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Blázquez-González P, Mirón-González R, Lendínez-Mesa A, Luengo-González R, Mancebo-Salas N, Camacho-Arroyo MT, Muriel-García A, García-Sastre MM. Efficacy of the use of video games on mood, anxiety and depression in stroke patients: preliminary findings of a randomised controlled trial. J Neurol 2024; 271:1224-1234. [PMID: 38197947 PMCID: PMC10896939 DOI: 10.1007/s00415-023-12043-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/29/2023] [Accepted: 09/30/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND In the different published studies, there is no consensus on the efficacy of virtual reality as an adjuvant treatment of mood states. AIM The aim of this study is to evaluate the impact of no immersive virtual reality with the Nintendo Switch device in rehabilitation treatment on mood, anxiety and depression in stroke patients admitted to neurorehabilitation units. METHODS Fifty-eight patients admitted to neurorehabilitation units underwent a 1:3 multicentre randomised clinical trial. The intervention group consisted of 17 patients and the control group of 41 patients. The intervention group performed 6 virtual reality sessions together with the conventional treatment, and the control group performed only the conventional rehabilitation sessions. Primary and secondary clinical outcomes were measured before and six weeks after the intervention. RESULTS Comparing the intervention group and control group, the anxiety levels of the intervention group decreased compared to the results observed in the control group (p = 0.01), as did the dependence of the intervention group (0.015). On the other hand, the results obtained after the intervention by the control group for anxiety (0.479) and depression (0.292) were not statistically significant. CONCLUSION Rehabilitation VR used as an adjuvant treatment to conventional treatment has a beneficial impact on the neurological status and state of anxiety of stroke patients admitted to neurorehabilitation units. TRIAL REGISTRATION Registered in the https://clinicaltrials.gov/ repository (NTC NCT05143385). Protocol registration date 7 October 2021, retrospectively registered.
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Affiliation(s)
- Patricia Blázquez-González
- Department of Nursing, Red Cross University, Madrid, Spain
- Biomechanics and Bioengineering Applied to Health, Doctoral School, University of Alcalá, Madrid, Spain
- Group for Research in Community Care and Social Determinants of Health, University of Alcalá, Madrid, Spain
| | - Rubén Mirón-González
- Group for Research in Community Care and Social Determinants of Health, University of Alcalá, Madrid, Spain
- Nursing and Physiotherapy Department, University of Alcalá, Madrid, Spain
| | - Alejandro Lendínez-Mesa
- Departamento de EnfermeríaServicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Raquel Luengo-González
- Group for Research in Community Care and Social Determinants of Health, University of Alcalá, Madrid, Spain.
- Nursing and Physiotherapy Department, University of Alcalá, Madrid, Spain.
- Group for Research in Nursing Care, Gregorio Marañón Health Research Institute (IiSGM), Madrid, Spain.
| | - Noelia Mancebo-Salas
- General Directorate of Social Services With the Ministry of Family, Youth and Social Policy of the, Community of Madrid, Madrid, Spain
| | | | - Alfonso Muriel-García
- Group for Research in Community Care and Social Determinants of Health, University of Alcalá, Madrid, Spain
- Nursing and Physiotherapy Department, University of Alcalá, Madrid, Spain
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS), CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - María Montserrat García-Sastre
- Group for Research in Community Care and Social Determinants of Health, University of Alcalá, Madrid, Spain
- Nursing and Physiotherapy Department, University of Alcalá, Madrid, Spain
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Colomer C, Llorens R, Sánchez C, Ugart P, Moliner B, Navarro MD, Noé E, Ferri J. Reliability and validity of the Spanish adaptation of the Functional Independence Measure + Functional Assessment Measure. Eur J Phys Rehabil Med 2023; 59:452-457. [PMID: 37226445 PMCID: PMC10548398 DOI: 10.23736/s1973-9087.23.07841-3] [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: 12/22/2022] [Revised: 04/05/2023] [Accepted: 05/09/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND The Functional Independence Measure + Functional Assessment Measure (FIM+FAM) Scale is one of the most widely used instruments to measure functional independence post-stroke, and features many cultural adaptations to various languages. AIM The aim of this study was to determine the psychometric properties of a Spanish cross-cultural adaptation of the FIM+FAM for use in the stroke population. DESIGN Observational study. SETTING Outpatient long-term service of a neurorehabilitation unit. POPULATION One hundred and twenty-two individuals with stroke. METHODS The functional independence of the participants was assessed with the adapted version of the FIM+FAM. Additionally, the functional, motor and cognitive condition of the participants was assessed with a battery of standardized clinical instruments. Finally, a group of 31 participants out of the total were evaluated a second time with the FIM+FAM by a different evaluator than the one who performed the first evaluation. Internal consistency, inter-rater reliability and convergent validity with other clinical instruments of the adapted version of the FIM+FAM were determined. RESULTS The internal consistency of the adapted version of the FIM+FAM was excellent, as evidenced by Cronbach's α values that exceeded 0.973. The inter-rater reliability was likewise excellent, with correlations above 0.990 in all domains and subscales. Additionally, the convergent validity of the scale adaptation with clinical instruments was variable, with values ranging from 0.264 to 0.983, but consistent with the construct assessed in the different instruments examined. CONCLUSIONS The internal consistency, inter-rater reliability and convergent validity of the Spanish-adapted version of the FIM+FAM Scale showed excellent reliability and validity of the adaptation, which supports its use to assess functional independence after stroke. CLINICAL REHABILITATION IMPACT Availability of a valid adaptation for the evaluation of functional independence after stroke in Spanish population.
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Affiliation(s)
- Carolina Colomer
- Instituto de Rehabilitación Neurológica (IRENEA), Fundación Vithas, Valencia, Spain -
| | - Roberto Llorens
- Instituto de Rehabilitación Neurológica (IRENEA), Fundación Vithas, Valencia, Spain
- Neurorehabilitation and Brain Research Group, Instituto Universitario de Investigación en Tecnología Centrada en el Ser Humano, Universitat Politècnica de València, Valencia, Spain
| | - Clara Sánchez
- Instituto de Rehabilitación Neurológica (IRENEA), Fundación Vithas, Valencia, Spain
| | - Patricia Ugart
- Instituto de Rehabilitación Neurológica (IRENEA), Fundación Vithas, Valencia, Spain
| | - Belén Moliner
- Instituto de Rehabilitación Neurológica (IRENEA), Fundación Vithas, Valencia, Spain
| | - María D Navarro
- Instituto de Rehabilitación Neurológica (IRENEA), Fundación Vithas, Valencia, Spain
| | - Enrique Noé
- Instituto de Rehabilitación Neurológica (IRENEA), Fundación Vithas, Valencia, Spain
| | - Joan Ferri
- Instituto de Rehabilitación Neurológica (IRENEA), Fundación Vithas, Valencia, Spain
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Garay-Sánchez A, Marcén-Román Y, Ferrando-Margelí M, Franco-Sierra MÁ, Suarez-Serrano C. Effect of Physiotherapy Treatment with Immersive Virtual Reality in Subjects with Stroke: A Protocol for a Randomized Controlled Trial. Healthcare (Basel) 2023; 11:healthcare11091335. [PMID: 37174877 PMCID: PMC10177902 DOI: 10.3390/healthcare11091335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/30/2023] [Accepted: 05/02/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Many stroke survivors suffer from sensorimotor deficits, especially balance impairments. The purpose of this trial is to investigate whether the designed Immersive Virtual Reality training program is better in the short term (15 sessions) and in the medium term (30 sessions) than physiotherapy training with Bayouk, Boucher and Leroux exercises, with respect to static balance in sitting and standing, dynamic balance and quality of life in patients with balance impairment in stroke survivors. METHODS This study is a randomized controlled trial with two treatment arms and evaluators blinded, and a functionality treatment group in combination with specific balance exercise training according to Bayouk, Boucher and Leroux (control group) or a balanced treatment using Immersive VR. The primary outcome will be static, Dynamic balance and gait measured by Bestest Assessment Score (BESTest), Berg Scale (BBS), Pass Scale (PASS) and Time Up and Go test (TUG). The secondary outcome will be the stroke-associated quality of life using the Stroke Quality of Life Scale (ECVI-38). CONCLUSIONS The results of this study may add new insights into how to address balance using Immersive Virtual Reality after a stroke. If the new training approach proves effective, the results may provide insight into how to design more comprehensive protocols in the future for people with balance impairments after stroke.
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Affiliation(s)
- Aitor Garay-Sánchez
- Institute for Health Research Aragón, 50009 Zaragoza, Spain
- Miguel Servet University Hospital, 50009 Zaragoza, Spain
| | - Yolanda Marcén-Román
- Institute for Health Research Aragón, 50009 Zaragoza, Spain
- Department of Human Anatomy and Histology, Faculty of Medicine, University of Zaragoza, 50009 Zaragoza, Spain
| | - Mercedes Ferrando-Margelí
- Institute for Health Research Aragón, 50009 Zaragoza, Spain
- Miguel Servet University Hospital, 50009 Zaragoza, Spain
- Department of Human Anatomy and Histology, Faculty of Medicine, University of Zaragoza, 50009 Zaragoza, Spain
| | - M Ángeles Franco-Sierra
- Institute for Health Research Aragón, 50009 Zaragoza, Spain
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Health Sciences, University of Zaragoza, 50009 Zaragoza, Spain
| | - Carmen Suarez-Serrano
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41009 Seville, Spain
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Martín-Dorta WJ, García-Hernández AM, Delgado-Hernández J, Sainz-Fregel E, Miranda-Martín RC, Suárez-Pérez A, Jiménez-Álvarez A, Martín-Felipe E, Brito-Brito PR. Psychometric Testing of the CEECCA Questionnaire to Assess Ability to Communicate among Individuals with Aphasia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3935. [PMID: 36900945 PMCID: PMC10001674 DOI: 10.3390/ijerph20053935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/19/2023] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
(1) Background: The CEECCA questionnaire assesses the ability to communicate among individuals with aphasia. It was designed using the NANDA-I and NOC standardised nursing languages (SNLs), reaching high content validity index and representativeness index values. The questionnaire was pilot-tested, demonstrating its feasibility for use by nurses in any healthcare setting. This study aims to identify the psychometric properties of this instrument. (2) Methods: 47 individuals with aphasia were recruited from primary and specialist care facilities. The instrument was tested for construct validity and criterion validity, reliability, internal consistency, and responsiveness. The NANDA-I and NOC SNLs and the Boston test were used for criterion validity testing. (3) Results: five language dimensions explained 78.6% of the total variance. Convergent criterion validity tests showed concordances of up to 94% (Cohen's κ: 0.9; p < 0.001) using the Boston test, concordances of up to 81% using DCs of NANDA-I diagnoses (Cohen's κ: 0.6; p < 0.001), and concordances of up to 96% (Cohen's κ: 0.9; p < 0.001) using NOC indicators. The internal consistency (Cronbach's alpha) was 0.98. Reliability tests revealed test-retest concordances of 76-100% (p < 0.001). (4) Conclusions: the CEECCA is an easy-to-use, valid, and reliable instrument to assess the ability to communicate among individuals with aphasia.
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Affiliation(s)
| | | | | | - Estela Sainz-Fregel
- Primary Care Management of Tenerife, The Canary Islands Health Service, 38400 Puerto de la Cruz, Spain
| | | | - Alejandra Suárez-Pérez
- Rehabilitation Department, University Hospital of the Canary Islands, The Canary Islands Health Service, 38320 San Cristóbal de La Laguna, Spain
| | - Alejandra Jiménez-Álvarez
- Rehabilitation Department, University Hospital of the Canary Islands, The Canary Islands Health Service, 38320 San Cristóbal de La Laguna, Spain
| | - Elena Martín-Felipe
- Neurology Department, Nuestra Señora de la Candelaria University Hospital, The Canary Islands Health Service, 38010 Santa Cruz de Tenerife, Spain
| | - Pedro-Ruymán Brito-Brito
- Training and Research in Care, Primary Care Management Board of Tenerife, The Canary Islands Health Service, Department of Nursing, University of La Laguna, 38200 San Cristóbal de La Laguna, Spain
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Kim JM, Yang SN. Diagnosis of Post-Stroke Aphasia: A Review of Language Tests in Korea. BRAIN & NEUROREHABILITATION 2022; 15:e18. [PMID: 36743197 PMCID: PMC9833477 DOI: 10.12786/bn.2022.15.e18] [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: 06/17/2022] [Revised: 07/15/2022] [Accepted: 07/18/2022] [Indexed: 11/08/2022] Open
Abstract
Aphasia is one of the most serious cognitive impairments in stroke patients. An accurate diagnosis of aphasia is important for early interventions that optimize patients' functional status. Therefore, we present a review of the aphasia assessment tools currently available in Korea. Aphasia is usually evaluated using a standardized comprehensive assessment battery to establish the diagnosis of aphasia, its severity, and the treatment plan. Before a comprehensive language test, a brief screening test for aphasia can be useful to identify whether any further assessment is necessary. Several standardized evaluation tools are readily available in Korea. The Paradise-Korean version of the Western Aphasia Battery (PK-WAB) is a commonly used comprehensive aphasia test for determining the presence, type, and severity of aphasia. The Korean version of the Boston Naming Test (K-BNT) is an in-depth test to evaluate naming ability. Several screening tests, such as the Korean version of the Frenchay Aphasia Screening Test (K-FAST), the Screening Test for Aphasia and Neurologic Communication Disorders (STAND), and Semantic Verbal Fluency (SVF), can be applied to identify patients at risk in terms of language performance. Depending on the outcome of these tests, patients can be referred for further evaluation.
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Affiliation(s)
- Jeong Min Kim
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Seung Nam Yang
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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Martín-Dorta WJ, Brito-Brito PR, García-Hernández AM. Development and Content Validation of the CEECCA Questionnaire to Assess Ability to Communicate among Individuals with Aphasia Based on the NANDA-I and NOC. Healthcare (Basel) 2021; 9:1459. [PMID: 34828504 PMCID: PMC8619169 DOI: 10.3390/healthcare9111459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/18/2021] [Accepted: 10/26/2021] [Indexed: 11/24/2022] Open
Abstract
This study presents the development and content validation of an instrument assessing the ability to communicate among individuals with aphasia. The study consists of three stages: (i) Selection and definition of the component dimensions and areas, construction of items assessing these dimensions, administration instructions, and qualitative criteria for assigning diagnoses; (ii) Face validity and content validity; (iii) Pilot test. The tentative questionnaire was designed using two defining characteristics of the NANDA-I ("Impaired verbal communication" and "Readiness for enhanced communication") and the NOC outcome indicators "Communication", "Communication: Expressive", "Communication: Receptive", and "Information Processing". The areas and items reached initial content validity index (CVI) and representativeness index (RI) values of 0.87 and above. Those that did not reach the expected values were modified after expert review. The resulting questionnaire was pilot-tested for feasibility and administration times. An instrument containing five dimensions, fourteen areas, and 43 items was obtained and administered in 15 (12-31) minutes. A panel of experts evaluated the final questionnaire (CEECCA), awarding its areas and items CVI and RI values of 0.90 and above. In the absence of further psychometric studies, the questionnaire appears to be useful for assessing ability to communicate in individuals with aphasia.
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Affiliation(s)
- Willian-Jesús Martín-Dorta
- Primary Care Management of Tenerife, The Canary Islands Health Service, 38003 Santa Cruz de Tenerife, Spain
| | - Pedro-Ruymán Brito-Brito
- Training and Research in Care, Primary Care Management of Tenerife, The Canary Islands Health Service, 38204 Santa Cruz de Tenerife, Spain;
- Department of Nursing, University of La Laguna, 38200 Santa Cruz de Tenerife, Spain
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Llorens R, Fuentes MA, Borrego A, Latorre J, Alcañiz M, Colomer C, Noé E. Effectiveness of a combined transcranial direct current stimulation and virtual reality-based intervention on upper limb function in chronic individuals post-stroke with persistent severe hemiparesis: a randomized controlled trial. J Neuroeng Rehabil 2021; 18:108. [PMID: 34210347 PMCID: PMC8252292 DOI: 10.1186/s12984-021-00896-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 06/09/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Functional impairments derived from the non-use of severely affected upper limb after stroke have been proposed to be mitigated by action observation and imagination-based techniques, whose effectiveness is enhanced when combined with transcranial direct current stimulation (tDCS). Preliminary studies in mildly impaired individuals in the acute phase post-stroke show intensified effects when action is facilitated by tDCS and mediated by virtual reality (VR) but the effectiveness in cases of severe impairment and chronic stroke is unknown. This study investigated the effectiveness of a combined tDCS and VR-based intervention in the sensorimotor function of chronic individuals post-stroke with persistent severe hemiparesis compared to conventional physical therapy. METHODS Twenty-nine participants were randomized into an experimental group, who received 30 minutes of the combined tDCS and VR-based therapy and 30 minutes of conventional physical therapy, or a control group, who exclusively received conventional physical therapy focusing on passive and active assistive range of motion exercises. The sensorimotor function of all participants was assessed before and after 25 one-hour sessions, administered three to five times a week, using the upper extremity subscale of the Fugl-Meyer Assessment, the time and ability subscales of the Wolf Motor Function Test, and the Nottingham Sensory Assessment. RESULTS A clinically meaningful improvement of the upper limb motor function was consistently revealed in all motor measures after the experimental intervention, but not after conventional physical therapy. Similar limited effects were detected in the sensory function in both groups. CONCLUSION The combined tDCS and VR-based paradigm provided not only greater but also clinically meaningful improvement in the motor function (and similar sensory effects) in comparison to conventional physical therapy.
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Affiliation(s)
- Roberto Llorens
- Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Camino de Vera s/n, 46011, Valencia, Spain.
- NEURORHB. Servicio de Neurorrehabilitación de Hospitales Vithas, Fundación Hospitales Vithas, Callosa d'En Sarrià 12, 46007, València, Spain.
| | - María Antonia Fuentes
- NEURORHB. Servicio de Neurorrehabilitación de Hospitales Vithas, Fundación Hospitales Vithas, Callosa d'En Sarrià 12, 46007, València, Spain
| | - Adrián Borrego
- Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Camino de Vera s/n, 46011, Valencia, Spain
| | - Jorge Latorre
- Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Camino de Vera s/n, 46011, Valencia, Spain
- NEURORHB. Servicio de Neurorrehabilitación de Hospitales Vithas, Fundación Hospitales Vithas, Callosa d'En Sarrià 12, 46007, València, Spain
| | - Mariano Alcañiz
- Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Camino de Vera s/n, 46011, Valencia, Spain
| | - Carolina Colomer
- NEURORHB. Servicio de Neurorrehabilitación de Hospitales Vithas, Fundación Hospitales Vithas, Callosa d'En Sarrià 12, 46007, València, Spain
| | - Enrique Noé
- NEURORHB. Servicio de Neurorrehabilitación de Hospitales Vithas, Fundación Hospitales Vithas, Callosa d'En Sarrià 12, 46007, València, Spain
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Mollà-Casanova S, Llorens R, Borrego A, Salinas-Martínez B, Serra-Añó P. Validity, reliability, and sensitivity to motor impairment severity of a multi-touch app designed to assess hand mobility, coordination, and function after stroke. J Neuroeng Rehabil 2021; 18:70. [PMID: 33892763 PMCID: PMC8066975 DOI: 10.1186/s12984-021-00865-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 04/14/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The assessment of upper-limb motor impairments after stroke is usually performed using clinical scales and tests, which may lack accuracy and specificity and be biased. Although some instruments exist that are capable of evaluating hand functions and grasping during functional tasks, hand mobility and dexterity are generally either not specifically considered during clinical assessments or these examinations lack accuracy. This study aimed to determine the convergent validity, reliability, and sensitivity to impairment severity after a stroke of a dedicated, multi-touch app, named the Hand Assessment Test. METHODS The hand mobility, coordination, and function of 88 individuals with stroke were assessed using the app, and their upper-limb functions were assessed using the Fugl-Meyer Assessment for Upper Extremity, the Jebsen-Taylor Hand Function Test, the Box and Block Test, and the Nine Hole Peg Test. Twenty-three participants were further considered to investigate inter- and intra-rater reliability, standard error of measurement, and the minimal detectable change threshold of the app. Finally, participants were categorized according to motor impairment severity and the sensitivity of the app relative to these classifications was investigated. RESULTS Significant correlations, of variable strengths, were found between the measurements performed by the app and the clinical scales and tests. Variable reliability, ranging from moderate to excellent, was found for all app measurements. Exercises that involved tapping and maximum finger-pincer grasp were sensitive to motor impairment severity. CONCLUSIONS The convergent validity, reliability, and sensitivity to motor impairment severity of the app, especially of those exercises that involved tapping and the maximum extension of the fingers, together with the widespread availability of the app, could support the use of this and similar apps to complement conventional clinical assessments of hand function after stroke.
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Affiliation(s)
| | - Roberto Llorens
- Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Valencia, Spain.
- NEURORHB. Servicio de Neurorrehabilitación de Hospitales Vithas, Fundación Vithas, Valencia, Spain.
- Neurorehabilitation and Brain Research Group, i3B Institute, Universitat Politècnica de València, Ciudad Politécnica de la Innovación, Building 8B, Access M, Floor 0. Camino de Vera s/n, 46022, Valencia, Spain.
| | - Adrián Borrego
- Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Valencia, Spain
| | | | - Pilar Serra-Añó
- UBIC, Departament de Fisioteràpia, Universitat de València, Valencia, Spain
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Paplikar A, Iyer GK, Varghese F, Alladi S, Pauranik A, Mekala S, Kaul S, Sharma M, Dhaliwal RS, Saroja AO, Dharamkar S, Dutt A, Divyaraj G, Ghosh A, Kandukuri R, Mathew R, Menon R, Narayanan J, Nehra A, Padma MV, Ramakrishnan S, Ravi SK, Shah U, Tripathi M, Sylaja PN, Varma RP. A Screening Tool to Detect Stroke Aphasia: Adaptation of Frenchay Aphasia Screening Test (FAST) to the Indian Context. Ann Indian Acad Neurol 2020; 23:S143-S148. [PMID: 33343139 PMCID: PMC7731676 DOI: 10.4103/aian.aian_499_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 05/23/2020] [Indexed: 12/01/2022] Open
Abstract
Background: Aphasia is a common consequence of stroke. To optimize recovery, it becomes critical as there are early identification and treatment of language deficits. The rising burden of stroke aphasia and lack of screening tools in the Indian context necessitates the need for a screening tool. Objective: We aimed to adapt and validate the Frenchay Aphasia Screening Test (FAST) to the Indian context in two widely spoken Indian languages, Telugu and Kannada, for the literate and illiterate population. Methods: A systematic process of adaptation and culturally appropriate modifications of the original FAST were done in 116 healthy controls and 115 patients. The validity of the adapted test was established. Results: The optimum cut-off values for detecting aphasia in our sample ranged from 25 to 25.5 (literate) and 13.5 to 15.5 (illiterate) with high sensitivity and specificity. There was also a significant correlation between aphasia scores for adapted FAST and the Western Aphasia Battery (WAB), establishing good convergent validity. Discussion: Results of the adaptation and validation of two Indian versions of FAST, suggest that it is an easy-to-use screening measure for detecting stroke-related language disabilities. The psychometric properties of the Indian version of FAST met the standardised requirements for adaptation and validation. Conclusions: The Indian version of FAST was found to be a reliable and valid bedside screening tool for aphasia in stroke patients. We aim that this study will facilitate the use of the test across other Indian languages and a large clinical population in the future.
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Affiliation(s)
- Avanthi Paplikar
- National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Gowri K Iyer
- Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.,Indian Institute of Public Health, Hyderabad, Telangana, India
| | - Feba Varghese
- National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Suvarna Alladi
- National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.,Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | | | - Shailaja Mekala
- Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Subhash Kaul
- Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.,Krishna Institute of Medical Sciences, Hyderabad, Telangana, India
| | | | - R S Dhaliwal
- Indian Council of Medical Research, New Delhi, India
| | | | | | - Aparna Dutt
- Duttanagar Mental Health Centre, Duttanagar, Kolkata,West Bengal, India
| | | | | | | | | | - Ramshekhar Menon
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | | | - Ashima Nehra
- All India Institute of Medical Sciences, Delhi, India
| | - M V Padma
- All India Institute of Medical Sciences, Delhi, India
| | | | - Sunil Kumar Ravi
- Shravana Institute of Speech and Hearing, Bellary, Karnataka, India
| | | | | | - P N Sylaja
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Ravi Prasad Varma
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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Navarro MD, Llorens R, Borrego A, Alcañiz M, Noé E, Ferri J. Competition Enhances the Effectiveness and Motivation of Attention Rehabilitation After Stroke. A Randomized Controlled Trial. Front Hum Neurosci 2020; 14:575403. [PMID: 33192404 PMCID: PMC7556305 DOI: 10.3389/fnhum.2020.575403] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/24/2020] [Indexed: 12/04/2022] Open
Abstract
Attention deficits are among the most common cognitive impairments observed after experiencing stroke. However, a very limited number of studies have investigated the effectiveness of interventions that specifically focus on the rehabilitation of attention deficits among subjects with impaired attention. Although several interventions have included the use of computerized programs to provide dynamic stimuli, real-time performance feedback, and motivating tasks, existing studies have not exploited the potential benefits of multi-user interactions. Group-based and competitive interventions have been reported to be more enjoyable and motivating, depending on individual traits, and may potentially be more demanding, which may increase their effectiveness. This study investigated the effectiveness and motivating abilities of an intervention specifically designed to address attention deficits. This intervention combined paper-and-pencil tasks and interactive, computerized, multi-touch exercises, which were administered, either non-competitively or competitively, to a group of 43 individuals with chronic stroke. The mediating effects of competitiveness were evaluated for both intervention effectiveness and motivation. Participants were randomly sorted into two groups and underwent 20 one-hour group-based sessions, during which they either worked individually or competed with peers, according to their group allocation. Participants were assessed before and after the intervention, using the Conners' Continuous Performance Test, the d2 Test of Attention, the Color Trail Test, the Digit Span Test, and the Spatial Span Test. The competitiveness and subjective experiences of the participants after the intervention were investigated with the Revised Competitiveness Index and the Intrinsic Motivation Inventory, respectively. The results showed that participants who competed demonstrated significantly greater improvements in all cognitive abilities, except for divided attention, and reported greater enjoyment than their non-competitive peers. Both groups reported comparable levels of perceived competence, pressure, and usefulness. Interestingly, the competitiveness of the participants did not alter either the effectiveness or the subjective experience of the intervention. These findings suggest that competition might enhance the effectiveness and enjoyment of rehabilitation interventions designed to address attention deficits in individuals post-stroke, regardless of their level of competitiveness and without having a negative effect on their perceived pressure and competence.
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Affiliation(s)
- María Dolores Navarro
- NEURORHB, Servicio de Neurorrehabilitación de Hospitales Vithas, Fundación Vithas, València, Spain
| | - Roberto Llorens
- NEURORHB, Servicio de Neurorrehabilitación de Hospitales Vithas, Fundación Vithas, València, Spain.,Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, València, Spain
| | - Adrián Borrego
- Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, València, Spain
| | - Mariano Alcañiz
- Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, València, Spain
| | - Enrique Noé
- NEURORHB, Servicio de Neurorrehabilitación de Hospitales Vithas, Fundación Vithas, València, Spain
| | - Joan Ferri
- NEURORHB, Servicio de Neurorrehabilitación de Hospitales Vithas, Fundación Vithas, València, Spain
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11
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Maza A, Moliner B, Ferri J, Llorens R. Visual Behavior, Pupil Dilation, and Ability to Identify Emotions From Facial Expressions After Stroke. Front Neurol 2020; 10:1415. [PMID: 32116988 PMCID: PMC7016192 DOI: 10.3389/fneur.2019.01415] [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: 07/12/2019] [Accepted: 12/27/2019] [Indexed: 11/16/2022] Open
Abstract
Social cognition is the innate human ability to interpret the emotional state of others from contextual verbal and non-verbal information, and to self-regulate accordingly. Facial expressions are one of the most relevant sources of non-verbal communication, and their interpretation has been extensively investigated in the literature, using both behavioral and physiological measures, such as those derived from visual activity and visual responses. The decoding of facial expressions of emotion is performed by conscious and unconscious cognitive processes that involve a complex brain network that can be damaged after cerebrovascular accidents. A diminished ability to identify facial expressions of emotion has been reported after stroke, which has traditionally been attributed to impaired emotional processing. While this can be true, an alteration in visual behavior after brain injury could also negatively contribute to this ability. This study investigated the accuracy, distribution of responses, visual behavior, and pupil dilation of individuals with stroke while identifying emotional facial expressions. Our results corroborated impaired performance after stroke and exhibited decreased attention to the eyes, evidenced by a diminished time and number of fixations made in this area in comparison to healthy subjects and comparable pupil dilation. The differences in visual behavior reached statistical significance in some emotions when comparing individuals with stroke with impaired performance with healthy subjects, but not when individuals post-stroke with comparable performance were considered. The performance dependence of visual behavior, although not determinant, might indicate that altered visual behavior could be a negatively contributing factor for emotion recognition from facial expressions.
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Affiliation(s)
- Anny Maza
- Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Valencia, Spain
| | - Belén Moliner
- NEURORHB, Servicio de Neurorrehabilitación de Hospitales Vithas, Valencia, Spain
| | - Joan Ferri
- NEURORHB, Servicio de Neurorrehabilitación de Hospitales Vithas, Valencia, Spain
| | - Roberto Llorens
- Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Valencia, Spain.,NEURORHB, Servicio de Neurorrehabilitación de Hospitales Vithas, Valencia, Spain
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12
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Borrego A, Latorre J, Alcañiz M, Llorens R. Embodiment and Presence in Virtual Reality After Stroke. A Comparative Study With Healthy Subjects. Front Neurol 2019; 10:1061. [PMID: 31649608 PMCID: PMC6795691 DOI: 10.3389/fneur.2019.01061] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 09/20/2019] [Indexed: 11/13/2022] Open
Abstract
The ability of virtual reality (VR) to recreate controlled, immersive, and interactive environments that provide intensive and customized exercises has motivated its therapeutic use after stroke. Interaction and bodily presence in VR-based interventions is usually mediated through virtual selves, which synchronously represent body movements or responses to events on external input devices. Embodied self-representations in the virtual world not only provide an anchor for visuomotor tasks, but their morphologies can have behavioral implications. While research has focused on the underlying subjective mechanisms of exposure to VR on healthy individuals, the transference of these findings to individuals with stroke is not evident and remains unexplored, which could affect the experience and, ultimately, the clinical effectiveness of neurorehabilitation interventions. This study determined and compared the sense of embodiment and presence elicited by a virtual environment under different perspectives and levels of immersion in healthy subjects and individuals with stroke. Forty-six healthy subjects and 32 individuals with stroke embodied a gender-matched neutral avatar in a virtual environment that was displayed in a first-person perspective with a head-mounted display and in a third-person perspective with a screen, and the participants were asked to interact in a virtual task for 10 min under each condition in counterbalanced order, and to complete two questionnaires about the sense of embodiment and presence experienced during the interaction. The sense of body-ownership, self-location, and presence were more vividly experienced in a first-person than in a third-person perspective by both healthy subjects (p < 0.001, ηp2 = 0.212; p = 0.005, ηp2 = 0.101; p = 0.001, ηp2 = 0.401, respectively) and individuals with stroke (p = 0.019, ηp2 = 0.070; p = 0.001, ηp2 = 0.135; p = 0.014, ηp2 = 0.077, respectively). In contrast, no agency perspective-related differences were found in any group. All measures were consistently higher for healthy controls than for individuals with stroke, but differences between groups only reached statistical significance in presence under the first-person condition (p < 0.010, ηp2 = 0.084). In spite of these differences, the participants experienced a vivid sense of embodiment and presence in almost all conditions. These results provide first evidence that, although less intensively, embodiment and presence are similarly experienced by individuals who have suffered a stroke and by healthy individuals, which could support the vividness of their experience and, consequently, the effectiveness of VR-based interventions.
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Affiliation(s)
- Adrián Borrego
- Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Valencia, Spain
| | - Jorge Latorre
- Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Valencia, Spain.,NEURORHB-Servicio de Neurorrehabilitación de Hospitales Vithas, Valencia, Spain
| | - Mariano Alcañiz
- Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Valencia, Spain
| | - Roberto Llorens
- Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Valencia, Spain.,NEURORHB-Servicio de Neurorrehabilitación de Hospitales Vithas, Valencia, Spain
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13
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Gait analysis with the Kinect v2: normative study with healthy individuals and comprehensive study of its sensitivity, validity, and reliability in individuals with stroke. J Neuroeng Rehabil 2019; 16:97. [PMID: 31349868 PMCID: PMC6660692 DOI: 10.1186/s12984-019-0568-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 07/17/2019] [Indexed: 12/04/2022] Open
Abstract
Background Gait is usually assessed by clinical tests, which may have poor accuracy and be biased, or instrumented systems, which potentially solve these limitations at the cost of being time-consuming and expensive. The different versions of the Microsoft Kinect have enabled human motion tracking without using wearable sensors at a low-cost and with acceptable reliability. This study aims: First, to determine the sensitivity of an open-access Kinect v2-based gait analysis system to motor disability and aging; Second, to determine its concurrent validity with standardized clinical tests in individuals with stroke; Third, to quantify its inter and intra-rater reliability, standard error of measurement, minimal detectable change; And, finally, to investigate its ability to identify fall risk after stroke. Methods The most widely used spatiotemporal and kinematic gait parameters of 82 individuals post-stroke and 355 healthy subjects were estimated with the Kinect v2-based system. In addition, participants with stroke were assessed with the Dynamic Gait Index, the 1-min Walking Test, and the 10-m Walking Test. Results The system successfully characterized the performance of both groups. Significant concurrent validity with correlations of variable strength was detected between all clinical tests and gait measures. Excellent inter and intra-rater reliability was evidenced for almost all measures. Minimal detectable change was variable, with poorer results for kinematic parameters. Almost all gait parameters proved to identify fall risk. Conclusions Results suggest that although its limited sensitivity to kinematic parameters, the Kinect v2-based gait analysis could be used as a low-cost alternative to laboratory-grade systems to complement gait assessment in clinical settings.
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Nursi A, Padrik M, Nursi L, Pähkel M, Virkunen L, Küttim-Rips A, Taba P. Adaption and validation of the Mississippi Aphasia Screening Test to Estonian speakers with aphasia. Brain Behav 2019; 9:e01188. [PMID: 30569561 PMCID: PMC6346641 DOI: 10.1002/brb3.1188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 11/15/2018] [Accepted: 11/23/2018] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The Mississippi Aphasia Screening Test (MAST) is a brief screening tool for assessing the expressive and receptive language abilities of patients with aphasia. The goal of this study was to adapt and validate the MAST into the Estonian language. The discriminant validity and internal consistency of the test were examined, as well as its sensitivity and specificity. METHODS The MASTest was administered in 50 left hemisphere stroke patients with aphasia (LHA+ group) in the acute phase after the stroke and 126 healthy volunteers in a control group (CG), stratified by age and level of education. Nonparametric tests were used to get normative values, compare the values of the MASTest scores between the LHA+ group and the CG, and to assess the discriminant validity, internal consistency, sensitivity, and specificity of the MASTest. RESULTS The summary scores: total score (MASTest-T), expressive score (MASTest-E), and receptive score (MASTest-R) correlated with age and educational level, and the normative values were adjusted accordingly. The LHA+ group showed more impairment than the CG in all subtests and summary scores. The internal reliability of the MASTest was high for the whole sample and LHA+ group. The sensitivity and specificity of the MASTest using the 5th percentile were 74% and 94%, respectively, but using receiver operating characteristic (ROC) analysis, it was 89% and 80%. CONCLUSION The MASTest is a valid screening tool for evaluating expressive and receptive language abilities in Estonian patients with aphasia in early stroke. The MASTest is the first validated aphasia screening test for Estonian-speaking people, who number less than one million worldwide.
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Affiliation(s)
- Aaro Nursi
- Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia.,Department of Neurology, Tartu University Hospital, Tartu, Estonia
| | - Marika Padrik
- Institute of Education, University of Tartu, Tartu, Estonia
| | - Liisa Nursi
- Department of Neurology, Tartu University Hospital, Tartu, Estonia
| | - Maarja Pähkel
- Institute of Education, University of Tartu, Tartu, Estonia
| | - Liis Virkunen
- Institute of Education, University of Tartu, Tartu, Estonia
| | | | - Pille Taba
- Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia.,Department of Neurology, Tartu University Hospital, Tartu, Estonia
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15
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Yang H, Tian S, Flamand-Roze C, Gao L, Zhang W, Li Y, Wang J, Sun Z, Su Y, Zhao L, Liang Z. A Chinese version of the Language Screening Test (CLAST) for early-stage stroke patients. PLoS One 2018; 13:e0196646. [PMID: 29727462 PMCID: PMC5935384 DOI: 10.1371/journal.pone.0196646] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 04/17/2018] [Indexed: 11/18/2022] Open
Abstract
There is a severe lack of aphasia screening tools for bedside use in Chinese. A number of aphasia assessment tools have recently been developed abroad, but some of these scales were not suitable for patients with acute stroke. The Language Screening Test (which includes two parallel versions [a/b]) in French has been proven to be an effective and time-saving aphasia screening scale for early-stage stroke patients. Therefore, we worked out a Chinese version of the LAST taking into consideration Chinese language and culture. Two preliminary parallel versions (a/b) were tested on 154 patients with stroke at acute phase and 107 patients with stroke at non-acute phase, with the Western Aphasia Battery serving as a gold standard. The equivalence between the two parallel versions and the reliability/validity of each version were assessed. The median time to complete one preliminary Chinese version (each had some item redundancy) was 98 seconds. Two final parallel versions were established after adjustment/elimination of the redundant items and were found to be equivalent (intra-class correlation coefficient: 0.991). Internal consistency is(Cronbach α for each version [a/b] was 0.956 and 0.965, respectively) good. Internal validity was fine: (a) no floor or ceiling effect/item redundancy; (b) construct validity revealed a 1-dimension structure, just like the French version. The higher educated subjects scored higher than their lower educated counterparts (p<0.01). The external validity: at the optimum cut-off point where the score of version a/b <14 in higher educated group(<13 in lower): the specificity of each version was 0.878/0.902(1/1 in lower) and sensitivity was 0.972/0.944(0.944/0.944 in lower). Inter-rater equivalence (intra-class correlation coefficient) was 1. The Chinese version of the Language Screening Test was proved to be an efficient and time-saving bedside aphasia screening tool for stroke patients at acute phase and can be used by an average medical physician.
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Affiliation(s)
- Hongyan Yang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong Science & Technology University, Wuhan, Hubei, China
| | - Shenghua Tian
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong Science & Technology University, Wuhan, Hubei, China
| | | | - Ling Gao
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong Science & Technology University, Wuhan, Hubei, China
| | - Wei Zhang
- Department of Neurology, First Affiliated Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yan Li
- Department of Neurology, Luoyang Central hospital affiliated to Zhengzhou University, Luoyang, Henan, China
| | - Jiajia Wang
- Department of Neurology, Binzhou people’s hospital, Binzhou, Shandong, China
| | - Zhou Sun
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong Science & Technology University, Wuhan, Hubei, China
| | - Ying Su
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong Science & Technology University, Wuhan, Hubei, China
| | - Libin Zhao
- Department of Anesthesia, Maternal & Child Health Hospital of Bao’an District, Shenzhen, Guangdong, China
| | - Zhihou Liang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong Science & Technology University, Wuhan, Hubei, China
- * E-mail:
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16
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Reliability and comparison of Kinect-based methods for estimating spatiotemporal gait parameters of healthy and post-stroke individuals. J Biomech 2018; 72:268-273. [DOI: 10.1016/j.jbiomech.2018.03.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 02/23/2018] [Accepted: 03/03/2018] [Indexed: 11/21/2022]
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17
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Llorens R, Noé E, Alcañiz M, Deutsch JE. Time since injury limits but does not prevent improvement and maintenance of gains in balance in chronic stroke. Brain Inj 2017; 32:303-309. [PMID: 29278927 DOI: 10.1080/02699052.2017.1418905] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To determine the influence of time since injury on the efficacy and maintenance of gains of rehabilitation of balance after stroke. METHOD Forty-seven participants were assigned to a least (6-12 months), a moderate (12-24 months), or a most chronic (>24 months) group. Participants trained for 20 one-hour sessions, administered three to five times a week, combining conventional physical therapy and visual feedback-based exercises that trained the ankle and hip strategies. Participants were assessed before, after the intervention, and one month later with a posturography test (Sway Speed and Limits of Stability) and clinical scales. RESULTS In contrast to other subjects, the most chronic participants failed to improve their sway and to maintain the benefits detected in the Limits of Stability after the intervention. Although all the participants improved in those clinical tests that better matched the trained skills, time since injury limited the improvement, and over all, the maintenance of gains. CONCLUSION Time since injury limits but does not prevent improvement in chronic stages post-stroke, and this effect appears to be more pronounced with maintaining gains. These findings support that training duration and intensity as well as type of therapy may need to be adjusted based on time post-stroke.
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Affiliation(s)
- Roberto Llorens
- a Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería , Universitat Politècnica de València , Valencia , Spain.,b Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales NISA , Fundación Hospitales NISA , Valencia , Spain
| | - Enrique Noé
- b Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales NISA , Fundación Hospitales NISA , Valencia , Spain
| | - Mariano Alcañiz
- a Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería , Universitat Politècnica de València , Valencia , Spain
| | - Judith E Deutsch
- c Rivers Lab, Department of Movement and Rehabilitation Sciences , Rutgers University-School of Professions , Newark , USA
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Llorens R, Borrego A, Palomo P, Cebolla A, Noé E, i Badia SB, Baños R. Body schema plasticity after stroke: Subjective and neurophysiological correlates of the rubber hand illusion. Neuropsychologia 2017; 96:61-69. [DOI: 10.1016/j.neuropsychologia.2017.01.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 12/14/2016] [Accepted: 01/06/2017] [Indexed: 02/08/2023]
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El Hachioui H, Visch-Brink EG, de Lau LML, van de Sandt-Koenderman MWME, Nouwens F, Koudstaal PJ, Dippel DWJ. Screening tests for aphasia in patients with stroke: a systematic review. J Neurol 2016; 264:211-220. [PMID: 27260296 PMCID: PMC5306063 DOI: 10.1007/s00415-016-8170-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 05/13/2016] [Accepted: 05/13/2016] [Indexed: 11/27/2022]
Abstract
Aphasia has a large impact on the quality of life and adds significantly to the costs of stroke care. Early recognition of aphasia in stroke patients is important for prognostication and well-timed treatment planning. We aimed to identify available screening tests for differentiating between aphasic and non-aphasic stroke patients, and to evaluate test accuracy, reliability, and feasibility. We searched PubMed, EMbase, Web of Science, and PsycINFO for published studies on screening tests aimed at assessing aphasia in stroke patients. The reference lists of the selected articles were scanned, and several experts were contacted to detect additional references. Of each screening test, we estimated the sensitivity, specificity, likelihood ratio of a positive test, likelihood ratio of a negative test, and diagnostic odds ratio (DOR), and rated the degree of bias of the validation method. We included ten studies evaluating eight screening tests. There was a large variation across studies regarding sample size, patient characteristics, and reference tests used for validation. Many papers failed to report on the consecutiveness of patient inclusion, time between aphasia onset and administration of the screening test, and blinding. Of the three studies that were rated as having an intermediate or low risk of bias, the DOR was highest for the Language Screening Test and ScreeLing. Several screening tools for aphasia in stroke are available, but many tests have not been verified properly. Methodologically sound validation studies of aphasia screening tests are needed to determine their usefulness in clinical practice.
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Affiliation(s)
- Hanane El Hachioui
- Department of Neurology, Erasmus MC University Medical Center, Room EE 2291, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
- Rijndam Rehabilitation Institute, Rotterdam, The Netherlands
| | - Evy G Visch-Brink
- Department of Neurology, Erasmus MC University Medical Center, Room EE 2291, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Lonneke M L de Lau
- Department of Neurology, Erasmus MC University Medical Center, Room EE 2291, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Neurology, Slotervaart Medical Center, Amsterdam, The Netherlands
| | - Mieke W M E van de Sandt-Koenderman
- Rijndam Rehabilitation Institute, Rotterdam, The Netherlands
- Department of Rehabilitation Medicine and Physical Therapy, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Femke Nouwens
- Department of Neurology, Erasmus MC University Medical Center, Room EE 2291, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
- Rijndam Rehabilitation Institute, Rotterdam, The Netherlands
| | - Peter J Koudstaal
- Department of Neurology, Erasmus MC University Medical Center, Room EE 2291, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Diederik W J Dippel
- Department of Neurology, Erasmus MC University Medical Center, Room EE 2291, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
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20
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Colomer C, Llorens R, Noé E, Alcañiz M. Effect of a mixed reality-based intervention on arm, hand, and finger function on chronic stroke. J Neuroeng Rehabil 2016; 13:45. [PMID: 27169462 PMCID: PMC4864937 DOI: 10.1186/s12984-016-0153-6] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 05/03/2016] [Indexed: 11/24/2022] Open
Abstract
Background Virtual and mixed reality systems have been suggested to promote motor recovery after stroke. Basing on the existing evidence on motor learning, we have developed a portable and low-cost mixed reality tabletop system that transforms a conventional table in a virtual environment for upper limb rehabilitation. The system allows intensive and customized training of a wide range of arm, hand, and finger movements and enables interaction with tangible objects, while providing audiovisual feedback of the participants’ performance in gamified tasks. This study evaluates the clinical effectiveness and the acceptance of an experimental intervention with the system in chronic stroke survivors. Methods Thirty individuals with stroke were included in a reversal (A-B-A) study. Phase A consisted of 30 sessions of conventional physical therapy. Phase B consisted of 30 training sessions with the experimental system. Both interventions involved flexion and extension of the elbow, wrist, and fingers, and grasping of different objects. Sessions were 45-min long and were administered three to five days a week. The body structures (Modified Ashworth Scale), functions (Motricity Index, Fugl-Meyer Assessment Scale), activities (Manual Function Test, Wolf Motor Function Test, Box and Blocks Test, Nine Hole Peg Test), and participation (Motor Activity Log) were assessed before and after each phase. Acceptance of the system was also assessed after phase B (System Usability Scale, Intrinsic Motivation Inventory). Results Significant improvement was detected after the intervention with the system in the activity, both in arm function measured by the Wolf Motor Function Test (p < 0.01) and finger dexterity measured by the Box and Blocks Test (p < 0.01) and the Nine Hole Peg Test (p < 0.01); and participation (p < 0.01), which was maintained to the end of the study. The experimental system was reported as highly usable, enjoyable, and motivating. Conclusions Our results support the clinical effectiveness of mixed reality interventions that satisfy the motor learning principles for upper limb rehabilitation in chronic stroke survivors. This characteristic, together with the low cost of the system, its portability, and its acceptance could promote the integration of these systems in the clinical practice as an alternative to more expensive systems, such as robotic instruments. Electronic supplementary material The online version of this article (doi:10.1186/s12984-016-0153-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Carolina Colomer
- Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales NISA. Fundación Hospitales NISA, Valencia, Spain
| | - Roberto Llorens
- Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales NISA. Fundación Hospitales NISA, Valencia, Spain. .,Instituto Interuniversitario de Investigación en Bioingeniería y Tecnología Orientada al Ser Humano, Universitat Politècnica de València, Camino de Vera s/n, Valencia, 46022, Spain.
| | - Enrique Noé
- Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales NISA. Fundación Hospitales NISA, Valencia, Spain
| | - Mariano Alcañiz
- Instituto Interuniversitario de Investigación en Bioingeniería y Tecnología Orientada al Ser Humano, Universitat Politècnica de València, Camino de Vera s/n, Valencia, 46022, Spain.,Ciber, Fisiopatología Obesidad y Nutrición, CB06/03 Instituto de Salud Carlos III, Av. Sos Baynat s/n, Univesity of Jaume I, Castellón, 12071, Spain
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21
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Llorens R, Latorre J, Noé E, Keshner EA. Posturography using the Wii Balance Board™: A feasibility study with healthy adults and adults post-stroke. Gait Posture 2016; 43:228-32. [PMID: 26584877 DOI: 10.1016/j.gaitpost.2015.10.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 09/16/2015] [Accepted: 10/08/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Posturography systems that incorporate force platforms are considered to assess balance and postural control with greater sensitivity and objectivity than conventional clinical tests. The Wii Balance Board (WBB) system has been shown to have similar performance characteristics as other force platforms, but with lower cost and size. OBJECTIVES To determine the validity and reliability of a freely available WBB-based posturography system that combined the WBB with several traditional balance assessments, and to assess the performance of a cohort of stroke individuals with respect to healthy individuals. METHODS Healthy subjects and individuals with stroke were recruited. Both groups were assessed using the WBB-based posturography system. Individuals with stroke were also assessed using a laboratory grade posturography system and a battery of clinical tests to determine the concurrent validity of the system. A group of subjects were assessed twice with the WBB-based system to determine its reliability. RESULTS A total of 144 healthy individuals and 53 individuals with stroke participated in the study. Concurrent validity with another posturography system was moderate to high. Correlations with clinical scales were consistent with previous research. The reliability of the system was excellent in almost all measures. In addition, the system successfully characterized individuals with stroke with respect to the healthy population. CONCLUSIONS The WBB-based posturography system exhibited excellent psychometric properties and sensitivity for identifying balance performance of individuals with stroke in comparison with healthy subjects, which supports feasibility of the system as a clinical tool.
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Affiliation(s)
- Roberto Llorens
- Instituto Interuniversitario de Investigación en Bioingeniería y Tecnología Orientada al Ser Humano, Universitat Politècnica de València, Camino de Vera s/n, 46022 Valencia, Spain; Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales NISA, Fundación Hospitales NISA, Río Tajo 1, 46011 Valencia, Spain.
| | - Jorge Latorre
- Instituto Interuniversitario de Investigación en Bioingeniería y Tecnología Orientada al Ser Humano, Universitat Politècnica de València, Camino de Vera s/n, 46022 Valencia, Spain
| | - Enrique Noé
- Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales NISA, Fundación Hospitales NISA, Río Tajo 1, 46011 Valencia, Spain
| | - Emily A Keshner
- Department of Physical Therapy, Temple University, 3307 N. Broad St., Philadelphia, PA 19140, USA
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Pagliarin KC, Ortiz KZ, Barreto SDS, Pimenta Parente MADM, Nespoulous JL, Joanette Y, Fonseca RP. Montreal–Toulouse Language Assessment Battery: Evidence of criterion validity from patients with aphasia. J Neurol Sci 2015; 357:246-51. [DOI: 10.1016/j.jns.2015.07.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 07/28/2015] [Accepted: 07/29/2015] [Indexed: 10/23/2022]
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Lloréns R, Noé E, Colomer C, Alcañiz M. Effectiveness, usability, and cost-benefit of a virtual reality-based telerehabilitation program for balance recovery after stroke: a randomized controlled trial. Arch Phys Med Rehabil 2014; 96:418-425.e2. [PMID: 25448245 DOI: 10.1016/j.apmr.2014.10.019] [Citation(s) in RCA: 197] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 10/20/2014] [Accepted: 10/24/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES First, to evaluate the clinical effectiveness of a virtual reality (VR)-based telerehabilitation program in the balance recovery of individuals with hemiparesis after stroke in comparison with an in-clinic program; second, to compare the subjective experiences; and third, to contrast the costs of both programs. DESIGN Single-blind, randomized, controlled trial. SETTING Neurorehabilitation unit. PARTICIPANTS Chronic outpatients with stroke (N=30) with residual hemiparesis. INTERVENTIONS Twenty 45-minute training sessions with the telerehabilitation system, conducted 3 times a week, in the clinic or in the home. MAIN OUTCOME MEASURES First, Berg Balance Scale for balance assessment. The Performance-Oriented Mobility Assessment balance and gait subscales, and the Brunel Balance Assessment were secondary outcome measures. Clinical assessments were conducted at baseline, 8 weeks (posttreatment), and 12 weeks (follow-up). Second, the System Usability Scale and the Intrinsic Motivation Inventory for subjective experiences. Third, cost (in dollars). RESULTS Significant improvement in both groups (in-clinic group [control] and a home-based telerehabilitation group) from the initial to the final assessment in the Berg Balance Scale (ηp(2)=.68; P=.001), in the balance (ηp(2)=.24; P=.006) and gait (ηp(2)=.57, P=.001) subscales of the Tinetti Performance-Oriented Mobility Assessment, and in the Brunel Balance Assessment (control: χ(2)=15.0; P=.002; experimental: χ(2)=21.9; P=.001). No significant differences were found between the groups in any balance scale or in the feedback questionnaires. With regard to subjective experiences, both groups considered the VR system similarly usable and motivating. The in-clinic intervention resulted in more expenses than did the telerehabilitation intervention ($654.72 per person). CONCLUSIONS First, VR-based telerehabilitation interventions can promote the reacquisition of locomotor skills associated with balance in the same way as do in-clinic interventions, both complemented with a conventional therapy program; second, the usability of and motivation to use the 2 interventions can be similar; and third, telerehabilitation interventions can involve savings that vary depending on each scenario.
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Affiliation(s)
- Roberto Lloréns
- Instituto Interuniversitario de Investigación en Bioingeniería y Tecnología Orientada al Ser Humano, Universitat Politècnica de València, Valencia, Spain; Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales NISA, Fundación Hospitales NISA, Valencia, Spain.
| | - Enrique Noé
- Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales NISA, Fundación Hospitales NISA, Valencia, Spain
| | - Carolina Colomer
- Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales NISA, Fundación Hospitales NISA, Valencia, Spain
| | - Mariano Alcañiz
- Instituto Interuniversitario de Investigación en Bioingeniería y Tecnología Orientada al Ser Humano, Universitat Politècnica de València, Valencia, Spain; Ciber, Fisiopatología Obesidad y Nutrición, CB06/03 Instituto de Salud Carlos III, Univesitat Jaume I, Castellón, Spain
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Lloréns R, Gil-Gómez JA, Alcañiz M, Colomer C, Noé E. Improvement in balance using a virtual reality-based stepping exercise: a randomized controlled trial involving individuals with chronic stroke. Clin Rehabil 2014; 29:261-8. [PMID: 25056999 DOI: 10.1177/0269215514543333] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To study the clinical effectiveness and the usability of a virtual reality-based intervention compared with conventional physical therapy in the balance recovery of individuals with chronic stroke. DESIGN Randomized controlled trial. SETTING Outpatient neurorehabilitation unit. PARTICIPANTS A total of 20 individuals with chronic stroke. INTERVENTIONS The intervention consisted of 20 one-hour sessions, five sessions per week. The experimental group combined 30 minutes with the virtual reality-based intervention with 30 minutes of conventional training. The control group underwent one hour conventional therapy. MAIN MEASURES Balance performance was assessed at the beginning and at the end of the trial using the Berg Balance Scale, the balance and gait subscales of the Tinetti Performance-Oriented Mobility Assessment, the Brunel Balance Assessment, and the 10-m Walking Test. Subjective data of the virtual reality-based intervention were collected from the experimental group, with a feedback questionnaire at the end of the trial. RESULTS The results revealed a significant group-by-time interaction in the scores of the Berg Balance Scale (p < 0.05) and in the 10-m Walking Test (p < 0.05). Post-hoc analyses showed greater improvement in the experimental group: 3.8 ±2.6 vs. 1.8 ±1.4 in the Berg Balance Scale, -1.9 ±1.6 seconds vs. 0.0 ±2.3 seconds in the 10-m Walking Test, and also in the number of participants who increased level in the Brunel Balance Assessment (χ(2) = 2.5, p < 0.01). CONCLUSIONS Virtual reality interventions can be an effective resource to enhance the improvement of balance in individuals with chronic stroke.
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Affiliation(s)
- Roberto Lloréns
- Instituto Interuniversitario de Investigación en Bioingeniería y Tecnología Orientada al Ser Humano, Universitat Politècnica de València, Valencia, Spain Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales NISA, Fundación Hospitales NISA, Valencia, Spain
| | - José-Antonio Gil-Gómez
- Instituto Interuniversitario de Investigación en Bioingeniería y Tecnología Orientada al Ser Humano, Universitat Politècnica de València, Valencia, Spain
| | - Mariano Alcañiz
- Instituto Interuniversitario de Investigación en Bioingeniería y Tecnología Orientada al Ser Humano, Universitat Politècnica de València, Valencia, Spain
| | - Carolina Colomer
- Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales NISA, Fundación Hospitales NISA, Valencia, Spain
| | - Enrique Noé
- Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales NISA, Fundación Hospitales NISA, Valencia, Spain
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Arruda JS, Reis FP, Fonseca V. Avaliação da linguagem após acidente vascular cerebral em adultos no estado de Sergipe. REVISTA CEFAC 2014. [DOI: 10.1590/1982-021620142613] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objetivo analisar a ocorrência de distúrbios de linguagem nos indivíduos que sofreram Acidente Vascular Cerebral. Métodos foi avaliada a linguagem de todos os pacientes acometidos por Acidente Vascular Cerebral, atendidos de fevereiro a agosto de 2012, no setor de fisioterapia de centro de referência em educação e saúde do Estado de Sergipe. A avaliação foi baseada no Teste do Rio de Janeiro (2005). A análise dos dados foi realizada por meio de estatística descritiva e probabilística através da distribuição de frequência, cálculos da média, desvio padrão e percentis, do Teste U de Mann-Whitney e Qui-Quadrado. Resultado foram encontrados 31 indivíduos, de ambos os gêneros, com idade variando de 30 a 94 anos. Foi evidenciado que as variáveis: gênero, escolaridade e idade, influenciam no desempenho do teste, verificando-se que o gênero masculino, sujeitos abaixo de 65 anos e os com escolaridade acima de fundamental incompleto pontuam mais. Conclusão maior percentual da amostra apresenta mais alteração na compreensão do que na expressão.
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Navarro MD, Lloréns R, Noé E, Ferri J, Alcañiz M. Validation of a low-cost virtual reality system for training street-crossing. A comparative study in healthy, neglected and non-neglected stroke individuals. Neuropsychol Rehabil 2013; 23:597-618. [PMID: 23767963 DOI: 10.1080/09602011.2013.806269] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Unilateral spatial neglect is a common consequence of stroke that directly affects the performance of activities of daily living. This impairment is traditionally assessed with paper-and-pencil tests that can lack correspondence to real life and are easily compensated. Virtual reality can immerse patients in more ecological scenarios, thus providing therapists with new tools to assess and train the effects of this impairment in simulated real tasks. This paper presents the clinical validation and convergent validity of a low-cost virtual reality system for training street-crossing in stroke patients with and without neglect. The performance of neglect patients was significantly worse than the performance of non-neglect and healthy participants. In addition, several correlations between the scores in the system and in the traditional scales were detected.
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Affiliation(s)
- María-Dolores Navarro
- Servicio de Neurorrehabilitación de los Hospitales NISA. Fundación Hospitales NISA, Valencia, Spain
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Efficacy of Armeo®Spring during the chronic phase of stroke. Study in mild to moderate cases of hemiparesis. NEUROLOGÍA (ENGLISH EDITION) 2013. [DOI: 10.1016/j.nrleng.2012.04.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Efficacy of Armeo® Spring during the chronic phase of stroke. Study in mild to moderate cases of hemiparesis. Neurologia 2012; 28:261-7. [PMID: 22727271 DOI: 10.1016/j.nrl.2012.04.017] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Revised: 04/10/2012] [Accepted: 04/27/2012] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy of a gravity-supported, computer-enhanced device (Armeo® Spring) for upper limb rehabilitation in chronic stroke patients. MATERIAL AND METHODS We included 23 chronic hemiparetic patients (chronicity: 328 ± 90.8 days; distribution: 17 men and 6 women) aged 54.6 ± 9.5 years, who had sustained ischaemic stroke (n=12) or haemorrhagic stroke (n=11). All patients completed 36 one-hour sessions using the Armeo® Spring system. Arm movement was assessed at the beginning and end of the treatment programme and once more 4 months later. Main outcome measurements covered structure, activity, and function, as per the International Classification of Functioning, Disability and Health: Modified Ashworth Scale, Motricity Index (MI), Fugl-Meyer Assessment Scale (FM), Motor Assessment Scale (MAS), Manual Function Test (MFT), and Wolf Motor Function Test (WMFT). RESULTS Repeated measures ANOVA showed significant improvement (time effect) for all function scales (P<.01 for FM and MI) and activity scales (P<.01 for MAS, MFT and WMFT-ability, and P<.05 WMFT-time) without significant changes in muscle tone. The post-hoc analysis (Bonferroni) showed different evolutionary patterns for function and activity measurements, and clear benefits related to Armeo® Spring training, especially on activity scales. CONCLUSIONS Armeo® Spring is an effective tool for rehabilitating the affected arm in patients with hemiparesis secondary to ictus, even in the chronic stage.
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