants). All studies adopted a unidimensional approach. Time was the most frequent dimension investigated (53%), followed by intensity (29%), and scheduling (18%). Overall, 95% studies reported an efficacy outcome; however, only 65% reported dose and 45% reported safety. Across studies, 61% were at high risk of bias, and the average percentage reporting of intervention description and quality was 61% and 67%, respectively. CONCLUSION This review highlights a need to undertake more high-quality, early-phase studies that systematically articulate intervention doses from a multidimensional perspective in the field of behavioral motor stroke recovery. To address this gap, we need to invest in adapting early phase trial designs, especially Phase I, to support multidimensional dose articulation.
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Affiliation(s)
- Emily J Dalton
- Melbourne School of Health Sciences, University of Melbourne, Heidelberg, Australia
| | - Leonid Churilov
- Melbourne Medical School, University of Melbourne, Parkville, Australia
| | - Natasha A Lannin
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Australia; Alfred Health, Melbourne, Australia
| | - Dale Corbett
- Cellular & Molecular Medicine and Canadian Partnership for Stroke Recovery, University of Ottawa, Canada
| | - Bruce C V Campbell
- Department of Medicine and Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Kathryn S Hayward
- Melbourne School of Health Sciences and Florey Institute of Neuroscience and Mental Health, University of Melbourne, 245 Burgundy Street, 3084 Heidelberg, Australia.
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14
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Joy MT, Carmichael ST. Encouraging an excitable brain state: mechanisms of brain repair in stroke. Nat Rev Neurosci 2021; 22:38-53. [PMID: 33184469 PMCID: PMC10625167 DOI: 10.1038/s41583-020-00396-7] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2020] [Indexed: 02/02/2023]
Abstract
Stroke induces a plastic state in the brain. This period of enhanced plasticity leads to the sprouting of new axons, the formation of new synapses and the remapping of sensory-motor functions, and is associated with motor recovery. This is a remarkable process in the adult brain, which is normally constrained in its levels of neuronal plasticity and connectional change. Recent evidence indicates that these changes are driven by molecular systems that underlie learning and memory, such as changes in cellular excitability during memory formation. This Review examines circuit changes after stroke, the shared mechanisms between memory formation and brain repair, the changes in neuronal excitability that underlie stroke recovery, and the molecular and pharmacological interventions that follow from these findings to promote motor recovery in animal models. From these findings, a framework emerges for understanding recovery after stroke, central to which is the concept of neuronal allocation to damaged circuits. The translation of the concepts discussed here to recovery in humans is underway in clinical trials for stroke recovery drugs.
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Affiliation(s)
- Mary T Joy
- Department of Neurology, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - S Thomas Carmichael
- Department of Neurology, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
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15
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Ward NS, Carmichael ST. Blowing up Neural Repair for Stroke Recovery: Preclinical and Clinical Trial Considerations. Stroke 2020; 51:3169-3173. [PMID: 32951539 DOI: 10.1161/strokeaha.120.030486] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The repair and recovery of the brain after stroke is a field that is emerging in its preclinical science and clinical trials. However, recent large, multicenter clinical trials have been negative, and conflicting results emerge on biological targets in preclinical studies. The coalescence of negative clinical translation and confusion in preclinical studies raises the suggestion that perhaps the field of stroke recovery faces a fate similar to stroke neuroprotection, with interesting science ultimately proving difficult to translate to the clinic. This review highlights improvements in 4 areas of the stroke neural repair field that should reorient the field toward successful clinical translation: improvements in rodent genetic models of stroke recovery, consideration of the biological target in stroke recovery, stratification in clinical trials, and the use of appropriate clinical trial end points.
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Affiliation(s)
- Nick S Ward
- Department of Clinical and Motor Neuroscience, UCL Queen Square Institute of Neurology, London (N.S.W.)
| | - S Thomas Carmichael
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA (S.T.C.)
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