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Yuan Y, Gu Q, Zhu M, Zhang Y, Lan M. Frailty-originated early rehabilitation reduces postoperative delirium in brain tumor patients: Results from a prospective randomized study. Asia Pac J Oncol Nurs 2023; 10:100263. [PMID: 37497156 PMCID: PMC10365981 DOI: 10.1016/j.apjon.2023.100263] [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: 05/03/2023] [Accepted: 06/13/2023] [Indexed: 07/28/2023] Open
Abstract
Objective To investigate the impact of frailty-originated, evidence-based early activity training on postoperative delirium in patients who have undergone brain tumor resection. Methods A randomized controlled trial was conducted at the Second Affiliated Hospital of Zhejiang University School of Medicine, from July 2019 to June 2020. Data on the patients' general information, incidence and duration of delirium, duration of hospital stay, and activities of daily living were collected. From the first day after surgery, the patients were randomly assigned to either the traditional care group or the frailty-originated rehabilitation towards intracranial tumors using distinct evidence (FORTITUDE) group. Non-parametric, chi-square, and log-rank tests were used to compare the onset time and duration of postoperative delirium and activities of daily living performed by the participants between the two groups. Results In total, 291 patients, 150 and 141 in the control group and FORTITUDE group, respectively, participated in the study. Patients in the FORTITUDE group had a lower incidence of postoperative delirium (15.6% vs. 28.7%, P = 0.007), delayed onset of delirium (Z = -2.108, P = 0.035), shorter duration of postoperative delirium (χ2 = 26.67, P < 0.001), shorter hospital stay (Z = -2.037, P = 0.042), and higher scores in the activities of daily living one week (Z = -2.304, P = 0.021) and one month (Z = -2.724, P = 0.006) after surgery than in the control group. Conclusions The FORTITUDE program was safe and effective in reducing the incidence and duration of postoperative delirium and improving the quality of life of patients who underwent brain tumor resection.
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Shen Y, Hu L, Ge J, Li L. Effect of electroacupuncture treatment combined with rehabilitation care on serum sirt3 level and motor function in elderly patients with stroke hemiparesis. Medicine (Baltimore) 2023; 102:e33403. [PMID: 37058075 PMCID: PMC10101298 DOI: 10.1097/md.0000000000033403] [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: 09/20/2022] [Accepted: 03/09/2023] [Indexed: 04/15/2023] Open
Abstract
OBJECTIVE Acupuncture treatment helps to improve neurological and motor function in elderly patients with stroke hemiplegia. However, the exact mechanism by which electroacupuncture improves stroke hemiparesis is uncertain. The aim of this study was to determine the effect of electroacupuncture care on sirt3 levels in elderly patients with stroke hemiparesis. METHODS One hundred and ten elderly patients with hemiplegia after first stroke were divided into an experimental group and a control group (n = 55 in each group). The control group was given conventional rehabilitation care by a rehabilitation therapist. In the experimental group, on the basis of conventional rehabilitation care, electroacupuncture was performed once a day for 28 days. RESULTS Fugl-Meyer assessment (FMA) and barthel index (BI) scores were significantly higher, while neurologic deficit scale (NDS) and physiological state scores were significantly lower in both groups after 14 and 28 days of intervention compared to preintervention. The Generalized estimating equation (GEE) model also showed that the experimental group showed more favorable improvements in all outcomes at postintervention time points compared to the control group. After the intervention, serum sirt3 levels increased significantly in both groups compared to preintervention, and the increase was more pronounced in the experimental group. Consistently, the GEE model showed that serum sirt3 levels were significantly higher in the experimental group compared to the control group at postintervention time points. Correlation analysis revealed that serum sirt3 levels in the experimental group were negatively correlated with FMA and BI pre- and postintervention, while showing a significant positive correlation with NDS and physiological state scores. CONCLUSION Electroacupuncture intervention led to significant improvements in motor function, activities of daily living and neurological function in elderly patients with stroke hemiplegia, which may be associate with increased serum sirt3 levels.
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Affiliation(s)
- Ying Shen
- International Clinic, Wuhan Union Hospital of China, Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Liping Hu
- Department of Geriatrics, Wuhan Union Hospital of China, Affiliated to Tongji Medical College of Huazhong University of Science and technology, Wuhan, Hubei, China
| | - Jing Ge
- Department of Geriatrics, Wuhan Union Hospital of China, Affiliated to Tongji Medical College of Huazhong University of Science and technology, Wuhan, Hubei, China
| | - Ling Li
- Department of Geriatrics, Wuhan Union Hospital of China, Affiliated to Tongji Medical College of Huazhong University of Science and technology, Wuhan, Hubei, China
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Liang C, Chen B, Hu Z, Li X, Huang Y. Dual-mobility cup total hip arthroplasty improves the quality of life compared to internal fixation in femoral neck fractures patients with severe neuromuscular disease in the lower extremity after stroke: a retrospective study. Front Surg 2023; 10:1120273. [PMID: 37139192 PMCID: PMC10149665 DOI: 10.3389/fsurg.2023.1120273] [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: 12/09/2022] [Accepted: 03/30/2023] [Indexed: 05/05/2023] Open
Abstract
Background This study aimed to demonstrate that dual-mobility cup total hip arthroplasty (DMC-THA) can significantly improve the quality of life (QOL) of elderly femoral neck fracture patients with severe neuromuscular disease in unilateral lower extremities due to stroke hemiplegia compared to internal fixation (IF). Methods Fifty-eight cases of severe neuromuscular disease in the unilateral lower extremities with muscle strength < grade 3/5 due to stroke were retrospectively examined From January 2015 to December 2020. Then, patients were divided into DMC and IF groups. The QOL was examined using the EQ-5D and SF-36 outcome measures. The physical and mental statuses were assessed using the Barthel Index (BI) and e Fall Efficacy Scale-International (FES-I), respectively. Results Patients in the DMC group had higher BI scores than those in the IF group at different time point. Regarding mental status, the FES-I mean score was 42.1 ± 5.3 in the DMC group and 47.3 ± 5.6 in the IF group (p = 0.002). For the QOL, the mean SF-36 score was 46.1 ± 18.3 for the health component and 59.5 ± 15.0 for the mental component in the DMC group compared to 35.3 ± 16.2 (p = 0.035), and 46.6 ± 17.4 (p = 0.006) compared to the IF group. The mean EQ-5D-5L values were 0.733 ± 0.190 and 0.303 ± 0.227 in the DMC and IF groups (p = 0.035), respectively. Conclusion DMC-THA significantly improved postoperative QOL compared to IF in elderly patients with femoral neck fractures and severe neuromuscular dysfunction in the lower extremity after stroke. The improved outcomes were related to the enhanced early, rudimentary motor function of patients.
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Affiliation(s)
- Chaolun Liang
- The 2nd Clinical Medical College, Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Bojian Chen
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhifeng Hu
- The 2nd Clinical Medical College, Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Xing Li
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yongming Huang
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
- Correspondence: Yongming Huang
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Cindy J H R, Prange-Lasonder GB, Prinsen EC, Buurke JH, Rietman JS. Detection thresholds for electrostimulation combined with robotic leg support in sub-acute stroke patients. IEEE Int Conf Rehabil Robot 2022; 2022:1-5. [PMID: 36176097 DOI: 10.1109/icorr55369.2022.9896576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Stroke is one of the leading causes of disability in adults in the European Union. It often leads to motor impairments, such as a hemiparetic lower extremity. Research indicates that early task-specific and intensive training promotes neuroplasticity and leads to recovery and/or compensation. One way to provide intensive training early after a stroke is via robot-supported training. A rehabilitation robot was designed by Life Science Robotics (Aalborg, Denmark) that can provide continuous repetitive movements of the hip, knee, and/or ankle in e.g., a lying position. In order to emphasize active contribution by the patient, actively triggered electrical stimulation (via muscle activation) can be combined with robotic assistance. The current study aims to compare different threshold estimation methods for detection of movement intention from muscle activity for actively triggered electrical stimulation during robot-supported leg movement in stroke patients. Three sub-acute stroke patients were included for a single measurement session. They performed knee extension and/or ankle dorsal flexion with four different threshold estimation methods to assess the intention detection threshold to initiate electrostimulation. The thresholds were based on the resting level of muscle activity (of m. rectus femoris or m. tibialis anterior) plus two or three times the standard deviation of the average resting value, or the resting level plus 5% or 10% of the peak muscle activity during a maximal voluntary contraction. The results showed that the method based on the resting muscle activity plus two times the standard deviation was the most stable across the three included stroke patients. This method had a detection success rate of 86.7% and was experienced as moderately comfortable. In conclusion, performing knee extension and/or ankle dorsal flexion with electromyography triggered electrostimulation is feasible in sub-acute stroke patients. Muscle activity-triggered electrostimulation combined with robotic support based on a threshold of resting levels plus two times the standard deviation seems to detect movement initiation most consistently in this small sample of sub-acute stroke patients.
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Liu G, Cai H, Leelayuwat N. Intervention Effect of Rehabilitation Robotic Bed Under Machine Learning Combined With Intensive Motor Training on Stroke Patients With Hemiplegia. Front Neurorobot 2022; 16:865403. [PMID: 35756160 PMCID: PMC9218362 DOI: 10.3389/fnbot.2022.865403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 04/19/2022] [Indexed: 11/30/2022] Open
Abstract
It was aimed to discuss the effect of bed-type rehabilitation robots under machine learning combined with intensive motor training on the motor function of lower limbs of stroke patients with hemiplegia. A total of 80 patients with stroke hemiplegia were taken as the subjects, who all had a course of treatment for less than 6 months in the Rehabilitation Medicine Department of Ganzhou Hospital. These patients were divided into the experimental group (40 cases) and the control group (40 cases) by random number method. For patients in the control group, conventional intensive motor training was adopted, whereas the conventional intensive motor training combined with the bed-type rehabilitation robot under machine learning was applied for patients in the experimental group. Fugl-Meyer Assessment of Lower Extremity (FMA-LE), Rivermead Mobility Index (RMI), and Modified Barthel Index (MBI) were used to evaluate the motor function and mobility of patients. The human–machine collaboration experiment system was constructed, and the software and hardware of the control system were designed. Then, the experimental platform for lower limb rehabilitation training robots was built, and the rehabilitation training methods for stroke patients with hemiplegia were determined by completing the contact force experiment. The results showed that the prediction effect of back-propagation neural network (BPNN) was better than that of the radial basis neural network (RBNN). The bed-type rehabilitation robot under machine learning combined with intensive motor training could significantly improve the motor function and mobility of the lower limbs of stroke patients with hemiplegia.
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Affiliation(s)
- Guangliang Liu
- Graduate School of Khon Kaen University, Khon Kaen, Thailand
| | - Haiqin Cai
- College of Music, Gannan Normal University, Ganzhou, China
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Effect of a Training Protocol on Movement Function in Men with Cerebrovascular Accident. Asian J Sports Med 2021. [DOI: 10.5812/asjsm.100546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
: Cerebrovascular accident (CVA) refers to any kind of damage caused by direct or indirect damage to the brain and its related elements. It is estimated that about 60% of brain injury victims have a permanent disorder. The consequences of CVA include reduced movement speed, weakness, functional impairment, reduced power, and balance. The purpose of this study was to investigate the effect of a 12-week selected training protocol on motor function following brain injury. In a semi-experimental study, 30 male subjects with a mean and standard deviation of 52.2 ± 5.4 years, weight 173.2 ± 4.2 kg, and height of 78.8 ± 5.3 cm were selected purposefully and accessible with inclusion and exclusion criteria. The participants were randomly divided into experimental (n = 15) and control groups (n = 15). In order to evaluate the physical-motor performance, 10-meter walking tests, get up and go tests, and climbing stairs tests were used. The training program lasted for 12 weeks, three sessions per week, and each session for 30 - 60 minutes. Data were analyzed by independent t-test and dependent t-test using SPSS-21 software at P ≤ 0.05 level. Based on dependent t-test and covariance test, there were significant differences in all three components of motor function (10 m walk time tests, get up and go test, and stair climbing test), there was a significant increase after training in men with CVA (P = 0.00). From the findings of this study, it can be concluded that the special exercises of the present study have a positive effect on motor function parameters of male patients with CVA, so it can be recommended as one of the most important rehabilitation strategies for these patients.
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Wang Z, Pan J, Wang L, Chen P. Clinical efficacy of comprehensive nursing in patients with cerebral hemorrhagic hemiplegia. Am J Transl Res 2021; 13:5526-5532. [PMID: 34150153 PMCID: PMC8205767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 01/07/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To explore the clinical efficacy of comprehensive rehabilitation nursing (CRN) intervention in patients with cerebral hemorrhagic hemiplegia (CHH). METHODS A total of 102 patients with CHH admitted to our hospital were selected for the prospective study. The patients were randomly divided into the control group (n=51) and the observation group (n=51) according to the random number table method. Routine nursing was performed in the control group, while CRN was conducted in the observation group. Fugl-Meyer motor function assessment scale, activity of daily living scale (Barthel index), self-rating anxiety scale (SAS), complications and muscle strength improvement (Brunnstrom assessment) were compared between the two groups. RESULTS Compared with those before nursing, Fugl-Meyer score, Barthel index and SAS score in the two groups after nursing were significantly improved (P<0.01). Fugl-Meyer score and Barthel index of the observation group were significantly higher than those of the control group after nursing, while SAS score showed the opposite change (P<0.001). The incidence of complications in the control group was 49.02%, and that in the observation group was 29.41% (P<0.05). The rate of muscle strength improvement in the observation group was 80.39% after nursing, which was significantly higher than that in the control group (60.78%; P<0.05). CONCLUSION CRN intervention has a positive clinical efficacy in patients with CHH. It can enhance motor ability, improve the ability of daily life, amend psychological mood and reduce the incidence of complications.
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Affiliation(s)
- Zi Wang
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University Shanghai City, China
| | - Jieqiong Pan
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University Shanghai City, China
| | - Li Wang
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University Shanghai City, China
| | - Ping Chen
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University Shanghai City, China
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BAL DT, KOCA T, BERK E, KOÇYİĞİT BF, NACİTARHAN V. İnme Hastalarında Çift Yönlü Görev Aktivitesinin Etkinliği. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2020. [DOI: 10.17517/ksutfd.743895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Ekechukwu END, Olowoyo P, Nwankwo KO, Olaleye OA, Ogbodo VE, Hamzat TK, Owolabi MO. Pragmatic Solutions for Stroke Recovery and Improved Quality of Life in Low- and Middle-Income Countries-A Systematic Review. Front Neurol 2020; 11:337. [PMID: 32695058 PMCID: PMC7336355 DOI: 10.3389/fneur.2020.00337] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/07/2020] [Indexed: 12/22/2022] Open
Abstract
Background: Given the limited healthcare resources in low and middle income countries (LMICs), effective rehabilitation strategies that can be realistically adopted in such settings are required. Objective: A systematic review of literature was conducted to identify pragmatic solutions and outcomes capable of enhancing stroke recovery and quality of life of stroke survivors for low- and middle- income countries. Methods: PubMed, HINARI, and Directory of Open Access Journals databases were searched for published Randomized Controlled Trials (RCTs) till November 2018. Only completed trials published in English with non-pharmacological interventions on adult stroke survivors were included in the review while published protocols, pilot studies and feasibility analysis of trials were excluded. Obtained data were synthesized thematically and descriptively analyzed. Results: One thousand nine hundred and ninety six studies were identified while 347 (65.22% high quality) RCTs were found to be eligible for the review. The most commonly assessed variables (and outcome measure utility) were activities of daily living [75.79% of the studies, with Barthel Index (37.02%)], motor function [66.57%; with Fugl Meyer scale (71.88%)], and gait [31.12%; with 6 min walk test (38.67%)]. Majority of the innovatively high technology interventions such as robot therapy (95.24%), virtual reality (94.44%), transcranial direct current stimulation (78.95%), transcranial magnetic stimulation (88.0%) and functional electrical stimulation (85.00%) were conducted in high income countries. Several traditional and low-cost interventions such as constraint-induced movement therapy (CIMT), resistant and aerobic exercises (R&AE), task oriented therapy (TOT), body weight supported treadmill training (BWSTT) were reported to significantly contribute to the recovery of motor function, activity, participation, and improvement of quality of life after stroke. Conclusion: Several pragmatic, in terms of affordability, accessibility and utility, stroke rehabilitation solutions, and outcome measures that can be used in resource-limited settings were found to be effective in facilitating and enhancing post-stroke recovery and quality of life.
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Affiliation(s)
- Echezona Nelson Dominic Ekechukwu
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Enugu, Nigeria
- LANCET Physiotherapy and Wellness and Research Centre, Enugu, Nigeria
| | - Paul Olowoyo
- Department of Medicine, Federal Teaching Hospital, Ido Ekiti, Nigeria
- College of Medicine and Health Sciences, Afe Babalola University, Ado Ekiti, Nigeria
| | - Kingsley Obumneme Nwankwo
- Stroke Control Innovations Initiative of Nigeria, Abuja, Nigeria
- Fitness Global Consult Physiotherapy Clinic, Abuja, Nigeria
| | - Olubukola A Olaleye
- Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Talhatu Kolapo Hamzat
- Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Mayowa Ojo Owolabi
- Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
- University College Hospital, Ibadan, Nigeria
- Blossom Specialist Medical Centre, Ibadan, Nigeria
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Lin RC, Chiang SL, Heitkemper MM, Weng SM, Lin CF, Yang FC, Lin CH. Effectiveness of Early Rehabilitation Combined With Virtual Reality Training on Muscle Strength, Mood State, and Functional Status in Patients With Acute Stroke: A Randomized Controlled Trial. Worldviews Evid Based Nurs 2020; 17:158-167. [PMID: 32212254 DOI: 10.1111/wvn.12429] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 11/10/2019] [Accepted: 11/16/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Early rehabilitation has been shown to enhance functional outcomes. Whether the addition of virtual reality (VR) training could further improve muscle strength, mood state, and functional status for patients with acute stroke is unknown. AIMS To investigate the effectiveness of VR training on muscle strength, mood state (depression, anxiety), and functional status in patients following acute stroke. METHODS A randomized controlled trial was conducted. Patients with acute ischemic stroke (N = 152) were selected and randomly assigned with a 1:3 randomization ratio to either experimental group (EG) or comparison group (CG). Both groups received early rehabilitation. The EG received an extra 5 days of VR training (15 min of time, two times a day), started 24 hr to 3 days poststroke. Muscle strength, mood state, and functional status were collected at admission and at the day of discharge. Generalized estimating equations were applied to examine the intervention effects. RESULTS A total of 143 participants (94%) completed the study, and 145 were included in the intention-to-treat analysis. Participants in the EG reported increased muscle strength of upper and lower limbs in both affected and unaffected sides, decreased depression and anxiety, and increased functional status at discharge. When the group-time interaction was examined, the EG had greater increased upper limb muscle strength of the unaffected side (ß = 0.34, p < .001) and decreased depression and anxiety scores (ß = -2.31, p = .011; ß = -1.63, p = .047) at discharge compared with the CG. However, there was no difference in the functional status change scores from baseline between EG and CG. LINKING EVIDENCE TO ACTION A poststroke program that includes both early rehabilitation and VR training has greater benefit in relation to mood state and muscle strength at discharge than early rehabilitation alone. Therefore, an early physical rehabilitation program that includes VR training for acute stroke inpatients should be considered for implementation in clinical settings.
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Affiliation(s)
- Ruei-Ching Lin
- Department of Nursing, Tri-Service General Hospital, Taipei, Taiwan
| | - Shang-Lin Chiang
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Margaret McLean Heitkemper
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, USA.,Division of Gastroenterology, University of Washington, Seattle, WA, USA.,Center for Research on Management of Sleep Disturbances, University of Washington, Seattle, WA, USA
| | - Shu-Min Weng
- Department of Nursing, Tri-Service General Hospital, Taipei, Taiwan
| | - Chi-Feng Lin
- Department of Nursing, Tri-Service General Hospital, Taipei, Taiwan
| | - Fu-Chi Yang
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chia-Huei Lin
- School of Nursing, National Defense Medical Center, Taipei, Taiwan.,Department of Nursing, Songshan Branch of Tri-Service General Hospital, Taipei, Taiwan
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