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Chen EW, Varghese MS, Wu WC. Geographic access to cardiac rehabilitation and cardiovascular disease outcomes: A study of rural United States counties. Curr Probl Cardiol 2024; 49:102740. [PMID: 38972468 DOI: 10.1016/j.cpcardiol.2024.102740] [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: 06/30/2024] [Accepted: 07/04/2024] [Indexed: 07/09/2024]
Abstract
Prior studies have examined rural-urban disparities in access to cardiac rehabilitation (CR). However, few have examined the relationship between disparate access to CR and cardiovascular disease outcomes in rural areas. In this analysis of 1975 nonmetro United States counties, we investigated the relationship between number of hospitals with CR and Medicare-population hospitalization rates (per 1000 adults ≥65 years) and county-population mortality rates (per 100,000 adults ≥18 years) due to coronary heart disease (CHD), heart failure (HF), or stroke, using multivariable linear-regression-modeling adjusting for socio-demographic and comorbid conditions. Median CHD hospitalization (13.0 vs. 12.2), HF hospitalization (16.1 vs. 13.3), HF death (114.2 vs. 110.9), stroke hospitalization (12.0 vs. 10.9), and stroke death (39.6 vs. 37.1) rates were higher in nonmetro counties without versus with a CR facility (p-values< 0.001). There were inverse correlations between number of hospitals with CR and CHD (r= -0.161), HF (r= -0.261) and stroke (r= -0.237) hospitalization rates, and stroke mortality (r= -0.144) rates (p-values< 0.001). After adjustment, as the number of hospitals with CR increased, there were decreases in hospitalization rates of 1.78 for CHD, 7.20 for HF, and 2.43 for stroke, per 1000 in the population (p-values < 0.001) and decreases in stroke deaths of 9.17 per 100,000 in the population (p= 0.02). Access to hospitals with CR in US nonmetro counties is inversely related to CHD, HF, and stroke hospitalization, and stroke mortality. Our findings call for reducing barriers to CR in nonmetro communities and further exploring the relationship between CR and stroke outcomes.
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Affiliation(s)
- Edward W Chen
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Merilyn S Varghese
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA; Department of Cardiology, Veterans Affair Connecticut Healthcare System, West Haven, CT, USA
| | - Wen-Chih Wu
- The Providence Veterans Affairs Medical Center, Lifespan Hospitals, and the Warren Alpert Medical School at Brown University, 830 Chalkstone Avenue, Providence, RI 02908, USA.
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Law ZK, Menon CS, Woodhouse LJ, Appleton JP, Al-Shahi Salman R, Robinson T, Werring D, Roffe C, Dineen RA, Bath PM, Sprigg N. Outcome 1 year after ICH: Data from the Tranexamic acid for IntraCerebral Haemorrhage 2 (TICH-2) trial. Eur Stroke J 2024:23969873241265939. [PMID: 39076020 DOI: 10.1177/23969873241265939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024] Open
Abstract
INTRODUCTION The Tranexamic acid for IntraCerebral Haemorrhage-2 (TICH-2) trial reported no significant improvement in death and dependency at day 90 despite reductions in haematoma expansion, early neurological deterioration and early death. However, significant recovery after stroke, particularly intracerebral haemorrhage (ICH), may take more than 3 months. Here we report the participant outcomes at 1 year after stroke. PATIENTS AND METHODS TICH-2 was a prospective randomised controlled trial that tested the efficacy and safety of tranexamic acid in spontaneous ICH when given within 8 h of onset. Patients with ICH on anticoagulation were excluded. Centralised blinded telephone follow up was performed for patients from the United Kingdom at 1 year. The primary outcome was modified Rankin Scale at 1 year. Secondary outcomes included Barthel index, Telephone Interview Cognitive Status-modified, EuroQoL-5D and Zung Depression Scale. This was a prespecified secondary analysis of the TICH-2 trial. RESULTS About 2325 patients were recruited into the trial (age 68.9 ± 13.8 years; 1301 male, 56%). About 1910 participants (82.2%) were eligible for day 365 follow up. 57 patients (3.0%) were lost to follow up. Tranexamic acid did not reduce the risk of poor functional outcome at 1 year (adjusted OR 0.91 95% CI 0.77-1.09; p = 0.302). However, Cox proportional hazard analysis revealed significant survival benefit in the tranexamic acid group (adjusted HR 0.83, 95% CI 0.70-0.99; p = 0.038). CONCLUSION There was no difference in functional outcome at 1 year after ICH. Tranexamic acid may reduce mortality at 1 year without an increase in severely dependent survivors. But this should be interpreted with caution as this is a result of secondary analysis in a neutral trial.
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Affiliation(s)
- Zhe Kang Law
- Stroke Medicine, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, UK
- Department of Medicine, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | | | - Lisa J Woodhouse
- Stroke Medicine, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Jason Philip Appleton
- Stroke Medicine, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, UK
- Stroke, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Thompson Robinson
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - David Werring
- Institute of Neurology and National Hospital for Neurology and Neurosurgery, University College London, London, UK
| | | | - Robert A Dineen
- Radiological Sciences, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Philip Michael Bath
- Stroke Medicine, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Nikola Sprigg
- Stroke Medicine, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, UK
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Nozoe M, Miyata K, Kubo H, Ishida M, Yamamoto K. Establishing minimal clinically important differences and cut-off values for the lower limb motricity index and trunk control test in older patients with acute stroke: a prospective cohort study. Top Stroke Rehabil 2024:1-10. [PMID: 38814857 DOI: 10.1080/10749357.2024.2359340] [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: 10/13/2023] [Accepted: 05/18/2024] [Indexed: 06/01/2024]
Abstract
OBJECTIVE To establish the Minimal Clinically Important Differences (MCIDs) for lower limb strength measured by the Motricity Index (LLMI) and trunk function assessed by the Trunk Control Test (TCT) in the acute phase of stroke in older patients. Further, the study sought to determine the cutoff values predicting functional prognosis at discharge for both the LLMI and TCT. METHODS This prospective cohort study was conducted for older patients (≥65 years) admitted for acute stroke, receiving guideline-based stroke care that includes early rehabilitation. The LLMI and TCT were measured within 7 days of admission and at discharge. The MCID was derived from receiving operating characteristic curves, based on a ≥ 1 point shift in the modified Rankin Scale (mRS) from admission to discharge. A good functional prognosis at discharge was defined as an mRS score of ≤ 3. RESULTS A total of 201 older patients with acute stroke were included. The TCT achieved an MCID of 13 (area under the curve [AUC] = 0.704, 95% confidence interval [CI]: 0.633-0.775), whereas the LLMI lacked the precision to produce a significant MCID. The optimal cutoff points for predicting a good outcome were found to be an LLMI score of 65 (AUC = 0.770, 95% CI: 0.705-0.835) and a TCT score of 25 (AUC = 0.827, 95% CI: 0.768-0.887) upon admission. CONCLUSIONS This study identified a valid MCID for the TCT, failed to do so for the LLMI, and established cutoff values for both the LLMI and TCT that can predict good outcomes in older patients with acute stroke.
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Affiliation(s)
- Masafumi Nozoe
- Department of Physical Therapy, Faculty of Rehabilitation, Kansai Medical University, Osaka, Japan
| | - Kazuhiro Miyata
- Department of Physical Therapy, Ibaraki Prefectural University of Health Science, Ibaraki, Japan
| | - Hiroki Kubo
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women's University, Kobe, Japan
| | - Mitsuru Ishida
- Department of Rehabilitation, Konan Medical Center, Kobe, Japan
| | - Kenta Yamamoto
- Department of Rehabilitation, Konan Medical Center, Kobe, Japan
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Kawabori M, Kuroda S, Shichinohe H, Kahata K, Shiratori S, Ikeda S, Harada T, Hirata K, Tha KK, Aragaki M, Terasaka S, Ito YM, Nishimoto N, Ohnishi S, Yabe I, Kudo K, Houkin K, Fujimura M. Intracerebral transplantation of MRI-trackable autologous bone marrow stromal cells for patients with subacute ischemic stroke. MED 2024; 5:432-444.e4. [PMID: 38547868 DOI: 10.1016/j.medj.2024.02.009] [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: 07/05/2023] [Revised: 10/19/2023] [Accepted: 02/26/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Ischemic stroke is one of the leading causes of death and neurological disability worldwide, and stem cell therapy is highly expected to reverse the sequelae. This phase 1/2, first-in-human study evaluated the safety, feasibility, and monitoring of an intracerebral-transplanted magnetic resonance imaging (MRI)-trackable autologous bone marrow stromal cell (HUNS001-01) for patients with subacute ischemic stroke. METHODS The study included adults with severe disability due to ischemic stroke. HUNS001-01 cultured with human platelet lysates and labeled with superparamagnetic iron oxide was stereotactically transplanted into the peri-infarct area 47-64 days after ischemic stroke onset (dose: 2 or 5 × 107 cells). Neurological and radiographic evaluations were performed throughout 1 year after cell transplantation. The trial was registered at UMIN Clinical Trial Registry (number UMIN000026130). FINDINGS All seven patients who met the inclusion criteria successfully achieved cell expansion, underwent intracerebral transplantation, and completed 1 year of follow-up. No product-related adverse events were observed. The median National Institutes of Health Stroke Scale and modified Rankin scale scores before transplantation were 13 and 4, which showed improvements of 1-8 and 0-2, respectively. Cell tracking proved that the engrafted cells migrated toward the infarction border area 1-6 months after transplantation, and the quantitative susceptibility mapping revealed that cell signals at the migrated area constantly increased throughout the follow-up period up to 34% of that of the initial transplanted site. CONCLUSIONS Intracerebral transplantation of HUNS001-01 was safe and well tolerated. Cell tracking shed light on the therapeutic mechanisms of intracerebral transplantation. FUNDING This work was supported by the Japan Agency for Medical Research and Development (AMED; JP17bk0104045 and JP20bk0104011).
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Affiliation(s)
- Masahito Kawabori
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido 060-8638, Japan.
| | - Satoshi Kuroda
- Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama 930-0194, Japan
| | - Hideo Shichinohe
- Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Hokkaido 060-8638, Japan
| | - Kaoru Kahata
- Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Hokkaido 060-8638, Japan
| | - Souichi Shiratori
- Department of Hematology, Hokkaido University Faculty of Medicine, Sapporo, Hokkaido 060-8638, Japan
| | - Satoshi Ikeda
- Department of Rehabilitation, Hokkaido University Hospital, Sapporo, Hokkaido 060-8638, Japan
| | - Taisuke Harada
- Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido 060-8638, Japan
| | - Kenji Hirata
- Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido 060-8638, Japan
| | - Khin Khin Tha
- Global Center for Biomedical Science and Engineering, Hokkaido University Faculty of Medicine, Sapporo, Hokkaido 060-8638, Japan
| | - Masato Aragaki
- Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Hokkaido 060-8638, Japan
| | - Shunsuke Terasaka
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido 060-8638, Japan
| | - Yoichi M Ito
- Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Hokkaido 060-8638, Japan
| | - Naoki Nishimoto
- Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Hokkaido 060-8638, Japan
| | - Shunsuke Ohnishi
- Laboratory of Molecular and Cellular Medicine, Hokkaido University Graduate School of Pharmacology, Sapporo, Hokkaido 060-8638, Japan
| | - Ichiro Yabe
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido 060-8638, Japan
| | - Kohsuke Kudo
- Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido 060-8638, Japan
| | - Kiyohiro Houkin
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido 060-8638, Japan
| | - Miki Fujimura
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido 060-8638, Japan
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Liu H, Xu Y, Jiang W, Hu F, Zhou Y, Pan L, Zhou F, Yin Y, Tan B. Effects of task-based mirror therapy on upper limb motor function in hemiplegia: study protocol for a randomized controlled clinical trial. Trials 2024; 25:254. [PMID: 38605413 PMCID: PMC11010366 DOI: 10.1186/s13063-024-08081-1] [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: 08/24/2023] [Accepted: 03/29/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND AND PURPOSE Research to date has lacked definitive evidence to determine whether mirror therapy promotes the recovery of upper extremity function after stroke. Considering that previous studies did not stratify patients based on structural retention, this may be one of the reasons for the negative results obtained in many trials. The goal evaluates the efficacy of TBMT (utilizing an innovatively designed mirror) versus standard occupational therapy for stroke patient's upper limb functionality. METHODS AND ANALYSIS This single-center randomized controlled trial will involve 50 patients with stroke. All patients will be randomly assigned to either the task-based mirror therapy or the control group. The interventions will be performed 5 days per week for 4 weeks. The primary outcomes will be the mean change in scores on both the FMA-UE and modified Barthel Index (MBI) from baseline to 4 weeks intervention and at 12 weeks follow-up between the two groups and within groups. The other outcomes will include the Action Research Arm Test (ARAT), the Nine Hole Peg Test (9HPT), the Functional Independence Measure, and MRI. DISCUSSION This trial will not only to establish that task-based mirror therapy (TBMT) could improve the recovery of hand function after stroke but also to explore the underlying mechanisms. We expect that this finding will clarify the brain activation and brain network mechanisms underlying the improvement of hand function with task-oriented mirror therapy and lead to new ideas for stroke hand function rehabilitation. TRIAL REGISTRATION URL: https://www.chictr.org.cn ; Unique identifier: ChiCTR2300068855. Registered on March 1, 2023.
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Affiliation(s)
- Hongzhen Liu
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, 74 Lin Jiang Road, Chongqing, 40010, China
| | - Yangjie Xu
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, 74 Lin Jiang Road, Chongqing, 40010, China
| | - Wei Jiang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, 74 Lin Jiang Road, Chongqing, 40010, China
| | - Fangchao Hu
- Department of Mechanical Engineering, Chongqing University of Technology, No. 69 Hongguang Avenue, Chongqing, 400054, China
| | - Yi Zhou
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, 74 Lin Jiang Road, Chongqing, 40010, China
| | - Lu Pan
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, 74 Lin Jiang Road, Chongqing, 40010, China
| | - Feng Zhou
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, 74 Lin Jiang Road, Chongqing, 40010, China
| | - Ying Yin
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, 74 Lin Jiang Road, Chongqing, 40010, China
| | - Botao Tan
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, 74 Lin Jiang Road, Chongqing, 40010, China.
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Noé E, Gómez A, Bernabeu M, Quemada I, Rodríguez R, Pérez T, López C, Laxe S, Colomer C, Ríos M, Juárez-Belaúnde A, González C, Pelayo R, Ferri J. Guidelines: basic principles of neurorehabilitation for patients with acquired brain injury. Recommendations of the Spanish Society of Neurorehabilitation. Neurologia 2024; 39:261-281. [PMID: 37116696 DOI: 10.1016/j.nrleng.2023.04.002] [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: 05/24/2021] [Accepted: 06/27/2021] [Indexed: 04/30/2023] Open
Abstract
INTRODUCTION We present the Spanish Society of Neurorehabilitation's guidelines for adult acquired brain injury (ABI) rehabilitation. These recommendations are based on a review of international clinical practice guidelines published between 2013 and 2020. DEVELOPMENT We establish recommendations based on the levels of evidence of the studies reviewed and expert consensus on population characteristics and the specific aspects of the intervention or procedure under research. CONCLUSIONS All patients with ABI should receive neurorehabilitation therapy once they present a minimal level of clinical stability. Neurorehabilitation should offer as much treatment as possible in terms of frequency, duration, and intensity (at least 45-60minutes of each specific form of therapy that is needed). Neurorehabilitation requires a coordinated, multidisciplinary team with the knowledge, experience, and skills needed to work in collaboration both with patients and with their families. Inpatient rehabilitation interventions are recommended for patients with more severe deficits and those in the acute phase, with outpatient treatment to be offered as soon as the patient's clinical situation allows it, as long as intensity criteria can be maintained. The duration of treatment should be based on treatment response and the possibilities for further improvement, according to the best available evidence. At discharge, patients should be offered health promotion, physical activity, support, and follow-up services to ensure that the benefits achieved are maintained, to detect possible complications, and to assess possible changes in functional status that may lead the patient to need other treatment programmes.
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Affiliation(s)
- E Noé
- NEURORHB Servicio de Neurorrehabilitación de Hospitales Vithas, Fundación Hospitales Vithas, Valencia, Spain.
| | - A Gómez
- Centro Estatal de Atención al Daño Cerebral-CEADAC, Madrid, Spain
| | | | - I Quemada
- Red Menni de Daño Cerebral, Bilbao, Spain
| | | | - T Pérez
- Clínica San Vicente, Madrid, Spain
| | - C López
- Centro Lescer, Madrid, Spain
| | - S Laxe
- Hospital Clínic, Barcelona, Spain
| | - C Colomer
- NEURORHB Servicio de Neurorrehabilitación de Hospitales Vithas, Fundación Hospitales Vithas, Valencia, Spain
| | - M Ríos
- Unidad de Daño Cerebral, Hospital Beata María Ana, Madrid, Spain
| | | | - C González
- Centro Estatal de Atención al Daño Cerebral-CEADAC, Madrid, Spain
| | - R Pelayo
- Institut Guttmann, Barcelona, Spain
| | - J Ferri
- NEURORHB Servicio de Neurorrehabilitación de Hospitales Vithas, Fundación Hospitales Vithas, Valencia, Spain
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Sieghartsleitner S, Sebastián-Romagosa M, Cho W, Grünwald J, Ortner R, Scharinger J, Kamada K, Guger C. Upper extremity training followed by lower extremity training with a brain-computer interface rehabilitation system. Front Neurosci 2024; 18:1346607. [PMID: 38500488 PMCID: PMC10944934 DOI: 10.3389/fnins.2024.1346607] [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] [Received: 11/29/2023] [Accepted: 02/08/2024] [Indexed: 03/20/2024] Open
Abstract
Introduction Brain-computer interfaces (BCIs) based on functional electrical stimulation have been used for upper extremity motor rehabilitation after stroke. However, little is known about their efficacy for multiple BCI treatments. In this study, 19 stroke patients participated in 25 upper extremity followed by 25 lower extremity BCI training sessions. Methods Patients' functional state was assessed using two sets of clinical scales for the two BCI treatments. The Upper Extremity Fugl-Meyer Assessment (FMA-UE) and the 10-Meter Walk Test (10MWT) were the primary outcome measures for the upper and lower extremity BCI treatments, respectively. Results Patients' motor function as assessed by the FMA-UE improved by an average of 4.2 points (p < 0.001) following upper extremity BCI treatment. In addition, improvements in activities of daily living and clinically relevant improvements in hand and finger spasticity were observed. Patients showed further improvements after the lower extremity BCI treatment, with walking speed as measured by the 10MWT increasing by 0.15 m/s (p = 0.001), reflecting a substantial meaningful change. Furthermore, a clinically relevant improvement in ankle spasticity and balance and mobility were observed. Discussion The results of the current study provide evidence that both upper and lower extremity BCI treatments, as well as their combination, are effective in facilitating functional improvements after stroke. In addition, and most importantly improvements did not stop after the first 25 upper extremity BCI sessions.
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Affiliation(s)
- Sebastian Sieghartsleitner
- g.tec Medical Engineering GmbH, Schiedlberg, Austria
- Institute of Computational Perception, Johannes Kepler University, Linz, Austria
| | | | - Woosang Cho
- g.tec Medical Engineering GmbH, Schiedlberg, Austria
| | - Johannes Grünwald
- g.tec Medical Engineering GmbH, Schiedlberg, Austria
- Institute of Computational Perception, Johannes Kepler University, Linz, Austria
| | - Rupert Ortner
- g.tec Medical Engineering Spain S.L., Barcelona, Spain
| | - Josef Scharinger
- Institute of Computational Perception, Johannes Kepler University, Linz, Austria
| | | | - Christoph Guger
- g.tec Medical Engineering GmbH, Schiedlberg, Austria
- g.tec Medical Engineering Spain S.L., Barcelona, Spain
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Gerardin E, Regnier M, Dricot L, Lambert J, van Ravestyn C, De Coene B, Bihin B, Lindberg P, Vandermeeren Y. Dexterity in the Acute Phase of Stroke: Impairments and Neural Substrates. Neurorehabil Neural Repair 2024; 38:229-239. [PMID: 38329006 DOI: 10.1177/15459683241230029] [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] [Indexed: 02/09/2024]
Abstract
BACKGROUND Stroke can impair manual dexterity, leading to loss of independence following incomplete recovery. Enhancing our understanding of dexterity impairment may improve neurorehabilitation. OBJECTIVES The study aimed to measure dexterity components in acute stroke patients with and without hand motor deficits, compare them to those of healthy controls (HC), and to explore the neural substrates involved in specific components of dexterity. METHODS We used the Dextrain Manipulandum to quantify fine finger force control, finger selection accuracy, coactivation, and reaction time (RT). Dexterity was evaluated twice (2 days apart) in 74 patients and 14 HC. Voxel-Lesion-Symptom-Mapping (VLSM) was used to analyze the relationship between tissue damage and dexterity. Results. Due to severe paresis or fatigue, 24 patients could not perform these tasks. In 50 patients (included 4.6 ± 3.3 days post-stroke), finger force control improved (P < .001), as it did in HC (P = .03) who performed better than patients on both evaluations. Accuracy of finger selection did not improve significantly in any group, but the HC performed better on both evaluations. Unexpectedly, coactivation was better in patients than in HC at D3 (P = .03). There were no between-group differences in RT. VLSM showed that damage to the superior temporal gyrus (STG) impaired finger force control while damage to the posterior limb of the internal capsule (PLIC) impaired finger selectivity. CONCLUSIONS Acute stroke affecting the STG or PLIC impaired selective components of dexterity. Patients with mild to moderate impairment showed better finger force control and accuracy selection within 48 hours, suggesting the feasibility of detecting early dexterity improvements.
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Affiliation(s)
- Eloïse Gerardin
- UCLouvain/CHU UCL Namur (Godinne), Neurology Department, Stroke Unit, Yvoir, Belgium
- UClouvain, Louvain Bionics, Louvain-la-Neuve, Belgium
- UCLouvain, Institute of NeuroScience (IoNS), NEUR Division, Brussels, Belgium
| | - Maxime Regnier
- UCLouvain, CHU UCL Namur (Godinne), Scientific Support Unit (USS), Yvoir, Belgium
| | - Laurence Dricot
- UCLouvain, Institute of NeuroScience (IoNS), NEUR Division, Brussels, Belgium
| | - Julien Lambert
- UCLouvain, Institute of NeuroScience (IoNS), COSY Division, Brussels, Belgium
| | - Coralie van Ravestyn
- UCLouvain/CHU UCL Namur (Godinne), Neurology Department, Stroke Unit, Yvoir, Belgium
- UClouvain, Louvain Bionics, Louvain-la-Neuve, Belgium
- UCLouvain, Institute of NeuroScience (IoNS), NEUR Division, Brussels, Belgium
| | - Béatrice De Coene
- UCLouvain/CHU UCL Namur (Godinne), Radiology Department, Yvoir, Belgium
| | - Benoît Bihin
- UCLouvain, CHU UCL Namur (Godinne), Scientific Support Unit (USS), Yvoir, Belgium
| | - Påvel Lindberg
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Paris, France
| | - Yves Vandermeeren
- UCLouvain/CHU UCL Namur (Godinne), Neurology Department, Stroke Unit, Yvoir, Belgium
- UClouvain, Louvain Bionics, Louvain-la-Neuve, Belgium
- UCLouvain, Institute of NeuroScience (IoNS), NEUR Division, Brussels, Belgium
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Sánchez-Martínez MP, Crisostomo MJ, Martín-San Agustín R, Montilla-Herrador J, Escolar-Reina MP, Valera-Novella E, Medina-Mirapeix F. Determination of Five Sit-to-Stand Test Performance at Discharge of Stroke Patients. Diagnostics (Basel) 2024; 14:521. [PMID: 38472993 DOI: 10.3390/diagnostics14050521] [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: 01/20/2024] [Revised: 02/21/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
The early identification of performance in the five-repetition sit-to-stand test (5-STS) at discharge in stroke patients could be of interest because it can determine independence for community-based activities. This study aimed to determine whether the initial measurement of the 5-STS test can be a determinant of the performance level prediction and amount of change in the 5-STS test at discharge in stroke patients. A prospective cohort study was conducted with a sample of 56 patients aged ≤60 d post-stroke. The 5-STS test results, as well as changes in patient condition, were measured at admission (T0) to an outpatient rehabilitation program, after the first month (T1), and at discharge (T2). The mean age was 62.7 (SD = 13.0), 58.9% of the subjects were male, and 75% had suffered an ischemic stroke. A multivariate linear regression model using the 5-STS test at T0 explained 57.7% of the variance in the performance at discharge. Using the 5-STS at T1 increased the variance to 75.5% (p < 0.001). Only the time from stroke onset at T0 significantly contributed to the two models. The measurement of the 5-STS at T0 and the amount of change in its performance at T2 explained 60.2% (p < 0.001) of the variance, while reassessment at T1 explained only 19.3% (p < 0.001). The level of patient performance on the 5-STS test at discharge, as well as any potential change, can be predicted by the admission measure of 5-STS in stroke patients.
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Affiliation(s)
| | | | - Rodrigo Martín-San Agustín
- Clinimetry and Technological Development in Therapeutic Exercise Research Group (CLIDET), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
| | | | | | | | - Francesc Medina-Mirapeix
- Department of Physiotherapy, University of Murcia, 30100 Murcia, Spain
- Clinimetry and Technological Development in Therapeutic Exercise Research Group (CLIDET), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
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Brannigan JFM, Fry A, Opie NL, Campbell BCV, Mitchell PJ, Oxley TJ. Endovascular Brain-Computer Interfaces in Poststroke Paralysis. Stroke 2024; 55:474-483. [PMID: 38018832 DOI: 10.1161/strokeaha.123.037719] [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] [Indexed: 11/30/2023]
Abstract
Stroke is a leading cause of paralysis, most frequently affecting the upper limbs and vocal folds. Despite recent advances in care, stroke recovery invariably reaches a plateau, after which there are permanent neurological impairments. Implantable brain-computer interface devices offer the potential to bypass permanent neurological lesions. They function by (1) recording neural activity, (2) decoding the neural signal occurring in response to volitional motor intentions, and (3) generating digital control signals that may be used to control external devices. While brain-computer interface technology has the potential to revolutionize neurological care, clinical translation has been limited. Endovascular arrays present a novel form of minimally invasive brain-computer interface devices that have been deployed in human subjects during early feasibility studies. This article provides an overview of endovascular brain-computer interface devices and critically evaluates the patient with stroke as an implant candidate. Future opportunities are mapped, along with the challenges arising when decoding neural activity following infarction. Limitations arise when considering intracerebral hemorrhage and motor cortex lesions; however, future directions are outlined that aim to address these challenges.
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Affiliation(s)
- Jamie F M Brannigan
- Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom (J.F.M.B.)
| | - Adam Fry
- Synchron, Inc, New York, NY (A.F., N.L.O., T.J.O.)
| | - Nicholas L Opie
- Synchron, Inc, New York, NY (A.F., N.L.O., T.J.O.)
- Vascular Bionics Laboratory, Department of Medicine, The University of Melbourne, Victoria, Australia (N.L.O., T.J.O.)
| | - Bruce C V Campbell
- Department of Neurology (B.C.V.C.), The Royal Melbourne Hospital, The University of Melbourne, Parkville, Australia
- Melbourne Brain Centre (B.C.V.C.), The Royal Melbourne Hospital, The University of Melbourne, Parkville, Australia
| | - Peter J Mitchell
- Department of Radiology (P.J.M.), The Royal Melbourne Hospital, The University of Melbourne, Parkville, Australia
| | - Thomas J Oxley
- Synchron, Inc, New York, NY (A.F., N.L.O., T.J.O.)
- Vascular Bionics Laboratory, Department of Medicine, The University of Melbourne, Victoria, Australia (N.L.O., T.J.O.)
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11
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Yang R, Hu N, Liu TY, Qu Y, Liu J, Wang JH, Yang BF, Li CL. Salvianolic acid A provides neuroprotective effects on cerebral ischemia-reperfusion injury in rats via PKA/CREB/c-Fos signaling pathway. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2024; 124:155326. [PMID: 38185068 DOI: 10.1016/j.phymed.2023.155326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 11/13/2023] [Accepted: 12/27/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Cerebral ischemia-reperfusion injury (CIRI) is a phenomenon that pathological injury of ischemic brain tissue is further aggravated after the restoration of blood supply. The complex pathological mechanism of CIRI has led to the failure of multiple neuroprotective agents in clinical studies. Salvianolic acid A (SAA) is a neuroprotective extract from Salvia miltiorrhiza Bge., with significant pharmacological activities in the treatment of brain injury. However, the neuroprotective mechanisms of SAA remain unclear. PURPOSE To explore the potential protective effect of SAA on CIRI and its mechanism, and to provide experimental basis for the research of new drugs for CIRI. STUDY DESIGN A model of transient middle cerebral artery occlusion (tMCAO) in rats was used to simulate clinical CIRI, and the neuroprotective effect of SAA on tMCAO rats was investigated within 14 days after reperfusion. The improvement effects of SAA on cognitive impairment of tMCAO rats were investigated by behavioral tests from days 7-14. Finally, the neuroprotective mechanism of SAA was investigated on day 14. METHODS The neuroprotective effects and mechanism of SAA were investigated by behavioral tests, HE and TUNEL staining, RNA sequence (RNA-seq) analysis and Western blot in tMCAO rats. RESULTS The brain protective effects of SAA were achieved by alleviating cerebral infarction, cerebral edema, cerebral atrophy and nerve injury in tMCAO rats. Meanwhile, SAA could effectively improve the cognitive impairment and pathological damage of hippocampal tissue, and inhibit cell apoptosis in tMCAO rats. Besides, SAA could provide neuroprotective effects by up-regulating the expression of Bcl-2, inhibiting the activation of Caspase 3, and regulating PKA/CREB/c-Fos signaling pathway. CONCLUSION SAA can significantly improve brain injury and cognitive impairment in CIRI rats, and this neuroprotective effect may be achieved through the anti-apoptotic effect and the regulation of PKA/CREB/c-Fos signaling pathway.
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Affiliation(s)
- Ran Yang
- Department of Pharmacology, Shenyang Pharmaceutical University, Shenyang, Liaoning 110016, PR China
| | - Nan Hu
- Department of Pharmacology, Shenyang Pharmaceutical University, Shenyang, Liaoning 110016, PR China
| | - Ting-Yu Liu
- Department of Pharmacology, Shenyang Pharmaceutical University, Shenyang, Liaoning 110016, PR China
| | - Yue Qu
- Department of Traditional Chinese Medicine, Shenyang Pharmaceutical University, Shenyang, Liaoning, PR China
| | - Jie Liu
- Department of Pharmacology, Shenyang Pharmaceutical University, Shenyang, Liaoning 110016, PR China
| | - Jin-Hui Wang
- Department of Pharmacy, Harbin Medical University, Harbin, Heilongjiang 150081, PR China
| | - Bao-Feng Yang
- Department of Pharmacology, Shenyang Pharmaceutical University, Shenyang, Liaoning 110016, PR China; Department of Pharmacy, Harbin Medical University, Harbin, Heilongjiang 150081, PR China.
| | - Chun-Li Li
- Department of Pharmacology, Shenyang Pharmaceutical University, Shenyang, Liaoning 110016, PR China.
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12
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McGlinchey MP, Faulkner-Gurstein R, Sackley CM, McKevitt C. Factors guiding therapist decision making in the rehabilitation of physical function after severely disabling stroke - an ethnographic study. Disabil Rehabil 2024; 46:672-684. [PMID: 36734838 DOI: 10.1080/09638288.2023.2172463] [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: 05/30/2022] [Accepted: 01/20/2023] [Indexed: 02/04/2023]
Abstract
PURPOSE Whilst strong evidence supports rehabilitation to improve outcomes post-stroke, there is limited evidence to guide rehabilitation in the most severely disabled group. In an era of evidence-based practice, the aim of the study was to understand what factors guide physiotherapists (PTs) and occupational therapists (OTs) to select particular interventions in the rehabilitation of physical function after severely disabling stroke. MATERIAL AND METHODS An ethnographic study was undertaken over an 18-month period involving five London, UK stroke services. Seventy-nine primary participants (30 PTs, 22 OTs, and 27 stroke survivors) were recruited to the study. Over 400 h of observation, 52 semi-structured interviews were conducted. Study data were analysed through thematic analysis. RESULTS Key factors guiding therapist decision making were clinical expertise, professional role, stroke survivors' clinical presentation, therapist perspectives about stroke recovery, and clinical guidelines. Research evidence, stroke survivors' treatment preferences, organisational type, and pathway design were less influential factors. Therapy practice did not always address the physical needs of severely disabled stroke survivors. CONCLUSIONS Multiple factors guided therapist decision making after severely disabling stroke. Alternative ways of therapist working should be considered to address the physical needs of severely disabled stroke survivors more fully.Implications for rehabilitationMultiple factors guide therapist decision making after severely disabling stroke, some of which result in the use of interventions that do not fully address stroke survivors' clinical needs.Therapists should critically reflect upon their personal beliefs and attitudes about severely disabling stroke to reduce potential sources of bias on decision making.Therapists should consider the timing and intensity of therapy delivery as well as their treatment approach to optimise outcomes after severely disabling stroke.
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Affiliation(s)
- Mark P McGlinchey
- Neurorehabilitation Service, Integrated Local Services, Guy's and St Thomas' NHS Foundation Trust, London, UK
- School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Rachel Faulkner-Gurstein
- School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Catherine M Sackley
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Christopher McKevitt
- School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
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13
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Van Criekinge T, Heremans C, Burridge J, Deutsch JE, Hammerbeck U, Hollands K, Karthikbabu S, Mehrholz J, Moore JL, Salbach NM, Schröder J, Veerbeek JM, Weerdesteyn V, Borschmann K, Churilov L, Verheyden G, Kwakkel G. Standardized measurement of balance and mobility post-stroke: Consensus-based core recommendations from the third Stroke Recovery and Rehabilitation Roundtable. Int J Stroke 2024; 19:158-168. [PMID: 37824730 DOI: 10.1177/17474930231205207] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
BACKGROUND Mobility is a key priority for stroke survivors. Worldwide consensus of standardized outcome instruments for measuring mobility recovery after stroke is an essential milestone to optimize the quality of stroke rehabilitation and recovery studies and to enable data synthesis across trials. METHODS Using a standardized methodology, which involved convening of 13 worldwide experts in the field of mobility rehabilitation, consensus was established through an a priori defined survey-based approach followed by group discussions. The group agreed on balance- and mobility-related definitions and recommended a core set of outcome measure instruments for lower extremity motor function, balance and mobility, biomechanical metrics, and technologies for measuring quality of movement. RESULTS Selected measures included the Fugl-Meyer Motor Assessment lower extremity subscale for motor function, the Trunk Impairment Scale for sitting balance, and the Mini Balance Evaluation System Test (Mini-BESTest) and Berg Balance Scale (BBS) for standing balance. The group recommended the Functional Ambulation Category (FAC, 0-5) for walking independence, the 10-meter Walk Test (10 mWT) for walking speed, the 6-Minute Walk Test (6 MWT) for walking endurance, and the Dynamic Gait Index (DGI) for complex walking. An FAC score of less than three should be used to determine the need for an additional standing test (FAC < 3, add BBS to Mini-BESTest) or the feasibility to assess walking (FAC < 3, 10 mWT, 6 MWT, and DGI are "not testable"). In addition, recommendations are given for prioritized kinetic and kinematic metrics to be investigated that measure recovery of movement quality of standing balance and walking, as well as for assessment protocols and preferred equipment to be used. CONCLUSIONS The present recommendations of measures, metrics, technology, and protocols build on previous consensus meetings of the International Stroke Recovery and Rehabilitation Alliance to guide the research community to improve the validity and comparability between stroke recovery and rehabilitation studies as a prerequisite for building high-quality, standardized "big data" sets. Ultimately, these recommendations could lead to high-quality, participant-specific data sets to aid the progress toward precision medicine in stroke rehabilitation.
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Affiliation(s)
| | | | - Jane Burridge
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Judith E Deutsch
- RiVERS Lab, Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers University, Newark, NJ, USA
| | - Ulrike Hammerbeck
- School of Sport and Health Sciences, University of Brighton, Brighton, UK
| | | | - Suruliraj Karthikbabu
- KMCH College of Physiotherapy, Kovai Medical Center Research and Educational Trust and The Tamil Nadu Dr. M.G.R. Medical University, Coimbatore, India
| | - Jan Mehrholz
- Department of Public Health, Dresden Medical School, Technical University Dresden, Dresden, Germany
| | - Jennifer L Moore
- Institute for Knowledge Translation, Carmel, IN, USA
- Southeastern Norway Regional Center for Knowledge Translation in Rehabilitation, Oslo, Norway
| | - Nancy M Salbach
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- The KITE Research Institute, University Health Network, Toronto, ON, Canada
| | - Jonas Schröder
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium
| | | | - Vivian Weerdesteyn
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
- Sint Maartenskliniek Research, Nijmegen, The Netherlands
| | - Karen Borschmann
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Leonid Churilov
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, VIC, Australia
- Department of Medicine, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Geert Verheyden
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Gert Kwakkel
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam Neuroscience, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Neurorehabilitation, Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands
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14
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Van Criekinge T, Heremans C, Burridge J, Deutsch JE, Hammerbeck U, Hollands K, Karthikbabu S, Mehrholz J, Moore JL, Salbach NM, Schröder J, Veerbeek JM, Weerdesteyn V, Borschmann K, Churilov L, Verheyden G, Kwakkel G. Standardized measurement of balance and mobility post-stroke: Consensus-based core recommendations from the third Stroke Recovery and Rehabilitation Roundtable. Neurorehabil Neural Repair 2024; 38:41-51. [PMID: 37837351 DOI: 10.1177/15459683231209154] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
BACKGROUND Mobility is a key priority for stroke survivors. Worldwide consensus of standardized outcome instruments for measuring mobility recovery after stroke is an essential milestone to optimize the quality of stroke rehabilitation and recovery studies and to enable data synthesis across trials. METHODS Using a standardized methodology, which involved convening of 13 worldwide experts in the field of mobility rehabilitation, consensus was established through an a priori defined survey-based approach followed by group discussions. The group agreed on balance- and mobility-related definitions and recommended a core set of outcome measure instruments for lower extremity motor function, balance and mobility, biomechanical metrics, and technologies for measuring quality of movement. RESULTS Selected measures included the Fugl-Meyer Motor Assessment lower extremity subscale for motor function, the Trunk Impairment Scale for sitting balance, and the Mini Balance Evaluation System Test (Mini-BESTest) and Berg Balance Scale (BBS) for standing balance. The group recommended the Functional Ambulation Category (FAC, 0-5) for walking independence, the 10-meter Walk Test (10 mWT) for walking speed, the 6-Minute Walk Test (6 MWT) for walking endurance, and the Dynamic Gait Index (DGI) for complex walking. An FAC score of less than three should be used to determine the need for an additional standing test (FAC < 3, add BBS to Mini-BESTest) or the feasibility to assess walking (FAC < 3, 10 mWT, 6 MWT, and DGI are "not testable"). In addition, recommendations are given for prioritized kinetic and kinematic metrics to be investigated that measure recovery of movement quality of standing balance and walking, as well as for assessment protocols and preferred equipment to be used. CONCLUSIONS The present recommendations of measures, metrics, technology, and protocols build on previous consensus meetings of the International Stroke Recovery and Rehabilitation Alliance to guide the research community to improve the validity and comparability between stroke recovery and rehabilitation studies as a prerequisite for building high-quality, standardized "big data" sets. Ultimately, these recommendations could lead to high-quality, participant-specific data sets to aid the progress toward precision medicine in stroke rehabilitation.
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Affiliation(s)
| | | | - Jane Burridge
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Judith E Deutsch
- RiVERS Lab, Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers University, Newark, NJ, USA
| | - Ulrike Hammerbeck
- School of Sport and Health Sciences, University of Brighton, Brighton, UK
| | | | - Suruliraj Karthikbabu
- KMCH College of Physiotherapy, Kovai Medical Center Research and Educational Trust and The Tamil Nadu Dr. M.G.R. Medical University, Coimbatore, India
| | - Jan Mehrholz
- Department of Public Health, Dresden Medical School, Technical University Dresden, Dresden, Germany
| | - Jennifer L Moore
- Institute for Knowledge Translation, Carmel, IN, USA
- Southeastern Norway Regional Center for Knowledge Translation in Rehabilitation, Oslo, Norway
| | - Nancy M Salbach
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- The KITE Research Institute, University Health Network, Toronto, ON, Canada
| | - Jonas Schröder
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium
| | | | - Vivian Weerdesteyn
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
- Sint Maartenskliniek Research, Nijmegen, The Netherlands
| | - Karen Borschmann
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Leonid Churilov
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, VIC, Australia
- Department of Medicine, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Geert Verheyden
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Gert Kwakkel
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam Neuroscience, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Neurorehabilitation, Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands
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15
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Cha KH, Kang NY, Huh S, Ko SH, Shin YI, Min JH. The Effects of Autonomic Dysfunction on Functional Outcomes in Patients with Acute Stroke. Brain Sci 2023; 13:1694. [PMID: 38137142 PMCID: PMC10741939 DOI: 10.3390/brainsci13121694] [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: 11/15/2023] [Revised: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
Autonomic dysfunction is a common complication of acute stroke, which impairs functional outcomes and increases mortality. There is a lack of well-established knowledge regarding the influence of autonomic dysfunction in patients with acute stroke. This study aims to investigate the impact of the severity of autonomic dysfunction on functional outcomes in patients with acute stroke. A retrospective analysis was conducted at a single center, involving 22 patients diagnosed with acute stroke. The severity of autonomic dysfunction was evaluated based on the Composite Autonomic Scoring Scale (CASS). The modified Barthel Index, Berg Balance Scale, Functional Ambulatory Category, and modified Rankin Scale were designated as functional outcome measures. The impact of the severity of autonomic dysfunction on functional outcomes was analyzed using one-way analysis of covariance (ANCOVA). A statistically significant difference was observed between the initial and follow-up functional outcomes based on the severity of autonomic dysfunction. This study presents evidence that the severity of autonomic dysfunction influences functional prognosis in patients with acute stroke. The findings will serve as additional considerations for the rehabilitation of patients with acute stroke.
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Affiliation(s)
- Kyoung Hyeon Cha
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan 50612, Republic of Korea; (K.H.C.); (N.Y.K.); (S.H.); (S.-H.K.); (Y.-I.S.)
| | - Nae Yoon Kang
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan 50612, Republic of Korea; (K.H.C.); (N.Y.K.); (S.H.); (S.-H.K.); (Y.-I.S.)
| | - Sungchul Huh
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan 50612, Republic of Korea; (K.H.C.); (N.Y.K.); (S.H.); (S.-H.K.); (Y.-I.S.)
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan 50612, Republic of Korea
| | - Sung-Hwa Ko
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan 50612, Republic of Korea; (K.H.C.); (N.Y.K.); (S.H.); (S.-H.K.); (Y.-I.S.)
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan 50612, Republic of Korea
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, 2 Busandaehak-ro 63beon-gil, Geumjeong-gu, Busan 46241, Republic of Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan 50612, Republic of Korea; (K.H.C.); (N.Y.K.); (S.H.); (S.-H.K.); (Y.-I.S.)
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan 50612, Republic of Korea
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, 2 Busandaehak-ro 63beon-gil, Geumjeong-gu, Busan 46241, Republic of Korea
| | - Ji Hong Min
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan 50612, Republic of Korea; (K.H.C.); (N.Y.K.); (S.H.); (S.-H.K.); (Y.-I.S.)
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan 50612, Republic of Korea
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Abstract
INTRODUCTION Telerehabilitation (TR) may be useful for rehabilitation therapy after stroke. However, stroke is a heterogeneous condition, and not all patients can be expected to derive the same benefit from TR, underscoring the need to identify predictors of response to TR. METHODS A prior trial provided patients with 6 weeks of intensive rehabilitation therapy targeting arm movement, randomly assigned to be provided in the home via TR (current focus) or in clinic. Eligible patients had moderate arm motor deficits and were in the subacute-chronic stage post stroke. Behavioral gains were measured as change in the arm motor Fugl-Meyer score from baseline to 30 days post therapy. To delineate predictors of TR response, multivariable linear regression was performed, advancing the most significant predictor from each of eight categories: patient demographics, stroke characteristics, medical history, rehabilitation therapy outside of study procedures, motivation, sensorimotor impairment, cognitive/affective deficits, and functional status. RESULTS The primary focus was on patients starting TR >90 days post stroke onset (n = 44), among whom female sex, less spasticity, and less visual field defects predicted greater motor gains. This model explained 39.3% of the variance in treatment-related gains. In secondary analysis that also included TR patients enrolled ≤90 days post stroke (total n = 59), only female sex was a predictor of treatment gains. A separate secondary analysis examined patients >90 days post stroke (n = 34) randomized to in-clinic therapy, among whom starting therapy earlier post stroke and less ataxia predicted greater motor gains. DISCUSSION Response to TR varies across patients, emphasizing the need to identify characteristics that predict treatment-related behavioral gain. The current study highlights factors that might be important to patient selection for home-based TR after stroke.
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Affiliation(s)
- Sang Min Paik
- Ewha Woman's University College of Medicine, Republic of Korea
| | - Steven C Cramer
- Department of Neurology, University of California Los Angeles, USA
- California Rehabilitation Institute, USA
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17
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Knutson JS, Fu MJ, Cunningham DA, Hisel TZ, Friedl AS, Gunzler DD, Plow EB, Busch RM, Pundik S. Contralaterally controlled functional electrical stimulation video game therapy for hand rehabilitation after stroke: a randomized controlled trial. Disabil Rehabil 2023:1-10. [PMID: 37962171 PMCID: PMC11090983 DOI: 10.1080/09638288.2023.2278174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 10/28/2023] [Indexed: 11/15/2023]
Abstract
PURPOSE To estimate the effect of integrating custom-designed hand therapy video games (HTVG) with contralaterally controlled functional electrical stimulation (CCFES) therapy. METHODS Fifty-two stroke survivors with chronic (>6 months) upper limb hemiplegia were randomized to 12 weeks of CCFES or CCFES + HTVG. Treatment involved self-administration of technology-mediated therapy at home plus therapist-administered CCFES-assisted task practice in the lab. Pre- and post-treatment assessments were made of hand dexterity, upper limb impairment and activity limitation, and cognitive function. RESULTS No significant between-group differences were found on any outcome measure, and the average magnitudes of improvement within both groups were small. The incidence of technical problems with study devices at home was greater for the CCFES + HTVG group. This negatively affected adherence and may partially explain the absence of effect of HTVG. At end-of-treatment, large majorities of both treatment groups had positive perceptions of treatment efficacy and expressed enthusiasm for the treatments. CONCLUSION This study makes an important contribution to the research literature on the importance of environmental factors, concomitant impairments, and technology simplification when designing technology-based therapies intended to be self-administered at home. This study failed to show any added benefit of HTVG to CCFES therapy.Clinicaltrials.gov (NCT03058796).
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Affiliation(s)
- Jayme S Knutson
- Research Service, Louis Stokes Cleveland VA Medical Center, Veterans Affairs Northeast OH Healthcare System, Cleveland, OH, USA
- Department of Physical Medicine and Rehabilitation, The MetroHealth System, Cleveland, OH, USA
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, OH, USA
| | - Michael J Fu
- Department of Physical Medicine and Rehabilitation, The MetroHealth System, Cleveland, OH, USA
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, OH, USA
- Department of Electrical, Computer, and Systems Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - David A Cunningham
- Department of Physical Medicine and Rehabilitation, The MetroHealth System, Cleveland, OH, USA
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, OH, USA
| | - Terri Z Hisel
- Department of Physical Medicine and Rehabilitation, The MetroHealth System, Cleveland, OH, USA
| | - Amy S Friedl
- Department of Physical Medicine and Rehabilitation, The MetroHealth System, Cleveland, OH, USA
| | - Douglas D Gunzler
- Center for Healthcare Research and Policy, The MetroHealth System, Cleveland, OH, USA
- Population Health and Equity Research Institute, The MetroHealth System, Cleveland, OH, USA
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Ela B Plow
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Physical Medicine and Rehabilitation, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Rehabilitation Hospitals, Cleveland, OH, USA
| | - Robyn M Busch
- Departments of Neurology and Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Svetlana Pundik
- Neurology Service, Louis Stokes Cleveland VA Medical Center, Veterans Affairs Northeast OH Healthcare System, Cleveland, OH, USA
- Department of Neurology, Case Western Reserve University, Cleveland, OH, USA
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18
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Marzolini S, Robertson AD, MacIntosh BJ, Corbett D, Anderson ND, Brooks D, Koblinsky N, Oh P. Effect of High-Intensity Interval Training and Moderate-Intensity Continuous Training in People With Poststroke Gait Dysfunction: A Randomized Clinical Trial. J Am Heart Assoc 2023; 12:e031532. [PMID: 37947080 PMCID: PMC10727274 DOI: 10.1161/jaha.123.031532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/03/2023] [Indexed: 11/12/2023]
Abstract
Background The exercise strategy that yields the greatest improvement in both cardiorespiratory fitness (V ̇ O 2 peak $$ \dot{\mathrm{V}}{\mathrm{O}}_{2\mathrm{peak}} $$ ) and walking capacity poststroke has not been determined. This study aimed to determine whether conventional moderate-intensity continuous training (MICT) or high-intensity interval training (HIIT) have different effects on V ̇ O 2 peak $$ \dot{\mathrm{V}}{\mathrm{O}}_{2\mathrm{peak}} $$ and 6-minute walk distance (6MWD). Methods and Results In this 24-week superiority trial, people with poststroke gait dysfunction were randomized to MICT (5 days/week) or HIIT (3 days/week with 2 days/week of MICT). MICT trained to target intensity at the ventilatory anaerobic threshold. HIIT trained at the maximal tolerable treadmill speed/grade using a novel program of 2 work-to-recovery protocols: 30:60 and 120:180 seconds. V̇O2 and heart rate was measured during performance of the exercise that was prescribed at 8 and 24 weeks for treatment fidelity. Main outcomes were change in V ̇ O 2 peak $$ \dot{\mathrm{V}}{\mathrm{O}}_{2\mathrm{peak}} $$ and 6MWD. Assessors were blinded to the treatment group for V ̇ O 2 peak $$ \dot{\mathrm{V}}{\mathrm{O}}_{2\mathrm{peak}} $$ but not 6MWD. Secondary outcomes were change in ventilatory anaerobic threshold, cognition, gait-economy, 10-meter gait-velocity, balance, stair-climb performance, strength, and quality-of-life. Among 47 participants randomized to either MICT (n=23) or HIIT (n=24) (mean age, 62±11 years; 81% men), 96% completed training. In intention-to-treat analysis, change in V ̇ O 2 peak $$ \dot{\mathrm{V}}{\mathrm{O}}_{2\mathrm{peak}} $$ for MICT versus HIIT was 2.4±2.7 versus 5.7±3.1 mL·kg-1·min-1 (mean difference, 3.2 [95% CI, 1.5-4.8]; P<0.001), and change in 6MWD was 70.9±44.3 versus 83.4±53.6 m (mean difference, 12.5 [95% CI, -17 to 42]; P=0.401). HIIT had greater improvement in ventilatory anaerobic threshold (mean difference, 2.07 mL·kg-1·min-1 [95% CI, 0.59-3.6]; P=0.008). No other between-group differences were observed. During V̇O2 monitoring at 8 and 24 weeks, MICT reached 84±14% to 87±18% of V ̇ O 2 peak $$ \dot{\mathrm{V}}{\mathrm{O}}_{2\mathrm{peak}} $$ while HIIT reached 101±22% to 112±14% of V ̇ O 2 peak $$ \dot{\mathrm{V}}{\mathrm{O}}_{2\mathrm{peak}} $$ (during peak bouts). Conclusions HIIT resulted in more than a 2-fold greater and clinically important change in V ̇ O 2 peak $$ \dot{\mathrm{V}}{\mathrm{O}}_{2\mathrm{peak}} $$ than MICT. Training to target (ventilatory anaerobic threshold) during MICT resulted in ~3 times the minimal clinically important difference in 6MWD, which was similar to HIIT. These findings show proof of concept that HIIT yields greater improvements in cardiorespiratory fitness than conventional MICT in appropriately screened individuals. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03006731.
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Affiliation(s)
- Susan Marzolini
- KITE Research Institute, Toronto Rehabilitation Institute, University Health NetworkTorontoONCanada
- Rehabilitation Sciences Institute, University of TorontoONCanada
- Faculty of Kinesiology and Physical Education, University of TorontoONCanada
| | | | - Bradley J. MacIntosh
- Sandra E Black Centre for Brain Resilience and Repair, Hurvitz Brain Sciences, Physical Sciences Platform, Sunnybrook Research InstituteTorontoONCanada
| | - Dale Corbett
- Department of Cellular and Molecular MedicineUniversity of OttawaONCanada
| | - Nicole D. Anderson
- Rotman Research Institute, Baycrest Academy for Research and EducationTorontoONCanada
| | - Dina Brooks
- KITE Research Institute, Toronto Rehabilitation Institute, University Health NetworkTorontoONCanada
- Rehabilitation Sciences Institute, University of TorontoONCanada
- McMaster University, Faculty of Health SciencesHamiltonONCanada
| | - Noah Koblinsky
- Rotman Research Institute, Baycrest Academy for Research and EducationTorontoONCanada
| | - Paul Oh
- KITE Research Institute, Toronto Rehabilitation Institute, University Health NetworkTorontoONCanada
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19
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Migdady I, Johnson-Black PH, Leslie-Mazwi T, Malhotra R. Current and Emerging Endovascular and Neurocritical Care Management Strategies in Large-Core Ischemic Stroke. J Clin Med 2023; 12:6641. [PMID: 37892779 PMCID: PMC10607145 DOI: 10.3390/jcm12206641] [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: 09/16/2023] [Revised: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
The volume of infarcted tissue in patients with ischemic stroke is consistently associated with increased morbidity and mortality. Initial studies of endovascular thrombectomy for large-vessel occlusion excluded patients with established large-core infarcts, even when large volumes of salvageable brain tissue were present, due to the high risk of hemorrhagic transformation and reperfusion injury. However, recent retrospective and prospective studies have shown improved outcomes with endovascular thrombectomy, and several clinical trials were recently published to evaluate the efficacy of endovascular management of patients presenting with large-core infarcts. With or without thrombectomy, patients with large-core infarcts remain at high risk of in-hospital complications such as hemorrhagic transformation, malignant cerebral edema, seizures, and others. Expert neurocritical care management is necessary to optimize blood pressure control, mitigate secondary brain injury, manage cerebral edema and elevated intracranial pressure, and implement various neuroprotective measures. Herein, we present an overview of the current and emerging evidence pertaining to endovascular treatment for large-core infarcts, recent advances in neurocritical care strategies, and their impact on optimizing patient outcomes.
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Affiliation(s)
- Ibrahim Migdady
- Division of Critical Care Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA
- Department of Neurology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA
- Department of Neurological Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Phoebe H. Johnson-Black
- Department of Neurosurgery, Division of Neurocritical Care, UCLA David Geffen School of Medicine, Ronald Reagan Medical Center, Los Angeles, CA 90095, USA;
| | | | - Rishi Malhotra
- Division of Critical Care Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA
- Department of Neurology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA
- Department of Neurological Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA
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20
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Gu M, Huang H. Effect of early rehabilitation nursing on neurological function and quality of life of patients with hemiplegia after stroke: A meta-analysis. Medicine (Baltimore) 2023; 102:e34919. [PMID: 37653810 PMCID: PMC10470741 DOI: 10.1097/md.0000000000034919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/11/2023] [Accepted: 08/03/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Meta-analysis was used to systematically evaluate the effects of early rehabilitation nursing on neurological function and quality of life of patients with hemiplegia after stroke. METHODS Literature was searched from PubMed, Web of Science, cochrane library, China National Knowledge Infrastructure, and Wanfang Database. Relevant literature up to 2022 was screened, followed by data extraction and quality evaluation. Next, Stata17.0 was employed for meta-analysis. RESULTS A total of 18 articles, including 1631 subjects, were enrolled in this study. The control group subjects (n = 825) received routine nursing, and the observation group subjects (n = 806) underwent early rehabilitation nursing. The results of meta-analysis showed that early rehabilitation nursing could significantly improve neurological function the National Institute of Health Stroke Scale [standardized mean difference (SMD) = -1.623, 95% confidence interval (CI) (-2.280, -0.967), P < .001], Fugl-Meyer assessment [SMD = 2.688, 95% CI (1.767, 3.608), P < .001], cure rate [relative risk = 1.333, 95% CI (1.138, 1.562), P < .001], quality of life activity of daily living [SMD = 1.784, 95% CI (0.791, 2.777), P < .001], Barthel index [SMD = 1.617, 95% CI (1.138, 2.096), P < .001] and nursing satisfaction [relative risk = 1.191, 95% CI (1.091, 1.300), P < .001] in patients with hemiplegia after stroke. There was no obvious publication bias for the included articles in this research. CONCLUSION Compared with the controls, early rehabilitation nursing can effectively improve neurological function and quality of life of patients with hemiplegia after stroke. This study provides a theoretical basis for the clinical application of early rehabilitation nursing in patients with hemiplegia after stroke.
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Affiliation(s)
- Minghuan Gu
- Department of Rehabilitation Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Hong Huang
- Department of Rehabilitation Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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21
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Smith DB, Scott SH, Semrau JA, Dukelow SP. Impairments of the ipsilesional upper-extremity in the first 6-months post-stroke. J Neuroeng Rehabil 2023; 20:106. [PMID: 37580751 PMCID: PMC10424459 DOI: 10.1186/s12984-023-01230-8] [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: 05/12/2023] [Accepted: 08/04/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Ipsilesional motor impairments of the arm are common after stroke. Previous studies have suggested that severity of contralesional arm impairment and/or hemisphere of lesion may predict the severity of ipsilesional arm impairments. Historically, these impairments have been assessed using clinical scales, which are less sensitive than robot-based measures of sensorimotor performance. Therefore, the objective of this study was to characterize progression of ipsilesional arm motor impairments using a robot-based assessment of motor function over the first 6-months post-stroke and quantify their relationship to (1) contralesional arm impairment severity and (2) stroke-lesioned hemisphere. METHODS A total of 106 participants with first-time, unilateral stroke completed a unilateral assessment of arm motor impairment (visually guided reaching task) using the Kinarm Exoskeleton. Participants completed the assessment along with a battery of clinical measures with both ipsilesional and contralesional arms at 1-, 6-, 12-, and 26-weeks post-stroke. RESULTS Robotic assessment of arm motor function revealed a higher incidence of ipsilesional arm impairment than clinical measures immediately post-stroke. The incidence of ipsilesional arm impairments decreased from 47 to 14% across the study period. Kolmogorov-Smirnov tests revealed that ipsilesional arm impairment severity, as measured by our task, was not related to which hemisphere was lesioned. The severity of ipsilesional arm impairments was variable but displayed moderate significant relationships to contralesional arm impairment severity with some robot-based parameters. CONCLUSIONS Ipsilesional arm impairments were variable. They displayed relationships of varying strength with contralesional impairments and were not well predicted by lesioned hemisphere. With standard clinical care, 86% of ipsilesional impairments recovered by 6-months post-stroke.
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Affiliation(s)
- Donovan B Smith
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, 1403 29th Street NW, Foothills Medical Centre, South Tower, Room 905, Calgary, AB, T2N 2T9, Canada
| | - Stephen H Scott
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - Jennifer A Semrau
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, USA
| | - Sean P Dukelow
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, 1403 29th Street NW, Foothills Medical Centre, South Tower, Room 905, Calgary, AB, T2N 2T9, Canada.
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22
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Schröder J, Saeys W, Embrechts E, Hallemans A, Yperzeele L, Truijen S, Kwakkel G. Recovery of Quiet Standing Balance and Lower Limb Motor Impairment Early Poststroke: How Are They Related? Neurorehabil Neural Repair 2023; 37:530-544. [PMID: 37596887 DOI: 10.1177/15459683231186983] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/21/2023]
Abstract
BACKGROUND Recovery of quiet standing balance early poststroke has been poorly investigated using repeated measurements. OBJECTIVE To investigate (1) the time course of steady-state balance in terms of postural stability and inter-limb symmetry, and (2) longitudinal associations with lower limb motor recovery in the first 3 months poststroke. METHODS Forty-eight hemiparetic subjects (age: 58.9 ± 16.1 years) were evaluated at weeks 3, 5, 8, and 12 poststroke. Motor impairments concerned the Fugl-Meyer assessment (FM-LE) and Motricity Index total score (MI-LE) or ankle item separately (MI-ankle). Postural stability during quiet 2-legged stance was calculated as the net center-of-pressure area (COPArea) and direction-dependent velocities (COPVel-ML and COPVel-AP). Dynamic control asymmetry (DCA) and weight-bearing asymmetry (WBA) estimated inter-limb symmetries in balance control and loading. Linear mixed models determined (1) time-dependent change and (2) the between- and within-subject associations between motor impairments and postural stability or inter-limb symmetry. RESULTS Time-dependent improvements were significant for FM-LE, MI-LE, MI-ankle, COPArea, COPVel-ML, and COPVel-AP, and tended to plateau by week 8. DCA and WBA did not exhibit significant change. Between-subject analyses yielded significant regression coefficients for FM-LE, MI-LE, and MI-ankle scores with COPArea, COPVel-ML, and COPVel-AP up until week 8, and with WBA until week 12. Within-subject regression coefficients of motor recovery with change in COPArea, COPVel-ML, COPVel-AP, DCA, or WBA were generally non-significant. CONCLUSIONS Postural stability improved significantly in the first 8 weeks poststroke, independent of lower limb motor recovery at the most affected side within subjects. Our findings suggest that subjects preferred to compensate with their less affected side, making metrics reflecting inter-limb asymmetries in balance invariant for change early poststroke.Clinical Trial Registration: Clinicaltrials.gov. unique identifier NCT03728036.
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Affiliation(s)
- Jonas Schröder
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Antwerp, Belgium
| | - Wim Saeys
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Antwerp, Belgium
- Department of Neurorehabilitation, RevArte Rehabilitation Hospital, Edegem, Belgium
| | - Elissa Embrechts
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Antwerp, Belgium
| | - Ann Hallemans
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Antwerp, Belgium
| | - Laetitia Yperzeele
- Neurovascular Center Antwerp and Stroke Unit, Department of Neurology, Antwerp University Hospital, Antwerp, Belgium
- Research Group on Translational Neurosciences, University of Antwerp, Antwerp, Belgium
| | - Steven Truijen
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Antwerp, Belgium
| | - Gert Kwakkel
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
- Amsterdam Rehabilitation Research Centre Reade, Amsterdam, The Netherlands
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23
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Evancho A, Tyler WJ, McGregor K. A review of combined neuromodulation and physical therapy interventions for enhanced neurorehabilitation. Front Hum Neurosci 2023; 17:1151218. [PMID: 37545593 PMCID: PMC10400781 DOI: 10.3389/fnhum.2023.1151218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 06/30/2023] [Indexed: 08/08/2023] Open
Abstract
Rehabilitation approaches for individuals with neurologic conditions have increasingly shifted toward promoting neuroplasticity for enhanced recovery and restoration of function. This review focuses on exercise strategies and non-invasive neuromodulation techniques that target neuroplasticity, including transcranial magnetic stimulation (TMS), vagus nerve stimulation (VNS), and peripheral nerve stimulation (PNS). We have chosen to focus on non-invasive neuromodulation techniques due to their greater potential for integration into routine clinical practice. We explore and discuss the application of these interventional strategies in four neurological conditions that are frequently encountered in rehabilitation settings: Parkinson's Disease (PD), Traumatic Brain Injury (TBI), stroke, and Spinal Cord Injury (SCI). Additionally, we discuss the potential benefits of combining non-invasive neuromodulation with rehabilitation, which has shown promise in accelerating recovery. Our review identifies studies that demonstrate enhanced recovery through combined exercise and non-invasive neuromodulation in the selected patient populations. We primarily focus on the motor aspects of rehabilitation, but also briefly address non-motor impacts of these conditions. Additionally, we identify the gaps in current literature and barriers to implementation of combined approaches into clinical practice. We highlight areas needing further research and suggest avenues for future investigation, aiming to enhance the personalization of the unique neuroplastic responses associated with each condition. This review serves as a resource for rehabilitation professionals and researchers seeking a comprehensive understanding of neuroplastic exercise interventions and non-invasive neuromodulation techniques tailored for specific diseases and diagnoses.
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Affiliation(s)
- Alexandra Evancho
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - William J. Tyler
- Department of Biomedical Engineering, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
- Department of Physical Medicine and Rehabilitation, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Keith McGregor
- Department of Clinical and Diagnostic Studies, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
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24
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Elmanowski J, Seelen H, Geers R, Kleynen M, Verbunt J. Effects of a remote-handling-concept-based task-oriented arm training (ReHab-TOAT) on arm-hand skill performance in chronic stroke: a study protocol for a two-armed randomized controlled trial. Trials 2023; 24:189. [PMID: 36918922 PMCID: PMC10012705 DOI: 10.1186/s13063-023-07139-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 02/07/2023] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND Improving arm-hand skill performance is a major therapeutic target in stroke rehabilitation and needs intensive and varied training. However, guided treatment time is limited. Technology can assist in the training of patients, offering a higher intensity and more variety in content. A new task-oriented arm training approach was developed, using a 'Remote Handling concept based' device to provide haptic feedback during the performance of daily living activities (ReHab-TOAT). This study aims to investigate the effects of ReHab-TOAT on patients' arm-hand function and arm-hand skill performance, quality of life of both patients in the chronic phase after stroke and their caregivers and the patients' perception regarding the usability of the intervention. METHODS A randomized clinical trial was designed. Adult chronic stroke patients suffering from hemiparesis and arm-hand problems, with an Utrechtse Arm-hand Test score of 1-3, will be invited to participate. Participants in the experimental group receive ReHab-TOAT additional to care as usual. ReHab-TOAT contains task-oriented arm training for stroke patients in combination with haptic feedback, generated by a remote handling device. They will train for 4 weeks, 3× per week, 1.5h per day. Participants in the control group will receive no additional therapy apart from care as usual. The Fugl-Meyer Assessment (FMA), measuring participants' motor performance of the affected arm, is used as the primary outcome measure. Secondary outcome measures are arm-hand capacity of the patient (ARAT), perceived arm-hand skill performance (MAL), actual arm-hand skill performance (accelerometry), patients' quality of life (EuoQol-5D) and caregivers' quality of life (CarerQoL). Participants' perception regarding the usability of the intervention, including both the developed approach and technology used, will be evaluated by the System Usability Scale and a questionnaire on the user experience of technology. Measurements will be performed at 1, 2, 3 and 4 weeks pre-intervention (baseline); immediately post-intervention; and 3, 6 and 9 months post-intervention. Statistical analysis includes linear mixed model analysis. DISCUSSION This study is designed to investigate the evidence regarding the effects of ReHab-TOAT on patients' performance at different levels of the International Classification of Functioning, disability and health (ICF) model, i.e. a framework measuring functioning and disability in relation to a health condition, and to provide insights on a successful development and research process regarding technology-assisted training in co-creation. TRIAL REGISTRATION Netherlands Trial Register NL9541. Registered on June 22, 2021.
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Affiliation(s)
- Jule Elmanowski
- Department of Rehabilitation Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands. .,Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands. .,Adelante Rehabilitation Centre, Hoensbroek, the Netherlands.
| | - Henk Seelen
- Department of Rehabilitation Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.,Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
| | - Richard Geers
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
| | - Melanie Kleynen
- Research Centre for Nutrition, Lifestyle and Exercise, Faculty of Health, Zuyd University of Applied Sciences, Heerlen, the Netherlands
| | - Jeanine Verbunt
- Department of Rehabilitation Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.,Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
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25
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Lai YT, Huang HL, Hsieh CC, Lin CH, Yang JC, Tsou HH, Lin CC, Li SY, Chan HL, Liu WS. The Effects of Yoga Exercise on Blood Pressure and Hand Grip Strength in Chronic Stroke Patients: A Pilot Controlled Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1108. [PMID: 36673861 PMCID: PMC9859542 DOI: 10.3390/ijerph20021108] [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: 11/27/2022] [Revised: 12/31/2022] [Accepted: 01/03/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND We investigated the beneficial effect of add-on yoga with rehabilitation on blood pressure (BP) and hand grip strength in patients with chronic stroke (more than 90 days). METHODS The study included patients 30-80 years of age who could stand independently for 1 min. Patients with psychiatric diseases or undergoing other therapies (like acupuncture) were excluded. The yoga group received training (1 h session twice weekly) with standard rehabilitation for 8 weeks. The control group received standard rehabilitation only. There were no differences in age, gender, hand grip strength, or BP between the two groups (16 subjects in each group) at baseline. RESULTS The systolic BP (p = 0.01) decreased significantly, and the diastolic BP also decreased but not significantly in the yoga group (p = 0.11). For hand grip strength, both the unaffected hand (p = 0.00025) and the affected hand (p = 0.027) improved significantly. The control group showed no significant change in systolic or diastolic BP, nor did the grip strength change in both hands. Gender and age also affected the results of overall rehabilitation in that women benefited more from a decrease in BP, while men and young people (lower than the mean age of 60) benefited from hand grip strength improvement. CONCLUSIONS Combining yoga with rehabilitation in chronic stroke patients can improve hand grip strength and decrease systolic BP.
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Affiliation(s)
- Yen-Ting Lai
- Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei 100, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu 300, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hsin-Chu Hospital, Hsinchu 300, Taiwan
| | - Hsiao-Ling Huang
- Department of Healthcare Management, Yuanpei University of Medical Technology, No. 306, Yuanpei Street, Hsinchu 300, Taiwan
| | - City C. Hsieh
- Department of Kinesiology, Research Center for Education and Mind Sciences, National Tsing Hua University, Hsinchu 300, Taiwan
| | - Chien-Hung Lin
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei 112, Taiwan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan
- College of Science and Engineering, Fu Jen Catholic University, New Taipei City 242, Taiwan
| | - Jung-Cheng Yang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu 300, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hsin-Chu Hospital, Hsinchu 300, Taiwan
| | - Han-Hsing Tsou
- Institute of Food Safety and Health Risk Assessment, National Yang Ming Chiao Tung University, Hsinchu 112, Taiwan
| | - Chih-Ching Lin
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Szu-Yuan Li
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Hsiang-Lin Chan
- Department of Child Psychiatry, Chang Gung Memorial Hospital and University, Taoyuan 333, Taiwan
| | - Wen-Sheng Liu
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan
- College of Science and Engineering, Fu Jen Catholic University, New Taipei City 242, Taiwan
- Institute of Food Safety and Health Risk Assessment, National Yang Ming Chiao Tung University, Hsinchu 112, Taiwan
- Division of Nephrology, Department of Medicine, Taipei City Hospital, Zhongxing Branch, Taipei 103, Taiwan
- Department of Special Education, University of Taipei, Taipei 100, Taiwan
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26
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Vansteensel MJ, Branco MP, Leinders S, Freudenburg ZF, Schippers A, Geukes SH, Gaytant MA, Gosselaar PH, Aarnoutse EJ, Ramsey NF. Methodological Recommendations for Studies on the Daily Life Implementation of Implantable Communication-Brain-Computer Interfaces for Individuals With Locked-in Syndrome. Neurorehabil Neural Repair 2022; 36:666-677. [PMID: 36124975 DOI: 10.1177/15459683221125788] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Implantable brain-computer interfaces (BCIs) promise to be a viable means to restore communication in individuals with locked-in syndrome (LIS). In 2016, we presented the world-first fully implantable BCI system that uses subdural electrocorticography electrodes to record brain signals and a subcutaneous amplifier to transmit the signals to the outside world, and that enabled an individual with LIS to communicate via a tablet computer by selecting icons in spelling software. For future clinical implementation of implantable communication-BCIs, however, much work is still needed, for example, to validate these systems in daily life settings with more participants, and to improve the speed of communication. We believe the design and execution of future studies on these and other topics may benefit from the experience we have gained. Therefore, based on relevant literature and our own experiences, we here provide an overview of procedures, as well as recommendations, for recruitment, screening, inclusion, imaging, hospital admission, implantation, training, and support of participants with LIS, for studies on daily life implementation of implantable communication-BCIs. With this article, we not only aim to inform the BCI community about important topics of concern, but also hope to contribute to improved methodological standardization of implantable BCI research.
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Affiliation(s)
- Mariska J Vansteensel
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mariana P Branco
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sacha Leinders
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Zac F Freudenburg
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anouck Schippers
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Simon H Geukes
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michael A Gaytant
- Department of Pulmonary Diseases/Home Mechanical Ventilation, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Peter H Gosselaar
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Erik J Aarnoutse
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nick F Ramsey
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
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Lai MW, Yang CH, Sung PY, Tsai SW. Intravascular Laser Irradiation of Blood Improves Functional Independence in Subacute Post-Stroke Patients: A Retrospective Observational Study from a Post-Stroke Acute Care Center in Taiwan. Photobiomodul Photomed Laser Surg 2022; 40:691-697. [DOI: 10.1089/photob.2022.0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Affiliation(s)
- Ming-Wei Lai
- Department of Physical Medicine and Rehabilitation, and Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung City, Taiwan
- Department of Post-Acute Care Center, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung City, Taiwan
| | - Chia-Hsin Yang
- Department of Physical Medicine and Rehabilitation, and Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung City, Taiwan
- Department of Post-Acute Care Center, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung City, Taiwan
| | - Pi-Yu Sung
- Department of Physical Medicine and Rehabilitation, and Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung City, Taiwan
- Department of Post-Acute Care Center, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung City, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Sen-Wei Tsai
- Department of Physical Medicine and Rehabilitation, and Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung City, Taiwan
- Department of Post-Acute Care Center, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung City, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, Tzu Chi University, Hualien, Taiwan
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Buvarp D, Rafsten L, Abzhandadze T, Sunnerhagen KS. A cohort study on longitudinal changes in postural balance during the first year after stroke. BMC Neurol 2022; 22:324. [PMID: 36042404 PMCID: PMC9425943 DOI: 10.1186/s12883-022-02851-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 08/24/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Many patients with strokes report increased incidence of fall that can be due to impaired postural balance. The recovery of balance in patients with varying degrees of impairments and activity limitations is less studied, and whether individuals with mild paresis can recover their balance faster is unclear. Better knowledge about factors influencing the recovery of postural balance can be used to guide clinical management after stroke to provide the right rehabilitation to the right person at the right time, and thus to avoid potential fall incidences. OBJECTIVE This study aims to examine longitudinal changes in postural balance during the first year after stroke. METHODS Postural balance was assessed using the Berg Balance Scale (BBS) within 5 days, 1, 2, and 3 months and 1-year post-stroke. Stroke severity was stratified using a cluster analysis by including multidimensional baseline measures. A longitudinal mixed-effect model was constructed to analyze changes in proportional balance impairment by stroke severity over time. Individuals with a cut-off of BBS below 45 scores were identified through a classification algorithm using baseline predictors. RESULTS A total of 135 patients were stratified to mild stroke (77 [57%] patients) or moderate stroke (58 [43%] patients). Ninety-three patients were included in the longitudinal analysis. Significant recovery was found at 1-year for moderate stroke (48% recovery from the initial impaired postural balance, adjusted P < 0.001), but not for mild stroke, after adjusting for age and cognition. Both stroke severities had a maximal recovery in postural balance at 3 months post-stroke, but the moderate stroke group deteriorated after that. Patients with higher age and worse cognition had more severe balance impairments. The classification model achieved a sensitivity of 0.95 (95% confidence interval [CI]: 0.91-0.98) and a specificity of 0.99 (95% CI: 0.98-1.0) for classifying individuals with BBS below 45 points. CONCLUSIONS This study indicates that continuous improvements in postural balance ends at 3 months regardless for mild or moderate stroke groups, and patients with moderate stroke significantly deteriorate in postural balance after 3 months.
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Affiliation(s)
- Dongni Buvarp
- Rehabilitation Medicine Research Group, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Per Dubbsgatan 14, 40530, Gothenburg, Sweden. .,Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Lena Rafsten
- Rehabilitation Medicine Research Group, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Per Dubbsgatan 14, 40530, Gothenburg, Sweden.,Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Tamar Abzhandadze
- Rehabilitation Medicine Research Group, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Per Dubbsgatan 14, 40530, Gothenburg, Sweden.,Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Katharina S Sunnerhagen
- Rehabilitation Medicine Research Group, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Per Dubbsgatan 14, 40530, Gothenburg, Sweden.,Sahlgrenska University Hospital, Gothenburg, Sweden
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Böttger T, Dennhardt S, Knape J, Marotzki U. "Back into Life-With a Power Wheelchair": Learning from People with Severe Stroke through a Participatory Photovoice Study in a Metropolitan Area in Germany. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10465. [PMID: 36078184 PMCID: PMC9518532 DOI: 10.3390/ijerph191710465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 06/15/2023]
Abstract
Severe stroke leads to permanent changes in everyday life. Many stroke survivors depend on support in community mobility (CM). This leads to restrictions and limited social participation. A power wheelchair (PWC) can enable independent CM and reduce such restrictions. This participatory study focused on how people with severe stroke experience their CM in a PWC in Berlin/Germany and what changes they want to initiate. A research team of five severe stroke survivors and two occupational therapists examined the question using photovoice. Stroke survivors took photos of their environment, presented, discussed, and analyzed them at group meetings to identify themes, and disseminated their findings at exhibitions and congresses. The photos emphasize the significance of and unique relationship to the PWC for the self-determined expression of personal freedom. As a complex, individualized construct, CM requires an accessible environment and diverse planning strategies by PWC users to arrive at their destination and overcome suddenly occurring obstacles. Desired changes stress CM independent of external help, increased social esteem, and active involvement in the provision of assistive devices. Voices of severe stroke survivors need to be heard more in healthcare and research to ensure the possibility of equal social participation.
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Affiliation(s)
- Tabea Böttger
- Institute of Health Science, Faculty of Medicine, University of Lübeck, 23562 Lübeck, Germany
- Faculty of Social Work and Health, University of Applied Sciences and Arts Hildesheim, Holzminden, Göttingen (HAWK), 31134 Hildesheim, Germany
| | - Silke Dennhardt
- Physio- and Occupational Therapy Program, Faculty of Health, Alice Salomon Hochschule Berlin (ASH), University of Applied Sciences, 12627 Berlin, Germany
| | - Julia Knape
- Independent Researcher, 10439 Berlin, Germany
| | - Ulrike Marotzki
- Faculty of Social Work and Health, University of Applied Sciences and Arts Hildesheim, Holzminden, Göttingen (HAWK), 31134 Hildesheim, Germany
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30
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Joundi RA, Adekanye J, Leung AA, Ronksley P, Smith EE, Rebchuk AD, Field TS, Hill MD, Wilton SB, Bresee LC. Health State Utility Values in People With Stroke: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2022; 11:e024296. [PMID: 35730598 PMCID: PMC9333363 DOI: 10.1161/jaha.121.024296] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/21/2022] [Indexed: 12/25/2022]
Abstract
Background Health state utility values are commonly used to provide summary measures of health-related quality of life in studies of stroke. Contemporaneous summaries are needed as a benchmark to contextualize future observational studies and inform the effectiveness of interventions aimed at improving post-stroke quality of life. Methods and Results We conducted a systematic search of the literature using Medline, EMBASE, and Web of Science from January 1995 until October 2020 using search terms for stroke, health-related quality of life, and indirect health utility metrics. We calculated pooled estimates of health utility values for EQ-5D-3L, EQ-5D-5L, AQoL, HUI2, HUI3, 15D, and SF-6D using random effects models. For the EQ-5D-3L we conducted stratified meta-analyses and meta-regression by key subgroups. We screened 14 251 abstracts and 111 studies met our inclusion criteria (sample size range 11 to 12 447). EQ-5D-3L was reported in 78% of studies (study n=87; patient n=56 976). The pooled estimate for EQ-5D-3L at ≥3 months following stroke was 0.65 (95% CI, 0.63-0.67), which was ≈20% below population norms. There was high heterogeneity (I2>90%) between studies, and estimates differed by study size, case definition of stroke, and country of study. Women, older individuals, those with hemorrhagic stroke, and patients prior to discharge had lower pooled EQ-5D-3L estimates. Conclusions Pooled estimates of health utility for stroke survivors were substantially below population averages. We provide reference values for health utility in stroke to support future clinical and economic studies and identify subgroups with lower healthy utility. Registration URL: https://www.crd.york.ac.uk/prospero/. Unique Identifier: CRD42020215942.
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Affiliation(s)
- Raed A. Joundi
- Department of Clinical NeurosciencesUniversity of CalgaryAlbertaCanada
- Division of NeurologyHamilton Health SciencesMcMaster University & Population Health Research InstituteHamiltonOntarioCanada
| | | | | | | | | | | | - Thalia S. Field
- University of British ColumbiaVancouverBritish ColumbiaCanada
| | | | | | - Lauren C. Bresee
- Department of Community Health SciencesUniversity of CalgaryAlbertaCanada
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Humphries JB, Mattos DJS, Rutlin J, Daniel AGS, Rybczynski K, Notestine T, Shimony JS, Burton H, Carter A, Leuthardt EC. Motor Network Reorganization Induced in Chronic Stroke Patients with the Use of a Contralesionally-Controlled Brain Computer Interface. BRAIN-COMPUTER INTERFACES 2022. [DOI: 10.1080/2326263x.2022.2057757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Joseph B. Humphries
- Departments of Neurosurgery, Washington University in St. Louis, St. Louis, MO, USA
| | | | - Jerrel Rutlin
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Andy G. S. Daniel
- Departments of Neurosurgery, Washington University in St. Louis, St. Louis, MO, USA
| | | | - Theresa Notestine
- Neurosurgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Joshua S. Shimony
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Harold Burton
- Neuroscience, Washington University in St. Louis, St. Louis, MO, USA
| | - Alexandre Carter
- Neurology, Washington University in St. Louis, St. Louis, MO, USA
| | - Eric C. Leuthardt
- Departments of Neurosurgery, Washington University in St. Louis, St. Louis, MO, USA
- Neurosurgery, Washington University in St. Louis, St. Louis, MO, USA
- Neuroscience, Washington University in St. Louis, St. Louis, MO, USA
- Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, MO, USA
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Improving outcomes for care partners of persons with traumatic brain injury: Protocol for a randomized control trial of a just-in-time-adaptive self-management intervention. PLoS One 2022; 17:e0268726. [PMID: 35679283 PMCID: PMC9182304 DOI: 10.1371/journal.pone.0268726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 03/29/2022] [Indexed: 01/08/2023] Open
Abstract
Informal family care partners of persons with traumatic brain injury (TBI) often experience intense stress resulting from their caregiver role. As such, there is a need for low burden, and easy to engage in interventions to improve health-related quality of life (HRQOL) for these care partners. This study is designed to evaluate the effectiveness of a personalized just-in-time adaptive intervention (JITAI) aimed at improving the HRQOL of care partners. Participants are randomized either to a control group, where they wear the Fitbit® and provide daily reports of HRQOL over a six-month (180 day) period (without the personalized feedback), or the JITAI group, where they wear the Fitbit®, provide daily reports of HRQOL and receive personalized self-management pushes for 6 months. 240 participants will be enrolled (n = 120 control group; n = 120 JITAI group). Outcomes are collected at baseline, 1-, 2-, 3-, 4-, 5- & 6-months, as well as 3- and 6-months post intervention. We hypothesize that the care partners who receive the intervention (JITAI group) will show improvements in caregiver strain (primary outcome) and mental health (depression and anxiety) after the 6-month (180 day) home monitoring period. Participant recruitment for this study started in November 2020. Data collection efforts should be completed by spring 2025; results are expected by winter 2025. At the conclusion of this randomized control trial, we will be able to identify care partners at greatest risk for negative physical and mental health outcomes, and will have demonstrated the efficacy of this JITAI intervention to improve HRQOL for these care partners. Trial registration: ClinicalTrial.gov NCT04570930; https://clinicaltrials.gov/ct2/show/NCT04570930.
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Norvang OP, Dahl AE, Thingstad P, Askim T. Resilience and Its Association With Activities of Daily Living 3 Months After Stroke. Front Neurol 2022; 13:881621. [PMID: 35775055 PMCID: PMC9237386 DOI: 10.3389/fneur.2022.881621] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 04/19/2022] [Indexed: 12/03/2022] Open
Abstract
Independence in basic activities of daily living (ADL) is an important outcome after stroke. Identifying factors associated with independence can contribute to improve post-stroke rehabilitation. Resilience, which is the ability of coping with a serious event, might be such a factor. Still, the impact of resilience and its role in rehabilitation after stroke is poorly investigated. Hence, the purpose of this study was to assess whether resilience assessed early after stroke can be associated with independence in basic ADL 3 months later. Hospitalized patients with a diagnosed acute stroke and a modified Rankin Scale score ≤ 4 were included. Bivariate and multivariate linear regression were applied to assess whether resilience as measured by the Brief Resilience Scale within the first 2 weeks after stroke was associated with basic ADL measured by Barthel Index at 3-month follow-up. Age, sex, fatigue, stroke severity at admission and pre-stroke disability were added as covariates. Sixty-four participants (35 (54.7%) male), aged 75.9 (SD 8.6) years were included 4.3 (SD 2.8) days after stroke. There was no significant change in resilience from baseline 3.1 (SD 0.3) to 3 months later 3.2 (SD 0.5). Resilience was not associated with basic ADL in neither the bivariate (b = 2.01, 95% CI −5.21, 9.23, p = 0.580) nor in the multivariate regression models (b = 0.50, 95% CI −4.87, 6.88, p = 0.853). Our results showed that resilience remained stable during follow-up. Early measurement of resilience was not associated with independence in basic activities of daily living 3 months after stroke. These results, indicate that resilience is a personal trait not associated with the outcome of physical adversity. However, future research should investigate whether resilience is related to the outcomes of psychosocial adversity after a stroke.
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Affiliation(s)
- Ole Petter Norvang
- Department of Neuromedicine and Movement Science, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Clinical Services, Department of Physiotherapy, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- *Correspondence: Ole Petter Norvang
| | - Anne Eitrem Dahl
- Clinical Services, Department of Physiotherapy, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Pernille Thingstad
- Department of Neuromedicine and Movement Science, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Torunn Askim
- Department of Neuromedicine and Movement Science, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Stroke Unit, Department of Medicine, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Rustamov N, Humphries J, Carter A, Leuthardt EC. Theta-gamma coupling as a cortical biomarker of brain-computer interface-mediated motor recovery in chronic stroke. Brain Commun 2022; 4:fcac136. [PMID: 35702730 PMCID: PMC9188323 DOI: 10.1093/braincomms/fcac136] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 03/19/2022] [Accepted: 05/23/2022] [Indexed: 11/15/2022] Open
Abstract
Chronic stroke patients with upper-limb motor disabilities are now beginning to see treatment options that were not previously available. To date, the two options recently approved by the United States Food and Drug Administration include vagus nerve stimulation and brain-computer interface therapy. While the mechanisms for vagus nerve stimulation have been well defined, the mechanisms underlying brain-computer interface-driven motor rehabilitation are largely unknown. Given that cross-frequency coupling has been associated with a wide variety of higher-order functions involved in learning and memory, we hypothesized this rhythm-specific mechanism would correlate with the functional improvements effected by a brain-computer interface. This study investigated whether the motor improvements in chronic stroke patients induced with a brain-computer interface therapy are associated with alterations in phase-amplitude coupling, a type of cross-frequency coupling. Seventeen chronic hemiparetic stroke patients used a robotic hand orthosis controlled with contralesional motor cortical signals measured with EEG. Patients regularly performed a therapeutic brain-computer interface task for 12 weeks. Resting-state EEG recordings and motor function data were acquired before initiating brain-computer interface therapy and once every 4 weeks after the therapy. Changes in phase-amplitude coupling values were assessed and correlated with motor function improvements. To establish whether coupling between two different frequency bands was more functionally important than either of those rhythms alone, we calculated power spectra as well. We found that theta-gamma coupling was enhanced bilaterally at the motor areas and showed significant correlations across brain-computer interface therapy sessions. Importantly, an increase in theta-gamma coupling positively correlated with motor recovery over the course of rehabilitation. The sources of theta-gamma coupling increase following brain-computer interface therapy were mostly located in the hand regions of the primary motor cortex on the left and right cerebral hemispheres. Beta-gamma coupling decreased bilaterally at the frontal areas following the therapy, but these effects did not correlate with motor recovery. Alpha-gamma coupling was not altered by brain-computer interface therapy. Power spectra did not change significantly over the course of the brain-computer interface therapy. The significant functional improvement in chronic stroke patients induced by brain-computer interface therapy was strongly correlated with increased theta-gamma coupling in bihemispheric motor regions. These findings support the notion that specific cross-frequency coupling dynamics in the brain likely play a mechanistic role in mediating motor recovery in the chronic phase of stroke recovery.
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Affiliation(s)
- Nabi Rustamov
- Department of Neurological Surgery, Washington University School of Medicine, St Louis, MO, USA
- Center for Innovation in Neuroscience and Technology, Washington University School of Medicine, St Louis, MO, USA
| | - Joseph Humphries
- Department of Biomedical Engineering, Washington University in St Louis, St Louis, MO, USA
| | - Alexandre Carter
- Department of Neurology, Washington University in St Louis, St Louis, MO, USA
| | - Eric C. Leuthardt
- Department of Neurological Surgery, Washington University School of Medicine, St Louis, MO, USA
- Center for Innovation in Neuroscience and Technology, Washington University School of Medicine, St Louis, MO, USA
- Department of Biomedical Engineering, Washington University in St Louis, St Louis, MO, USA
- Department of Neuroscience, Washington University School of Medicine, St Louis, MO, USA
- Department of Mechanical Engineering and Materials Science, Washington University in St Louis, St Louis, MO, USA
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Wang L, Ge J, Chen Y, Liu Y, Li C, Dong Y, Liu L, Xing Y. Predictors for the prognosis and recurrence of ischaemic stroke among young Chinese patients: a cohort study. BMJ Open 2022; 12:e052289. [PMID: 35501080 PMCID: PMC9062810 DOI: 10.1136/bmjopen-2021-052289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To identify predictors of young Chinese patients with ischaemic stroke outcome and recurrence of stroke. DESIGN Through considered the risk factors, neuroimaging findings, distribution, vascular stenosis, and the post-stroke treatment of young Chinese patients with ischemic stroke. SETTING The First Hospital of Jilin University. PARTICIPANTS We enrolled 579 patients (median age 45 years, range 15-49, men 81.0%) treated for the first occurrence of ischaemic stroke between January 2014 and December 2017. MAIN OUTCOME MEASURES We assessed stroke outcome based on the modified Rankin Scale (mRS) scores and recurrence of cerebrovascular events at 12 months. Multivariate logistic regression was used to identify the independent predictors of unfavourable outcomes (mRS score ≥2) and recurrence. RESULTS We observed stenosis in 295 patients (50.9%)-middle cerebral artery stenosis was the most common (18.1%). Of all 579 included patients, normal or mild, moderate and severe stenoses or occlusions were observed in 51.8%, 6.0% and 42.1% of patients, respectively. Unfavourable outcomes were observed in 91 patients (15.7%), including 10 patients (1.7%) who died. The rate of stroke recurrence was 7.9%. Independent predictors of unfavourable outcomes included a high National Institutes of Health Stroke Scale score (OR 1.151, 95% CI 1.094 to 1.210; p<0.001) and severe vascular stenosis or occlusion (OR 1.867, 95% CI 1.181 to 2.952; p=0.008). Predictors of recurrence included age of ≥45 years (OR 2.072, 95% CI 1.066 to 4.025; p=0.032) and atrial fibrillation (OR 15.207, 95% CI 4.273 to 54.120; p<0.001). CONCLUSIONS Our research shows that when developing prevention strategies for young people, measures that focus on mitigating risk factors should be considered. In addition, vascular screening of young populations is also of vital importance for stroke prevention and poor prognosis prediction.
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Affiliation(s)
- Lijuan Wang
- Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Jiaojiao Ge
- Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Ying Chen
- Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Ying Liu
- Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Cong Li
- Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Yanan Dong
- Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Li Liu
- Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin, China
- Department of Neurology, Changchun People's Hospital, Changchun, Jilin, China
| | - Yingqi Xing
- Department of Vascular Ultrasonography, Xuanwu Hospital Capital Medical University, Beijing, China
- Center of Vascular Ultrasonography, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China
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Kokorelias KM, Nelson MLA, Cameron JI, Colquhoun H, Munce S, Hitzig SL, Salbach NM, Martyniuk J, Steele Gray C, Tang T, Wang RH, Lindsay P, Bayley M, Kaur N, Singh H. Exploring the poststroke experiences and unmet needs of South Asian communities in high-income countries: a scoping review protocol. BMJ Open 2022; 12:e059017. [PMID: 35477869 PMCID: PMC9047763 DOI: 10.1136/bmjopen-2021-059017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION South Asian groups experience a higher burden of stroke and poorer functional outcomes after stroke than their White counterparts. However, within the stroke literature, there has been little focus on the unique poststroke needs of the South Asian community and opportunities for community-based services to address these needs. RESEARCH QUESTION What is the current knowledge base related to the experiences and needs, including unmet needs of people living with stroke and their caregivers from South Asian communities living in high-income countries? AIMS This is a protocol for a review that intends to synthesise existing studies of the poststroke experiences and needs of individuals from South Asian communities to uncover opportunities for community-based resources to address these needs. METHODS AND ANALYSIS This scoping review methodology will be guided by modified Arksey and O'Malley (2005) and Joanna Briggs Institute frameworks. A search on OVID Medline, OVID Embase, OVID PsycINFO, EBSCO CINAHL, the Cochrane Library, Scopus and Global Index Medicus will be conducted to synthesise existing peer-reviewed literature (all study designs). Grey literature will be searched through detailed hand searching. Literature focusing on the poststroke experiences and needs of South Asian groups impacted by stroke residing in high-income countries will be included. Study descriptors will be extracted (eg, study location, type, methodology). Data will be analysed descriptively and thematically. Team meetings will provide opportunities for peer debriefing, thereby enhancing analytic rigour. CONCLUSION AND IMPLICATIONS Findings will enhance knowledge of the poststroke experiences and needs of South Asian communities living in high-income countries and identify actionable opportunities for community-based resources to address needs. ETHICS AND DISSEMINATION Ethics approval was not required for this scoping review protocol. Community-based organisations will be consulted to provide insights into the analysis and assist with dissemination. Dissemination of findings will also occur through a publication and academic presentations.
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Affiliation(s)
- Kristina M Kokorelias
- St John's Rehab Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Michelle L A Nelson
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Jill I Cameron
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- KITE - Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
- Rehabiliation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Heather Colquhoun
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Rehabiliation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Munce
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- KITE - Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
- Rehabiliation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sander L Hitzig
- St John's Rehab Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Rehabiliation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nancy M Salbach
- KITE - Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
- Rehabiliation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Julia Martyniuk
- Gerstein Science Information Centre, University of Toronto, Toronto, Ontario, Canada
| | - Carolyn Steele Gray
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Terence Tang
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rosalie H Wang
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- KITE - Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
- Rehabiliation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Patrice Lindsay
- Heart and Stroke Foundation of Canada, Toronto, Ontario, Canada
| | - Mark Bayley
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
- KITE - Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
- Rehabiliation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
| | - Navaldeep Kaur
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Hardeep Singh
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- KITE - Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
- Rehabiliation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Gardener H, Romano LA, Smith EE, Campo-Bustillo I, Khan Y, Tai S, Riley N, Sacco RL, Khatri P, Alger HM, Mac Grory B, Gulati D, Sangha NS, Olds KE, Benesch CG, Kelly AG, Brehaut SS, Kansara AC, Schwamm LH, Romano JG. Functional status at 30 and 90 days after mild ischaemic stroke. Stroke Vasc Neurol 2022; 7:svn-2021-001333. [PMID: 35474180 PMCID: PMC9614160 DOI: 10.1136/svn-2021-001333] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 03/23/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND/OBJECTIVE This study compares the global disability status of patients who had a mild ischaemic stroke at 30 and 90 days poststroke, as measured by the modified Rankin Scale (mRS), and identifies predictors of change in disability status between 30 and 90 days. METHODS The study population included 1339 patients who had a ischaemic stroke enrolled in the Mild and Rapidly Improving Stroke Study with National Institutes of Health (NIH) stroke score 0-5 and mRS measurements at 30 and 90 days. Outcomes were (1) Improvement defined as having mRS >1 at 30 days and mRS 0-1 at 90 days OR mRS >2 at 30 days and mRS 0-2 at 90 days and (2) Worsening defined as an increase of ≥2 points or a worsening from mRS of 1 at 30 days to 2 at 90 days. Demographic and clinical characteristics at hospital arrival were abstracted from medical records, and regression models were used to identify predictors of functional improvement and decline from 30 to 90 days post-stroke. Significant predictors were mutually adjusted in multivariable models that also included age and stroke severity. RESULTS Fifty-seven per cent of study participants had no change in mRS value from 30 to 90 days. Overall, there was moderate agreement in mRS between the two time points (weighted kappa=0.59 (95% CI 0.56 to 0.62)). However, worsening on the mRS was observed in 7.54% of the study population from 30 to 90 days, and 17.33% improved. Participants of older age (per year OR 1.02, 95% CI 1.00 to 1.03), greater stroke severity (per NIH Stroke Scale (NIHSS) point at admission OR 1.17, 95% CI 1.03 to 1.34), and those with no alteplase treatment (OR 1.72, 95% CI 1.11 to 2.69) were more likely to show functional decline after mutual adjustment. DISCUSSION A quarter of all mild ischaemic stroke participants exhibited functional changes between 30 and 90 days, suggesting that the 30-day outcome may insufficiently represent long-term recovery in mild stroke and longer follow-up may be clinically necessary. TRIAL REGISTRATION NUMBER NCT02072681.
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Affiliation(s)
- Hannah Gardener
- Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Leo A Romano
- Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Eric E Smith
- Hotchkiss Brain Institute, Univ Calgary, Calgary, Alberta, Canada
| | | | - Yosef Khan
- American Heart Association, American Heart Association, Dallas, Texas, USA
| | - Sofie Tai
- American Heart Association, American Heart Association, Dallas, Texas, USA
| | - Nikesha Riley
- American Heart Association, American Heart Association, Dallas, Texas, USA
| | - Ralph L Sacco
- Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Pooja Khatri
- Neurology and Rehabilitation Medicine, Univ Cincinnati, Cincinnati, Ohio, USA
| | - Heather M Alger
- American Heart Association, American Heart Association, Dallas, Texas, USA
| | - Brian Mac Grory
- Neurology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Deepak Gulati
- Neurology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Neurology, Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Navdeep S Sangha
- Neurology, Los Angeles Medical Center, Los Angeles, California, USA
| | - Karin E Olds
- Neurology, St Luke's Hospital, Kansas City, Missouri, USA
| | | | - Adam G Kelly
- Neurology, University of Rochester, Rochester, New York, USA
| | - Scott S Brehaut
- Stroke Center, Faxton St. Luke's Healthcare, Utica, New York, USA
| | - Amit C Kansara
- Neurology, Providence St Vincent Medical Center, Portland, Oregon, USA
| | - Lee H Schwamm
- Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jose G Romano
- Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
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Hadjiosif AM, Branscheidt M, Anaya MA, Runnalls KD, Keller J, Bastian AJ, Celnik PA, Krakauer JW. Dissociation between abnormal motor synergies and impaired reaching dexterity after stroke. J Neurophysiol 2022; 127:856-868. [PMID: 35108107 PMCID: PMC8957333 DOI: 10.1152/jn.00447.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/23/2021] [Accepted: 01/12/2022] [Indexed: 11/22/2022] Open
Abstract
Most patients with stroke experience motor deficits, usually referred to collectively as hemiparesis. Although hemiparesis is one of the most common and clinically recognizable motor abnormalities, it remains undercharacterized in terms of its behavioral subcomponents and their interactions. Hemiparesis comprises both negative and positive motor signs. Negative signs consist of weakness and loss of motor control (dexterity), whereas positive signs consist of spasticity, abnormal resting posture, and intrusive movement synergies (abnormal muscle co-activations during voluntary movement). How positive and negative signs interact, and whether a common mechanism generates them, remains poorly understood. Here, we used a planar, arm-supported reaching task to assess poststroke arm dexterity loss, which we compared with the Fugl-Meyer stroke scale; a measure primarily reflecting abnormal synergies. We examined 53 patients with hemiparesis after a first-time ischemic stroke. Reaching kinematics were markedly more impaired in patients with subacute (<3 mo) compared to chronic (>6 mo) stroke even for similar Fugl-Meyer scores. This suggests a dissociation between abnormal synergies (reflected in the Fugl-Meyer scale) and loss of dexterity, which in turn suggests different underlying mechanisms. Moreover, dynamometry suggested that Fugl-Meyer scores capture weakness as well as abnormal synergies, in line with these two deficits sharing a neural substrate. These findings have two important implications: First, clinical studies that test for efficacy of rehabilitation interventions should specify which component of hemiparesis they are targeting and how they propose to measure it. Metrics used widely for this purpose may not always be chosen appropriately. For example, as we show here, the Fugl-Meyer score may capture some hemiparesis components (abnormal synergies and weakness) but not others (loss of dexterity). Second, there may be an opportunity to design rehabilitation interventions to address specific subcomponents of hemiparesis.NEW & NOTEWORTHY Motor impairment is common after stroke and comprises reduced dexterity, weakness, and abnormal muscle synergies. Here we report that, when matched on an established synergy and weakness scale (Fugl-Meyer), patients with subacute stroke have worse reaching dexterity than chronic ones. This result suggests that the components of hemiparesis are dissociable and have separable mechanisms and, thus, may require distinct assessments and treatments.
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Affiliation(s)
- Alkis M Hadjiosif
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland
| | - Meret Branscheidt
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland
- Cereneo Center for Research and Neurorehabilitation, Weggis, Switzerland
| | - Manuel A Anaya
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland
| | - Keith D Runnalls
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland
| | | | - Amy J Bastian
- Department of Neuroscience, Johns Hopkins University, Baltimore, Maryland
- Kennedy Krieger Institute, Baltimore, Maryland
| | - Pablo A Celnik
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland
| | - John W Krakauer
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland
- Department of Neuroscience, Johns Hopkins University, Baltimore, Maryland
- Santa Fe Institute, Santa Fe, New Mexico
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Medina-Mirapeix F, Crisostomo MJ, Martín San Agustín R, Sánchez-Martínez MP. Prognostic value of balance performance for improvements of community ambulation among stroke patients: a cohort study. Eur J Phys Rehabil Med 2022; 58:171-178. [PMID: 34498829 PMCID: PMC9980493 DOI: 10.23736/s1973-9087.21.06996-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Despite the positive impact of improving the level of community ambulation among stroke patients, little prognostic research has focused on this indicator. AIM To investigate the prognostic value of the side-by-side, semi-tandem, and tandem standing balance positions and the five-sit-stand (5STS) test for discriminating patients undergoing physical rehabilitation who improve level of functional ambulation and predicting transition time. DESIGN A cohort study with assessments repeated monthly until discharge for classifying patients in a community ambulation class. SETTING A neurological rehabilitation unit of a hospital in Spain. POPULATION A consecutive sample of 109 stroke patients (68.5±12.0 years) was screened and included within four months post stroke. Of them no one refused, 3 died, and 5 were lost earlier to transition or discharge. METHODS Balance tests, the 5STS and gait speed were measured at the center at baseline and monthly until discharge. Transition from household or limited community ambulation to a higher ambulatory capacity or class. Area under the curve (AUC) were used to compare discriminative abilities of the tests and Cox regression analysis to evaluate the association between the tests and time of transition. RESULTS For household non-ambulators, the semi-tandem was the best discriminative test (AUC=0.850) and the three balance tests showed an association with time to transition. Among the limited community ambulators, the 5STS test also revealed discriminative ability (AUC: 0.822 [0.63-1.00]), with a good prognostic cut-off (14.8 seconds) and association with time to transition (Hazard Ratio: 1.22; 95%CI: 1.05-1.43). CONCLUSIONS Semi-tandem and the 5STS tests can discriminate patients who improve level of functional ambulation and predict transition times within three months in non-ambulators and limited community ambulation patients, respectively. CLINICAL REHABILITATION IMPACT The semi-tandem and the 5STS tests can be performed easily in clinical settings to predict improvement of functional ambulation level in patients following stroke.
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Affiliation(s)
| | - M José Crisostomo
- Department of Rehabilitation, Jerez Hospital, Jerez de la Frontera, Spain
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Schröder J, Saeys W, Yperzeele L, Kwakkel G, Truijen S. Time Course and Mechanisms Underlying Standing Balance Recovery Early After Stroke: Design of a Prospective Cohort Study With Repeated Measurements. Front Neurol 2022; 13:781416. [PMID: 35265023 PMCID: PMC8899509 DOI: 10.3389/fneur.2022.781416] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/17/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Although most stroke survivors show some spontaneous neurological recovery from motor impairments of the most-affected leg, the contribution of this leg to standing balance control remains often poor. Consequently, it is unclear how spontaneous processes of neurological recovery contributes to early improvements in standing balance. Objective We aim to investigate (1) the time course of recovery of quiet stance balance control in the first 12 weeks poststroke and (2) how clinically observed improvements of lower limb motor impairments longitudinally relate to this limb's relative contribution to balance control. Methods and Analysis In this prospective longitudinal study, a cohort of 60 adults will be recruited within the first 3 weeks after a first-ever hemispheric stroke and mild-to-severe motor impairments. Individual recovery trajectories will be investigated by means of repeated measurements scheduled at 3, 5, 8, and 12 weeks poststroke. The Fugl-Meyer Motor Assessment and Motricity Index of the lower limb serve as clinical measures of motor impairments at the hemiplegic side. As soon as subjects are able to stand independently, bilateral posturography during quietly standing will be measured. First, the obtained center-of-pressure (COP) trajectories at each foot will be used for synchronization and contribution measures that establish (a-)symmetries between lower limbs. Second, the COP underneath both feet combined will be used to estimate overall stability. Random coefficient analyses will be used to model time-dependent changes in these measures and, subsequently, a hybrid model will be used to investigate longitudinal associations with improved motor impairments. Discussion The current study aims to investigate how stroke survivors "re-learn" to maintain standing balance as an integral part of daily life activities. The knowledge gained through this study may contribute to recommending treatment strategies for early stroke rehabilitation targeting behavioral restitution of the most-affected leg or learning to compensate with the less-affected leg.
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Affiliation(s)
- Jonas Schröder
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Health Sciences, University of Antwerp, Wilrijk, Belgium.,M2OCEAN Lab, The Multidisciplinary Motor Centre Antwerp, Faculty of Health Sciences, University of Antwerp, Edegem, Belgium
| | - Wim Saeys
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Health Sciences, University of Antwerp, Wilrijk, Belgium.,M2OCEAN Lab, The Multidisciplinary Motor Centre Antwerp, Faculty of Health Sciences, University of Antwerp, Edegem, Belgium.,RevArte Rehabilitation Hospital, Edegem, Belgium
| | - Laetitia Yperzeele
- Department of Neurology, Neurovascular Reference Center, Antwerp University Hospital, Edegem, Belgium.,Research Group Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Gert Kwakkel
- Department of Rehabilitation Medicine and Amsterdam Neuroscience, Amsterdam Movement Sciences, Amsterdam University Medical Centre, Amsterdam, Netherlands.,Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.,Department of Neurorehabilitation, Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, Netherlands
| | - Steven Truijen
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Health Sciences, University of Antwerp, Wilrijk, Belgium.,M2OCEAN Lab, The Multidisciplinary Motor Centre Antwerp, Faculty of Health Sciences, University of Antwerp, Edegem, Belgium
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Ciceron C, Sappey-Marinier D, Riffo P, Bellaiche S, Kocevar G, Hannoun S, Stamile C, Redoute J, Cotton F, Revol P, Andre-Obadia N, Luaute J, Rode G. Case Report: True Motor Recovery of Upper Limb Beyond 5 Years Post-stroke. Front Neurol 2022; 13:804528. [PMID: 35250813 PMCID: PMC8891374 DOI: 10.3389/fneur.2022.804528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/11/2022] [Indexed: 11/21/2022] Open
Abstract
Most of motor recovery usually occurs within the first 3 months after stroke. Herein is reported a remarkable late recovery of the right upper-limb motor function after a left middle cerebral artery stroke. This recovery happened progressively, from two to 12 years post-stroke onset, and along a proximo-distal gradient, including dissociated finger movements after 5 years. Standardized clinical assessment and quantified analysis of the reach-to-grasp movement were repeated over time to characterize the recovery. Twelve years after stroke onset, diffusion tensor imaging (DTI), functional magnetic resonance imaging (fMRI), and transcranial magnetic stimulation (TMS) analyses of the corticospinal tracts were carried out to investigate the plasticity mechanisms and efferent pathways underlying motor control of the paretic hand. Clinical evaluations and quantified movement analysis argue for a true neurological recovery rather than a compensation mechanism. DTI showed a significant decrease of fractional anisotropy, associated with a severe atrophy, only in the upper part of the left corticospinal tract (CST), suggesting an alteration of the CST at the level of the infarction that is not propagated downstream. The finger opposition movement of the right paretic hand was associated with fMRI activations of a broad network including predominantly the contralateral sensorimotor areas. Motor evoked potentials were normal and the selective stimulation of the right hemisphere did not elicit any response of the ipsilateral upper limb. These findings support the idea that the motor control of the paretic hand is mediated mainly by the contralateral sensorimotor cortex and the corresponding CST, but also by a plasticity of motor-related areas in both hemispheres. To our knowledge, this is the first report of a high quality upper-limb recovery occurring more than 2 years after stroke with a genuine insight of brain plasticity mechanisms.
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Affiliation(s)
- Carine Ciceron
- Service de Médecine Physique et Réadaptation, Plateforme Mouvement et Handicap, Hôpital Henry Gabrielle, Hospices Civils de Lyon, Pierre-Bénite, France
- CRNL (Lyon Neuroscience Research Center, Trajectoires Team), INSERM U1028 & CNRS UMR 5292, Université Claude Bernard-Lyon 1, Bron, France
- *Correspondence: Carine Ciceron
| | - Dominique Sappey-Marinier
- CREATIS, CNRS UMR 5220 & INSERM U1294, Université Claude Bernard-Lyon1, INSA de Lyon, Université de Lyon, Villeurbanne, France
- CERMEP-Imagerie du Vivant, Université de Lyon, Bron, France
| | - Paola Riffo
- Service de Médecine Physique et Réadaptation, Plateforme Mouvement et Handicap, Hôpital Henry Gabrielle, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Soline Bellaiche
- Service de Médecine Physique et Réadaptation, Plateforme Mouvement et Handicap, Hôpital Henry Gabrielle, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Gabriel Kocevar
- CREATIS, CNRS UMR 5220 & INSERM U1294, Université Claude Bernard-Lyon1, INSA de Lyon, Université de Lyon, Villeurbanne, France
| | - Salem Hannoun
- CREATIS, CNRS UMR 5220 & INSERM U1294, Université Claude Bernard-Lyon1, INSA de Lyon, Université de Lyon, Villeurbanne, France
- Medical Imaging Sciences Program, Division of Health Professions, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Claudio Stamile
- CREATIS, CNRS UMR 5220 & INSERM U1294, Université Claude Bernard-Lyon1, INSA de Lyon, Université de Lyon, Villeurbanne, France
| | - Jérôme Redoute
- CERMEP-Imagerie du Vivant, Université de Lyon, Bron, France
| | - Francois Cotton
- CREATIS, CNRS UMR 5220 & INSERM U1294, Université Claude Bernard-Lyon1, INSA de Lyon, Université de Lyon, Villeurbanne, France
- Service de Radiologie, Center Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Patrice Revol
- Service de Médecine Physique et Réadaptation, Plateforme Mouvement et Handicap, Hôpital Henry Gabrielle, Hospices Civils de Lyon, Pierre-Bénite, France
- CRNL (Lyon Neuroscience Research Center, Trajectoires Team), INSERM U1028 & CNRS UMR 5292, Université Claude Bernard-Lyon 1, Bron, France
| | - Nathalie Andre-Obadia
- Service de Neurologie Fonctionnelle et Epileptologie, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Bron, France
- CRNL (Lyon Neuroscience Research Center, NeuroPain Team), INSERM U1028 & CNRS UMR 5292, University Claude Bernard-Lyon 1, Bron, France
| | - Jacques Luaute
- Service de Médecine Physique et Réadaptation, Plateforme Mouvement et Handicap, Hôpital Henry Gabrielle, Hospices Civils de Lyon, Pierre-Bénite, France
- CRNL (Lyon Neuroscience Research Center, Trajectoires Team), INSERM U1028 & CNRS UMR 5292, Université Claude Bernard-Lyon 1, Bron, France
| | - Gilles Rode
- Service de Médecine Physique et Réadaptation, Plateforme Mouvement et Handicap, Hôpital Henry Gabrielle, Hospices Civils de Lyon, Pierre-Bénite, France
- CRNL (Lyon Neuroscience Research Center, Trajectoires Team), INSERM U1028 & CNRS UMR 5292, Université Claude Bernard-Lyon 1, Bron, France
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Boyne P, Doren S, Scholl V, Staggs E, Whitesel D, Carl D, Shatz R, Sawyer R, Awosika OO, Reisman DS, Billinger SA, Kissela B, Vannest J, Dunning K. Preliminary Outcomes of Combined Treadmill and Overground High-Intensity Interval Training in Ambulatory Chronic Stroke. Front Neurol 2022; 13:812875. [PMID: 35185766 PMCID: PMC8854218 DOI: 10.3389/fneur.2022.812875] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/11/2022] [Indexed: 12/20/2022] Open
Abstract
Purpose Locomotor high-intensity interval training (HIIT) is a promising intervention for stroke rehabilitation. However, overground translation of treadmill speed gains has been somewhat limited, some important outcomes have not been tested and baseline response predictors are poorly understood. This pilot study aimed to guide future research by assessing preliminary outcomes of combined overground and treadmill HIIT. Materials and Methods Ten participants >6 months post-stroke were assessed before and after a 4-week no-intervention control phase and a 4-week treatment phase involving 12 sessions of overground and treadmill HIIT. Results Overground and treadmill gait function both improved during the treatment phase relative to the control phase, with overground speed changes averaging 61% of treadmill speed changes (95% CI: 33–89%). Moderate or larger effect sizes were observed for measures of gait performance, balance, fitness, cognition, fatigue, perceived change and brain volume. Participants with baseline comfortable gait speed <0.4 m/s had less absolute improvement in walking capacity but similar proportional and perceived changes. Conclusions These findings reinforce the potential of locomotor HIIT research for stroke rehabilitation and provide guidance for more definitive studies. Based on the current results, future locomotor HIIT studies should consider including: (1) both overground and treadmill training; (2) measures of cognition, fatigue and brain volume, to complement typical motor and fitness assessment; and (3) baseline gait speed as a covariate.
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Affiliation(s)
- Pierce Boyne
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
- *Correspondence: Pierce Boyne
| | - Sarah Doren
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Victoria Scholl
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Emily Staggs
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Dustyn Whitesel
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Daniel Carl
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Rhonna Shatz
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Russell Sawyer
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Oluwole O. Awosika
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Darcy S. Reisman
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, DE, United States
| | - Sandra A. Billinger
- Department of Physical Therapy and Rehabilitation Science, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, United States
| | - Brett Kissela
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Jennifer Vannest
- Department of Communication Sciences and Disorders, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Kari Dunning
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
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Jang SH, Byun DH. Delayed gait recovery by resolution of limb-kinetic apraxia in a chronic hemiparetic stroke patient: A case report. Medicine (Baltimore) 2022; 101:e28711. [PMID: 35089235 PMCID: PMC8797483 DOI: 10.1097/md.0000000000028711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 01/10/2022] [Indexed: 01/05/2023] Open
Abstract
RATIONALE This paper reports on a chronic hemiparetic stroke patient who showed delayed gait recovery due to resolution of limb-kinetic apraxia (LKA). PATIENT CONCERNS A 49-year-old man underwent comprehensive rehabilitation at a local rehabilitation hospital since 3 weeks after spontaneous intracerebral haemorrhage. However, he could not walk independently because of severe motor weakness in his right leg until 19 months after the onset. DIAGNOSIS At the beginning of rehabilitation at our hospital (19 months after onset), we thought that he had the neurological potential to walk independently because the unaffected (right) corticospinal tract and corticoreticulospinal tract were closely related to the gait potential, representing intact integrities. As a result, we assumed that the severe motor weakness in the right leg was mainly ascribed to LKA. INTERVENTIONS At our hospital, he underwent comprehensive rehabilitation including increased doses of dopaminergic drugs (pramipexole, ropinirole, amantadine, and carbidopa/levodopa). OUTCOMES After 10 days to our hospital, he could walk independently on an even floor with verbal supervision, concurrent with motor recovery of the right leg. After 24 days after hospital admission, he could walk independently on an even floor. LESSONS We believe that the resolution of LKA in his right leg by the administration of adequate doses of dopaminergic drugs was the main reason for the delayed gait recovery in this patient. The results suggest the importance of detecting the neurological potential for gait ability of a stroke patient who cannot walk after the gait recovery phase and the causes of gait inability for individual patients.
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Combining Yoga Exercise with Rehabilitation Improves Balance and Depression in Patients with Chronic Stroke: A Controlled Trial. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12020922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background: We combined yoga with standard stroke rehabilitation and compared it to the rehabilitation alone for depression and balance in patients. Methods: Forty patients aged from 30 to 80 who had suffered a stroke 90 or more days previously were divided evenly with age stratification and patients’ will (hence not randomized). In the intervention group 16 completed 8-week stroke rehabilitation combined with 1 h of yoga twice weekly. Another 19 patients completed the standard rehabilitation as the control group. Results: The yoga group showed significant improvement in depression (Taiwanese Depression Questionnaire, p = 0.002) and balance (Berg Balance Scale, p < 0.001). However, the control group showed improvement only in balance (p = 0.001) but not in depression (p = 0.181). Further analysis showed both sexes benefitted in depression, but men had a greater improvement in balance than women. Depression in left-brain lesion patients improved more significantly than in those with right-brain lesion, whereas balance improved equally despite lesion site. For patients under or above the age of 60, depression and balance both significantly improved after rehabilitation. Older age is significantly related to poor balance but not depression. Conclusions: Combining yoga with rehabilitation has the potential to improve depression and balance. Factors related to sex, brain lesion site and age may influence the differences.
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45
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Neuromuscular Stimulation as an Intervention Tool for Recovery from Upper Limb Paresis after Stroke and the Neural Basis. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12020810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Neuromodulators at the periphery, such as neuromuscular electrical stimulation (NMES), have been developed as add-on tools to regain upper extremity (UE) paresis after stroke, but this recovery has often been limited. To overcome these limits, novel strategies to enhance neural reorganization and functional recovery are needed. This review aims to discuss possible strategies for enhancing the benefits of NMES. To date, NMES studies have involved some therapeutic concerns that have been addressed under various conditions, such as the time of post-stroke and stroke severity and/or with heterogeneous stimulation parameters, such as target muscles, doses or durations of treatment and outcome measures. We began by identifying factors sensitive to NMES benefits among heterogeneous conditions and parameters, based on the “progress rate (PR)”, defined as the gains in UE function scores per intervention duration. Our analysis disclosed that the benefits might be affected by the target muscles, stroke severity and time period after stroke. Likewise, repetitive peripheral neuromuscular magnetic stimulation (rPMS) is expected to facilitate motor recovery, as already demonstrated by a successful study. In parallel, our efforts should be devoted to further understanding the precise neural mechanism of how neuromodulators make UE function recovery occur, thereby leading to overcoming the limits. In this study, we discuss the possible neural mechanisms.
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Dobkin BH. Rehabilitation and Recovery of the Patient With Stroke. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00060-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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E Wurzinger H, Abzhandadze T, Rafsten L, Sunnerhagen KS. Dependency in Activities of Daily Living During the First Year After Stroke. Front Neurol 2021; 12:736684. [PMID: 34819908 PMCID: PMC8606514 DOI: 10.3389/fneur.2021.736684] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 10/15/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Dependency in personal activities of daily living (ADL) is a common short-term and long-term consequence of stroke and requires targeted rehabilitation. As the duration of hospital stay has become shorter in recent decades, early identification of patients who require rehabilitation has become vital. To our knowledge, no study has investigated whether ADL dependency in the very early stages after admission to the stroke unit can explain ADL dependency 3 and 12 months later. This knowledge would facilitate planning for very early discharge and patient-centered rehabilitation. Objective: This study evaluated whether ADL dependency within 2 days after stroke could explain ADL dependency at 3 and 12 months after stroke. Methods: This longitudinal cohort study included patients with stroke who were treated at a stroke unit in the Sahlgrenska University Hospital (Gothenburg, Sweden) between May 2011 and March 2016. The primary independent variable was ADL dependency at 36–48 h after admission to the stroke unit, which was assessed using a Barthel Index (BI) score of ≤90. The dependent variables were self-reported personal ADL dependency at 3 and 12 months after stroke. Binary logistic regression analyses were performed. Results: Of 366 eligible patients (58% male; median age 71 years), a majority (76%) had mild stroke and 60% were ADL dependent 36–48 h after stroke. Univariable and multivariable logistic regression analyses showed that patients who were dependent within the first 2 days after stroke had higher odds for being dependent 3 months as well as 12 months after stroke. Conclusion: The results indicated that dependency in personal ADL during the first 2 days can explain dependency at 3- and 12-month post-stroke. Therefore, early ADL assessments post-stroke can be used for understanding rehabilitation needs after stroke.
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Affiliation(s)
- Hannah E Wurzinger
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Tamar Abzhandadze
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lena Rafsten
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Katharina S Sunnerhagen
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
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Sylaja PN, Nair SS, Pandian J, Khurana D, Srivastava MVP, Kaul S, Arora D, Sarma PS, Singhal AB. Impact of Pre-Stroke Antiplatelet Use on 3-Month Outcome After Ischemic Stroke. Neurol India 2021; 69:1645-1649. [PMID: 34979663 DOI: 10.4103/0028-3886.333484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Pre-stroke anti-platelet (PAP) therapy can potentially influence the severity and outcome after ischemic stroke. Methods We analyzed data from the prospective multicenter Indo-US collaborative stroke project for the impact of PAP therapy. Outcome measures included the admission National Institute of Health Stroke Scale (NIHSS) score, 3-month modified Rankin scale (mRS) score, and rates of in-hospital mortality and post-ischemic intracerebral hemorrhage. Results Among 2048 of 2066 patients (M:F = 2:1) with known pre-stroke medication status, 336 (16.3%) were on PAP therapy. As compared to the non-PAP group, the PAP group had significantly higher mean age (62.2 vs 57.4 years, P < 0.001) and significantly more men, vascular risk factors, cerebral microbleeds (12.8% vs 6.2%, P = 0.001) and intravenous thrombolysis treatment (17% vs. 10.6%, P = 0.001). Cardioembolic strokes were significantly more in the PAP group (P < 0.001), but not large artery atherosclerosis. No significant differences were observed in the median NIHSS score (9 vs. 10, P = 0.274), 3-month mRS (score 0-2,51.4% vs. 49.0%, P = 0.428), in-hospital mortality (8.6% vs. 7.8%, P = 0.592), or symptomatic post ischemic intracerebral haemorrhage (12.2% vs. 10.6%, P = 0.382). The PAP group had more stroke recurrence (6.6% vs. 2.9%, P = 0.002) which was not significant (P = 0.065) after multivariate regression analysis adjusting for age, sex and vascular risk factors. PAP therapy was not an independent predictor of initial stroke severity or stroke outcome. Conclusion PAP therapy has no significant effect on initial stroke severity, rates of post-ischemic hemorrhage with or without thrombolysis, in-hospital mortality, stroke recurrence, and 3-month outcome after ischemic stroke.
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Affiliation(s)
- P N Sylaja
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Sruthi S Nair
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Jeyaraj Pandian
- Department of Neurology, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - Dheeraj Khurana
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - M V Padma Srivastava
- Department of Neurology, All India Institutes of Medical Sciences, New Delhi, India
| | - Subhash Kaul
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Deepti Arora
- Department of Neurology, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - P Sankara Sarma
- Department of Biostatistics, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Aneesh B Singhal
- Department of Neurology, Stroke Service, Massachusetts General Hospital, Boston, USA
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Mang CS, Peters S. Advancing motor rehabilitation for adults with chronic neurological conditions through increased involvement of kinesiologists: a perspective review. BMC Sports Sci Med Rehabil 2021; 13:132. [PMID: 34689800 PMCID: PMC8542408 DOI: 10.1186/s13102-021-00361-6] [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: 05/12/2021] [Accepted: 10/18/2021] [Indexed: 11/10/2022]
Abstract
Many people with neurological conditions experience challenges with movement. Although rehabilitation is often provided acutely and sub-acutely following the onset of a condition, motor deficits commonly persist in the long-term and are exacerbated by disuse and inactivity. Notably, motor rehabilitation approaches that incorporate exercise and physical activity can support gains in motor function even in the chronic stages of many neurological conditions. However, delivering motor rehabilitation on a long-term basis to people with chronic neurological conditions is a challenge within health care systems, and the onus is often placed on patients to find and pay for services. While neurological motor rehabilitation is largely the domain of physical and occupational therapists, kinesiologists may be able to complement existing care and support delivery of long-term neurological motor rehabilitation, specifically through provision of supported exercise and physical activity programs. In this perspective style review article, we discuss potential contributions of kinesiologists to advancing the field through exercise programming, focusing on community-based interventions that increase physical activity levels. We conclude with recommendations on how kinesiologists' role might be further optimized towards improving long-term outcomes for people with chronic neurological conditions, considering issues related to professional regulation and models of care.
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Affiliation(s)
- Cameron S Mang
- Faculty of Kinesiology and Health Studies, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada.
| | - Sue Peters
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Canada
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Liu D, Lu M, Lakshmanan P, Hu Z, Chen X. Increased Provision of Bioavailable Mg through Vegetables Could Significantly Reduce the Growing Health and Economic Burden Caused by Mg Malnutrition. Foods 2021; 10:foods10112513. [PMID: 34828794 PMCID: PMC8620491 DOI: 10.3390/foods10112513] [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: 09/16/2021] [Revised: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 12/05/2022] Open
Abstract
Magnesium (Mg) is an essential mineral nutrient for human health and its deficiency associated with many diseases, including stroke, heart failure, and type 2 diabetes. Vegetables are an important source of dietary Mg for humans. In this study, we quantified vegetable Mg content by a global meat analysis, analyzed human health, and economic impact caused by Mg deficiency. Results revealed that vegetable Mg content showed a large variation with an average value of 19.3 mg 100 g−1 FW. Variation in per capita vegetable-Mg supply in different continents is largely ascribed to continental difference in the amount and the type of vegetables produced. The health and economic loss attributed to Mg deficiency are estimated to be 1.91 million disability-adjusted life years (DALYs) and 15.8 billion dollars (0.14% of GDP), respectively. A scenario analysis indicated that the increasing vegetable production (increased by 8.9% and 20.7% relative to 2017 in 2030 and 2050) and vegetable Mg content (increased by 22% through biofortification) could significantly reduce DALYs (1.24 million years) and economic burden (0.09% of GDP). This study could guide a major re-balance of production practices, species cultivated, and Mg biofortification to provide sufficient vegetable Mg for better human Mg nutrition.
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Affiliation(s)
- Dunyi Liu
- Key Laboratory of Efficient Utilization of Soil and Fertilizer Resources, College of Resources and Environment, Southwest University, Chongqing 400715, China; (D.L.); (M.L.); (Z.H.)
- Interdisciplinary Research Center for Agriculture Green Development in Yangtze River Basin, Southwest University, Chongqing 400715, China;
| | - Ming Lu
- Key Laboratory of Efficient Utilization of Soil and Fertilizer Resources, College of Resources and Environment, Southwest University, Chongqing 400715, China; (D.L.); (M.L.); (Z.H.)
| | - Prakash Lakshmanan
- Interdisciplinary Research Center for Agriculture Green Development in Yangtze River Basin, Southwest University, Chongqing 400715, China;
- Sugarcane Research Institute, Guangxi Academy of Agricultural Sciences, Nanning 530007, China
- Queensland Alliance for Agriculture and Food Innovation, University of Queensland, St. Lucia, QLD 4067, Australia
| | - Ziyi Hu
- Key Laboratory of Efficient Utilization of Soil and Fertilizer Resources, College of Resources and Environment, Southwest University, Chongqing 400715, China; (D.L.); (M.L.); (Z.H.)
| | - Xinping Chen
- Key Laboratory of Efficient Utilization of Soil and Fertilizer Resources, College of Resources and Environment, Southwest University, Chongqing 400715, China; (D.L.); (M.L.); (Z.H.)
- Interdisciplinary Research Center for Agriculture Green Development in Yangtze River Basin, Southwest University, Chongqing 400715, China;
- Correspondence: ; Tel.: +86-23-6825-1082
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