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Johnson KH, Gardener H, Gutierrez C, Marulanda E, Campo-Bustillo I, Gordon Perue G, Brown SC, Ying H, Zhou L, Bishop L, Veledar E, Fakoori F, Asdaghi N, Romano JG, Rundek T. The effect of 30-day adequate transitions of acute stroke care on 90-day readmission or death. J Stroke Cerebrovasc Dis 2024; 33:107842. [PMID: 38955245 PMCID: PMC11347106 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107842] [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: 01/24/2024] [Revised: 06/20/2024] [Accepted: 06/27/2024] [Indexed: 07/04/2024] Open
Abstract
OBJECTIVES We explore patient-reported behaviors and activities within 30-days post-stroke hospitalization and their role in reducing death or readmissions within 90-days post-stroke. METHODS We constructed the adequate transitions of care (ATOC) composite score, measuring patient-reported participation in eligible behaviors and activities (diet modification, weekly exercise, follow-up medical appointment attendance, medication adherence, therapy use, and toxic habit cessation) within 30 days post-stroke hospital discharge. We analyzed ATOC scores in ischemic and intracerebral hemorrhage stroke patients discharged from the hospital to home or rehabilitation facilities and enrolled in the NIH-funded Transitions of Care Stroke Disparities Study (TCSD-S). We utilized Cox regression analysis, with the progressive adjustment for sociodemographic variables, social determinants of health, and stroke risk factors, to determine the associations between ATOC score within 30-days and death or readmission within 90-days post-stroke. RESULTS In our sample of 1239 stroke patients (mean age 64 +/- 14, 58 % male, 22 % Hispanic, 22 % Black, 52 % White, 76 % discharged home), 13 % experienced a readmission or death within 90 days (3 deaths, 160 readmissions, 3 readmissions with subsequent death). Seventy percent of participants accomplished a ≥75 % ATOC score. A 25 % increase in ATOC was associated with a respective 20 % (95 % CI 3-33 %) reduced risk of death or readmission within 90-days. CONCLUSION ATOC represents modifiable behaviors and activities within 30-days post-stroke that are associated with reduced risk of death or readmission within 90-days post-stroke. The ATOC score should be validated in other populations, but it can serve as a tool for improving transitions of stroke care initiatives and interventions.
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Affiliation(s)
- Karlon H Johnson
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 919, Miami, FL 33136, USA.
| | - Hannah Gardener
- Department of Neurology, University of Miami Miller School of Medicine, 1150 NW 14th St. #609 Miami, FL 33136, USA
| | - Carolina Gutierrez
- Department of Neurology, University of Miami Miller School of Medicine, 1150 NW 14th St. #609 Miami, FL 33136, USA
| | - Erika Marulanda
- Department of Neurology, University of Miami Miller School of Medicine, 1150 NW 14th St. #609 Miami, FL 33136, USA
| | - Iszet Campo-Bustillo
- Department of Neurology, University of Miami Miller School of Medicine, 1150 NW 14th St. #609 Miami, FL 33136, USA
| | - Gillian Gordon Perue
- Department of Neurology, University of Miami Miller School of Medicine, 1150 NW 14th St. #609 Miami, FL 33136, USA
| | - Scott C Brown
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 919, Miami, FL 33136, USA
| | - Hao Ying
- Department of Neurology, University of Miami Miller School of Medicine, 1150 NW 14th St. #609 Miami, FL 33136, USA
| | - Lili Zhou
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 919, Miami, FL 33136, USA
| | - Lauri Bishop
- Department of Neurology, University of Miami Miller School of Medicine, 1150 NW 14th St. #609 Miami, FL 33136, USA
| | - Emir Veledar
- Department of Neurology, University of Miami Miller School of Medicine, 1150 NW 14th St. #609 Miami, FL 33136, USA
| | - Farya Fakoori
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 919, Miami, FL 33136, USA
| | - Negar Asdaghi
- Department of Neurology, University of Miami Miller School of Medicine, 1150 NW 14th St. #609 Miami, FL 33136, USA
| | - Jose G Romano
- Department of Neurology, University of Miami Miller School of Medicine, 1150 NW 14th St. #609 Miami, FL 33136, USA
| | - Tatjana Rundek
- Department of Neurology, University of Miami Miller School of Medicine, 1150 NW 14th St. #609 Miami, FL 33136, USA
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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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3
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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, unsupervised home rehabilitation program for people with upper extremity hemiparesis due to stroke. A randomized controlled trial. RESEARCH SQUARE 2024:rs.3.rs-4438077. [PMID: 38883760 PMCID: PMC11177982 DOI: 10.21203/rs.3.rs-4438077/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Background This parallel, randomized controlled trial examines intrinsic motivation, adherence and motor function improvement demonstrated by two groups of subjects that performed a twelve-week, home-based upper extremity rehabilitation program. Seventeen subjects played 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 to 80 years of age, at least six 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 system. Subjects had the Home Virtual Rehabilitation System [1]systems 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 twelve 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. Classification and Regression Tree (CART) models were generated to predict responders using demographics and baseline measures. 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 between groups. 21 subjects from both groups, demonstrated clinically important improvements in UEFMA score of at least 4.25 points. Subjects with pre training UEFMA scores below 53.5 averaged a seven-point UEFMA increase. IMI scores were stable pre to post training. Conclusions Scaffolding did not have a meaningful impact on adherence or motor function improvement. A sparsely supervised program of game-based treatment in the home was sufficient to elicit meaningful improvements in motor function and activities of daily living. Common factors considered barriers to the utilization of telerehabilitation did not impact adherence or motor outcome. Trial registration Clinical Trials.gov - NCT03985761, Registered June 14, 2019.
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Affiliation(s)
| | - Qinyin Qiu
- Rutgers, The State University of New Jersey
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Assayag N, Bar-Shalita T, Rand D. The Functional-Cognitive and Sensory Treatment (F-CaST) to improve rehabilitation outcomes of individuals with substance use disorder: a study protocol for a mixed-method randomized controlled trial. Addict Sci Clin Pract 2024; 19:28. [PMID: 38594737 PMCID: PMC11003090 DOI: 10.1186/s13722-024-00449-7] [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: 08/17/2023] [Accepted: 03/07/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Substance use disorder (SUD) is associated with executive function (EF) deficits and sensory modulation dysfunction (SMD). Yet, these deficits are not addressed therapeutically. This study aims to examine the effectiveness of the Functional-Cognitive and Sensory Treatment (F-CaST) compared to standard care to improve everyday performance and behavior and length of stay at the therapeutic community (TC) in individuals with SUD. In addition, to assess the improvement in EF, sensory modulation, participation, self-efficacy, life satisfaction, and use of strategies within and between groups. Satisfaction with F-CaST will also be assessed. METHODS Forty-eight participants from a community of men in a TC, aged 18-45 years will be randomly allocated to (i) F-CaST-(experimental group) providing sensory and EF strategies for improving daily function; (ii) standard care (control group) as provided in the TC. Assessments will be conducted by assessors blind to group allocation at 4 time points: T1- pre-intervention; T2- post-intervention; T3- 1-month follow-up; and T4- 3-month follow-up. Primary outcome measures will be everyday performance, assessed by the Canadian Occupational Performance Measure (COPM), behavior and length of stay in the TC; secondary outcome measures will assess EF, SMD. Semi-structured in-depth qualitative interviews will be conducted at T1, T2 and T4. DISCUSSION We hypothesize that F-CaST will lead to improved everyday performance and longer length of stay in the TC, compared to the control group. If F-CaST will prove to be effective, cognitive and sensory strategies may be incorporated as an adjunctive intervention in SUD rehabilitation. TRIAL REGISTRATION ClinicalTrials.gov NCT05647863 Registered on 13 December 2022, https://classic. CLINICALTRIALS gov/ct2/show/NCT05647863 .
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Affiliation(s)
- Naama Assayag
- Department of Occupational Therapy, School of Health Professions, Faculty of Medical and Health Sciences, Tel Aviv University, 6997801, Tel Aviv, Israel
| | - Tami Bar-Shalita
- Department of Occupational Therapy, School of Health Professions, Faculty of Medical and Health Sciences, Tel Aviv University, 6997801, Tel Aviv, Israel.
| | - Debbie Rand
- Department of Occupational Therapy, School of Health Professions, Faculty of Medical and Health Sciences, Tel Aviv University, 6997801, Tel Aviv, Israel
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Yang CL, Connell LA, Eng JJ. Evaluating the Dissemination and Implementation Impact of a Rehabilitation Intervention: The Graded Repetitive Arm Supplementary Program (GRASP). Physiother Can 2023; 75:105-117. [PMID: 37736384 PMCID: PMC10510554 DOI: 10.3138/ptc-2022-0117] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/17/2023] [Accepted: 01/23/2023] [Indexed: 09/23/2023]
Abstract
Purpose To evaluate the dissemination and implementation impacts of a rehabilitation intervention. Methods Systematic evaluation of data sources including academic publishing metrics, publications, and surveys was used to describe the dissemination and implementation impact of the graded repetitive arm supplementary program (GRASP). Three categories in the Payback Framework were evaluated: knowledge production and dissemination, benefits to future research and research use, and real-world uptake and implementation. Results In the Knowledge production and dissemination category, seven publications, authored by the GRASP research team, were associated with the GRASP, and there were approximately 17,000 download counts of GRASP manuals from the website from 120 countries. In the Benefits to future research and research use category, 15 studies and 8 registered clinical trials, authored by researchers outside of the GRASP team, have used GRASP as an intervention. In the real-world uptake and implementation category, GRASP has informed recommendations in 2 clinical guidelines and 20 review papers, and had high implementation uptake (e.g., 35% [53/154] of UK therapists surveyed had used GRASP; 95% [649/681] who downloaded GRASP had used it). More than 75% of those who had used GRASP identified that GRASP provides more intensity in upper extremity rehabilitation, is evidence-based and easy to implement, and the equipment and manual are easy to obtain. Conclusion The Payback Framework is useful to evaluate the dissemination and implementation impacts of a rehabilitation intervention. GRASP has been implemented extensively in clinical practice and community in a relatively short time since it has been developed.
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Affiliation(s)
- Chieh-ling Yang
- From the:
Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Louise A. Connell
- School of Sport & Health Sciences, University of Central Lancashire, Preston, United Kingdom
- East Lancashire Hospitals NHS Trust, Burnley, United Kingdom
| | - Janice J. Eng
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver, British Columbia, Canada
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Westlake K, Akinlosotu R, Udo J, Goldstein Shipper A, Waller SM, Whitall J. Some home-based self-managed rehabilitation interventions can improve arm activity after stroke: A systematic review and narrative synthesis. Front Neurol 2023; 14:1035256. [PMID: 36816549 PMCID: PMC9932529 DOI: 10.3389/fneur.2023.1035256] [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: 09/02/2022] [Accepted: 01/06/2023] [Indexed: 02/05/2023] Open
Abstract
Background There is an increased need for home-based, self-managed, and low maintenance stroke rehabilitation as well as interest in targeting the arm, which often lags behind leg recovery. Previous reviews have not controlled for concurrent standard of care and the ratio of self-managed care to therapist input. Objectives To determine the effectiveness of home-based, self-managed and low maintenance programs for upper-limb motor recovery in individuals after stroke. A secondary objective explored the adherence to home-based self-managed programs. Data sources We searched PubMed (1809-present), Embase (embase.com, 1974-present), Cochrane CENTRAL Register of Controlled Trials (Wiley), CINAHL (EBSCOhost, 1937-present), Physiotherapy Evidence Database (pedro.org.au), OTseeker (otseeker.com), and REHABDATA (National Rehabilitation Information Center). All searches were completed on June 9, 2022. Bibliographic references of included articles also were searched. Eligibility criteria Randomized controlled trials (RCT) in adults after stroke, where both intervention and control were home-based, at least 75% self-managed and did not involve concurrent therapy as a confounding factor. Primary outcome was performance in functional motor activities after training. Secondary outcome was sensorimotor impairment. All outcomes after a retention period were also considered secondary outcomes. Data collection and analysis Two review authors independently screened titles/abstracts, three review authors screened full papers and extracted data, and two review authors undertook assessment of risk of bias (i.e., allocation bias, measurement bias, confounding factors) using the NHLBI Study Quality Assessment Tool. Main results We identified seven heterogenous studies, including five with fair to good quality. All studies had an alternative treatment, dose-equivalent control. Only one trial reported a positive, sustained, between-group effect on activity for the experimental group. The remaining studies reported seven interventions having a within-group training effect with three interventions having sustained effects at follow up. One study reported a between group effect on an impairment measure with no follow-up. Overall adherence rates were high, but three studies reported differential group rates. Compliance with daily logs was higher when the logs were collected on a weekly basis. Limitations By excluding studies that allowed concurrent therapy, we likely minimized the number of studies that included participants in the early sub-acute post-stroke stage. By focusing on RCTs, we are unable to comment on other potentially promising home-based, self-managed single cohort programs. By including only published and English language studies, we may have included publication bias. Conclusions and implications There is some evidence that a variety of home-based, self-managed training program can be beneficial after stroke. Future research could compare such programs with natural history controls. Clinicians might utilize home exercise programs with explicit directions and some form of weekly contact to aid compliance.
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Affiliation(s)
- Kelly Westlake
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, Baltimore, MD, United States
| | - Ruth Akinlosotu
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, Baltimore, MD, United States
| | - Jean Udo
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, Baltimore, MD, United States
| | - Andrea Goldstein Shipper
- Health Sciences and Human Services Library, University of Maryland, Baltimore, MD, United States
| | - Sandy McCombe Waller
- Division of Health, Business, Technology, and Science, Frederick Community College, Frederick, MD, United States
| | - Jill Whitall
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, Baltimore, MD, United States
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Zhu Y, Wang C, Li J, Zeng L, Zhang P. Effect of different modalities of artificial intelligence rehabilitation techniques on patients with upper limb dysfunction after stroke-A network meta-analysis of randomized controlled trials. Front Neurol 2023; 14:1125172. [PMID: 37139055 PMCID: PMC10150552 DOI: 10.3389/fneur.2023.1125172] [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: 12/16/2022] [Accepted: 03/21/2023] [Indexed: 05/05/2023] Open
Abstract
Background This study aimed to observe the effects of six different types of AI rehabilitation techniques (RR, IR, RT, RT + VR, VR and BCI) on upper limb shoulder-elbow and wrist motor function, overall upper limb function (grip, grasp, pinch and gross motor) and daily living ability in subjects with stroke. Direct and indirect comparisons were drawn to conclude which AI rehabilitation techniques were most effective in improving the above functions. Methods From establishment to 5 September 2022, we systematically searched PubMed, EMBASE, the Cochrane Library, Web of Science, CNKI, VIP and Wanfang. Only randomized controlled trials (RCTs) that met the inclusion criteria were included. The risk of bias in studies was evaluated using the Cochrane Collaborative Risk of Bias Assessment Tool. A cumulative ranking analysis by SUCRA was performed to compare the effectiveness of different AI rehabilitation techniques for patients with stroke and upper limb dysfunction. Results We included 101 publications involving 4,702 subjects. According to the results of the SUCRA curves, RT + VR (SUCRA = 84.8%, 74.1%, 99.6%) was most effective in improving FMA-UE-Distal, FMA-UE-Proximal and ARAT function for subjects with upper limb dysfunction and stroke, respectively. IR (SUCRA = 70.5%) ranked highest in improving FMA-UE-Total with upper limb motor function amongst subjects with stroke. The BCI (SUCRA = 73.6%) also had the most significant advantage in improving their MBI daily living ability. Conclusions The network meta-analysis (NMA) results and SUCRA rankings suggest RT + VR appears to have a greater advantage compared with other interventions in improving upper limb motor function amongst subjects with stroke in FMA-UE-Proximal and FMA-UE-Distal and ARAT. Similarly, IR had shown the most significant advantage over other interventions in improving the FMA-UE-Total upper limb motor function score of subjects with stroke. The BCI also had the most significant advantage in improving their MBI daily living ability. Future studies should consider and report on key patient characteristics, such as stroke severity, degree of upper limb impairment, and treatment intensity/frequency and duration. Systematic review registration www.crd.york.ac.uk/prospero/#recordDetail, identifier: CRD42022337776.
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Affiliation(s)
- Yu Zhu
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
- Linfen Central Hospital, Linfen, Shanxi, China
| | - Chen Wang
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Jin Li
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Liqing Zeng
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Peizhen Zhang
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
- *Correspondence: Peizhen Zhang
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Gelineau A, Perrochon A, Robin L, Daviet JC, Mandigout S. Measured and Perceived Effects of Upper Limb Home-Based Exergaming Interventions on Activity after Stroke: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9112. [PMID: 35897472 PMCID: PMC9329711 DOI: 10.3390/ijerph19159112] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 07/20/2022] [Accepted: 07/24/2022] [Indexed: 01/25/2023]
Abstract
After discharge from the hospital to home, stroke patients may experience weakness and reduced movement in their hemiparetic arms that limits their ability to perform daily activities. Therapists can use exercise games (exergames) to maintain functional abilities and daily use of the arm at home. A systematic review and meta-analysis was conducted to determine the efficiency of upper limb home-based rehabilitation, using exergaming on activity abilities in stroke. Randomized controlled trials were reviewed in the CENTRAL, MEDLINE, CINAHL, EMBASE, and SCOPUS online databases. Clinical measures of observation and self-reporting were studied in post-intervention and follow-up. Nine studies were included in this systematic review (535 participants). The Physiotherapy Evidence Database (PEDro) score was 6.6/10 (SD 1.0, range 5-8), indicating good quality. This systematic review and meta-analysis showed that upper limb home-based exergaming interventions were no more effective in terms of activity than conventional therapy after stroke, according to the observational and subjective assessments in post-intervention and follow-up. Using this same approach, future studies should focus on evaluating home-based exergames through subgroup analysis to be able to propose recommendations.
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Affiliation(s)
- Axelle Gelineau
- HAVAE Laboratory UR 20217, University of Limoges, 87000 Limoges, France; (A.P.); (L.R.); (J.-C.D.); (S.M.)
| | - Anaick Perrochon
- HAVAE Laboratory UR 20217, University of Limoges, 87000 Limoges, France; (A.P.); (L.R.); (J.-C.D.); (S.M.)
| | - Louise Robin
- HAVAE Laboratory UR 20217, University of Limoges, 87000 Limoges, France; (A.P.); (L.R.); (J.-C.D.); (S.M.)
| | - Jean-Christophe Daviet
- HAVAE Laboratory UR 20217, University of Limoges, 87000 Limoges, France; (A.P.); (L.R.); (J.-C.D.); (S.M.)
- Department of Physical Medicine and Rehabilitation, University Hospital Center, 87000 Limoges, France
| | - Stéphane Mandigout
- HAVAE Laboratory UR 20217, University of Limoges, 87000 Limoges, France; (A.P.); (L.R.); (J.-C.D.); (S.M.)
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9
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Hernandez A, Bubyr L, Archambault PS, Higgins J, Levin MF, Kairy D. VR-based rehabilitation as a Feasible and Engaging Tool for the Management of Chronic Post-Stroke Upper Extremity Function Recovery: A Randomized Controlled Trial (Preprint). JMIR Serious Games 2022; 10:e37506. [PMID: 36166289 PMCID: PMC9555337 DOI: 10.2196/37506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/27/2022] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alejandro Hernandez
- Centre for Interdisciplinary Research in Rehabilitation, Montreal, QC, Canada
| | | | - Philippe S Archambault
- Centre for Interdisciplinary Research in Rehabilitation, Montreal, QC, Canada
- School of Physical & Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Johanne Higgins
- Centre for Interdisciplinary Research in Rehabilitation, Montreal, QC, Canada
- Ecole de sciences de la réadaptation, Université de Montréal, Montreal, QC, Canada
| | - Mindy F Levin
- Centre for Interdisciplinary Research in Rehabilitation, Montreal, QC, Canada
- School of Physical & Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Dahlia Kairy
- Centre for Interdisciplinary Research in Rehabilitation, Montreal, QC, Canada
- Ecole de sciences de la réadaptation, Université de Montréal, Montreal, QC, Canada
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10
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Jin M, Pei J, Bai Z, Zhang J, He T, Xu X, Zhu F, Yu D, Zhang Z. Effects of virtual reality in improving upper extremity function after stroke: A systematic review and meta-analysis of randomized controlled trials. Clin Rehabil 2021; 36:573-596. [PMID: 34898298 DOI: 10.1177/02692155211066534] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To investigate the effect of virtual reality on arm motor impairment, activity limitation, participation restriction, and quality of life in patients with stroke. To determine potential moderators that affect the efficacy of virtual reality. DATA SOURCES CINAHL, Medline, PubMed, EMBASE, Cochrane Library, Chinese National Knowledge Infrastructure, and Wanfang Data from inception to October 23, 2021. REVIEW METHODS Randomized controlled trials that investigated the effect of virtual reality on arm recovery in adult patients with stroke compared to conventional therapy or sham control were included. Physiotherapy Evidence Database Scale was used to assess the methodological quality of each study. RESULTS Forty studies with 2018 participants were identified. Quality of included studies was fair to high. Virtual reality exhibited better effects on overall arm function (g = 0.28, p < 0.001), motor impairment (g = 0.36, p < 0.001) and activity limitation (daily living) (g = 0.24, p < 0.001) compared with the control group. No significant improvement was observed in participation restriction and activity limitation (specific task). The result for quality of life was described qualitatively. Subgroup analyses demonstrated that immersive virtual reality produced a greater beneficial effect (g = 0.60, p < 0.001). Patients with moderate to severe arm paresis could make more progress after training (g = 0.71, p < 0.001). CONCLUSION Virtual reality is recommended for improving motor impairment and activities of daily living after stroke and is favorable to patients with moderate to severe paresis. An immersive design could produce greater improvement.
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Affiliation(s)
- Minxia Jin
- School of Medicine, Tongji University, Shanghai YangZhi Rehabilitation Hospital (435846Shanghai Sunshine Rehabilitation Center), Shanghai, China
| | - Junjie Pei
- School of Medicine, Tongji University, Shanghai YangZhi Rehabilitation Hospital (435846Shanghai Sunshine Rehabilitation Center), Shanghai, China
| | - Zhongfei Bai
- School of Medicine, Tongji University, Shanghai YangZhi Rehabilitation Hospital (435846Shanghai Sunshine Rehabilitation Center), Shanghai, China.,Department of Rehabilitation Sciences, 26680The Hong Kong Polytechnic University, Hong Kong
| | - Jiaqi Zhang
- Department of Rehabilitation Sciences, 26680The Hong Kong Polytechnic University, Hong Kong
| | - Ting He
- School of Medicine, Tongji University, Shanghai YangZhi Rehabilitation Hospital (435846Shanghai Sunshine Rehabilitation Center), Shanghai, China
| | - Xiaojing Xu
- School of Medicine, Tongji University, Shanghai YangZhi Rehabilitation Hospital (435846Shanghai Sunshine Rehabilitation Center), Shanghai, China
| | - Feifei Zhu
- School of Medicine, Tongji University, Shanghai YangZhi Rehabilitation Hospital (435846Shanghai Sunshine Rehabilitation Center), Shanghai, China
| | - Dan Yu
- School of Medicine, Tongji University, Shanghai YangZhi Rehabilitation Hospital (435846Shanghai Sunshine Rehabilitation Center), Shanghai, China
| | - Ziwei Zhang
- School of Medicine, Tongji University, Shanghai YangZhi Rehabilitation Hospital (435846Shanghai Sunshine Rehabilitation Center), Shanghai, China
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11
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Chan KGF, Jiang Y, Choo WT, Ramachandran HJ, Lin Y, Wang W. Effects of exergaming on functional outcomes in people with chronic stroke: A systematic review and meta-analysis. J Adv Nurs 2021; 78:929-946. [PMID: 34877698 DOI: 10.1111/jan.15125] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/12/2021] [Accepted: 11/25/2021] [Indexed: 11/28/2022]
Abstract
AIMS The aim of this review is to synthesize and evaluate effectiveness of exergaming on balance, lower limb functional mobility and functional independence in individuals with chronic stroke. DESIGN The present review is a systematic review and meta-analysis. The review is written in accordance with the guidelines from the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) DATA SOURCE: Searches were conducted across seven databases (PubMed, EMBASE, Web of Science, CINAHL, CENTRAL, Scopus and PEDro) and in grey literature from inception until January 2021. REVIEW METHODS Only randomized controlled trials (RCTs) written in English were included. All eligible studies were assessed for risk of bias by two reviewers independently. Meta-analyses were performed using RevMan 5.4.1 software. Narrative syntheses were adopted whenever meta-analysis was inappropriate. The overall quality of evidence from included studies was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework. RESULTS 4511 records were retrieved, with 32 RCTs eligible for inclusion and 27 RCTs included in meta-analysis. Meta-analyses reported statistically significant small effect sizes favouring exergaming on balance (pooled standardized mean difference [SMD] = 0.25, 95% confidence interval [CI, 0.08-0.41], p = .004), lower limb functional mobility (pooled SMD = 0.29, 95% CI [0.08-0.50], p = .007) and functional independence (pooled SMD = 0.41, 95% CI [0.09-0.73], p = .01). Most of the included studies failed to provide adequate description of the measures taken to prevent bias. CONCLUSION Exergaming has favourable effects on improving balance, lower limb functional mobility and functional independence among individuals with chronic stroke, making it a suitable adjunct to conventional physiotherapy. IMPACT People with chronic stroke have difficulty achieving the required rehab intensity. Exergaming can help individuals with chronic stroke to undertake further rehabilitation exercises at home. It can be a suitable adjunct to conventional physiotherapy.
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Affiliation(s)
- Kendy Gui Fang Chan
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ying Jiang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wen Ting Choo
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hadassah Joann Ramachandran
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yanjuan Lin
- Department of Nursing, Fujian Medical University Union Hospital, Fuzhou, China
| | - Wenru Wang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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12
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Everard G, Luc A, Doumas I, Ajana K, Stoquart G, Edwards MG, Lejeune T. Self-Rehabilitation for Post-Stroke Motor Function and Activity-A Systematic Review and Meta-Analysis. Neurorehabil Neural Repair 2021; 35:1043-1058. [PMID: 34696645 DOI: 10.1177/15459683211048773] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Due to an increasing stroke incidence, a lack of resources to implement effective rehabilitation and a significant proportion of patients with remaining impairments after treatment, there is a rise in demand for effective and prolonged rehabilitation. Development of self-rehabilitation programs provides an opportunity to meet these increasing demands.Objective. The primary aim of this meta-analysis was to determine the effect of self-rehabilitation on motor outcomes, in comparison to conventional rehabilitation, among patients with stroke. The secondary aim was to assess the influence of trial location (continent), technology, time since stroke (acute/subacute vs chronic), dose (total training duration > vs ≤ 15 hours), and intervention design (self-rehabilitation in addition/substitution to conventional therapy) on effect of self-rehabilitation.Methods. Studies were selected if participants were adults with stroke; the intervention consisted of a self-rehabilitation program defined as a tailored program where for most of the time, the patient performed rehabilitation exercises independently; the control group received conventional therapy; outcomes included motor function and activity; and the study was a randomized controlled trial with a PEDro score ≥5.Results. Thirty-five trials were selected (2225 participants) and included in quantitative synthesis regarding motor outcomes. Trials had a median PEDro Score of 7 [6-8]. Self-rehabilitation programs were shown to be as effective as conventional therapy. Trial location, use of technology, stroke stage, and intervention design did not appear to have a significant influence on outcomes.Conclusion. This meta-analysis showed low to moderate evidence that self-rehabilitation and conventional therapy efficacy was equally valuable for post-stroke motor function and activity.
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Affiliation(s)
- Gauthier Everard
- Neuro Musculo Skeletal Lab (NMSK), Institut de Recherche Expérimentale et Clinique, Secteur des Sciences de la Santé, 193391Université catholique de Louvain, Brussels, Belgium.,Louvain Bionics, 83415Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Alexandre Luc
- Neuro Musculo Skeletal Lab (NMSK), Institut de Recherche Expérimentale et Clinique, Secteur des Sciences de la Santé, 193391Université catholique de Louvain, Brussels, Belgium
| | - Ioannis Doumas
- Neuro Musculo Skeletal Lab (NMSK), Institut de Recherche Expérimentale et Clinique, Secteur des Sciences de la Santé, 193391Université catholique de Louvain, Brussels, Belgium.,Louvain Bionics, 83415Université catholique de Louvain, Louvain-la-Neuve, Belgium.,Service de médecine physique et réadaptation, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Khawla Ajana
- Psychological Sciences Research Institute (IPSY), 83415Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Gaëtan Stoquart
- Neuro Musculo Skeletal Lab (NMSK), Institut de Recherche Expérimentale et Clinique, Secteur des Sciences de la Santé, 193391Université catholique de Louvain, Brussels, Belgium.,Louvain Bionics, 83415Université catholique de Louvain, Louvain-la-Neuve, Belgium.,Service de médecine physique et réadaptation, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Martin Gareth Edwards
- Louvain Bionics, 83415Université catholique de Louvain, Louvain-la-Neuve, Belgium.,Psychological Sciences Research Institute (IPSY), 83415Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Thierry Lejeune
- Neuro Musculo Skeletal Lab (NMSK), Institut de Recherche Expérimentale et Clinique, Secteur des Sciences de la Santé, 193391Université catholique de Louvain, Brussels, Belgium.,Louvain Bionics, 83415Université catholique de Louvain, Louvain-la-Neuve, Belgium.,Service de médecine physique et réadaptation, Cliniques universitaires Saint-Luc, Brussels, Belgium
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13
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Applying Game-Based Approaches for Physical Rehabilitation of Poststroke Patients: A Systematic Review. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:9928509. [PMID: 34567491 PMCID: PMC8457987 DOI: 10.1155/2021/9928509] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 06/15/2021] [Accepted: 07/31/2021] [Indexed: 11/17/2022]
Abstract
Objective A large number of patients need critical physical rehabilitation after the stroke. This study aimed to review and report the result of published studies, in which newly emerged games were employed for physical rehabilitating in poststroke patients. Materials and Methods This systematic review study was performed based on the PRISMA method. A comprehensive search of PubMed, Scopus, IEEE Xplore Digital Library, and ISI Web of Science was conducted from January 1, 2014, to November 9, 2020, to identify related articles. Studies have been entered in this review based on inclusion and exclusion criteria, in which new games have been used for physical rehabilitation. Results Of the 1326 retrieved studies, 60 of them met our inclusion criteria. Virtual reality-oriented games were the most popular type of physical rehabilitation approach for poststroke patients. “The Nintendo Wii Fit” game was used more than other games. The reviewed games were mostly operated to balance training and limb mobilization. Based on the evaluation results of the utilized games, only in three studies, applied games were not effective. In other studies, games had effective outcomes for target body members. Conclusions The results indicate that modern games are efficient in poststroke patients' physical rehabilitation and can be used alongside conventional methods.
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14
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Gandhi DBC, Pandian JD, Szturm T, Kanitkar A, Kate MP, Bhanot K. A computer-game-based rehabilitation platform for individuals with fine and gross motor upper extremity deficits post-stroke (CARE fOR U) - Protocol for a randomized controlled trial. Eur Stroke J 2021; 6:291-301. [PMID: 34746426 PMCID: PMC8564152 DOI: 10.1177/2396987321994293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 01/06/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND & PURPOSE Activity-based neuroplasticity and re-organization leads to motor learning via replicating real-life movements. Increased repetition of such movements has growing evidence over last few decades. In particular, computer-game-based rehabilitation is found to be effective, feasible and acceptable for post-stroke upper limb deficits. Our study aims to evaluate the feasibility and effectiveness of 12 weeks of computer-game-based rehabilitation platform (GRP) on fine and gross motor skills post-stroke in India. METHODS Through this trial we will study the effect of adjunctive in-hospital GRP (using a motion-sensing airmouse with off-the-shelf computer games) in 80 persons with subacute stroke, for reduction of post-stroke upper limb deficits in a single-centre prospective Randomized Open, Blinded End- point trial when compared to conventional therapy alone. RESULTS We intend to evaluate between-group differences using Wolf Motor Function test, Stroke Specific Quality of Life, and GRP assessment tool. Feasibility will be assessed via recruitment rates, adherence to intervention periods, drop-out rate and qualitative findings of patient experience with the intervention. CONCLUSION The CARE FOR U trial is designed to test the feasibility and effectiveness of a computer-game based rehabilitation platform in treating upper limb deficits after stroke. In case of positive findings GRP can be widely applicable for stroke populations needing intensive and regular therapy with supervision.
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Affiliation(s)
- Dorcas BC Gandhi
- Department of Neurology, College of
Physiotherapy, Christian Medical College and Hospital, Ludhiana, India
| | | | - Tony Szturm
- College of Rehabilitation Sciences,
University of Manitoba, Winnipeg, Canada
| | | | - Mahesh P Kate
- Department of Clinical
Neurosciences, University of Alberta Hospital, Edmonton, Canada
| | - Komal Bhanot
- Department of Neurology, Christian
Medical College and Hospital, Ludhiana, India
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15
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Bell A, Grampurohit N, Marino RJ, Duff S, Kaplan G, Calhoun Thielen C, Mulcahey M. Home Activity-based Interventions for the Neurologically Impaired Upper Extremity: A Scoping Review. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2021. [DOI: 10.1177/1084822320953836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Activity-based therapy (ABT) for the upper extremity (UE) enables neurologic recovery with tasks that are functional, intense, and highly repetitive. A large proportion of rehabilitation occurs in the home and there is a gap in literature on the application of ABT within the home. The objective of this scoping review was to describe ABT in the home-setting for the neurologically-impaired UE. Methods: A systematic scoping review included searches of: MEDLINE, CINAHL, Cochrane, and OTSeeker. Results: A systematic search yielded 51 final studies. About 61% of ABT studies were exclusively within the home, others included outpatient visits (37%). Telerehabilitation was used in 37% of the studies with live-video and store forward techniques equally represented. ABT supported by technology was used in 61% of studies. Dosing of intervention ranged from 7 to 120 hours, with a mean of 34.5 hours of practice. Adherence with intended dosing was reported in 27% of studies and subjects completed a mean of 86% of the intended practice time. Sixty-seven percent of studies reported some degree of practice without therapist supervision. Conclusions: The results showed wide variability in the intervention methods, dosing and technology used in homebased settings. The high rate of adherence with dosing is encouraging for the application of homebased neurologic UE interventions. This scoping review highlights feasibility of UE ABT within the home and need for further research.
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Affiliation(s)
- Alison Bell
- Thomas Jefferson University, Philadelphia, PA, USA
| | | | | | | | - Gary Kaplan
- Thomas Jefferson University, Philadelphia, PA, USA
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16
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Perseverance with technology-facilitated home-based upper limb practice after stroke: a systematic mixed studies review. J Neuroeng Rehabil 2021; 18:43. [PMID: 33627126 PMCID: PMC7905577 DOI: 10.1186/s12984-021-00819-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 01/12/2021] [Indexed: 12/20/2022] Open
Abstract
Background Technology is being increasingly investigated as an option to allow stroke survivors to exploit their full potential for recovery by facilitating home-based upper limb practice. This review seeks to explore the factors that influence perseverance with technology-facilitated home-based upper limb practice after stroke. Methods A systematic mixed studies review with sequential exploratory synthesis was undertaken. Studies investigating adult stroke survivors with upper limb disability undertaking technology-facilitated home-based upper limb practice administered ≥ 3 times/week over a period of ≥ 4 weeks were included. Qualitative outcomes were stroke survivors’ and family members’ perceptions of their experience utilising technology to facilitate home-based upper limb practice. Quantitative outcomes were adherence and dropouts, as surrogate measures of perseverance. The Mixed Methods Appraisal Tool was used to assess quality of included studies. Results Forty-two studies were included. Six studies were qualitative and of high quality; 28 studies were quantitative and eight were mixed methods studies, all moderate to low quality. A conceptual framework of perseverance with three stages was formed: (1) getting in the game; (2) sticking with it, and; (3) continuing or moving on. Conditions perceived to influence perseverance, and factors mediating these conditions were identified at each stage. Adherence with prescribed dose ranged from 13 to 140%. Participants were found to be less likely to adhere when prescribed sessions were more frequent (6–7 days/week) or of longer duration (≥ 12 weeks). Conclusion From the mixed methods findings, we propose a framework for perseverance with technology-facilitated home-based upper limb practice. The framework offers opportunities for clinicians and researchers to design strategies targeting factors that influence perseverance with practice, in both the clinical prescription of practice and technology design. To confirm the clinical utility of this framework, further research is required to explore perseverance and the factors influencing perseverance. Registration: PROSPERO CRD42017072799—https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=72799
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17
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Karamians R, Proffitt R, Kline D, Gauthier LV. Effectiveness of Virtual Reality- and Gaming-Based Interventions for Upper Extremity Rehabilitation Poststroke: A Meta-analysis. Arch Phys Med Rehabil 2020; 101:885-896. [DOI: 10.1016/j.apmr.2019.10.195] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 10/30/2019] [Accepted: 10/31/2019] [Indexed: 12/14/2022]
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18
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Donoso Brown EV, Nolfi D, Wallace SE, Eskander J, Hoffman JM. Home program practices for supporting and measuring adherence in post-stroke rehabilitation: a scoping review. Top Stroke Rehabil 2019; 27:377-400. [PMID: 31891554 DOI: 10.1080/10749357.2019.1707950] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND After stroke, individuals face a variety of impairments that impact function. Increasingly, rehabilitation for these impairments has moved into the community and home settings through the use of home programs. However, adherence to these programs is often low, limiting effectiveness. OBJECTIVE This scoping review investigated home program implementation and measurement of adherence with persons post-stroke to identify commonly reported practices and determine areas for further research. METHODS The electronic databases of PubMed, CINAHL, Scopus, Cochrane Database of Systematic Reviews, and PEDro were searched. Studies focused on post-stroke rehabilitation with an independent home program were selected. Qualitative studies, commentaries, and single-case studies were excluded. Title and abstract screenings were completed by two reviewers with a third for tie-breaking. The full-text review was completed by two reviewers using consensus to resolve any differences. Of the 1,197 articles initially found only 6% (n = 70) met criteria for data extraction. Elements for data extraction included: type of study, area of intervention, description of home program, presence of strategies to support adherence, methods to measure adherence and reported adherence. RESULTS Most commonly reported strategies to support home practice were the use of technology, personalization, and written directions. Only 20 studies reported achieving adherence at or greater than 75% and 18 studies did not report adherence outcomes. CONCLUSIONS Future investigations that directly compare and identify the most effective strategies to support adherence to home programs for this population are warranted. The implementation of guidelines for reporting adherence to home programs is recommended.
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Affiliation(s)
| | - David Nolfi
- Gumberg Library, Duquesne University , Pittsburgh, USA
| | - Sarah E Wallace
- Department of Speech Language Pathology, Duquesne University , Pittsburgh, PA, USA
| | - Joanna Eskander
- Department of Occupational Therapy, Duquesne University , Pittsburgh, PA, USA
| | - Jeanne M Hoffman
- Department of Rehabilitation Medicine, University of Washington , Seattle, WA, USA
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19
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Ahn S, Hwang S. Virtual rehabilitation of upper extremity function and independence for stoke: a meta-analysis. J Exerc Rehabil 2019; 15:358-369. [PMID: 31316927 PMCID: PMC6614763 DOI: 10.12965/jer.1938174.087] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 05/28/2019] [Indexed: 11/22/2022] Open
Abstract
We aimed to conduct a systematic literature review with a meta-analysis to investigate whether virtual reality (VR) approaches have beneficial effects on the upper extremity function and independent activities of stroke survivors. Experimental studies published between 2007 and 2017 were searched from two databases (EBSCOhost and PubMed). This study reviewed abstracts and assessed full articles to obtain evidence on qualitative studies. For the meta-analysis, the studies that estimated the standardized mean between the two groups analyzed the statistical values necessary for calculating the effect size. The present study also evaluated the statistical heterogeneity. In total, 34 studies with 1,604 participants were included, and the number of participants in each study ranged from 10 to 376. Nine studies were assessed to evaluate the quantitative statistical analysis for 698 patients with hemiparetic stroke. The results of the meta-analysis were as follows: The overall effect size was moderate (0.41, P<0.001). The 95% confidence interval ranged from 0.25 to 0.57. However, no significant heterogeneity and publication bias were observed. The results of this study showed that VR approaches are effective in improving upper extremity function and independent activities in stroke survivors.
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Affiliation(s)
- Sinae Ahn
- Department of Occupational Therapy, Cheongju University, Cheonju, Korea
| | - Sujin Hwang
- Department of Physical Therapy, Division of Health Science, Baekseok University, Cheonan, Korea
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20
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Yacoby A, Zeilig G, Weingarden H, Weiss R, Rand D. Feasibility of, Adherence to, and Satisfaction With Video Game Versus Traditional Self-Training of the Upper Extremity in People With Chronic Stroke: A Pilot Randomized Controlled Trial. Am J Occup Ther 2019; 73:7301205080p1-7301205080p14. [PMID: 30839263 DOI: 10.5014/ajot.2019.026799] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE We compared the feasibility of, adherence to, and satisfaction with a newly developed upper extremity (UE) self-training protocol using commercial video games with a traditional self-training program for people with chronic stroke. METHOD Twenty-four participants with mild to moderate UE weakness were randomized to a video game (n = 13) or traditional (n = 11) self-training program. Participants were requested to train 60 min/day, 6×/wk. During the 5-wk self-training program and 4-wk follow-up, participants documented their self-training time and rated their perceived enjoyment and exertion. RESULTS Eleven participants completed video game training; 9 completed traditional self-training. During the follow-up period, 8 participants (72.7%) continued the video game training, and 4 (44.4%) continued traditional training. Perceived enjoyment, satisfaction, and benefit for UE improvement were relatively high. CONCLUSIONS Participants demonstrated high adherence to and satisfaction with both self-training programs. More participants continued to play video games after the intervention, indicating its potential to maintain ongoing activity.
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Affiliation(s)
- Anat Yacoby
- Anat Yacoby, MSc, OT, is Occupational Therapist. She was Master's Student, Department of Occupational Therapy, The Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, at the time of the study
| | - Gabi Zeilig
- Gabi Zeilig, MD, is Director, Neurological Rehabilitation Department, Chaim Sheba Medical Center at Tel-HaShomer, Tel-HaShomer, Israel, and Chair, Department of Physical Medicine and Rehabilitation, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Harold Weingarden
- Harold Weingarden, MD, is Senior Physician, Department of Neurological Rehabilitation, Chaim Sheba Medical Center at Tel-HaShomer, Tel-HaShomer, Israel
| | - Ronit Weiss
- Ronit Weiss, MSc, OT, is Occupational Therapist, Occupational Therapy Unit, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel. She was Master's Student, Department of Occupational Therapy, The Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, at the time of the study
| | - Debbie Rand
- Debbie Rand, PhD, OT, is Senior Lecturer and Chair, Department of Occupational Therapy, The Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;
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21
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Maier M, Rubio Ballester B, Duff A, Duarte Oller E, Verschure PFMJ. Effect of Specific Over Nonspecific VR-Based Rehabilitation on Poststroke Motor Recovery: A Systematic Meta-analysis. Neurorehabil Neural Repair 2019; 33:112-129. [PMID: 30700224 PMCID: PMC6376608 DOI: 10.1177/1545968318820169] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background. Despite the rise of virtual reality (VR)-based interventions in stroke rehabilitation over the past decade, no consensus has been reached on its efficacy. This ostensibly puzzling outcome might not be that surprising given that VR is intrinsically neutral to its use—that is, an intervention is effective because of its ability to mobilize recovery mechanisms, not its technology. As VR systems specifically built for rehabilitation might capitalize better on the advantages of technology to implement neuroscientifically grounded protocols, they might be more effective than those designed for recreational gaming. Objective. We evaluate the efficacy of specific VR (SVR) and nonspecific VR (NSVR) systems for rehabilitating upper-limb function and activity after stroke. Methods. We conducted a systematic search for randomized controlled trials with adult stroke patients to analyze the effect of SVR or NSVR systems versus conventional therapy (CT). Results. We identified 30 studies including 1473 patients. SVR showed a significant impact on body function (standardized mean difference [SMD] = 0.23; 95% CI = 0.10 to 0.36; P = .0007) versus CT, whereas NSVR did not (SMD = 0.16; 95% CI = −0.14 to 0.47; P = .30). This result was replicated in activity measures. Conclusions. Our results suggest that SVR systems are more beneficial than CT for upper-limb recovery, whereas NSVR systems are not. Additionally, we identified 6 principles of neurorehabilitation that are shared across SVR systems and are possibly responsible for their positive effect. These findings may disambiguate the contradictory results found in the current literature.
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Affiliation(s)
- Martina Maier
- 1 Laboratory of Synthetic, Perceptive, Emotive and Cognitive Systems (SPECS), Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Belén Rubio Ballester
- 1 Laboratory of Synthetic, Perceptive, Emotive and Cognitive Systems (SPECS), Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Armin Duff
- 1 Laboratory of Synthetic, Perceptive, Emotive and Cognitive Systems (SPECS), Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Esther Duarte Oller
- 2 Rehabilitation Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Physical Medicine and Rehabilitation Department Parc de Salut Mar (Hospital del Mar, Hospital de l'Esperança), Barcelona, Spain
| | - Paul F M J Verschure
- 1 Laboratory of Synthetic, Perceptive, Emotive and Cognitive Systems (SPECS), Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology, Barcelona, Spain.,3 Institució Catalana de Recerca I Estudis Avançats (ICREA), Barcelona, Spain
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Abstract
Whole-body movement is required to interact (play) with Microsoft Xbox with the 3D Kinect sensor (Xbox-Kinect) and, therefore, may be suitable for encouraging and practicing movements as part of stroke rehabilitation. We aimed to describe (i) game analysis, (ii) clinical use, and (iii) to characterize the Xbox-Kinect game experience with individuals with chronic stroke. Four therapists played the Xbox-Kinect games and then carried out a games analysis on the basis of the categories suggested by Deutsch. Eleven participants (age 29-69 years) with chronic stroke and varying motor deficits played Xbox-Kinect games for 4-22 sessions as part of a video-game group intervention and the clinical use was documented. The game experience of 'Bowling' (Kinect-Sport) and '20 000 leaks' (Kinect Adventures) was characterized by self-report questionnaires. Detailed tables of game analysis are provided. The clinical use of the console with the participants is presented. Participants reported high enjoyment and 'somewhat-high' perceived exertion after playing the two games and stated that overall the console suited their therapeutic goals. This information can assist clinicians with their clinical reasoning and decision-making for incorporating the Xbox-Kinect into stroke rehabilitation. Potentially, the Xbox-Kinect could be used as an on-going tool to facilitate whole-body movement and physical activity of individuals with chronic stroke.
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Mandehgary Najafabadi M, Azad A, Mehdizadeh H, Behzadipour S, Fakhar M, Taghavi Azar Sharabiani P, Parnianpour M, Taghizadeh G, Khalaf K. Improvement of Upper Limb Motor Control and Function After Competitive and Noncompetitive Volleyball Exercises in Chronic Stroke Survivors: A Randomized Clinical Trial. Arch Phys Med Rehabil 2018; 100:401-411. [PMID: 30419232 DOI: 10.1016/j.apmr.2018.10.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 08/06/2018] [Accepted: 10/15/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate the effects of competitive and noncompetitive volleyball exercises on the functional performance and motor control of the upper limbs in chronic stroke survivors. DESIGN Randomized clinical trial. SETTING Outpatient rehabilitation center. PARTICIPANTS Chronic stroke survivors (N=48). INTERVENTIONS Participants were randomly assigned to competitive (n=16) or noncompetitive (n=16) volleyball exercise groups (60min/d volleyball exercise+30min/d traditional rehabilitation, 3d/wk for 7wk) and control group (n=16). MAIN OUTCOME MEASURES Reach and grasp motor control measures were evaluated through kinematic analysis. Functional outcomes were assessed via Motor Activity Log, Wolf Motor Function Test (WMFT), Box and Block Test, and Wrist Position Sense Test. RESULTS Significant improvement of functional performance was observed in both competitive (P<.0001) and noncompetitive volleyball exercise groups (P<.01), but not in the control group (P>.05), with the exception of WMFT score. Volleyball training, in general, resulted in more efficient spatiotemporal control of reach and grasp functions, as well as less dependence on feedback control as compared to the control group. Moreover, the competitive volleyball exercise group exhibited greater improvement in both functional performance and motor control levels. CONCLUSIONS Volleyball team exercises, especially in a competitive format, resulted in enhancing the efficacy of the preprogramming and execution of reach and grasp movements, as well as a shift from feedback to feedforward control of the affected upper limb in chronic stroke survivors. This may well be a potential underlying mechanism for improving functional performance.
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Affiliation(s)
- Mahbubeh Mandehgary Najafabadi
- Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Akram Azad
- Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Hajar Mehdizadeh
- Department of Occupational Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeed Behzadipour
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran; Mowafaghian Research Center in Neurorehabilitation Technologies, Tehran, Iran
| | - Maliheh Fakhar
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | | | - Mohamad Parnianpour
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Ghorban Taghizadeh
- Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran; Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Kinda Khalaf
- Department of Biomedical Engineering, Khalifa University of Science, Technology and Research, Abu Dhabi, UAE
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Fujioka T, Dawson DR, Wright R, Honjo K, Chen JL, Chen JJ, Black SE, Stuss DT, Ross B. The effects of music-supported therapy on motor, cognitive, and psychosocial functions in chronic stroke. Ann N Y Acad Sci 2018; 1423:264-274. [PMID: 29797585 DOI: 10.1111/nyas.13706] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 03/02/2018] [Accepted: 03/11/2018] [Indexed: 02/01/2023]
Abstract
Neuroplasticity accompanying learning is a key mediator of stroke rehabilitation. Training in playing music in healthy populations and patients with movement disorders requires resources within motor, sensory, cognitive, and affective systems, and coordination among these systems. We investigated effects of music-supported therapy (MST) in chronic stroke on motor, cognitive, and psychosocial functions compared to conventional physical training (GRASP). Twenty-eight adults with unilateral arm and hand impairment were randomly assigned to MST (n = 14) and GRASP (n = 14) and received 30 h of training over a 10-week period. The assessment was conducted at four time points: before intervention, after 5 weeks, after 10 weeks, and 3 months after training completion. As for two of our three primary outcome measures concerning motor function, all patients slightly improved in Chedoke-McMaster Stroke Assessment hand score, while the time to complete Action Research Arm Test became shorter in the MST group. The third primary outcome measure for well-being, Stroke Impact Scale, was improved for emotion and social communication earlier in MST and coincided with the improved executive function for task switching and music rhythm perception. The results confirmed previous findings and expanded the potential usage of MST for enhancing quality of life in community-dwelling chronic-stage survivors.
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Affiliation(s)
- Takako Fujioka
- Center for Computer Research in Music and Acoustics, Department of Music, Stanford University, Stanford, California
- Stanford Neurosciences Institute, Stanford University, Stanford, California
- Rotman Research Institute, Baycrest Centre, Toronto, Ontario, Canada
| | - Deirdre R Dawson
- Rotman Research Institute, Baycrest Centre, Toronto, Ontario, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Rebecca Wright
- Rotman Research Institute, Baycrest Centre, Toronto, Ontario, Canada
| | - Kie Honjo
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Joyce L Chen
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - J Jean Chen
- Rotman Research Institute, Baycrest Centre, Toronto, Ontario, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Sandra E Black
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Medicine, Division of Neurology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Donald T Stuss
- Rotman Research Institute, Baycrest Centre, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Bernhard Ross
- Rotman Research Institute, Baycrest Centre, Toronto, Ontario, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
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