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Lyu S, Zhong S, Luo Y, Yan S, Ran H, Duan M, Song K, Ye K, Miao H, Hu Y, Song Z, Lai S, Zhang Y, He J, Zhu Y, Jia Y. Effects of virtual reality-based cognitive training for adolescents with depressive episodes: A pilot randomized controlled study. Psychiatry Res 2024; 340:116144. [PMID: 39167866 DOI: 10.1016/j.psychres.2024.116144] [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: 05/05/2023] [Revised: 07/20/2024] [Accepted: 08/11/2024] [Indexed: 08/23/2024]
Abstract
Cognitive impairment is a common symptom in depression, yet few intervention strategies target adolescents. This study investigated the effects of an attention and working memory cognitive training system based on virtual reality (VRCT) in adolescents with mild to moderate depressive episodes. Adolescents with depression were randomized into a VR training group (VRG, n = 47) or a waitlist control group (WT, n = 46). The VR training consisted of three 10-min tasks per session, conducted three sessions per week for 20 sessions over 7 weeks. Forty-four healthy adolescents participated as a comparison group for baseline cognitive assessment. Cognitive functions and depressive symptoms were assessed using the Das-Naglieri cognitive assessment system, driven by the Planning, Attention, Simultaneous, and Successive (PASS) processing theory, and the Hamilton Depression Rating Scale-24 at pre- and post-intervention. Baseline results indicated significantly lower cognitive scores in patients compared to healthy adolescents. Post-intervention, the VRG demonstrated significant improvements in all four cognitive scales (effect sizes 0.56 to 0.76) and a significant reduction in depressive symptoms compared to the WT. These findings suggest that VRCT holds potential for improving cognitive impairments and alleviating depressive symptoms in adolescents with depression. Further large-scale and follow-up studies are necessary to confirm long-term benefits.
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Affiliation(s)
- Sihui Lyu
- Department of Psychiatry, First Affiliated Hospital, Jinan University, Guangzhou 510630, China
| | - Shuming Zhong
- Department of Psychiatry, First Affiliated Hospital, Jinan University, Guangzhou 510630, China
| | - Yange Luo
- School of Management, Jinan University, Guangzhou 510630, China
| | - Shuya Yan
- Department of Psychiatry, First Affiliated Hospital, Jinan University, Guangzhou 510630, China
| | - Hanglin Ran
- School of Management, Jinan University, Guangzhou 510630, China
| | - Manying Duan
- School of Management, Jinan University, Guangzhou 510630, China
| | - Kailin Song
- School of Management, Jinan University, Guangzhou 510630, China
| | - Kaiwei Ye
- School of Management, Jinan University, Guangzhou 510630, China
| | - Haofei Miao
- School of Management, Jinan University, Guangzhou 510630, China
| | - Yilei Hu
- School of Management, Jinan University, Guangzhou 510630, China
| | - Zijin Song
- School of Management, Jinan University, Guangzhou 510630, China
| | - Shunkai Lai
- Department of Psychiatry, First Affiliated Hospital, Jinan University, Guangzhou 510630, China
| | - Yiliang Zhang
- Department of Psychiatry, First Affiliated Hospital, Jinan University, Guangzhou 510630, China
| | - Jiali He
- Department of Psychiatry, First Affiliated Hospital, Jinan University, Guangzhou 510630, China
| | - Yunxia Zhu
- Department of Psychiatry, First Affiliated Hospital, Jinan University, Guangzhou 510630, China
| | - Yanbin Jia
- Department of Psychiatry, First Affiliated Hospital, Jinan University, Guangzhou 510630, China.
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Ismail UN, Yahya N, Manan HA. Investigating functional connectivity related to stroke recovery: A systematic review. Brain Res 2024; 1840:149023. [PMID: 38815644 DOI: 10.1016/j.brainres.2024.149023] [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: 02/03/2024] [Revised: 05/22/2024] [Accepted: 05/23/2024] [Indexed: 06/01/2024]
Abstract
INTRODUCTION Stroke recovery is a complex process influenced by various factors, including specific neural reorganization. The objective of this systematic review was to identify important functional connectivity (FC) changes in resting-state fMRI data that were often correlated with motor, emotional, and cognitive outcome improvement. METHOD A systematic search using PubMed and SCOPUS databases was conducted to identify relevant studies published between 2010 and 2023. RESULTS A total of 766 studies were identified, of which 20 studies (602 S individuals) met the inclusion criteria. Fourteen studies focussed on motor recovery while six on cognitive recovery. All studies reported interhemispheric FC to be strongly associated with motor and cognitive recovery. The preservation and changes of M1-M1 (eight incidences) and M1-SMA (nine incidences) FC were found to be strongly correlated with motor function improvement. For cognitive recovery, restoration and preservation of FC with and between default mode network (DMN)-related regions were important for the process. CONCLUSIONS This review identified specific patterns of FC that were consistently reported with recovery of motor and cognitive function. The findings may serve in refining future management strategies to enhance patient outcomes.
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Affiliation(s)
- Umi Nabilah Ismail
- Makmal Pemprosesan Imej Kefungsian (Functional Image Processing Laboratory), Department of Radiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56 000 Cheras, Kuala Lumpur, Malaysia
| | - Noorazrul Yahya
- Diagnostic Imaging & Radiotherapy Program, Centre of Diagnostic, Therapeutic and Investigative Sciences (CODTIS), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, 50300 Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Malaysia
| | - Hanani Abdul Manan
- Makmal Pemprosesan Imej Kefungsian (Functional Image Processing Laboratory), Department of Radiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56 000 Cheras, Kuala Lumpur, Malaysia; Department of Radiology and Intervention, Hospital Pakar Kanak-Kanak (Children Specialist Hospital), Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Kuala Lumpur, Malaysia.
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Elvrum AKG, Kårstad SB, Hansen G, Bjørkøy IR, Lydersen S, Grunewaldt KH, Eliasson AC. The Small Step Early Intervention Program for Infants at High Risk of Cerebral Palsy: A Single-Subject Research Design Study. J Clin Med 2024; 13:5287. [PMID: 39274500 DOI: 10.3390/jcm13175287] [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: 07/29/2024] [Revised: 08/29/2024] [Accepted: 09/02/2024] [Indexed: 09/16/2024] Open
Abstract
Background/Objectives: Early interventions for infants at high risk of cerebral palsy (CP) are recommended, but limited evidence exists. Our objective was, therefore, to evaluate the effects of the family-centered and interprofessional Small Step early intervention program on motor development in infants at high risk of CP (ClinicalTrials.gov: NCT03264339). Methods: A single-subject research design was employed to investigate participant characteristics (motor dysfunction severity measured using the Hammersmith Infant Neurological Examination (HINE) and Alberta Infant Motor Scale (AIMS) at three months of corrected age (3mCA) related to intervention response. The repeated measures Peabody Developmental Motor Scales-2 fine and gross motor composite (PDMS2-FMC and -GMC) and Hand Assessment for Infants (HAI) were analyzed visually by cumulative line graphs, while the Gross Motor Function Measure-66 (GMFM-66) was plotted against reference percentiles for various Gross Motor Function Classification System (GMFCS) levels. Results: All infants (n = 12) received the Small Step program, and eight completed all five training steps. At two years of corrected age (2yCA), nine children were diagnosed with CP. The children with the lowest HINE < 25 and/or AIMS ≤ 6 at 3mCA (n = 4) showed minor improvements during the program and were classified at GMFCS V 2yCA. Children with HINE = 25-40 (n = 5) improved their fine motor skills during the program, and four children had larger GMFM-66 improvements than expected according to the reference curves but that did not always happen during the mobility training steps. Three children with HINE = 41-50 and AIMS > 7 showed the largest improvements and were not diagnosed with CP 2yCA. Conclusions: Our results indicate that the Small Step program contributed to the children's motor development, with better results for those with an initial higher HINE (>25). The specificity of training could not be confirmed.
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Affiliation(s)
- Ann-Kristin G Elvrum
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, 7491 Trondheim, Norway
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, 7491 Trondheim, Norway
- Clinic of Rehabilitation, St. Olav's Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - Silja Berg Kårstad
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU Central Norway), Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, 7491 Trondheim, Norway
- Child and Adolescent Mental Health Services, St. Olav's Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - Gry Hansen
- Children and Youth Clinic, St. Olav's Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - Ingrid Randby Bjørkøy
- Children and Youth Clinic, St. Olav's Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - Stian Lydersen
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU Central Norway), Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, 7491 Trondheim, Norway
| | - Kristine Hermansen Grunewaldt
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, 7491 Trondheim, Norway
- Children and Youth Clinic, St. Olav's Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - Ann-Christin Eliasson
- Neuropediatric Unit, Department of Women's and Children's Health, Karolinska Institutet, 17671 Stockholm, Sweden
- Neuropediatric Research Unit, Astrid Lindgren Children's Hospital, 17176 Stockholm, Sweden
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Zhang H, Peng B, Chen Z, Peng Y, Zhou X, Geng Y, Li G. Characterizing upper limb motor dysfunction with temporal and spatial distribution of muscle synergy extracted from high-density surface electromyography. J Neural Eng 2024; 21:056006. [PMID: 39146971 DOI: 10.1088/1741-2552/ad6fd5] [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: 08/05/2023] [Accepted: 08/15/2024] [Indexed: 08/17/2024]
Abstract
Objective.To promote the development of objective and comprehensive motion function assessment for patients, based on high-density surface electromyography (HD-sEMG), this study investigates the temporal and spatial variations of neuromuscular activities related to upper limb motor dysfunction.Approach.Patients with unilateral upper limb motor dysfunction and healthy controls were enrolled in the study. HD-sEMG was collected from both arms while they were performing eight hand and wrist movements. Muscle synergies were extracted from the HD-sEMG. Symmetry of bilateral upper limb synergies and synergy differences between motions were proposed as spatial indicators to measure alterations in synergy spatial distribution. Additionally, as a temporal characteristic, the correlation of bilateral upper limb activation coefficient was proposed to describe the coordination control of the central nervous system. All temporal and spatial indicators were compared between patients and healthy subjects.Main results.The patients showed a significant decrease (p< 0.05) in the symmetry of bilateral upper limb synergy spatial distribution and correlation of bilateral upper limb activation coefficient. Patients with motor dysfunction also showed an increase in synergy similarity between motions, indicating altered spatial distribution of muscle synergies.Significance.These findings provide valuable insights into specific patterns associated with motor dysfunction, informing motor function assessment, and guiding targeted interventions and rehabilitation strategies for neurologically disordered patients.
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Affiliation(s)
- Haoshi Zhang
- Shenzhen Institutes of Advanced Technology (SIAT), Chinese Academy of Sciences (CAS), Shenzhen 518055, People's Republic of China
- University of Chinese Academy of Sciences, Beijing 100049, People's Republic of China
| | - Boxing Peng
- Shenzhen Institutes of Advanced Technology (SIAT), Chinese Academy of Sciences (CAS), Shenzhen 518055, People's Republic of China
- University of Chinese Academy of Sciences, Beijing 100049, People's Republic of China
| | - Ziyin Chen
- Shenzhen Institutes of Advanced Technology (SIAT), Chinese Academy of Sciences (CAS), Shenzhen 518055, People's Republic of China
| | - Yinghu Peng
- Shenzhen Institutes of Advanced Technology (SIAT), Chinese Academy of Sciences (CAS), Shenzhen 518055, People's Republic of China
| | - Xiaomeng Zhou
- Shenzhen Institutes of Advanced Technology (SIAT), Chinese Academy of Sciences (CAS), Shenzhen 518055, People's Republic of China
| | - Yanjuan Geng
- Shenzhen Institutes of Advanced Technology (SIAT), Chinese Academy of Sciences (CAS), Shenzhen 518055, People's Republic of China
| | - Guanglin Li
- Shenzhen Institutes of Advanced Technology (SIAT), Chinese Academy of Sciences (CAS), Shenzhen 518055, People's Republic of China
- Shandong Zhongke Advanced Technology Co., Ltd, Jinan 250000, People's Republic of China
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Norris TA, Augenstein TE, Rodriguez KM, Claflin ES, Krishnan C. Shaping corticospinal pathways in virtual reality: effects of task complexity and sensory feedback during mirror therapy in neurologically intact individuals. J Neuroeng Rehabil 2024; 21:154. [PMID: 39232841 PMCID: PMC11373181 DOI: 10.1186/s12984-024-01454-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Accepted: 08/27/2024] [Indexed: 09/06/2024] Open
Abstract
BACKGROUND Restoration of limb function for individuals with unilateral weakness typically requires volitional muscle control, which is often not present for individuals with severe impairment. Mirror therapy-interventions using a mirror box to reflect the less-impaired limb onto the more-impaired limb-can facilitate corticospinal excitability, leading to enhanced recovery in severely impaired clinical populations. However, the mirror box applies limitations on mirror therapy, namely that all movements appear bilateral and are confined to a small area, impeding integration of complex activities and multisensory feedback (e.g., visuo-tactile stimulation). These limitations can be addressed with virtual reality, but the resulting effect on corticospinal excitability is unclear. OBJECTIVE Examine how virtual reality-based unilateral mirroring, complex activities during mirroring, and visuo-tactile stimulation prior to mirroring affect corticospinal excitability. MATERIALS AND METHODS Participants with no known neurological conditions (n = 17) donned a virtual reality system (NeuRRoVR) that displayed a first-person perspective of a virtual avatar that matched their motions. Transcranial magnetic stimulation-induced motor evoked potentials in the nondominant hand muscles were used to evaluate corticospinal excitability in four conditions: resting, mirroring, mirroring with prior visuo-tactile stimulation (mirroring + TACT), and control. During mirroring, the movements of each participant's dominant limb were reflected onto the nondominant limb of the virtual avatar, and the avatar's dominant limb was kept immobile (i.e., unilateral mirroring). The mirroring + TACT condition was the same as the mirroring condition, except that mirroring was preceded by visuo-tactile stimulation of the nondominant limb. During the control condition, unilateral mirroring was disabled. During all conditions, participants performed simple (flex/extend fingers) and complex (stack virtual blocks) activities. RESULTS We found that unilateral mirroring increased corticospinal excitability compared to no mirroring (p < 0.001), complex activities increased excitability compared to simple activities during mirroring (p < 0.001), and visuo-tactile stimulation prior to mirroring decreased excitability (p = 0.032). We also found that these features did not interact with each other. DISCUSSIONS The findings of this study shed light onto the neurological mechanisms of mirror therapy and demonstrate the unique ways in which virtual reality can augment mirror therapy. The findings have important implications for rehabilitation for design of virtual reality systems for clinical populations.
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Affiliation(s)
- Trevor A Norris
- Neuromuscular & Rehabilitation Robotics Laboratory (NeuRRo Lab), Michigan Medicine, University of Michigan, 325 E Eisenhower Parkway (Room 3013), Ann Arbor, MI, 48108, USA
| | - Thomas E Augenstein
- Neuromuscular & Rehabilitation Robotics Laboratory (NeuRRo Lab), Michigan Medicine, University of Michigan, 325 E Eisenhower Parkway (Room 3013), Ann Arbor, MI, 48108, USA
- Robotics Department, University of Michigan, Ann Arbor, MI, USA
- Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA
| | - Kazandra M Rodriguez
- Neuromuscular & Rehabilitation Robotics Laboratory (NeuRRo Lab), Michigan Medicine, University of Michigan, 325 E Eisenhower Parkway (Room 3013), Ann Arbor, MI, 48108, USA
- Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA
| | - Edward S Claflin
- Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA
| | - Chandramouli Krishnan
- Neuromuscular & Rehabilitation Robotics Laboratory (NeuRRo Lab), Michigan Medicine, University of Michigan, 325 E Eisenhower Parkway (Room 3013), Ann Arbor, MI, 48108, USA.
- Robotics Department, University of Michigan, Ann Arbor, MI, USA.
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA.
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA.
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.
- Department of Physical Therapy, University of Michigan-Flint, Flint, MI, USA.
- Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA.
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Gmelig Meyling C, Verschuren O, Rentinck ICM, van Driel D, Te Slaa E, Engelbert RH, Gorter JW. "Your brain can't wait": perspectives of children and adolescents with acquired brain injury and their parents on physical rehabilitation during the subacute phase. Disabil Rehabil 2024; 46:4420-4427. [PMID: 37909065 DOI: 10.1080/09638288.2023.2275742] [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: 03/26/2023] [Revised: 09/13/2023] [Accepted: 10/23/2023] [Indexed: 11/02/2023]
Abstract
PURPOSE Physical interventions during subacute rehabilitation have potential to improve functional recovery. This study explored the perspectives of children and adolescents with acquired brain injury (ABI) and their parents with respect to physical rehabilitation during the subacute phase. METHODS Thirteen children and adolescents with ABI and their parents were included and interviewed using semi-structured interviews. Interview transcripts were analysed using inductive thematic analysis approach. RESULTS Six themes were identified: 1) beliefs of physical rehabilitation, 2) content of physical rehabilitation, 3) tailored care, 4) impact of context, 5) communication and 6) transition. The importance of intensive physical practice was widely supported. The positive can-do mentality was emphasised to create an atmosphere of hope, meaning that every effort would be made to achieve maximum recovery. Intensive involvement of parents is considered essential during subacute rehabilitation including an open and mutual dialogue about the focus of rehabilitation, therapy goals and future participation in their own environment. CONCLUSIONS Our findings highlight the need for an intensive rehabilitation approach, tailored to the individual's needs. The perspectives of children and adolescents and their parents in our study contribute to a better understanding of factors that are important for optimal recovery through physical rehabilitation during the subacute phase.
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Affiliation(s)
- Christiaan Gmelig Meyling
- UMC Utrecht Brain Center and Center of Excellence for Rehabilitation Medicine, Utrecht University, Utrecht, The Netherlands
- Department of Paediatric Rehabilitation, De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- Institute of Human Movement Studies, Master Program Physiotherapy Specialization Paediatric Physiotherapy, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Olaf Verschuren
- UMC Utrecht Brain Center and Center of Excellence for Rehabilitation Medicine, Utrecht University, Utrecht, The Netherlands
| | - Ingrid C M Rentinck
- Department of Paediatric Rehabilitation, De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Dimara van Driel
- Institute of Human Movement Studies, Master Program Physiotherapy Specialization Paediatric Physiotherapy, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Esmée Te Slaa
- Institute of Human Movement Studies, Master Program Physiotherapy Specialization Paediatric Physiotherapy, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Raoul H Engelbert
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- Department of Paediatrics, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan Willem Gorter
- UMC Utrecht Brain Center and Center of Excellence for Rehabilitation Medicine, Utrecht University, Utrecht, The Netherlands
- Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
- CanChild Centre for Childhood Disability Research, Department of Paediatrics, McMaster University, Hamilton, Ontario, Canada
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Goikoetxea-Sotelo G, van Hedel HJA. Reporting Completeness of Intensity-, Dose-, and Dosage-Related Items in Active Pediatric Upper Limb Neurorehabilitation Trials: A Systematic Review. Arch Phys Med Rehabil 2024; 105:1784-1792. [PMID: 38160897 DOI: 10.1016/j.apmr.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 12/06/2023] [Accepted: 12/12/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE To analyze the reporting completeness of the TIDieR items 8-12, in particular intensity, dose, and dosage, in active pediatric upper limb neurorehabilitation trials. DATA SOURCES We searched PubMed Central, Scopus, CINAHL, OTseeker, and Web of Science for eligible publications. STUDY SELECTION We included publications analyzing active pediatric upper limb neurorehabilitation interventions and assessed the reporting completeness of 11 items for each intervention and control group. DATA EXTRACTION Two raters independently screened titles and abstracts and selected the publications using the RYYAN platform. We unblinded the results after the raters had completed their selection and resolved the disagreements by discussion. We used the same procedures to review the full texts. DATA SYNTHESIS We included 52 randomized controlled trials with 65 intervention and 48 control groups. Authors did not report all 11 items in any of the study groups. The overall reporting completeness varied between 1% (intensity) to 95% (length of the intervention). The reporting completeness of the TIDieR items ranged from 2% (modifications) to 64% (when and how much). We found no significant differences in the reporting completeness between the intervention and control groups. CONCLUSIONS Information essential for dose-response calculations is often missing in randomized controlled trials of pediatric upper limb neurorehabilitation interventions. Reporting completeness should be improved, and new measures to accurately quantify intensity should be discussed and developed.
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Affiliation(s)
- Gaizka Goikoetxea-Sotelo
- Swiss Children's Rehab, University Children's Hospital Zurich, University of Zurich, Affoltern am Albis, Switzerland; Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland; Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Hubertus J A van Hedel
- Swiss Children's Rehab, University Children's Hospital Zurich, University of Zurich, Affoltern am Albis, Switzerland; Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland.
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Knutson JS, Fu MJ, Cunningham DA, Hisel TZ, Friedl AS, Gunzler DD, Plow EB, Busch RM, Pundik S. Contralaterally controlled functional electrical stimulation video game therapy for hand rehabilitation after stroke: a randomized controlled trial. Disabil Rehabil 2024; 46:4466-4475. [PMID: 37962171 PMCID: PMC11090983 DOI: 10.1080/09638288.2023.2278174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 10/26/2023] [Accepted: 10/28/2023] [Indexed: 11/15/2023]
Abstract
PURPOSE To estimate the effect of integrating custom-designed hand therapy video games (HTVG) with contralaterally controlled functional electrical stimulation (CCFES) therapy. METHODS Fifty-two stroke survivors with chronic (>6 months) upper limb hemiplegia were randomized to 12 weeks of CCFES or CCFES + HTVG. Treatment involved self-administration of technology-mediated therapy at home plus therapist-administered CCFES-assisted task practice in the lab. Pre- and post-treatment assessments were made of hand dexterity, upper limb impairment and activity limitation, and cognitive function. RESULTS No significant between-group differences were found on any outcome measure, and the average magnitudes of improvement within both groups were small. The incidence of technical problems with study devices at home was greater for the CCFES + HTVG group. This negatively affected adherence and may partially explain the absence of effect of HTVG. At end-of-treatment, large majorities of both treatment groups had positive perceptions of treatment efficacy and expressed enthusiasm for the treatments. CONCLUSION This study makes an important contribution to the research literature on the importance of environmental factors, concomitant impairments, and technology simplification when designing technology-based therapies intended to be self-administered at home. This study failed to show any added benefit of HTVG to CCFES therapy.Clinicaltrials.gov (NCT03058796).
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Affiliation(s)
- Jayme S Knutson
- Research Service, Louis Stokes Cleveland VA Medical Center, Veterans Affairs Northeast OH Healthcare System, Cleveland, OH, USA
- Department of Physical Medicine and Rehabilitation, The MetroHealth System, Cleveland, OH, USA
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, OH, USA
| | - Michael J Fu
- Department of Physical Medicine and Rehabilitation, The MetroHealth System, Cleveland, OH, USA
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, OH, USA
- Department of Electrical, Computer, and Systems Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - David A Cunningham
- Department of Physical Medicine and Rehabilitation, The MetroHealth System, Cleveland, OH, USA
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, OH, USA
| | - Terri Z Hisel
- Department of Physical Medicine and Rehabilitation, The MetroHealth System, Cleveland, OH, USA
| | - Amy S Friedl
- Department of Physical Medicine and Rehabilitation, The MetroHealth System, Cleveland, OH, USA
| | - Douglas D Gunzler
- Center for Healthcare Research and Policy, The MetroHealth System, Cleveland, OH, USA
- Population Health and Equity Research Institute, The MetroHealth System, Cleveland, OH, USA
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Ela B Plow
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Physical Medicine and Rehabilitation, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Rehabilitation Hospitals, Cleveland, OH, USA
| | - Robyn M Busch
- Departments of Neurology and Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Svetlana Pundik
- Neurology Service, Louis Stokes Cleveland VA Medical Center, Veterans Affairs Northeast OH Healthcare System, Cleveland, OH, USA
- Department of Neurology, Case Western Reserve University, Cleveland, OH, USA
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Villeneuve M, Ogourtsova T, Deblock-Bellamy A, Blanchette A, Bühler MA, Fung J, McFadyen BJ, Menon A, Perez C, Sangani S, Lamontagne A. Development of a virtual reality-based intervention for community walking post stroke: an integrated knowledge translation approach. Disabil Rehabil 2024; 46:4428-4438. [PMID: 37921690 DOI: 10.1080/09638288.2023.2277397] [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: 02/16/2023] [Revised: 10/20/2023] [Accepted: 10/25/2023] [Indexed: 11/04/2023]
Abstract
PURPOSE To develop a virtual reality (VR) based intervention targeting community walking requirements. METHODS Two focus groups each involving 7 clinicians allowed exploring optimal features, needed support and perceived favorable/unfavorable factors associated with the use of the VR-based intervention from the clinicians' perspective. Three stroke survivors and 2 clinicians further interacted with the intervention and filled questionnaires related to acceptability and favorable/unfavorable perceptions on the VR intervention. Stroke participants additionally rated their perceived effort (NASA Tax Load Index), presence (Slater-Usoh-Steed) and cybersickness (Simulator Sickness Questionnaire). RESULTS Results identified optimal features (patient eligibility criteria, task complexity), needed support (training, human assistance), as well as favorable (cognitive stimulation, engagement, representativeness of therapeutic goals) and unfavorable factors (misalignment with a natural walking pattern, client suitability, generalization to real-life) associated with the intervention. Acceptability scores following the interaction with the tool were 28 and 42 (max 56) for clinicians and ranged from 43 to 52 for stroke participants. Stroke participants reported moderate perceptions of effort (range:20-33/max:60), high levels of presence (29-42/42) and minimal cybersickness (0-3/64). CONCLUSION Findings collected in the early development phase of the VR intervention will allow addressing favorable/unfavorable factors and incorporating desired optimal features, prior to conducting effectiveness and implementation studies.
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Affiliation(s)
- Myriam Villeneuve
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital site of CISSS-Laval and research site of the Montreal Centre for Interdisciplinary Research in Rehabilitation (CRIR), Laval, Canada
| | - Tatiana Ogourtsova
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital site of CISSS-Laval and research site of the Montreal Centre for Interdisciplinary Research in Rehabilitation (CRIR), Laval, Canada
| | - Anne Deblock-Bellamy
- École des sciences de la réadaptation, Université Laval, Quebec City, Canada
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (CIRRIS), Quebec City, Canada
- Department of Occupational Therapy, University of Applied Sciences and Arts Western Switzerland (HETSL |HES-SO), Lausanne, Switzerland
| | - Andréanne Blanchette
- École des sciences de la réadaptation, Université Laval, Quebec City, Canada
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (CIRRIS), Quebec City, Canada
| | - Marco A Bühler
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital site of CISSS-Laval and research site of the Montreal Centre for Interdisciplinary Research in Rehabilitation (CRIR), Laval, Canada
| | - Joyce Fung
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital site of CISSS-Laval and research site of the Montreal Centre for Interdisciplinary Research in Rehabilitation (CRIR), Laval, Canada
| | - Bradford J McFadyen
- École des sciences de la réadaptation, Université Laval, Quebec City, Canada
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (CIRRIS), Quebec City, Canada
| | - Anita Menon
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Claire Perez
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital site of CISSS-Laval and research site of the Montreal Centre for Interdisciplinary Research in Rehabilitation (CRIR), Laval, Canada
| | - Samir Sangani
- Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital site of CISSS-Laval and research site of the Montreal Centre for Interdisciplinary Research in Rehabilitation (CRIR), Laval, Canada
| | - Anouk Lamontagne
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital site of CISSS-Laval and research site of the Montreal Centre for Interdisciplinary Research in Rehabilitation (CRIR), Laval, Canada
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10
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Goncalves S, Le Bourvellec M, Duclos NC, Mandigout S. Recommended moderate to vigorous physical activity levels for people in the chronic phase of stroke can be achieved in outpatient physiotherapy: a multicentre observational study. Top Stroke Rehabil 2024:1-10. [PMID: 39172127 DOI: 10.1080/10749357.2024.2392447] [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: 03/23/2024] [Accepted: 08/10/2024] [Indexed: 08/23/2024]
Abstract
BACKGROUND Rehabilitation in the chronic phase of stroke should include 20 minutes of moderate to vigorous physical activity (MVPA). However, the level of compliance with MVPA guidelines in outpatient physiotherapy is unknown. OBJECTIVES To investigate (1) whether people in the chronic phase of stroke perform the recommended 20 minutes of MVPA during outpatient physiotherapy sessions in France, (2) whether the person's clinical characteristics influence MVPA time and (3) which interventions contribute to achievement of recommended MVPA time. METHODS This was a multicentre, cross-sectional observational study of routine outpatient physiotherapy sessions in France in people in the chronic phase of stroke. The main measures included MVPA time (determined using a heart rate monitor), clinical tests and types of physiotherapy interventions (recorded by external investigator during 2 sessions for each participant). RESULTS 84 people in the chronic phase of stroke and 152 outpatient physiotherapy sessions in 29 outpatient clinics were included (2021-2022). Median (interquartile range) MVPA time was 25 (7-45) minutes across all sessions. Fifty-nine percent of the sessions fulfilled MVPA guidelines. Among clinical tests, only the Mini-Mental Scale Examination was significantly associated with MVPA time. Endurance, balance, and functional lower limb training were associated with the achievement of MVPA guidelines. CONCLUSION Outpatient physiotherapy sessions have the potential to meet the MVPA guidelines. Further research is needed to understand the variability of compliance with MVPA guidelines and to develop strategies to increase the integration of MVPA into outpatient physiotherapy sessions.
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Affiliation(s)
- Stéphanie Goncalves
- Physical Activity and Sport Sciences, Limoges University, HAVAE, UR 20217, Limoges, France
| | - Morgane Le Bourvellec
- Physical Activity and Sport Sciences, Poitiers University, MOVE UR 20296, Poitiers, France
| | - Noémie C Duclos
- University Institute of Rehabilitation Science, INSERM, BPH ACTIVE U1219, Bordeaux University, Bordeaux, France
| | - Stéphane Mandigout
- Physical Activity and Sport Sciences, Limoges University, HAVAE, UR 20217, Limoges, France
- ILFOMER, Limoges University, HAVAE, UR 20217, Limoges, France
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11
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Dahl SSH, Arntzen EC, Gallagher S, Normann B. In search of the pleasure of moving through bodily re-explorations and interactions with the surroundings: a qualitative study on changed perceptions of physical activity in people with mild multiple sclerosis. Physiother Theory Pract 2024:1-14. [PMID: 39161181 DOI: 10.1080/09593985.2024.2392183] [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: 03/29/2024] [Revised: 07/23/2024] [Accepted: 08/08/2024] [Indexed: 08/21/2024]
Abstract
INTRODUCTION Reduced physical activity (PA) among people with multiple sclerosis (pwMS) with low disability is a significant concern. Developing healthcare to promote PA requires a comprehensive understanding of pwMS's perspectives. PURPOSE To explore how pwMS with mild disability perceive PA and the impact of individual, professional, social, and environmental aspects on their PA engagement. METHODS Qualitative, in-depth interviews with 27 pwMS (21 women, 6 men; aged 31-66; EDSS ≤ 3.5) were analyzed via systematic text condensation and informed by enactive theory. RESULTS Three categories were formed: Perception Shifts after Diagnosis: Participants adapted their perceptions to PA throughout their disease journey. Initial uncertainty concerning bodily capacities, prospects and safety reduced PA. Moving "correctly" during activities was emphasized to facilitate PA levels. Affective Experiences Drive Behavior: Pleasure associated with movement was a highlighted motivator, however, some experienced PA less rewarding after diagnosis. Discomfort and fear were barriers to PA engagement. The Surroundings Influence Perceptions: Participants sought social interactions and outdoor-environments to improve PA. Healthcare professionals were trusted to provide possibilities for PA, but early-stage and tailored follow-up was often lacking. CONCLUSION This study illuminates changed PA perceptions after MS diagnosis and how affect, shaped by personal, interpersonal, and environmental aspects, drive PA engagement. Moreover, it calls for early follow-up and the implementation of tailored healthcare throughout the disease course to promote PA engagement. Considering these findings, we have put forth a model aimed at fostering a nuanced comprehension of PA in pwMS with mild disabilities. Further development and exploration of this model is needed.
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Affiliation(s)
| | | | - Shaun Gallagher
- Philosophy, University of Memphis, Memphis, TN, USA
- SOLA, Department of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia
| | - Britt Normann
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- Department of Physiotherapy, Nordland Hospital Trust, Bodø, Norway
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12
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Kamarunas E, Murray K, Drulia T, Szynkiewicz S, Griffin L, Mulheren R. Biofeedback and Exercise Load Affect Accuracy of Tongue Strength Exercise Performance. Dysphagia 2024:10.1007/s00455-024-10751-w. [PMID: 39154305 DOI: 10.1007/s00455-024-10751-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 08/12/2024] [Indexed: 08/19/2024]
Abstract
Rehabilitative exercises require precise movement coordination and target accuracy for optimal effectiveness. This paper explores the impact of tongue strength exercises (TSE) performance accuracy on exercise outcomes, adherence, and participant confidence and motivation. An 8-week randomized clinical trial included 84 typically aging participants divided into four groups defined by access to biofeedback (present/absent) and TSE intensity dosing (maximal/submaximal) during a home exercise program (HEP). Retention, training, and HEP accuracy were tracked at biweekly visits and during HEP for participants with access to a biofeedback device. Associations with tongue strength outcomes, participant factors, biofeedback, and intensity dosing were analyzed. Exercise accuracy measures did not contribute to tongue strength outcomes at the end of 8 weeks. Increased training accuracy (less practice required to achieve competency) was associated with higher participant confidence and better adherence to the HEP. The presence of biofeedback was associated with reduced adherence but better retention accuracy, while maximal intensity was associated with improvements in all accuracy measures compared to submaximal intensity exercise. These findings in typically aging participants suggest the need for tailored approaches in swallowing-related exercise programs, given the effects of biofeedback and exercise intensity on motor learning and exercise retention. Accuracy performance and its effect on clinical outcomes warrants study in clinical populations with dysphagia and with various rehabilitative approaches.Trial Registration Clincialtrials.gov: NCT04809558.
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Affiliation(s)
- Erin Kamarunas
- Department of Communication Sciences and Disorders, James Madison University, 235 MLK Jr. Way, MSC 4304, Harrisonburg, VA, 22807, USA.
| | - Kelsey Murray
- Department of Communication Sciences and Disorders, James Madison University, 235 MLK Jr. Way, MSC 4304, Harrisonburg, VA, 22807, USA
| | - Teresa Drulia
- Davies School of Communication Sciences and Disorders, Texas Christian University, Fort Worth, TX, USA
| | - Sarah Szynkiewicz
- Department of Communication Sciences and Disorders, Samford University, Birmingham, AL, USA
| | - Lindsay Griffin
- Department of Communication Sciences and Disorders, Emerson College, Boston, MA, USA
| | - Rachel Mulheren
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH, USA
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13
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Brito R, Marroquim B, Shirahige L, Baltar A, Rocha S, Perruci A, Monte-Silva K. Trans-spinal magnetic stimulation combined with kinesiotherapy as a new method for enhancing functional recovery in patients with spinal cord injury due to neuromyelitis optica: a case report. J Med Case Rep 2024; 18:386. [PMID: 39152447 PMCID: PMC11330148 DOI: 10.1186/s13256-024-04636-7] [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: 07/27/2022] [Accepted: 06/02/2024] [Indexed: 08/19/2024] Open
Abstract
BACKGROUND Experimental studies have shown that repetitive trans-spinal magnetic stimulation (TsMS) decreases demyelination and enables recovery after spinal cord injury (SCI). However, the usefulness of TsMS in humans with SCI remains unclear. Therefore, the main objective of this study is to evaluate the effects of TsMS combined with kinesiotherapy on SCI symptoms. We describe a protocol treatment with TsMS and kinesiotherapy in a patient with SCI due to neuromyelitis optica (NMO)-associated transverse myelitis. CASE PRESENTATION A 23-year-old white male with NMO spectrum disorders started symptoms in 2014 and included lumbar pain evolving into a mild loss of strength and sensitivity in both lower limbs. Five months later, the symptoms improved spontaneously, and there were no sensorimotor deficits. Two years later, in 2016, the symptoms recurred with a total loss of strength and sensitivity in both lower limbs. Initially, physiotherapy was provided in 15 sessions with goals of motor-sensory recovery and improving balance and functional mobility. Subsequently, TsMS (10 Hz, 600 pulses, 20-seconds inter-trains interval, at 90% of resting motor threshold of the paravertebral muscle) was applied at the 10th thoracic vertebral spinous process before physiotherapy in 12 sessions. Outcomes were assessed at three time points: prior to physiotherapy alone (T-1), before the first session of TsMS combined with kinesiotherapy (T0), and after 12 sessions of TsMS combined with kinesiotherapy (T1). The patient showed a 25% improvement in walking independence, a 125% improvement in balance, and an 18.8% improvement in functional mobility. The Patient Global Impression of Change Scale assessed the patient's global impression of change as 'much improved'. CONCLUSION TsMS combined with kinesiotherapy may safely and effectively improve balance, walking independence, and functional mobility of patients with SCI due to NMO-associated transverse myelitis.
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Affiliation(s)
- Rodrigo Brito
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Jornalista Aníbal Fernandes Avenue, Recife, PE, 50740-560, Brazil
- NAPeN Network (Núcleo de Assistência e Pesquisa em Neuromodulação), Recife, Brazil
| | - Bárbara Marroquim
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Jornalista Aníbal Fernandes Avenue, Recife, PE, 50740-560, Brazil
| | - Lívia Shirahige
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Jornalista Aníbal Fernandes Avenue, Recife, PE, 50740-560, Brazil
- NAPeN Network (Núcleo de Assistência e Pesquisa em Neuromodulação), Recife, Brazil
| | - Adriana Baltar
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Jornalista Aníbal Fernandes Avenue, Recife, PE, 50740-560, Brazil
- NAPeN Network (Núcleo de Assistência e Pesquisa em Neuromodulação), Recife, Brazil
| | - Sérgio Rocha
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Jornalista Aníbal Fernandes Avenue, Recife, PE, 50740-560, Brazil
| | - Alexia Perruci
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Jornalista Aníbal Fernandes Avenue, Recife, PE, 50740-560, Brazil
| | - Katia Monte-Silva
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Jornalista Aníbal Fernandes Avenue, Recife, PE, 50740-560, Brazil.
- NAPeN Network (Núcleo de Assistência e Pesquisa em Neuromodulação), Recife, Brazil.
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14
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Salah S, Belhaj Maaouia C, Toulgui E, Kalai A, Ben Salah Frih Z, Ben Saad H. Postoperative multimodal rehabilitation for spontaneous smile restoration in severe Moebius syndrome: A case report and a short literature review. SAGE Open Med Case Rep 2024; 12:2050313X241271857. [PMID: 39161924 PMCID: PMC11331456 DOI: 10.1177/2050313x241271857] [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: 03/24/2024] [Accepted: 07/01/2024] [Indexed: 08/21/2024] Open
Abstract
Moebius syndrome (MS) is a rare congenital disorder characterized by bilateral facial paralysis, significantly impacting an individual's ability to convey emotions. The lengthening temporalis myoplasty (LTM) surgery is a crucial palliative intervention that can restore the smile in patients with MS by transferring the functional temporalis muscle to the paralyzed facial commissure. However, successful outcomes are closely tied to postoperative functional rehabilitation. This case report details the experience of a 29-year-old woman with severe MS who underwent LTM surgery followed by a comprehensive rehabilitation program. Over a period of 12 months, the patient achieved a spontaneous and symmetrical smile through a three-stage rehabilitation program focused on mandibular, voluntary, and spontaneous smile recovery. Speech therapy and psychological support were also integral components. This case underscores the importance of adopting a holistic approach to ensure successful and enduring outcomes from smile restoration surgery in patients with MS.
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Affiliation(s)
- Sana Salah
- Department of Physical Medicine and Rehabilitation, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
- Laboratoire Technologies et Imagerie Médicale LR12ES06, University of Monastir, Monastir, Tunisia
| | | | - Emna Toulgui
- Department of Physical Medicine and Rehabilitation, Sahloul University Hospital, Faculty of Medicine, University of Sousse, Monastir, Tunisia
| | - Amine Kalai
- Department of Physical Medicine and Rehabilitation, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
- Laboratoire Technologies et Imagerie Médicale LR12ES06, University of Monastir, Monastir, Tunisia
| | - Zohra Ben Salah Frih
- Department of Physical Medicine and Rehabilitation, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Helmi Ben Saad
- Laboratoire de recherche LR12SP09 «Insuffisance cardiaque», Hôpital Farhat Hached, Université de Sousse, Monastir, Tunisie
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15
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Fluet G, Qiu Q, Gross A, Gorin H, Patel J, Merians A, Adamovich S. The influence of scaffolding on intrinsic motivation and autonomous adherence to a game-based, sparsely supervised home rehabilitation program for people with upper extremity hemiparesis due to stroke. A randomized controlled trial. J Neuroeng Rehabil 2024; 21:143. [PMID: 39138516 PMCID: PMC11321133 DOI: 10.1186/s12984-024-01441-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 08/08/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND This parallel, randomized controlled trial examined intrinsic motivation, adherence and motor function improvement demonstrated by two groups of subjects that performed a 12-week, home-based upper extremity rehabilitation program. Seventeen subjects played scaffolded games, presenting eight to twelve discrete levels of increasing difficulty. Sixteen subjects performed the same activities controlled by success algorithms that modify game difficulty incrementally. METHODS 33 persons 20-80 years of age, at least 6 months post stroke with moderate to mild hemiparesis were randomized using a random number generator into the two groups. They were tested using the Action Research Arm Test, Upper Extremity Fugl Meyer Assessment, Stroke Impact Scale and Intrinsic Motivation Inventory pre and post training. Adherence was measured using timestamps generated by the gaming system. Subjects had the Home Virtual Rehabilitation System (Qiu in J Neuroeng Rehabil 17: 1-10, 2020) placed in their homes and were taught to perform rehabilitation games using it. Subjects were instructed to train twenty minutes per day but were allowed to train as much as they chose. Subjects trained for 12 weeks without appointments and received intermittent support from study staff. Group outcomes were compared using ANOVA. Correlations between subject demographics and adherence, as well as motor outcome, were evaluated using Pearson Correlation Coefficients. RESULTS There were 5 dropouts and no adverse events. The main effect of time was statistically significant for four of the five clinical outcome measures. There were no significant training group by time interactions. Measures of adherence did not differ significantly between groups. The combined groups improved their UEFMA scores on average by 5.85 (95% CI 4.73-6.98). 21 subjects from both groups demonstrating improvements in UEFMA scores of at least 5 points, exceeding the minimal clinically important difference of 4.25. IMI scores were stable pre to post training. CONCLUSIONS Scaffolding challenges during game based rehabilitation did not elicit higher levels of adherence when compared to algorithm control of game difficulty. Both sparsely supervised programs of game-based treatment in the home were sufficient to elicit statistically significant, clinically meaningful improvements in motor function and activities of daily living. TRIAL REGISTRATION Clinical Trials.gov-NCT03985761, Registered June 14, 2019.
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Affiliation(s)
- Gerard Fluet
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers The State University of New Jersey, 65 Bergen St, Newark, NJ, 07101, USA.
| | - Qinyin Qiu
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers The State University of New Jersey, 65 Bergen St, Newark, NJ, 07101, USA
| | - Amanda Gross
- Department of Biomedical Engineering, New Jersey Institute of Technology, University Heights, Newark, NJ, 07015, USA
| | - Holly Gorin
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers The State University of New Jersey, 65 Bergen St, Newark, NJ, 07101, USA
| | - Jigna Patel
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers The State University of New Jersey, 65 Bergen St, Newark, NJ, 07101, USA
| | - Alma Merians
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers The State University of New Jersey, 65 Bergen St, Newark, NJ, 07101, USA
| | - Sergei Adamovich
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers The State University of New Jersey, 65 Bergen St, Newark, NJ, 07101, USA
- Department of Biomedical Engineering, New Jersey Institute of Technology, University Heights, Newark, NJ, 07015, USA
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16
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Lockwich J, Kitzman P, Skubik-Peplaski C, Andreatta R, Schwartzkopf-Phifer K. Pushing the limit to reach meaningful change: the impact of intensity-driven exercise on clinical outcomes for individuals with Parkinson's disease. A single-subject design. Disabil Rehabil 2024:1-8. [PMID: 39126138 DOI: 10.1080/09638288.2024.2388873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 07/31/2024] [Accepted: 08/01/2024] [Indexed: 08/12/2024]
Abstract
PURPOSE Parkinson's disease creates an inability to perform previous learned autonomic tasks, such as walking, which worsens with disease progression. Recommendations to incorporate exercise at moderate to high intensities for this population has been established but there is limited knowledge about its impact on clinical based outcomes. The purpose of this research is to investigate the effectiveness of a 6-week intensity-driven walking program on clinical-based outcomes in individuals with PD. MATERIALS/METHODS Five individuals with PD were recruited for this single-subject withdrawal design (A-B-A-B) study. 6-minute walk performance and other core neurological measures of gait were collected. Intervention phases incorporated a 30-minute individualized intensity-driven treadmill walking program practiced at 65% or more of ones maximum heart rate. Increased treadmill speed, incline, and resistance were manipulated to reach the target heart rate zone. RESULTS 6-minute walk test within condition visual analysis demonstrated a therapeutic change during intervention phases and a countertherapeutic change during withdraw periods for all 5 individuals. An abrupt therapeutic effect was demonstrated for all individuals between conditions with the percent of nonoverlapping data ranging from 70-90%. Band method analysis revealed a range of 9-19 sessions two standard deviations above baseline mean performances for all individuals. CONCLUSION To achieve sufficient walking performance, gait practiced at higher intensity levels may provide the optimal solution as an adjunct to standard care for individuals with PD who want to improve their walking.
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Affiliation(s)
- J Lockwich
- Department of Physical Therapy, Duquesne University, Pittsburgh, PA, USA
| | - P Kitzman
- Department of Rehabilitation Sciences, University of KY, Lexington, KY, USA
| | - C Skubik-Peplaski
- Department of Occupational Science and Occupational Therapy, Eastern Kentucky University, Richmond, KY, USA
| | - R Andreatta
- Department of Rehabilitation Sciences, University of KY, Lexington, KY, USA
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17
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Sudati IP, Damiano D, Rovai G, de Campos AC. Neural Correlates of Mobility in Children with Cerebral Palsy: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:1039. [PMID: 39200649 PMCID: PMC11354175 DOI: 10.3390/ijerph21081039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 07/23/2024] [Accepted: 07/31/2024] [Indexed: 09/02/2024]
Abstract
Recent advances in brain mapping tools have enabled the study of brain activity during functional tasks, revealing neuroplasticity after early brain injuries and resulting from rehabilitation. Understanding the neural correlates of mobility limitations is crucial for treating individuals with cerebral palsy (CP). The aim is to summarize the neural correlates of mobility in children with CP and to describe the brain mapping methods that have been utilized in the existing literature. This systematic review was conducted based on PRISMA guidelines and was registered on PROSPERO (n° CRD42021240296). The literature search was conducted in the PubMed and Embase databases. Observational studies involving participants with CP, with a mean age of up to 18 years, that utilized brain mapping techniques and correlated these with mobility outcomes were included. The results were analyzed in terms of sample characteristics, brain mapping methods, mobility measures, and main results. The risk of bias was evaluated using a checklist previously created by our research group, based on STROBE guidelines, the Cochrane Handbook, and the Critical Appraisal Skills Programme (CASP). A total of 15 studies comprising 313 children with CP and 229 with typical development using both static and mobile techniques met the inclusion criteria. The studies indicate that children"with'CP have increased cerebral activity and higher variability in brain reorganization during mobility activities, such as gait, quiet standing, cycling, and gross motor tasks when compared with children with typical development. Altered brain activity and reorganization underline the importance of conducting more studies to investigate the neural correlates during mobility activities in children with CP. Such information could guide neurorehabilitation strategies targeting brain neuroplasticity for functional gains.
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Affiliation(s)
- Isabella Pessóta Sudati
- Department of Physical Therapy, Child Development Analysis Laboratory (LADI), Federal University of São Carlos (UFSCar), São Carlos 13565-905, SP, Brazil;
| | - Diane Damiano
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health (NIH), Bethesda, MD 20892, USA;
| | - Gabriela Rovai
- Department of Physical Therapy, Child Development Analysis Laboratory (LADI), Federal University of São Carlos (UFSCar), São Carlos 13565-905, SP, Brazil;
| | - Ana Carolina de Campos
- Department of Physical Therapy, Child Development Analysis Laboratory (LADI), Federal University of São Carlos (UFSCar), São Carlos 13565-905, SP, Brazil;
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18
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Johnson L, Burridge J, Ewings S, Demain S. A pilot cluster randomised controlled trial, of an IMPlicit learning approach versus standard care, on recovery of mobility following stroke (IMPS). Clin Rehabil 2024:2692155241267205. [PMID: 39105429 DOI: 10.1177/02692155241267205] [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: 08/07/2024]
Abstract
OBJECTIVES To evaluate the delivery of rehabilitation using implicit motor learning principles in an acute stroke setting. DESIGN Pilot, assessor-blind, cluster randomised controlled trial with nested qualitative evaluation. SETTING Eight inpatient stroke units, UK. PARTICIPANTS People within 14 days of stroke onset, presenting with lower limb hemiplegia. INTERVENTIONS Participants at control clusters received usual care. Participants at intervention clusters received rehabilitation using an Implicit Learning Approach (ILA); primarily consisting of reduced frequency instructions/feedback, and promotion of an external focus of attention. Video recording was used to understand the ability of intervention site therapists to adhere to the implicit learning principles, and to compare differences between groups. MEASURES Ability to recruit and retain clusters/participants; suitability and acceptability of data collection processes; appropriateness of fidelity monitoring methods; and appropriateness of chosen outcome measures. RESULTS Eight stroke units participated, with four assigned to each group (intervention/control). Fifty-one participants were enrolled (intervention group 21; control group 30). Mean time since stroke was 6 days (SD 3.42; 0-14); mean age was 73 years (SD 14, 25-94). Of those approached to take part, 72% agreed. We found clear differences between groups with respect to the frequency and type of instructional statement. The ILA was acceptable to both patients and therapists. CONCLUSION It is feasible to evaluate the application and effectiveness of motor learning principles within acute stroke rehabilitation, using a cluster randomised design. A larger study is required to evaluate the benefits of each approach; we provide a range of sample size estimates required for this.
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Affiliation(s)
- Louise Johnson
- University Hospitals Dorset NHS Foundation Trust, Bournemouth, UK
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Jane Burridge
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Sean Ewings
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Sara Demain
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
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19
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Benn NL, Jervis-Rademeyer H, Souza WH, Pakosh M, Inness EL, Musselman KE. Balance Interventions to Improve Upright Balance Control and Balance Confidence in People With Motor-Incomplete Spinal Cord Injury or Disease: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2024:S0003-9993(24)01162-6. [PMID: 39111646 DOI: 10.1016/j.apmr.2024.07.013] [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: 02/09/2024] [Revised: 06/18/2024] [Accepted: 07/02/2024] [Indexed: 08/27/2024]
Abstract
OBJECTIVES To assist with clinical decision making, evidence syntheses are needed to demonstrate the efficacy of available interventions and examine the intervention components and dosage parameters. This systematic review and meta-analysis described the efficacy, components and dosage of interventions targeting upright balance control, balance confidence, and/or falls in adults with motor-incomplete spinal cord injury/disease (SCI/D). DATA SOURCES A search strategy following the population, intervention, control, outcome framework was developed. Six databases were searched: APA PsychInfo, Cumulative Index to Nursing and Allied Health Literature, Embase, Emcare Nursing, Web of Science CC, and Medline. STUDY SELECTION Title, abstract, and full-text screening were conducted by 2 researchers independently. Inclusion criteria included the following: (1) adults with chronic, motor-incomplete SCI/D; (2) physical intervention targeting upright postural control; and (3) clinical and/or biomechanical measures of upright balance control and/or balance confidence and/or documentation of falls. DATA EXTRACTION Participant characteristics, balance intervention details, adverse events, and study results were extracted. The Downs and Black Checklist was used to assess methodological quality. Meta-analyses on pre-post intervention outcomes and a meta-regression of dosage were completed. Grading of Recommendations, Assessment, Development, and Evaluations approach was used to evaluate the quality of the evidence. DATA SYNTHESIS The search returned 1664 unique studies; 26 were included. Methodological quality was moderate to good. Participants were 500 individuals with SCI/D, aged 18-74 years (males: females = 2.4:1). Minor adverse events were reported in 8 studies (eg, muscle soreness and fatigue). Walking interventions and upright balance training with visual feedback had clinically meaningful and significant pooled effects on improving standing balance control. Only walking interventions had a significant pooled effect on improving balance confidence. There were no significant findings on dosage response. Few studies evaluated the effects of balance interventions on the occurrence of falls. CONCLUSIONS Walking interventions and upright balance training with visual feedback had greater effects on upright balance control than conventional physiotherapy; however, the quality of the evidence was very low.
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Affiliation(s)
- Natasha L Benn
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada; KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, Canada
| | | | - Wagner H Souza
- KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, Canada
| | - Maureen Pakosh
- KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, Canada
| | - Elizabeth L Inness
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada; KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, Canada; Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Kristin E Musselman
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada; KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, Canada; Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
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20
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Gordon KE, Dusane S, Kahn JH, Shafer A, Brazg G, Henderson H, Kim KYA. Amplify Gait to Improve Locomotor Engagement in Spinal Cord Injury (AGILE SCI) trial: study protocol for an assessor blinded randomized controlled trial. BMC Neurol 2024; 24:271. [PMID: 39097695 PMCID: PMC11297765 DOI: 10.1186/s12883-024-03757-2] [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: 07/01/2024] [Accepted: 07/11/2024] [Indexed: 08/05/2024] Open
Abstract
BACKGROUND Among ambulatory people with incomplete spinal cord injury (iSCI), balance deficits are a primary factor limiting participation in walking activities. There is broad recognition that effective interventions are needed to enhance walking balance following iSCI. Interventions that amplify self-generated movements (e.g., error augmentation) can accelerate motor learning by intensifying sensorimotor feedback and facilitating exploration of motor control strategies. These features may be beneficial for retraining walking balance after iSCI. We have developed a cable-driven robot that creates a movement amplification environment during treadmill walking. The robot applies a continuous, laterally-directed, force to the pelvis that is proportional in magnitude to real-time lateral velocity. Our purpose is to investigate the effects of locomotor training in this movement amplification environment on walking balance. We hypothesize that for ambulatory people with iSCI, locomotor training in a movement amplification environment will be more effective for improving walking balance and participation in walking activities than locomotor training in a natural environment (no applied external forces). METHODS We are conducting a two-arm parallel-assignment intervention. We will enroll 36 ambulatory participants with chronic iSCI. Participants will be randomized into either a control or experimental group. Each group will receive 20 locomotor training sessions. Training will be performed in either a traditional treadmill environment (control) or in a movement amplification environment (experimental). We will assess changes using measures that span the International Classification of Functioning, Disability and Health (ICF) framework including 1) clinical outcome measures of gait, balance, and quality of life, 2) biomechanical assessments of walking balance, and 3) participation in walking activities quantified by number of steps taken per day. DISCUSSION Training walking balance in people with iSCI by amplifying the individual's own movement during walking is a radical departure from current practice and may result in new strategies for addressing balance impairments. Knowledge gained from this study will expand our understanding of how people with iSCI improve walking balance and how an intervention targeting walking balance affects participation in walking activities. Successful outcomes could motivate development of clinically feasible tools to replicate the movement amplification environment within clinical settings. TRIAL REGISTRATION NCT04340063.
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Affiliation(s)
- Keith E Gordon
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Feinberg School of Medicine, Chicago, IL, 60611, USA.
- Research Service, Edward Hines Jr. VA Hospital, Hines, IL, 60141, USA.
| | - Shamali Dusane
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Jennifer H Kahn
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Anna Shafer
- Research Service, Edward Hines Jr. VA Hospital, Hines, IL, 60141, USA
| | | | - Heather Henderson
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Kwang-Youn A Kim
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL, 60611, USA
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21
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Marzouqah R, Dharmakulaseelan L, Colelli DR, Lindo CJ, Costa YS, Jairam T, Xiong K, Murray BJ, Chen JL, Thorpe K, Yunusova Y, Boulos MI. Strengthening oropharyngeal muscles as an approach to treat post-stroke obstructive sleep apnea: A feasibility randomised controlled trial. J Sleep Res 2024; 33:e14086. [PMID: 37909249 DOI: 10.1111/jsr.14086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 10/13/2023] [Accepted: 10/15/2023] [Indexed: 11/02/2023]
Abstract
This study aimed to determine the feasibility of a randomised controlled trial (RCT) evaluating oropharyngeal exercise (OPE) intervention as an alternative therapy for obstructive sleep apnea (OSA) in patients with stroke or transient ischaemic attack (TIA). Despite the high prevalence of OSA in this population, the standard therapy, continuous positive airway pressure (CPAP), is often poorly tolerated. Thirty stroke/TIA patients with OSA unable to tolerate CPAP were randomly assigned to an oropharyngeal exercise or sham exercise protocol. They performed exercises for 6 weeks, 5 days per week, 30 minutes twice per day. Feasibility was ascertained by the proportion of enrolled patients who completed more than 80% of the OPE regimen. Isometric tongue pressures, apnea-hypopnea index (AHI), oxygen desaturation index (ODI), daytime sleepiness, and quality of life (QOL) outcomes were collected at baseline, post-training (6-week follow-up), and retention (10-week follow-up) to document preliminary efficacy. Adherence to study exercises was excellent, with 83% of participants completing more than 80% of the exercises. The isometric tongue pressures were observed to improve in the oropharyngeal exercise group (compared with the sham group), along with a decrease in OSA severity (measured by the AHI and ODI), reduced daytime sleepiness, and enhanced quality of life outcomes following the exercise programme. Only the effects on posterior isometric tongue pressure and daytime sleepiness remained significantly different between groups at the retention session. In conclusion, an RCT evaluating the efficacy of oropharyngeal exercises on post-stroke/TIA OSA is feasible and our preliminary results suggest a clinically meaningful effect.
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Affiliation(s)
- Reeman Marzouqah
- Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- University Health Network - KITE, Toronto Rehabilitation Institute, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Laavanya Dharmakulaseelan
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - David R Colelli
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - C J Lindo
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Yakdehikandage S Costa
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Trevor Jairam
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Kathy Xiong
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Brian J Murray
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Joyce L Chen
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Kevin Thorpe
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Yana Yunusova
- Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- University Health Network - KITE, Toronto Rehabilitation Institute, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Mark I Boulos
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
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22
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Albishi AM. How does combining physical therapy with transcranial direct stimulation improve upper-limb motor functions in patients with stroke? A theory perspective. Ann Med Surg (Lond) 2024; 86:4601-4607. [PMID: 39118708 PMCID: PMC11305811 DOI: 10.1097/ms9.0000000000002287] [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: 02/22/2024] [Accepted: 06/06/2024] [Indexed: 08/10/2024] Open
Abstract
More than half of stroke survivors suffer from upper-limb dysfunction that persists years after stroke, negatively impacting patients' independence and, therefore, affecting their quality of life. Intense motor rehabilitation is required after a stroke to facilitate motor recovery. More importantly, finding new ways to maximize patients' motor recovery is a core goal of stroke rehabilitation. Thus, researchers have explored the potential benefits of combining the effects of non-invasive brain stimulation with physical therapy rehabilitation. Specifically, combining transcranial direct stimulation (tDCS) with neurorehabilitation interventions can boost the brain's responses to interventions and maximize the effects of rehabilitation to improve upper-limb recovery post-stroke. However, it is still unclear which modes of tDCS are optimal for upper-limb motor recovery in patients with stroke when combined with physical therapy interventions. Here, the authors review the existing literature suggesting combining physical therapy rehabilitation with tDCS can maximize patients' motor recovery using the Interhemispheric Competition Model in Stroke. The authors focus on two main rehabilitation paradigms, which are constraint-induced movement therapy (CIMT) and Mirror therapy with and without tDCS. The authors also discuss potential studies to elucidate further the benefit of using tDCS adjunct with these upper-limb rehabilitation paradigms and its effectiveness in patients with stroke, with the ultimate goal of maximizing patients' motor recovery.
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Affiliation(s)
- Alaa. M. Albishi
- Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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23
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Augenstein TE, Nagalla D, Mohacey A, Cubillos LH, Lee MH, Ranganathan R, Krishnan C. A novel virtual robotic platform for controlling six degrees of freedom assistive devices with body-machine interfaces. Comput Biol Med 2024; 178:108778. [PMID: 38925086 DOI: 10.1016/j.compbiomed.2024.108778] [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: 01/27/2024] [Revised: 05/14/2024] [Accepted: 06/15/2024] [Indexed: 06/28/2024]
Abstract
Body-machine interfaces (BoMIs)-systems that control assistive devices (e.g., a robotic manipulator) with a person's movements-offer a robust and non-invasive alternative to brain-machine interfaces for individuals with neurological injuries. However, commercially-available assistive devices offer more degrees of freedom (DOFs) than can be efficiently controlled with a user's residual motor function. Therefore, BoMIs often rely on nonintuitive mappings between body and device movements. Learning these mappings requires considerable practice time in a lab/clinic, which can be challenging. Virtual environments can potentially address this challenge, but there are limited options for high-DOF assistive devices, and it is unclear if learning with a virtual device is similar to learning with its physical counterpart. We developed a novel virtual robotic platform that replicated a commercially-available 6-DOF robotic manipulator. Participants controlled the physical and virtual robots using four wireless inertial measurement units (IMUs) fixed to the upper torso. Forty-three neurologically unimpaired adults practiced a target-matching task using either the physical (sample size n = 25) or virtual device (sample size n = 18) involving pre-, mid-, and post-tests separated by four training blocks. We found that both groups made similar improvements from pre-test in movement time at mid-test (Δvirtual: 9.9 ± 9.5 s; Δphysical: 11.1 ± 9.9 s) and post-test (Δvirtual: 11.1 ± 9.1 s; Δphysical: 11.8 ± 10.5 s) and in path length at mid-test (Δvirtual: 6.1 ± 6.3 m/m; Δphysical: 3.3 ± 3.5 m/m) and post-test (Δvirtual: 6.6 ± 6.2 m/m; Δphysical: 3.5 ± 4.0 m/m). Our results indicate the feasibility of using virtual environments for learning to control assistive devices. Future work should determine how these findings generalize to clinical populations.
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Affiliation(s)
- Thomas E Augenstein
- Robotics Department, University of Michigan, Ann Arbor, MI, USA; NeuRRo Lab, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Deepak Nagalla
- Robotics Department, University of Michigan, Ann Arbor, MI, USA; NeuRRo Lab, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Alexander Mohacey
- Robotics Department, University of Michigan, Ann Arbor, MI, USA; NeuRRo Lab, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Luis H Cubillos
- Robotics Department, University of Michigan, Ann Arbor, MI, USA; NeuRRo Lab, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Mei-Hua Lee
- Department of Kinesiology, Michigan State University, Lansing, MI, USA
| | - Rajiv Ranganathan
- Department of Kinesiology, Michigan State University, Lansing, MI, USA; Department of Mechanical Engineering, Michigan State University, Lansing, MI, USA
| | - Chandramouli Krishnan
- Robotics Department, University of Michigan, Ann Arbor, MI, USA; NeuRRo Lab, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA; Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA; Department of Kinesiology, University of Michigan, Ann Arbor, MI, USA; Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA; Department of Physical Therapy, University of Michigan, Flint, MI, USA.
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24
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Zhang C, Yu S. The Technology to Enhance Patient Motivation in Virtual Reality Rehabilitation: A Review. Games Health J 2024; 13:215-233. [PMID: 39159237 DOI: 10.1089/g4h.2023.0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/21/2024] Open
Abstract
Virtual reality (VR) technology has experienced a steady rise and has been widely applied in the field of rehabilitation. The integration of VR technology in rehabilitation has shown promising results in enhancing their motivation for treatment, thereby enabling patients to actively engage in rehab training. Despite the advancement, there is a dearth of comprehensive summary and analysis on the use of VR technology to enhance patient motivation in rehabilitation. Thus, this narrative review aims to evaluate the potential of VR technology in enhancing patient motivation during motor rehabilitation training. This review commences with an explanation of how enhancing motivation through the VR rehabilitation system could improve the efficiency and effectiveness of rehabilitation training. Then, the technology was analyzed to improve patient motivation in the present VR rehabilitation system in detail. Furthermore, these technologies are classified and summarized to provide a comprehensive overview of the state-of-the-art approaches for enhancing patient motivation in VR rehabilitation. Findings showed VR rehabilitation training utilizes game-like exercises to enhance the engagement and enjoyment of rehabilitation training. By immersing patients in a simulated environment with multisensory feedback, VR systems offer a unique approach to rehabilitation that can lead to improved patient motivation. Both ultimately lead to improved patient outcomes, which is not typically achievable with traditional rehabilitation methods. The review concludes that VR rehabilitation presents an opportunity to improve patient motivation and adherence to long-term rehabilitation training. However, to further enhance patient self-efficacy, VR rehabilitation should integrate psychology and incorporate methods. Moreover, it is necessary to build a game design theory for rehabilitation games, and the latest VR feedback technology should also be introduced.
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Affiliation(s)
- Chengjie Zhang
- School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Suiran Yu
- School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
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25
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Fluet GG, Gorin H, Rothpletz Puglia P, Qiu Q, Patel J, Merians AS, Cronce AL, Adamovich SV. A Convergent Mixed Methods Design to Assess the Use of the Home Virtual Rehabilitation System By Persons with Chronic Stroke. Games Health J 2024; 13:278-287. [PMID: 38563678 DOI: 10.1089/g4h.2024.0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Purpose: Patients poststroke utilized the Home Virtual Rehabilitation System (HoVRS) to perform home-based, gamified upper extremity rehabilitation over 12 weeks. Outcomes related to adherence and clinical improvement were collected, and semistructured interviews were conducted to assess intrinsic and extrinsic motivators that impacted engagement with the system. Methods: Subjects performed between 299 and 2020 minutes of self-scheduled, sparsely supervised hand rehabilitation activities in their homes. Results: As a group, the subjects demonstrated statistically significant improvements at the structure/function, activity, and activities of daily living levels of function. Qualitative analysis generated seven themes that both positively and negatively influenced each subject's experience with HoVRS, including challenge as a primary intrinsic motivator and pursuing additional therapy and/or a return to higher functional status as a key extrinsic motivator. Subjects' ratings of the system using the Intrinsic Motivation Inventory before and after treatment were uniformly positive, but interview-based feedback was more balanced between positive and negative.
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Affiliation(s)
- Gerard G Fluet
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers The State University of New Jersey, Newark, New Jersey, USA
| | - Holly Gorin
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers The State University of New Jersey, Newark, New Jersey, USA
| | - Pamela Rothpletz Puglia
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers The State University of New Jersey, Newark, New Jersey, USA
| | - Qinyin Qiu
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers The State University of New Jersey, Newark, New Jersey, USA
| | - Jigna Patel
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers The State University of New Jersey, Newark, New Jersey, USA
| | - Alma S Merians
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers The State University of New Jersey, Newark, New Jersey, USA
| | - Amanda L Cronce
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, New Jersey, USA
| | - Sergei V Adamovich
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, New Jersey, USA
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26
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Kim MS, Park H, Kwon I, An KO, Shin JH. Brain-computer interface on wrist training with or without neurofeedback in subacute stroke: a study protocol for a double-blinded, randomized control pilot trial. Front Neurol 2024; 15:1376782. [PMID: 39144712 PMCID: PMC11322049 DOI: 10.3389/fneur.2024.1376782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 07/15/2024] [Indexed: 08/16/2024] Open
Abstract
Background After a stroke, damage to the part of the brain that controls movement results in the loss of motor function. Brain-computer interface (BCI)-based stroke rehabilitation involves patients imagining movement without physically moving while the system measures the perceptual-motor rhythm in the motor cortex. Visual feedback through virtual reality and functional electrical stimulation is provided simultaneously. The superiority of real BCI over sham BCI in the subacute phase of stroke remains unclear. Therefore, we aim to compare the effects of real and sham BCI on motor function and brain activity among patients with subacute stroke with weak wrist extensor strength. Methods This is a double-blinded randomized controlled trial. Patients with stroke will be categorized into real BCI and sham BCI groups. The BCI task involves wrist extension for 60 min/day, 5 times/week for 4 weeks. Twenty sessions will be conducted. The evaluation will be conducted four times, as follows: before the intervention, 2 weeks after the start of the intervention, immediately after the intervention, and 4 weeks after the intervention. The assessments include a clinical evaluation, electroencephalography, and electromyography using motor-evoked potentials. Discussion Patients will be categorized into two groups, as follows: those who will be receiving neurofeedback and those who will not receive this feedback during the BCI rehabilitation training. We will examine the importance of motor imaging feedback, and the effect of patients' continuous participation in the training rather than their being passive.Clinical Trial Registration: KCT0008589.
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Affiliation(s)
- Myeong Sun Kim
- Translational Research Center for Rehabilitation Robots, National Rehabilitation Center, Ministry of Health and Welfare, Seoul, Republic of Korea
- Department of Rehabilitative and Assistive Technology, National Rehabilitation Center, Rehabilitation Research Institute, Ministry of Health and Welfare, Seoul, Republic of Korea
| | - Hyunju Park
- Translational Research Center for Rehabilitation Robots, National Rehabilitation Center, Ministry of Health and Welfare, Seoul, Republic of Korea
- Department of Rehabilitative and Assistive Technology, National Rehabilitation Center, Rehabilitation Research Institute, Ministry of Health and Welfare, Seoul, Republic of Korea
| | - Ilho Kwon
- Translational Research Center for Rehabilitation Robots, National Rehabilitation Center, Ministry of Health and Welfare, Seoul, Republic of Korea
- Department of Rehabilitative and Assistive Technology, National Rehabilitation Center, Rehabilitation Research Institute, Ministry of Health and Welfare, Seoul, Republic of Korea
| | - Kwang-Ok An
- Department of Healthcare and Public Health Research, National Rehabilitation Center, Rehabilitation Research Institute, Ministry of Health and Welfare, Seoul, Republic of Korea
| | - Joon-Ho Shin
- Translational Research Center for Rehabilitation Robots, National Rehabilitation Center, Ministry of Health and Welfare, Seoul, Republic of Korea
- Department of Rehabilitation Medicine, National Rehabilitation Center, Ministry of Health and Welfare, Seoul, Republic of Korea
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27
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Kim HJ, Weon HW, Son HK. Effects of neurofeedback training on the alpha activity in quantitative electroencephalography, cognitive function, and speech perception in elderly with presbycusis: a quasi-experimental study. BMC Geriatr 2024; 24:639. [PMID: 39085795 PMCID: PMC11293253 DOI: 10.1186/s12877-024-05234-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 07/21/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND This study aimed to investigate the effects of neurofeedback training (NFT) on alpha activity in quantitative electroencephalography (QEEG), cognitive function, and speech perception in elderly with presbycusis. METHODS This study was conducted from June 15 to November 30, 2020. The experimental group (n = 28) underwent NFT, while the control group (n = 31) was instructed to continue with their routine daily life. The NFT conducted for 40 min, two times a week, for a total of 16 sessions and was performed using Neuroharmony S and BrainHealth 2.7. The alpha activity was measured as alpha waves using QEEG. The cognitive function was measured using the Korean version of Mini-Mental Status Examination, digit span forward and backward (DSF and DSB). The speech perception was measured using the word and sentence recognition score (WRS and SRS) using an audiometer with the Korean Standard Monosyllabic Word Lists for Adults. RESULTS The experimental group demonstrated improvement in the alpha wave of the left frontal lobe measured as alpha activity (t=-2.521, p = .018); MMSE-K (t=-3.467, p < .01), and DSF (t=-2.646, p < .05) measured as cognitive function; and WRS (t=-3.255, p = .003), and SRS (t=-2.851, p = .008) measured as speech perception compared to the control group. CONCLUSIONS This study suggests that NFT could be considered an effective cognitive and auditory rehabilitation method based on brain and cognitive science for improving alpha activity, cognitive function, and speech perception.
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Affiliation(s)
- Hyoung Jae Kim
- Korean Academy of Audiology, Hallym University, 1 Hallymdaehak-gil, Chuncheon-si, 24252, Korea
| | - Hee Wook Weon
- Department of Brain and Cognitive Science, Seoul University of Buddhism, 8 Doksan-dong 70-gil, Geumcheon-gu, Seoul, 08559, Korea
| | - Hae Kyoung Son
- Department of Nursing, Eulji University, 553 Sanseong-daero, Sujeong-gu, Seongnam-si, 13135, Korea.
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28
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Barzacchi V, Mangani G, Del Lucchese B, Menici V, Bombonato C, Beani E, Biagioni E, Palla I, Posteraro F, Trieste L, Turchetti G, Sgandurra G, Cioni G, Consortium OBOTT. TABLET TOSCANA to Develop Innovative Organizational Models for Tele-Rehabilitation in Subjects with Congenital and Acquired Developmental Disabilities: A Wait-List Control Group Trial Protocol. J Clin Med 2024; 13:4159. [PMID: 39064206 PMCID: PMC11277580 DOI: 10.3390/jcm13144159] [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: 06/19/2024] [Revised: 07/04/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024] Open
Abstract
Background/Objectives: In recent years, the advent of new technologies has fostered their application in neuro-psychomotor and language rehabilitation, particularly since the COVID-19 pandemic. Tele-rehabilitation has emerged as an innovative and timely solution, enabling personalized interventions monitored by clinicians. TABLET TOSCANA project aims to develop innovative tele-rehabilitation organizational models in children, adolescents and young adults with congenital and acquired developmental disabilities, using the Virtual Reality Rehabilitation System (VRRS) Home Kit and the MedicoAmico APP. Methods: The trial is designed according to the CONSORT statement guidelines. The project encompasses three phases: adapting the technologies for pediatric use, validating them through a wait-list study, and analyzing feasibility and effectiveness data to define new organizational models. A randomized wait-list-control study with 100 subjects aged 6 to 30 years will compare tele-rehabilitation versus prosecution of standard care. Discussion: Although literature highlights tele-rehabilitation benefits such as improved access, cost savings, and enhanced treatment adherence, practical implementation remains limited (i.e., the definition of standardized procedures). TABLET TOSCANA project seeks to address these gaps by focusing on multi-domain treatments for neurodevelopmental disabilities and emphasizing the integration of tele-rehabilitation into local health services. Conclusion: The project aims to improve the continuity and intensity of care through innovative models that integrate tele-rehabilitation into local health services. The results could inform healthcare policies and promote the development of innovative and collaborative models of care, paving the way for more effective and widespread tele-rehabilitation solutions and fostering collaborative networks among professionals.
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Affiliation(s)
- Veronica Barzacchi
- Developmental Neurology and Neurorehabilitation Unit, IRCCS Stella Maris Foundation, 56126 Pisa, Italy; (V.B.); (G.M.); (B.D.L.); (V.M.); (C.B.); (E.B.); (G.C.)
- Tuscan Ph.D. Programme of Neuroscience, University of Florence, 50121 Florence, Italy
| | - Gloria Mangani
- Developmental Neurology and Neurorehabilitation Unit, IRCCS Stella Maris Foundation, 56126 Pisa, Italy; (V.B.); (G.M.); (B.D.L.); (V.M.); (C.B.); (E.B.); (G.C.)
| | - Benedetta Del Lucchese
- Developmental Neurology and Neurorehabilitation Unit, IRCCS Stella Maris Foundation, 56126 Pisa, Italy; (V.B.); (G.M.); (B.D.L.); (V.M.); (C.B.); (E.B.); (G.C.)
| | - Valentina Menici
- Developmental Neurology and Neurorehabilitation Unit, IRCCS Stella Maris Foundation, 56126 Pisa, Italy; (V.B.); (G.M.); (B.D.L.); (V.M.); (C.B.); (E.B.); (G.C.)
- Ph.D. Programme in Clinical and Translational Sciences, University of Pisa, Via Roma 67, 56126 Pisa, Italy
| | - Clara Bombonato
- Developmental Neurology and Neurorehabilitation Unit, IRCCS Stella Maris Foundation, 56126 Pisa, Italy; (V.B.); (G.M.); (B.D.L.); (V.M.); (C.B.); (E.B.); (G.C.)
| | - Elena Beani
- Developmental Neurology and Neurorehabilitation Unit, IRCCS Stella Maris Foundation, 56126 Pisa, Italy; (V.B.); (G.M.); (B.D.L.); (V.M.); (C.B.); (E.B.); (G.C.)
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Enrico Biagioni
- UOC Neuropsichiatria Infantile, ASL Toscana Nord-Ovest, 56126 Pisa, Italy;
| | - Ilaria Palla
- Institute of Management, Scuola Superiore Sant’Anna, 56126 Pisa, Italy; (I.P.); (L.T.); (G.T.)
| | - Federico Posteraro
- Rehabilitation Department, Versilia Hospital, AUSL Toscana Nord Ovest, 55049 Lucca, Italy;
| | - Leopoldo Trieste
- Institute of Management, Scuola Superiore Sant’Anna, 56126 Pisa, Italy; (I.P.); (L.T.); (G.T.)
| | - Giuseppe Turchetti
- Institute of Management, Scuola Superiore Sant’Anna, 56126 Pisa, Italy; (I.P.); (L.T.); (G.T.)
| | - Giuseppina Sgandurra
- Developmental Neurology and Neurorehabilitation Unit, IRCCS Stella Maris Foundation, 56126 Pisa, Italy; (V.B.); (G.M.); (B.D.L.); (V.M.); (C.B.); (E.B.); (G.C.)
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Giovanni Cioni
- Developmental Neurology and Neurorehabilitation Unit, IRCCS Stella Maris Foundation, 56126 Pisa, Italy; (V.B.); (G.M.); (B.D.L.); (V.M.); (C.B.); (E.B.); (G.C.)
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Steurer H, Albrecht F, Gustafsson JK, Razi A, Franzén E, Schalling E. Speech and neuroimaging effects following HiCommunication: a randomized controlled group intervention trial in Parkinson's disease. Brain Commun 2024; 6:fcae235. [PMID: 39051026 PMCID: PMC11267236 DOI: 10.1093/braincomms/fcae235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 05/07/2024] [Accepted: 07/10/2024] [Indexed: 07/27/2024] Open
Abstract
Speech, voice and communication changes are common in Parkinson's disease. HiCommunication is a novel group intervention for speech and communication in Parkinson's disease based on principles driving neuroplasticity. In a randomized controlled trial, 95 participants with Parkinson's disease were allocated to HiCommunication or an active control intervention. Acoustic analysis was performed pre-, post- and six months after intervention. Intention-to-treat analyses with missing values imputed in linear multilevel models and complimentary per-protocol analyses were performed. The proportion of participants with a clinically relevant increase in the primary outcome measure of voice sound level was calculated. Resting-state functional MRI was performed pre- and post-intervention. Spectral dynamic causal modelling and the parametric empirical Bayes methods were applied to resting-state functional MRI data to describe effective connectivity changes in a speech-motor-related network of brain regions. From pre- to post-intervention, there were significant group-by-time interaction effects for the measures voice sound level in text reading (unstandardized b = 2.3, P = 0.003), voice sound level in monologue (unstandardized b = 2.1, P = 0.009), Acoustic Voice Quality Index (unstandardized b = -0.5, P = 0.016) and Harmonics-to-Noise Ratio (unstandardized b = 1.3, P = 0.014) post-intervention. For 59% of the participants, the increase in voice sound level after HiCommunication was clinically relevant. There were no sustained effects at the six-month follow-up. In the effective connectivity analysis, there was a significant decrease in inhibitory self-connectivity in the left supplementary motor area and increased connectivity from the right supplementary motor area to the left paracentral gyrus after HiCommunication compared to after the active control intervention. In conclusion, the HiCommunication intervention showed promising effects on voice sound level and voice quality in people with Parkinson's disease, motivating investigations of barriers and facilitators for implementation of the intervention in healthcare settings. Resting-state brain effective connectivity was altered following the intervention in areas implicated, possibly due to reorganization in brain networks.
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Affiliation(s)
- Hanna Steurer
- Department of Clinical Science, Intervention and Technology, Division of Speech and Language Pathology, Karolinska Institutet, 141 86 Huddinge, Stockholm, Sweden
- Research & Development Unit, Stockholms Sjukhem, 112 19 Stockholm, Sweden
| | - Franziska Albrecht
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 141 83 Huddinge, Stockholm, Sweden
- Women’s Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy & Physiotherapy, Karolinska University Hospital, 141 57 Huddinge, Stockholm, Sweden
| | - Joakim Körner Gustafsson
- Department of Clinical Science, Intervention and Technology, Division of Speech and Language Pathology, Karolinska Institutet, 141 86 Huddinge, Stockholm, Sweden
| | - Adeel Razi
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, 3800, Australia
- Wellcome Trust Centre for Neuroimaging, Institute of Neurology, University College London, London WC1N 3AR, UK
- CIFAR Azrieli Global Scholars Program, CIFAR, Toronto, ON M5G 1M1, Canada
| | - Erika Franzén
- Research & Development Unit, Stockholms Sjukhem, 112 19 Stockholm, Sweden
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 141 83 Huddinge, Stockholm, Sweden
- Women’s Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy & Physiotherapy, Karolinska University Hospital, 141 57 Huddinge, Stockholm, Sweden
| | - Ellika Schalling
- Department of Clinical Science, Intervention and Technology, Division of Speech and Language Pathology, Karolinska Institutet, 141 86 Huddinge, Stockholm, Sweden
- Department of Public Health and Caring Sciences, Speech-Language Pathology, Uppsala University, 751 22 Uppsala, Sweden
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Winterbottom L, Chen A, Mendonca R, Nilsen DM, Ciocarlie M, Stein J. Clinician perceptions of a novel wearable robotic hand orthosis for post-stroke hemiparesis. Disabil Rehabil 2024:1-10. [PMID: 38975689 DOI: 10.1080/09638288.2024.2375056] [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: 10/19/2023] [Accepted: 06/27/2024] [Indexed: 07/09/2024]
Abstract
PURPOSE Wearable robotic devices are currently being developed to improve upper limb function for individuals with hemiparesis after stroke. Incorporating the views of clinicians during the development of new technologies can help ensure that end products meet clinical needs and can be adopted for patient care. METHODS In this cross-sectional mixed-methods study, an anonymous online survey was used to gather clinicians' perceptions of a wearable robotic hand orthosis for post-stroke hemiparesis. Participants were asked about their clinical experience and provided feedback on the prototype device after viewing a video. RESULTS 154 participants completed the survey. Only 18.8% had previous experience with robotic technology. The majority of participants (64.9%) reported that they would use the device for both rehabilitative and assistive purposes. Participants perceived that the device could be used in supervised clinical settings with all phases of stroke. Participants also indicated a need for insurance coverage and quick setup time. CONCLUSIONS Engaging clinicians early in the design process can help guide the development of wearable robotic devices. Both rehabilitative and assistive functions are valued by clinicians and should be considered during device development. Future research is needed to understand a broader set of stakeholders' perspectives on utility and design.
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Affiliation(s)
- Lauren Winterbottom
- Department of Rehabilitation and Regenerative Medicine, Columbia University, New York, NY, USA
| | - Ava Chen
- Department of Mechanical Engineering, Columbia University, New York, NY, USA
| | - Rochelle Mendonca
- Department of Rehabilitation and Regenerative Medicine, Columbia University, New York, NY, USA
| | - Dawn M Nilsen
- Department of Rehabilitation and Regenerative Medicine, Columbia University, New York, NY, USA
- NewYork-Presbyterian Hospital, New York, NY, USA
| | - Matei Ciocarlie
- Department of Mechanical Engineering, Columbia University, New York, NY, USA
| | - Joel Stein
- Department of Rehabilitation and Regenerative Medicine, Columbia University, New York, NY, USA
- NewYork-Presbyterian Hospital, New York, NY, USA
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Huber SK, Knols RH, Held JPO, Betschart M, de Bruin ED. PEMOCS: Evaluating the effects of a concept-guided, PErsonalised, MOtor-Cognitive exergame training on cognitive functions and gait in chronic Stroke-study protocol for a randomised controlled trial. Trials 2024; 25:451. [PMID: 38965612 PMCID: PMC11223407 DOI: 10.1186/s13063-024-08283-7] [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: 01/16/2024] [Accepted: 06/21/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Many stroke survivors remain with residual cognitive and motor impairments despite receiving timely acute and sub-acute rehabilitation. This indicates that rehabilitation following stroke should be continuous to meet the needs of individual stroke patients. Both cognitive and motor functions are essential for mastering daily life and, therefore, should be aimed at with rehabilitation. Exergames, motor-cognitive exercises performed using video games, are an auspicious method to train both motor and cognitive functions and at the same time may foster the long-term motivation for training. This study aims to assess the effect of concept-guided, personalised, motor-cognitive exergame training on cognitive and motor functions in chronic stroke survivors. METHODS This study is a single-blinded, randomised controlled trial. Assessments are performed at baseline, after a 12-week intervention, and at a 24-weeks follow-up. Chronic stroke patients (≥ 18 years old, ≥ 6 months post-stroke) able to stand for 3 min, independently walk 10 m, follow a two-stage command, and without other neurological diseases apart from cognitive deficits or dementia are included. Participants in the intervention group perform the exergame training twice per week for 30 (beginning) up to 40 (end) minutes additionally to their usual care programme. Participants in the control group receive usual care without additional intervention(s). Global cognitive functioning (total Montreal Cognitive Assessment (MoCA) score) is the primary outcome. Secondary outcomes include health-related quality of life, specific cognitive functions, single- and dual-task mobility, and spatiotemporal gait parameters. The target sample size for this trial is 38 participants. Linear mixed models with the post-outcome scores as dependent variables and group and time as fixed effects will be performed for analysis. DISCUSSION Superior improvements in global cognitive functioning and in the abovementioned secondary outcomes in the intervention group compared to the control group are hypothesised. The results of this study may guide future design of long-term rehabilitation interventions after stroke. TRIAL REGISTRATION ClinicalTrials.gov (NCT05524727). Registered on September 1, 2022.
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Affiliation(s)
- S K Huber
- Physiotherapy Occupational Therapy Research Center, Directorate of Research and Education, University Hospital Zurich, Zurich, Switzerland.
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.
| | - R H Knols
- Physiotherapy Occupational Therapy Research Center, Directorate of Research and Education, University Hospital Zurich, Zurich, Switzerland
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - J P O Held
- Rehabilitation Center Triemli Zurich, Valens Clinics, Zurich, Switzerland
| | - M Betschart
- Department of Health, OST - Eastern Swiss University of Applied Sciences, St. Gallen, Switzerland
- Institute of Therapy and Rehabilitation, Kantonsspital Winterthur, Winterthur, Switzerland
| | - E D de Bruin
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Department of Health, OST - Eastern Swiss University of Applied Sciences, St. Gallen, Switzerland
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
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Skovgaard Jensen J, Sørensen AS, Kruuse C, Nielsen HH, Skov CD, Jensen HB, Buckwalter MS, Bojsen-Møller J, Lambertsen KL, Holsgaard-Larsen A. The effect of robot-assisted versus standard training on motor function following subacute rehabilitation after ischemic stroke - protocol for a randomised controlled trial nested in a prospective cohort (RoboRehab). BMC Neurol 2024; 24:233. [PMID: 38965499 PMCID: PMC11223295 DOI: 10.1186/s12883-024-03734-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 06/17/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Body weight unloaded treadmill training has shown limited efficacy in further improving functional capacity after subacute rehabilitation of ischemic stroke patients. Dynamic robot assisted bodyweight unloading is a novel technology that may provide superior training stimuli and continued functional improvements in individuals with residual impairments in the chronic phase after the ischemic insult. The aim of the present study is to investigate the effect of dynamic robot-assisted versus standard training, initiated 6 months post-stroke, on motor function, physical function, fatigue, and quality of life in stroke-affected individuals still suffering from moderate-to-severe disabilities after subacute rehabilitation. METHODS Stroke-affected individuals with moderate to severe disabilities will be recruited into a prospective cohort with measurements at 3-, 6-, 12- and 18-months post-stroke. A randomised controlled trial (RCT) will be nested in the prospective cohort with measurements pre-intervention (Pre), post-intervention (Post) and at follow-up 6 months following post-intervention testing. The present RCT will be conducted as a multicentre parallel-group superiority of intervention study with assessor-blinding and a stratified block randomisation design. Following pre-intervention testing, participants in the RCT study will be randomised into robot-assisted training (intervention) or standard training (active control). Participants in both groups will train 1:1 with a physiotherapist two times a week for 6 months (groups are matched for time allocated to training). The primary outcome is the between-group difference in change score of Fugl-Meyer Lower Extremity Assessment from pre-post intervention on the intention-to-treat population. A per-protocol analysis will be conducted analysing the differences in change scores of the participants demonstrating acceptable adherence. A priori sample size calculation allowing the detection of the minimally clinically important between-group difference of 6 points in the primary outcome (standard deviation 6 point, α = 5% and β = 80%) resulted in 34 study participants. Allowing for dropout the study will include 40 participants in total. DISCUSSION For stroke-affected individuals still suffering from moderate to severe disabilities following subacute standard rehabilitation, training interventions based on dynamic robot-assisted body weight unloading may facilitate an appropriate intensity, volume and task-specificity in training leading to superior functional recovery compared to training without the use of body weight unloading. TRIAL REGISTRATION ClinicalTrials.gov. NCT06273475. TRIAL STATUS Recruiting. Trial identifier: NCT06273475. Registry name: ClinicalTrials.gov. Date of registration on ClinicalTrials.gov: 22/02/2024.
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Affiliation(s)
- Jon Skovgaard Jensen
- Orthopaedic Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
- Department of Orthopaedics and Traumatoloy, Odense University Hospital, J.B. Winsløwsvej 4, Odense, 5000, Denmark.
| | - Anders Stengaard Sørensen
- SDU UAS Center, The Maersk Mc-Kinney Moller Institute, University of Southern Denmark, Odense, Denmark
| | - Christina Kruuse
- Department of Brain and Spinal Cord Injuries, Neuroscience Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Helle Hvilsted Nielsen
- Neurobiology Research Unit, Department of Molecular Medicine, University of Southern Denmark, Odense, Denmark
- Department of Neurology, OUH, and BRIDGE - Brain Research Inter Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Cecilie Dollerup Skov
- Orthopaedic Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Orthopaedics and Traumatoloy, Odense University Hospital, J.B. Winsløwsvej 4, Odense, 5000, Denmark
| | - Henrik Boye Jensen
- Brain and Nerve Diseases, Department of Regional Health Research, Lillebaelt Hospital, University of Southern Denmark, Kolding, Denmark
| | - Marion S Buckwalter
- Department of Neurology and Neurological Sciences, and, Department of Neurosurgery, Stanford School of Medicine, Stanford, CA, USA
| | - Jens Bojsen-Møller
- Research Unit of Muscle Physiology and Biomechanics, Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Kate Lykke Lambertsen
- Neurobiology Research Unit, Department of Molecular Medicine, University of Southern Denmark, Odense, Denmark
- Department of Neurology, OUH, and BRIDGE - Brain Research Inter Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Anders Holsgaard-Larsen
- Orthopaedic Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Orthopaedics and Traumatoloy, Odense University Hospital, J.B. Winsløwsvej 4, Odense, 5000, Denmark
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Sabet A, Galloway JC. Harnessing Mobility: A Medically Complex Child's Home Program Utilizing an In-Home Body Weight Support System. Pediatr Phys Ther 2024; 36:347-352. [PMID: 39023763 DOI: 10.1097/pep.0000000000001112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
PURPOSE To describe a home program for a child with medical complexity using an over-ground body weight support (BWS) system. SUMMARY OF KEY POINTS Children with medical complexity often use home programs due to challenges with regular therapy attendance. In this case, effective home program components including child centered design, family leadership, and best practice principles were prioritized around the PUMA (portable mobility aid for children). This BWS system was to be used for 1 hour per day to support mobility and active play. STATEMENT OF CONCLUSIONS The CMC and family demonstrated high adherence, using over-ground BWS 87% of the 135 days it was accessible with an average daily usage of 59 min spread across 1-3 bouts per day. The average daily fun index during usage was 7/10. RECOMMENDATIONS FOR CLINICAL PRACTICE This home program demonstrated over-ground BWS technology as a feasible, fun platform for functional mobility and socialization in a child with significant medical and physical limitations.
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Affiliation(s)
- Andrina Sabet
- Go Baby Go, Mobility Matters, LLC, Cleveland, Ohio (Ms Sabet); Go Baby Go, University of Delaware, Newark, Delaware Physical Therapy, Baylor University, Waco, Texas (Dr Galloway)
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Choi JY, Kim SK, Hong J, Park H, Yang SS, Park D, Song MK. Overground Gait Training With a Wearable Robot in Children With Cerebral Palsy: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2422625. [PMID: 39037815 PMCID: PMC11265136 DOI: 10.1001/jamanetworkopen.2024.22625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 05/17/2024] [Indexed: 07/24/2024] Open
Abstract
Importance Cerebral palsy (CP) is the most common developmental motor disorder in children. Robot-assisted gait training (RAGT) using a wearable robot can provide intensive overground walking experience. Objective To investigate the effectiveness of overground RAGT in children with CP using an untethered, torque-assisted, wearable exoskeletal robot. Design, Setting, and Participants This multicenter, single-blind randomized clinical trial was conducted from September 1, 2021, to March 31, 2023, at 5 rehabilitation institutions in Korea. Ninety children with CP in Gross Motor Function Classification System levels II to IV were randomized. Intervention The RAGT group underwent 18 sessions of RAGT during 6 weeks, whereas the control group received standard physical therapy for the same number of sessions during the same period. Main Outcome and Measures The primary outcome measure was the Gross Motor Function Measure 88 (GMFM-88) score. Secondary outcome measures were the GMFM-66, Pediatric Balance Scale, selective control assessment of the lower extremity, Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT), 6-minute walking test scores (distance and oxygen consumption), muscle and fat mass via bioelectrical impedance analysis, and gait parameters measured via 3-dimensional analysis. All assessments were performed for all patients at baseline, at the end of the 6-week intervention, and after the 4-week follow-up. Results Of the 90 children (mean [SD] age, 9.51 [2.48] years; 49 [54.4%] male and 41 [45.6%] female) in the study, 78 (86.7%) completed the intervention, with 37 participants (mean [SD] age, 9.57 [2.38] years; 19 [51.4%] male) and 41 participants (mean [SD] age, 9.32 [2.37] years; 26 [63.4%] male) randomly assigned to the RAGT and control groups, respectively. Changes in the RAGT group significantly exceeded changes in the control group in GMFM-88 total (mean difference, 2.64; 95% CI, 0.50-4.78), GMFM-E (mean difference, 2.70; 95% CI, 0.08-5.33), GMFM-66 (mean difference, 1.31; 95% CI, 0.01-2.60), and PEDI-CAT responsibility domain scores (mean difference, 2.52; 95% CI, 0.42-4.63), indicating independence in daily living at postintervention assessment. At the 4-week follow-up, the RAGT group showed significantly greater improvements in balance control (mean difference, 1.48; 95% CI, 0.03-2.94) and Gait Deviation Index (mean difference, 6.48; 95% CI, 2.77-10.19) compared with the control group. Conclusions and Relevance In this randomized clinical trial, overground RAGT using a wearable robot significantly improved gross motor function and gait pattern. This new torque-assisted wearable exoskeletal robot, based on assist-as-needed control, may complement standard rehabilitation by providing adequate assistance and therapeutic support to children with CP. Trial Registration CRIS Identifier: KCT0006273.
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Affiliation(s)
- Ja Young Choi
- Department of Rehabilitation Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Seung Ki Kim
- Department and Rehabilitation Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Juntaek Hong
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hankyul Park
- Department and Rehabilitation Medicine, Seoul Rehabilitation Hospital, Seoul, Korea
| | - Shin-seung Yang
- Department of Rehabilitation Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Dongho Park
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta
- Institute for Robotics and Intelligent Machines, Georgia Institute of Technology, Atlanta
| | - Min-Keun Song
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School and Hospital, Gwangju, Korea
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Zhang C, Yu S, Ji J. CFI: a VR motor rehabilitation serious game design framework integrating rehabilitation function and game design principles with an upper limb case. J Neuroeng Rehabil 2024; 21:113. [PMID: 38951891 PMCID: PMC11218288 DOI: 10.1186/s12984-024-01373-2] [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: 01/18/2024] [Accepted: 05/08/2024] [Indexed: 07/03/2024] Open
Abstract
Virtual reality (VR) Rehabilitation holds the potential to address the challenge that patients feel bored and give up long-term rehabilitation training. Despite the introduction of gaming elements by some researchers in rehabilitation training to enhance engagement, there remains a notable lack of in-depth research on VR rehabilitation serious game design methods, particularly the absence of a concrete design framework for VR rehabilitation serious games. Hence, we introduce the Clinical-Function-Interesting (CFI): a VR rehabilitation serious game design framework, harmonizing rehabilitation function and game design theories. The framework initiates with clinic information, defining game functions through the functional decomposition of rehabilitation training. Subsequently, it integrates gaming elements identified through the analysis and comparison of related literature to provide enduring support for long-term training. Furthermore, VR side-effect and enhancement are considered. Building upon this design framework, we have developed an upper limb VR rehabilitation serious game tailored for mild to moderate stroke patients and aligned our framework with another developed VR rehabilitation serious game to validate its practical feasibility. Overall, the proposed design framework offers a systematic VR rehabilitation serious game design methodology for the VR rehabilitation field, assisting developers in more accurately designing VR rehabilitation serious games that are tailored to specific rehabilitation goals.
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Affiliation(s)
- Chengjie Zhang
- School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Suiran Yu
- School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Jiancheng Ji
- Shenzhen Polytechnic University, Shenzhen, China.
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Tang P, Liu Y, Peng S, Cai Z, Tang G, Zhou Z, Hu K, Zhong Y. Cerebral [ 18F]AIF-FAPI-42-Based PET Imaging of Fibroblast Activation Protein for Non-invasive Quantification of Fibrosis After Ischemic Stroke. Transl Stroke Res 2024:10.1007/s12975-024-01269-2. [PMID: 38940873 DOI: 10.1007/s12975-024-01269-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 06/08/2024] [Accepted: 06/17/2024] [Indexed: 06/29/2024]
Abstract
The development of fibrosis after injury to the brain or spinal cord limits the regeneration of the central nervous system in adult mammals. However, the extent of fibrosis in the injured brain has not been systematically investigated in mammals in vivo. This study aimed to assess whether [18F]AlF-FAPI-42-based cerebral positron emission tomography (PET) can be utilized to assess the extent of fibrosis in ischemic regions of the brain in vivo. Sprague-Dawley rats underwent permanent occlusion of the right middle cerebral artery (MCAO). On days 3, 7, 14, and 21 after MCAO, the uptake of [18F]AlF-FAPI-42 in the ischemic region of the brain in the MCAO groups surpassed that in the control group (day 0). The specific expression of fibroblast activation protein-α (FAP) in ischemic regions of the brain was also confirmed in immunohistofluorescence experiments in vitro. [18F]AlF-FAPI-42 intensity correlated with the density of collagen deposition in the ischemic hemisphere (p < 0.001). [18F]AlF-FAPI-42 PET/CT imaging demonstrated a specific uptake of radioactivity in the infarcted area in an ischemic stroke patient. PET imaging by using [18F]AlF-FAPI-42 offers a promising non-invasive method for monitoring the progression of cerebral fibrosis caused by ischemic stroke and may facilitate the clinical management of stroke patients. Trial registration: chictr.org.cn ChiCTR2200059004. Registered April 22, 2022.
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Affiliation(s)
- Peipei Tang
- Department of Rehabilitation Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Yang Liu
- Department of Nuclear Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
- School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, 510515, China
| | - Simin Peng
- Department of Nuclear Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
- School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, 510515, China
| | - Zhikai Cai
- Department of Nuclear Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Ganghua Tang
- Department of Nuclear Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
- School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, 510515, China
| | - Zhou Zhou
- Department of Rehabilitation Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Kongzhen Hu
- Department of Nuclear Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
- School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, 510515, China.
| | - Yuhua Zhong
- Department of Rehabilitation Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
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Dallal-York J, Troche MS. Hypotussic cough in persons with dysphagia: biobehavioral interventions and pathways to clinical implementation. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1394110. [PMID: 38933659 PMCID: PMC11199739 DOI: 10.3389/fresc.2024.1394110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 05/13/2024] [Indexed: 06/28/2024]
Abstract
Cough is a powerful, protective expulsive behavior that assists in maintaining respiratory health by clearing foreign material, pathogens, and mucus from the airways. Therefore, cough is critical to survival in both health and disease. Importantly, cough protects the airways and lungs from both antegrade (e.g., food, liquid, saliva) and retrograde (e.g., bile, gastric acid) aspirate contents. Aspiration is often the result of impaired swallowing (dysphagia), which allows oral and/or gastric contents to enter the lung, especially in individuals who also have cough dysfunction (dystussia). Cough hyposensitivity, downregulation, or desensitization- collectively referred to as hypotussia- is common in individuals with dysphagia, and increases the likelihood that aspirated material will reach the lung. The consequence of hypotussia with reduced airway clearance can include respiratory tract infection, chronic inflammation, and long-term damage to the lung parenchyma. Despite the clear implications for health, the problem of managing hypotussia in individuals with dysphagia is frequently overlooked. Here, we provide an overview of the current interventions and treatment approaches for hypotussic cough. We synthesize the available literature to summarize research findings that advance our understanding of these interventions, as well as current gaps in knowledge. Further, we highlight pragmatic resources to increase awareness of hypotussic cough interventions and provide support for the clinical implementation of evidence-based treatments. In culmination, we discuss potential innovations and future directions for hypotussic cough research.
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Affiliation(s)
- Justine Dallal-York
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, United States
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Huber SK, Manser P, de Bruin ED. PEMOCS: theory derivation of a concept for PErsonalized MOtor-Cognitive exergame training in chronic Stroke-a methodological paper with an application example. Front Sports Act Living 2024; 6:1397949. [PMID: 38915297 PMCID: PMC11194322 DOI: 10.3389/fspor.2024.1397949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 05/27/2024] [Indexed: 06/26/2024] Open
Abstract
Background Coping with residual cognitive and gait impairments is a prominent unmet need in community-dwelling chronic stroke survivors. Motor-cognitive exergames may be promising to address this unmet need. However, many studies have so far implemented motor-cognitive exergame interventions in an unstructured manner and suitable application protocols remain yet unclear. We, therefore, aimed to summarize existing literature on this topic, and developed a training concept for motor-cognitive exergame interventions in chronic stroke. Methods The development of the training concept for personalized motor-cognitive exergame training for stroke (PEMOCS) followed Theory Derivation procedures. This comprised (1.1) a thorough (narrative) literature search on long-term stroke rehabilitation; (1.2) a wider literature search beyond the topic of interest to identify analogies, and to induce creativity; (2) the identification of parent theories; (3) the adoption of suitable content or structure of the main parent theory; and (4) the induction of modifications to adapt it to the new field of interest. We also considered several aspects of the "Framework for Developing and Evaluating Complex Interventions" by the Medical Research Council. Specifically, a feasibility study was conducted, and refining actions based on the findings were performed. Results A training concept for improving cognitive functions and gait in community-dwelling chronic stroke survivors should consider the principles for neuroplasticity, (motor) skill learning, and training. We suggest using a step-based exergame training for at least 12 weeks, 2-3 times a week for approximately 45 min. Gentile's Taxonomy for Motor Learning was identified as suitable fundament for the personalized progression and variability rules, and extended by a third cognitive dimension. Concepts and models from related fields inspired further additions and modifications to the concept. Conclusion We propose the PEMOCS concept for improving cognitive functioning and gait in community-dwelling chronic stroke survivors, which serves as a guide for structuring and implementing motor-cognitive exergame interventions. Future research should focus on developing objective performance parameters that enable personalized progression independent of the chosen exergame type.
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Affiliation(s)
- Simone K. Huber
- Physiotherapy and Occupational Therapy Research Centre, Directorate of Research and Education, University Hospital Zurich, Zurich, Switzerland
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Patrick Manser
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Eling D. de Bruin
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Department of Health, OST—Eastern Swiss University of Applied Sciences, St. Gallen, Switzerland
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
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Ettema S, Pennink GH, Buurke TJW, David S, van Bennekom CAM, Houdijk H. Clinical indications and protocol considerations for selecting initial body weight support levels in gait rehabilitation: a systematic review. J Neuroeng Rehabil 2024; 21:97. [PMID: 38849899 PMCID: PMC11157893 DOI: 10.1186/s12984-024-01389-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 05/20/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Body weight support (BWS) training devices are frequently used to improve gait in individuals with neurological impairments, but guidance in selecting an appropriate level of BWS is limited. Here, we aim to describe the initial BWS levels used during gait training, the rationale for this selection and the clinical goals aligned with BWS training for different diagnoses. METHOD A systematic literature search was conducted in PubMed, Embase and Web of Science, including terms related to the population (individuals with neurological disorders), intervention (BWS training) and outcome (gait). Information on patient characteristics, type of BWS device, BWS level and training goals was extracted from the included articles. RESULTS Thirty-three articles were included, which described outcomes using frame-based (stationary or mobile) and unidirectional ceiling-mounted devices on four diagnoses (multiple sclerosis (MS), spinal cord injury (SCI), stroke, traumatic brain injury (TBI)). The BWS levels were highest for individuals with MS (median: 75%, IQR: 6%), followed by SCI (median: 40%, IQR: 35%), stroke (median: 30%, IQR: 4.75%) and TBI (median: 15%, IQR: 0%). The included studies reported eleven different training goals. Reported BWS levels ranged between 30 and 75% for most of the training goals, without a clear relationship between BWS level, diagnosis, training goal and rationale for BWS selection. Training goals were achieved in all included studies. CONCLUSION Initial BWS levels differ considerably between studies included in this review. The underlying rationale for these differences was not clearly motivated in the included studies. Variation in study designs and populations does not allow to draw a conclusion on the effectiveness of BWS levels. Hence, it remains difficult to formulate guidelines on optimal BWS settings for different diagnoses, BWS devices and training goals. Further efforts are required to establish clinical guidelines and to experimentally investigate which initial BWS levels are optimal for specific diagnoses and training goals.
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Affiliation(s)
- Sanne Ettema
- Research and Development, Heliomare Rehabilitation, Wijk aan Zee, the Netherlands.
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - Geertje H Pennink
- Research and Development, Heliomare Rehabilitation, Wijk aan Zee, the Netherlands
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Tom J W Buurke
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Sina David
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Coen A M van Bennekom
- Research and Development, Heliomare Rehabilitation, Wijk aan Zee, the Netherlands
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam, the Netherlands
| | - Han Houdijk
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Del Vecchio A, Enoka RM, Farina D. Specificity of early motor unit adaptations with resistive exercise training. J Physiol 2024; 602:2679-2688. [PMID: 38686581 DOI: 10.1113/jp282560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 04/10/2024] [Indexed: 05/02/2024] Open
Abstract
After exposure of the human body to resistive exercise, the force-generation capacity of the trained muscles increases significantly. Despite decades of research, the neural and muscular stimuli that initiate these changes in muscle force are not yet fully understood. The study of these adaptations is further complicated by the fact that the changes may be partly specific to the training task. For example, short-term strength training does not always influence the neural drive to muscles during the early phase (<100 ms) of force development in rapid isometric contractions. Here we discuss some of the studies that have investigated neuromuscular adaptations underlying changes in maximal force and rate of force development produced by different strength training interventions, with a focus on changes observed at the level of spinal motor neurons. We discuss the different motor unit adjustments needed to increase force or speed, and the specificity of some of the adaptations elicited by differences in the training tasks.
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Affiliation(s)
- Alessandro Del Vecchio
- Department Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Roger Maro Enoka
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA
| | - Dario Farina
- Department of Bioengineering, Imperial College London, London, UK
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Choy J, Pourkazemi F, Bogaardt H, Anderson C, Chai SY, Pebdani RN. "One of the biggest grey areas": A focus group study exploring dosage of swallowing exercises from speech-language pathologist perspectives. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 26:445-456. [PMID: 37652163 DOI: 10.1080/17549507.2023.2240038] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Purpose: To explore the perspectives and practices of speech-language pathologists on dosage of swallowing exercises in stroke rehabilitation.Method: Online focus groups involved 20 speech-language pathologists working in various settings across Australia. Focus group data were recorded, deidentified, and analysed using inductive thematic analysis guided by an interpretivist phenomenological approach.Result: Analysis resulted in four main themes: (1) "Getting the most bang for your buck": Importance of dosage in swallowing, (2) "No patient is identical": Personalising swallowing exercise dosage to the patient, (3) "You've got what you should do, and then what you can do": Gap between recommendations and practical application, and (4) "Not much guidance out there about dosage": More research needed to guide dosage. Speech-language pathologists agreed that dosage was theoretically important for swallowing exercises, but practical application of dosage was impacted by patient factors, limited access to resources, and lack of research-based guidelines.Conclusion: Speech-language pathologists reported trying to provide optimal care despite multiple barriers to prescribing dosages of swallowing exercises in practice. Personalising exercise dosage to the patient, creative clinician strategies, improved and equitable access to resources, and research-based guidelines on swallowing exercise dosages are needed to address these barriers.
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Affiliation(s)
- Jacinda Choy
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, Australia
- HammondCare Braeside Hospital, Prairiewood, NSW, Australia
- Royal Rehab, Ryde, NSW, Australia
| | - Fereshteh Pourkazemi
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Hans Bogaardt
- School of Allied Health Science and Practice, University of Adelaide, Adelaide, SA, Australia
| | - Caitlin Anderson
- HammondCare Braeside Hospital, Prairiewood, NSW, Australia
- Nepean Hospital, Kingswood, NSW, Australia
| | - Shing Yee Chai
- HammondCare Braeside Hospital, Prairiewood, NSW, Australia
| | - Roxanna N Pebdani
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, Centre for Disability Research and Policy, The University of Sydney, Sydney, NSW, Australia
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Chen S, Zhang W, Wang D, Chen Z. How robot-assisted gait training affects gait ability, balance and kinematic parameters after stroke: a systematic review and meta-analysis. Eur J Phys Rehabil Med 2024; 60:400-411. [PMID: 38647534 PMCID: PMC11261306 DOI: 10.23736/s1973-9087.24.08354-0] [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: 11/27/2023] [Revised: 02/28/2024] [Accepted: 04/09/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Gait ability is often cited by stroke survivors. Robot-assisted gait training (RAGT) can help stroke patients with lower limb motor impairment regain motor coordination. EVIDENCE ACQUISITION PubMed, Cochrane Library, Embase were systematically searched until September 2023, to identify randomized controlled trials presenting: stroke survivors as participants; RAGT as intervention; conventional rehabilitation as a comparator; gait assessment, through scales or quantitative parameters, as outcome measures. EVIDENCE SYNTHESIS Twenty-seven publications involving 1167 patients met the inclusion criteria. Meta-analysis showed no significant differences in speed, cadence, spatial symmetry, and changes in joint mobility angles between the RAGT group and the control group. In addition, RAGT was associated with changes in affected side step length (SMD=0.02, 95% CI: 0.01, 0.03; P<0.0001), temporal symmetry (SMD=-0.38, 95% CI: -0.6, -0.16; P=0.0006], Six-Minute Walk Test (SMD=25.14, 95% CI: 10.19, 40.09; P=0.0010] and Functional Ambulation Categories (SMD=0.32, 95% CI: 0.01, 0.63; P=0.04). According to the PEDro scale, 19 (70.4%) studies were of high quality and eight were of moderate quality (29.6%). CONCLUSIONS Taken together, the review synthesis showed that RAGT might have a potential role in the recovery of walking dysfunction after stroke. However, its superiority over conventional rehabilitation requires further research. Additionally, it may provide unexpected benefits that the effects of RAGT with different types or treatment protocols were further compared.
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Affiliation(s)
- Shishi Chen
- The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- Department of Rehabilitation, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Wanying Zhang
- The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- Department of Rehabilitation, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Dingyu Wang
- The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Zhaoming Chen
- Center for Rehabilitation Medicine, Rehabilitation and Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China -
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Gomes E, Alder G, Bright FAS, Signal N. Understanding task "challenge" in stroke rehabilitation: an interdisciplinary concept analysis. Disabil Rehabil 2024:1-11. [PMID: 38821140 DOI: 10.1080/09638288.2024.2356010] [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: 10/26/2023] [Accepted: 05/10/2024] [Indexed: 06/02/2024]
Abstract
PURPOSE Rehabilitation plays a critical role in minimising disability after stroke, with the concept of "challenge" proposed to be essential to rehabilitation efficacy and outcomes. This review unpacks how challenge is conceptualised in stroke rehabilitation literature from the perspectives of physiotherapy, occupational therapy, speech-language therapy and people with stroke. A secondary purpose was to provide a definition of challenge that is applicable to stroke rehabilitation. METHODS Principle-based concept analysis was utilised to examine challenge within the stroke rehabilitation literature. Forty-two papers were included. Data analysis involved immersion, analytical questioning, coding and synthesis to elicit the conceptual components of challenge. RESULTS Challenge was understood as a multidimensional and dynamic concept with three facets: nominal, functional and perceived challenge. Functional and perceived challenge were integral to optimal challenge. Optimal challenge was central to enhancing the outcomes and experiences of people with stroke, in rehabilitation and everyday life. CONCLUSIONS Challenge is a key concept which, when carefully optimised to the person's ability and experience, may positively influence their learning, recovery and engagement after stroke. This review lays a conceptual foundation for better understanding, operationalisation and advancement of challenge, offering important implications for addressing the growing burden of stroke disability, through rehabilitation.
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Affiliation(s)
- Emeline Gomes
- Rehabilitation Innovation Centre, Auckland University of Technology, Auckland, New Zealand
| | - Gemma Alder
- Rehabilitation Innovation Centre, Auckland University of Technology, Auckland, New Zealand
| | - Felicity A S Bright
- Centre for Person Centred Research, Auckland University of Technology, Auckland, New Zealand
| | - Nada Signal
- Rehabilitation Innovation Centre, Auckland University of Technology, Auckland, New Zealand
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Towersey NCM, Sasse K, Stavric V, Alder G, Saywell NL. Freely available, online videos to support neurological physiotherapists and students in task-specific training skill acquisition: a scoping review. BMC MEDICAL EDUCATION 2024; 24:603. [PMID: 38822287 PMCID: PMC11143672 DOI: 10.1186/s12909-024-05545-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 05/09/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND Videos to support learning of clinical skills are effective; however, little is known about the scope and educational quality of the content of freely available online videos demonstrating task-specific training (TST). This review aimed to determine the extent, characteristics of freely available online videos, and whether the content is suitable to guide skill acquisition of task-specific training for neurological physiotherapists and students. METHODS A scoping review was conducted. Google video and YouTube were searched in December 2022. Videos that met our eligibility criteria and were explicitly designed for (TST) skill acquisition were included in the report. RESULTS Ten videos met the inclusion criteria and were difficult to find amongst the range of videos available. Most were presented by physiotherapists or occupational therapists, originated from the USA, featured stroke as the condition of the person being treated, and involved a range of interventions (upper limb, constraint induced movement therapy, balance, bicycling). Most videos were created by universities or private practices and only two used people with a neurological condition as the participant. When the content of videos and their presentation (instruction and/or demonstration), was assessed against each key component of TST (practice structure, specificity, repetition, modification, progression, feedback), five of the videos were rated very suitable and five moderately suitable to guide skill acquisition. Most videos failed to demonstrate and provide instruction on each key component of TST and were missing at least one component, with feedback most frequently omitted. CONCLUSIONS There are many freely available online videos which could be described as demonstrating TST; very few are suitable to guide skill acquisition. The development of a standardised and validated assessment tool, that is easy to use and assesses the content of TST videos is required to support learners to critically evaluate the educational quality of video content. Guidelines based on sound teaching theory and practice are required to assist creators of online videos to provide suitable resources that meet the learning needs of neurological physiotherapists and students.
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Affiliation(s)
- Nicola C M Towersey
- School of Clinical Sciences, Department of Physiotherapy, Health and Rehabilitation Research Institute, Auckland University of Technology, Northshore Campus, Private Bag 92006, Auckland, 1142, New Zealand.
| | - Kelvin Sasse
- School of Clinical Sciences, Department of Physiotherapy, Health and Rehabilitation Research Institute, Auckland University of Technology, Northshore Campus, Private Bag 92006, Auckland, 1142, New Zealand
| | - Verna Stavric
- School of Clinical Sciences, Department of Physiotherapy, Health and Rehabilitation Research Institute, Auckland University of Technology, Northshore Campus, Private Bag 92006, Auckland, 1142, New Zealand
| | - Gemma Alder
- School of Clinical Sciences, Department of Physiotherapy, Health and Rehabilitation Research Institute, Auckland University of Technology, Northshore Campus, Private Bag 92006, Auckland, 1142, New Zealand
| | - Nicola L Saywell
- School of Clinical Sciences, Department of Physiotherapy, Health and Rehabilitation Research Institute, Auckland University of Technology, Northshore Campus, Private Bag 92006, Auckland, 1142, New Zealand
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Urbina J, Abarca VE, Elias DA. Integration of music-based game approaches with wearable devices for hand neurorehabilitation: a narrative review. J Neuroeng Rehabil 2024; 21:89. [PMID: 38811987 PMCID: PMC11134927 DOI: 10.1186/s12984-024-01379-w] [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: 01/19/2024] [Accepted: 05/10/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Restoring hand functionality is critical for fostering independence in individuals with neurological disorders. Various therapeutic approaches have emerged to address motor function restoration, with music-based therapies demonstrating notable advantages in enhancing neuroplasticity, an integral component of neurorehabilitation. Despite the positive effects observed, there remains a gap in the literature regarding implementing music treatments in neurorehabilitation, such as Neurologic Music Therapy (NMT), especially in conjunction with emerging fields like wearable devices and game-based therapies. METHODS A literature search was conducted in various databases, including PubMed, Scopus, IEEE Xplore, and ACM Digital Library. The search was performed using a literature search methodology based on keywords. Information collected from the studies pertained to the approach used in music therapy, the design of the video games, and the types of wearable devices utilized. RESULTS A total of 158 articles were found, including 39 from PubMed, 34 from IEEE Xplore, 48 from Scopus, 37 from ACM Digital Library, and 35 from other sources. Duplicate entries, of which there were 41, were eliminated. In the first screening phase, 152 papers were screened for title and abstract. Subsequently, 89 articles were removed if they contained at least one exclusion criterion. Sixteen studies were considered after 63 papers had their full texts verified. CONCLUSIONS The convergence of NMT with emerging fields, such as gamification and wearable devices designed for hand functionality, not only expands therapeutic horizons but also lays the groundwork for innovative, personalized approaches to neurorehabilitation. However, challenges persist in effectively incorporating NMT into rehabilitation programs, potentially hindering its effectiveness.
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Affiliation(s)
- Javier Urbina
- Biomechanics and Applied Robotics Research Laboratory, Pontificia Universidad Católica del Perú, 15008, Lima, Peru
| | - Victoria E Abarca
- Biomechanics and Applied Robotics Research Laboratory, Pontificia Universidad Católica del Perú, 15008, Lima, Peru.
| | - Dante A Elias
- Biomechanics and Applied Robotics Research Laboratory, Pontificia Universidad Católica del Perú, 15008, Lima, Peru
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Sabadell V, Trébuchon A, Alario FX. An exploration of anomia rehabilitation in drug-resistant temporal lobe epilepsy. Epilepsy Behav Rep 2024; 27:100681. [PMID: 38881885 PMCID: PMC11178986 DOI: 10.1016/j.ebr.2024.100681] [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: 02/28/2024] [Revised: 05/15/2024] [Accepted: 05/27/2024] [Indexed: 06/18/2024] Open
Abstract
Around 40% of patients who undergo a left temporal lobe epilepsy (LTLE) surgery suffer from anomia (word-finding difficulties), a condition that negatively impacts quality of life. Despite these observations, language rehabilitation is still understudied in LTLE. We assessed the effect of a four-week rehabilitation on four drug-resistant LTLE patients after their surgery. The anomia rehabilitation was based on cognitive descriptions of word finding deficits in LTLE. Its primary ingredients were psycholinguistic tasks and a psychoeducation approach to help patients cope with daily communication issues. We repeatedly assessed naming skills for trained and untrained words, before and during the therapy using an A-B design with follow-up and replication. Subjective anomia complaint and standardized language assessments were also collected. We demonstrated the effectiveness of the rehabilitation program for trained words despite the persistence of seizures. Furthermore, encouraging results were observed for untrained items. Variable changes in anomia complaint were observed. One patient who conducted the protocol as self-rehabilitation responded similarly to the others, despite the different manner of intervention. These results open promising avenues for helping epileptic patients suffering from anomia. For example, this post-operative program could easily be adapted to be conducted preoperatively.
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Affiliation(s)
| | - Agnès Trébuchon
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
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Adhikari SP, Stranges TN, Tehrani SNZ, Porter S, Mason K, van Donkelaar P. Investigating the Efficacy of a Community Support Network Rehabilitation Intervention for Improving Resiliency, Quality of Life, and Neurocognitive Function in Survivors of Intimate Partner Violence-Caused Brain Injury: Protocol for a Feasibility Study. JMIR Res Protoc 2024; 13:e54605. [PMID: 38788207 PMCID: PMC11177797 DOI: 10.2196/54605] [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: 11/15/2023] [Revised: 02/27/2024] [Accepted: 02/29/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Globally, approximately 1 in 3 women experience intimate partner violence (IPV) in their lifetime. Brain injury (BI) is a common, yet often unrecognized, consequence of IPV. BIs caused by IPV tend to be mild, occur repetitively over the course of months or years, are remote in time, and result in chronic symptoms. Similar to BI from other causes, therapeutic treatment for women with IPV-caused BI (IPV-BI) is crucial to help resolve any physical or cognitive impairments, enhance the quality of life (QoL), and minimize longer-term neurodegeneration. OBJECTIVE This study aims to investigate the feasibility and efficacy of a community support network (CSN) rehabilitation intervention regarding its impact on resiliency, QoL, and neurocognitive function. METHODS In this pre- and postexperimental design, women (aged 18 to 50 years) who are survivors of IPV and IPV-BI will be recruited from various community organizations serving survivors of IPV. Exclusion criteria will include current pregnancy and any diagnosed neurological disorder known to affect cerebrovascular, neurocognitive, or sensorimotor function. A CSN rehabilitation intervention that includes aerobic exercise, cognitive training, mindfulness meditation, and counseling will be administered. A trauma-informed approach will be integrated into the design and implementation of the program. Furthermore, the program will include a participant navigator who will provide trauma- and violence-informed advocacy and systems navigation support to participants, in addition to facilitating a monthly peer support group. The intervention will be provided for 2.5 hours a day and 2 days a week for 3 months. Participants will complete psychological assessments and provide clinic-demographic information in the first assessment. In the second (before intervention), third (after intervention), and fourth (at follow-up) sessions, they will complete tests of resiliency, QoL, and neurocognition. The estimated sample size is 100. The objective of this study will be accomplished by quantitatively measuring resiliency, QoL, and neurocognition before and immediately after the intervention. A follow-up assessment will occur 3 months after the completion of the intervention to evaluate the maintenance of any improvements in function. One-way ANOVAs will be used to evaluate the intervention outcome across the testing times. Relationships among various variables will be explored using regression analysis. RESULTS We anticipate that the CSN rehabilitation intervention will be effective in improving resiliency, QoL, and neurocognitive function in women who have experienced IPV-BI. Furthermore, we anticipate that this intervention will be feasible in terms of study recruitment, adherence, and retention. CONCLUSIONS The CSN rehabilitation intervention will have a positive impact on resiliency, QoL, and neurocognitive functions in survivors of IPV-BI. Subsequently, a comparative study will be conducted by recruiting a control group receiving usual care. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/54605.
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Affiliation(s)
| | - Tori N Stranges
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
| | | | | | - Karen Mason
- Supporting Survivors of Abuse and Brain Injury Through Research (SOAR), Kelowna, BC, Canada
| | - Paul van Donkelaar
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
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Hao J, Yao Y, Remis A, Zhu D, Sun Y, Wu S. Effects of spinal mobilization on physical function in patients with stroke: a systematic review and meta-analysis. Neurol Sci 2024:10.1007/s10072-024-07603-8. [PMID: 38780853 DOI: 10.1007/s10072-024-07603-8] [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: 04/16/2024] [Accepted: 05/15/2024] [Indexed: 05/25/2024]
Abstract
This systematic review and meta-analysis aimed to identify, critically appraise, and synthesize current evidence regarding the effects of spinal mobilization on physical function in patients with stroke. Three databases, PubMed, Embase, and Scopus, were searched from inception to March 15, 2024. Randomized controlled trials comparing the effects of spinal mobilization to conventional therapy were eligible for inclusion. Methodological quality was assessed using the Physiotherapy Evidence Database scale. Meta-analyses were performed to determine the effects of spinal mobilization. Nine randomized controlled trials were included, with a total of 294 patients with stroke. All included studies were evaluated as good or above for quality assessment. No adverse events related to spinal mobilization were reported. Compared to conventional therapy, spinal mobilization demonstrated significantly improved forward head posture (SMD: 1.00, 95% CI: 0.53 to 1.46, p < 0.001); there were no between-group differences on forced vital capacity (SMD: 0.44, 95% CI: -0.01 to 0.88, p = 0.06), forced expiratory volume (SMD: 0.33, 95% CI: -0.12 to 0.77, p = 0.15), balance (SMD: 0.36, 95% CI: -0.04 to 0.77, p = 0.08), gait speed (SMD: 0.48, 95% CI: -0.44 to 1.40, p = 0.31), and trunk function (SMD: 0.79, 95% CI: -0.17 to 1.75, p = 0.11). Cervical mobilization significantly improved forward head posture; however, no significant differences were found in other outcomes. Clinicians may consider spinal mobilization as an adjunctive intervention in stroke rehabilitation to address posture-related impairments to expand treatment strategy and optimize quality of care.
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Affiliation(s)
- Jie Hao
- Department of Physical Therapy and Rehabilitation, Southeast Colorado Hospital, 81073, Springfield, CO, USA.
- Department of Health & Rehabilitation Sciences, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA.
| | - Yao Yao
- Department of Health & Rehabilitation Sciences, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA
| | - Andréas Remis
- Health Research Association of Keck Medicine, University of Southern California, Los Angeles, CA, 90033, USA
| | - Dongqi Zhu
- Department of Rehabilitation Medicine, Shanghai Sixth People's Hospital, Shanghai, P.R. China
| | - Yuxiao Sun
- Department of Rehabilitation Medicine, West China Hospital, Chengdu, Sichuan, P.R. China
| | - Siyao Wu
- Department of Rehabilitation Medicine, Beijing Hospital, Institution of Geriatric Medicine, National Center of Gerontology, Chinese Academy of Medical Science, Beijing, P.R. China
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Malik MA, Weber AM, Lang D, Vanderwal T, Zwicker JG. Changes in cortical grey matter volume with Cognitive Orientation to daily Occupational Performance intervention in children with developmental coordination disorder. Front Hum Neurosci 2024; 18:1316117. [PMID: 38841123 PMCID: PMC11150831 DOI: 10.3389/fnhum.2024.1316117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 05/03/2024] [Indexed: 06/07/2024] Open
Abstract
Introduction Cognitive Orientation to daily Occupational Performance (CO-OP) is a cognitive-based, task-specific intervention recommended for children with developmental coordination disorder (DCD). We recently showed structural and functional brain changes after CO-OP, including increased cerebellar grey matter. This study aimed to determine whether CO-OP intervention induced changes in cortical grey matter volume in children with DCD, and if these changes were associated with improvements in motor performance and movement quality. Methods This study is part of a randomized waitlist-control trial (ClinicalTrials.gov ID: NCT02597751). Children with DCD (N = 78) were randomized to either a treatment or waitlist group and underwent three MRIs over 6 months. The treatment group received intervention (once weekly for 10 weeks) between the first and second scan; the waitlist group received intervention between the second and third scan. Cortical grey matter volume was measured using voxel-based morphometry (VBM). Behavioral outcome measures included the Performance Quality Rating Scale (PQRS) and Bruininks-Oseretsky Test of Motor Proficiency-2 (BOT-2). Of the 78 children, 58 were excluded (mostly due to insufficient data quality), leaving a final N = 20 for analyses. Due to the small sample size, we combined both groups to examine treatment effects. Cortical grey matter volume differences were assessed using a repeated measures ANOVA, controlling for total intracranial volume. Regression analyses examined the relationship of grey matter volume changes to BOT-2 (motor performance) and PQRS (movement quality). Results After CO-OP, children had significantly decreased grey matter in the right superior frontal gyrus and middle/posterior cingulate gyri. We found no significant associations of grey matter volume changes with PQRS or BOT-2 scores. Conclusion Decreased cortical grey matter volume generally reflects greater brain maturity. Decreases in grey matter volume after CO-OP intervention were in regions associated with self-regulation and motor control, consistent with our other studies. Decreased grey matter volume may be due to focal increases in synaptic pruning, perhaps as a result of strengthening networks in the brain via the repeated learning and actions in therapy. Findings from this study add to the growing body of literature demonstrating positive neuroplastic changes in the brain after CO-OP intervention.
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Affiliation(s)
- Myrah Anum Malik
- Graduate Programs in Rehabilitation Science, University of British Columbia, Vancouver, BC, Canada
| | - Alexander Mark Weber
- Brain, Behaviour, and Development Theme, BC Children’s Hospital Research Institute, Vancouver, BC, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Donna Lang
- Brain, Behaviour, and Development Theme, BC Children’s Hospital Research Institute, Vancouver, BC, Canada
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Tamara Vanderwal
- Brain, Behaviour, and Development Theme, BC Children’s Hospital Research Institute, Vancouver, BC, Canada
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Jill G. Zwicker
- Brain, Behaviour, and Development Theme, BC Children’s Hospital Research Institute, Vancouver, BC, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
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Lee S, Faroqi-Shah Y. A Meta-Analysis of Anomia Treatment in Bilingual Aphasia: Within- and Cross-Language Generalization and Predictors of the Treatment Outcomes. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:1558-1600. [PMID: 38629966 PMCID: PMC11087086 DOI: 10.1044/2024_jslhr-23-00026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 09/15/2023] [Accepted: 01/14/2024] [Indexed: 05/09/2024]
Abstract
PURPOSE The present meta-analysis investigated the efficacy of anomia treatment in bilingual and multilingual persons with aphasia (BPWAs) by assessing the magnitudes of six anomia treatment outcomes. Three of the treatment outcomes pertained to the "trained language": improvement of trained words (treatment effect [TE]), within-language generalization of semantically related untrained words (WLG-Related), and within-language generalization of unrelated words (WLG-Unrelated). Three treatment outcomes were for the "untrained language": improvement of translations of the trained words (cross-language generalization of trained words [CLG-Tx]), cross-language generalization of semantically related untrained words (CLG-Related), and cross-language generalization of unrelated untrained words (CLG-Unrelated). This study also examined participant- and treatment-related predictors of these treatment outcomes. METHOD This study is registered in the International Prospective Register of Systematic Reviews (PROSPERO) under the number CRD42023418147. Nine electronic databases were searched to identify word retrieval treatment studies of poststroke BPWAs of at least 6 months postonset. Pre- and posttreatment single-word naming scores were extracted for each eligible participant and used to calculate effect sizes (within-case Cohen's d) of the six treatment outcomes. Random-effects meta-analyses were conducted to assess weighted mean effect sizes of the treatment outcomes across studies. Multiple linear regression analyses were used to examine the effects of participant-related variables (pretreatment single-word naming and comprehension representing poststroke lexical processing abilities) and treatment-related variables (type, language, and duration). The methodological quality of eligible studies and the risk of bias in this meta-analysis were assessed. RESULTS A total of 17 published studies with 39 BPWAs were included in the meta-analysis. The methodological quality of the included studies ranged from fair (n = 4) to good (n = 13). Anomia treatment produced a medium effect size for TE (M = 8.36) and marginally small effect sizes for WLG-Related (M = 1.63), WLG-Unrelated (M = 0.68), and CLG-Tx (M = 1.56). Effect sizes were nonsignificant for CLG-Related and CLG-Unrelated. TE was significantly larger than the other five types of treatment outcomes. TE and WLG-Related effect sizes were larger for BPWAs with milder comprehension or naming impairments and for treatments of longer duration. WLG-Unrelated was larger when BPWAs received phonological treatment than semantic and mixed treatments. The overall risk of bias in the meta-analysis was low with a potential risk of bias present in the study identification process. CONCLUSIONS Current anomia treatment practices for bilingual speakers are efficacious in improving trained items but produce marginally small within-language generalization and cross-language generalization to translations of the trained items. These results highlight the need to provide treatment in each language of BPWAs and/or investigate other approaches to promote cross-language generalization. Furthermore, anomia treatment outcomes are influenced by BPWAs' poststroke single-word naming and comprehension abilities as well as treatment duration and the provision of phonological treatment. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.25595712.
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Affiliation(s)
- Seongsil Lee
- Department of Hearing and Speech Sciences, University of Maryland, College Park
| | - Yasmeen Faroqi-Shah
- Department of Hearing and Speech Sciences, University of Maryland, College Park
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