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Lu K, Xu G, Li W, Huo C, Liu Q, Lv Z, Wang Y, Li Z, Fan Y. Frequency-specific functional connectivity related to the rehabilitation task of stroke patients. Med Phys 2019; 46:1545-1560. [PMID: 30675729 DOI: 10.1002/mp.13398] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 12/21/2018] [Accepted: 01/17/2019] [Indexed: 01/15/2023] Open
Abstract
PURPOSES Stroke survivors suffering from deficits in motor control typically show persistent motor symptoms and limited functional abilities, which affect their functional independence in daily life. Active rehabilitation training is commonly applied for stroke patients to recover from motor dysfunction. The global connectivity reflects the synchronization of cardiac and respiratory activities in the cerebral regions. However, the understanding of the patterns of frequency-specific global connectivity (GC) and functional connectivity (FC) when performing active rehabilitation training is still far from comprehensive. This study was conducted to investigate the brain network patterns of stroke patients while performing a four-limb linkage rehabilitation training using the functional near-infrared spectroscopy (fNIRS) method. METHODS Two groups of stroke patients (LH, left hemiplegia; RH, right hemiplegia) and one healthy group were recruited to participate in this study. The wavelet phase coherence (WPCO) method was used to calculate the frequency-specific GC and FC of the brain network in four frequency bands: I, 0.6-2 Hz; II, 0.145-0.6 Hz; III, 0.052-0.145 Hz; and IV, 0.021-0.052 Hz. RESULTS Results showed that the healthy group exhibited lower WPCO in the four frequency bands during the task state than during the resting state (P < 0.05). Interestingly, the stroke groups showed increased WPCO in the frequency band II during the task state than during the resting state (P < 0.05). Moreover, significantly lower WPCO values in the frequency bands III (P < 0.05) were found during task state in the RH and LH groups compared with the healthy group. The RH group showed increased WPCO values in the frequency band II during the task state compared with the healthy group (P < 0.05). In addition, the RH group showed increased WPCO in the frequency bands I (P < 0.05) and II (P < 0.05) than the LH group. Notably, the rehabilitation task did not induce significant changes in stroke groups in the frequency band IV, which implied the neurogenic activity. CONCLUSIONS The reductions in FC suggested that the brain impairments caused a disturbed neurovascular coupling regulation in stroke patients. Results in frequency band IV suggested that the limb movement rehabilitation task intrinsically may not produce remarkable effect on the neurogenic activity of stroke patients. Significant differences in WPCO between the LH and RH groups suggested that the rehabilitation task should be specifically designed for individual rehabilitation. The frequency-specific FC methods based on WPCO would provide a potential approach to quantitatively assess the effect of rehabilitation tasks.
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Affiliation(s)
- Kuan Lu
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, 100086, Beijing, China
| | - Gongcheng Xu
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, 100086, Beijing, China
| | - Wenhao Li
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, 100086, Beijing, China
| | - Congcong Huo
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids Beijing, Beijing, 100176, China
| | - Qianying Liu
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, 100086, Beijing, China
| | - Zeping Lv
- Rehabilitation Hospital, National Research Center for Rehabilitation Technical Aids, Beijing, 100176, China
| | - Yonghui Wang
- Qilu Hospital, ShanDong University, Jinan, 250061, China
| | - Zengyong Li
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids Beijing, Beijing, 100176, China.,Key Laboratory of Rehabilitation Aids Technology and System of the Ministry of Civil Affairs, Beijing, 100176, China
| | - Yubo Fan
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, 100086, Beijing, China.,Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids Beijing, Beijing, 100176, China.,Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, 100083, China
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Carey LM, Seitz RJ. Functional Neuroimaging in Stroke Recovery and Neurorehabilitation: Conceptual Issues and Perspectives. Int J Stroke 2016; 2:245-64. [DOI: 10.1111/j.1747-4949.2007.00164.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background In stroke, functional neuroimaging has become a potent diagnostic tool; opened new insights into the pathophysiology of ischaemic damage in the human brain; and made possible the assessment of functional–structural relationships in postlesion recovery. Summary of review Here, we give a critical account on the potential and limitation of functional neuroimaging and discuss concepts related to the use of neuroimaging for exploring the neurobiological and neuroanatomical mechanisms of poststroke recovery and neurorehabilitation. We identify and provide evidence for five hypotheses that functional neuroimaging can provide new insights into: adaptation occurs at the level of functional brain systems; the brain–behaviour relationship varies with recovery and over time; functional neuroimaging can improve our ability to predict recovery and select individuals for rehabilitation; mechanisms of recovery reflect different pathophysiological phases; and brain adaptation may be modulated by experience and specific rehabilitation. The significance and application of this new evidence is discussed, and recommendations made for investigations in the field. Conclusion Functional neuroimaging is an important tool to explore the mechanisms underlying brain plasticity and, thereby, to guide clinical research in neurorehabilitation.
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Affiliation(s)
- Leeanne M. Carey
- National Stroke Research Institute, Neurosciences Building, Heidelberg Heights, Vic., Australia
- School of Occupational Therapy, LaTrobe University, Bundoora, Vic., Australia
| | - Rüdiger J. Seitz
- National Stroke Research Institute, Neurosciences Building, Heidelberg Heights, Vic., Australia
- Institute of Advanced Study, La Trobe University, Bundoora, Vic., Australia
- Department of Neurology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
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de Oliveira Cacho R, Cacho EWA, Ortolan RL, Cliquet A, Borges G. Trunk restraint therapy: the continuous use of the harness could promote feedback dependence in poststroke patients: a randomized trial. Medicine (Baltimore) 2015; 94:e641. [PMID: 25816031 PMCID: PMC4554010 DOI: 10.1097/md.0000000000000641] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The objective of this study was to evaluate the long-term effects of the task-specific training with trunk restraint compared with the free one in poststroke reaching movements. The design was randomized trial. The setting was University of Campinas (Unicamp). Twenty hemiparetic chronic stroke patients were selected and randomized into 2 training groups: trunk restraint group (TRG) (reaching training with trunk restraint) and trunk free group (TFG) (unrestraint reaching). Twenty sessions with 45 minutes of training were accomplished. The patients were evaluated in pretreatment (PRE), posttreatment (POST) and 3 months after the completed training (RET) (follow-up). Main outcome measures were modified Ashworth scale, Barthel index, Fugl-Meyer scale, and kinematic analysis (movement trajectory, velocity, angles). A significant improvement, which maintained in the RET test, was found in the motor (P < 0.001) and functional (P = 0.001) clinical assessments for both groups. For trunk displacement, only TFG obtained a reduction statistical significance from PRE to the POST test (P = 0.002), supporting this result in the RET test. Despite both groups presenting a significant increase in the shoulder horizontal adduction (P = 0.003), only TRG showed a significant improvement in the shoulder (P = 0.001--PRE to POST and RET) and elbow (P = 0.038--PRE to RET) flexion extension, and in the velocity rate (P = 0.03--PRE to RET). The trunk restraint therapy showed to be a long-term effective treatment in the enhancement of shoulder and elbow active joint range and velocity rate but not in the maintenance of trunk retention. Trial registration: NCT02364141.
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Affiliation(s)
- Roberta de Oliveira Cacho
- From the Faculty of Health Science at Trairi - Federal University of Rio Grande do Norte (FACISA/UFRN) (RdOC, EWAC), Santa Cruz, RN; Department of Computer Engineering (RLO), Federal Institute of Education, Science and Technology of southern Minas (IFSULDEMINAS), Poços de Caldas, MG; Department of Electrical Engineering (AC), University of São Paulo - EESC/USP; Department of Orthopaedics and Traumatology (AC), Faculty of Medical Sciences, University of Campinas; and Department of Neurology and Neurosurgery (GB), Faculty of Medical Science, University of Campinas - UNICAMP, Campinas, SP, Brazil
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Wing K, Lynskey JV, Bosch PR. Whole-Body Intensive Rehabilitation Is Feasible and Effective in Chronic Stroke Survivors: A Retrospective Data Analysis. Top Stroke Rehabil 2015; 15:247-55. [DOI: 10.1310/tsr1503-247] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Soares AV, Woellner SS, Andrade CDS, Mesadri TJ, Bruckheimer AD, Hounsell MDS. The use of Virtual Reality for upper limb rehabilitation of hemiparetic Stroke patients. FISIOTERAPIA EM MOVIMENTO 2014. [DOI: 10.1590/0103-5150.027.003.ao01] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction The Stroke is a neurologic disturbs that leads to a serious impact to the functionality and the quality of life of the survivors. It is necessary to develop new tools with rehabilitation objectives, where the Virtual Reality (VR) is introduced as a useful therapeutic resource to the motor recovery, in an attractive and efficient way, restoring functions through adapted games. Objective Analyzing the therapeutic effects of the Virtual Reality (Serious Game) in the recovery of the upper limb in hemiparetic Stroke patients. Methods Quasi-experimental research type time series, there are three pre and three post-tests already accomplished around 20 VR sessions. In the assessments the following measurement instruments were used: Fugl-Meyer Scale – session of the upper limb (FMS - UL); Range of Motion (ROM) for flexion and abduction shoulder; Box and Block Test (BBT); Nine Holes and Peg Test (9HPT); the Nottingham Health Profile (NHP); and the Modified Ashworth Scale (MAS). Results Significant gains were observed in the FMS-UL tests, with increase of 25.6%; increase ROM of shoulder with 34.0% for abduction and 19% for flexion; BBT 25.0%; also reported improvement in quality of life by NHP; it did not occurred significant alterations for 9HPT nor in MAS. Conclusion Although the results found in this research are preliminary, they are indicative that the VR can contribute for the recovery of the upper limb in hemiparetic Stroke patients.
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Parker J, Mawson S, Mountain G, Nasr N, Zheng H. Stroke patients' utilisation of extrinsic feedback from computer-based technology in the home: a multiple case study realistic evaluation. BMC Med Inform Decis Mak 2014; 14:46. [PMID: 24903401 PMCID: PMC4070341 DOI: 10.1186/1472-6947-14-46] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 04/22/2014] [Indexed: 11/10/2022] Open
Abstract
Background Evidence indicates that post − stroke rehabilitation improves function, independence and quality of life. A key aspect of rehabilitation is the provision of appropriate information and feedback to the learner. Advances in information and communications technology (ICT) have allowed for the development of various systems to complement stroke rehabilitation that could be used in the home setting. These systems may increase the provision of rehabilitation a stroke survivor receives and carries out, as well as providing a learning platform that facilitates long-term self-managed rehabilitation and behaviour change. This paper describes the application of an innovative evaluative methodology to explore the utilisation of feedback for post-stroke upper-limb rehabilitation in the home. Methods Using the principles of realistic evaluation, this study aimed to test and refine intervention theories by exploring the complex interactions of contexts, mechanisms and outcomes that arise from technology deployment in the home. Methods included focus groups followed by multi-method case studies (n = 5) before, during and after the use of computer-based equipment. Data were analysed in relation to the context-mechanism-outcome hypotheses case by case. This was followed by a synthesis of the findings to answer the question, ‘what works for whom and in what circumstances and respects?’ Results Data analysis reveals that to achieve desired outcomes through the use of ICT, key elements of computer feedback, such as accuracy, measurability, rewarding feedback, adaptability, and knowledge of results feedback, are required to trigger the theory-driven mechanisms underpinning the intervention. In addition, the pre-existing context and the personal and environmental contexts, such as previous experience of service delivery, personal goals, trust in the technology, and social circumstances may also enable or constrain the underpinning theory-driven mechanisms. Conclusions Findings suggest that the theory-driven mechanisms underpinning the utilisation of feedback from computer-based technology for home-based upper-limb post-stroke rehabilitation are dependent on key elements of computer feedback and the personal and environmental context. The identification of these elements may therefore inform the development of technology; therapy education and the subsequent adoption of technology and a self-management paradigm; long-term self-managed rehabilitation; and importantly, improvements in the physical and psychosocial aspects of recovery.
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Affiliation(s)
- Jack Parker
- ScHARR, University of Sheffield, Innovation Centre, 217 Portobello, Sheffield S1 4DP, UK.
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The mirror neuron system in post-stroke rehabilitation. Int Arch Med 2013; 6:41. [PMID: 24134862 PMCID: PMC4016580 DOI: 10.1186/1755-7682-6-41] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 10/12/2013] [Indexed: 11/13/2022] Open
Abstract
Different treatments for stroke patients have been proposed; among them the mirror therapy and motion imagery lead to functional recovery by providing a cortical reorganization. Up today the basic concepts of the current literature on mirror neurons and the major findings regarding the use of mirror therapy and motor imagery as potential tools to promote reorganization and functional recovery in post-stroke patients. Bibliographic research was conducted based on publications over the past thirteen years written in English in the databases Scielo, Pubmed/MEDLINE, ISI Web of Knowledge. The studies showed how the interaction among vision, proprioception and motor commands promotes the recruitment of mirror neurons, thus providing cortical reorganization and functional recovery of post-stroke patients. We conclude that the experimental advances on Mirror Neurons will bring new rational therapeutic approaches to post-stroke rehabilitation.
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Parker J, Mawson S, Mountain G, Nasr N, Davies R, Zheng H. The provision of feedback through computer-based technology to promote self-managed post-stroke rehabilitation in the home. Disabil Rehabil Assist Technol 2013; 9:529-38. [PMID: 24131369 DOI: 10.3109/17483107.2013.845611] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Building on previous research findings, this article describes the development of the feedback interfaces for a Personalised Self-Managed Rehabilitation System (PSMrS) for home-based post-stroke rehabilitation using computer-based technology. METHOD Embedded within a realistic evaluative methodological approach, the development of the feedback interfaces for the PSMrS involved the incorporation of existing and emerging theories and a hybrid of health and social sciences research and user-centred design methods. RESULTS User testing confirmed that extrinsic feedback for home-based post-stroke rehabilitation through computer-based technology needs to be personalisable, accurate, rewarding and measurable. In addition, user testing also confirmed the feasibility of using specific components of the PSMrS. CONCLUSIONS A number of key elements are crucial for the development and potential utilisation of technology in what is an inevitable shift towards the use of innovative methods of delivering post-stroke rehabilitation. This includes the specific elements that are essential for the promotion of self-managed rehabilitation and rehabilitative behaviour change; the impact of the context on the mechanisms; and, importantly, the need for reliability and accuracy of the technology.
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Affiliation(s)
- Jack Parker
- School of Health and Related Research (ScHARR), Innovation Centre, University of Sheffield , Sheffield , UK and
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Bermudez i Badia S, Garcia Morgade A, Samaha H, Verschure PFMJ. Using a Hybrid Brain Computer Interface and Virtual Reality System to Monitor and Promote Cortical Reorganization through Motor Activity and Motor Imagery Training. IEEE Trans Neural Syst Rehabil Eng 2013. [DOI: 10.1109/tnsre.2012.2229295] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Parker J, Mountain G, Hammerton J. A review of the evidence underpinning the use of visual and auditory feedback for computer technology in post-stroke upper-limb rehabilitation. Disabil Rehabil Assist Technol 2011; 6:465-72. [PMID: 21314295 DOI: 10.3109/17483107.2011.556209] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To identify and review the evidence to determine the current scientific basis underpinning the use of visual and/or auditory feedback for computer technology in home-based upper-limb stroke rehabilitation. METHOD A systematic search was conducted using the following databases: CINAHL (EBSCO), MEDLINE (Ovid and CSA), PubMed, Science Direct (Elsevier) and Cochrane Library. Journals, book chapters and conference proceedings were also used in the systematic search. Relevant papers were critically appraised using the Critical Appraisal Skills Programme tool for randomised controlled trials/quantitative designs. RESULTS Four controlled trials were identified as being relevant. Although the evidence is scarce, existing findings suggest that extrinsic visual and auditory feedback may improve motor and functional performance. In addition, concurrent feedback, knowledge of performance, knowledge of results and explicit feedback may be key components in the promotion of improved performance. CONCLUSIONS There is a paucity of evidence to inform the development and the use of technological systems for home-based stroke rehabilitation and specifically how such systems might be developed to provide best forms of feedback in the absence of a therapist. Further work is required to first investigate the efficacy of visual and auditory feedback using technology systems and second to explore their utilisation with the end user.
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Affiliation(s)
- Jack Parker
- The Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, S10 2BP, UK.
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Baeten SA, van Exel NJA, Dirks M, Koopmanschap MA, Dippel DWJ, Niessen LW. Lifetime health effects and medical costs of integrated stroke services - a non-randomized controlled cluster-trial based life table approach. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2010; 8:21. [PMID: 21083901 PMCID: PMC2998455 DOI: 10.1186/1478-7547-8-21] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Accepted: 11/17/2010] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Economic evaluation of stroke services indicates that such services may lead to improved quality of life at affordable cost. The present study assesses lifetime health impact and cost consequences of stroke in an integrated service setting. METHODS The EDISSE study is a prospective non-randomized controlled cluster trial that compared stroke services (n = 151 patients) to usual care (n = 187 patients). Health status and cost trial-data were entered in multi-dimensional stroke life-tables. The tables distinguish four levels of disability which are defined by the modified Rankin scale. Quality-of-life scores (EuroQoL-5D), transition and survival probabilities are based on concurrent Dutch follow-up studies. Outcomes are quality-adjusted life years lived and lifetime medical cost by disability category. An economic analysis compares outcomes from a successful stroke service to usual care, by bootstrapping individual costs and effects data from patients in each arm. RESULTS Lifetime costs and QALYs after stroke depend on age-of-onset of first-ever stroke. Lifetime QALYs after stroke are 2.42 (90% CI - 0.49 - 2.75) for male patients in usual care and 2.75 (-0.61; 6.26) for females. Lifetime costs for men in the usual care setting are €39,335 (15,951; 79,837) and €42,944 (14,081; 95,944) for women. A comparison with the stroke service results in an ICER of €11,685 saved per QALY gained (€14,211 and €7,745 for men and women respectively). This stroke service is with 90% certainty cost-effective. CONCLUSIONS Our analysis shows the potential of large health benefits and cost savings of stroke services, taking a lifetime perspective, also in other European settings.
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Affiliation(s)
- Stefan A Baeten
- Netherlands Institute for Health Sciences, PO Box 2040, 3000 CA Rotterdam, The Netherlands
- Erasmus University, Department of Health Policy and Management (iBMG), PO Box 1738, 3000 DR Rotterdam, The Netherlands
- Erasmus University, Institute for Medical Technology Assessment (iMTA), PO Box 1738, 3000 DR Rotterdam, The Netherlands
| | - N Job A van Exel
- Erasmus University, Department of Health Policy and Management (iBMG), PO Box 1738, 3000 DR Rotterdam, The Netherlands
- Erasmus University, Institute for Medical Technology Assessment (iMTA), PO Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Maaike Dirks
- Erasmus Medical Centre, Department of Neurology, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Marc A Koopmanschap
- Erasmus University, Department of Health Policy and Management (iBMG), PO Box 1738, 3000 DR Rotterdam, The Netherlands
- Erasmus University, Institute for Medical Technology Assessment (iMTA), PO Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Diederik WJ Dippel
- Erasmus Medical Centre, Department of Neurology, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Louis W Niessen
- Erasmus University, Department of Health Policy and Management (iBMG), PO Box 1738, 3000 DR Rotterdam, The Netherlands
- School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, USA
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Isaac V, Stewart R, Krishnamoorthy ES. Caregiver Burden and Quality of Life of Older Persons With Stroke. J Appl Gerontol 2010. [DOI: 10.1177/0733464810369340] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This article reports a preliminary investigation in India of the association between caregiver burden and quality of life (QOL) in older persons with stroke after controlling for disability, depression, and sociodemographic factors. A cross-sectional analysis was carried out with 46 stroke patients attending a community hospital in India. The primary outcome variable was patient QOL assessed using the World Health Organization Quality of Life questionnaire–short form (WHOQOL-Bref). The primary explanatory variable was caregiver burden, assessed using the Zarit Inventory. Patient economic dissatisfaction ( F = 6.12, p = .04), patient depression ( F = 20.8, p < .001), and caregiver burden ( F = 7.36, p = .009) were found to be associated with lower patient QOL. Caregiver burden was independently associated with lower patient QOL after controlling for patient depression, disability, and economic dissatisfaction (standardized B coefficient = −0.28, p = .03). The level of caregiver burden was a significant correlate of QOL after stroke. Implications for future studies and practice are discussed.
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Kohler F, Schmitz-Rode T, Disselhorst-Klug C. Introducing a feedback training system for guided home rehabilitation. J Neuroeng Rehabil 2010; 7:2. [PMID: 20078852 PMCID: PMC2821380 DOI: 10.1186/1743-0003-7-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2008] [Accepted: 01/15/2010] [Indexed: 11/26/2022] Open
Abstract
As the number of people requiring orthopaedic intervention is growing, individualized physiotherapeutic rehabilitation and adequate postoperative care becomes increasingly relevant. The chances of improvement in the patients condition is directly related to the performance and consistency of the physiotherapeutic exercises. In this paper a smart, cost-effective and easy to use Feedback Training System for home rehabilitation based on standard resistive elements is introduced. This ensures high accuracy of the exercises performed and offers guidance and control to the patient by offering direct feedback about the performance of the movements. 46 patients were recruited and performed standard physiotherapeutic training to evaluate the system. The results show a significant increase in the patient's ability to reproduce even simple physiotherapeutic exercises when being supported by the Feedback Training System. Thus physiotherapeutic training can be extended into the home environment whilst ensuring a high quality of training.
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Affiliation(s)
- Fabian Kohler
- Dept of Rehabilitation- and Prevention Engineering, Institute of Applied Medical Engineering, RWTH Aachen University, Helmholtz Institute, Pauwelsstr 20, Aachen, 52074, Germany.
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Menniti FS, Ren J, Coskran TM, Liu J, Morton D, Sietsma DK, Som A, Stephenson DT, Tate BA, Finklestein SP. Phosphodiesterase 5A inhibitors improve functional recovery after stroke in rats: optimized dosing regimen with implications for mechanism. J Pharmacol Exp Ther 2009; 331:842-50. [PMID: 19729580 DOI: 10.1124/jpet.109.156919] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Phosphodiesterase 5A (PDE5A) inhibitors improve functional recovery after middle cerebral artery occlusion (MCA-o) in rats. We used the PDE5A inhibitor 3-(4-(2-hydroxyethyl)piperazin-1-yl)-7-(6-methoxypyridin-3-yl)-1-(2-propoxyethyl)pyrido[3,4-b]pyrazin-2(1H)-one hydrochloride (PF-5) to determine the timing, duration, and degree of inhibition that yields maximum efficacy. We also investigated the localization of PDE5A to determine the tissues and cells that would be targets for PDE5 inhibition and that may mediate efficacy. Nearly complete inhibition of PDE5A, starting 24 h after MCA-o and continued for 7 days, resulted in nearly complete recovery of sensorimotor function that was sustained for 3 months. Delaying administration until 72 h after MCA-o resulted in equivalent efficacy, whereas delaying treatment for 14 days was ineffective. Treatment for 7 days was equivalently efficacious to 28 or 84 days of treatment, whereas treatment for 1 day was less effective. In the normal forebrain, PDE5A immunoreactivity was prominent in smooth muscle of meningeal arteries and a few smaller blood vessels, with weak staining in a few widely scattered cortical neurons and glia. At 24 and 48 h after MCA-o, the number and intensity of blood vessel staining increased in the infarcted cortex and striatum. PDE5A immunoreactivity also was increased at 48 h in putative microglia in penumbra, whereas there was no change in staining of the scattered cortical neurons. Given the window for efficacy and the PDE5A distribution, we hypothesize that efficacy results from an effect on vasculature, and perhaps modulation of microglial function, both of which may facilitate recovery of neuronal function.
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Affiliation(s)
- Frank S Menniti
- Neuroscience Biology, Pfizer Global Research & Development, Groton, Connecticut, USA.
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Cauraugh JH, Kim SB, Summers JJ. Chronic Stroke Longitudinal Motor Improvements: Cumulative Learning Evidence Found in the Upper Extremity. Cerebrovasc Dis 2007; 25:115-21. [DOI: 10.1159/000112321] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2007] [Accepted: 07/31/2007] [Indexed: 01/17/2023] Open
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Stinear CM, Fleming MK, Barber PA, Byblow WD. Lateralization of motor imagery following stroke. Clin Neurophysiol 2007; 118:1794-801. [PMID: 17581773 DOI: 10.1016/j.clinph.2007.05.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2007] [Revised: 04/12/2007] [Accepted: 05/10/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Motor imagery may activate the primary motor cortex (M1) and promote functional recovery following stroke. We investigated whether the hemisphere affected by stroke affects performance and M1 activity during motor imagery. METHODS Twelve stroke patients (6 left, 6 right hemisphere) and eight healthy age-matched adults participated. Experiment 1 assessed the speed and ease of actual and imagined motor performance. Experiment 2 measured corticomotor excitability during imagined movement of each hand separately, and both hands together, using transcranial magnetic stimulation. RESULTS For control participants, imagined movements were performed more slowly than actual movements, and right-hand MEPs were facilitated when they imagined moving their right hand or both hands together. Patients reported being able to imagine movements with either hand, despite no measurable facilitation of MEPs in the stroke-affected hand. In left hemisphere patients, MEPs were facilitated in the left hand during imagery of the right hand and both hands together. In right hemisphere patients, motor imagery did not facilitate MEPs in either hand. CONCLUSIONS Motor imagery does not appear to facilitate the ipsilesional M1 following stroke. SIGNIFICANCE Motor imagery may play a role in rehabilitating movement planning, but its role in directly facilitating corticomotor output appears limited.
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Affiliation(s)
- Cathy M Stinear
- Department of Sport & Exercise Science, Movement Neuroscience Laboratory, University of Auckland, and Department of Neurology, Auckland City Hospital, Auckland, New Zealand.
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Brandt T. Motor and Functional Recovery After Stroke. Stroke 2007; 38:2030-1. [PMID: 17540962 DOI: 10.1161/strokeaha.107.487256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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