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Marzolini S, Robertson AD, MacIntosh BJ, Corbett D, Anderson ND, Brooks D, Koblinsky N, Oh P. Effect of High-Intensity Interval Training and Moderate-Intensity Continuous Training in People With Poststroke Gait Dysfunction: A Randomized Clinical Trial. J Am Heart Assoc 2023; 12:e031532. [PMID: 37947080 PMCID: PMC10727274 DOI: 10.1161/jaha.123.031532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/03/2023] [Indexed: 11/12/2023]
Abstract
Background The exercise strategy that yields the greatest improvement in both cardiorespiratory fitness (V ̇ O 2 peak $$ \dot{\mathrm{V}}{\mathrm{O}}_{2\mathrm{peak}} $$ ) and walking capacity poststroke has not been determined. This study aimed to determine whether conventional moderate-intensity continuous training (MICT) or high-intensity interval training (HIIT) have different effects on V ̇ O 2 peak $$ \dot{\mathrm{V}}{\mathrm{O}}_{2\mathrm{peak}} $$ and 6-minute walk distance (6MWD). Methods and Results In this 24-week superiority trial, people with poststroke gait dysfunction were randomized to MICT (5 days/week) or HIIT (3 days/week with 2 days/week of MICT). MICT trained to target intensity at the ventilatory anaerobic threshold. HIIT trained at the maximal tolerable treadmill speed/grade using a novel program of 2 work-to-recovery protocols: 30:60 and 120:180 seconds. V̇O2 and heart rate was measured during performance of the exercise that was prescribed at 8 and 24 weeks for treatment fidelity. Main outcomes were change in V ̇ O 2 peak $$ \dot{\mathrm{V}}{\mathrm{O}}_{2\mathrm{peak}} $$ and 6MWD. Assessors were blinded to the treatment group for V ̇ O 2 peak $$ \dot{\mathrm{V}}{\mathrm{O}}_{2\mathrm{peak}} $$ but not 6MWD. Secondary outcomes were change in ventilatory anaerobic threshold, cognition, gait-economy, 10-meter gait-velocity, balance, stair-climb performance, strength, and quality-of-life. Among 47 participants randomized to either MICT (n=23) or HIIT (n=24) (mean age, 62±11 years; 81% men), 96% completed training. In intention-to-treat analysis, change in V ̇ O 2 peak $$ \dot{\mathrm{V}}{\mathrm{O}}_{2\mathrm{peak}} $$ for MICT versus HIIT was 2.4±2.7 versus 5.7±3.1 mL·kg-1·min-1 (mean difference, 3.2 [95% CI, 1.5-4.8]; P<0.001), and change in 6MWD was 70.9±44.3 versus 83.4±53.6 m (mean difference, 12.5 [95% CI, -17 to 42]; P=0.401). HIIT had greater improvement in ventilatory anaerobic threshold (mean difference, 2.07 mL·kg-1·min-1 [95% CI, 0.59-3.6]; P=0.008). No other between-group differences were observed. During V̇O2 monitoring at 8 and 24 weeks, MICT reached 84±14% to 87±18% of V ̇ O 2 peak $$ \dot{\mathrm{V}}{\mathrm{O}}_{2\mathrm{peak}} $$ while HIIT reached 101±22% to 112±14% of V ̇ O 2 peak $$ \dot{\mathrm{V}}{\mathrm{O}}_{2\mathrm{peak}} $$ (during peak bouts). Conclusions HIIT resulted in more than a 2-fold greater and clinically important change in V ̇ O 2 peak $$ \dot{\mathrm{V}}{\mathrm{O}}_{2\mathrm{peak}} $$ than MICT. Training to target (ventilatory anaerobic threshold) during MICT resulted in ~3 times the minimal clinically important difference in 6MWD, which was similar to HIIT. These findings show proof of concept that HIIT yields greater improvements in cardiorespiratory fitness than conventional MICT in appropriately screened individuals. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03006731.
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Affiliation(s)
- Susan Marzolini
- KITE Research Institute, Toronto Rehabilitation Institute, University Health NetworkTorontoONCanada
- Rehabilitation Sciences Institute, University of TorontoONCanada
- Faculty of Kinesiology and Physical Education, University of TorontoONCanada
| | | | - Bradley J. MacIntosh
- Sandra E Black Centre for Brain Resilience and Repair, Hurvitz Brain Sciences, Physical Sciences Platform, Sunnybrook Research InstituteTorontoONCanada
| | - Dale Corbett
- Department of Cellular and Molecular MedicineUniversity of OttawaONCanada
| | - Nicole D. Anderson
- Rotman Research Institute, Baycrest Academy for Research and EducationTorontoONCanada
| | - Dina Brooks
- KITE Research Institute, Toronto Rehabilitation Institute, University Health NetworkTorontoONCanada
- Rehabilitation Sciences Institute, University of TorontoONCanada
- McMaster University, Faculty of Health SciencesHamiltonONCanada
| | - Noah Koblinsky
- Rotman Research Institute, Baycrest Academy for Research and EducationTorontoONCanada
| | - Paul Oh
- KITE Research Institute, Toronto Rehabilitation Institute, University Health NetworkTorontoONCanada
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2
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A Unified Model for Stroke Recovery and Rehabilitation: Why Now? Am J Phys Med Rehabil 2023; 102:S3-S9. [PMID: 36634323 DOI: 10.1097/phm.0000000000002141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
ABSTRACT The current model of stroke care delivery in the United States and in many parts of the world is fragmented, resulting in lack of continuity of care, inability to track recovery meaningfully across the continuum, and lack of access to the frequency, intensity, and duration of high-quality rehabilitation necessary to optimally harness recovery processes. The process of recovery itself has been overshadowed by a focus on length of stay and the movement of patients across levels of care. Here, we describe the rationale behind the recent efforts at the Johns Hopkins Sheikh Khalifa Stroke Institute to define and coordinate an intensive, strategic effort to develop effective stroke systems of care across the continuum through the development of a unified Sheikh Khalifa Stroke Institute model of recovery and rehabilitation.
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3
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Early chronic obstructive pulmonary disease: Associations of two spirometry criteria with clinical features. Respir Med 2022; 204:107011. [DOI: 10.1016/j.rmed.2022.107011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/16/2022] [Accepted: 10/08/2022] [Indexed: 11/22/2022]
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4
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Bonifacio GB, Ward NS, Emsley HCA, Cooper J, Bernhardt J. Optimising rehabilitation and recovery after a stroke. Pract Neurol 2022; 22:478-485. [PMID: 35896376 DOI: 10.1136/practneurol-2021-003004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2022] [Indexed: 11/03/2022]
Abstract
Stroke can cause significant disability and impact quality of life. Multidisciplinary neurorehabilitation that meets individual needs can help to optimise recovery. Rehabilitation is essential for best quality care but should start early, be ongoing and involve effective teamwork. We describe current stroke rehabilitation processes, from the hyperacute setting through to inpatient and community rehabilitation, to long-term care and report on which UK quality care standards are (or are not) being met. We also examine the gap between what stroke rehabilitation is recommended and what is being delivered, and suggest areas for further improvement.
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Affiliation(s)
| | - Nick S Ward
- Department of Clinical and Movement Neurosciences, University College London, London, UK.,Department of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Hedley C A Emsley
- Lancaster Medical School, Lancaster University Faculty of Health and Medicine, Lancaster, UK
| | - Jon Cooper
- Stroke Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Julie Bernhardt
- Stroke Division, Florey Institute of Neuroscience and Mental Health - Austin Campus, Heidelberg, Victoria, Australia
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Nayak P, Mahmood A, Kumaran D S, Natarajan M, Unnikrishnan B, Solomon JM. Adaptive sports for promoting physical activity in community-dwelling adults with stroke: A feasibility study. J Bodyw Mov Ther 2021; 28:341-347. [PMID: 34776162 DOI: 10.1016/j.jbmt.2021.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 06/01/2021] [Accepted: 07/13/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite proven health benefits of regular participation in physical activities (PA), adults with stroke fail to achieve recommended levels of PA. Sports being an enjoyable activity is more likely to encourage participation. Therefore, the objectives of the present study are i) to develop and test the feasibility of adaptive sports for promoting PA and Quality of Life (QoL) in community-dwelling adults with stroke, and ii) to explore the participants perception and experiences of playing adaptive sports. METHODS Two focus groups were conducted among the eight experts and a person with stroke to develop adaptive sports. To test the feasibility of these adaptive sports, in a multi methods study eighteen community dwelling adults with stroke were recruited. Participants played adaptive sports twice a week for two months in a community center. Participants pre and post intervention PA levels and QoL were measured. Participants were also interviewed at the end of the program to explore their experiences of participation in adaptive sports. RESULTS At the end of the program retention rate of the participants was 83.33% and there was a significant improvement in PA levels, while the improvement in QoL was not statistically significant. Participants expressed positive experience with the program. There were no adverse events during or after the participation. Health benefits, fitness, and fun were reported as facilitators, while lack of access to the sporting facility and lack of caregiver support were reported as barriers to participation. CONCLUSION Adaptive sports appear to be safe, feasible, and well accepted by the adults with stroke.
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Affiliation(s)
- Pradeepa Nayak
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India; Centre for Comprehensive Stroke Rehabilitation and Research (CCSRR), Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - Amreen Mahmood
- Department of Physiotherapy, Kasturba Medical College, Mangalore, India; Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - Senthil Kumaran D
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India; Centre for Comprehensive Stroke Rehabilitation and Research (CCSRR), Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - Manikandan Natarajan
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India; Centre for Comprehensive Stroke Rehabilitation and Research (CCSRR), Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - Bhaskaran Unnikrishnan
- Manipal Academy of Higher Education, Manipal, Karnataka, India; Department of Community Medicine, Kasturba Medical College, Mangalore, India.
| | - John M Solomon
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India; Centre for Comprehensive Stroke Rehabilitation and Research (CCSRR), Manipal Academy of Higher Education, Manipal, Karnataka, India.
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Han SC, Fu TC, Hsu CC, Huang SC, Lin HY, Wang JS. The validation of oxygen uptake efficiency slope in patients with stroke. Medicine (Baltimore) 2021; 100:e27384. [PMID: 34678866 PMCID: PMC8542132 DOI: 10.1097/md.0000000000027384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 09/14/2021] [Indexed: 01/05/2023] Open
Abstract
To evaluate the real aerobic capacity is difficult due to impaired limbs function in stroke patients. Oxygen uptake efficiency slope (OUES) could represent the aerobic capacity in submaximal exercise test. Hence, we designed this observational study to investigate the application of the OUES for evaluating aerobic capacity in these patients.Thirty-seven stroke patients were classified into 2 groups according to their Brunnstrom stage of affected lower limbs. Patients underwent cardiopulmonary exercise testing to assess cardiorespiratory fitness. Minute ventilation and oxygen consumption were measured, and OUES was calculated, compared with healthy reference values, and correlated with the peak oxygen consumption. The predictive validity of submaximal OUES was derived.Study participants' OUES (median 566.2 [IQR, 470.0-711.6]) was 60% of healthy reference values and correlated positively with the peak oxygen consumption (r = 0.835) (P < .01). The predictive validity of oxygen uptake efficiency slope at 50% of maximal exercise duration (OUES50) and oxygen uptake efficiency slope at 75% of maximal exercise duration (OUES75) for oxygen uptake efficiency slope at 100% of maximal exercise duration (OUES100) was 0.877 and 0.973, respectively (P < .01). The OUES50, OUES75, and OUES100 groups were not significantly different; agreement of submaximal and maximal OUES values was strong.OUES is a valuable submaximal index for evaluating cardiorespiratory fitness in stroke patients. Moderate-to-high concurrent validity of this parameter with peak oxygen consumption and the high predictive validity of OUES50 and OUES75 for OUES100 suggest maximal exercise testing in stroke patients who cannot reach maximal exercise is unnecessary.
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Affiliation(s)
- Sheng-Chieh Han
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Tieh-Cheng Fu
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Keelung, Taiwan
- Heart Failure Research Center, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Chin Hsu
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Keelung, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shu-Chun Huang
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Hsin-Yu Lin
- Department of Gerontological and Long-term Care Business, School of Nursing, Fooyin University, Taiwan
| | - Jong-Shyan Wang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Keelung, Taiwan
- Graduate Institute of Rehabilitation Science, Department of Physical Therapy, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Research Center for Chinese Herbal Medicine, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, Taiwan
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7
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Association between physical exercise and stroke recurrence among first-ever ischemic stroke survivors. Sci Rep 2021; 11:13372. [PMID: 34183726 PMCID: PMC8238988 DOI: 10.1038/s41598-021-92736-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 05/25/2021] [Indexed: 02/05/2023] Open
Abstract
The relationship between exercise and stroke recurrence is controversial. This study was designed to test whether an association exists between exercise and ischemic stroke recurrence in first-ever ischemic stroke survivors. Data were collected from January 2010 to June 2016. Baseline information was obtained during face-to-face interviews, and follow-up phone interviews were conducted every 3 months. Exercise type, frequency, intensity, and duration were recorded. Discrete-time survival analysis was used to determine the relationship between exercise and stroke recurrence. 760 first-ever ischemic stroke survivors who were able to exercise were enrolled. After adjusting for covariates, patients who exercised 3.5–7 h per week and more than 7 h per week had a lower relapse risk than patients who did not exercise (3.5–7: OR 0.415; > 7: OR 0.356). Moreover, if the fluctuation of exercise duration was over 4 h, the patients had a higher risk of stroke recurrence than those with variability of less than 2 h (OR 2.153, P = 0.013). Stroke survivors who engage in long-term regular mild exercise (more than 5 sessions per week and lasting on average 40 min per session) have a lower recurrence rate. Irregular exercise increases the risk of stroke recurrence.
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Gronek P, Boraczyński M, Haas AN, Adamczyk J, Pawlaczyk M, Czarny W, Clark CC, Czerniak U, Demuth A, Celka R, Wycichowska P, Gronek J, Król-Zielińska M. Body adaptation to Dance: A Gerontological Perspective. Aging Dis 2021; 12:902-913. [PMID: 34094650 PMCID: PMC8139205 DOI: 10.14336/ad.2020.1107] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/07/2020] [Indexed: 02/03/2023] Open
Abstract
A number of studies have investigated the effectiveness of dance in older adults in the context of healthy aging. Analysing results across studies is important to understand whether dance in older adults is an effective adjunctive intervention for the healthy aging. To summarize the current research results about the effectiveness of dance in older adults in the context of healthy aging, and to identify key areas for future research. The search was conducted in Web of Science, PubMed and Google Scholar databases, using the following search string and Boolean logic (‘AND’, ‘OR’) locating studies published between database inception and September 2018: Dance OR contemporary dance OR ballroom dance OR Latin dance OR standard dance OR hip-hop dance OR tango AND Cardiovascular OR circulation AND Emotion OR well-being OR blood pressure OR disease OR thrombosis OR vascular OR glucose OR blood OR cardiac OR mental OR heart rate. Two reviewers independently extracted studies data. Eight suitable publications were included. The results showed that dance promote improvements in cognitive parameters when compared to other types of exercise or no-exercise. Significant effects were found on some physiological parameters, even after a short intervention period. Dance proved to be able to assist older adults in the context of healthy aging. The improvements in the cognitive, physiological and motor control parameters are very relevant for this population, due to the impact in a better quality of life.
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Affiliation(s)
- Piotr Gronek
- 1Faculty of Sport Sciences, Poznan University of Physical Education, Poznan, Poland
| | - Michał Boraczyński
- 2Department of Public Health, Faculty of Health Sciences, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Aline Nogueira Haas
- 3School of Physical Education, Physiotherapy and Dance, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Jan Adamczyk
- 1Faculty of Sport Sciences, Poznan University of Physical Education, Poznan, Poland
| | - Mariola Pawlaczyk
- 4Department of Geriatric Medicine and Gerontology, Poznan University of Medical Sciences, Poznan, Poland
| | - Wojciech Czarny
- 5College of Medical Sciences, Institute of Physical Culture Studies, University of Rzeszow, Rzeszow, Poland
| | - Cain Ct Clark
- 6Faculty of Health and Life Sciences, Coventry University, Coventry, England
| | - Urszula Czerniak
- 7Department of Anthropology and Biometry, Faculty of Sport Science, Poznan University of Physical Education, Poznan, Poland
| | - Anna Demuth
- 7Department of Anthropology and Biometry, Faculty of Sport Science, Poznan University of Physical Education, Poznan, Poland
| | - Roman Celka
- 1Faculty of Sport Sciences, Poznan University of Physical Education, Poznan, Poland
| | - Paulina Wycichowska
- 1Faculty of Sport Sciences, Poznan University of Physical Education, Poznan, Poland
| | - Joanna Gronek
- 1Faculty of Sport Sciences, Poznan University of Physical Education, Poznan, Poland
| | - Magdalena Król-Zielińska
- 8Department of Physical Education and Lifelong Sports, Faculty of Sport Science, Poznan University of Physical Education, Poznan, Poland
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Strengthening the Case for Cluster Set Resistance Training in Aged and Clinical Settings: Emerging Evidence, Proposed Benefits and Suggestions. Sports Med 2021; 51:1335-1351. [PMID: 33983613 DOI: 10.1007/s40279-021-01455-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2021] [Indexed: 12/13/2022]
Abstract
Resistance training (RT) is a fundamental component of exercise prescription aimed at improving overall health and function. RT techniques such as cluster set (CS) configurations, characterized by additional short intra-set or inter-repetition rest intervals, have been shown to maintain acute muscular force, velocity, and 'power' outputs across a RT session, and facilitate positive longer-term neuromuscular adaptations. However, to date CS have mainly been explored from a human performance perspective despite potential for application in health and clinical exercise settings. Therefore, this current opinion piece aims to highlight emerging evidence and provide a rationale for why CS may be an advantageous RT technique for older adults, and across several neurological, neuromuscular, cardiovascular and pulmonary settings. Specifically, CS may minimize acute fatigue and adverse physiologic responses, improve patient tolerance of RT and promote functional adaptations (i.e., force, velocity, and power). Moreover, we propose that CS may be a particularly useful exercise rehabilitation technique where injury or illness, persistent fatigue, weakness and dysfunction exist. We further suggest that CS offer an alternative RT strategy that can be easily implemented alongside existing exercise/rehabilitation programs requiring no extra cost, minimal upskilling and/or time commitment for the patient and professional. In light of the emerging evidence and likely efficacy in clinical exercise practice, future research should move toward further direct investigation of CS-based RT in a variety of adverse health conditions and across the lifespan given the already demonstrated benefits in healthy populations.
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Nindorera F, Nduwimana I, Thonnard JL, Kossi O. Effectiveness of walking training on balance, motor functions, activity, participation and quality of life in people with chronic stroke: a systematic review with meta-analysis and meta-regression of recent randomized controlled trials. Disabil Rehabil 2021; 44:3760-3771. [PMID: 33715555 DOI: 10.1080/09638288.2021.1894247] [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] [Indexed: 12/14/2022]
Abstract
PURPOSE To review and quantify the effects of walking training for the improvement of various aspects of physical function of people with chronic stroke. METHODS We conducted a systematic search and meta-analysis of randomized controlled trials (RCTs) of chronic stroke rehabilitation interventions published from 2008 to 2020 in English or French. Of the 6476-screened articles collated from four databases, 15 RCTs were included and analyzed. We performed a meta-regression with the total training time as dependent variable in order to have a better understanding of how did the training dosage affect the effect sizes. RESULTS Treadmill walking training was more effective on balance and motor functions (standardized mean difference (SMD)=0.70[0.02, 1.37], p = 0.04) and 0.56[0.15, 0.96], p = 0.007 respectively). Overground walking training improved significantly walking endurance (SMD = 0.38[0.16, 0.59], p < 0.001), walking speed (MD = 0.12[0.05, 0.18], p < 0.001), participation (SMD = 0.35[0.02, 0.68], p = 0.04) and quality of life (SMD = 0.46[0.12, 0.80], p = 0.008). Aquatic training improved balance (SMD = 2.41[1.20, 3.62], p < 0.001). The Meta-regression analysis did not show significant effect of total training time on the effect sizes. CONCLUSION Treadmill and overground walking protocols consisting of ≥30 min sessions conducted at least 3 days per week for about 8 weeks are beneficial for improving motor impairments, activity limitations, participation, and quality of life in people with chronic stroke.Implications for rehabilitationTreadmill walking training is effective for improving balance and motor functions.Overground walking training improved significantly walking endurance, walking speed, participation and quality of life.Treadmill and overground walking protocols consisting of ≥30 min sessions conducted at least 3 days per week for about 8 weeks are beneficial for improving motor impairments, activity limitations, participation, and quality of life in patient with chronic stroke.
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Affiliation(s)
- Félix Nindorera
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium.,National Center for Physical Therapy and Rehabilitation (CNRKR), Bujumbura, Burundi
| | - Ildephonse Nduwimana
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium.,National Center for Physical Therapy and Rehabilitation (CNRKR), Bujumbura, Burundi
| | - Jean Louis Thonnard
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium.,National Center for Physical Therapy and Rehabilitation (CNRKR), Bujumbura, Burundi
| | - Oyéné Kossi
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium.,Unité de NeuroRehabilitation, Service de Neurologie, Hospital Universitaire de Parakou, Parakou, Benin.,ENATSE (Ecole Nationale des Techniciens Supérieurs en Santé Publique et Surveillance Epidémiologique), Université de Parakou, Parakou, Benin
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11
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Cyr S, Guo DX, Marcil MJ, Dupont P, Jobidon L, Benrimoh D, Guertin MC, Brouillette J. Posttraumatic stress disorder prevalence in medical populations: A systematic review and meta-analysis. Gen Hosp Psychiatry 2021; 69:81-93. [PMID: 33582645 DOI: 10.1016/j.genhosppsych.2021.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/19/2021] [Accepted: 01/19/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE PTSD is increasingly recognized following medical traumas although is highly heterogeneous. It is difficult to judge which medical contexts have the most traumatic potential and where to concentrate further research and clinical attention for prevention, early detection and treatment. The objective of this study was to compare PTSD prevalence in different medical populations. METHODS A systematic review of the literature on PTSD following medical traumas was conducted as well as a meta-analysis with final pooled result and 95% confidence intervals presented. A meta-regression was used to investigate the impact of potential effect modifiers (PTSD severity, age, sex, timeline) on study effect size between prevalence studies. RESULTS From 3278 abstracts, the authors extracted 292 studies reporting prevalence. Using clinician-administered reports, the highest 24 month or longer PTSD prevalence was found for intraoperative awareness (18.5% [95% CI=5.1%-36.6%]) and the lowest was found for epilepsy (4.5% [95% CI=0.2%-12.6%]). In the overall effect of the meta-regression, only medical events or procedures emerged as significant (p = 0.006) CONCLUSION: This review provides clinicians with greater awareness of medical contexts most associated with PTSD, which may assist them in the decision to engage in more frequent, earlier screening and referral to mental health services.
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Affiliation(s)
- Samuel Cyr
- Research Center, Montreal Heart Institute, Montreal, Quebec, Canada; Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada
| | - De Xuan Guo
- Research Center, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Marie-Joëlle Marcil
- Research Center, Montreal Heart Institute, Montreal, Quebec, Canada; Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Patrice Dupont
- Health Sciences Library, Université de Montréal, Montreal, Quebec, Canada
| | - Laurence Jobidon
- Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - David Benrimoh
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Marie-Claude Guertin
- Montreal Health Innovations Coordinating Center, Montreal, Montreal, Quebec, Canada
| | - Judith Brouillette
- Research Center, Montreal Heart Institute, Montreal, Quebec, Canada; Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.
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Nayak P, Kumaran D S, Mahmood A, Manikandan N, Unnikrishnan B, Solomon JM. Feasibility of context-specific activities for improving physical activity levels among Indian adults with stroke. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2021. [DOI: 10.1080/21679169.2020.1866663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Pradeepa Nayak
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education (MAHE), Manipal, India
- Centre for Comprehensive Stroke Rehabilitation and Research (CCSRR), Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Senthil Kumaran D
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education (MAHE), Manipal, India
- Centre for Comprehensive Stroke Rehabilitation and Research (CCSRR), Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Amreen Mahmood
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education (MAHE), Manipal, India
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Natarajan Manikandan
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education (MAHE), Manipal, India
- Centre for Comprehensive Stroke Rehabilitation and Research (CCSRR), Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Bhaskaran Unnikrishnan
- Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - John M Solomon
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education (MAHE), Manipal, India
- Centre for Comprehensive Stroke Rehabilitation and Research (CCSRR), Manipal Academy of Higher Education (MAHE), Manipal, India
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Fahey M, Brazg G, Henderson CE, Plawecki A, Lucas E, Reisman DS, Schmit BD, Hornby TG. The Value of High Intensity Locomotor Training Applied to Patients With Acute-Onset Neurologic Injury. Arch Phys Med Rehabil 2020; 103:S178-S188. [PMID: 33383032 DOI: 10.1016/j.apmr.2020.09.399] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/31/2020] [Accepted: 09/17/2020] [Indexed: 11/02/2022]
Abstract
Long-standing research in animal models and humans with stroke or incomplete spinal cord injury (iSCI) indicate that specific physical training variables, such as the specificity and amount of practice, may influence neurologic recovery and locomotor function. More recent data highlight the contributions of exercise intensity, as estimated indirectly by cardiovascular exertion, as potentially more important than previously considered. The effects of exercise intensity are well described in neurologically intact individuals, although confusion regarding the definitions of intensity and safety concerns have limited its implementation during physical rehabilitation of patients with neurologic injury. The purpose of this review is to delineate some of the evidence regarding the effects of exercise intensity during locomotor training in patients with stroke and iSCI. We provide specific definitions of exercise intensity used within the literature, describe methods used to ensure appropriate levels of exertion, and discuss potential adverse events and safety concerns during its application. Further details on the effects of locomotor training intensity on clinical outcomes, and on neuromuscular and cardiovascular function will be addressed as available. Existing literature across multiple studies and meta-analyses reveals that exercise training intensity is likely a major factor that can influence locomotor function after neurologic injury. To extend these findings, we describe previous attempts to implement moderate to high intensity interventions during physical rehabilitation of patients with neurologic injury, including the utility of specific strategies to facilitate implementation, and to navigate potential barriers that may arise during implementation efforts.
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Affiliation(s)
- Meghan Fahey
- Rehabilitation Institute of Chicago, Chicago, IL
| | | | - Christopher E Henderson
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN; Rehabilitation Hospital of Indiana, Indianapolis, IN
| | | | - Emily Lucas
- Rehabilitation Hospital of Indiana, Indianapolis, IN
| | - Darcy S Reisman
- Department of Physical Therapy, University of Delaware, Newark, DE
| | - Brian D Schmit
- Department of Biomedical Engineering, Marquette University, Milwaukee, WI
| | - T George Hornby
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN; Rehabilitation Hospital of Indiana, Indianapolis, IN.
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Barzideh A, Marzolini S, Danells C, Jagroop D, Huntley AH, Inness EL, Mathur S, Mochizuki G, Oh P, Mansfield A. Effect of reactive balance training on physical fitness poststroke: study protocol for a randomised non-inferiority trial. BMJ Open 2020; 10:e035740. [PMID: 32606059 PMCID: PMC7328813 DOI: 10.1136/bmjopen-2019-035740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Regular exercise is essential in the chronic phase of stroke recovery for improving or maintaining function, and reducing the risk of a second stroke. To achieve these goals, multiple components of fitness should be targeted with poststroke exercise, including aerobic capacity, strength and balance. However, following the recommended frequency and duration of each component separately can take a long time and lead to fatigue in people with stroke. Therefore, finding types of exercise that target multiple components of fitness all together is valuable.Reactive balance training (RBT) is a novel type of exercise where individuals repeatedly lose their balance in order to practise balance reactions. When people do RBT, they increase their heart rate and exert forces with their leg muscles which could improve aerobic fitness and muscle strength, respectively. This means that RBT could have the potential to improve multiple components of fitness, simultaneously. METHODS AND ANALYSIS This is a randomised controlled non-inferiority trial with internal pilot study. Participants with chronic stroke will be randomly assigned to one of two groups: (1) RBT or (2) aerobic and strength training (AST). Participants in both groups will complete 1 hour of exercise, three times/week for 12 weeks. The primary objective is to determine the effect of RBT on aerobic capacity and knee muscles' strength. The secondary objective is to determine the effects of RBT and AST on balance control and balance confidence. We expect to find that RBT is superior to AST in terms of improving balance control and balance confidence, yet not inferior to AST in terms of its effects on aerobic capacity and strength. ETHICS AND DISSEMINATION Research ethics approval has been received. Results will be disseminated directly to study participants at the end of the trial, and to other stakeholders via publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT04042961.
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Affiliation(s)
- Azadeh Barzideh
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Susan Marzolini
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Cynthia Danells
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - David Jagroop
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Andrew H Huntley
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Elizabeth L Inness
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Sunita Mathur
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | | | - Paul Oh
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Avril Mansfield
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Evaulative Clinical Sciences, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
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Dam SL, Rhind DJA. The perceived benefits of community-based group exercise sessions for survivors of stroke. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2020. [DOI: 10.12968/ijtr.2016.0049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background/aims Post-stroke physical disability, cognitive impairment and emotional trauma can adversely affect the wellbeing of people who have survived stroke. Active participation in group exercise programmes has been advocated as an intervention to potentially enhance wellbeing. This study adopted a qualitative approach to explore the experiences of survivors of stroke who were participating in ongoing community-based group exercise sessions and their impact on subjective wellbeing. Methods Interviews were conducted with 12 participants from four community-based group exercise sessions. Of these, 6 were survivors of stroke (44–60 years) and the remaining 6 participants comprised caregivers, group coordinators and/or instructors, who were closely involved with sessions attended by the stroke survivors. Results Thematic analysis revealed that participation in community-based group exercise sessions offered survivors opportunities for building confidence; enhancing motivation; improving physical ability of affected limbs; enhancing interpersonal relationships; and providing support and knowledge. Participants all agreed that these physical and psychosocial benefits contributed to improved wellbeing and this supported previous research on the benefits of group work. Conclusions Participants explained how community-based group exercise sessions had facilitated their recovery journey and hence it is recommended that such programmes are made available, accessible and affordable to survivors of stroke.
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Affiliation(s)
- Seshnee L Dam
- Sport and Exercise Psychology, Brunel University London, Uxbridge, UK
- Sport and Exercise Psychology, Liverpool John Moores University, Liverpool, UK
| | - Daniel JA Rhind
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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Abstract
Stroke is a leading cause of mortality and morbidity all around the world. Identification of stroke risk factors and protective lifestyles is necessary for optimizing personalized treatment and reducing mortality. Sedentary lifestyle is a well-known modifiable risk factor in primary and secondary stroke prevention. Also, in recent years, exercise has been described as a neuroprotective and neuroreparative factor. Here we summarized the existing available evidence of the relationship between physical activity and stroke.
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Affiliation(s)
- Carmen García-Cabo
- Stroke Unit, Department of Neurology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Elena López-Cancio
- Stroke Unit, Department of Neurology, Hospital Universitario Central de Asturias, Oviedo, Spain
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17
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Kelly C, Meyer J, Hanks V, Barefield C. Neurorehabilitation for an individual with bilateral thalamic stroke and preexisting visual impairment presenting with impaired use of sensory cues: a case report. Physiother Theory Pract 2019; 37:1139-1145. [PMID: 31657267 DOI: 10.1080/09593985.2019.1683920] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Impaired balance is one of the primary causes of functional limitations. Related to sensory deficits specifically, balance disorder in stroke may be caused by decreased central integration of sensory cues, including somatosensory, visual and vestibular input.Case Presentation: This case describes a 23-year-old male with bilateral thalamic stroke following surgical resection of a recurring optic nerve meningioma. He had a complex medical history and is legally blind. He presented to outpatient neurorehabilitation 5 months following his stroke. He demonstrated absent light touch sensation and absent proprioception and kinesthetic awareness in his upper extremities, lower extremities, and trunk. Secondary to absent proprioception and vision and significant impairments related to shunt malfunction, he required total assistance for all mobility at initial examination.Discussion: After 8 months of intensive rehabilitation, he demonstrated substantial improvements in all functional mobility and recovery of sensation. Rehabilitation included interventions such as electrical stimulation, fluidotherapy, repetitive task training, and most significantly, external augmented feedback. This feedback included sensory cues, auditory and tactile cues, and maximizing the use of vestibular input. This case demonstrates that neurorehabilitation can benefit patients with impaired use of sensory cues and central integration.
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Affiliation(s)
- Christina Kelly
- Pi Beta Phi Rehabilitation Institute, Vanderbilt University Medical Center, Nashville, TN, USA.,Physical Therapy Department, Daemen College, Amherst, NY, USA
| | - Jen Meyer
- Pi Beta Phi Rehabilitation Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Valery Hanks
- Pi Beta Phi Rehabilitation Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christy Barefield
- Pi Beta Phi Rehabilitation Institute, Vanderbilt University Medical Center, Nashville, TN, USA
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Improvement of Cognitive Function after Continuous Positive Airway Pressure Treatment for Subacute Stroke Patients with Obstructive Sleep Apnea: A Randomized Controlled Trial. Brain Sci 2019; 9:brainsci9100252. [PMID: 31557935 PMCID: PMC6826775 DOI: 10.3390/brainsci9100252] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 09/23/2019] [Accepted: 09/23/2019] [Indexed: 01/10/2023] Open
Abstract
Background: Obstructive sleep apnea (OSA) is common after stroke. Various studies on continuous positive airway pressure (CPAP) therapy for OSA after stroke have been published. However, there have been no studies from Korea and Asia. The present Korean study aimed to determine whether CPAP treatment during inpatient rehabilitation of stroke patients with sleep disorders, especially OSA, improves function, cognition, sleep quality, and daytime sleepiness. Methods: This single-blind randomized controlled study included 40 stroke patients with OSA between November 2017 and November 2018. The patients were divided into the CPAP treatment group (CPAP and rehabilitation; n = 20) and control group (only rehabilitation; n = 20). The intervention period was 3 weeks. The primary outcomes were function and cognition improvements, and the secondary outcomes were sleep-related improvements. Results: CPAP treatment started at an average of 4.6 ± 2.8 days after admission. Both groups showed improvements in stroke severity, function, and cognition after the 3-week intervention. However, after the intervention, the degree of change in attention and calculation was significantly higher in the CPAP treatment group than in the control group. Additionally, the improvements in sleep quality and daytime sleepiness were greater in the CPAP treatment group than in the control group. Conclusion: CPAP treatment can improve cognitive function, sleep quality, and daytime sleepiness, and it should be considered as part of the rehabilitation program for patients with stroke. Our findings might help in the treatment of stroke patients with OSA in Korea.
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Nayak P, Kumaran SD, Babu AS, Maiya AG, Solomon JM. Levels of physical activity and quality of life among community-dwelling adults with stroke in a developing country. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2019. [DOI: 10.1080/21679169.2019.1663927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Pradeepa Nayak
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Senthil D. Kumaran
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Abraham Samuel Babu
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Arun G. Maiya
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - John M. Solomon
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
- Centre for Comprehensive Stroke Rehabilitation and Research, Manipal Academy of Higher Education, Manipal, India
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Abstract
BACKGROUND AND PURPOSE Aerobic training (AT) is recommended for people after stroke, yet uptake and operationalization of AT in clinical practice in Canada have not been measured. We surveyed inclusion of structured AT and barriers to implementation in public inpatient/outpatient stroke rehabilitation programs across Canada. METHODS A Web-based questionnaire was sent to 89 stroke rehabilitation program leads. RESULTS Forty-six programs from 7 of 9 eligible Canadian provinces/territories completed the questionnaire. Seventy-eight percent of programs reported including AT, with most (75%) excluding participants with severe physical impairments, and 28% excluding those with coexisting cardiac conditions. A greater proportion of dedicated stroke rehabilitation programs prescribed AT, compared to nondedicated stroke units (68.8% vs 31.3%, P = 0.02). The top 2 challenges for programs that included and did not include AT were "insufficient time within therapy sessions" and "length of stay in rehabilitation." Programs that did not include AT ranked "not a goal of most patients" and "not an organizational/program priority" as third and fourth, whereas they were ranked eighth and thirteenth by programs with AT. Best practice recommendations were inconsistently followed for conducting preparticipation exercise testing (36.1%) and for monitoring patients from higher-risk populations, specifically people with diabetes at risk for hypoglycemia (78.8%) and hypertension (36.6%). Of programs conducting preparticipation exercise testing, 91% did not monitor electrocardiography. DISCUSSION AND CONCLUSIONS Most stroke rehabilitation programs across Canada include AT. People with severe physical impairment and those with cardiac, metabolic, and hemodynamic comorbidities may be excluded or not appropriately monitored during exercise. More detailed guidelines and training practices are needed to address these challenges.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A233).
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Ofori EK, Subramaniam S, Wang S, Bhatt T. Kinematic analysis of dance-based exergaming: effect of song pace on center of mass and joint mobility. J Phys Ther Sci 2019; 31:708-716. [PMID: 31631943 PMCID: PMC6751052 DOI: 10.1589/jpts.31.708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 05/15/2019] [Indexed: 12/01/2022] Open
Abstract
[Purpose] To establish a quantitative kinematic assessment method for examining postural
stability and physical mobility during dance-based exergaming. [Participants and Methods]
Fifteen young adults participated in one session of dance-based exergaming assessment
using segments from Kinect ‘Just Dance 3’ consisting of slow-, medium-, and fast-paced
songs. A motion capture system was used to record full body kinematics, and a customized
MATLAB code was used to compute the variables of interest, such as center of mass sway
area, excursion, and peaks, as well as step count and joint excursions. [Results] Total
center of mass sway area and excursion were significantly greater for slow-paced (total
sway area=1,077.6 ± 209.9 cm2; total excursion=629.8 ± 380.5 cm) and fast-paced
(total sway area=314.1 ± 133.6 cm2; total excursion=478.5 ± 149.0 cm) songs
than for the medium-paced song (total sway area=212.9 ± 346.0 cm2; total
excursion=311.2 ± 119.5 cm). Joint excursion was greater for the knee (ranging from: (slow
to fast-paced songs: 55.5°–83.1°) and hip (slow to fast-paced: 40.6°–50.4°) than for the
ankle (slow to fast-paced: 32.2°–46.7°) for all three dance paces. Additionally, step
count was significantly, positively correlated with song pace (r=0.52). [Conclusion] The
current study was able to quantify and provide normative values for postural control and
joint mobility among healthy young adults during dance-based exergaming with 3 hip-hop
songs of different paces from the Microsoft Kinect ‘Just Dance 3’. The results indicated
that different paces (intensities) of dance songs corresponded to distinct movement
kinematic trends, particularly with slow-paced song having the maximum center of mass
excursion and lowest joint excursion, while fast-paced song exhibits the reverse, along
with medium-paced song exhibiting the highest hip and ankle joint angle excursions, while
the fast-paced song had increased knee joint angle excursions.
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Affiliation(s)
- Ernest Kwesi Ofori
- Department of Physical Therapy, University of Illinois at Chicago: 1919 W Taylor St., Chicago, Illinois 60612, USA
| | - Savitha Subramaniam
- Department of Physical Therapy, University of Illinois at Chicago: 1919 W Taylor St., Chicago, Illinois 60612, USA
| | - Shuaijie Wang
- Department of Physical Therapy, University of Illinois at Chicago: 1919 W Taylor St., Chicago, Illinois 60612, USA
| | - Tanvi Bhatt
- Department of Physical Therapy, University of Illinois at Chicago: 1919 W Taylor St., Chicago, Illinois 60612, USA
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Cherbuin N, Walsh EI. Sugar in mind: Untangling a sweet and sour relationship beyond type 2 diabetes. Front Neuroendocrinol 2019; 54:100769. [PMID: 31176793 DOI: 10.1016/j.yfrne.2019.100769] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 05/17/2019] [Accepted: 06/05/2019] [Indexed: 12/17/2022]
Abstract
It is widely recognised that type 2 diabetes (T2D) represents a major disease burden but it is only recently that its role in neurodegeneration has attracted more attention. This research has shown that T2D is associated with impaired cerebral health, cognitive decline and dementia. However, the impact on the brain of progressive metabolic changes associated with the pre-clinical development of the disease is less clear. The aim of this review is to comprehensively summarise how the emergence of risk factors and co-morbid conditions linked to the development of T2D impact cerebral health. Particular attention is directed at characterising how normal but elevated blood glucose levels in individuals without T2D contribute to neurodegenerative processes, and how the main risk factors for T2D including obesity, physical activity and diet modulate these effects. Where available, evidence from the animal and human literature is contrasted, and sex differences in risk and outcomes are highlighted.
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Affiliation(s)
- Nicolas Cherbuin
- Centre for Research on Ageing, Health and Wellbeing, Australian National University, Canberra, Australia.
| | - Erin I Walsh
- Centre for Research on Ageing, Health and Wellbeing, Australian National University, Canberra, Australia
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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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Omon K, Hara M, Ishikawa H. Virtual Reality-guided, Dual-task, Body Trunk Balance Training in the Sitting Position Improved Walking Ability without Improving Leg Strength. Prog Rehabil Med 2019; 4:20190011. [PMID: 32789258 PMCID: PMC7365233 DOI: 10.2490/prm.20190011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 05/19/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Virtual reality (VR) technology has been recently introduced in a variety of clinical settings, such as physical, occupational, cognitive, and psychological rehabilitation or training. However, the clinical efficacy of VR rehabilitation compared with traditional training techniques remains to be elucidated. CASE A 90-year-old man underwent VR-guided, dual-task, body trunk balance training in the sitting position using a newly developed medical device (mediVR KAGURA, mediVR, Inc., Toyonaka, Japan) after his physical activity level had plateaued. The patient had difficulty in walking outside the hospital even after having undergone traditional physical training. VR-guided training was performed for 40 min every weekday for 2 weeks. Trunk balance training was performed using reaching tasks, and cognitive stimulation was designed to emulate the cognitive processing involved when walking in a city or town. After the VR-guided training, the patient's 6-min walk distance improved from 430 m to 500 m even though there had been no improvement in muscle strength of the lower extremities. Furthermore, the patient could successfully walk outside the hospital without falling or colliding with obstacles. DISCUSSION It is noteworthy that the patient's walking ability improved further by the addition of VR-guided, dual-task, trunk balance training carried out in the sitting position. This finding suggests several possible new approaches to overcoming walking disability. Walking requires lower-extremity muscle strength, postural balance, and dual-task processing. Currently, no effective quantitative methods have been identified for postural balance and dual-task training with the patient in the sitting position. Herein, we discuss the possible advantages of VR-guided rehabilitation over traditional training methods.
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Affiliation(s)
- Kyohei Omon
- Department of Rehabilitation, Eishinkai Kishiwada
Rehabilitation Hospital, Kishiwada, Japan
| | - Masahiko Hara
- Department of Medical Device Development, mediVR, Inc.,
Toyonaka, Japan
- Center for Community-based Healthcare Research and
Education, Shimane University, Izumo, Japan
| | - Hideo Ishikawa
- Hemoptysis and Pulmonary-Circulation Center, Eishinkai
Kishiwada Rehabilitation Hospital, Kishiwada, Japan
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Ngueleu AM, Blanchette AK, Maltais D, Moffet H, McFadyen BJ, Bouyer L, Batcho CS. Validity of Instrumented Insoles for Step Counting, Posture and Activity Recognition: A Systematic Review. SENSORS 2019; 19:s19112438. [PMID: 31141973 PMCID: PMC6603748 DOI: 10.3390/s19112438] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 05/23/2019] [Accepted: 05/24/2019] [Indexed: 11/16/2022]
Abstract
With the growing interest in daily activity monitoring, several insole designs have been developed to identify postures, detect activities, and count steps. However, the validity of these devices is not clearly established. The aim of this systematic review was to synthesize the available information on the criterion validity of instrumented insoles in detecting postures activities and steps. The literature search through six databases led to 33 articles that met inclusion criteria. These studies evaluated 17 different insole models and involved 290 participants from 16 to 75 years old. Criterion validity was assessed using six statistical indicators. For posture and activity recognition, accuracy varied from 75.0% to 100%, precision from 65.8% to 100%, specificity from 98.1% to 100%, sensitivity from 73.0% to 100%, and identification rate from 66.2% to 100%. For step counting, accuracies were very high (94.8% to 100%). Across studies, different postures and activities were assessed using different criterion validity indicators, leading to heterogeneous results. Instrumented insoles appeared to be highly accurate for steps counting. However, measurement properties were variable for posture and activity recognition. These findings call for a standardized methodology to investigate the measurement properties of such devices.
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Affiliation(s)
- Armelle M Ngueleu
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec City, QC G1M2S8, Canada.
| | - Andréanne K Blanchette
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec City, QC G1M2S8, Canada.
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, QC G1M2S8, Canada.
| | - Désirée Maltais
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec City, QC G1M2S8, Canada.
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, QC G1M2S8, Canada.
| | - Hélène Moffet
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec City, QC G1M2S8, Canada.
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, QC G1M2S8, Canada.
| | - Bradford J McFadyen
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec City, QC G1M2S8, Canada.
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, QC G1M2S8, Canada.
| | - Laurent Bouyer
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec City, QC G1M2S8, Canada.
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, QC G1M2S8, Canada.
| | - Charles S Batcho
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec City, QC G1M2S8, Canada.
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, QC G1M2S8, Canada.
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Howes T, Mahenderan N, Freene N. Cardiac Rehabilitation: Are People With Stroke or Transient Ischaemic Attack Being Included? A Cross-Sectional Survey. Heart Lung Circ 2019; 29:483-490. [PMID: 31053485 DOI: 10.1016/j.hlc.2019.03.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 03/05/2019] [Accepted: 03/27/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Cardiac rehabilitation (CR) may be an effective secondary prevention program for people with stroke or transient ischaemic attack (TIA). The aims of this study were to determine whether people with stroke or TIA were attending CR in Australia and if there were any barriers to attendance. METHODS An invitation to participate in an online survey was distributed between January and April 2018, via email, to 411 phase 2 CR coordinators located across Australia. These coordinators were identified through a publicly available directory. The survey contained questions on the demographics of CR programs and attendance of people with stroke or TIA. A Likert scale was used to investigate perceived barriers to CR for people with stroke or TIA. Descriptive statistics were completed for all survey responses except those from open text questions, which were analysed via an inductive qualitative approach. RESULTS In total, 149 CR coordinators responded who managed a total of 154 programs. The programs were primarily located in regional (40%) or metropolitan (31%) areas. Nearly 50% of programs were based in a public hospital-based gym/outpatient centre. Over 90% (n = 97/104) of coordinators reported that people with a primary diagnosis of stroke or TIA accounted for less than 2% of their patient population. Despite this, 52% of coordinators thought CR was an appropriate form of secondary prevention for people with stroke or TIA. The largest perceived barriers to attendance were safety (79%, n = 80/101), limited staff to patient ratio (76%, n = 77/101), integration difficulties (68%. n = 69/101) and a lack of referrals (66%, n = 67/101). CONCLUSION Few people with a primary diagnosis of stroke or TIA attend CR in Australia, despite over half of CR coordinators believing that CR is appropriate for this group. Cardiac rehabilitation may be particularly suitable for people with mild-stroke or TIA. However, further research is required.
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Affiliation(s)
- Tom Howes
- Physiotherapy, Faculty of Health, University of Canberra, Canberra, ACT, Australia.
| | - Niru Mahenderan
- Physiotherapy, Faculty of Health, University of Canberra, Canberra, ACT, Australia; Health Research Institute, University of Canberra, Canberra, ACT, Australia
| | - Nicole Freene
- Physiotherapy, Faculty of Health, University of Canberra, Canberra, ACT, Australia; Health Research Institute, University of Canberra, Canberra, ACT, Australia
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Hesam-Shariati N, Trinh T, Thompson-Butel AG, Shiner CT, Redmond SJ, McNulty PA. Improved Kinematics and Motor Control in a Longitudinal Study of a Complex Therapy Movement in Chronic Stroke. IEEE Trans Neural Syst Rehabil Eng 2019; 27:682-691. [DOI: 10.1109/tnsre.2019.2895018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Acute Effects of Assisted Cycling Therapy on Post-Stroke Motor Function: A Pilot Study. Rehabil Res Pract 2019; 2019:9028714. [PMID: 30906597 PMCID: PMC6393872 DOI: 10.1155/2019/9028714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 12/02/2018] [Accepted: 01/22/2019] [Indexed: 12/31/2022] Open
Abstract
Background Stroke is the most common cause of long-term disability in the United States (US). Assisted Cycling Therapy (ACT) at cadences of about 80 rpm has been associated with improvements in motor and clinical function in other clinical populations. The acute effects of ACT on motor function of persons with stroke have not been investigated. Objectives The primary purpose of this cross-over trial was to compare the effects of ACT, voluntary cycling (VC), and no cycling (NC) on upper (Box and Blocks Test) and lower extremity motor function (Lower Extremity Motor Coordination Test) in adults with chronic stroke (age: 60 ± 16 years; months since stroke: 96 ± 85). The secondary purpose was to examine average cycling cadence and ratings of perceived exertion as predictors of change in motor function following the exercise session. Methods Twenty-two participants (female = 6, male = 16) completed one 20-min session each of ACT (mean cadence = 79.5 rpm, VC (mean cadence = 51.5 rpm), and NC on separate days in quasi-counterbalanced fashion). Results Main effects of intervention did not differ between ACT and VC. Within-intervention analyses revealed significant (p < 0.05) pre- to posttest changes in all outcome measures for ACT but only in the Lower Extremity Motor Coordination Test on the non-paretic side for VC. Trend analyses revealed a positive relationship between average ACT cadences and improvements in upper and lower extremity motor function (p < 0.05). A positive relationship between average VC cadences and lower extremity function was also revealed (p < 0.05). Conclusion ACT and VC produced similar acute improvements in paretic and non-paretic lower extremity motor function whereas changes in upper extremity motor function were more limited. Faster cycling cadences seem to be associated with greater acute effects.
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Verdelho A, Madureira S, Correia M, Ferro JM, Rodrigues M, Gonçalves-Pereira M, Gonçalves M, Santos AC, Vilela P, Bárrios H, Borges M, Santa-Clara H. Impact of physical activity in vascular cognitive impairment (AFIVASC): study protocol for a randomised controlled trial. Trials 2019; 20:114. [PMID: 30744681 PMCID: PMC6371566 DOI: 10.1186/s13063-019-3174-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 01/02/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Cognitive impairment and cerebrovascular pathology are both frequent with ageing. Cognitive impairment due to vascular pathology of the brain, termed vascular cognitive impairment (VCI), is one of the most frequent causes of cognitive impairment in elderly subjects. Thus far, VCI has no specific pharmacological treatment. Recent observational studies have suggested a protective effect of physical activity in cognition, but adequate randomised controlled trials (RCT) are lacking. METHODS AFIVASC is a multi-centre randomised controlled trial, with a 6-month intervention treatment and an additional follow-up of 6 months, that aims to estimate the impact of 6 months of moderate intensity physical activity on cognition (the primary outcome) at 6 and 12 months in subjects with VCI. Participants are community dwellers with criteria for VCI without dementia or who have had previous stroke or transient ischaemic attack (TIA). Patients may be self-referred or referred from a medical appointment. After confirming the inclusion criteria, a run-in period of 1 month is conducted to access adherence; only after that are subjects randomly assigned (using a computerised program blinded to clinical details) to two groups (intervention group and best practice usual care group). The intervention consists of three physical activity sessions of 60 min each (two supervised and one unsupervised) per week. The primary outcome is measured by the presence or absence of decline in cognitive status. Secondary outcomes include changes in neuro-cognitive measures, quality of life, and functional and motor status. Primary and secondary outcomes are evaluated at 6 and 12 months by investigators blinded to both intervention and randomisation. A required sample size of 280 subjects was estimated. Statistical analyses will include regression analysis with repeated measures. The study was approved by the Ethics Committee for Health of Centro Hospitalar de Lisboa Norte (ref. no. 1063/13) and by the Ethics Committee for Health of Centro Hospitalar do Porto CHP (ref. no. 2016.055(049-DEFI/048-CES)). DISCUSSION We aim to show whether or not moderate physical activity has a beneficial impact on cognition, quality of life, motor, and functional status in people with vascular cognitive impairment, and to generate new insights on the applicability of implementing physical activity in this specific population. TRIAL REGISTRATION ClinicalTrials.gov, NCT03578614 July 6, 2018.
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Affiliation(s)
- Ana Verdelho
- Department of Neurosciences and Mental Health, Faculdade de Medicina, Centro Hospitalar Universitário Lisboa Norte Hospital de Santa Maria, Instituto de Medicina Molecular (IMM) and Instituto de Saúde Ambiental (ISAMB), Universidade de Lisboa, Avenida Professor Egas Moniz, 1649035 Lisbon, Portugal
| | - Sofia Madureira
- Department of Psychology, ISCTE-IUL, NOVA Medical School / Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Instituto de Medicina Molecular (IMM), Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Manuel Correia
- Neurology Service, Hospital de Santo António, Centro Hospitalar do Porto and Instituto de Ciências Biomédicas Abel Salazar (ICBAS), University of Porto, Porto, Portugal
| | - José Manuel Ferro
- Instituto de Medicina Molecular (IMM), Faculdade de Medicina, Universidade de Lisboa and Department of Neuroscience, Hospital de Santa Maria-CHLN, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Mário Rodrigues
- Instituto de Medicina Molecular (IMM), Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Manuel Gonçalves-Pereira
- CEDOC, Chronic Diseases Research Center, NOVA Medical School /Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Mafalda Gonçalves
- Instituto de Medicina Molecular (IMM), Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Ana Catarina Santos
- Instituto de Medicina Molecular (IMM), Faculdade de Medicina, Universidade de Lisboa and Dementia Unit, Hospital do Mar, Lisbon, Portugal
| | - Pedro Vilela
- Neuroradiology - Imaging Department, Hospital da Luz, Lisbon, Portugal
| | - Helena Bárrios
- NOVA Medical School, Universidade Nova de Lisboa, Portugal and Instituto de Medicina Molecular (IMM), Hospital do Mar Lisboa, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Mariana Borges
- Instituto de Medicina Molecular (IMM), Faculdade de Medicina, Universidade de Lisboa and Faculdade de Motricidade Humana,Universidade de Lisboa, Lisbon, Portugal
| | - Helena Santa-Clara
- Faculdade de Motricidade Humana, Universidade de Lisboa, CIPER – Centro Interdisciplinar de Estudo da Performance Humana, Lisbon, Portugal
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Nakayama S, Tolbert TJ, Nov O, Porfiri M. Social Information as a Means to Enhance Engagement in Citizen Science‐Based Telerehabilitation. J Assoc Inf Sci Technol 2018. [DOI: 10.1002/asi.24147] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Shinnosuke Nakayama
- Department of Mechanical and Aerospace Engineering New York University Tandon School of Engineering 6 MetroTech Center, Brooklyn NY 11201
| | - Tyrone J. Tolbert
- Department of Mechanical and Aerospace Engineering New York University Tandon School of Engineering 6 MetroTech Center, Brooklyn NY 11201
| | - Oded Nov
- Department of Technology Management and Innovation New York University Tandon School of Engineering 5 MetroTech Center, Brooklyn NY 11201
| | - Maurizio Porfiri
- Department of Mechanical and Aerospace Engineering and Department of Biomedical Engineering, New York University Tandon School of Engineering 6 MetroTech Center, Brooklyn NY 11201
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Derungs A, Schuster-Amft C, Amft O. Physical Activity Comparison Between Body Sides in Hemiparetic Patients Using Wearable Motion Sensors in Free-Living and Therapy: A Case Series. Front Bioeng Biotechnol 2018; 6:136. [PMID: 30386777 PMCID: PMC6199363 DOI: 10.3389/fbioe.2018.00136] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 09/12/2018] [Indexed: 11/27/2022] Open
Abstract
Background: Physical activity (PA) is essential in stroke rehabilitation of hemiparetic patients to avoid health risks, and moderate to vigorous PA could promote patients' recovery. However, PA assessments are limited to clinical environments. Little is known about PA in unguided free-living. Wearable sensors could reveal patients' PA during rehabilitation, and day-long long-term measurements over several weeks might reveal recovery trends of affected and less-affected body sides. Methods: We investigated PA in an observation study during outpatient rehabilitation in a day-care center. PA of affected and less-affected body sides, including upper and lower limbs were derived using wearable motion sensors. In this analysis we focused on PA during free-living and clinician guided therapies, and investigated differences between body-sides. Linear regressions were used to estimate metabolic equivalents for each limb at comparable scale. Non-parametric statistics were derived to quantify PA differences between body sides. Results: We analyzed 102 full-day movement data recordings from eleven hemiparetic patients during individual rehabilitation periods up to 79 days. The comparison between free-living and clinician guided therapy showed on average 16.1 % higher PA in the affected arm during therapy and 5.3 % higher PA in the affected leg during therapy. Average differences between free-living and therapy in the less-affected side were below 4.5 %. Conclusion: We analyzed PA of patients with a hemiparesis in two distinct rehabilitation settings, including free-living and clinician guided therapies over several weeks and compared MET values of affected and less-affected body sides. In particular, we investigated PA using individual regression models for each limb. We demonstrated that wearable motion sensors provide insights in patient's PA during rehabilitation. Although, no clear PA trends were found, our analysis showed patients' tendency to sedentary behavior, confirming previous lab study results. Our PA analysis approach could be used beyond clinical rehabilitation to devise personalized patient and limb-specific exercise recommendations in future remote rehabilitation.
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Affiliation(s)
- Adrian Derungs
- Lehrstuhl für Digital Health, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Corina Schuster-Amft
- Research Department, Reha Rheinfelden, Rheinfelden, Switzerland.,Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, Burgdorf, Switzerland.,Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Oliver Amft
- Lehrstuhl für Digital Health, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
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Hara M, Kitamura T, Murakawa Y, Shimba K, Yamaguchi S, Tamaki M. Safety and Feasibility of Dual-task Rehabilitation Program for Body Trunk Balance Using Virtual Reality and Three-dimensional Tracking Technologies. Prog Rehabil Med 2018; 3:20180016. [PMID: 32789241 DOI: 10.2490/prm.20180016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 10/15/2018] [Indexed: 01/27/2023] Open
Abstract
Objective The ability to walk is one of the most important basic functional activities of daily living, and the number of patients with walking disability who need rehabilitation is increasing worldwide. The purpose of this first-in-man study was to evaluate the safety and feasibility of an off-label, tailor-made, dual-task rehabilitation program for body trunk balance using the mediVR01 system (mediVR, Inc. Osaka, Japan), which incorporates virtual reality (VR) and three-dimensional tracking technologies. Methods We prospectively enrolled 31 healthy volunteers to take part in the trial (Trial Registration UMIN000029659). After an assessment of body trunk balance, a tailor-made, dual-task, rehabilitation training program lasting 10-15 min was provided. The primary endpoint was the postprocedural number of simulator sickness questionnaire (SSQ) symptoms. The secondary endpoints were adverse events and satisfaction with the program. Results The median age of participants was 68 years, with 67.7% being elderly (>65 years) and 54.8% being male. The number of SSQ symptoms immediately after the rehabilitation programs significantly increased from 0 (interquartile range 0-0) to 0 (0-1.5) (P=0.009), with a significant difference between the young and elderly participants (P-interaction<0.001). The most frequent symptom was sweating (22.6%), followed by fatigue (19.4%). All participants successfully completed the rehabilitation programs without significant adverse events such as fall or injuries. Moreover, all participants considered the VR rehabilitation programs to be enjoyable, and 93.5% of participants reported a sense of achievement. Group attendance was associated with higher levels of satisfaction (P=0.049). Conclusion The tailor-made, dual-task rehabilitation training programs for body trunk balance using VR and three-dimensional tracking technologies were safe and feasible even for elderly participants.
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Affiliation(s)
- Masahiko Hara
- Center for Community-based Healthcare Research and Education, Shimane University, Izumo, Japan.,Department of Medical Device Development, mediVR, Inc., Osaka, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yuichiro Murakawa
- Division of Stroke Rehabilitation, National Cerebral and Cardiovascular Center Hospital, Suita, Japan
| | - Kyosuke Shimba
- Department of Medical Device Development, mediVR, Inc., Osaka, Japan
| | - Shimpei Yamaguchi
- Department of Medical Device Development, mediVR, Inc., Osaka, Japan
| | - Masatake Tamaki
- Department of Medical Device Development, mediVR, Inc., Osaka, Japan
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Aggio D, Papachristou E, Papacosta O, Lennon LT, Ash S, Whincup PH, Wannamethee SG, Jefferis BJ. Twenty-Year Trajectories of Physical Activity Types from Midlife to Old Age. Med Sci Sports Exerc 2018; 51:481-489. [PMID: 30303936 DOI: 10.1249/mss.0000000000001802] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Correlates of physical activity (PA) vary according to type. However, predictors of long-term patterns of PA types into old age are unknown. This study aimed to identify 20-yr trajectories of PA types into old age and their predictors. METHODS Seven thousand seven hundred thirty-five men (age, 40-59 yr) recruited from UK towns in 1978 to 1980 were followed up after 12, 16, and 20 yr. Men reported participation in sport/exercise, recreational activity and walking, health status, lifestyle behaviors and socio-demographic characteristics. Group-based trajectory modeling identified the trajectories of PA types and associations with time-stable and time-varying covariates. RESULTS Men with ≥3 measures of sport/exercise (n = 5116), recreational activity (n = 5085) and walking (n = 5106) respectively were included in analyses. Three trajectory groups were identified for sport/exercise, four for recreational activity and three for walking. Poor health, obesity and smoking were associated with reduced odds of following a more favorable trajectory for all PA types. A range of socioeconomic, regional and lifestyle factors were also associated with PA trajectories but the magnitude and direction were specific to PA type. For example, men with manual occupations were less likely to follow a favorable sport/exercise trajectory but more likely to follow an increasing walking trajectory compared to men with nonmanual occupations. Retirement was associated with increased PA but this was largely due to increased sport/exercise participation. CONCLUSIONS Physical activity trajectories from middle to old age vary by activity type. The predictors of these trajectories and effects of major life events, such as retirement, are also specific to the type of PA.
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Affiliation(s)
- Daniel Aggio
- UCL Department of Primary Care & Population Health, UCL Medical School, Rowland Hill Street, London, UNITED KINGDOM.,UCL Physical Activity Research Group, London, UNITED KINGDOM
| | - Efstathios Papachristou
- Department of Psychology & Human Development, UCL Institute of Education, London, UNITED KINGDOM
| | - Olia Papacosta
- UCL Department of Primary Care & Population Health, UCL Medical School, Rowland Hill Street, London, UNITED KINGDOM
| | - Lucy T Lennon
- UCL Department of Primary Care & Population Health, UCL Medical School, Rowland Hill Street, London, UNITED KINGDOM
| | - Sarah Ash
- UCL Department of Primary Care & Population Health, UCL Medical School, Rowland Hill Street, London, UNITED KINGDOM
| | - Peter H Whincup
- Population Health Research Institute, St George's University of London, Cranmer Terrace, London, UNITED KINGDOM
| | - S Goya Wannamethee
- UCL Department of Primary Care & Population Health, UCL Medical School, Rowland Hill Street, London, UNITED KINGDOM
| | - Barbara J Jefferis
- UCL Department of Primary Care & Population Health, UCL Medical School, Rowland Hill Street, London, UNITED KINGDOM.,UCL Physical Activity Research Group, London, UNITED KINGDOM
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Magdon-Ismail Z, Ledneva T, Sun M, Schwamm LH, Sherman B, Qian F, Bettger JP, Xian Y, Stein J. Factors associated with 1-year mortality after discharge for acute stroke: what matters? Top Stroke Rehabil 2018; 25:576-583. [PMID: 30281414 DOI: 10.1080/10749357.2018.1499303] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To evaluate factors associated with 1-year mortality after discharge for acute stroke. METHODS In this retrospective cohort study, we studied 305 patients with ischemic stroke or intracerebral hemorrhage discharged in 2010/2011. We linked Get With The Guidelines®-Stroke clinical data with New York State administrative data and used multivariate regression models to examine variables related to 1-year all-cause mortality poststroke. RESULTS The mean age was 68.6 ± 14.8 years and 51.1% were women. A total of 146 (47.9%) were discharged directly home, 96 (31.5%) to inpatient rehabilitation facilities (IRFs), and 63 (20.7%) to skilled nursing facilities (SNFs). Overall, 24 (7.9%) patients died within 1-year post-discharge. Older age (adjusted odds ratio [OR] 1.05, 95% confidence interval [CI] 1.00-1.10), higher National Institutes of Health Stroke Scale (NIHSS) on admission (OR 1.10, 95% CI 1.03-1.17), and discharge destination (IRF vs. home, OR 0.10, 95% CI 0.01-0.94; and SNF vs. home, OR 2.22, 95% CI 0.71-6.95) were factors associated with 1-year all-cause mortality. When ambulation status at discharge was added to the model, ambulation with assistance and non-ambulation were significantly associated with mortality (ambulatory with assistance vs. ambulatory, OR 9.42, 95% CI 1.87-47.61; nonambulatory vs. ambulatory, OR 12.65, 95% CI 1.89-84.89). CONCLUSIONS While age and NIHSS on admission are important predictors of long-term outcomes, factors at discharge - ambulation status at discharge and discharge destination - are associated with 1-year mortality post-discharge for acute stroke and therefore could represent therapeutic targets to improve long-term survival in future studies.
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Affiliation(s)
- Zainab Magdon-Ismail
- a American Heart Association/American Stroke Association, Founders Affiliate , Albany , NY.,b School of Public Health , University at Albany, State University of New York , Rensselaer , NY
| | | | - Mingzeng Sun
- c The New York State Department of Health , Albany , NY
| | - Lee H Schwamm
- d Department of Neurology , Massachusetts General Hospital , Boston , MA.,e Harvard Medical School , Boston , MA
| | - Barry Sherman
- b School of Public Health , University at Albany, State University of New York , Rensselaer , NY
| | - Feng Qian
- b School of Public Health , University at Albany, State University of New York , Rensselaer , NY
| | | | - Ying Xian
- f Duke Clinical Research Institute , Durham , NC
| | - Joel Stein
- g Department of Rehabilitation and Regenerative Medicine , Columbia University College of Physicians and Surgeons , New York , NY.,h Department of Rehabilitation Medicine , Weill Cornell Medical College , New York , NY.,i New York-Presbyterian Hospital , New York , NY
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Marzolini S. Integrating Individuals With Stroke Into Cardiac Rehabilitation Following Traditional Stroke Rehabilitation: Promoting a Continuum of Care. Can J Cardiol 2018; 34:S240-S246. [PMID: 30201255 DOI: 10.1016/j.cjca.2018.06.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 06/25/2018] [Accepted: 06/26/2018] [Indexed: 12/29/2022] Open
Abstract
Following stroke, people are at high risk for repeat strokes and for complications related to coronary artery disease (CAD). Indeed, stroke and CAD share many of the same risk factors. Unfortunately, patients become sedentary after stroke, which leads to cardiorespiratory deconditioning as well as muscle atrophy and weakness that in turn leads to deterioration in metabolic, cardiorespiratory, and functional health. Access to intensive secondary prevention programs with structured exercise components that include both aerobic and resistance training can help to prevent and reverse these health hazards. Traditional stroke rehabilitation programs face many barriers to providing exercise programming early post-stroke, such as lack of available therapy time and short length of stay, lack of equipment for exercise and assessments, and concerns for patient safety related to cardiac status. Building a partnership between traditional stroke rehabilitation programs and cardiac rehabilitation by operationalizing an automatic referral process has the potential to affect secondary prevention of stroke and cardiovascular risk significantly. It could also mitigate the tremendous burden on patients and their family members. This is an easily identified group that can achieve significant gains over multiple domains of recovery with the targeted exercise and risk-factor modification components offered by comprehensive cardiac rehabilitation programs.
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Affiliation(s)
- Susan Marzolini
- Toronto Rehab-University Health Network, Toronto, Ontario, Canada.
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36
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Mohanty R, Sinha AM, Remsik AB, Dodd KC, Young BM, Jacobson T, McMillan M, Thoma J, Advani H, Nair VA, Kang TJ, Caldera K, Edwards DF, Williams JC, Prabhakaran V. Machine Learning Classification to Identify the Stage of Brain-Computer Interface Therapy for Stroke Rehabilitation Using Functional Connectivity. Front Neurosci 2018; 12:353. [PMID: 29896082 PMCID: PMC5986965 DOI: 10.3389/fnins.2018.00353] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 05/07/2018] [Indexed: 01/19/2023] Open
Abstract
Interventional therapy using brain-computer interface (BCI) technology has shown promise in facilitating motor recovery in stroke survivors; however, the impact of this form of intervention on functional networks outside of the motor network specifically is not well-understood. Here, we investigated resting-state functional connectivity (rs-FC) in stroke participants undergoing BCI therapy across stages, namely pre- and post-intervention, to identify discriminative functional changes using a machine learning classifier with the goal of categorizing participants into one of the two therapy stages. Twenty chronic stroke participants with persistent upper-extremity motor impairment received neuromodulatory training using a closed-loop neurofeedback BCI device, and rs-functional MRI (rs-fMRI) scans were collected at four time points: pre-, mid-, post-, and 1 month post-therapy. To evaluate the peak effects of this intervention, rs-FC was analyzed from two specific stages, namely pre- and post-therapy. In total, 236 seeds spanning both motor and non-motor regions of the brain were computed at each stage. A univariate feature selection was applied to reduce the number of features followed by a principal component-based data transformation used by a linear binary support vector machine (SVM) classifier to classify each participant into a therapy stage. The SVM classifier achieved a cross-validation accuracy of 92.5% using a leave-one-out method. Outside of the motor network, seeds from the fronto-parietal task control, default mode, subcortical, and visual networks emerged as important contributors to the classification. Furthermore, a higher number of functional changes were observed to be strengthening from the pre- to post-therapy stage than the ones weakening, both of which involved motor and non-motor regions of the brain. These findings may provide new evidence to support the potential clinical utility of BCI therapy as a form of stroke rehabilitation that not only benefits motor recovery but also facilitates recovery in other brain networks. Moreover, delineation of stronger and weaker changes may inform more optimal designs of BCI interventional therapy so as to facilitate strengthened and suppress weakened changes in the recovery process.
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Affiliation(s)
- Rosaleena Mohanty
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, United States.,Department of Electrical Engineering, University of Wisconsin-Madison, Madison, WI, United States
| | - Anita M Sinha
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, United States.,Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, United States
| | - Alexander B Remsik
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, United States.,Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, United States
| | - Keith C Dodd
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, United States.,Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, United States
| | - Brittany M Young
- Medical Scientist Training Program, University of Wisconsin-Madison, Madison, WI, United States.,Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI, United States
| | - Tyler Jacobson
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, United States.,Deparment of Psychology, University of Wisconsin-Madison, Madison, WI, United States
| | - Matthew McMillan
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, United States.,Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, United States
| | - Jaclyn Thoma
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, United States.,Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI, United States
| | - Hemali Advani
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, United States
| | - Veena A Nair
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, United States
| | - Theresa J Kang
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, United States
| | - Kristin Caldera
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, United States
| | - Dorothy F Edwards
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, United States
| | - Justin C Williams
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, United States
| | - Vivek Prabhakaran
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, United States.,Medical Scientist Training Program, University of Wisconsin-Madison, Madison, WI, United States.,Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI, United States.,Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, United States
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Marzolini S, Brooks D, Oh P, Jagroop D, MacIntosh BJ, Anderson ND, Alter D, Corbett D. Aerobic With Resistance Training or Aerobic Training Alone Poststroke: A Secondary Analysis From a Randomized Clinical Trial. Neurorehabil Neural Repair 2018; 32:209-222. [PMID: 29600726 DOI: 10.1177/1545968318765692] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Stroke is associated with muscle atrophy and weakness, mobility deficits, and cardiorespiratory deconditioning. Aerobic and resistance training (AT and RT) each have the potential to improve deficits, yet there is limited evidence on the utility of combined training. OBJECTIVE To examine the effects of AT+RT versus AT on physiological outcomes in chronic stroke with motor impairments. METHODS Participants (n = 73) were randomized to 6 months of AT (5 d/wk) or AT+RT (3 and 2 d/wk, respectively). Outcomes included those related to body composition by dual-energy X-ray absorptiometry, mobility (6-minute walk distance [6MWD], sit-to-stand, and stair climb performance), cardiorespiratory fitness (VO2peak, oxygen uptake at the ventilatory threshold [VO2VT]), and muscular strength. RESULTS A total of 68 (93.2%) participants (age, mean ± SD = 63.7 ± 11.9) completed the study. AT+RT and AT yielded similar and significant improvements in 6MWD (39.9 ± 55.6 vs 36.5 ± 63.7 m, P = .8), VO2peak (16.4% ± 43.8% vs 15.2% ± 24.7%, P = .9), sit-to-stand time (-2.3 ± 5.1 vs 1.02 ± 9.5 s, P = .05), and stair climb performance (8.2% ± 19.6% vs 7.5% ± 23%, P = .97), respectively. AT+RT produced greater improvements than AT alone for total body lean mass (1.23 ± 2.3 vs 0.27 ± 1.6 kg, P = .039), predominantly trunk ( P = .02) and affected-side limbs ( P = .04), VO2VT (19.1% ± 26.8% vs 10.5% ± 28.9%, P = .046), and upper- and lower-limb muscular strength ( P < .03, all except affected-side leg). CONCLUSION Despite being prescribed 40% less AT, AT+RT resulted in similar and significant improvement in mobility and VO2peak, superior improvements in VO2VT and muscular strength, and an almost 5-fold greater increase in lean mass compared with AT. RT is the most neglected exercise component following stroke but should be prescribed with AT for metabolic, cardiorespiratory, and strength recovery.
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Affiliation(s)
- Susan Marzolini
- 1 Toronto Rehab-University Health Network, Toronto, ON, Canada.,2 University of Toronto, Toronto, ON, Canada.,3 Canadian Partnership for Stroke Recovery
| | - Dina Brooks
- 1 Toronto Rehab-University Health Network, Toronto, ON, Canada.,2 University of Toronto, Toronto, ON, Canada.,3 Canadian Partnership for Stroke Recovery
| | - Paul Oh
- 1 Toronto Rehab-University Health Network, Toronto, ON, Canada.,3 Canadian Partnership for Stroke Recovery
| | - David Jagroop
- 1 Toronto Rehab-University Health Network, Toronto, ON, Canada.,4 University of Ontario Institute of Technology, Oshawa, ON, Canada
| | - Bradley J MacIntosh
- 3 Canadian Partnership for Stroke Recovery.,5 Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Nicole D Anderson
- 2 University of Toronto, Toronto, ON, Canada.,3 Canadian Partnership for Stroke Recovery.,6 Rotman Research Institute, Baycrest Health Sciences, Toronto, ON
| | - David Alter
- 1 Toronto Rehab-University Health Network, Toronto, ON, Canada.,7 Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Dale Corbett
- 3 Canadian Partnership for Stroke Recovery.,8 University of Ottawa, Ottawa, Canada
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Simić-Panić D, Bošković K, Milićević M, Rabi Žikić T, Cvjetković Bošnjak M, Tomašević-Todorović S, Jovićević M. The Impact of Comorbidity on Rehabilitation Outcome after Ischemic Stroke. Acta Clin Croat 2018; 57:5-15. [PMID: 30256006 PMCID: PMC6400340 DOI: 10.20471/acc.2018.57.01.01] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
SUMMARY – Comorbidity decreases survival but it still remains unknown to what extent functional recovery after ischemic stroke is affected. The aim of this research was to determine the prevalence of the most common comorbidities in patients with ischemic stroke and to examine their predictive value on the functional status and recovery. In order to obtain relevant information for this research, we conducted a prospective study over a two-year period. It included patients with acute/subacute ischemic stroke who had inhospital rehabilitation treatment in our institution. Functional status of the patients was evaluated by the following three aspects at the beginning and at the end of rehabilitation treatment: Rivermead Mobility Index was used for mobility, Barthel Index for independence in activities of daily living, and modified Rankin Scale for total disability. Modified Charlston Comorbidity Index was used to assess comorbidity. Multivariate analysis was applied to evaluate the impact of recorded comorbidities on the patient functional outcome. Independent predictors of rehabilitation success in our study were the value of modified Charlston Comorbidity Index, atrial fibrillation and myocardial infarction. Our study demonstrated that patients with more comorbidities had worse functional outcome after stroke, so it is important to consider the comorbidity status when planning the rehabilitation treatment.
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Affiliation(s)
| | - Ksenija Bošković
- Faculty of Medicine, University of Novi Sad, Department of Medical Rehabilitation, Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Marija Milićević
- Department of Neurology, Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Tamara Rabi Žikić
- Faculty of Medicine, University of Novi Sad, Department of Neurology, Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Mina Cvjetković Bošnjak
- Faculty of Medicine, University of Novi Sad, Department of Psychiatry, Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Snežana Tomašević-Todorović
- Faculty of Medicine, University of Novi Sad, Department of Medical Rehabilitation, Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Mirjana Jovićević
- Faculty of Medicine, University of Novi Sad, Department of Neurology, Clinical Center of Vojvodina, Novi Sad, Serbia
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Bernardes WL, Montenegro RA, Monteiro WD, de Almeida Freire R, Massaferri R, Farinatti P. Optimizing a Treadmill Ramp Protocol to Evaluate Aerobic Capacity of Hemiparetic Poststroke Patients. J Strength Cond Res 2018; 32:876-884. [PMID: 29466277 DOI: 10.1519/jsc.0000000000002297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Bernardes, WL, Montenegro, RA, Monteiro, WD, de Almeida Freire, R, Massaferri, R, and Farinatti, P. Optimizing a treadmill ramp protocol to evaluate aerobic capacity of hemiparetic poststroke patients. J Strength Cond Res 32(3): 876-884, 2018-A correct assessment of cardiopulmonary capacity is important for aerobic training within motor rehabilitation of poststroke hemiparetic patients (PSHPs). However, specific cardiopulmonary exercise testing (CPET) for these patients are scarce. We proposed adaptations in a protocol originally developed for PSHPs by Ovando et al. (CPET1). We hypothesized that our adapted protocol (CPET2) would improve the original test, by preventing early fatigue and increasing patients' peak performance. Eleven PSHPs (52 ± 14 years, 10 men) performed both protocols. CPET2 integrated changes in final speed (100-120% vs. 140% maximal speed in 10-m walking test), treadmill inclination (final inclination of 5 vs. 10%), and estimated test duration (10 vs. 8 minutes) to smooth the rate of workload increment of CPET1. Peak oxygen uptake (V[Combining Dot Above]O2peak) (20.3 ± 6.1 vs. 18.6 ± 5.0 ml·kg·min; p = 0.04), V[Combining Dot Above]O2 at gas exchange transition (V[Combining Dot Above]O2-GET) (11.5 ± 2.9 vs. 9.8 ± 2.0 ml·kg·min; p = 0.04), and time to exhaustion (10 ± 3 vs. 6 ± 2 minutes; p < 0.001) were higher in CPET2 than in CPET1. Slopes and intercepts of regressions describing relationships between V[Combining Dot Above]O2 vs. workload, heart rate vs. workload, and V[Combining Dot Above]O2 vs. heart rate were similar between CPETs. However, standard errors of estimates obtained for regressions between heart rate vs. workload (3.0 ± 1.3 vs. 3.8 ± 1.0 b·min; p = 0.004) and V[Combining Dot Above]O2 vs. heart rate (6.0 ± 2.1 vs. 4.8 ± 2.4 ml·kg·min; p = 0.05) were lower in CPET2 than in CPET1. In conclusion, the present adaptations in Ovando's CPET protocol increased exercise tolerance of PSHPs, eliciting higher V[Combining Dot Above]O2peak and V[Combining Dot Above]O2-GET, preventing earlier fatigue, and providing better physiological relationships along submaximal workloads.
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Affiliation(s)
- Wendell L Bernardes
- Graduate Program in Physical Activity Sciences, Salgado de Oliveira University, Rio de Janeiro, Brazil
| | - Rafael A Montenegro
- Laboratory of Physical Activity and Health Promotion, Institute of Physical Education and Sports, University of Rio de Janeiro State, Rio de Janeiro, Brazil.,Graduate Program in Clinical and Experimental Physiopathology, University of Rio de Janeiro State, Rio de Janeiro, Brazil
| | - Walace D Monteiro
- Graduate Program in Physical Activity Sciences, Salgado de Oliveira University, Rio de Janeiro, Brazil.,Laboratory of Physical Activity and Health Promotion, Institute of Physical Education and Sports, University of Rio de Janeiro State, Rio de Janeiro, Brazil
| | - Raul de Almeida Freire
- Laboratory of Physical Activity and Health Promotion, Institute of Physical Education and Sports, University of Rio de Janeiro State, Rio de Janeiro, Brazil
| | - Renato Massaferri
- Laboratory of Physical Activity and Health Promotion, Institute of Physical Education and Sports, University of Rio de Janeiro State, Rio de Janeiro, Brazil.,Graduate Program in Clinical and Experimental Physiopathology, University of Rio de Janeiro State, Rio de Janeiro, Brazil
| | - Paulo Farinatti
- Graduate Program in Physical Activity Sciences, Salgado de Oliveira University, Rio de Janeiro, Brazil.,Laboratory of Physical Activity and Health Promotion, Institute of Physical Education and Sports, University of Rio de Janeiro State, Rio de Janeiro, Brazil
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40
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Kaupp C, Pearcey GEP, Klarner T, Sun Y, Cullen H, Barss TS, Zehr EP. Rhythmic arm cycling training improves walking and neurophysiological integrity in chronic stroke: the arms can give legs a helping hand in rehabilitation. J Neurophysiol 2017; 119:1095-1112. [PMID: 29212917 DOI: 10.1152/jn.00570.2017] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Training locomotor central pattern-generating networks (CPGs) through arm and leg cycling improves walking in chronic stroke. These outcomes are presumed to result from enhanced interlimb connectivity and CPG function. The extent to which rhythmic arm training activates interlimb CPG networks for locomotion remains unclear and was assessed by studying chronic stroke participants before and after 5 wk of arm cycling training. Strength was assessed bilaterally via maximal voluntary isometric contractions in the legs and hands. Muscle activation during arm cycling and transfer to treadmill walking were assessed in the more affected (MA) and less affected (LA) sides via surface electromyography. Changes to interlimb coupling during rhythmic movement were evaluated using modulation of cutaneous reflexes elicited by electrical stimulation of the superficial radial nerve at the wrist. Bilateral soleus stretch reflexes were elicited at rest and during 1-Hz arm cycling. Clinical function tests assessed walking, balance, and motor function. Results show significant changes in function and neurophysiological integrity. Training increased bilateral grip strength, force during MA plantarflexion, and muscle activation. "Normalization" of cutaneous reflex modulation was found during arm cycling. There was enhanced activity in the dorsiflexor muscles on the MA side during the swing phase of walking. Enhanced interlimb coupling was shown by increased modulation of MA soleus stretch reflex amplitudes during arm cycling after training. Clinical evaluations showed enhanced walking ability and balance. These results are consistent with training-induced changes in CPG function and interlimb connectivity and underscore the need for arm training in the functional rehabilitation of walking after neurotrauma. NEW & NOTEWORTHY It has been suggested but not tested that training the arms may influence rehabilitation of walking due to activation of interneuronal patterning networks after stroke. We show that arm cycling training improves strength, clinical function, coordination of muscle activity during walking, and neurological connectivity between the arms and the legs. The arms can, in fact, give the legs a helping hand in rehabilitation of walking after stroke.
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Affiliation(s)
- Chelsea Kaupp
- Rehabilitation Neuroscience Laboratory, University of Victoria , Victoria, British Columbia , Canada.,Human Discovery Science, International Collaboration on Repair Discoveries (ICORD) , Vancouver, British Columbia , Canada.,Centre for Biomedical Research, University of Victoria , Victoria, British Columbia , Canada
| | - Gregory E P Pearcey
- Rehabilitation Neuroscience Laboratory, University of Victoria , Victoria, British Columbia , Canada.,Human Discovery Science, International Collaboration on Repair Discoveries (ICORD) , Vancouver, British Columbia , Canada.,Centre for Biomedical Research, University of Victoria , Victoria, British Columbia , Canada
| | - Taryn Klarner
- Rehabilitation Neuroscience Laboratory, University of Victoria , Victoria, British Columbia , Canada.,Human Discovery Science, International Collaboration on Repair Discoveries (ICORD) , Vancouver, British Columbia , Canada.,Centre for Biomedical Research, University of Victoria , Victoria, British Columbia , Canada
| | - Yao Sun
- Rehabilitation Neuroscience Laboratory, University of Victoria , Victoria, British Columbia , Canada.,Human Discovery Science, International Collaboration on Repair Discoveries (ICORD) , Vancouver, British Columbia , Canada.,Centre for Biomedical Research, University of Victoria , Victoria, British Columbia , Canada
| | - Hilary Cullen
- Rehabilitation Neuroscience Laboratory, University of Victoria , Victoria, British Columbia , Canada.,Human Discovery Science, International Collaboration on Repair Discoveries (ICORD) , Vancouver, British Columbia , Canada.,Centre for Biomedical Research, University of Victoria , Victoria, British Columbia , Canada
| | - Trevor S Barss
- Human Neurophysiology Laboratory, University of Alberta , Edmonton, Alberta , Canada
| | - E Paul Zehr
- Rehabilitation Neuroscience Laboratory, University of Victoria , Victoria, British Columbia , Canada.,Human Discovery Science, International Collaboration on Repair Discoveries (ICORD) , Vancouver, British Columbia , Canada.,Centre for Biomedical Research, University of Victoria , Victoria, British Columbia , Canada.,Division of Medical Sciences, University of Victoria , Victoria, British Columbia , Canada
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41
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Swatridge K, Regan K, Staines WR, Roy E, Middleton LE. The Acute Effects of Aerobic Exercise on Cognitive Control among People with Chronic Stroke. J Stroke Cerebrovasc Dis 2017; 26:2742-2748. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.06.050] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 06/27/2017] [Accepted: 06/28/2017] [Indexed: 11/26/2022] Open
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42
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Veerabhadrappa P, Schutte AE. Homocysteine and Nighttime Blood Pressure Dipping-Is There a Connection? Am J Hypertens 2017; 30:1151-1152. [PMID: 28985273 DOI: 10.1093/ajh/hpx141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 07/25/2017] [Indexed: 12/13/2022] Open
Affiliation(s)
| | - Aletta E Schutte
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
- South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
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43
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Gell NM, Mroz TM, Patel KV. Rehabilitation Services Use and Patient-Reported Outcomes Among Older Adults in the United States. Arch Phys Med Rehabil 2017; 98:2221-2227.e3. [DOI: 10.1016/j.apmr.2017.02.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 02/06/2017] [Accepted: 02/27/2017] [Indexed: 10/19/2022]
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44
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Worthington E, Hawkins L, Lincoln N, Drummond A. The day-to-day experiences of people with fatigue after stroke: Results from the Nottingham Fatigue After Stroke study. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2017. [DOI: 10.12968/ijtr.2017.24.10.449] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Esme Worthington
- Research Fellow, School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, UK
| | - Louise Hawkins
- Stroke Association Postgraduate Fellow, School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, UK
| | - Nadina Lincoln
- Professor of Clinical Psychology, School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, UK
| | - Avril Drummond
- Professor of Healthcare Research, School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, UK
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45
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Flück M, Bosshard R, Lungarella M. Cardiovascular and Muscular Consequences of Work-Matched Interval-Type of Concentric and Eccentric Pedaling Exercise on a Soft Robot. Front Physiol 2017; 8:640. [PMID: 28912726 PMCID: PMC5583980 DOI: 10.3389/fphys.2017.00640] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 08/15/2017] [Indexed: 11/23/2022] Open
Abstract
Eccentric types of endurance exercise are an acknowledged alternative to conventional concentric types of exercise rehabilitation for the cardiac patient, because they reduce cardiorespiratory strain due to a lower metabolic cost of producing an equivalent mechanical output. The former contention has not been tested in a power- and work-matched situation of interval-type exercise under identical conditions because concentric and eccentric types of exercise pose specific demands on the exercise machinery, which are not fulfilled in current practice. Here we tested cardiovascular and muscular consequences of work-matched interval-type of leg exercise (target workload of 15 sets of 1-min bipedal cycles of knee extension and flexion at 30 rpm with 17% of maximal concentric power) on a soft robotic device in healthy subjects by concomitantly monitoring respiration, blood glucose and lactate, and power during exercise and recovery. We hypothesized that interval-type of eccentric exercise lowers strain on glucose-related aerobic metabolism compared to work-matched concentric exercise, and reduces cardiorespiratory strain to levels being acceptable for the cardiac patient. Eight physically active male subjects (24.0 years, 74.7 kg, 3.4 L O2 min−1), which power and endurance performance was extensively characterized, completed the study, finalizing 12 sets on average. Average performance was similar during concentric and eccentric exercise (p = 0.75) but lower than during constant load endurance exercise on a cycle ergometer at 75% of peak aerobic power output (126 vs. 188 Watt) that is recommended for improving endurance capacity. Peak oxygen uptake (−17%), peak ventilation (−23%), peak cardiac output (−16%), and blood lactate (−37%) during soft robotic exercise were lower during eccentric than concentric exercise. Glucose was 8% increased after eccentric exercise when peak RER was 12% lower than during concentric exercise. Muscle power and RFD were similarly reduced after eccentric and concentric exercise. The results highlight that the deployed interval-type of eccentric leg exercise reduces metabolic strain of the cardiovasculature and muscle compared to concentric exercise, to recommended levels for cardio-rehabilitation (i.e., 50–70% of peak heart rate). Increases in blood glucose concentration indicate that resistance to contraction-induced glucose uptake after the deployed eccentric protocol is unrelated to muscle fatigue.
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Affiliation(s)
- Martin Flück
- Department of Orthopedics, University of ZurichZurich, Switzerland.,Zurich Center for Integrative Human Physiology, University of ZurichZurich, Switzerland
| | - Rebekka Bosshard
- Department of Orthopedics, University of ZurichZurich, Switzerland.,Department of Health Sciences and Technology, ETH ZurichZurich, Switzerland
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46
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Foster D. Neurologists should endorse active transportation for their patients. Neurol Clin Pract 2017; 7:372-376. [DOI: 10.1212/cpj.0000000000000377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 03/20/2017] [Indexed: 11/15/2022]
Abstract
AbstractIt has been well-established that social determinants prevent far more deaths than medical care. Both behavior and social circumstance are closely linked to transportation. The connection between health and transportation is both direct (pedestrian injury, for example) and indirect (commuting access to work leading to employer-based health insurance, for example). Thus, transportation policy and health policy are interrelated. Neurologists should join community partnerships to promote safe and healthy transportation options for all people but especially for their patients.
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47
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Loprinzi PD, Addoh O. Accelerometer-Determined Physical Activity and All-Cause Mortality in a National Prospective Cohort Study of Adults Post-Acute Stroke. Am J Health Promot 2017; 32:24-27. [PMID: 28718295 DOI: 10.1177/0890117117720061] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE No epidemiological study has examined the association of objectively measured physical activity with all-cause mortality among adults who have had a stroke, which was the purpose of this study. DESIGN Prospective. SETTING National Health and Nutrition Examination Survey 2003 to 2006. PARTICIPANTS One hundred eighty-four patients with stroke. MEASURES Physical activity assessed via accelerometry (ActiGraph 7164), with stroke assessed via self-report of physician diagnosis. Mortality was assessed via linkage with the National Death Index, with follow-up through 2011. ANALYSIS Cox proportional hazard model. RESULTS The median follow-up period was 71.96 months, with 13 241 person-months; 53 deaths occurred during this follow-up period. After adjustments, for every 60 min/d increase in total physical activity, adults who have had a stroke had a 28% (hazard ratio = 0.72; 95% confidence interval: 0.59-0.88) reduced risk of all-cause mortality. CONCLUSION Physical activity among stroke survivors is inversely associated with all-cause mortality.
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Affiliation(s)
- Paul D Loprinzi
- 1 Jackson Heart Study Vanguard Center of Oxford, Oxford, MS, USA.,2 Physical Activity Epidemiology Laboratory, Department of Health, Exercise Science and Recreation Management, The University of Mississippi, Oxford, MS, USA
| | - Ovuokerie Addoh
- 2 Physical Activity Epidemiology Laboratory, Department of Health, Exercise Science and Recreation Management, The University of Mississippi, Oxford, MS, USA
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Joseph C, Conradsson D, Hagströmer M, Lawal I, Rhoda A. Objectively assessed physical activity and associated factors of sedentary behavior among survivors of stroke living in Cape Town, South Africa. Disabil Rehabil 2017. [PMID: 28625084 DOI: 10.1080/09638288.2017.1338761] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE To investigate objectively measured physical activity in stroke survivors living in low-income areas of Cape Town, South Africa, specifically to: (a) describe the volume of daily physical activity and time spent in different intensity levels and (b) investigate the association of factors covering the International Classification of Functioning, Disability and Health with sedentary behavior. MATERIALS AND METHODS A cross-sectional design was used, where forty-five ambulatory community-dwelling stroke survivors participated. Volume and intensity of physical activity were assessed with accelerometers for three to five consecutive days. Personal and environmental factors, along with body function and activity, were captured. Multiple linear regression was used to investigate factors associated with the percentage of days spent sedentary. RESULTS The median number of steps per day was 2393, and of the average 703 minutes of wear time, 80% were spent in sedentary, 15% in light, and 5% in moderate-to-vigorous intensity physical activity. Age, stroke severity, and failing to receive outpatient rehabilitation were independently associated with sedentary, which, taken together, explained 52% of the variance. CONCLUSIONS Low volumes of physical activity and high amount of sedentary time emphasize the need to develop strategies that will increase physical activity. Providing outpatient rehabilitation in a systematic manner post-stroke is a potential target of health care programs in order to reduce sedentary behavior. Implications for rehabilitation Objectively measured physical activity among community-dwelling survivors of stroke in Cape Town, South Africa was low in volume, and the majority did not meet the recommendations of 150 minutes of at least moderate intensity physical activity. The majority of stroke survivors in South Africa spent most of their time sedentary, which could further increase the risk of cardiovascular impairments. Outpatient rehabilitation should be provided to all patients after stroke since it appears to reduce sedentary time.
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Affiliation(s)
- Conran Joseph
- a Physiotherapy Department , University of the Western Cape , Cape Town , South Africa.,b Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy , Karolinska Institutet , Stockholm , Sweden
| | - David Conradsson
- b Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy , Karolinska Institutet , Stockholm , Sweden.,c Functional Area Occupational Therapy & Physiotherapy , Allied Health Professionals Function, Karolinska University Hospital , Stockholm , Sweden
| | - Maria Hagströmer
- b Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy , Karolinska Institutet , Stockholm , Sweden.,c Functional Area Occupational Therapy & Physiotherapy , Allied Health Professionals Function, Karolinska University Hospital , Stockholm , Sweden
| | - Isa Lawal
- a Physiotherapy Department , University of the Western Cape , Cape Town , South Africa
| | - Anthea Rhoda
- a Physiotherapy Department , University of the Western Cape , Cape Town , South Africa
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The Interface of Clinical Decision-Making With Study Protocols for Knowledge Translation From a Walking Recovery Trial. J Neurol Phys Ther 2017; 41:59-67. [PMID: 27977522 DOI: 10.1097/npt.0000000000000158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Despite efforts to translate knowledge into clinical practice, barriers often arise in adapting the strict protocols of a randomized, controlled trial (RCT) to the individual patient. The Locomotor Experience Applied Post-Stroke (LEAPS) RCT demonstrated equal effectiveness of 2 intervention protocols for walking recovery poststroke; both protocols were more effective than usual care physical therapy. The purpose of this article was to provide knowledge-translation tools to facilitate implementation of the LEAPS RCT protocols into clinical practice. METHODS Participants from 2 of the trial's intervention arms: (1) early Locomotor Training Program (LTP) and (2) Home Exercise Program (HEP) were chosen for case presentation. The two cases illustrate how the protocols are used in synergy with individual patient presentations and clinical expertise. Decision algorithms and guidelines for progression represent the interface between implementation of an RCT standardized intervention protocol and clinical decision-making. OUTCOMES In each case, the participant presents with a distinct clinical challenge that the therapist addresses by integrating the participant's unique presentation with the therapist's expertise while maintaining fidelity to the LEAPS protocol. Both participants progressed through an increasingly challenging intervention despite their own unique presentation. SUMMARY Decision algorithms and exercise progression for the LTP and HEP protocols facilitate translation of the RCT protocol to the real world of clinical practice. The two case examples to facilitate translation of the LEAPS RCT into clinical practice by enhancing understanding of the protocols, their progression, and their application to individual participants.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A147).
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50
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Peters HT, Pisegna J, Faieta J, Page SJ. Functional Brain Stimulation in a Chronic Stroke Survivor With Moderate Impairment. Am J Occup Ther 2017; 71:7103190080p1-7103190080p6. [PMID: 28422634 DOI: 10.5014/ajot.2017.025247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To determine the impact of transcranial direct current stimulation (tDCS) combined with repetitive, task-specific training (RTP) on upper-extremity (UE) impairment in a chronic stroke survivor with moderate impairment. METHOD The participant was a 54-yr-old woman with chronic, moderate UE hemiparesis after a single stroke that had occurred 10 yr before study enrollment. She participated in 45-min RTP sessions 3 days/wk for 8 wk. tDCS was administered concurrent to the first 20 min of each RTP session. RESULTS Immediately after intervention, the participant demonstrated marked score increases on the UE section of the Fugl-Meyer Scale and the Motor Activity Log (on both the Amount of Use and the Quality of Movement subscales). CONCLUSION These data support the use of tDCS combined with RTP to decrease impairment and increase UE use in chronic stroke patients with moderate impairment. This finding is crucial, given the paucity of efficacious treatment approaches in this impairment level.
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Affiliation(s)
- Heather T Peters
- Heather T. Peters, MOT, OTR/L, is PhD Candidate, Department of Occupational Therapy and B.R.A.I.N. Laboratory, Ohio State University Medical Center, Columbus;
| | - Janell Pisegna
- Janell Pisegna, MOT, OTR/L, is Occupational Therapist, Licking Memorial Hospital, Newark, NJ
| | - Julie Faieta
- Julie Faieta, MOT, OTR/L, is PhD Student, Department of Occupational Therapy and B.R.A.I.N. Laboratory, Ohio State University Medical Center, Columbus
| | - Stephen J Page
- Stephen J. Page, PhD, MS, MOT, OTR/L, FAHA, FACRM, FAOTA, is Associate Professor, Department of Occupational Therapy and B.R.A.I.N. Laboratory, Ohio State University Medical Center, Columbus
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