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Nayak N, Mahendran N, Kuys S, Brauer SG. What factors at discharge predict physical activity and walking outcomes 6 months after stroke? A systematic review. Clin Rehabil 2024:2692155241261698. [PMID: 39053141 DOI: 10.1177/02692155241261698] [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: 07/27/2024]
Abstract
OBJECTIVE This study aimed to identify factors at hospital discharge that predict physical activity and walking outcomes in the first 6 months after stroke. DATA SOURCES Searches were conducted in CINAHL (EBSCO), Web of Science, PubMed and Scopus from inception to 30 April 2024. Reference lists of included articles were manually screened to identify additional studies. REVIEW METHODS Studies of adults with stroke reporting predictors at hospital discharge and outcomes of physical activity or walking across the first 6 months after hospital discharge were included. Two reviewers independently screened titles, abstracts and reviewed full texts. Quality of included studies was assessed with Quality in Prognostic Studies screening tool. A narrative synthesis was undertaken. RESULTS The search strategy retrieved 7834 studies, from which 6 eligible studies were identified, including a total of 1433 participants. Overall, studies had a low risk of bias. Age, balance, walking speed and walking distance at hospital discharge predicted physical activity outcomes after stroke (n = 2 studies). Cognition, lower limb cycling rhythm and self-efficacy for walking at hospital discharge predicted walking outcomes after stroke (n = 4 studies). CONCLUSIONS A range of factors predicted physical activity and walking outcomes 6 months after stroke. Physical capabilities at discharge appear to be a predictor of these outcomes; however, this needs to be interpreted with caution. Diverse measures and time points were used across studies to characterise physical activity and walking outcomes, highlighting the need for consistency in measurement and longitudinal studies in stroke research.
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Affiliation(s)
- Neelam Nayak
- Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - Niruthikha Mahendran
- Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - Suzanne Kuys
- Physiotherapy, School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia
| | - Sandra G Brauer
- Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
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Sato H, Okawa S, Kakehata R, Takayama A, Okuma K, Fukata K, Miki H, Kobayashi Y, Hasegawa K, Matsuda T, Fujino Y. Factors influencing the prognosis of patients with acute cerebral infarction who received usual care: a multicenter prospective cohort study. J Phys Ther Sci 2024; 36:352-358. [PMID: 38832215 PMCID: PMC11144472 DOI: 10.1589/jpts.36.352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 03/11/2024] [Indexed: 06/05/2024] Open
Abstract
[Purpose] The prognostic factors for patients with acute stroke who received usual care (mobilization ≥48 h after admission) remain unclear. This study aimed to investigate the prognostic factors that predict functional outcomes using evaluations performed immediately after onset in patients with acute cerebral infarction who received usual care from admission until discharge. [Participants and Methods] Participants with acute cerebral infarction admitted to five acute care hospitals in Tokyo and Saitama, Japan and prescribed physical therapy were included. Participants information, functional evaluations, and progress were recorded during the first physical therapy session, mobilization, and discharge. Participants who received usual care were assigned to either the good- or poor-outcome group based on the Modified Rankin Scale at discharge. [Results] In total, 161 Participants receiving usual care (mobilization ≥48 h after admission) were included. Reinfarction and the First National Institutes of Health Stroke Scale score were identified as independent predictors of functional outcome at hospital discharge in participants who received usual care (median, 22.0 d). The cutoff NIHSS score was 4. [Conclusion] Our results provided evidence that the National Institutes of Health Stroke Scale score and reinfarction are useful predictors of functional outcomes in participants who received usual care.
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Affiliation(s)
- Hirofumi Sato
- Department of Rehabilitation, Saitama Citizens Medical
Center, Japan
| | - Shinsuke Okawa
- Department of Rehabilitation, Saitama Citizens Medical
Center, Japan
| | - Reina Kakehata
- Department of Rehabilitation, Saitama Citizens Medical
Center, Japan
| | - Asuka Takayama
- Department of Rehabilitation, Saitama Citizens Medical
Center, Japan
| | - Katsunobu Okuma
- Department of Rehabilitation, Saitama Citizens Medical
Center, Japan
| | | | - Hiroshi Miki
- Department of Rehabilitation, Tokyo Saiseikai Central
Hospital, Japan
| | - Yohei Kobayashi
- Department of Rehabilitation, Saitama Sekishinkai Hospital,
Japan
| | - Koki Hasegawa
- Department of Rehabilitation, Sainokuni Higashiomiya
Medical Center, Japan
| | - Tadamitsu Matsuda
- Department of Physical Therapy, Faculty of Health Science,
Juntendo University: 3-2-12 Hongo Bunkyo-ku, Tokyo 113-0033, Japan
| | - Yuji Fujino
- Department of Physical Therapy, Faculty of Health Science,
Juntendo University: 3-2-12 Hongo Bunkyo-ku, Tokyo 113-0033, Japan
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Vora I, Gochyyev P, Engineer N, Wolf SL, Kimberley TJ. Distal Versus Proximal Arm Improvement After Paired Vagus Nerve Stimulation Therapy After Chronic Stroke. Arch Phys Med Rehabil 2024:S0003-9993(24)01014-1. [PMID: 38815953 DOI: 10.1016/j.apmr.2024.05.018] [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: 10/11/2023] [Revised: 05/15/2024] [Accepted: 05/19/2024] [Indexed: 06/01/2024]
Abstract
OBJECTIVE To evaluate differences in upper-extremity (UE) segment-specific (proximal or distal segment) recovery after vagus nerve stimulation (VNS) paired with UE rehabilitation (Paired-VNS) compared with rehabilitation with sham-VNS (Control). We also assessed whether gains in specific UE segments predicted clinically meaningful improvement. DESIGN This study reports on a secondary analysis of Vagus nerve stimulation paired with rehabilitation for UE motor function after chronic ischemic stroke (VNS-REHAB), a randomized, triple-blinded, sham-controlled pivotal trial. A Rasch latent regression was used to determine differences between Paired-VNS and Controls for distal and proximal UE changes after in-clinic therapy and 3 months later. Subsequently, we ran a random forest model to assess candidate predictors of meaningful improvement. Each item of the Fugl-Meyer Assessment-Upper Extremity (FMA-UE) and Wolf Motor Function Test (WMFT) was evaluated as a predictor of response to treatment. SETTING Nineteen stroke rehabilitation centers in the USA and UK. PARTICIPANTS Dataset included 108 participants (N=108) with chronic ischemic stroke and moderate-to-severe UE impairments. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES FMA-UE and WMFT. RESULTS Distal UE improvement was significantly greater in the Paired-VNS group than in Controls immediately after therapy (95% confidence interval, 0.27-0.73; P≤.001) and after 3 months (95% confidence interval, 0.16-0.75; P=.003). Both groups showed similar improvement in proximal UE at both time points. A subset of both distal and proximal items from the FMA-UE and WMFT were predictors of meaningful improvement. CONCLUSIONS Paired-VNS improved distal UE impairment in chronic stroke to a greater degree than intensive rehabilitation alone. Proximal improvements were equally responsive to either treatment. Given that meaningful UE recovery is predicted by improvements across both proximal and distal segments, Paired-VNS may facilitate improvement that is otherwise elusive.
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Affiliation(s)
- Isha Vora
- Department of Rehabilitation Science, School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA
| | - Perman Gochyyev
- Department of Rehabilitation Science, School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA; Berkeley Evaluation and Assessment Research Center, University of California, Berkeley, Berkeley, CA
| | | | - Steven L Wolf
- Division of Physical Therapy, Center for Physical Therapy and Movement Science, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA
| | - Teresa J Kimberley
- Department of Rehabilitation Science, School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA; Department of Physical Therapy, School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA.
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Wouda NC, Knijff B, Punt M, Visser-Meily JMA, Pisters MF. Predicting Recovery of Independent Walking After Stroke: A Systematic Review. Am J Phys Med Rehabil 2024; 103:458-464. [PMID: 38363655 DOI: 10.1097/phm.0000000000002436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
ABSTRACT Patients recovering from a stroke experience reduced participation, especially when they are limited in daily activities involving walking. Understanding the recovery of independent walking, can be used by clinicians in the decision-making process during rehabilitation, resulting in more personalized stroke rehabilitation. Therefore, it is necessary to gain insight in predicting the recovery of independent walking in patients after stroke. This systematic review provided an overview of current evidence about prognostic models and its performance to predict recovery of independent walking after stroke. Therefore, MEDLINE, CINAHL, and Embase were searched for all relevant studies in English and Dutch. Descriptive statistics, study methods, and model performance were extracted and divided into two categories: subacute phase and chronic phase. This resulted in 16 articles that fulfilled all the search criteria, which included 30 prognostic models. Six prognostic models showed an excellent performance (area under the curve value and/or overall accuracy ≥0.90). The model of Smith et al. (2017) showed highest overall accuracy (100%) in predicting independent walking in the subacute phase after stroke ( Neurorehabil Neural Repair 2017;31(10-11):955-64.). Recovery of independent walking can be predicted in the subacute and chronic phase after stroke. However, proper external validation and the applicability in clinical practice of identified prognostic models are still lacking.
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Affiliation(s)
- Natasja Charon Wouda
- From the Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, the Netherlands (NCW, JMAV-M); De Hoogstraat Rehabilitation, Department of Neurorehabilitation, Utrecht, the Netherlands (NCW); Research Group Lifestyle and Health, University of Applied Sciences Utrecht, Utrecht, the Netherlands (BK, MP); Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands (JMAV-M, MFP); Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, the Netherlands (MFP); and Research Group Empowering Healthy Behaviour, Department of Health Innovations and Technology, Fontys University of Applied Sciences, Eindhoven, the Netherlands (MFP)
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Smith MC, Scrivener BJ, Stinear CM. Do lower limb motor-evoked potentials predict walking outcomes post-stroke? J Neurol Neurosurg Psychiatry 2024; 95:348-355. [PMID: 37798093 DOI: 10.1136/jnnp-2023-332018] [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: 06/14/2023] [Accepted: 09/14/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND This observational study examined whether lower limb (LL) motor-evoked potentials (MEPs) 1 week post-stroke predict recovery of independent walking, use of ankle-foot orthosis (AFO) or walking aid, at 3 and 6 months post-stroke. METHODS Non-ambulatory participants were recruited 5 days post-stroke. Transcranial magnetic stimulation was used to determine tibialis anterior MEP status and clinical assessments (age, National Institutes of Health Stroke Scale (NIHSS), ankle dorsiflexion strength, LL motricity index, Berg Balance Test) were completed 1 week post-stroke. Functional Ambulation Category (FAC), use of AFO and walking aid were assessed 3 months and 6 months post-stroke. MEP status, alone and combined with clinical measures, and walking outcomes at 3 and 6 months were analysed with Pearson χ2 and multivariate binary logistic regression. RESULTS Ninety participants were included (median age 72 years (38-97 years)). Most participants (81%) walked independently (FAC ≥ 4), 17% used an AFO, and 49% used a walking aid 3 months post-stroke with similar findings at 6 months. Independent walking was better predicted by age, LL strength and Berg Balance Test (accuracy 92%, 95% CI 85% to 97%) than MEP status (accuracy 73%, 95% CI 63% to 83%). AFO use was better predicted by NIHSS and MEP status (accuracy 88%, 95% CI 79% to 94%) than MEP status alone (accuracy 76%, 95% CI 65% to 84%). No variables predicted use of walking aids. CONCLUSIONS The presence of LL MEPs 1-week post-stroke predicts independent walking at 3 and 6 months post-stroke. However, the absence of MEPs does not preclude independent walking. Clinical factors, particularly age, balance and stroke severity, more strongly predict independent walking than MEP status. LL MEP status adds little value as a biomarker for walking outcomes.
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Affiliation(s)
- Marie-Claire Smith
- Department of Exercise Sciences, The University of Auckland, Auckland, New Zealand
- Department of Medicine, The University of Auckland, Auckland, New Zealand
| | - Benjamin J Scrivener
- Department of Medicine, The University of Auckland, Auckland, New Zealand
- Neurology, Auckland City Hospital, Auckland, New Zealand
| | - Cathy M Stinear
- Department of Medicine, The University of Auckland, Auckland, New Zealand
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Ribeiro Batista L, Silva SLAD, Cunha Polese J, Silva AC, Teixeira-Salmela LF, Faria CDCDM, Faria-Fortini I. Longitudinal associations between stroke-related neurologic deficits and course of basic activities of daily living up to six months after stroke. Disabil Rehabil 2024:1-7. [PMID: 38318868 DOI: 10.1080/09638288.2024.2313124] [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: 06/21/2023] [Accepted: 01/27/2024] [Indexed: 02/07/2024]
Abstract
PURPOSE To investigate the course of basic activities of daily living (ADL) from admission up to six months after the stroke and the longitudinal associations between stroke-related neurological deficits at admission to the stroke unit and course of basic ADL. MATERIALS AND METHODS 180 individuals with a first-ever stroke were assessed at admission to the stroke unit and at follow-ups of three and six months. Stroke-related neurological deficits were assessed at admission with the National Institutes of Stroke Scale (NIHSS). Independence in basic ADL was assessed at admission and three and six months after the stroke by the Modified Barthel Index (MBI). Generalized Estimating Equations (GEE) were performed. RESULTS Dependence in basic ADL reduced overtime, with most changes occurring over the first three months. Individuals, who had moderate/severe stroke-related neurological deficits (NIHSS ≥6) at admission, had higher chances of becoming more dependent in activities related to feeding (OR:1.27;95%CI = 1.03-1.55;p = 0.021), bathing (OR:1.30;95%CI = 1.11-1.50;p = 0.0005), dressing (OR:1.19;95%CI = 1.04-1.36;p = 0.010), transfers (OR:1.24;95%CI = 1.05-1.46;p = 0.0072), stair climbing (OR:1.46;95%CI = 1.27-1.66;p < 0.0001), and ambulation (OR:1.21;95%CI = 1.02-1.43;p < 0.0001). CONCLUSIONS Decreases in dependence in basic ADL occurred mainly over three months after the stroke and showed different patterns for specific ADL. Baseline moderate/severe stroke-related neurological deficits were associated with poor functional status in basic ADL over the follow-up period.
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Affiliation(s)
- Ludmilla Ribeiro Batista
- Graduate Program in Occupational Studies, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Janaine Cunha Polese
- Department of Physiotherapy, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
| | - Aryane Carolina Silva
- Graduate Program in Rehabilitation Sicences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Iza Faria-Fortini
- Department of Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Rothacher C, Liepert J. [Factors Modulating Motor Function Changes in Stroke Patients During Inpatient Neurological Rehabilitation]. DIE REHABILITATION 2024; 63:31-38. [PMID: 38335972 DOI: 10.1055/a-2204-3952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
PURPOSE To identify factors that have an impact on the degree of functional improvements in stroke patients during inpatient neurological rehabilitation. METHODS Retrospective analysis of 398 stroke patients who participated in an inpatient Phase C rehabilitation (Barthel index between 30 and 70 points). We correlated changes in 3 physiotherapeutic assessments (transfer from sitting to standing; transfer from bed to (wheel)chair; climbing stairs) and 3 occupational therapeutic assessments (eating/drinking; dressing of the upper part of the body; object manipulation) with the factors age, gender, Barthel-Index at admission, time since stroke, length of stay in inpatient rehab, number and extent of therapies and ischemic versus hemorrhagic stroke. In addition, a stepwise regression analysis was performed. RESULTS The patient group showed significant improvements in all assessments. Length of stay in inpatient rehab and number/extent of therapies correlated with improvements of transfer from sitting to standing, transfer from bed to (wheel)chair, climbing stairs, and dressing of the upper part of the body. Number/extent of therapies also correlated with eating/drinking. Barthel-Index at admission was negatively correlated with transfer from sitting to standing, transfer from bed to (wheel)chair, and dressing of the upper part of the body. No correlation between changes of motor functions and age or gender or type of stroke (ischemic versus hemorrhagic) was found. Patients<3 months after stroke showed stronger improvements of transfer from sitting to standing, transfer from bed to (wheel)chair, climbing stairs, dressing of the upper part of the body, and object manipulation than patients>6 months after stroke. However, patients<3 months after stroke also stayed 10 days longer in inpatient rehab. The stepwise regression analysis identified the number of physiotherapies and Barthel-Index at admission as the most important factors for changes in transfer from sitting to standing and transfer from bed to (wheel)chair, number of physiotherapies and time since stroke for climbing stairs, number of occupational therapies for eating/drinking, number of occupational therapies and time since stroke for dressing the upper part of the body and number of occupational therapies and length of inpatient rehab for object manipulation. CONCLUSION In stroke patients, a higher number of therapies is associated with greater improvements of motor functions. Age, gender and type of stroke have no relevant impact on changes of motor functions during inpatient rehabilitation.
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Rizk HI, Magdy R, Emam K, Mohammed MS, Aboulfotooh AM. Substance use disorder in young adults with stroke: clinical characteristics and outcome. Acta Neurol Belg 2024; 124:65-72. [PMID: 37454034 PMCID: PMC10874343 DOI: 10.1007/s13760-023-02317-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 06/20/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE Stroke incidence among young adults has risen in the last decade. This research attempts to determine the effect of substance use disorder (SUD) on the clinical characteristics of stroke, mortality, outcome after IV thrombolysis, and functional dependency after 1 month among young adults. METHODS Through a retrospective study, data were extracted from the electronic medical records of stroke in young adults admitted to intensive care units in Kasr Al-Ainy Hospital (February 2018-January 2021). The National Institute of Health Stroke Scale (NIHSS) and the Modified Rankin Scale were documented at the onset and after 1 month. RESULTS The study included 225 young adults with stroke (median age of 40, IQR: 34-44). Only 93 young adults (41%) met the criteria of SUD. Anabolic steroid use disorder was significantly associated with cerebral venous thrombosis (P-value = 0.02), while heroin use disorder was significantly associated with a hemorrhagic stroke (P-value = 0.01). Patients with tramadol, cannabis, and cocaine use disorders had significantly more frequent strokes in the posterior than the anterior circulation. Patients with heroin use disorders had significantly higher mortality than those without heroin use disorders (P-value = 0.01). The risk of poor outcomes was doubled by alcohol or heroin use disorder, while it was tripled by cocaine use disorder (P-value = 0.01 for each). CONCLUSION Forty-one percent of young adults diagnosed with a stroke had SUD, with a relatively higher posterior circulation involvement. Increased mortality was associated with heroin use disorder more than other substances. Poor stroke outcome was associated with alcohol, heroin, and cocaine use disorders.
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Affiliation(s)
- Hoda Ibrahim Rizk
- Department of Public Health and Community Medicine, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rehab Magdy
- Department of Neurology, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Khadiga Emam
- Department of Public Health and Community Medicine, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mona Soliman Mohammed
- Department of Public Health and Community Medicine, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
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Silva EADM, Batista LR, Braga MAF, Teixeira-Salmela LF, Faria CDCDM, Faria-Fortini I. Predicting self-perceived manual ability at three and six months after stroke: A prospective longitudinal study. J Stroke Cerebrovasc Dis 2024; 33:107479. [PMID: 37984045 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107479] [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: 07/14/2023] [Revised: 10/25/2023] [Accepted: 11/06/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Recovery of manual ability is a critical issue in rehabilitation. Currently, little is known regarding the baseline predictors of self-perceived manual ability, which could capture information on individual's perceived functional ability, especially in carrying-out routine tasks outside clinical settings. OBJECTIVE To identify baseline predictors, which can be easily obtained within clinical settings, of self-perceived manual ability at three and six months after discharge from a stroke unit. METHODS A 6-month longitudinal study was carried-out. Participants were recruited from a stroke unit of a public hospital. The dependent outcome was self-perceived manual ability, and the following predictors were investigated: age, stroke severity, upper-limb motor impairments, cognitive function, muscle strength, and functional capacity. Linear regression analyses were employed to identify multivariate predictors of manual ability at three and six months after discharge (α=5%). RESULTS Participated 131 individuals, 69 women (mean age of 60 years). Regression analyses revealed that stroke severity and age accounted for 31% and 47% of the variance in manual ability at three and six months after stroke, respectively. Stroke severity was the best predictor of manual ability at three (R2=29%; F=44.7; p<0.0001) and six months (R2=45%; F=88.2; p<0.0001) after stroke, respectively. CONCLUSION Stroke severity showed to be the best predictor of manual ability at both three and six months after stroke. Although significant, age added little to the explained variance.
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Affiliation(s)
| | - Ludmilla Ribeiro Batista
- Graduate Program in Occupational Studies, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | | | | | - Iza Faria-Fortini
- Department of Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
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Kiper P, Godart N, Cavalier M, Berard C, Cieślik B, Federico S, Kiper A, Pellicciari L, Meroni R. Effects of Immersive Virtual Reality on Upper-Extremity Stroke Rehabilitation: A Systematic Review with Meta-Analysis. J Clin Med 2023; 13:146. [PMID: 38202153 PMCID: PMC10780020 DOI: 10.3390/jcm13010146] [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: 11/02/2023] [Revised: 12/07/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
Virtual reality (VR) is an innovative rehabilitation tool increasingly used in stroke rehabilitation. Fully immersive VR is a type of VR that closely simulates real-life scenarios, providing a high level of immersion, and has shown promising results in improving rehabilitation functions. This study aimed to assess the effect of immersive VR-based therapy for stroke patients on the upper extremities, activities of daily living (ADLs), and pain reduction and its acceptability and side effects. For this review, we gathered all suitable randomized controlled trials from PubMed, EMBASE, Cochrane Library, Scopus, and Web of Science. Out of 1532, 10 articles were included, with 324 participants. The results show that immersive VR offers greater benefits in comparison with conventional rehabilitation, with significant improvements observed in ADLs (SMD 0.58, 95% CI 0.25 to 0.91, I2 = 0%, p = 0.0005), overall function as measured by the Fugl-Meyer Assessment (MD 6.33, 95% CI 4.15 to 8.50, I2 = 25%, p = 0.00001), and subscales for the shoulder (MD 4.96, 95% CI-1.90-8.03, I2 = 25%, p = 0.002), wrist (MD 2.41, 95% CI-0.56-4.26, I2 = 0%, p = 0.01), and hand (MD 2.60, 95% CI-0.70-4.5°, I2 = 0%, p = 0.007). These findings highlight the potential of immersive VR as a valuable therapeutic option for stroke survivors, enhancing their ADL performance and upper-limb function. The immersive nature of VR provides an engaging and immersive environment for rehabilitation.
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Affiliation(s)
- Pawel Kiper
- Healthcare Innovation Technology Lab, IRCCS San Camillo Hospital, 30126 Venice, Italy (S.F.)
| | - Nathalie Godart
- Department of Physiotherapy, LUNEX International University of Health Exercise and Sports, L-4671 Differdange, Luxembourg; (N.G.)
| | - Manon Cavalier
- Department of Physiotherapy, LUNEX International University of Health Exercise and Sports, L-4671 Differdange, Luxembourg; (N.G.)
| | - Charlotte Berard
- Department of Physiotherapy, LUNEX International University of Health Exercise and Sports, L-4671 Differdange, Luxembourg; (N.G.)
| | - Błażej Cieślik
- Healthcare Innovation Technology Lab, IRCCS San Camillo Hospital, 30126 Venice, Italy (S.F.)
| | - Sara Federico
- Healthcare Innovation Technology Lab, IRCCS San Camillo Hospital, 30126 Venice, Italy (S.F.)
| | - Aleksandra Kiper
- Doctoral School of the University of Rzeszów, University of Rzeszów, 35-959 Rzeszów, Poland
| | | | - Roberto Meroni
- Department of Physiotherapy, LUNEX International University of Health Exercise and Sports, L-4671 Differdange, Luxembourg; (N.G.)
- Luxembourg Health & Sport Sciences Research Institute ASBL, L-4671 Differdange, Luxembourg
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Newton SP, Dalton EJ, Ang JY, Klaic M, Thijs V, Hayward KS. Dose, Content, and Context of Usual Care in Stroke Upper Limb Motor Interventions: A Systematic Review. Clin Rehabil 2023; 37:1437-1450. [PMID: 37151039 PMCID: PMC10492439 DOI: 10.1177/02692155231172295] [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: 11/05/2022] [Accepted: 04/11/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE The objectives of this systematic review were to describe the current dose and content of usual care upper limb motor intervention for inpatients following stroke and examine if context factors alter dose and content. DATA SOURCES A systematic search (EMBASE, MEDLINE) was completed from January 2015 to February 2023 (PROSPERO CRD42021281986). METHODS Studies were eligible if they reported non-protocolised usual care upper limb motor intervention dose data for stroke inpatients. Studies were rated using the Johanna Briggs Institute critical appraisal tool. Data were descriptively reported for dose dimensions of time (on task or, in therapy) and intensity (repetitions, repetition/minute), content (intervention type/mode), and context (e.g., severity strata). RESULTS Eight studies were included from four countries, largely reflecting inpatient rehabilitation. Time in therapy ranged from 23 to 121 min/day. Time on task ranged from 8 to 44 min/day. Repetitions ranged from 36 to 57/session, and 15 to 282/day. Time on task was lowest in the stratum of people with severe upper limb impairment (8 min/day), the upper limit for this stratum was 41.5 min/day. There was minimal reporting of usual care content across all studies. CONCLUSION Upper limb motor intervention dose appears to be increasing in usual care compared to prior reports (e.g., average 21 min/day and 23 to 32 repetitions/session). Context variability suggests that doses are lowest in the stratum of patients with a severely impaired upper limb. Consistent reporting of the multiple dimensions of dose and content is necessary to better understand usual care offered during inpatient rehabilitation.
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Affiliation(s)
- Sarah P Newton
- Melbourne School of Health Sciences, University of Melbourne, Melbourne, Australia
- Department of Occupational Therapy, Austin Health, Melbourne, Australia
| | - Emily J Dalton
- Melbourne School of Health Sciences, University of Melbourne, Melbourne, Australia
- Department of Occupational Therapy, Austin Health, Melbourne, Australia
| | - Jia Y Ang
- Melbourne School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Marlena Klaic
- Melbourne School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Vincent Thijs
- Stroke Theme, Florey Institute of Neurosciences and Mental Health, Melbourne, Australia
- Department of Neurology, Austin Health, Melbourne, Australia
- Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Kathryn S Hayward
- Melbourne School of Health Sciences, University of Melbourne, Melbourne, Australia
- Stroke Theme, Florey Institute of Neurosciences and Mental Health, Melbourne, Australia
- Melbourne Medical School, University of Melbourne, Melbourne, Australia
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Hernandez S, Mill C, Irvine D, Clarke K, Granger CL, Da Silva A, Bower W. Can gait outcomes be predicted early after a stroke? Physiother Theory Pract 2023; 39:2154-2162. [PMID: 35437107 DOI: 10.1080/09593985.2022.2064379] [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: 08/24/2020] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To determine the ability of clinical measures collected within 72 hours of neurological insult to predict independent gait 6 and 12 months after a stroke. METHODS Patients with a confirmed stroke diagnosis were eligible for inclusion in this prospective cohort study. Sitting balance, National Institutes of Health Stroke Scale (NIHSS) motor leg, NIHSS motor arm, and Motricity Index (MI) were measured within 72 hours post-stroke. Follow-up assessments were conducted at 6 and 12 months post-stroke to measure gait recovery. RESULTS A total of 78 patients were included at baseline for analysis. At 6 and 12 months, 38% (n = 38) and 35% (n = 42) of patients used a gait aid, and 80% and 87% were independently ambulant, respectively. Sitting balance, NIHSS motor leg, and NIHSS motor arm were not significantly associated with ambulation at 6 or 12 months or with the use of a gait aid. Thrombolysis was significantly associated with independent outdoors ambulation at 6 months (p = .011). A worse MI score was significantly associated with a higher number of falls at 6 months (p < .010) but not with the need for a gait aid. The number of falls at 6 months was independently predicted by urinary incontinence post-stroke (p < .001), NIHSS leg score (p < .005), and depression and anxiety while in acute care (p < .005). CONCLUSIONS Clinical bedside assessments may be less important in predicting safe, independent gait than previously thought. Urinary incontinence and poor mental health should be addressed in the hospital. Increased utilization of reperfusion techniques may alter functional recovery patterns.
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Affiliation(s)
- Sabrina Hernandez
- Discipline of Physiotherapy, Department of Allied Health, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Chloe Mill
- Discipline of Physiotherapy, Department of Allied Health, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Damon Irvine
- Discipline of Physiotherapy, Department of Allied Health, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Katherine Clarke
- Discipline of Physiotherapy, Department of Allied Health, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Catherine L Granger
- Discipline of Physiotherapy, Department of Allied Health, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Alisha Da Silva
- Discipline of Physiotherapy, Department of Allied Health, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Wendy Bower
- Discipline of Physiotherapy, Department of Allied Health, The Royal Melbourne Hospital, Parkville, VIC, Australia
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13
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Cf G, Mg G, L B, Mj R. Association between balance recovery during inpatient rehabilitation and gait without physical assistance in severe subacute post-stroke patients. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2023; 28:e2029. [PMID: 37330694 DOI: 10.1002/pri.2029] [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: 01/24/2023] [Revised: 05/12/2023] [Accepted: 06/06/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND AND PURPOSE Studies that analyze gait without physical assistance recovery post-stroke are scarce. There are few of the studies that analyze longitudinally the recovery of balance during the subacute post-stroke inpatient rehabilitation. The aim of the study was to analyze the association between balance recovery during subacute stroke inpatient rehabilitation and gait without physical assistance achievement. Secondarily, to analyze the association between balance at admission of inpatient rehabilitation and gait without physical assistance achievement. METHODS An observational, longitudinal, and retrospective cohort study was conducted. Subacute stroke subjects with an admission Berg Balance Scale below or equal to 4 points were included (n = 164). Two logistic regression models were developed. Model 1 analyzes the association between balance recovery during inpatient rehabilitation and gait without physical assistance at discharge. Model 2 analyzes the association between balance at the admission and gait without physical assistance at discharge. RESULTS Of 164 severe post-stroke patients, 60 (36.5%) achieved gait without physical assistance. Although the two models developed a statistically significant association (p < 0.001), Model 1 evinced better discrimination performance (Model 1: area below the curve was of 0.987 -CI 95%: 0.975-0.998- vs. Model 2: area below the curve 2 was of 0.705 -CI 95%: 0.789-0.601-). DISCUSSION Balance recovery during rehabilitation was strongly associated with gait without physical assistance achievement at the time of discharge in severe subacute post-stroke patients. IMPLICATIONS FOR PHYSIOTHERAPY PRACTICE The longitudinal analysis of motor recovery in severe subacute post-stroke patients may be helpful in the decision making process during inpatient rehabilitation.
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Affiliation(s)
| | - Gianella Mg
- Physical Therapy Unit, Belen de Escobar, Argentina
| | - Bonamico L
- Departament of Rehabilitation Medicine, Belen de Escobar, Argentina
| | - Russo Mj
- Departament of Rehabilitation Medicine, Belen de Escobar, Argentina
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14
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Alhusayni AI, Cowey ES, Coulter E, Barber M, Paul L. Personalised Online Upper-Limb Physiotherapy for Stroke Survivors during the Inpatient Phase: A Feasibility Study. Healthcare (Basel) 2023; 11:2582. [PMID: 37761779 PMCID: PMC10531470 DOI: 10.3390/healthcare11182582] [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: 08/05/2023] [Revised: 09/07/2023] [Accepted: 09/17/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND After a stroke, inpatients often receive less than the recommended dose of therapy. Telerehabilitation may assist by providing personalised rehabilitation programmes without face-to-face therapy time. This study aimed to evaluate the acceptability and feasibility of an individualised programme of upper-limb rehabilitation that is delivered via an online rehabilitation platform for inpatient stroke survivors. METHODS Stroke survivors were recruited from three stroke units in one NHS Board in Scotland and randomised to the intervention (personalised upper-limb exercise programme delivered via an online physiotherapy platform for four weeks, up to 30 min five times per week, in addition to usual care) or the control group (usual care). The main outcomes are related to recruitment, attrition, adherence and safety. The clinical measures were the Action Research Arm Test, Trunk Impairment Scale and Modified Ashworth Scale. The intervention participants, their carers and physiotherapists completed questionnaires on the acceptability of the intervention. RESULTS Twenty-six participants, 42% males, were recruited around three weeks post-stroke, on average. There were 13 participants in each group, with a mean age of 69 years (SD of 12) and 67 years (SD of 11) for the control and intervention groups, respectively. Overall, 47% of those screened for eligibility were randomised, and attrition was 23% in the intervention group mainly due to discharge before the end of the intervention. Participants who adhered to their programme (completed more than two-thirds), generally those with an engaged carer, demonstrated a trend toward improved clinical outcomes. Overall, the patients, carers and physiotherapists were positive regarding the intervention. There was a total of five reported adverse events, none of which were related to the study. CONCLUSION An upper-limb unsupervised exercise intervention using an online physiotherapy platform for inpatient stroke survivors is feasible, safe and acceptable to patients, carers and physiotherapists. A fully powered RCT is warranted to investigate the clinical- and cost-effectiveness of such interventions for this patient group.
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Affiliation(s)
| | | | - Elaine Coulter
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow G4 0BA, UK; (E.C.); (L.P.)
| | | | - Lorna Paul
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow G4 0BA, UK; (E.C.); (L.P.)
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15
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Camardella C, Germanotta M, Aprile I, Cappiello G, Curto Z, Scoglio A, Mazzoleni S, Frisoli A. A Decision Support System to Provide an Ongoing Prediction of Robot-Assisted Rehabilitation Outcome in Stroke Survivors. IEEE Int Conf Rehabil Robot 2023; 2023:1-6. [PMID: 37941244 DOI: 10.1109/icorr58425.2023.10304700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
Clinicians often deal with complex robotic platform and serious games in stroke patients rehabilitation contexts, and they face two main problems: 1) the interpretation of either the performance in game or measures of a robotic system from the motor recovery point of view, and 2) the duration and complexity of clinical scales administration that makes repetitive assessments during the therapy unpractical. In this paper, a Random Tree Forest based system was trained and tested to provide a prediction of different clinical outcomes (i.e. FMA, ARAT, and MI) along the whole therapy duration, having non-clinical measures only as inputs, acting as a simulated decision support system. The dataset includes 30 post-stroke patients, that underwent a 30-session robot-assisted rehabilitation treatment. Results have shown that the system is able to produce very accurate and reliable predictions about the motor recovery of the patient at the end of the therapy, already in the first phases of the rehabilitation (i40% of therapy execution), just using robotic platform measures. Such a tool would provide a great benefit in terms of rehabilitation objectives planning, as a decision support tool for highly personalized rehabilitation treatments.
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16
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Lin C, Arevalo A, Nanavati HD. Association of inpatient rehabilitation with functional outcome in patients with stroke receiving mechanical thrombectomy. Neurol Res 2023; 45:578-582. [PMID: 36646651 PMCID: PMC10164039 DOI: 10.1080/01616412.2023.2167534] [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: 06/03/2022] [Accepted: 01/09/2023] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Patients with ischemic strokes that have undergone mechanical thrombectomy (MT) can still have poor functional outcomes. Limited research exists on factors that impact functional outcomes in these patients who are discharged to inpatient rehabilitation. We examined patient characteristics correlated with 90-day outcomes in ischemic stroke patients having undergone MT and undergo acute rehabilitation. METHODS This is a retrospective study of patients (≥18 years) who were consecutively admitted to inpatient rehabilitation after undergoing MT following an ischemic stroke event from 2015 through 2018. Functional outcomes at 90-days were determined by the modified Rankin Score (mRS). Binary logistic regression models were used to measure the association of meaningful Functional Independence Measure (FIM) change with poor-outcome (mRS >2). RESULTS Out of 56 stroke patients undergoing MT, 36 had poor outcome (mRS >2) at 90-days. One unit increase in discharge FIM significantly decreased the likelihood of poor outcome by 4% [aOR = 0.96; 95% CI = 95% CI = 0.92, 0.99]. Admission FIM [aOR = 0.95; 95% CI = 0.90, 1.00] and change in FIM [aOR = 0.97; 95% CI = 0.93, 1.02] were not significantly associated poor outcome in the adjusted models. CONCLUSION Patients with ischemic stroke who received MT who have a worse disability, particularly at discharge, while undergoing inpatient rehabilitation have higher odds of having poor future functional outcomes. This was regardless of age, sex, or race. Future research is needed to understand the mechanisms that can improve functional performance in our patient population at the IRF.
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Affiliation(s)
- Chen Lin
- Department of Neurology, University of Alabama at Birmingham
| | - Andrea Arevalo
- Department of Neurology, University of Alabama at Birmingham
| | - Hely D. Nanavati
- Department of Epidemiology, University of Alabama at Birmingham
- Department of Biostatistics, University of Alabama at Birmingham
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17
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Sheng R, Chen C, Chen H, Yu P. Repetitive transcranial magnetic stimulation for stroke rehabilitation: insights into the molecular and cellular mechanisms of neuroinflammation. Front Immunol 2023; 14:1197422. [PMID: 37283739 PMCID: PMC10239808 DOI: 10.3389/fimmu.2023.1197422] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/10/2023] [Indexed: 06/08/2023] Open
Abstract
Stroke is a leading cause of mortality and disability worldwide, with most survivors reporting dysfunctions of motor, sensation, deglutition, cognition, emotion, and speech, etc. Repetitive transcranial magnetic stimulation (rTMS), one of noninvasive brain stimulation (NIBS) techniques, is able to modulate neural excitability of brain regions and has been utilized in neurological and psychiatric diseases. Moreover, a large number of studies have shown that the rTMS presents positive effects on function recovery of stroke patients. In this review, we would like to summarized the clinical benefits of rTMS for stroke rehabilitation, including improvements of motor impairment, dysphagia, depression, cognitive function, and central post-stroke pain. In addition, this review will also discuss the molecular and cellular mechanisms underlying rTMS-mediated stroke rehabilitation, especially immune regulatory mechanisms, such as regulation of immune cells and inflammatory cytokines. Moreover, the neuroimaging technique as an important tool in rTMS-mediated stroke rehabilitation has been discussed, to better understanding the mechanisms underlying the effects of rTMS. Finally, the current challenges and future prospects of rTMS-mediated stroke rehabilitation are also elucidated with the intention to accelerate its widespread clinical application.
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Affiliation(s)
- Rongjun Sheng
- Department of Radiology, The First People’s Hospital of Linping District, Hangzhou, China
| | - Changchun Chen
- Department of Radiology, The People’s Hospital of Qiandongnan Miao and Dong Autonomous Prefecture, Guizhou, China
| | - Huan Chen
- Department of Radiology, The People’s Hospital of Longyou, Quzhou, China
| | - Peipei Yu
- Department of Radiology, Sanmen People’s Hospital, Taizhou, China
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Fu J, Chen S, Shu X, Lin Y, Jiang Z, Wei D, Gao J, Jia J. Functional-oriented, portable brain-computer interface training for hand motor recovery after stroke: a randomized controlled study. Front Neurosci 2023; 17:1146146. [PMID: 37250399 PMCID: PMC10213744 DOI: 10.3389/fnins.2023.1146146] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/07/2023] [Indexed: 05/31/2023] Open
Abstract
Background Brain-computer interfaces (BCIs) have been proven to be effective for hand motor recovery after stroke. Facing kinds of dysfunction of the paretic hand, the motor task of BCIs for hand rehabilitation is relatively single, and the operation of many BCI devices is complex for clinical use. Therefore, we proposed a functional-oriented, portable BCI equipment and explored the efficiency of hand motor recovery after a stroke. Materials and methods Stroke patients were randomly assigned to the BCI group and the control group. The BCI group received BCI-based grasp/open motor training, while the control group received task-oriented guidance training. Both groups received 20 sessions of motor training in 4 weeks, and each session lasted for 30 min. The Fugl-Meyer assessment of the upper limb (FMA-UE) was applied for the assessment of rehabilitation outcomes, and the EEG signals were obtained for processing. Results The progress of FMA-UE between the BCI group [10.50 (5.75, 16.50)] and the control group [5.00 (4.00, 8.00)] was significantly different (Z = -2.834, P = 0.005). Meanwhile, the FMA-UE of both groups improved significantly (P < 0.001). A total of 24 patients in the BCI group achieved the minimal clinically important difference (MCID) of FMA-UE with an effective rate of 80%, and 16 in the control group achieved the MCID, with an effective rate of 51.6%. The lateral index of the open task in the BCI group was significantly decreased (Z = -2.704, P = 0.007). The average BCI accuracy for 24 stroke patients in 20 sessions was 70.7%, which was improved by 5.0% in the final session compared with the first session. Conclusion Targeted hand movement and two motor task modes, namely grasp and open, to be applied in a BCI design may be suitable in stroke patients with hand dysfunction. The functional-oriented, portable BCI training can promote hand recovery after a stroke, and it is expected to be widely used in clinical practice. The lateral index change of inter-hemispheric balance may be the mechanism of motor recovery. Trial registration number ChiCTR2100044492.
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Affiliation(s)
- Jianghong Fu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Shugeng Chen
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaokang Shu
- School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Yifang Lin
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Zewu Jiang
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Dongshuai Wei
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Jiajia Gao
- Department of Rehabilitation Medicine, Shanghai No. 3 Rehabilitation Hospital, Shanghai, China
| | - Jie Jia
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Huashan Hospital, Fudan University, Shanghai, China
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19
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Fu J, Jiang Z, Shu X, Chen S, Jia J. Correlation between the ERD in grasp/open tasks of BCIs and hand function of stroke patients: a cross-sectional study. Biomed Eng Online 2023; 22:36. [PMID: 37061673 PMCID: PMC10105926 DOI: 10.1186/s12938-023-01091-1] [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: 10/04/2022] [Accepted: 03/02/2023] [Indexed: 04/17/2023] Open
Abstract
BACKGROUND AND AIMS Brain-computer interfaces (BCIs) are emerging as a promising tool for upper limb recovery after stroke, and motor tasks are an essential part of BCIs for patient training and control of rehabilitative/assistive BCIs. However, the correlation between brain activation with different levels of motor impairment and motor tasks in BCIs is still not so clear. Thus, we aim to compare the brain activation of different levels of motor impairment in performing the hand grasping and opening tasks in BCIs. METHODS We instructed stroke patients to perform motor attempts (MA) to grasp and open the affected hand for 30 trials, respectively. During this period, they underwent EEG acquisition and BCIs accuracy recordings. They also received detailed history records and behavioral scale assessments (the Fugl-Meyer assessment of upper limb, FMA-UE). RESULTS The FMA-UE was negatively correlated with the event-related desynchronization (ERD) of the affected hemisphere during open MA (R = - 0.423, P = 0.009) but not with grasp MA (R = - 0.058, P = 0.733). Then we divided the stroke patients into group 1 (Brunnstrom recovery stages between I to II, n = 19) and group 2 (Brunnstrom recovery stages between III to VI, n = 23). No difference during the grasping task (t = 0.091, P = 0.928), but a significant difference during the open task (t = 2.156, P = 0.037) was found between the two groups on the affected hemisphere. No significant difference was found in the unaffected hemisphere. CONCLUSIONS The study indicated that brain activation is positively correlated with the hand function of stroke in open-hand tasks. In the grasping task, the patients in the different groups have a similar brain response, while in the open task, mildly injured patients have more brain activation in open the hand than the poor hand function patients.
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Affiliation(s)
- Jianghong Fu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, 12 Mid-Wulumuqi Road, Jing'an District, Shanghai, 200040, China
| | - ZeWu Jiang
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, 12 Mid-Wulumuqi Road, Jing'an District, Shanghai, 200040, China
| | - Xiaokang Shu
- School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Shugeng Chen
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, 12 Mid-Wulumuqi Road, Jing'an District, Shanghai, 200040, China.
| | - Jie Jia
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, 12 Mid-Wulumuqi Road, Jing'an District, Shanghai, 200040, China.
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China.
- National Center for Neurological Disorders, Shanghai, China.
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20
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Igarashi T, Takeda R, Tani Y, Takahashi N, Ono T, Ishii Y, Hayashi S, Usuda S. Predictive discriminative accuracy of walking abilities at discharge for community ambulation levels at 6 months post-discharge among inpatients with subacute stroke. J Phys Ther Sci 2023; 35:257-264. [PMID: 36866018 PMCID: PMC9974317 DOI: 10.1589/jpts.35.257] [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: 11/16/2022] [Accepted: 12/14/2022] [Indexed: 03/04/2023] Open
Abstract
[Purpose] This study aimed to compare the predictive accuracy of walking ability at discharge among subacute stroke inpatients at 6 months post-discharge in terms of community ambulation level and establish optimal cut-off values. [Participants and Methods] This prospective observational study included 78 patients who completed follow-up assessments. Patients were classified into three groups based on the Modified Functional Walking Category (household/most limited community walkers, least limited community walkers, and unlimited community walkers) obtained by telephone survey at 6 months post-discharge. Predictive accuracy and cut-off values for discriminating among groups were calculated from 6-minute walking distance and comfortable walking speed measured at the time of discharge using receiver operating characteristic curves. [Results] Between household/most limited and least limited community walkers, 6-minute walking distance and comfortable walking speed offered similar predictive accuracy (area under the curve, 0.6-0.7), with cut-off values of 195 m and 0.56 m/s, respectively. Between least limited and unlimited community walkers, the areas under the curve were 0.896 for 6-minute walking distance and 0.844 for comfortable walking speed, with cut-off values of 299 m and 0.94 m/s, respectively. [Conclusion] Walking endurance and walking speed among inpatients with subacute stroke provided superior predictive accuracy for unlimited community walkers at 6 months post-discharge.
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Affiliation(s)
- Tatsuya Igarashi
- Physical Therapy Division, Department of Rehabilitation,
Numata Neurosurgery and Cardiovascular Hospital: 8 Sakaecho, Numata-shi, Gunma 378-0014,
Japan, Gunma University Graduate School of Health Sciences,
Japan,Corresponding author. Tatsuya Igarashi (E-mail: )
| | - Ren Takeda
- Physical Therapy Division, Department of Rehabilitation,
Numata Neurosurgery and Cardiovascular Hospital: 8 Sakaecho, Numata-shi, Gunma 378-0014,
Japan, Gunma University Graduate School of Health Sciences,
Japan
| | - Yuta Tani
- Physical Therapy Division, Department of Rehabilitation,
Numata Neurosurgery and Cardiovascular Hospital: 8 Sakaecho, Numata-shi, Gunma 378-0014,
Japan, Gunma University Graduate School of Health Sciences,
Japan
| | - Naoya Takahashi
- Physical Therapy Division, Department of Rehabilitation,
Numata Neurosurgery and Cardiovascular Hospital: 8 Sakaecho, Numata-shi, Gunma 378-0014,
Japan
| | - Takuto Ono
- Physical Therapy Division, Department of Rehabilitation,
Numata Neurosurgery and Cardiovascular Hospital: 8 Sakaecho, Numata-shi, Gunma 378-0014,
Japan
| | | | - Shota Hayashi
- Department of Physical Therapy, Gunma Paz University,
Japan
| | - Shigeru Usuda
- Gunma University Graduate School of Health Sciences,
Japan
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21
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Pedlow K, McDonough S, Klempel N, Hylands J, Hughes N, Campbell Z, Eng JJ, Stephenson A, Kennedy N. PREP Plus combined postrehabilitation programme to support upper limb recovery in community-dwelling stroke survivors: protocol for a mixed-methods, cluster-assigned feasibility study. BMJ Open 2023; 13:e069016. [PMID: 36669847 PMCID: PMC9872469 DOI: 10.1136/bmjopen-2022-069016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 11/03/2022] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Poor recovery of the upper limb following a stroke has been recognised as a significant problem in the UK. Although there is good evidence that early, intense rehabilitation can lead to upper limb recovery, often this is not maintained, with less than 50% of people regaining the ability to use their upper limb for independent function at 6 months. Upper limb recovery potential is reported for many years poststroke, yet current long-term provision is insufficient. METHODS AND ANALYSIS 60 participants will be recruited into this feasibility study, with 30 allocated to a Post Rehabilitation Enablement Programme (PREP) alone and 30 allocated to a combined programme, PREP Plus, consisting of PREP and the Graded Repetitive Arm Supplementary Programme (GRASP). We will aim to complete four iterative waves. Within each wave, the intervention design will be refined, based on participant feedback. Within each wave, there will be one cluster unit (one intervention group ;PREP Plus) and one control group ;PREP alone)). A total of five PREP sites within Northern Ireland Health and Social Care Trusts will be used for this study. PREP Plus will have a home exercise component along with exercises logs and a behaviour contract. Qualitative and quantitative measures will evaluate the acceptability and feasibility to determine how feasible it is to embed the intervention into practice, as well as to determine the feasibility of a larger, mixed-methods, randomised controlled trial to assess intervention efficacy. Clinical endpoints will also be explored. ETHICS AND DISSEMINATION This study has been approved by the Health and Social Care Research Ethics Committee A, IRAS project ID (278620). Participants will provide informed consent prior to participating in the study. Information outlining the purpose of the study, what data will be collected and how the data will be managed will be provided. Results will be published in peer-reviewed journals and any published data will be available on the university data repository. The project management group will advise on different avenues for dissemination to ensure it reaches appropriate audiences. TRIAL REGISTRATION NUMBER NCT05090163.
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Affiliation(s)
- Katy Pedlow
- School of Health Sciences, Ulster University, Londonderry, UK
| | | | - Natalie Klempel
- School of Health Sciences, Ulster University, Londonderry, UK
| | - Jenny Hylands
- School of Health Sciences, Ulster University, Londonderry, UK
| | | | - Zoe Campbell
- Northern Ireland Chest Heart and Stroke, Belfast, UK
| | - Janice J Eng
- Physical Therapy, University of British Columbia, Vancouver, Columbia, Canada
| | | | - Niamh Kennedy
- School of Psychology, Ulster University, Coleraine, UK
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22
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Prognosis of Individual-Level Mobility and Daily Activities Recovery From Acute Care to Community, Part 2: A Proof-of-Concept Single Group Prospective Cohort Study. Arch Phys Med Rehabil 2022; 104:580-589. [PMID: 36596404 DOI: 10.1016/j.apmr.2022.08.980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 08/12/2022] [Accepted: 08/24/2022] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To demonstrate a proof-of-concept for prognostic models of post-stroke recovery on activity level outcomes. DESIGN Longitudinal cohort with repeated measures from acute care, inpatient rehabilitation, and post-discharge follow-up to 6 months post-stroke. SETTING Enrollment from a single Midwest USA inpatient rehabilitation facility with community follow-up. PARTICIPANTS One-hundred fifteen persons recovering from stroke admitted to an acute rehabilitation facility (N=115). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE(S) Activity Measure for Post-Acute Care Basic Mobility and Daily Activities domains administered as 6 Clicks and patient-reported short forms. RESULTS The final Basic Mobility model defined a group-averaged trajectory rising from a baseline (pseudo-intercept) T score of 35.5 (P<.001) to a plateau (asymptote) T score of 56.4 points (P<.001) at a negative exponential rate of -1.49 (P<.001). Individual baseline scores varied by age, acute care tissue plasminogen activator, and acute care length of stay. Individual plateau scores varied by walking speed, acute care tissue plasminogen activator, and lower extremity Motricity Index scores. The final Daily Activities model defined a group-averaged trajectory rising from a baseline T score of 24.5 (P<.001) to a plateau T score of 41.3 points (P<.001) at a negative exponential rate of -1.75 (P<.001). Individual baseline scores varied by acute care length of stay, and plateau scores varied by self-care, upper extremity Motricity Index, and Berg Balance Scale scores. CONCLUSIONS As a proof-of-concept, individual activity-level recovery can be predicted as patient-level trajectories generated from electronic medical record data, but models require attention to completeness and accuracy of data elements collected on a fully representative patient sample.
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23
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Kozlowski AJ, Gooch C, Reeves MJ, Butzer JF. Prognosis of Individual-Level Mobility and Self-Care Stroke Recovery During Inpatient Rehabilitation, Part 1: A Proof-of-Concept Single Group Retrospective Cohort Study. Arch Phys Med Rehabil 2022; 104:569-579. [PMID: 36596405 DOI: 10.1016/j.apmr.2022.12.189] [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: 04/11/2022] [Revised: 11/01/2022] [Accepted: 12/20/2022] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To demonstrate feasibility of generating predictive short-term individual trajectory recovery models after acute stroke by extracting clinical data from an electronic medical record (EMR) system. DESIGN Single-group retrospective patient cohort design. SETTING Stroke rehabilitation unit at an independent inpatient rehabilitation facility (IRF). PARTICIPANTS Cohort of 1408 inpatients with acute ischemic or hemorrhagic stroke with a mean ± SD age of 66 (14.5) years admitted between April 2014 and October 2019 (N=1408). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES 0-100 Rasch-scaled Functional Independence Measure (FIM) Mobility and Self-Care subscales. RESULTS Unconditional models were best-fit on FIM Mobility and Self-Care subscales by spline fixed-effect functions with knots at weeks 1 and 2, and random effects on the baseline (FIM 0-100 Rasch score at IRF admission), initial rate (slope at time zero), and second knot (change in slope pre-to-post week 2) parameters. The final Mobility multivariable model had intercept associations with Private/Other Insurance, Ischemic Stroke, Serum Albumin, Motricity Index Lower Extremity, and FIM Cognition; and initial slope associations with Ischemic Stroke, Private/Other and Medicaid Insurance, and FIM Cognition. The final Self-Care multivariable model had intercept associations with Private/Other Insurance, Ischemic Stroke, Living with One or More persons, Serum Albumin, and FIM Cognition; and initial slope associations with Ischemic Stroke, Private/Other and Medicaid Insurance, and FIM Cognition. Final models explained 52% and 27% of the variance compared with unconditional Mobility and Self-Care models. However, some EMR data elements had apparent coding errors or missing data, and desired elements from acute care were not available. Also, unbalanced outcome data may have biased trajectories. CONCLUSIONS We demonstrate the feasibility of developing individual-level prognostic models from EMR data; however, some data elements were poorly defined, subject to error, or missing for some or all cases. Development of prognostic models from EMR will require improvements in EMR data collection and standardization.
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Affiliation(s)
- Allan J Kozlowski
- Department of Epidemiology and Biostatistics, Michigan State University - College of Human Medicine, Grand Rapids, MI; John F. Butzer Center for Research and Innovation, Mary Free Bed Rehabilitation Hospital, Grand Rapids, MI; Division of Rehabilitation, Michigan State University - College of Human Medicine, Grand Rapids, MI.
| | - Cally Gooch
- Department of Biostatistics, Grand Valley State University, Grand Rapids, MI
| | - Mathew J Reeves
- Department of Epidemiology and Biostatistics, Michigan State University - College of Human Medicine, Grand Rapids, MI
| | - John F Butzer
- John F. Butzer Center for Research and Innovation, Mary Free Bed Rehabilitation Hospital, Grand Rapids, MI; Division of Rehabilitation, Michigan State University - College of Human Medicine, Grand Rapids, MI
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Serrano-López Terradas PA, Criado Ferrer T, Jakob I, Calvo-Arenillas JI. Quo Vadis, Amadeo Hand Robot? A Randomized Study with a Hand Recovery Predictive Model in Subacute Stroke. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:690. [PMID: 36613027 PMCID: PMC9820043 DOI: 10.3390/ijerph20010690] [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: 08/31/2022] [Revised: 12/22/2022] [Accepted: 12/26/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Early identification of hand-prognosis-factors at patient's admission could help to select optimal synergistic rehabilitation programs based on conventional (COHT) or robot-assisted (RAT) therapies. METHODS In this bi-phase cross-over prospective study, 58 stroke patients were enrolled in two randomized groups. Both groups received same treatments A + B (A = 36 COHT sessions for 10 weeks; B = 36 RAT sessions for 10 weeks; 45 min/session; 3 to 5 times per week). Outcome repeated measures by blinded assessors included FMUL, BBT, NHPT, Amadeo Robot (AHR) and AMPS. Statistical comparisons by Pearson's rank correlations and one-way analyses of variance (ANOVA) with Bonferroni posthoc tests, with size effects and statistic power, were reported. Multiple backward linear regression models were used to predict the variability of sensorimotor and functional outcomes. RESULTS Isolated COHT or RAT treatments improved hand function at 3 months. While "higher hand paresis at admission" affected to sensorimotor and functional outcomes, "laterality of injury" did not seem to affect the recovery of the hand. Kinetic-kinematic parameters of robot allowed creating a predictive model of hand recovery at 3 and 6 months from 1st session. CONCLUSIONS Hand impairment is an important factor in define sensorimotor and functional outcomes, but not lesion laterality, to predict hand recovery.
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Affiliation(s)
- Pedro Amalio Serrano-López Terradas
- Robotics Unit, Brain Damage Service, Hospital Beata María Ana, 28007 Madrid, Spain
- Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain
- Occupational Thinks Research Group, Occupational Therapy Department, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - Teresa Criado Ferrer
- Robotics Unit, Brain Damage Service, Hospital Beata María Ana, 28007 Madrid, Spain
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Fu J, Chen S, Jia J. Sensorimotor Rhythm-Based Brain-Computer Interfaces for Motor Tasks Used in Hand Upper Extremity Rehabilitation after Stroke: A Systematic Review. Brain Sci 2022; 13:brainsci13010056. [PMID: 36672038 PMCID: PMC9856697 DOI: 10.3390/brainsci13010056] [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: 11/16/2022] [Revised: 12/05/2022] [Accepted: 12/25/2022] [Indexed: 12/29/2022] Open
Abstract
Brain-computer interfaces (BCIs) are becoming more popular in the neurological rehabilitation field, and sensorimotor rhythm (SMR) is a type of brain oscillation rhythm that can be captured and analyzed in BCIs. Previous reviews have testified to the efficacy of the BCIs, but seldom have they discussed the motor task adopted in BCIs experiments in detail, as well as whether the feedback is suitable for them. We focused on the motor tasks adopted in SMR-based BCIs, as well as the corresponding feedback, and searched articles in PubMed, Embase, Cochrane library, Web of Science, and Scopus and found 442 articles. After a series of screenings, 15 randomized controlled studies were eligible for analysis. We found motor imagery (MI) or motor attempt (MA) are common experimental paradigms in EEG-based BCIs trials. Imagining/attempting to grasp and extend the fingers is the most common, and there were multi-joint movements, including wrist, elbow, and shoulder. There were various types of feedback in MI or MA tasks for hand grasping and extension. Proprioception was used more frequently in a variety of forms. Orthosis, robot, exoskeleton, and functional electrical stimulation can assist the paretic limb movement, and visual feedback can be used as primary feedback or combined forms. However, during the recovery process, there are many bottleneck problems for hand recovery, such as flaccid paralysis or opening the fingers. In practice, we should mainly focus on patients' difficulties, and design one or more motor tasks for patients, with the assistance of the robot, FES, or other combined feedback, to help them to complete a grasp, finger extension, thumb opposition, or other motion. Future research should focus on neurophysiological changes and functional improvements and further elaboration on the changes in neurophysiology during the recovery of motor function.
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Affiliation(s)
- Jianghong Fu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Shugeng Chen
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Jie Jia
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
- National Center for Neurological Disorders, Shanghai 200040, China
- Correspondence: ; Tel./Fax: +86-021-5288-7820
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Moore SA, Boyne P, Fulk G, Verheyden G, Fini NA. Walk the Talk: Current Evidence for Walking Recovery After Stroke, Future Pathways and a Mission for Research and Clinical Practice. Stroke 2022; 53:3494-3505. [PMID: 36069185 PMCID: PMC9613533 DOI: 10.1161/strokeaha.122.038956] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Achieving safe, independent, and efficient walking is a top priority for stroke survivors to enable quality of life and future health. This narrative review explores the state of the science in walking recovery after stroke and potential for development. The importance of targeting walking capacity and performance is explored in relation to individual stroke survivor gait recovery, applying a common language, measurement, classification, prediction, current and future intervention development, and health care delivery. Findings are summarized in a model of current and future stroke walking recovery research and a mission statement is set for researchers and clinicians to drive the field forward to improve the lives of stroke survivors and their carers.
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Affiliation(s)
- Sarah A Moore
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK, and Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom (S.A.M.)
| | - Pierce Boyne
- Department of Rehabilitation Exercise and Nutritional Science, University of Cincinnati, OH (P.B.)
| | - George Fulk
- Department of Rehabilitation Medicine, Emory University, Atlanta, GA (G.F.)
| | - Geert Verheyden
- Department of Rehabilitation Sciences, KU Leuven, University of Leuven, Belgium (G.V.)
| | - Natalie A Fini
- Medicine Dentistry and Health Sciences, The University of Melbourne, Australia (N.A.F.)
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Elsyaad MSA, Fayed AM, Megahed MMAS, Hamouda NH, Elmenshawy AM. Early assessment of aspiration risk in acute stroke by fiberoptic endoscopy in critically ill patients. Acute Crit Care 2022; 37:276-285. [PMID: 35791662 PMCID: PMC9475167 DOI: 10.4266/acc.2021.01375] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/03/2021] [Indexed: 11/30/2022] Open
Abstract
Background Fiberoptic endoscopic evaluation of swallowing (FEES) has been recommended to assess aspiration in stroke. This study aimed to determine the diagnostic and prognostic roles of FEES in the early assessment of aspiration, intensive care unit (ICU) stay and mortality in acute stroke patients. Methods Fifty-two patients with acute stroke admitted to the Alexandria Main University Hospital were included. Complete examinations and assessment of aspiration using the 8-point penetration-aspiration scale (PAS) with FEES protocol were performed. Results The patients were classified into three groups: normal with no or low risk of aspiration (n=15, 27.3%; PAS level 1), low to moderate risk (n=8, 14.5%; PAS level 2–4), and high risk (n=32, 58.2%; PAS ≥5). There was high incidence of aspiration pneumonia, prolonged ICU stay, and mortality in both moderate- and high-risk groups (P=0.001, P<0.001, and P<0.001, respectively). The PAS score predicted aspiration pneumonia (hospital-acquired pneumonia) with sensitivity and specificity of 80.0% and 76.0%, respectively (negative predictive value [NPV], 76.0; positive predictive value [PPV], 80.0; 95% confidence interval [CI], 0.706–0.940) and mortality with sensitivity and specificity of 88.46% and 68.97% (NPV, 87.0; PPV, 71.9; 95% CI, 0.749–0.951). The PAS score could predict the length of ICU stay with sensitivity and specificity of 70.21% and 87.50, respectively (NPV, 33.3; PPV, 97.1; 95% CI, 0.605–0.906). Conclusions The standard FEES protocol using PAS score is a useful tool to assess aspiration in acute stroke patients and could be used to predict length of ICU stay and mortality.
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McFeeters C, Pedlow K, Kennedy N, Colquhoun H, McDonough S. A summary of the body of knowledge on physical activity for people following stroke: a scoping review. PHYSICAL THERAPY REVIEWS 2022. [DOI: 10.1080/10833196.2022.2102748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Claire McFeeters
- School of Health Sciences, Ulster University, Londonderry, Northern Ireland
| | - Katy Pedlow
- School of Health Sciences, Ulster University, Londonderry, Northern Ireland
| | - Niamh Kennedy
- School of Psychology, Ulster University, Coleraine, Northern Ireland
| | - Heather Colquhoun
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Suzanne McDonough
- School Of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
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Camardella C, Cappiello G, Curto Z, Germanotta M, Aprile I, Mazzoleni S, Scoglio A, Frisoli A. A Random Tree Forest decision support system to personalize upper extremity robot-assisted rehabilitation in stroke: a pilot study. IEEE Int Conf Rehabil Robot 2022; 2022:1-6. [PMID: 36176136 DOI: 10.1109/icorr55369.2022.9896509] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Robotic-based rehabilitation administered by means of serious games certainly represents the frontier of rehabilitation treatments, offering a high degree of customization of therapy, to meet individual patients' needs and to tailor a proper rehabilitation therapy. Despite the rush on developing complex rehabilitation systems, they often do not provide clinicians with long-term information about the outcome of rehabilitation, thus, not supporting them in the initial set-up phase of the therapy. In this paper, a Random-Forest based system was trained and tested to provide a prediction at discharge of several clinical scales outcomes (i.e. FMA, ARAT, and MI), having clinical scale scores and measures from the robotic system at the enrollment as inputs. The dataset includes 25 post-stroke patients from different clinics, that underwent a variable number of days of rehabilitation with a robotic treatment. Results have shown that the system is able to predict the final outcome with an accuracy ranging from 60% to 73% on the selected scales. Also results provide information on which variables are more relevant for the prediction of outcome of therapy, in particular clinical scales scores such as FMA, ARAT, MI, NRS, PCS, and MCS and robotic automatically extracted measurements related to patient's work expenditure and time. This supports the idea of using such a system in a clinical environment in a decision support tool for clinicians.
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Shin H, Kim JK, Choo YJ, Choi GS, Chang MC. Prediction of Motor Outcome of Stroke Patients Using a Deep Learning Algorithm with Brain MRI as Input Data. Eur Neurol 2022; 85:460-466. [PMID: 35738236 DOI: 10.1159/000525222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/22/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Deep learning techniques can outperform traditional machine learning techniques and learn from unstructured and perceptual data, such as images and languages. We evaluated whether a convolutional neural network (CNN) model using whole axial brain T2-weighted magnetic resonance (MR) images as input data can help predict motor outcomes of the upper and lower limbs at the chronic stage in stroke patients. METHODS We collected MR images taken at the early stage of stroke in 1,233 consecutive stroke patients. We categorized modified Brunnstrom classification (MBC) scores of ≥5 and functional ambulatory category (FAC) scores of ≥4 at 6 months after stroke as favorable outcomes in the upper and lower limbs, respectively, and MBC scores of <5 and FAC scores of <4 as poor outcomes. We applied a CNN to train the image data. Of the 1,233 patients, 70% (863 patients) were randomly selected for the training set and the remaining 30% (370 patients) were assigned to the validation set. RESULTS In the prediction of upper limb motor function on the validation dataset, the area under the curve (AUC) was 0.768, and for lower limb motor function, the AUC was 0.828. CONCLUSION We showed that a CNN model trained using whole-brain axial T2-weighted MR images of stroke patients would help predict upper and lower limb motor function at the chronic stage.
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Affiliation(s)
- Hyunkwang Shin
- Department of Information and Communication Engineering, Yeungnam University, Gyeongsan-si, Republic of Korea
| | - Jeoung Kun Kim
- Department of Business Administration, School of Business, Yeungnam University, Gyeongsan-si, Republic of Korea
| | - Yoo Jin Choo
- Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Gyu Sang Choi
- Department of Information and Communication Engineering, Yeungnam University, Gyeongsan-si, Republic of Korea
| | - Min Cheol Chang
- Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
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31
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Smith MC, Barber AP, Scrivener BJ, Stinear CM. The TWIST Tool Predicts When Patients Will Recover Independent Walking After Stroke: An Observational Study. Neurorehabil Neural Repair 2022; 36:461-471. [PMID: 35586876 DOI: 10.1177/15459683221085287] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The likelihood of regaining independent walking after stroke influences rehabilitation and hospital discharge planning. OBJECTIVE This study aimed to develop and internally validate a tool to predict whether and when a patient will walk independently in the first 6 months post-stroke. METHODS Adults with stroke were recruited if they had new lower limb weakness and were unable to walk independently. Clinical assessments were completed one week post-stroke. The primary outcome was time post-stroke by which independent walking (Functional Ambulation Category score ≥ 4) was achieved. Cox hazard regression identified predictors for achieving independent walking by 4, 6, 9, 16, or 26 weeks post-stroke. The cut-off and weighting for each predictor was determined using β-coefficients. Predictors were assigned a score and summed for a final TWIST score. The probability of achieving independent walking at each time point for each TWIST score was calculated. RESULTS We included 93 participants (36 women, median age 71 years). Age < 80 years, knee extension strength Medical Research Council grade ≥ 3/5, and Berg Balance Test < 6, 6 to 15, or ≥ 16/56, predicted independent walking and were combined to form the TWIST prediction tool. The TWIST prediction tool was at least 83% accurate for all time points. CONCLUSIONS The TWIST tool combines routine bedside tests at one week post-stroke to accurately predict the probability of an individual patient achieving independent walking by 4, 6, 9, 16, or 26 weeks post-stroke. If externally validated, the TWIST prediction tool may benefit patients and clinicians by informing rehabilitation decisions and discharge planning.
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Affiliation(s)
- Marie-Claire Smith
- Department of Medicine, 1415University of Auckland, Auckland, New Zealand.,Department of Exercise Sciences, 1415University of Auckland, Auckland, New Zealand.,Centre for Brain Research, 1415University of Auckland, Auckland, New Zealand
| | - Alan P Barber
- Department of Medicine, 1415University of Auckland, Auckland, New Zealand.,Centre for Brain Research, 1415University of Auckland, Auckland, New Zealand.,Neurology, 1387Auckland District Health Board, Auckland, New Zealand
| | - Benjamin J Scrivener
- Department of Medicine, 1415University of Auckland, Auckland, New Zealand.,Neurology, 1387Auckland District Health Board, Auckland, New Zealand
| | - Cathy M Stinear
- Department of Medicine, 1415University of Auckland, Auckland, New Zealand.,Centre for Brain Research, 1415University of Auckland, Auckland, New Zealand
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de Havenon A, Heitsch L, Sunmonu A, Braun R, Lohse KR, Cole JW, Mistry E, Lindgren A, Worrall BB, Cramer SC. Accurate Prediction of Persistent Upper Extremity Impairment in Patients With Ischemic Stroke. Arch Phys Med Rehabil 2022; 103:964-969. [PMID: 34813742 PMCID: PMC9064879 DOI: 10.1016/j.apmr.2021.10.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 09/24/2021] [Accepted: 10/11/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To develop a simple and effective risk score for predicting which stroke patients will have persistent impairment of upper extremity motor function at 90 days. DESIGN Post hoc analysis of clinical trial patients hospitalized with acute ischemic stroke who were followed for 90 days to determine functional outcome. SETTING Patient were hospitalized at facilities across the United States. PARTICIPANTS We created a harmonized cohort of individual patients (N=1653) from the NINDS tPA, ALIAS part 2, IMS-III, DEFUSE 3, and FAST-MAG trials. We split the cohort into balanced derivation and validation samples. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The primary outcome was persistent arm impairment, defined as a National Institutes of Health Stroke Scale (NIHSS) arm domain score of 2 to 4 at 90 days in patients who had a 24-hour NIHSS arm score of 1 or more. We used least absolute shrinkage and selection operator regression to determine the elements of the persistent upper extremity impairment (PUPPI) index, which we validated as a predictive tool. RESULTS We included 1653 patients (827 derivation, 826 validation), of whom 803 (48.6%) had persistent arm impairment. The PUPPI index gives 1 point each for age 55 years or older and NIHSS values of worse arm (4), worse leg (>2), facial palsy (3), and total NIHSS (≥10). The optimal cutpoint for the PUPPI index was 3 or greater, at which the area under the curve was greater than 0.75 for the derivation and validation cohorts and when using NIHSS values from either 24 hours or in a subacute or discharge time window. Results were similar across different levels of stroke severity. CONCLUSION The PUPPI index uses readily available information to accurately predict persistent upper extremity motor impairment at 90 days poststroke. The PUPPI index can be administered in minutes and could be used as inclusion criterion in recovery-related clinical trials or, with additional development, as a prognostic tool for patients, caregivers, and clinicians.
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Affiliation(s)
- Adam de Havenon
- Department of Neurology, University of Utah, Salt Lake City, UT.
| | - Laura Heitsch
- Department of Emergency Medicine, Washington University, St. Louis, MO
| | - Abimbola Sunmonu
- Department of Neurology, University of Virginia, Charlotteville, VA
| | - Robynne Braun
- Department of Neurology, University of Maryland, College Park, MD
| | - Keith R Lohse
- Department of Neurology, University of Utah, Salt Lake City, UT
| | - John W Cole
- Department of Neurology, University of Maryland, College Park, MD
| | - Eva Mistry
- Department of Neurology, Vanderbilt University, Nashville, TN
| | - Arne Lindgren
- Section of Neurology, Skåne University Hospital, Scania, Sweden; Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden
| | | | - Steven C Cramer
- Department of Emergency Medicine, University of California Los Angeles, Los Angeles, CA; California Rehabilitation Institute, Los Angeles, CA
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Christie LJ, Fearn N, McCluskey A, Lovarini M, Rendell R, Pearce A. Cost-Effectiveness of Constraint-Induced Movement Therapy Implementation in Neurorehabilitation: The ACTIveARM Project. PHARMACOECONOMICS - OPEN 2022; 6:437-450. [PMID: 35316523 PMCID: PMC9043065 DOI: 10.1007/s41669-022-00323-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/17/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Constraint-induced movement therapy (CIMT) is a recommended intervention for improving arm recovery following stroke and traumatic brain injury; however, delivery in practice remains rare. PURPOSE The aim of this study was to investigate the costs and cost effectiveness of CIMT delivery, and the use of a CIMT implementation package designed to improve CIMT uptake and delivery by therapists in Sydney, Australia. METHODS This economic evaluation was conducted with a subset of CIMT programmes (n = 20) delivered by neurological rehabilitation teams at five varied hospitals within a mixed methods implementation study (ACTIveARM). The costs of delivering the CIMT implementation package and publicly funded CIMT were calculated using a bottom-up approach. A cost-effectiveness analysis was conducted, using decision analytic modelling. We compared the uptake and outcomes of people who received CIMT from health services that had received a CIMT implementation package, with those receiving standard upper limb therapy. An Australian health care system perspective was used in the model, over a 3-week time horizon (the average timeframe of a CIMT programme). All costs were calculated in Australian dollars (AUD). Inputs were derived from the ACTIveARM study and relevant literature. The Action Research Arm Test was used to measure arm outcomes. Sensitivity analyses assessed the impact of improving CIMT uptake, scale-up of the implementation package and resource adjustment, including a 'best-case' scenario analysis. RESULTS The total cost of delivering the implementation package to nine teams across five hospitals was $110,336.43 AUD over 18 months. The mean cost of delivering an individual CIMT programme was $1233.38 AUD per participant, and $936.03 AUD per participant for group-based programmes. The incremental cost-effectiveness ratio (ICER) of individual CIMT programmes was $8052 AUD per additional person achieving meaningful improvement in arm function, and $6045 AUD for group-based CIMT. The ICER was most sensitive to reductions in staffing costs. In the 'best-case' scenario, the ICER for both individual and group-based CIMT was $245 AUD per additional person gaining a meaningful change in function. CONCLUSION Therapists improved CIMT uptake and delivery with the support of an implementation package, however cost effectiveness was unclear. CLINICAL TRIAL REGISTRATION https://anzctr.org.au/Trial ID: ACTRN12617001147370.
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Affiliation(s)
- Lauren J Christie
- Brain Injury Rehabilitation Unit, Liverpool Hospital, Sydney, NSW, Australia.
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.
- Discipline of Occupational Therapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
- Allied Health Research Unit, St Vincent's Health Network, Sydney, NSW, Australia.
- Nursing Research Institute, St Vincent's Health Network, Sydney, NSW, Australia.
| | - Nicola Fearn
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
- Discipline of Occupational Therapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Allied Health Research Unit, St Vincent's Health Network, Sydney, NSW, Australia
| | - Annie McCluskey
- Discipline of Occupational Therapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- The StrokeEd Collaboration, Sydney, NSW, Australia
| | - Meryl Lovarini
- Discipline of Occupational Therapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Reem Rendell
- Brain Injury Rehabilitation Unit, Liverpool Hospital, Sydney, NSW, Australia
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Alison Pearce
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Li X, Wang L, Miao S, Yue Z, Tang Z, Su L, Zheng Y, Wu X, Wang S, Wang J, Dou Z. Sensorimotor Rhythm-Brain Computer Interface With Audio-Cue, Motor Observation and Multisensory Feedback for Upper-Limb Stroke Rehabilitation: A Controlled Study. Front Neurosci 2022; 16:808830. [PMID: 35360158 PMCID: PMC8962957 DOI: 10.3389/fnins.2022.808830] [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: 11/04/2021] [Accepted: 01/27/2022] [Indexed: 12/02/2022] Open
Abstract
Several studies have shown the positive clinical effect of brain computer interface (BCI) training for stroke rehabilitation. This study investigated the efficacy of the sensorimotor rhythm (SMR)-based BCI with audio-cue, motor observation and multisensory feedback for post-stroke rehabilitation. Furthermore, we discussed the interaction between training intensity and training duration in BCI training. Twenty-four stroke patients with severe upper limb (UL) motor deficits were randomly assigned to two groups: 2-week SMR-BCI training combined with conventional treatment (BCI Group, BG, n = 12) and 2-week conventional treatment without SMR-BCI intervention (Control Group, CG, n = 12). Motor function was measured using clinical measurement scales, including Fugl-Meyer Assessment-Upper Extremities (FMA-UE; primary outcome measure), Wolf Motor Functional Test (WMFT), and Modified Barthel Index (MBI), at baseline (Week 0), post-intervention (Week 2), and follow-up week (Week 4). EEG data from patients allocated to the BG was recorded at Week 0 and Week 2 and quantified by mu suppression means event-related desynchronization (ERD) in mu rhythm (8–12 Hz). All functional assessment scores (FMA-UE, WMFT, and MBI) significantly improved at Week 2 for both groups (p < 0.05). The BG had significantly higher FMA-UE and WMFT improvement at Week 4 compared to the CG. The mu suppression of bilateral hemisphere both had a positive trend with the motor function scores at Week 2. This study proposes a new effective SMR-BCI system and demonstrates that the SMR-BCI training with audio-cue, motor observation and multisensory feedback, together with conventional therapy may promote long-lasting UL motor improvement. Clinical Trial Registration: [http://www.chictr.org.cn], identifier [ChiCTR2000041119].
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Affiliation(s)
- Xin Li
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Lu Wang
- Institute of Robotics and Intelligent Systems, School of Mechanical Engineering, Xi’an Jiaotong University, Xi’an, China
| | - Si Miao
- Institute of Robotics and Intelligent Systems, School of Mechanical Engineering, Xi’an Jiaotong University, Xi’an, China
| | - Zan Yue
- Institute of Robotics and Intelligent Systems, School of Mechanical Engineering, Xi’an Jiaotong University, Xi’an, China
| | - Zhiming Tang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Liujie Su
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yadan Zheng
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiangzhen Wu
- Department of Rehabilitation Medicine, Shenzhen Hengsheng Hospital, Shenzhen, China
| | - Shan Wang
- Air Force Medical Center, PLA, Beijing, China
- *Correspondence: Shan Wang,
| | - Jing Wang
- Institute of Robotics and Intelligent Systems, School of Mechanical Engineering, Xi’an Jiaotong University, Xi’an, China
- Jing Wang,
| | - Zulin Dou
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Zulin Dou,
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Park S, Tang A, Pollock C, Sakakibara BM. Telerehabilitation for lower extremity recovery poststroke: a systematic review and meta-analysis protocol. BMJ Open 2022; 12:e055527. [PMID: 35264359 PMCID: PMC8915270 DOI: 10.1136/bmjopen-2021-055527] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Approximately 30% of individuals with stroke report unmet lower extremity recovery needs after formal hospital-based rehabilitation programmes have ended. Telerehabilitation can mitigate issues surrounding accessibility of rehabilitation services by providing ongoing support to promote recovery, however, no review exists that is specific to telerehabilitation for lower extremity recovery. This paper describes the protocol of a systematic review and meta-analysis that aims to describe and evaluate the effectiveness of lower extremity-focused telerehabilitation interventions on clinical outcomes poststroke. METHODS AND ANALYSIS A systematic review of relevant electronic databases (MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, Google Scholar, PEDro, PubMed and Cochrane Library) between inception and February 2022 will be undertaken to identify eligible interventional studies published in English that compared telerehabilitation focusing on lower extremity recovery to another intervention or usual care for individuals living in the community with stroke. Clinical outcomes examined will include those related to physical function and impairment, activities and participation that are typically assessed in clinical practice and research. Two reviewers will independently screen results, identify studies to be included for review, extract data and assess risk of bias. Meta-analyses will be performed if sufficient data exist. Sensitivity analyses will be performed by removing studies with low methodological quality, and subgroup analyses will be performed if data allow by stratifying papers based on salient demographic or stroke factors and comparing results. The reporting of the review will follow the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The quality of evidence regarding various outcomes for telerehabilitation for lower extremity recovery poststroke will be assessed according to the Grading of Recommendation, Assessment, Development and Evaluation approach. ETHICS AND DISSEMINATION No ethical approval or informed consent is needed for this systematic review. The findings of this review will be disseminated via peer-reviewed publications and conference presentations. PROSPERO REGISTRATION NUMBER CRD42021246886.
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Affiliation(s)
- Sarah Park
- Faculty of Medicine, Graduate Program in Rehabilitation Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
- Faculty of Medicine, Centre for Chronic Disease Prevention and Management, The University of British Columbia, Kelowna, British Columbia, Canada
| | - Ada Tang
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Courtney Pollock
- Faculty of Medicine, Graduate Program in Rehabilitation Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
- Faculty of Medicine, Physical Therapy, The University of British Columbia, Vancouver, British Columbia, Canada
- GF Strong Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Brodie M Sakakibara
- Faculty of Medicine, Graduate Program in Rehabilitation Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
- Faculty of Medicine, Centre for Chronic Disease Prevention and Management, The University of British Columbia, Kelowna, British Columbia, Canada
- GF Strong Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- Faculty of Medicine, Occupational Science and Occupational Therapy, The University of British Columbia, Vancouver, British Columbia, Canada
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Preston E, Ada L, Stanton R, Mahendran N, Dean CM. Prediction of Independent Walking in People Who Are Nonambulatory Early After Stroke: A Systematic Review. Stroke 2021; 52:3217-3224. [PMID: 34238016 DOI: 10.1161/strokeaha.120.032345] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE One systematic review has examined factors that predict walking outcome at one month in initially nonambulatory patients after stroke. The purpose of this systematic review was to examine, in nonambulatory people within a month of stroke, which factors predict independent walking at 3, 6, and 12 months. METHODS Prognostic factors: Any factors measured within one month after stroke with the aim of predicting independent walking. Outcome of interest: Independent walking defined as walking with or without an aid but with no human assistance. RESULTS Fifteen studies comprising 2344 nonambulatory participants after stroke were included. Risk of bias was low in 7 studies and moderate in 8 studies. Individual meta-analyses of 2 to 4 studies were performed to calculate the pooled estimate of the odds ratio for 12 prognostic factors. Younger age (odds ratio [OR], 3.4, P<0.001), an intact corticospinal tract (OR, 8.3, P<0.001), good leg strength (OR, 5.0, P<0.001), no cognitive impairment (OR, 3.5, P<0.001), no neglect (OR, 2.4, P=0.006), continence (OR, 2.3, P<0.001), good sitting (OR, 7.9, P<0.001), and independence in activities of daily living (OR 10.5, P<0.001) predicted independent walking at 3 months. Younger age (OR, 2.1, P<0.001), continence (OR, 13.8, P<0.001), and good sitting (OR, 19.1, P<0.001) predicted independent walking at 6 months. There were insufficient data at 12 months. CONCLUSIONS Younger age, an intact corticospinal tract, good leg strength, continence, no cognitive impairment, no neglect, good sitting, and independence in activities of daily living in patients who are nonambulatory early after stroke predict independent walking at 3 months. Registration: URL: https://www.crd.york.ac.uk/prospero/; Unique identifier: CRD42018108794.
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Affiliation(s)
- Elisabeth Preston
- Faculty of Health, University of Canberra, Australia (E.P.).,Faculty of Health Sciences, University of Sydney, Australia (L.A.).,Canberra Health Services, Physiotherapy, Australia (R.S.).,School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia (N.M.).,Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia (C.M.D.)
| | - Louise Ada
- Faculty of Health, University of Canberra, Australia (E.P.).,Faculty of Health Sciences, University of Sydney, Australia (L.A.).,Canberra Health Services, Physiotherapy, Australia (R.S.).,School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia (N.M.).,Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia (C.M.D.)
| | - Rosalyn Stanton
- Faculty of Health, University of Canberra, Australia (E.P.).,Faculty of Health Sciences, University of Sydney, Australia (L.A.).,Canberra Health Services, Physiotherapy, Australia (R.S.).,School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia (N.M.).,Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia (C.M.D.)
| | - Niruthikha Mahendran
- Faculty of Health, University of Canberra, Australia (E.P.).,Faculty of Health Sciences, University of Sydney, Australia (L.A.).,Canberra Health Services, Physiotherapy, Australia (R.S.).,School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia (N.M.).,Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia (C.M.D.)
| | - Catherine M Dean
- Faculty of Health, University of Canberra, Australia (E.P.).,Faculty of Health Sciences, University of Sydney, Australia (L.A.).,Canberra Health Services, Physiotherapy, Australia (R.S.).,School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia (N.M.).,Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia (C.M.D.)
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Wu Q, Ge Y, Ma D, Pang X, Cao Y, Zhang X, Pan Y, Zhang T, Dou W. Analysis of Prognostic Risk Factors Determining Poor Functional Recovery After Comprehensive Rehabilitation Including Motor-Imagery Brain-Computer Interface Training in Stroke Patients: A Prospective Study. Front Neurol 2021; 12:661816. [PMID: 34177767 PMCID: PMC8222567 DOI: 10.3389/fneur.2021.661816] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 04/20/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Upper limb (UL) motor function recovery, especially distal function, is one of the main goals of stroke rehabilitation as this function is important to perform activities of daily living (ADL). The efficacy of the motor-imagery brain-computer interface (MI-BCI) has been demonstrated in patients with stroke. Most patients with stroke receive comprehensive rehabilitation, including MI-BCI and routine training. However, most aspects of MI-BCI training for patients with subacute stroke are based on routine training. Risk factors for inadequate distal UL functional recovery in these patients remain unclear; therefore, it is more realistic to explore the prognostic factors of this comprehensive treatment based on clinical practice. The present study aims to investigate the independent risk factors that might lead to inadequate distal UL functional recovery in patients with stroke after comprehensive rehabilitation including MI-BCI (CRIMI-BCI). Methods: This prospective study recruited 82 patients with stroke who underwent CRIMI-BCI. Motor-imagery brain-computer interface training was performed for 60 min per day, 5 days per week for 4 weeks. The primary outcome was improvement of the wrist and hand dimensionality of Fugl-Meyer Assessment (δFMA-WH). According to the improvement score, the patients were classified into the efficient group (EG, δFMA-WH > 2) and the inefficient group (IG, δFMA-WH ≤ 2). Binary logistic regression was used to analyze clinical and demographic data, including aphasia, spasticity of the affected hand [assessed by Modified Ashworth Scale (MAS-H)], initial UL function, age, gender, time since stroke (TSS), lesion hemisphere, and lesion location. Results: Seventy-three patients completed the study. After training, all patients showed significant improvement in FMA-UL (Z = 7.381, p = 0.000**), FMA-SE (Z = 7.336, p = 0.000**), and FMA-WH (Z = 6.568, p = 0.000**). There were 35 patients (47.9%) in the IG group and 38 patients (52.1%) in the EG group. Multivariate analysis revealed that presence of aphasia [odds ratio (OR) 4.617, 95% confidence interval (CI) 1.435-14.860; p < 0.05], initial FMA-UL score ≤ 30 (OR 5.158, 95% CI 1.150-23.132; p < 0.05), and MAS-H ≥ level I+ (OR 3.810, 95% CI 1.231-11.790; p < 0.05) were the risk factors for inadequate distal UL functional recovery in patients with stroke after CRIMI-BCI. Conclusion: We concluded that CRIMI-BCI improved UL function in stroke patients with varying effectiveness. Inferior initial UL function, significant hand spasticity, and presence of aphasia were identified as independent risk factors for inadequate distal UL functional recovery in stroke patients after CRIMI-BCI.
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Affiliation(s)
- Qiong Wu
- School of Rehabilitation Medicine, China Rehabilitation Research Center, Capital Medical University, Beijing, China.,Department of Rehabilitation Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Yunxiang Ge
- Department of Electronic Engineering, Beijing National Research Center for Information Science and Technology (BNRist), Tsinghua University, Beijing, China
| | - Di Ma
- Department of Rehabilitation Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Xue Pang
- Department of Rehabilitation Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Yingyu Cao
- School of Mechanical Engineering, Beijing Institute of Petrochemical Technology, Beijing, China
| | - Xiaofei Zhang
- Department of Clinical Epidemiology and Biostatistics, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Yu Pan
- Department of Rehabilitation Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Tong Zhang
- School of Rehabilitation Medicine, China Rehabilitation Research Center, Capital Medical University, Beijing, China
| | - Weibei Dou
- Department of Electronic Engineering, Beijing National Research Center for Information Science and Technology (BNRist), Tsinghua University, Beijing, China
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Langerak AJ, McCambridge AB, Stubbs PW, Fabricius J, Rogers K, Quel de Oliveira C, Nielsen JF, Verhagen AP. Externally validated model predicting gait independence after stroke showed fair performance and improved after updating. J Clin Epidemiol 2021; 137:73-82. [PMID: 33812010 DOI: 10.1016/j.jclinepi.2021.03.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/21/2021] [Accepted: 03/25/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To externally validate recent prognostic models that predict independent gait following stroke. STUDY DESIGN AND SETTING A systematic search identified recent models (<10 years) that predicted independent gait in adult stroke patients, using easily obtainable predictors. Predictors from the original models were assigned proxies when required, and model performance was evaluated in the validation cohort (n = 957). Models were updated to determine if performance could be improved. RESULTS Three prognostic models met our criteria, all with high Risk of Bias. Validation data was only available for the Australian model. This model used National Institute of Health Stroke Scale (NIHSS) and age to predict independent gait, using Motor Assessment Scale (MAS) walking item. For validation, Scandinavian Stroke Scale (SSS) was a proxy for NIHSS, and Functional Independence Measure (FIM) locomotion item was a proxy for MAS. The Area Under the Curve was 0.77 (0.74-0.80) and had good calibration in the validation dataset. Adjustment of the intercept and regression coefficients slightly improved discrimination. By adding paretic leg strength, the model further improved (AUC 0.82). CONCLUSION External validation of the Australian model with proxies showed fair discrimination and good calibration. Updating the model by adding paretic leg strength further improved model performance.
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Affiliation(s)
- Anthonia J Langerak
- University of Technology Sydney, Graduate School of Health, Discipline of Physiotherapy, Sydney, Australia; Utrecht University, University Medical Center Utrecht, Physical Therapy Sciences, program in Clinical Health Sciences, Utrecht, the Netherlands
| | - Alana B McCambridge
- University of Technology Sydney, Graduate School of Health, Discipline of Physiotherapy, Sydney, Australia
| | - Peter W Stubbs
- University of Technology Sydney, Graduate School of Health, Discipline of Physiotherapy, Sydney, Australia
| | - Jesper Fabricius
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Hammel, Denmark
| | - Kris Rogers
- University of Technology Sydney, Graduate School of Health, Discipline of Physiotherapy, Sydney, Australia
| | - Camila Quel de Oliveira
- University of Technology Sydney, Graduate School of Health, Discipline of Physiotherapy, Sydney, Australia
| | - Jørgen F Nielsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Hammel, Denmark
| | - Arianne P Verhagen
- University of Technology Sydney, Graduate School of Health, Discipline of Physiotherapy, Sydney, Australia.
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Gath CF, Gianella MG, Bonamico L, Olmos L, Russo MJ. Prediction of Balance After Inpatient Rehabilitation in Stroke Subjects with Severe Balance Alterations at the Admission. J Stroke Cerebrovasc Dis 2021; 30:105627. [PMID: 33508725 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 11/12/2020] [Accepted: 01/16/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Patients with severe motor alterations would be those on who the prediction of the expected motor response after inpatient rehabilitation programs is most required. OBJECTIVES To analyze if the balance progress measured by the Berg Balance Scale and the time of hospitalization could be independent predictors of the Berg Balance at the end of a post stroke rehabilitation program in patients with severe balance alteration at the admission. Secondly, to compare a Berg Balance prediction model at the time of discharge based on the Berg Balance at the time of admission (model 1) to a Berg Balance prediction model at the time of discharge based on Berg Balance progress and the time of hospitalization (model 2). METHODS Subjects suffering a first subacute supratentorial stroke admitted for inpatient rehabilitation between 2010 through 2018 were included to develop two linear regression models of predicted Berg Balance at discharge (n=149). RESULTS According to model 1 (p < 0.0001, R2= 0.166), the Berg Balance at the admission would be a predictor of the Berg Balance at discharge from hospitalization. According to model 2 (p < 0.0001, R2= 0.993) the Berg Balance progress (β= 1.026; p < 0.0001) and the hospitalization time (β=-0.006; p < 0.0001) would be independent predictors of the Berg Balance at discharge. CONCLUSIONS The motor response to the rehabilitation programs in subacute patients with severe motor alterations could be explained on the basis of balance condition at the admission, but this explanation may be improved considering the progress on the balance the patients achieve during inpatient rehabilitation irrespective the time of hospitalization.
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Affiliation(s)
- Christian Federico Gath
- Physical Therapy Unit, Fleni, Ruta 9 Km 52.5, Colectora Este (B1625), Escobar, Buenos Aires, Argentina.
| | - Matias Gabriel Gianella
- Physical Therapy Unit, Fleni, Ruta 9 Km 52.5, Colectora Este (B1625), Escobar, Buenos Aires, Argentina.
| | - Lucas Bonamico
- Department of Rehabilitation Medicine, Fleni, Escobar, Buenos Aires, Argentina.
| | - Lisandro Olmos
- Department of Rehabilitation Medicine, Fleni, Escobar, Buenos Aires, Argentina.
| | - Maria Julieta Russo
- Department of Rehabilitation Medicine, Fleni, Escobar, Buenos Aires, Argentina.
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MUTU CC, CEREI Larisa-Georgiana. The effect of the thrombolytic therapy on the early rehabilitation of patients with acute ischemic stroke – study report. BALNEO RESEARCH JOURNAL 2020. [DOI: 10.12680/balneo.2020.386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction. r-TPA intravenous thrombolytic therapy is a big step in acute management of ischemic stroke (IS) but is burdened by a small therapeutic window (max. 4.5 hours) that restricts patient access. NIH stroke scale (NIHSS) is the largest worldwide tool used by doctors in order to objectively quantify the severity of neurological impairment in acute IS, in the initial stage as well as in the subsequent stages. Material and method. The aim of this paper is to present the results of an observational, prospective, analytical study on a number of 110 patients with acute IS, hospitalized within two months in the Neurology Clinic of Sibiu (19 patients with thrombolytic therapy applied, 91 patients with classic therapy). NIHSS has been applied to all patients on the first day of the admission and at the discharge date. Results and discussions. The mean value of NIHSS at admission and at discharge (A/D) were 12,84/4.06 points for the patient with thrombolytic therapy and 7,73/4,45 points for the patients without thrombolytic therapy. In hospital NIHSS score reduction, meaning early recovery of patients, was consistent with type of applied therapy (8.78 vs3.28 points). The pattern of neurological impairment is specific for each subtype of IS. Conclusions. The degree of early recovery was superior for patients with versus without thrombolytic therapy (68.4% versus 42.4%). Average hospital care period was reduced with 8,33% for patients with thrombolytic therapy (11,4 versus 12,2 days care in hospital).
Keywords: ischemic stroke, early rehabilitation, NIH stroke scale, neurological pattern,
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Affiliation(s)
- Cătălin Cosmin MUTU
- 1. “Lucian Blaga” University of Sibiu, Romania 2. Clinical County Emergency Hospital, CVASIC Research Center, Sibiu, Romania
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Stroke Severity and Maximum Inspiratory Pressure are Independently Associated with Functional Mobility in Individuals After Stroke. J Stroke Cerebrovasc Dis 2020; 29:105375. [PMID: 33039768 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105375] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 09/12/2020] [Accepted: 09/27/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Clinical changes after stroke can contribute to reduced mobility and negatively affect the survival of these individuals. The objective of this study was to verify factors associated with functional mobility in stroke individuals. METHODS Crosssectional study carried out with stroke individuals in an outpatient clinic. Demographic and clinical data were collected and the following measures were applied: National Institute of Health Stroke Scale (NIHSS), modified Barthel Index, Trunk Impairment Scale, Functional Reach Test, Timed Up and Go Test, and the International Physical Activity Questionnaire. Respiratory muscle strength was assessed by measuring the maximum inspiratory pressure (MIP) and the maximum expiratory pressure (MEP).Variables with p < .05 in univariate logistic regression analysis were included in the multivariate logistic regression model, using the backward stepwise method. RESULTS 53 individuals were enrolled with a mean age of 55 years (±13.43). 51% were male and the median NIHSS score was 2.25 (0-13). The final multivariate model included NIHSS (OR = 1.872; 95% CI 1.167-3.006; p = 0.009), physical therapy treatment (OR = 15.467; 95% CI 1.838-130.178; p = 0.012) and MIP (OR = 1.078; 95% CI 1.024-1.135; p = 0.004). CONCLUSION Stroke severity and inspiratory muscle strength were factros associated with functional mobility in individuals after stroke, regardless stroke time.
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Lin YY, Guo SJ, Quan H, Zhao YX, Huang DY. Donepezil Improves Gait Performance in Patients with an Acute Cerebral Infarction: A Prospective Observational Cohort Study. Curr Neurovasc Res 2020; 17:304-311. [PMID: 32282302 DOI: 10.2174/1567202617666200413130101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 03/11/2020] [Accepted: 03/14/2020] [Indexed: 12/18/2022]
Abstract
Background:
Hemiplegia is a common symptom after acute cerebral infarction.
Objective:
This study aimed to explore the influence factors of gait performance and investigate
whether donepezil could improve gait performance in patients with an acute cerebral infarction.
Methods:
A total of 107 patients who experienced unilateral paresis after an acute cerebral infarction
incident were enrolled in this prospectively observational study. Participants underwent a 3-
month assessment. At the study's conclusion, patients were divided into 2 groups-those who received
donepezil daily (observation Group) and those who did not (Control Group).
Results:
There was a significant difference (t=3.269, P=0.001) of Wisconsin Gait Scale (WGS)
score between single site infarction (27.11±6.65) and multiple sites infarction (31.54±6.42). For
gender, smoking, drinking, hypertension, hyperlipidemia and diabetes, there was no difference in
WGS scores between subgroups (P>0.05), respectively. The patient's admission National Institute
of Health Stroke Scale(NIHSS) score had a strongly positive correlation with WGS score (r=0.850,
P<0.001). Besides, age (r=0.218, P=0.024), glycosylated hemoglobin (r=0.274, P=0.004), MMSE
(r=-0.261, P=0.007) and Montreal Cognitive Assessment (MoCA) (r=-0.272, P=0.005) had a weak
correlation with WGS scores. Multivariate analysis showed age (95% CI: 0.042~0.188, P=0.002),
admission NIHSS score (95% CI: 2.405~3.137, P<0.001) and multiple sites infarction (95% CI:
0.044~2.983, P=0.044) were independent risk factors of WGS scores. WGS scores of both observation
and control groups gradually decreased after admission (P<0.001). At 3 months after admission,
WGS score of the observation group was significantly lower than the control group
(t=2.468, P=0.015). There were no significant differences between observation and control group
at admission and 1 month after admission (P>0.05) and WGS scores of both single site and multiple
sites infarction gradually decreased at one month and three months after admission (P<0.001),
while there was no significant difference between two groups (P>0.05).
Conclusion:
Admission NIHSS score, age and multiple sites infarction were independent risk factors
of WGS score. Donepezil could improve gait performance in patients with acute cerebral infarction.
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Affiliation(s)
- Ying-Ying Lin
- Department of Neurology, Tongji University School of Medicine, Shanghai Tenth People’s Hospital, 301 Middle Yanchang Road, Shanghai 200072, China
| | - Shi-Jie Guo
- Department of Neurology, Tongji University School of Medicine, Shanghai Tenth People’s Hospital, 301 Middle Yanchang Road, Shanghai 200072, China
| | - Hui Quan
- Department of Neurology, Tongji University School of Medicine, Shanghai Tenth People’s Hospital, 301 Middle Yanchang Road, Shanghai 200072, China
| | - Yan-Xin Zhao
- Department of Neurology, Tongji University School of Medicine, Shanghai Tenth People’s Hospital, 301 Middle Yanchang Road, Shanghai 200072, China
| | - Dong-Ya Huang
- Department of Neurology, Tongji University School of Medicine, East Hospital, 150 Jimo Road, Shanghai 200120, China
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Lee J, Kim H, Kim J, Lee HJ, Chang WH, Kim YH. Differential early predictive factors for upper and lower extremity motor recovery after ischaemic stroke. Eur J Neurol 2020; 28:132-140. [PMID: 32881176 DOI: 10.1111/ene.14494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 08/20/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Various clinical and neuroimaging predictive factors have been identified for the recovery of upper extremity (UE) motor function after stroke. However, few studies have addressed factors related to the recovery of lower extremity (LE) motor function after stroke or performed direct comparisons of UE and LE motor recovery in the same set of patients. In this study, predictive factors for UE and LE motor recovery after stroke were investigated using clinical and neuroimaging characteristics. METHODS Forty-two subacute ischaemic stroke patients underwent structural and functional magnetic resonance imaging data acquisition and cognitive/behavioral assessments using the Fugl-Meyer assessment, the National Institutes of Health Stroke Scale (NIHSS) and the Mini-Mental State Examination (MMSE) 2 weeks after stroke onset. Neuroimaging factors, including corticospinal tract (CST) fractional anisotropy, lesion volume, CST lesion load and interhemispheric homotopic functional connectivity, were extracted. The outcome of motor function was assessed by Fugl-Meyer assessment scores 3 months after onset. RESULTS Early clinical and neuroimaging factors for predicting motor recovery were noticeably different for UE and LE. UE motor function recovery was related to age, NIHSS, MMSE, CST lesion load, lesion volume, ipsilesional CST integrity and interhemispheric homotopic functional connectivity. In contrast, LE motor recovery was related to ipsilesional and contralesional CST integrity and MMSE. Specifically, LE recovery showed a strong relationship to the preservation of cognitive function compared with motor impairment. CONCLUSIONS Our results indicate that different mechanisms underlie UE and LE motor recovery after stroke. LE motor recovery seems to be more intensively modulated by cognitive functions than UE.
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Affiliation(s)
- J Lee
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - H Kim
- Department of Health Sciences and Technology, Department of Medical Device Management and Research, Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - J Kim
- Department of Health Sciences and Technology, Department of Medical Device Management and Research, Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - H-J Lee
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Health Sciences and Technology, Department of Medical Device Management and Research, Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - W H Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Y-H Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Health Sciences and Technology, Department of Medical Device Management and Research, Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
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Kitaji Y, Harashima H, Miyano S. Relationship between first mobilization following the onset of stroke and clinical outcomes in patients with ischemic stroke in the general ward of a hospital: A cohort study. Phys Ther Res 2020; 23:209-215. [PMID: 33489661 PMCID: PMC7814213 DOI: 10.1298/ptr.e10022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 06/25/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The purpose of this study was to compare the effects of first mobilization following a stroke with independently performing the activities of daily living at discharge in acute phase ischemic stroke patients in a general ward of a hospital. METHODS A total of 158 patients with ischemic strokes were admitted to a general ward from June 1, 2014 to March 31, 2015. Of the 158 patients, 53 met the study's eligibility criteria. First mobilization was defined as the transfer of a patient from the bed to a wheelchair by a rehabilitation therapist. A favorable primary outcome at discharge was defined as a modified Rankin Scale score of < 3. The outcome was analyzed using the proportional hazards analysis and receiver operating characteristic curves. RESULTS The age of the participants was 78.2 ± 11.7 years, stroke severity evaluated by the National Institutes of Health Stroke Scale scores on admission was 14.3 ± 10.6 points, and first mobilization of this population was 6.4 ± 5.2 days. Thirteen [25%] patients had a favorable outcome. Hazards analysis showed a favorable outcome due to first mobilization (adjusted hazards ratio 0.80, 95% confidence interval 0.65-0.98; p < 0.05). The cutoff point for first mobilization to produce a favorable outcome was 6.5 days after the stroke onset (area under the curve 0.729; p < 0.05). CONCLUSION As seen in stroke units, early first mobilization is associated with improved clinical outcomes in ischemic stroke patients admitted to a general ward.
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Age is negatively associated with upper limb recovery after conventional but not robotic rehabilitation in patients with stroke: a secondary analysis of a randomized-controlled trial. J Neurol 2020; 268:474-483. [PMID: 32844309 DOI: 10.1007/s00415-020-10143-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/03/2020] [Accepted: 08/05/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND There is consistent evidence that robotic rehabilitation is at least as effective as conventional physiotherapy for upper extremity (UE) recovery after stroke, suggesting to focus research on which subgroups of patients may better respond to either intervention. In this study, we evaluated which baseline variables are associated with the response after the two approaches. METHODS This is a secondary analysis of a randomized-controlled trial comparing robotic and conventional treatment for the UE. After the assigned intervention, changes of the Fugl-Meyer Assessment UE score by ≥ 5 points classified patients as responders to treatment. Variables associated with the response were identified in a univariate analysis. Then, variables independently associated with recovery were investigated, in the whole group, and the two groups separately. RESULTS A sample of 190 patients was evaluated after the treatment; 121 were responders. Age, baseline impairment, and neglect were significantly associated with worse response to the treatment. Age was the only independently associated variable (OR 0.967, p = 0.023). Considering separately the two interventions, age remained negatively associated with recovery (OR 0.948, p = 0.013) in the conventional group, while none of the variables previously identified were significantly associated with the response to treatment in the robotic group. CONCLUSIONS We found that, in our sample, age is significantly associated with the outcome after conventional but not robotic UE rehabilitation. Possible explanations may include an enhanced positive attitude of the older patients towards technological training and reduced age-associated fatigue provided by robotic-assisted exercise. The possibly higher challenge proposed by robotic training, unbiased by the negative stereotypes concerning very old patients' expectations and chances to recover, may also explain our findings. TRIAL REGISTRATION NUMBER NCT02879279.
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Wall A, Borg J, Vreede K, Palmcrantz S. A randomized controlled study incorporating an electromechanical gait machine, the Hybrid Assistive Limb, in gait training of patients with severe limitations in walking in the subacute phase after stroke. PLoS One 2020; 15:e0229707. [PMID: 32109255 PMCID: PMC7048283 DOI: 10.1371/journal.pone.0229707] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 02/11/2020] [Indexed: 01/21/2023] Open
Abstract
Early onset, intensive and repetitive, gait training may improve outcome after stroke but for patients with severe limitations in walking, rehabilitation is a challenge. The Hybrid Assistive Limb (HAL) is a gait machine that captures voluntary actions and support gait motions. Previous studies of HAL indicate beneficial effects on walking, but these results need to be confirmed in blinded, randomized controlled studies. This study aimed to explore effects of incorporating gait training with HAL as part of an inpatient rehabilitation program after stroke. Thirty-two subacute stroke patients with severe limitations in walking were randomized to incorporated HAL training (4 days/week for 4 weeks) or conventional gait training only. Blinded assessments were carried out at baseline, after the intervention, and at 6 months post stroke. The primary outcome was walking independence according to the Functional Ambulation Categories. Secondary outcomes were the Fugl-Meyer Assessment, 2-Minute Walk Test, Berg Balance Scale, and the Barthel Index. No significant between-group differences were found regarding any primary or secondary outcomes. At 6 months, two thirds of all patients were independent in walking. Prediction of independent walking at 6 months was not influenced by treatment group, but by age (OR 0.848, CI 0.719-0.998, p = 0.048). This study found no difference between groups for any outcomes despite the extra resources required for the HAL training, but highlights the substantial improvements in walking seen when evidence-based rehabilitation is provided to patients, with severe limitations in walking in the subacute stage after stroke. In future studies potential subgroups of patients who will benefit the most from electromechanically-assisted gait training should be explored.
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Affiliation(s)
- Anneli Wall
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Jörgen Borg
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Katarina Vreede
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Susanne Palmcrantz
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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Parker J, Powell L, Mawson S. Effectiveness of Upper Limb Wearable Technology for Improving Activity and Participation in Adult Stroke Survivors: Systematic Review. J Med Internet Res 2020; 22:e15981. [PMID: 31913131 PMCID: PMC6996755 DOI: 10.2196/15981] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/16/2019] [Accepted: 10/22/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND With advances in technology, the adoption of wearable devices has become a viable adjunct in poststroke rehabilitation. Upper limb (UL) impairment affects up to 77% of stroke survivors impacting on their ability to carry out everyday activities. However, despite an increase in research exploring these devices for UL rehabilitation, little is known of their effectiveness. OBJECTIVE This review aimed to assess the effectiveness of UL wearable technology for improving activity and participation in adult stroke survivors. METHODS Randomized controlled trials (RCTs) and randomized comparable trials of UL wearable technology for poststroke rehabilitation were included. Primary outcome measures were validated measures of activity and participation as defined by the International Classification of Functioning, Disability, and Health. Databases searched were MEDLINE, Web of Science (Core collection), CINAHL, and the Cochrane Library. The Cochrane Risk of Bias Tool was used to assess the methodological quality of the RCTs and the Downs and Black Instrument for the quality of non RCTs. RESULTS In the review, we included 11 studies with collectively 354 participants at baseline and 323 participants at final follow-up including control groups and participants poststroke. Participants' stroke type and severity varied. Only 1 study found significant between-group differences for systems functioning and activity (P≤.02). The 11 included studies in this review had small sample sizes ranging from 5 to 99 participants at an average (mean) age of 57 years. CONCLUSIONS This review has highlighted a number of reasons for insignificant findings in this area including low sample sizes and the appropriateness of the methodology for complex interventions. However, technology has the potential to measure outcomes, provide feedback, and engage users outside of clinical sessions. This could provide a platform for motivating stroke survivors to carry out more rehabilitation in the absence of a therapist, which could maximize recovery. TRIAL REGISTRATION PROSPERO CRD42017057715; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=57715.
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Patrama AP, Tresno T, Purwanza SW. Development The National Institutes of Health Stroke Scale (NIHSS) for Predicting Disability and Functional Outcome to Support Discharge Planning After Ischemic Stroke. JURNAL NERS 2020. [DOI: 10.20473/jn.v14i3.17220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction: A discharged stroke patients with disability from hospital need special identify in order to obtain a meaningful quality of life, to improve the functional status of patient’s life quality can be started immediately at admission patient in health sevices. The initial discharge planning was carried out to explore patient’s needs during inpatient and discharge with the National Institutes of Health Stroke Scale (NIHSS). NIHSS as a predictor model to discharge stroke patient with disability , need to identify effectivity of it to improve the functional status of patient’s life quality with stroke.Methods: Search of journal articles used PECOT framework in the database; Sciencedirect, CINAHL, Elseiver, Sage, Scopus, Ebscohost, and Medline with limitations of publication time is in the last 15 years (2004-2019) by including keywords Natioanal Institutes of Health Stroke Scale, discharge planning, ischemic stroke.Results: There are 10 journals according specified criteria design that discuss the interventions of discharge planning model patient stroke.Conclusion: NIHSS can be applied to predicting disability and functional outcome status of patient’s life quality with stroke.
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Gianella M, Gath C, Bonamico L, Olmos L, Russo M. Prediction of Gait without Physical Assistance after Inpatient Rehabilitation in Severe Subacute Stroke Subjects. J Stroke Cerebrovasc Dis 2019; 28:104367. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.104367] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 05/29/2019] [Accepted: 08/22/2019] [Indexed: 12/23/2022] Open
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Affiliation(s)
- Cathy M Stinear
- From the Department of Medicine (C.M.S., M.-C.S.), University of Auckland, New Zealand.,Centre for Brain Research (C.M.S., M.-C.S., W.D.B.), University of Auckland, New Zealand
| | - Marie-Claire Smith
- From the Department of Medicine (C.M.S., M.-C.S.), University of Auckland, New Zealand.,Centre for Brain Research (C.M.S., M.-C.S., W.D.B.), University of Auckland, New Zealand
| | - Winston D Byblow
- Centre for Brain Research (C.M.S., M.-C.S., W.D.B.), University of Auckland, New Zealand.,Department of Exercise Sciences (W.D.B.), University of Auckland, New Zealand
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