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Kamper D, Bansal N, Barry A, Seo NJ, Celian C, Vidakovic L, Stoykov ME, Roth E. Combining Cyproheptadine Hydrochloride With Targeted Muscle Activation Training to Treat Upper Extremity Stroke: A Randomized, Placebo-Controlled Trial. Arch Phys Med Rehabil 2024; 105:1938-1945. [PMID: 39033950 DOI: 10.1016/j.apmr.2024.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 06/11/2024] [Accepted: 06/30/2024] [Indexed: 07/23/2024]
Abstract
OBJECTIVE To examine a treatment for upper extremity impairment in stroke survivors that combines administration of cyproheptadine hydrochloride with repetitive practice focused on control of muscle activation patterns. DESIGN Double-blind, randomized controlled trial. SETTINGS Laboratory within a free-standing rehabilitation hospital. PARTICIPANTS A total of 94 stroke survivors with severe, chronic hand impairment were randomly assigned to 1 of 4 treatment groups. INTERVENTIONS Participants received either a placebo or cyproheptadine hydrochloride in identical pill form. The daily dosage of cyproheptadine/placebo was gradually increased from 8 to 24 mg/d over 3 weeks and then maintained over the next 6 weeks while participants completed 18 therapy sessions. Therapy consisted of either (1) active practice of muscle activation patterns to play "serious" computer games or control a custom hand exoskeleton or (2) passive, cyclical finger stretching imposed by the exoskeleton. MAIN OUTCOME MEASURES Hand control was evaluated with the primary outcome measure of time to complete the Graded Wolf Motor Function Test (GWMFT) and secondary outcome measures including finger strength and spasticity. RESULTS Across the 88 participants who completed the study, a repeated-measures analysis of variance revealed a significant effect of GroupxEvaluation interaction on GWMFT (F=1.996, P=.026). The 3 groups receiving cyproheptadine and/or actively practicing muscle activation pattern control exhibited significant reduction in mean time to complete the GWMFT tasks; roughly one-third of these participants experienced at least a 10% reduction in completion time. Gains were maintained at the 1-month follow-up evaluation. The group receiving placebo and passive stretching did not show improvement. No significant differences among groups were observed in terms of changes in strength or spasticity. CONCLUSIONS Despite chronic, severe impairment, stroke survivors were able to complete the therapy focused on muscle activations and achieved statistically significant improvement in hand motor control. Cyproheptadine hydrochloride is a potential complementary treatment modality for stroke survivors with hand impairment.
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Affiliation(s)
- Derek Kamper
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC; Joint Department of Biomedical Engineering, North Carolina State University, Raleigh, NC.
| | - Naveen Bansal
- Department of Mathematical and Statistical Sciences, Marquette University, Milwaukee, WI
| | | | - Na Jin Seo
- Department of Rehabilitation Sciences, Medical University of South Carolina, Charleston, SC
| | | | | | - Mary Ellen Stoykov
- Shirley Ryan AbilityLab, Chicago, IL; Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Elliot Roth
- Shirley Ryan AbilityLab, Chicago, IL; Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL
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Sporn S, Coll M, Bestmann S, Ward NS. Chronic stroke survivors underestimate their upper limb motor ability in a simple 2D motor task. J Neuroeng Rehabil 2024; 21:175. [PMID: 39354594 PMCID: PMC11443716 DOI: 10.1186/s12984-024-01471-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 09/18/2024] [Indexed: 10/03/2024] Open
Abstract
BACKGROUND Stroke survivors can exhibit a mismatch between the actual motor ability of their affected upper limb and how much they use it in daily life. The resulting non-use of the affected upper limb has a negative impact on participation in neurorehabilitation and functional independence. The factors leading to non-use of the affected upper limb are poorly understood. One possibility is that non-use comes about through inappropriately low confidence in their own upper limb motor abilities. OBJECTIVE We asked whether chronic stroke survivors underestimate the motor ability of their affected upper limb. METHODS 20 chronic stroke survivors (Mean FM: 28.2 ± 10.5) completed a 2D reaching task using an exoskeleton robot. Target sizes were individually altered to ensure success rates were similar for both upper limbs. Prior to each reaching movement, participants rated their confidence about successfully hitting the target (estimated upper limb motor ability). RESULTS Confidence ratings were significantly lower for the affected upper limb (estimated ability), even though it was equally successful in the reaching task in comparison to the less affected upper limb (actual ability). Furthermore, confidence ratings did not correlate with level of impairment. CONCLUSIONS Our results demonstrate that chronic stroke survivors can underestimate the actual motor abilities of their affected upper limb, independent of impairment level. Low confidence in affected upper limb motor abilities should be considered as a therapeutic target to increase the incorporation of the affected upper limb into activities of daily living.
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Affiliation(s)
- Sebastian Sporn
- Department of Clinical and Movement Neuroscience, Queens Square Institute of Neurology, UCL, London, UK.
| | - M Coll
- Department of Clinical and Movement Neuroscience, Queens Square Institute of Neurology, UCL, London, UK
| | - S Bestmann
- Department of Clinical and Movement Neuroscience, Queens Square Institute of Neurology, UCL, London, UK
| | - N S Ward
- Department of Clinical and Movement Neuroscience, Queens Square Institute of Neurology, UCL, London, UK
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Faux-Nightingale A, Philp F, Leone E, Helliwell BB, Pandyan A. Exploring stroke survivors' and physiotherapists' perspectives of the potential for markerless motion capture technology in community rehabilitation. J Neuroeng Rehabil 2024; 21:168. [PMID: 39300565 DOI: 10.1186/s12984-024-01467-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 09/09/2024] [Indexed: 09/22/2024] Open
Abstract
INTRODUCTION Many stroke survivors do not receive optimal levels of personalised therapy to support their recovery. Use of technology for stroke rehabilitation has increased in recent years to help minimise gaps in service provision. Markerless motion capture technology is currently being used for musculoskeletal and occupational health screening and could offer a means to provide personalised guidance to stroke survivors struggling to access rehabilitation. AIMS This study considered context, stakeholders, and key uncertainties surrounding the use of markerless motion capture technology in community stroke rehabilitation from the perspectives of stroke survivors and physiotherapists with a view to adapting an existing intervention in a new context. METHODS Three focus groups were conducted with eight stroke survivors and five therapists. Data were analysed using reflexive thematic analysis. RESULTS Five themes were identified: limited access to community care; personal motivation; pandemic changed rehabilitation practice; perceptions of technology; and role of markerless technology for providing feedback. CONCLUSIONS Participants identified problems associated with the access of community stroke rehabilitation, exacerbated by Covid-19 restrictions. Participants were positive about the potential for the use of markerless motion capture technology to support personalised, effective stroke rehabilitation in the future, providing it is developed to meet stroke survivor specific needs.
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Affiliation(s)
| | - Fraser Philp
- School of Allied Health Professions and Nursing, University of Liverpool, Liverpool, L69 3BX, UK.
| | - Enza Leone
- School of Allied Health Professions, Keele University, Keele, ST5 5BG, UK
| | | | - Anand Pandyan
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, BH8 8GP, UK
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4
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Zhang Y, Yin X, Liu T, Ji W, Wang G. Association between the stress hyperglycemia ratio and mortality in patients with acute ischemic stroke. Sci Rep 2024; 14:20962. [PMID: 39251650 PMCID: PMC11385565 DOI: 10.1038/s41598-024-71778-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 08/30/2024] [Indexed: 09/11/2024] Open
Abstract
The stress hyperglycemia ratio (SHR) is established as a reliable marker for assessing the severity of stress-induced hyperglycemia. While its effectiveness in managing patients with Acute Ischemic Stroke (AIS) remains to be fully understood. We aim to explore the relationship between SHR and clinical prognosis in AIS patients and to assess how diabetes status influences this relationship. In this study, we analyzed data from the Medical Information Mart for Intensive Care (MIMIC-IV) database, selecting patients with AIS who required ICU admission. These patients were categorized into tertiles based on their SHR levels. We applied Cox hazard regression models and used restricted cubic spline (RCS) curves to investigate relationships between outcomes and SHR. The study enrolled a total of 2029 patients. Cox regression demonstrated that a strong correlation was found between increasing SHR levels and higher all-cause mortality. Patients in the higher two tertiles of SHR experienced significantly elevated 30-day and 90-day mortality rates compared to those in the lowest tertile. This pattern remained consistent regardless of diabetes status. Further, RCS analysis confirmed a progressively increasing risk of all-cause mortality with higher SHR levels. The findings indicate that SHR is association with increased 30-day and 90-day mortality among AIS patients, underscoring its potential value in risk stratification. Although the presence of diabetes may weaken this association, significant correlations persist in diabetic patients.
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Affiliation(s)
- Yaxin Zhang
- Department of Neurology, Xiamen Humanity Hospital, Fujian Medical University, Xiamen, 361009, Fujian, China
| | - Xinxin Yin
- Department of Neurology, Xiamen Humanity Hospital, Fujian Medical University, Xiamen, 361009, Fujian, China
| | - Tingting Liu
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Xi'an Jiaotong University, NO.277 YanTa West Road, Xi'an, 710061, Shanxi, China
| | - Wenwen Ji
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Xi'an Jiaotong University, NO.277 YanTa West Road, Xi'an, 710061, Shanxi, China
| | - Guangdong Wang
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Xi'an Jiaotong University, NO.277 YanTa West Road, Xi'an, 710061, Shanxi, China.
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Skrobot M, Sa RD, Walter J, Vogt A, Paulat R, Lips J, Mosch L, Mueller S, Dominiak S, Sachdev R, Boehm-Sturm P, Dirnagl U, Endres M, Harms C, Wenger N. Refined movement analysis in the staircase test reveals differential motor deficits in mouse models of stroke. J Cereb Blood Flow Metab 2024; 44:1551-1564. [PMID: 39234984 PMCID: PMC11418716 DOI: 10.1177/0271678x241254718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 03/05/2024] [Accepted: 04/22/2024] [Indexed: 09/06/2024]
Abstract
Accurate assessment of post-stroke deficits is crucial in translational research. Recent advances in machine learning offer precise quantification of rodent motor behavior post-stroke, yet detecting lesion-specific upper extremity deficits remains unclear. Employing proximal middle cerebral artery occlusion (MCAO) and cortical photothrombosis (PT) in mice, we assessed post-stroke impairments via the Staircase test. Lesion locations were identified using 7 T-MRI. Machine learning was applied to reconstruct forepaw kinematic trajectories and feature analysis was achieved with MouseReach, a new data-processing toolbox. Lesion reconstructions pinpointed ischemic centers in the striatum (MCAO) and sensorimotor cortex (PT). Pellet retrieval alterations were observed, but were unrelated to overall stroke volume. Instead, forepaw slips and relative reaching success correlated with increasing cortical lesion size in both models. Striatal lesion size after MCAO was associated with prolonged reach durations that occurred with delayed symptom onset. Further analysis on the impact of selective serotonin reuptake inhibitors in the PT model revealed no clear treatment effects but replicated strong effect sizes of slips for post-stroke deficit detection. In summary, refined movement analysis unveiled specific deficits in two widely-used mouse stroke models, emphasizing the value of deep behavioral profiling in preclinical stroke research to enhance model validity for clinical translation.
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Affiliation(s)
- Matej Skrobot
- Department of Neurology with Experimental Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Rafael De Sa
- Department of Neurology with Experimental Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Josefine Walter
- Department of Neurology with Experimental Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
- QUEST Center for Transforming Biomedical Research, Berlin Institute of Health (BIH), Berlin, Germany
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Arend Vogt
- Department of Neurology with Experimental Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Raik Paulat
- Department of Neurology with Experimental Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Janet Lips
- Department of Neurology with Experimental Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Larissa Mosch
- Department of Neurology with Experimental Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Susanne Mueller
- Department of Neurology with Experimental Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
- NeuroCure Cluster of Excellence and Charité Core Facility 7T Experimental MRIs, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Sina Dominiak
- Institute of Biology, Humboldt University of Berlin, Berlin, Germany
- Sussex Neuroscience, School of Life Sciences, University of Sussex, Brighton, UK
| | - Robert Sachdev
- Sussex Neuroscience, School of Life Sciences, University of Sussex, Brighton, UK
| | - Philipp Boehm-Sturm
- Department of Neurology with Experimental Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
- NeuroCure Cluster of Excellence and Charité Core Facility 7T Experimental MRIs, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ulrich Dirnagl
- Department of Neurology with Experimental Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
- QUEST Center for Transforming Biomedical Research, Berlin Institute of Health (BIH), Berlin, Germany
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Berlin, Germany
- DZNE (German Center for Neurodegenerative Diseases), Berlin, Germany
| | - Matthias Endres
- Department of Neurology with Experimental Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Berlin, Germany
- DZNE (German Center for Neurodegenerative Diseases), Berlin, Germany
- DZPG (German Center of Mental Health), Berlin, Germany
| | - Christoph Harms
- Department of Neurology with Experimental Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Berlin, Germany
| | - Nikolaus Wenger
- Department of Neurology with Experimental Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
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Hu C, Ti CHE, Shi X, Yuan K, Leung TWH, Tong RKY. Development and External Validation of a Motor Intention-Integrated Prediction Model for Upper Extremity Motor Recovery After Intention-Driven Robotic Hand Training for Chronic Stroke. Arch Phys Med Rehabil 2024:S0003-9993(24)01194-8. [PMID: 39218244 DOI: 10.1016/j.apmr.2024.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Revised: 07/19/2024] [Accepted: 08/20/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVE To derive and validate a prediction model for minimal clinically important differences (MCIDs) in upper extremity (UE) motor function after intention-driven robotic hand training using residual voluntary electromyography (EMG) signals from affected UE. DESIGN A prospective longitudinal multicenter cohort study. We collected preintervention candidate predictors: demographics, clinical characteristics, Fugl-Meyer assessment of UE (FMAUE), Action Research Arm Test scores, and motor intention of flexor digitorum and extensor digitorum (ED) measured by EMG during maximal voluntary contraction (MVC). For EMG measures, recognizing challenges for stroke survivors to move paralyzed hand, peak signals were extracted from 8 time windows during MVC-EMG (0.1-5s) to identify subjects' motor intention. Classification and regression tree algorithm was employed to predict survivors with MCID of FMAUE. Relationship between predictors and motor improvements was further investigated. SETTING Nine rehabilitation centers. PARTICIPANTS Chronic stroke survivors (N=131), including 87 for derivation sample, and 44 for validation sample. INTERVENTIONS All participants underwent 20-session robotic hand training (40min/session, 3-5sessions/wk). MAIN OUTCOME MEASURES Prediction efficacies of models were assessed by area under the receiver operating characteristic curve (AUC). The best effective model was final model and validated using AUC and overall accuracy. RESULTS The best model comprised FMAUE (cutoff score, 46) and peak activity of ED from 1-second MVC-EMG (MVC-EMG 4.604 times higher than resting EMG), which demonstrated significantly higher prediction accuracy (AUC, 0.807) than other time windows or solely using clinical scores (AUC, 0.595). In external validation, this model displayed robust prediction (AUC, 0.916). Significant quadratic relationship was observed between ED-EMG and FMAUE increases. CONCLUSIONS This study presents a prediction model for intention-driven robotic hand training in chronic stroke survivors. It highlights significance of capturing motor intention through 1-second EMG window as a predictor for MCID improvement in UE motor function after 20-session robotic training. Survivors in 2 conditions showed high percentage of clinical motor improvement: moderate-to-high motor intention and low-to-moderate function; as well as high intention and high function.
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Affiliation(s)
- Chengpeng Hu
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Chun Hang Eden Ti
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Xiangqian Shi
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Kai Yuan
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Thomas W H Leung
- Division of Neurology, Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Raymond Kai-Yu Tong
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
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Kuvijitsuwan P, Klaphajone J, Singjai P, Kumpika T, Thawinchai N, Angkurawaranon C, Aramrat C, Utarachon K. Validity and reliability of a finger training tool for assessing metacarpal phalangeal joint ranges of motion in asymptomatic participants. Sci Rep 2024; 14:20113. [PMID: 39209933 PMCID: PMC11362323 DOI: 10.1038/s41598-024-71094-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 08/23/2024] [Indexed: 09/04/2024] Open
Abstract
This pilot study aims to evaluate concurrent validity using the goniometer as a reference tool and test-retest reliability of flexion of metacarpal phalangeal joint (MCP) measurements taken from a finger training device (air-guitar system) in healthy participants. There were ten self -reported asymptomatic participants recruited to test the devices. The measurements of all metacarpophangeal joints of the dominant hands were conducted using a finger goniometer and the air-guitar system. Two measuring sessions were conducted on the same day. The concurrent validity of the air-guitar indicated by strong concordance correlation coefficient (0.62-0.90) with the goniometer and mean difference (approximately 1°) between the two instruments are well below the limit of 5°. The test-retest reliability of MCP measurements from the air-guitar glove (0.82-0.99) was acceptable as a clinically meaningful measurement tool as the intraclass correlation coefficients were higher than 0.7. The standard error of measurement and minimal detectable change of the air-guitar are similar to those of the goniometer. The air-guitar tracking features, when used as a home-based therapy tool, may assist in monitoring change of MCP flexion over a time course with good reliability and strongly associated with the measurements from the goniometer.
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Affiliation(s)
- P Kuvijitsuwan
- Department of Physical Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - J Klaphajone
- Department of Physical Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
| | - P Singjai
- Department of Physics and Materials Science, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
| | - T Kumpika
- Department of Physics and Materials Science, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
| | - N Thawinchai
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - C Angkurawaranon
- Department of Family Medicine, Faculty Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - C Aramrat
- Department of Family Medicine, Faculty Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - K Utarachon
- Department of Physical Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Sahely A, Sintler C, Soundy A, Rosewilliam S. Feasibility of a self-management intervention to improve mobility in the community after stroke (SIMS): A mixed-methods pilot study. PLoS One 2024; 19:e0286611. [PMID: 39137233 PMCID: PMC11321569 DOI: 10.1371/journal.pone.0286611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 05/12/2024] [Indexed: 08/15/2024] Open
Abstract
OBJECTIVE To evaluate the feasibility of implementing a self-management intervention to improve mobility in the community for stroke survivors. METHODS A two-phase sequential mixed methods design was used (a pilot randomised controlled trial and focus groups). Participants were adult stroke survivors within six months post discharge from hospital with functional and cognitive capacity for self-management. The intervention included education sessions, goal setting and action planning, group sessions, self-monitoring and follow up. The control group received usual care and both groups enrolled for 3 months in the study. Feasibility outcomes (recruitment and retention rates, randomisation and blinding, adherence to the intervention, collection of outcome measures, and the fidelity and acceptability of the intervention). Participants assessed at baseline, 3 months and 6 months for functional mobility and walking, self-efficacy, goal attainment, cognitive ability, and general health. A descriptive analysis was done for quantitative data and content analysis for the qualitative data. Findings of quantitative and qualitative data were integrated to present the final results of the study. RESULTS Twenty-four participants were recruited and randomised into two groups (12 each). It was feasible to recruit from hospital and community and to deliver the intervention remotely. Randomisation and blinding were successful. Participants were retained (83%) at 3 months and (79.2%) at 6 months assessments. Adherence to the intervention varied due to multiple factors. Focus groups discussed participants' motivations for joining the programme, their perspectives on the intervention (fidelity and acceptability) and methodology, perceived improvements in mobility, facilitators and challenges for self-management, and suggestions for improvement. CONCLUSION The self-management intervention seems feasible for implementation for stroke survivors in the community. Participants appreciated the support provided and perceived improvement in their mobility. The study was not powered enough to draw a conclusion about the efficacy of the program and a future full-scale study is warranted.
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Affiliation(s)
- Ahmad Sahely
- Physical Therapy Department, Collage of Applied Health Sciences, Jazan University, Jazan, Saudi Arabia
| | - Carron Sintler
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Andrew Soundy
- School of Sports, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Sheeba Rosewilliam
- School of Sports, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
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Krueger J, Krauth R, Reichert C, Perdikis S, Vogt S, Huchtemann T, Dürschmid S, Sickert A, Lamprecht J, Huremovic A, Görtler M, Nasuto SJ, Tsai IC, Knight RT, Hinrichs H, Heinze HJ, Lindquist S, Sailer M, Millán JDR, Sweeney-Reed CM. Hebbian plasticity induced by temporally coincident BCI enhances post-stroke motor recovery. Sci Rep 2024; 14:18700. [PMID: 39134592 PMCID: PMC11319604 DOI: 10.1038/s41598-024-69037-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/30/2024] [Indexed: 08/15/2024] Open
Abstract
Functional electrical stimulation (FES) can support functional restoration of a paretic limb post-stroke. Hebbian plasticity depends on temporally coinciding pre- and post-synaptic activity. A tight temporal relationship between motor cortical (MC) activity associated with attempted movement and FES-generated visuo-proprioceptive feedback is hypothesized to enhance motor recovery. Using a brain-computer interface (BCI) to classify MC spectral power in electroencephalographic (EEG) signals to trigger FES-delivery with detection of movement attempts improved motor outcomes in chronic stroke patients. We hypothesized that heightened neural plasticity earlier post-stroke would further enhance corticomuscular functional connectivity and motor recovery. We compared subcortical non-dominant hemisphere stroke patients in BCI-FES and Random-FES (FES temporally independent of MC movement attempt detection) groups. The primary outcome measure was the Fugl-Meyer Assessment, Upper Extremity (FMA-UE). We recorded high-density EEG and transcranial magnetic stimulation-induced motor evoked potentials before and after treatment. The BCI group showed greater: FMA-UE improvement; motor evoked potential amplitude; beta oscillatory power and long-range temporal correlation reduction over contralateral MC; and corticomuscular coherence with contralateral MC. These changes are consistent with enhanced post-stroke motor improvement when movement is synchronized with MC activity reflecting attempted movement.
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Affiliation(s)
- Johanna Krueger
- Neurocybernetics and Rehabilitation, Department of Neurology, Otto von Guericke University, Magdeburg, Germany
| | - Richard Krauth
- Neurocybernetics and Rehabilitation, Department of Neurology, Otto von Guericke University, Magdeburg, Germany
| | | | - Serafeim Perdikis
- School of Computer Science and Electronic Engineering, University of Essex, Colchester, UK
| | - Susanne Vogt
- Neurocybernetics and Rehabilitation, Department of Neurology, Otto von Guericke University, Magdeburg, Germany
- Department of Neurology, Otto von Guericke University, Magdeburg, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Otto von Guericke University, Magdeburg, Germany
| | - Tessa Huchtemann
- Neurocybernetics and Rehabilitation, Department of Neurology, Otto von Guericke University, Magdeburg, Germany
- Department of Neurology, Otto von Guericke University, Magdeburg, Germany
- Department of Neurology, University Hospital Münster, Münster, Germany
| | - Stefan Dürschmid
- Leibniz Institute for Neurobiology, Magdeburg, Germany
- Center for Behavioral Brain Sciences (CBBS), Otto von Guericke University, Magdeburg, Germany
| | - Almut Sickert
- Neurorehabilitation Centre, MEDIAN, Magdeburg, Germany
| | - Juliane Lamprecht
- Neurorehabilitation Centre, MEDIAN, Magdeburg, Germany
- Health and Care Sciences, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Almir Huremovic
- Neurorehabilitation Centre, MEDIAN, Magdeburg, Germany
- Department of Neurology, Ingolstadt Hospital, Ingolstadt, Germany
| | - Michael Görtler
- Department of Neurology, Otto von Guericke University, Magdeburg, Germany
| | | | - I-Chin Tsai
- Neurocybernetics and Rehabilitation, Department of Neurology, Otto von Guericke University, Magdeburg, Germany
| | - Robert T Knight
- Helen Wills Neuroscience Institute, University of California -Berkeley, Berkeley, USA
- Department of Psychology, University of California -Berkeley, Berkeley, USA
| | - Hermann Hinrichs
- Leibniz Institute for Neurobiology, Magdeburg, Germany
- Department of Neurology, Otto von Guericke University, Magdeburg, Germany
- Center for Behavioral Brain Sciences (CBBS), Otto von Guericke University, Magdeburg, Germany
| | - Hans-Jochen Heinze
- Leibniz Institute for Neurobiology, Magdeburg, Germany
- University Hospital Magdeburg, Otto von Guericke University, Magdeburg, Germany
| | - Sabine Lindquist
- Department of Neurology, Pfeiffersche Stiftung, Magdeburg, Germany
| | | | - Jose Del R Millán
- Chandra Family Department of Electrical and Computer Engineering, The University of Texas at Austin, Austin, USA
- Department of Neurology, The University of Texas at Austin, Austin, USA
- Mulva Clinic for the Neurosciences, The University of Texas at Austin, Austin, USA
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, USA
| | - Catherine M Sweeney-Reed
- Neurocybernetics and Rehabilitation, Department of Neurology, Otto von Guericke University, Magdeburg, Germany.
- Center for Behavioral Brain Sciences (CBBS), Otto von Guericke University, Magdeburg, Germany.
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Pan JW, Sidarta A, Wu TL, Kwong WHP, Ong PL, Tay MRJ, Phua MW, Chong WB, Ang WT, Chua KSG. Unraveling stroke gait deviations with movement analytics, more than meets the eye: a case control study. Front Neurosci 2024; 18:1425183. [PMID: 39104608 PMCID: PMC11298395 DOI: 10.3389/fnins.2024.1425183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 07/11/2024] [Indexed: 08/07/2024] Open
Abstract
Background This study aimed to identify and quantify the kinematic and kinetic gait deviations in post-stroke hemiplegic patients with matched healthy controls using Statistical Parametric Mapping (SPM). Methods Fifteen chronic stroke patients [4 females, 11 males; age 53.7 (standard deviation 12.2) years; body mass 65.4 (10.4) kg; standing height 168.5 (9.6) cm] and 15 matched healthy controls [4 females, 11 males; age 52.9 (11.7) years; body weight 66.5 (10.7) years; standing height 168.3 (8.8) cm] were recruited. In a 10-m walking task, joint angles, ground reaction forces (GRF), and joint moments were collected, analyzed, and compared using SPM for an entire gait cycle. Results Generally, when comparing the stroke patients' affected (hemiplegic) and less-affected (contralateral) limbs with the control group, SPM identified significant differences in the late stance phase and early swing phase in the joint angles and moments in bilateral limbs (all p < 0.005). In addition, the vertical and anteroposterior components of GRF were significantly different in various periods of the stance phase (all p < 0.005), while the mediolateral component showed no differences between the two groups. Conclusion SPM was able to detect abnormal gait patterns in both the affected and less-affected limbs of stroke patients with significant differences when compared with matched controls. The findings draw attention to significant quantifiable gait deviations in the less-affected post-stroke limb with the potential impact to inform gait retraining strategies for clinicians and physiotherapists.
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Affiliation(s)
- Jing Wen Pan
- Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore, Singapore
- Department of Sports Science and Physical Education, Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Ananda Sidarta
- Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore, Singapore
| | - Tsung-Lin Wu
- Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore, Singapore
| | - Wai Hang Patrick Kwong
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Poo Lee Ong
- Institute of Rehabilitation Excellence (IREx), Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore
| | - Matthew Rong Jie Tay
- Institute of Rehabilitation Excellence (IREx), Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Min Wee Phua
- Institute of Rehabilitation Excellence (IREx), Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore
| | - Wei Binh Chong
- Institute of Rehabilitation Excellence (IREx), Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore
| | - Wei Tech Ang
- Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
| | - Karen Sui Geok Chua
- Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore, Singapore
- Institute of Rehabilitation Excellence (IREx), Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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11
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O’Flaherty D, Ali K. Recommendations for Upper Limb Motor Recovery: An Overview of the UK and European Rehabilitation after Stroke Guidelines (2023). Healthcare (Basel) 2024; 12:1433. [PMID: 39057576 PMCID: PMC11276617 DOI: 10.3390/healthcare12141433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 07/01/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
Upper limb impairment is common after stroke, with a significant impact on the stroke survivor's function, social participation and quality of life. Clinical guidelines are needed to inform clinical practise, tailor interventions to improve outcomes and address unresolved research questions. This review contributes to the evidence guiding clinical practise for upper limb motor recovery after stroke by summarising the recommendations from the UK rehabilitation guidelines (National Institute for Health and Care Excellence (NICE) and the Intercollegiate Stroke Working Party (ISWP)) and the European Stroke Organisation (ESO) guidelines, all published in 2023. All three guidelines target researchers, clinical practitioners, stroke survivors and their social networks. An important feature in all three guidelines was therapeutic intensity, with all guidelines recommending increased therapeutic intensity. Unlike the ESO, the NICE and ISWP additionally include specific research recommendations. While the NICE guidelines seem more holistic and target a wider audience, the three guidelines are complimentary. We recommend that a future consensus statement should be developed in partnership between all three organisations, agreeing on scope and using the same terminology, on recommendations to improve stroke rehabilitation in the UK and Europe.
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Affiliation(s)
- Daniel O’Flaherty
- University Hospital Southampton NHS Foundation Trust, Hampshire SO16 6YD, UK
| | - Khalid Ali
- Department of Geriatrics, Brighton and Sussex Medical School, Brighton BN1 9PX, UK
- University Hospitals Sussex NHS Foundation Trust, Princess Royal Hospital, Haywards Heath RH16 4EX, UK
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12
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Winterbottom L, Chen A, Mendonca R, Nilsen DM, Ciocarlie M, Stein J. Clinician perceptions of a novel wearable robotic hand orthosis for post-stroke hemiparesis. Disabil Rehabil 2024:1-10. [PMID: 38975689 DOI: 10.1080/09638288.2024.2375056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 06/27/2024] [Indexed: 07/09/2024]
Abstract
PURPOSE Wearable robotic devices are currently being developed to improve upper limb function for individuals with hemiparesis after stroke. Incorporating the views of clinicians during the development of new technologies can help ensure that end products meet clinical needs and can be adopted for patient care. METHODS In this cross-sectional mixed-methods study, an anonymous online survey was used to gather clinicians' perceptions of a wearable robotic hand orthosis for post-stroke hemiparesis. Participants were asked about their clinical experience and provided feedback on the prototype device after viewing a video. RESULTS 154 participants completed the survey. Only 18.8% had previous experience with robotic technology. The majority of participants (64.9%) reported that they would use the device for both rehabilitative and assistive purposes. Participants perceived that the device could be used in supervised clinical settings with all phases of stroke. Participants also indicated a need for insurance coverage and quick setup time. CONCLUSIONS Engaging clinicians early in the design process can help guide the development of wearable robotic devices. Both rehabilitative and assistive functions are valued by clinicians and should be considered during device development. Future research is needed to understand a broader set of stakeholders' perspectives on utility and design.
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Affiliation(s)
- Lauren Winterbottom
- Department of Rehabilitation and Regenerative Medicine, Columbia University, New York, NY, USA
| | - Ava Chen
- Department of Mechanical Engineering, Columbia University, New York, NY, USA
| | - Rochelle Mendonca
- Department of Rehabilitation and Regenerative Medicine, Columbia University, New York, NY, USA
| | - Dawn M Nilsen
- Department of Rehabilitation and Regenerative Medicine, Columbia University, New York, NY, USA
- NewYork-Presbyterian Hospital, New York, NY, USA
| | - Matei Ciocarlie
- Department of Mechanical Engineering, Columbia University, New York, NY, USA
| | - Joel Stein
- Department of Rehabilitation and Regenerative Medicine, Columbia University, New York, NY, USA
- NewYork-Presbyterian Hospital, New York, NY, USA
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13
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Jiryaei Z, Jafarpisheh AS. The usefulness of assistive soft robotics in the rehabilitation of patients with hand impairment: A systematic review. J Bodyw Mov Ther 2024; 39:398-409. [PMID: 38876658 DOI: 10.1016/j.jbmt.2024.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 11/29/2023] [Accepted: 02/25/2024] [Indexed: 06/16/2024]
Abstract
INTRODUCTION Loss of hand function causes severe limitations in activity in daily living. The hand-soft robot is one of the methods that has recently been growing to increase the patient's independence. The purpose of the present systematic review was to provide a classification, a comparison, and a design overview of mechanisms and the efficacy of the soft hand robots to help researchers approach this field. METHODS The literature research regarding such tools was conducted in PubMed, Google Scholar, Science Direct, and Cochrane Central Register for Controlled Trials. We included peer-reviewed studies that considered a soft robot glove as an assistive device to provide function. The two investigators screened the titles and abstracts, then independently reviewed the full-text articles. Disagreements about inclusion were resolved by consensus or a third reviewer. RESULTS A total of 15 articles were identified, describing 210 participants (23 healthy subjects). The tools were in three categories according to their actuation type (pneumatic system, cable-driven, another design). The most critical outcomes in studies included functional tasks (fourteen studies), grip strength (four studies), range of motion (ROM) (five studies), and user satisfaction (five studies). DISCUSSION Function and grip parameters are the most common critical parameters for tests of hand robots. Cable-driven transmission and soft pneumatic actuators are the most common choices for the actuation unit. Radder et al. study had the highest grade from other studies. That was the only RCT among studies. CONCLUSION Although few soft robotic gloves can be considered ready to reach the market, it seems these tools have the potential to be practical for people with a disability. But, we lack consistent evidence of comparing two or more soft robot gloves on the hand functions. Future research needs to assess the effect of soft robotic gloves on people with hand disorders with more populations.
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Affiliation(s)
- Zahra Jiryaei
- Rehabilitation Research Center, Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Science, Tehran, Iran
| | - Amir Salar Jafarpisheh
- Department of Ergonomics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
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14
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Pan H, Xiong Y, Huang Y, Zhao J, Wan H. Association between stress hyperglycemia ratio with short-term and long-term mortality in critically ill patients with ischemic stroke. Acta Diabetol 2024; 61:859-868. [PMID: 38499778 DOI: 10.1007/s00592-024-02259-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 02/11/2024] [Indexed: 03/20/2024]
Abstract
AIMS Hyperglycemia on admission is associated with poor prognosis in ischemic stroke (IS) patients. We aimed to investigate the relationship between stress hyperglycemia ratio (SHR) and short-term or long-term mortality in IS patients in the ICU and to explore whether this relationship is influenced by diabetes status. MATERIALS AND METHODS We collected patients with severe IS requiring ICU admission in the Medical Information Mart for Intensive Care (MIMIC-IV) database and calculated SHR. Outcomes included 30-day, 90-day, and 1-year mortality. The association between SHR and mortality in patients with critical IS was elucidated using Multivariate Cox regression and subgroup analysis for diabetes. RESULTS A total of 1376 patients were recruited. After adjusting for potential confounders, patients in the third and fourth quartiles had a significantly increased risk of death at 30 days, 90 days, and 1 year compared to the first quartile of SHR (Q3 vs. Q1: HR 1.56-1.80, all p < 0.02; Q4 vs. Q1: HR 1.75-2.15, all p < 0.001; all p for trend < 0.001). In addition, the highest quartile of SHR was significantly associated with short-term or long-term mortality compared with the first quartile, regardless of diabetes status. CONCLUSIONS Our results suggest that stress hyperglycemia, defined by the glucose/HbA1c ratio, is associated with increased short-term and long-term mortality in patients with ischemic stroke, independent of the patient's diabetes status.
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Affiliation(s)
- Haowei Pan
- Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yiqun Xiong
- Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yanming Huang
- Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
- Department of Anesthesiology, Hangzhou Red Cross Hospital, 208 East Huancheng Road, Hangzhou, 310003, China
| | - Jie Zhao
- Department of Anesthesiology, Hangzhou Red Cross Hospital, 208 East Huancheng Road, Hangzhou, 310003, China
| | - Haifang Wan
- Department of Anesthesiology, Hangzhou Red Cross Hospital, 208 East Huancheng Road, Hangzhou, 310003, China.
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15
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Zhang Y, Zhang X, Cheng C, Huang S, Hua Y, Hu J, Wang Y, Zhang W, Yang Y, Liu Y, Jia J, Gou P, Zhang P, Zhou F, Wei X, Bai Y. Mirror therapy combined with contralaterally controlled functional electrical stimulation for the upper limb motor function after stroke: a randomized controlled trial. Disabil Rehabil 2024; 46:2528-2534. [PMID: 37341447 DOI: 10.1080/09638288.2023.2225878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 06/10/2023] [Indexed: 06/22/2023]
Abstract
PURPOSE In this study, we investigated the effects of mirror therapy (MT) combined with contralaterally controlled functional electrical stimulation (CCFES) on upper limb motor function, activities of daily life, and corticospinal excitability in post-stroke patients. METHODS Sixty post-stroke patients were randomly divided into four groups: CCFES, MT, MT combined with CCFES, and control. All the patients underwent routine rehabilitation. Those in the MT, CCFES, MT combined with CCFES, and control groups received MT, CCFES, MT combined with CCFES, and routine rehabilitation alone, respectively. Upper limb motor function, activities of daily living, and corticospinal excitability were evaluated before and after a 3-week intervention period. RESULTS MT combined with CCFES demonstrated a significantly greater therapeutic effect on motor function of the paretic wrist than CCFES, MT, or routine rehabilitation alone. However, there was no significant difference in the overall motor function of the affected upper limb, activities of daily life, or corticospinal excitability between the MT combined with CCFES group and the other three groups. CONCLUSION MT combined with CCFES may be a potential adjuvant therapy to promote motor function in paretic wrist after stroke.
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Affiliation(s)
- Yuqian Zhang
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Xingnan Zhang
- Department of Rehabilitation Medicine, Baoji Central Hospital, Baoji, China
| | - Cancan Cheng
- Department of Rehabilitation Medicine, Baoji Central Hospital, Baoji, China
| | - Songhua Huang
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yan Hua
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Jian Hu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuyuan Wang
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Weizhou Zhang
- Department of Rehabilitation Medicine, Baoji Central Hospital, Baoji, China
| | - Yi Yang
- Department of Rehabilitation Medicine, Baoji Central Hospital, Baoji, China
| | - Yafeng Liu
- Department of Rehabilitation Medicine, Baoji Central Hospital, Baoji, China
| | - Jian Jia
- Department of Rehabilitation Medicine, Baoji Central Hospital, Baoji, China
| | - Pingping Gou
- Department of Rehabilitation Medicine, Baoji Central Hospital, Baoji, China
| | - Pei Zhang
- Department of Rehabilitation Medicine, Baoji Central Hospital, Baoji, China
| | - Feng Zhou
- Department of Neurosurgery, Baoji Central Hospital, Baoji, China
| | - Xiaoli Wei
- Department of Rehabilitation Medicine, Baoji Central Hospital, Baoji, China
| | - Yulong Bai
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
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16
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Miller AE, Lang CE, Bland MD, Lohse KR. Quantifying the effects of sleep on sensor-derived variables from upper limb accelerometry in people with and without upper limb impairment. J Neuroeng Rehabil 2024; 21:86. [PMID: 38807245 PMCID: PMC11131201 DOI: 10.1186/s12984-024-01384-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 05/15/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Despite the promise of wearable sensors for both rehabilitation research and clinical care, these technologies pose significant burden on data collectors and analysts. Investigations of factors that may influence the wearable sensor data processing pipeline are needed to support continued use of these technologies in rehabilitation research and integration into clinical care settings. The purpose of this study was to investigate the effect of one such factor, sleep, on sensor-derived variables from upper limb accelerometry in people with and without upper limb impairment and across a two-day wearing period. METHODS This was a secondary analysis of data collected during a prospective, longitudinal cohort study (n = 127 individuals, 62 with upper limb impairment and 65 without). Participants wore a wearable sensor on each wrist for 48 h. Five upper limb sensor variables were calculated over the full wear period (sleep included) and with sleep time removed (sleep excluded): preferred time, non-preferred time, use ratio, non-preferred magnitude and its standard deviation. Linear mixed effects regression was used to quantify the effect of sleep on each sensor variable and determine if the effect differed between people with and without upper limb impairment and across a two-day wearing period. RESULTS There were significant differences between sleep included and excluded for the variables preferred time (p < 0.001), non-preferred time (p < 0.001), and non-preferred magnitude standard deviation (p = 0.001). The effect of sleep was significantly different between people with and without upper limb impairment for one variable, non-preferred magnitude (p = 0.02). The effect of sleep was not substantially different across wearing days for any of the variables. CONCLUSIONS Overall, the effects of sleep on sensor-derived variables of upper limb accelerometry are small, similar between people with and without upper limb impairment and across a two-day wearing period, and can likely be ignored in most contexts. Ignoring the effect of sleep would simplify the data processing pipeline, facilitating the use of wearable sensors in both research and clinical practice.
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Affiliation(s)
- Allison E Miller
- Program in Physical Therapy, Washington University School of Medicine, 4444 Forest Park Avenue, MSC: 8502-66-1101, St. Louis, MO, 63018, USA.
| | - Catherine E Lang
- Program in Physical Therapy, Washington University School of Medicine, 4444 Forest Park Avenue, MSC: 8502-66-1101, St. Louis, MO, 63018, USA
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, 63018, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, 63018, USA
| | - Marghuretta D Bland
- Program in Physical Therapy, Washington University School of Medicine, 4444 Forest Park Avenue, MSC: 8502-66-1101, St. Louis, MO, 63018, USA
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, 63018, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, 63018, USA
| | - Keith R Lohse
- Program in Physical Therapy, Washington University School of Medicine, 4444 Forest Park Avenue, MSC: 8502-66-1101, St. Louis, MO, 63018, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, 63018, USA
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17
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Ferris JK, Lo BP, Barisano G, Brodtmann A, Buetefisch CM, Conforto AB, Donnelly MR, Egorova-Brumley N, Hayward KS, Khlif MS, Revill KP, Zavaliangos-Petropulu A, Boyd L, Liew SL. Modulation of the Association Between Corticospinal Tract Damage and Outcome After Stroke by White Matter Hyperintensities. Neurology 2024; 102:e209387. [PMID: 38701386 PMCID: PMC11196095 DOI: 10.1212/wnl.0000000000209387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/04/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Motor outcomes after stroke relate to corticospinal tract (CST) damage. The brain leverages surviving neural pathways to compensate for CST damage and mediate motor recovery. Thus, concurrent age-related damage from white matter hyperintensities (WMHs) might affect neurologic capacity for recovery after CST injury. The role of WMHs in post-stroke motor outcomes is unclear. In this study, we evaluated whether WMHs modulate the relationship between CST damage and post-stroke motor outcomes. METHODS We used data from the multisite ENIGMA Stroke Recovery Working Group with T1 and T2/fluid-attenuated inversion recovery imaging. CST damage was indexed with weighted CST lesion load (CST-LL). WMH volumes were extracted with Freesurfer's SAMSEG. Mixed-effects beta-regression models were fit to test the impact of CST-LL, WMH volume, and their interaction on motor impairment, controlling for age, days after stroke, and stroke volume. RESULTS A total of 223 individuals were included. WMH volume related to motor impairment above and beyond CST-LL (β = 0.178, 95% CI 0.025-0.331, p = 0.022). Relationships varied by WMH severity (mild vs moderate-severe). In individuals with mild WMHs, motor impairment related to CST-LL (β = 0.888, 95% CI 0.604-1.172, p < 0.001) with a CST-LL × WMH interaction (β = -0.211, 95% CI -0.340 to -0.026, p = 0.026). In individuals with moderate-severe WMHs, motor impairment related to WMH volume (β = 0.299, 95% CI 0.008-0.590, p = 0.044), but did not significantly relate to CST-LL or a CST-LL × WMH interaction. DISCUSSION WMHs relate to motor outcomes after stroke and modify relationships between motor impairment and CST damage. WMH-related damage may be under-recognized in stroke research as a factor contributing to variability in motor outcomes. Our findings emphasize the importance of brain structural reserve in motor outcomes after brain injury.
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Affiliation(s)
- Jennifer K Ferris
- From the Gerontology Research Centre (J.K.F.), Simon Fraser University; Department of Physical Therapy and Djavad Mowafaghian Centre for Brain Health (J.K.F.), University of British Columbia, Vancouver, Canada; Chan Division of Occupational Science and Occupational Therapy (B.P.L., M.R.D., S.-L.L.), University of Southern California, Los Angeles; Department of Neurosurgery (G.B.), Stanford School of Medicine, Stanford University, CA; Central Clinical School (A.B., M.S.K.), Monash University, Melbourne, Victoria, Australia; Department of Medicine (A.B.), Royal Melbourne Hospital, University of Melbourne, Victoria, Australia; Department of Neurology (C.M.B.), Department of Rehabilitation Medicine (C.M.B.), and Department of Radiology (C.M.B.), Emory University, Atlanta, GA; Hospital das Clinicas HCFMUSP (A.B.C.), Faculdade de Medicina, Universidade de São Paulo; Hospital Israelita Albert Einstein (A.B.C.), São Paulo, Brazil; Melbourne School of Psychological Sciences (N.E.-B.), University of Melbourne; Departments of Physiotherapy, Medicine (RMH) & The Florey Institute of Neuroscience and Mental Health (K.S.H.), University of Melbourne, Victoria, Australia; Facility for Education and Research in Neuroscience (K.P.R.), Emory University, Atlanta, GA; Brain Mapping Center (A.Z.-P.), Department of Neurology, Geffen School of Medicine, University of California Los Angeles; and Mark and Mary Stevens Neuroimaging and Informatics Institute and Keck School of Medicine (L.B., S.-L.L.), University of Southern California, Los Angeles
| | - Bethany P Lo
- From the Gerontology Research Centre (J.K.F.), Simon Fraser University; Department of Physical Therapy and Djavad Mowafaghian Centre for Brain Health (J.K.F.), University of British Columbia, Vancouver, Canada; Chan Division of Occupational Science and Occupational Therapy (B.P.L., M.R.D., S.-L.L.), University of Southern California, Los Angeles; Department of Neurosurgery (G.B.), Stanford School of Medicine, Stanford University, CA; Central Clinical School (A.B., M.S.K.), Monash University, Melbourne, Victoria, Australia; Department of Medicine (A.B.), Royal Melbourne Hospital, University of Melbourne, Victoria, Australia; Department of Neurology (C.M.B.), Department of Rehabilitation Medicine (C.M.B.), and Department of Radiology (C.M.B.), Emory University, Atlanta, GA; Hospital das Clinicas HCFMUSP (A.B.C.), Faculdade de Medicina, Universidade de São Paulo; Hospital Israelita Albert Einstein (A.B.C.), São Paulo, Brazil; Melbourne School of Psychological Sciences (N.E.-B.), University of Melbourne; Departments of Physiotherapy, Medicine (RMH) & The Florey Institute of Neuroscience and Mental Health (K.S.H.), University of Melbourne, Victoria, Australia; Facility for Education and Research in Neuroscience (K.P.R.), Emory University, Atlanta, GA; Brain Mapping Center (A.Z.-P.), Department of Neurology, Geffen School of Medicine, University of California Los Angeles; and Mark and Mary Stevens Neuroimaging and Informatics Institute and Keck School of Medicine (L.B., S.-L.L.), University of Southern California, Los Angeles
| | - Giuseppe Barisano
- From the Gerontology Research Centre (J.K.F.), Simon Fraser University; Department of Physical Therapy and Djavad Mowafaghian Centre for Brain Health (J.K.F.), University of British Columbia, Vancouver, Canada; Chan Division of Occupational Science and Occupational Therapy (B.P.L., M.R.D., S.-L.L.), University of Southern California, Los Angeles; Department of Neurosurgery (G.B.), Stanford School of Medicine, Stanford University, CA; Central Clinical School (A.B., M.S.K.), Monash University, Melbourne, Victoria, Australia; Department of Medicine (A.B.), Royal Melbourne Hospital, University of Melbourne, Victoria, Australia; Department of Neurology (C.M.B.), Department of Rehabilitation Medicine (C.M.B.), and Department of Radiology (C.M.B.), Emory University, Atlanta, GA; Hospital das Clinicas HCFMUSP (A.B.C.), Faculdade de Medicina, Universidade de São Paulo; Hospital Israelita Albert Einstein (A.B.C.), São Paulo, Brazil; Melbourne School of Psychological Sciences (N.E.-B.), University of Melbourne; Departments of Physiotherapy, Medicine (RMH) & The Florey Institute of Neuroscience and Mental Health (K.S.H.), University of Melbourne, Victoria, Australia; Facility for Education and Research in Neuroscience (K.P.R.), Emory University, Atlanta, GA; Brain Mapping Center (A.Z.-P.), Department of Neurology, Geffen School of Medicine, University of California Los Angeles; and Mark and Mary Stevens Neuroimaging and Informatics Institute and Keck School of Medicine (L.B., S.-L.L.), University of Southern California, Los Angeles
| | - Amy Brodtmann
- From the Gerontology Research Centre (J.K.F.), Simon Fraser University; Department of Physical Therapy and Djavad Mowafaghian Centre for Brain Health (J.K.F.), University of British Columbia, Vancouver, Canada; Chan Division of Occupational Science and Occupational Therapy (B.P.L., M.R.D., S.-L.L.), University of Southern California, Los Angeles; Department of Neurosurgery (G.B.), Stanford School of Medicine, Stanford University, CA; Central Clinical School (A.B., M.S.K.), Monash University, Melbourne, Victoria, Australia; Department of Medicine (A.B.), Royal Melbourne Hospital, University of Melbourne, Victoria, Australia; Department of Neurology (C.M.B.), Department of Rehabilitation Medicine (C.M.B.), and Department of Radiology (C.M.B.), Emory University, Atlanta, GA; Hospital das Clinicas HCFMUSP (A.B.C.), Faculdade de Medicina, Universidade de São Paulo; Hospital Israelita Albert Einstein (A.B.C.), São Paulo, Brazil; Melbourne School of Psychological Sciences (N.E.-B.), University of Melbourne; Departments of Physiotherapy, Medicine (RMH) & The Florey Institute of Neuroscience and Mental Health (K.S.H.), University of Melbourne, Victoria, Australia; Facility for Education and Research in Neuroscience (K.P.R.), Emory University, Atlanta, GA; Brain Mapping Center (A.Z.-P.), Department of Neurology, Geffen School of Medicine, University of California Los Angeles; and Mark and Mary Stevens Neuroimaging and Informatics Institute and Keck School of Medicine (L.B., S.-L.L.), University of Southern California, Los Angeles
| | - Cathrin M Buetefisch
- From the Gerontology Research Centre (J.K.F.), Simon Fraser University; Department of Physical Therapy and Djavad Mowafaghian Centre for Brain Health (J.K.F.), University of British Columbia, Vancouver, Canada; Chan Division of Occupational Science and Occupational Therapy (B.P.L., M.R.D., S.-L.L.), University of Southern California, Los Angeles; Department of Neurosurgery (G.B.), Stanford School of Medicine, Stanford University, CA; Central Clinical School (A.B., M.S.K.), Monash University, Melbourne, Victoria, Australia; Department of Medicine (A.B.), Royal Melbourne Hospital, University of Melbourne, Victoria, Australia; Department of Neurology (C.M.B.), Department of Rehabilitation Medicine (C.M.B.), and Department of Radiology (C.M.B.), Emory University, Atlanta, GA; Hospital das Clinicas HCFMUSP (A.B.C.), Faculdade de Medicina, Universidade de São Paulo; Hospital Israelita Albert Einstein (A.B.C.), São Paulo, Brazil; Melbourne School of Psychological Sciences (N.E.-B.), University of Melbourne; Departments of Physiotherapy, Medicine (RMH) & The Florey Institute of Neuroscience and Mental Health (K.S.H.), University of Melbourne, Victoria, Australia; Facility for Education and Research in Neuroscience (K.P.R.), Emory University, Atlanta, GA; Brain Mapping Center (A.Z.-P.), Department of Neurology, Geffen School of Medicine, University of California Los Angeles; and Mark and Mary Stevens Neuroimaging and Informatics Institute and Keck School of Medicine (L.B., S.-L.L.), University of Southern California, Los Angeles
| | - Adriana B Conforto
- From the Gerontology Research Centre (J.K.F.), Simon Fraser University; Department of Physical Therapy and Djavad Mowafaghian Centre for Brain Health (J.K.F.), University of British Columbia, Vancouver, Canada; Chan Division of Occupational Science and Occupational Therapy (B.P.L., M.R.D., S.-L.L.), University of Southern California, Los Angeles; Department of Neurosurgery (G.B.), Stanford School of Medicine, Stanford University, CA; Central Clinical School (A.B., M.S.K.), Monash University, Melbourne, Victoria, Australia; Department of Medicine (A.B.), Royal Melbourne Hospital, University of Melbourne, Victoria, Australia; Department of Neurology (C.M.B.), Department of Rehabilitation Medicine (C.M.B.), and Department of Radiology (C.M.B.), Emory University, Atlanta, GA; Hospital das Clinicas HCFMUSP (A.B.C.), Faculdade de Medicina, Universidade de São Paulo; Hospital Israelita Albert Einstein (A.B.C.), São Paulo, Brazil; Melbourne School of Psychological Sciences (N.E.-B.), University of Melbourne; Departments of Physiotherapy, Medicine (RMH) & The Florey Institute of Neuroscience and Mental Health (K.S.H.), University of Melbourne, Victoria, Australia; Facility for Education and Research in Neuroscience (K.P.R.), Emory University, Atlanta, GA; Brain Mapping Center (A.Z.-P.), Department of Neurology, Geffen School of Medicine, University of California Los Angeles; and Mark and Mary Stevens Neuroimaging and Informatics Institute and Keck School of Medicine (L.B., S.-L.L.), University of Southern California, Los Angeles
| | - Miranda R Donnelly
- From the Gerontology Research Centre (J.K.F.), Simon Fraser University; Department of Physical Therapy and Djavad Mowafaghian Centre for Brain Health (J.K.F.), University of British Columbia, Vancouver, Canada; Chan Division of Occupational Science and Occupational Therapy (B.P.L., M.R.D., S.-L.L.), University of Southern California, Los Angeles; Department of Neurosurgery (G.B.), Stanford School of Medicine, Stanford University, CA; Central Clinical School (A.B., M.S.K.), Monash University, Melbourne, Victoria, Australia; Department of Medicine (A.B.), Royal Melbourne Hospital, University of Melbourne, Victoria, Australia; Department of Neurology (C.M.B.), Department of Rehabilitation Medicine (C.M.B.), and Department of Radiology (C.M.B.), Emory University, Atlanta, GA; Hospital das Clinicas HCFMUSP (A.B.C.), Faculdade de Medicina, Universidade de São Paulo; Hospital Israelita Albert Einstein (A.B.C.), São Paulo, Brazil; Melbourne School of Psychological Sciences (N.E.-B.), University of Melbourne; Departments of Physiotherapy, Medicine (RMH) & The Florey Institute of Neuroscience and Mental Health (K.S.H.), University of Melbourne, Victoria, Australia; Facility for Education and Research in Neuroscience (K.P.R.), Emory University, Atlanta, GA; Brain Mapping Center (A.Z.-P.), Department of Neurology, Geffen School of Medicine, University of California Los Angeles; and Mark and Mary Stevens Neuroimaging and Informatics Institute and Keck School of Medicine (L.B., S.-L.L.), University of Southern California, Los Angeles
| | - Natalia Egorova-Brumley
- From the Gerontology Research Centre (J.K.F.), Simon Fraser University; Department of Physical Therapy and Djavad Mowafaghian Centre for Brain Health (J.K.F.), University of British Columbia, Vancouver, Canada; Chan Division of Occupational Science and Occupational Therapy (B.P.L., M.R.D., S.-L.L.), University of Southern California, Los Angeles; Department of Neurosurgery (G.B.), Stanford School of Medicine, Stanford University, CA; Central Clinical School (A.B., M.S.K.), Monash University, Melbourne, Victoria, Australia; Department of Medicine (A.B.), Royal Melbourne Hospital, University of Melbourne, Victoria, Australia; Department of Neurology (C.M.B.), Department of Rehabilitation Medicine (C.M.B.), and Department of Radiology (C.M.B.), Emory University, Atlanta, GA; Hospital das Clinicas HCFMUSP (A.B.C.), Faculdade de Medicina, Universidade de São Paulo; Hospital Israelita Albert Einstein (A.B.C.), São Paulo, Brazil; Melbourne School of Psychological Sciences (N.E.-B.), University of Melbourne; Departments of Physiotherapy, Medicine (RMH) & The Florey Institute of Neuroscience and Mental Health (K.S.H.), University of Melbourne, Victoria, Australia; Facility for Education and Research in Neuroscience (K.P.R.), Emory University, Atlanta, GA; Brain Mapping Center (A.Z.-P.), Department of Neurology, Geffen School of Medicine, University of California Los Angeles; and Mark and Mary Stevens Neuroimaging and Informatics Institute and Keck School of Medicine (L.B., S.-L.L.), University of Southern California, Los Angeles
| | - Kathryn S Hayward
- From the Gerontology Research Centre (J.K.F.), Simon Fraser University; Department of Physical Therapy and Djavad Mowafaghian Centre for Brain Health (J.K.F.), University of British Columbia, Vancouver, Canada; Chan Division of Occupational Science and Occupational Therapy (B.P.L., M.R.D., S.-L.L.), University of Southern California, Los Angeles; Department of Neurosurgery (G.B.), Stanford School of Medicine, Stanford University, CA; Central Clinical School (A.B., M.S.K.), Monash University, Melbourne, Victoria, Australia; Department of Medicine (A.B.), Royal Melbourne Hospital, University of Melbourne, Victoria, Australia; Department of Neurology (C.M.B.), Department of Rehabilitation Medicine (C.M.B.), and Department of Radiology (C.M.B.), Emory University, Atlanta, GA; Hospital das Clinicas HCFMUSP (A.B.C.), Faculdade de Medicina, Universidade de São Paulo; Hospital Israelita Albert Einstein (A.B.C.), São Paulo, Brazil; Melbourne School of Psychological Sciences (N.E.-B.), University of Melbourne; Departments of Physiotherapy, Medicine (RMH) & The Florey Institute of Neuroscience and Mental Health (K.S.H.), University of Melbourne, Victoria, Australia; Facility for Education and Research in Neuroscience (K.P.R.), Emory University, Atlanta, GA; Brain Mapping Center (A.Z.-P.), Department of Neurology, Geffen School of Medicine, University of California Los Angeles; and Mark and Mary Stevens Neuroimaging and Informatics Institute and Keck School of Medicine (L.B., S.-L.L.), University of Southern California, Los Angeles
| | - Mohamed Salah Khlif
- From the Gerontology Research Centre (J.K.F.), Simon Fraser University; Department of Physical Therapy and Djavad Mowafaghian Centre for Brain Health (J.K.F.), University of British Columbia, Vancouver, Canada; Chan Division of Occupational Science and Occupational Therapy (B.P.L., M.R.D., S.-L.L.), University of Southern California, Los Angeles; Department of Neurosurgery (G.B.), Stanford School of Medicine, Stanford University, CA; Central Clinical School (A.B., M.S.K.), Monash University, Melbourne, Victoria, Australia; Department of Medicine (A.B.), Royal Melbourne Hospital, University of Melbourne, Victoria, Australia; Department of Neurology (C.M.B.), Department of Rehabilitation Medicine (C.M.B.), and Department of Radiology (C.M.B.), Emory University, Atlanta, GA; Hospital das Clinicas HCFMUSP (A.B.C.), Faculdade de Medicina, Universidade de São Paulo; Hospital Israelita Albert Einstein (A.B.C.), São Paulo, Brazil; Melbourne School of Psychological Sciences (N.E.-B.), University of Melbourne; Departments of Physiotherapy, Medicine (RMH) & The Florey Institute of Neuroscience and Mental Health (K.S.H.), University of Melbourne, Victoria, Australia; Facility for Education and Research in Neuroscience (K.P.R.), Emory University, Atlanta, GA; Brain Mapping Center (A.Z.-P.), Department of Neurology, Geffen School of Medicine, University of California Los Angeles; and Mark and Mary Stevens Neuroimaging and Informatics Institute and Keck School of Medicine (L.B., S.-L.L.), University of Southern California, Los Angeles
| | - Kate P Revill
- From the Gerontology Research Centre (J.K.F.), Simon Fraser University; Department of Physical Therapy and Djavad Mowafaghian Centre for Brain Health (J.K.F.), University of British Columbia, Vancouver, Canada; Chan Division of Occupational Science and Occupational Therapy (B.P.L., M.R.D., S.-L.L.), University of Southern California, Los Angeles; Department of Neurosurgery (G.B.), Stanford School of Medicine, Stanford University, CA; Central Clinical School (A.B., M.S.K.), Monash University, Melbourne, Victoria, Australia; Department of Medicine (A.B.), Royal Melbourne Hospital, University of Melbourne, Victoria, Australia; Department of Neurology (C.M.B.), Department of Rehabilitation Medicine (C.M.B.), and Department of Radiology (C.M.B.), Emory University, Atlanta, GA; Hospital das Clinicas HCFMUSP (A.B.C.), Faculdade de Medicina, Universidade de São Paulo; Hospital Israelita Albert Einstein (A.B.C.), São Paulo, Brazil; Melbourne School of Psychological Sciences (N.E.-B.), University of Melbourne; Departments of Physiotherapy, Medicine (RMH) & The Florey Institute of Neuroscience and Mental Health (K.S.H.), University of Melbourne, Victoria, Australia; Facility for Education and Research in Neuroscience (K.P.R.), Emory University, Atlanta, GA; Brain Mapping Center (A.Z.-P.), Department of Neurology, Geffen School of Medicine, University of California Los Angeles; and Mark and Mary Stevens Neuroimaging and Informatics Institute and Keck School of Medicine (L.B., S.-L.L.), University of Southern California, Los Angeles
| | - Artemis Zavaliangos-Petropulu
- From the Gerontology Research Centre (J.K.F.), Simon Fraser University; Department of Physical Therapy and Djavad Mowafaghian Centre for Brain Health (J.K.F.), University of British Columbia, Vancouver, Canada; Chan Division of Occupational Science and Occupational Therapy (B.P.L., M.R.D., S.-L.L.), University of Southern California, Los Angeles; Department of Neurosurgery (G.B.), Stanford School of Medicine, Stanford University, CA; Central Clinical School (A.B., M.S.K.), Monash University, Melbourne, Victoria, Australia; Department of Medicine (A.B.), Royal Melbourne Hospital, University of Melbourne, Victoria, Australia; Department of Neurology (C.M.B.), Department of Rehabilitation Medicine (C.M.B.), and Department of Radiology (C.M.B.), Emory University, Atlanta, GA; Hospital das Clinicas HCFMUSP (A.B.C.), Faculdade de Medicina, Universidade de São Paulo; Hospital Israelita Albert Einstein (A.B.C.), São Paulo, Brazil; Melbourne School of Psychological Sciences (N.E.-B.), University of Melbourne; Departments of Physiotherapy, Medicine (RMH) & The Florey Institute of Neuroscience and Mental Health (K.S.H.), University of Melbourne, Victoria, Australia; Facility for Education and Research in Neuroscience (K.P.R.), Emory University, Atlanta, GA; Brain Mapping Center (A.Z.-P.), Department of Neurology, Geffen School of Medicine, University of California Los Angeles; and Mark and Mary Stevens Neuroimaging and Informatics Institute and Keck School of Medicine (L.B., S.-L.L.), University of Southern California, Los Angeles
| | - Lara Boyd
- From the Gerontology Research Centre (J.K.F.), Simon Fraser University; Department of Physical Therapy and Djavad Mowafaghian Centre for Brain Health (J.K.F.), University of British Columbia, Vancouver, Canada; Chan Division of Occupational Science and Occupational Therapy (B.P.L., M.R.D., S.-L.L.), University of Southern California, Los Angeles; Department of Neurosurgery (G.B.), Stanford School of Medicine, Stanford University, CA; Central Clinical School (A.B., M.S.K.), Monash University, Melbourne, Victoria, Australia; Department of Medicine (A.B.), Royal Melbourne Hospital, University of Melbourne, Victoria, Australia; Department of Neurology (C.M.B.), Department of Rehabilitation Medicine (C.M.B.), and Department of Radiology (C.M.B.), Emory University, Atlanta, GA; Hospital das Clinicas HCFMUSP (A.B.C.), Faculdade de Medicina, Universidade de São Paulo; Hospital Israelita Albert Einstein (A.B.C.), São Paulo, Brazil; Melbourne School of Psychological Sciences (N.E.-B.), University of Melbourne; Departments of Physiotherapy, Medicine (RMH) & The Florey Institute of Neuroscience and Mental Health (K.S.H.), University of Melbourne, Victoria, Australia; Facility for Education and Research in Neuroscience (K.P.R.), Emory University, Atlanta, GA; Brain Mapping Center (A.Z.-P.), Department of Neurology, Geffen School of Medicine, University of California Los Angeles; and Mark and Mary Stevens Neuroimaging and Informatics Institute and Keck School of Medicine (L.B., S.-L.L.), University of Southern California, Los Angeles
| | - Sook-Lei Liew
- From the Gerontology Research Centre (J.K.F.), Simon Fraser University; Department of Physical Therapy and Djavad Mowafaghian Centre for Brain Health (J.K.F.), University of British Columbia, Vancouver, Canada; Chan Division of Occupational Science and Occupational Therapy (B.P.L., M.R.D., S.-L.L.), University of Southern California, Los Angeles; Department of Neurosurgery (G.B.), Stanford School of Medicine, Stanford University, CA; Central Clinical School (A.B., M.S.K.), Monash University, Melbourne, Victoria, Australia; Department of Medicine (A.B.), Royal Melbourne Hospital, University of Melbourne, Victoria, Australia; Department of Neurology (C.M.B.), Department of Rehabilitation Medicine (C.M.B.), and Department of Radiology (C.M.B.), Emory University, Atlanta, GA; Hospital das Clinicas HCFMUSP (A.B.C.), Faculdade de Medicina, Universidade de São Paulo; Hospital Israelita Albert Einstein (A.B.C.), São Paulo, Brazil; Melbourne School of Psychological Sciences (N.E.-B.), University of Melbourne; Departments of Physiotherapy, Medicine (RMH) & The Florey Institute of Neuroscience and Mental Health (K.S.H.), University of Melbourne, Victoria, Australia; Facility for Education and Research in Neuroscience (K.P.R.), Emory University, Atlanta, GA; Brain Mapping Center (A.Z.-P.), Department of Neurology, Geffen School of Medicine, University of California Los Angeles; and Mark and Mary Stevens Neuroimaging and Informatics Institute and Keck School of Medicine (L.B., S.-L.L.), University of Southern California, Los Angeles
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18
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Braga MAF, Faria-Fortini I, Soares CLDA, Rodrigues NAG, Sant Anna RV, Faria CDCDM. Acute clinical outcomes predict both generic and specific health-related quality of life six and 12 months after stroke: A one-year prospective study developed in a middle-income country. J Stroke Cerebrovasc Dis 2024; 33:107777. [PMID: 38795794 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 01/30/2024] [Accepted: 05/16/2024] [Indexed: 05/28/2024] Open
Abstract
OBJECTIVE To identify acute predictors of generic and specific health-related quality of life (HRQoL) six and 12 months after stroke in individuals from a middle-income country. MATERIAL AND METHODS This was a prospective study. The dependent outcomes assessed during six and 12 months after stroke included both generic and specific HRQoL (Short Form Health Survey-36 [SF-36] and stroke-specific quality of life [SSQOL]). The predictors were age, sex, education level, length of hospital stay, current living arrangement, stroke severity, functional independence, and motor impairment. RESULTS 122 (59.9±14 years) and 103 (59.8±14.71 years) individuals were evaluated six and 12 months after stroke, respectively. Functional independence and sex were significant acute predictors of both generic and specific HRQoL. Functional independence was the strongest predictor (0.149≤R2≤0.262; 20.01≤F≤43.96, p<0.001), except for generic HRQoL at 12 months, where sex was the strongest predictor (R2=0.14; F=17.97, p<0.001). CONCLUSION Generic and specific HRQoL in chronic individuals six and 12 months after stroke, from a middle-income country, can be predicted based on functional independence, the strongest predictor, assessed in the acute phase, except for generic HRQoL at 12 months. Functional independence can be modified by rehabilitation strategies and thus should be considered for HRQoL prognoses at chronic phase.
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Affiliation(s)
- Marcela Aline Fernandes Braga
- Graduate Program in Rehabilitation Sciences of the Universidade Federal de Minas Gerais, (UFMG), Belo Horizonte, (MG), Brazil
| | - Iza Faria-Fortini
- Department of Occupational Therapy, Universidade Federal de Minas Gerais, (UFMG), Belo Horizonte, (MG), Brazil; Graduate Program in Occupation Studies of the Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, (MG), Brazil
| | - Carolina Luísa de Almeida Soares
- Graduate Program in Rehabilitation Sciences of the Universidade Federal de Minas Gerais, (UFMG), Belo Horizonte, (MG), Brazil; Physiotherapy graduation in Universidade Federal de Minas Gerais, (UFMG), Belo Horizonte, (MG), Brazil
| | | | - Romeu Vale Sant Anna
- Neurologist, coordinator of the stroke unit at the public hospital Risoleta Tolentino Neves, Belo Horizonte, (MG), Brazil
| | - Christina Danielli Coelho de Morais Faria
- Graduate Program in Rehabilitation Sciences of the Universidade Federal de Minas Gerais, (UFMG), Belo Horizonte, (MG), Brazil; Department of Physical Therapy, Universidade Federal de Minas Gerais, (UFMG), Belo Horizonte, (MG), Brazil.
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19
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Ceradini M, Losanno E, Micera S, Bandini A, Orlandi S. Immersive VR for upper-extremity rehabilitation in patients with neurological disorders: a scoping review. J Neuroeng Rehabil 2024; 21:75. [PMID: 38734690 PMCID: PMC11088157 DOI: 10.1186/s12984-024-01367-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Neurological disorders, such as stroke and chronic pain syndromes, profoundly impact independence and quality of life, especially when affecting upper extremity (UE) function. While conventional physical therapy has shown effectiveness in providing some neural recovery in affected individuals, there remains a need for improved interventions. Virtual reality (VR) has emerged as a promising technology-based approach for neurorehabilitation to make the patient's experience more enjoyable. Among VR-based rehabilitation paradigms, those based on fully immersive systems with headsets have gained significant attention due to their potential to enhance patient's engagement. METHODS This scoping review aims to investigate the current state of research on the use of immersive VR for UE rehabilitation in individuals with neurological diseases, highlighting benefits and limitations. We identified thirteen relevant studies through comprehensive searches in Scopus, PubMed, and IEEE Xplore databases. Eligible studies incorporated immersive VR for UE rehabilitation in patients with neurological disorders and evaluated participants' neurological and motor functions before and after the intervention using clinical assessments. RESULTS Most of the included studies reported improvements in the participants rehabilitation outcomes, suggesting that immersive VR represents a valuable tool for UE rehabilitation in individuals with neurological disorders. In addition, immersive VR-based interventions hold the potential for personalized and intensive training within a telerehabilitation framework. However, further studies with better design are needed for true comparison with traditional therapy. Also, the potential side effects associated with VR head-mounted displays, such as dizziness and nausea, warrant careful consideration in the development and implementation of VR-based rehabilitation programs. CONCLUSION This review provides valuable insights into the application of immersive VR in UE rehabilitation, offering the foundation for future research and clinical practice. By leveraging immersive VR's potential, researchers and rehabilitation specialists can design more tailored and patient-centric rehabilitation strategies, ultimately improving the functional outcome and enhancing the quality of life of individuals with neurological diseases.
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Affiliation(s)
- Matteo Ceradini
- The Biorobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy.
| | - Elena Losanno
- The Biorobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy
- Modular Implantable Neuroprostheses (MINE) Laboratory, Università Vita-Salute San Raffaele & Scuola Superiore Sant'Anna, Milan, Italy
| | - Silvestro Micera
- The Biorobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy
- Modular Implantable Neuroprostheses (MINE) Laboratory, Università Vita-Salute San Raffaele & Scuola Superiore Sant'Anna, Milan, Italy
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Andrea Bandini
- The Biorobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy
- Modular Implantable Neuroprostheses (MINE) Laboratory, Università Vita-Salute San Raffaele & Scuola Superiore Sant'Anna, Milan, Italy
- Health Science Interdisciplinary Research Center, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Silvia Orlandi
- Department of Electrical, Electronic and Information Engineering "Guglielmo Marconi", University of Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
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20
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Ito D, Fukuda M, Hosoi Y, Hirose R, Teramae T, Kamimoto T, Yamada Y, Tsuji T, Noda T, Kawakami M. Optimizing shoulder elevation assist rate in exoskeletal rehabilitation based on muscular activity indices: a clinical feasibility study. BMC Neurol 2024; 24:144. [PMID: 38724916 PMCID: PMC11080160 DOI: 10.1186/s12883-024-03651-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Restoring shoulder function is critical for upper-extremity rehabilitation following a stroke. The complex musculoskeletal anatomy of the shoulder presents a challenge for safely assisting elevation movements through robotic interventions. The level of shoulder elevation assistance in rehabilitation is often based on clinical judgment. There is no standardized method for deriving an optimal level of assistance, underscoring the importance of addressing abnormal movements during shoulder elevation, such as abnormal synergies and compensatory actions. This study aimed to investigate the effectiveness and safety of a newly developed shoulder elevation exoskeleton robot by applying a novel optimization technique derived from the muscle synergy index. METHODS Twelve chronic stroke participants underwent an intervention consisting of 100 robot-assisted shoulder elevation exercises (10 × 10 times, approximately 40 min) for 10 days (4-5 times/week). The optimal robot assist rate was derived by detecting the change points using the co-contraction index, calculated from electromyogram (EMG) data obtained from the anterior deltoid and biceps brachii muscles during shoulder elevation at the initial evaluation. The primary outcomes were the Fugl-Meyer assessment-upper extremity (FMA-UE) shoulder/elbow/forearm score, kinematic outcomes (maximum angle of voluntary shoulder flexion and elbow flexion ratio during shoulder elevation), and shoulder pain outcomes (pain-free passive shoulder flexion range of motion [ROM] and visual analogue scale for pain severity during shoulder flexion). The effectiveness and safety of robotic therapy were examined using the Wilcoxon signed-rank sum test. RESULTS All 12 patients completed the procedure without any adverse events. Two participants were excluded from the analysis because the EMG of the biceps brachii was not obtained. Ten participants (five men and five women; mean age: 57.0 [5.5] years; mean FMA-UE total score: 18.7 [10.5] points) showed significant improvement in the FMA-UE shoulder/elbow/forearm score, kinematic outcomes, and pain-free passive shoulder flexion ROM (P < 0.05). The shoulder pain outcomes remained unchanged or improved in all patients. CONCLUSIONS The study presents a method for deriving the optimal robotic assist rate. Rehabilitation using a shoulder robot based on this derived optimal assist rate showed the possibility of safely improving the upper-extremity function in patients with severe stroke in the chronic phase.
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Affiliation(s)
- Daisuke Ito
- Department of Rehabilitation Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Mori Fukuda
- Graduate School of Science and Technology, Keio University, Tokyo, Kanagawa, Japan
| | - Yuichiro Hosoi
- Department of Rehabilitation Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Ryotaro Hirose
- Graduate School of Science and Technology, Keio University, Tokyo, Kanagawa, Japan
| | - Tatsuya Teramae
- Department of Brain Robot Interface, Brain Information Communication Research Laboratory Group, Advanced Telecommunications Research Institute International, Kyoto, Japan
| | - Takayuki Kamimoto
- Department of Rehabilitation Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yuka Yamada
- Department of Rehabilitation Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Tetsuya Tsuji
- Department of Rehabilitation Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Tomoyuki Noda
- Department of Rehabilitation Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
- Department of Brain Robot Interface, Brain Information Communication Research Laboratory Group, Advanced Telecommunications Research Institute International, Kyoto, Japan
| | - Michiyuki Kawakami
- Department of Rehabilitation Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
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21
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Gooch HJ, Jarvis KA, Stockley RC. Behavior Change Approaches in Digital Technology-Based Physical Rehabilitation Interventions Following Stroke: Scoping Review. J Med Internet Res 2024; 26:e48725. [PMID: 38656777 PMCID: PMC11079774 DOI: 10.2196/48725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 11/14/2023] [Accepted: 12/26/2023] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Digital health technologies (DHTs) are increasingly used in physical stroke rehabilitation to support individuals in successfully engaging with the frequent, intensive, and lengthy activities required to optimize recovery. Despite this, little is known about behavior change within these interventions. OBJECTIVE This scoping review aimed to identify if and how behavior change approaches (ie, theories, models, frameworks, and techniques to influence behavior) are incorporated within physical stroke rehabilitation interventions that include a DHT. METHODS Databases (Embase, MEDLINE, PsycINFO, CINAHL, Cochrane Library, and AMED) were searched using keywords relating to behavior change, DHT, physical rehabilitation, and stroke. The results were independently screened by 2 reviewers. Sources were included if they reported a completed primary research study in which a behavior change approach could be identified within a physical stroke rehabilitation intervention that included a DHT. Data, including the study design, DHT used, and behavior change approaches, were charted. Specific behavior change techniques were coded to the behavior change technique taxonomy version 1 (BCTTv1). RESULTS From a total of 1973 identified sources, 103 (5%) studies were included for data charting. The most common reason for exclusion at full-text screening was the absence of an explicit approach to behavior change (165/245, 67%). Almost half (45/103, 44%) of the included studies were described as pilot or feasibility studies. Virtual reality was the most frequently identified DHT type (58/103, 56%), and almost two-thirds (65/103, 63%) of studies focused on upper limb rehabilitation. Only a limited number of studies (18/103, 17%) included a theory, model, or framework for behavior change. The most frequently used BCTTv1 clusters were feedback and monitoring (88/103, 85%), reward and threat (56/103, 54%), goals and planning (33/103, 32%), and shaping knowledge (33/103, 32%). Relationships between feedback and monitoring and reward and threat were identified using a relationship map, with prominent use of both of these clusters in interventions that included virtual reality. CONCLUSIONS Despite an assumption that DHTs can promote engagement in rehabilitation, this scoping review demonstrates that very few studies of physical stroke rehabilitation that include a DHT overtly used any form of behavior change approach. From those studies that did consider behavior change, most did not report a robust underpinning theory. Future development and research need to explicitly articulate how including DHTs within an intervention may support the behavior change required for optimal engagement in physical rehabilitation following stroke, as well as establish their effectiveness. This understanding is likely to support the realization of the transformative potential of DHTs in stroke rehabilitation.
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Affiliation(s)
- Helen J Gooch
- Stroke Research Team, School of Nursing and Midwifery, University of Central Lancashire, Preston, United Kingdom
| | - Kathryn A Jarvis
- Stroke Research Team, School of Nursing and Midwifery, University of Central Lancashire, Preston, United Kingdom
| | - Rachel C Stockley
- Stroke Research Team, School of Nursing and Midwifery, University of Central Lancashire, Preston, United Kingdom
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Pilipenko V, Upite J, Revina BL, Jansone B. Long-Term Alterations in Motor Skills, Neurogenesis and Astrocyte Numbers following Transient Cerebral Ischemia in Mice. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:658. [PMID: 38674304 PMCID: PMC11052140 DOI: 10.3390/medicina60040658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 04/11/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024]
Abstract
Background and Objectives. Neurogenesis is an integral process in post-stroke recovery, involving the recruitment of proliferating neuroblasts from neurogenic niches of the mammal brain. However, the role of neurogenesis in the long-term restoration following ischemic stroke is fragmented. Post-stroke motor dysfunction includes challenges in the proper, coordinated use of hands and is present in roughly two-thirds of human patients. In this study, we investigated chronic behavioral and biochemical alterations after transient cerebral ischemia in adult male mice. Materials and Methods: Twelve-week-old C57BL/6N male mice were used, and fMCAo lasting 60 min was induced. At multiple timepoints after fMCAo induction, a single pellet reaching task was performed. Six months after the procedure, we immunohistochemically determined the number of proliferating neuroblasts (BrdU and DCX-positive) and the number of differentiated astrocytes (GFAP-positive) in both brain hemispheres. Results: The reaching ability of fMCAo mice was impaired from one month to six months after the induction of ischemia. Neuroblast proliferation was increased in the ipsilateral SVZ, whereas GFAP+ cell count was elevated in the hippocampal DG of both hemispheres of the fMCAo group mice. Conclusions: Our current report demonstrates the long-term effects of transient cerebral ischemia on mice functional parameters and neurogenesis progression. Our data demonstrate that transient cerebral ischemia promotes a long-lasting regenerative response in the ipsilateral brain hemisphere, specifically in the neurogenic SVZ and DG regions.
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Affiliation(s)
- Vladimirs Pilipenko
- Department of Pharmacology, Faculty of Medicine, University of Latvia, Raina Blvd. 19, LV-1586 Riga, Latvia; (J.U.); (B.L.R.)
| | | | | | - Baiba Jansone
- Department of Pharmacology, Faculty of Medicine, University of Latvia, Raina Blvd. 19, LV-1586 Riga, Latvia; (J.U.); (B.L.R.)
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23
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Devittori G, Dinacci D, Romiti D, Califfi A, Petrillo C, Rossi P, Ranzani R, Gassert R, Lambercy O. Unsupervised robot-assisted rehabilitation after stroke: feasibility, effect on therapy dose, and user experience. J Neuroeng Rehabil 2024; 21:52. [PMID: 38594727 PMCID: PMC11005116 DOI: 10.1186/s12984-024-01347-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/22/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Unsupervised robot-assisted rehabilitation is a promising approach to increase the dose of therapy after stroke, which may help promote sensorimotor recovery without requiring significant additional resources and manpower. However, the unsupervised use of robotic technologies is not yet a standard, as rehabilitation robots often show low usability or are considered unsafe to be used by patients independently. In this paper we explore the feasibility of unsupervised therapy with an upper limb rehabilitation robot in a clinical setting, evaluate the effect on the overall therapy dose, and assess user experience during unsupervised use of the robot and its usability. METHODS Subacute stroke patients underwent a four-week protocol composed of daily 45 min-sessions of robot-assisted therapy. The first week consisted of supervised therapy, where a therapist explained how to interact with the device. The second week was minimally supervised, i.e., the therapist was present but intervened only if needed. After this phase, if participants learnt how to use the device, they proceeded to two weeks of fully unsupervised training. Feasibility, dose of robot-assisted therapy achieved during unsupervised use, user experience, and usability of the device were evaluated. Questionnaires to evaluate usability and user experience were performed after the minimally supervised week and at the end of the study, to evaluate the impact of therapists' absence. RESULTS Unsupervised robot-assisted therapy was found to be feasible, as 12 out of the 13 recruited participants could progress to unsupervised training. During the two weeks of unsupervised therapy participants on average performed an additional 360 min of robot-assisted rehabilitation. Participants were satisfied with the device usability (mean System Usability Scale scores > 79), and no adverse events or device deficiencies occurred. CONCLUSIONS We demonstrated that unsupervised robot-assisted therapy in a clinical setting with an actuated device for the upper limb was feasible and can lead to a meaningful increase in therapy dose. These results support the application of unsupervised robot-assisted therapy as a complement to usual care in clinical settings and pave the way to its application in home settings. TRIAL REGISTRATION Registered on 13.05.2020 on clinicaltrials.gov (NCT04388891).
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Affiliation(s)
- Giada Devittori
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Switzerland.
| | - Daria Dinacci
- Clinica Hildebrand Centro di riabilitazione Brissago, Brissago, Switzerland
| | - Davide Romiti
- Clinica Hildebrand Centro di riabilitazione Brissago, Brissago, Switzerland
| | - Antonella Califfi
- Clinica Hildebrand Centro di riabilitazione Brissago, Brissago, Switzerland
| | - Claudio Petrillo
- Clinica Hildebrand Centro di riabilitazione Brissago, Brissago, Switzerland
| | - Paolo Rossi
- Clinica Hildebrand Centro di riabilitazione Brissago, Brissago, Switzerland
| | - Raffaele Ranzani
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Switzerland
| | - Roger Gassert
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Switzerland
- Future Health Technologies programme, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Switzerland
- Future Health Technologies programme, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
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24
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Denny MC, Rosendale N, Gonzales NR, Leslie‐Mazwi TM, Middleton S. Addressing Disparities in Acute Stroke Management and Prognosis. J Am Heart Assoc 2024; 13:e031313. [PMID: 38529656 PMCID: PMC11179759 DOI: 10.1161/jaha.123.031313] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 01/03/2024] [Indexed: 03/27/2024]
Abstract
There are now abundant data demonstrating disparities in acute stroke management and prognosis; however, interventions to reduce these disparities remain limited. This special report aims to provide a critical review of the current landscape of disparities in acute stroke care and highlight opportunities to use implementation science to reduce disparities throughout the early care continuum. In the prehospital setting, stroke symptom recognition campaigns that have been successful in reducing prehospital delays used a multilevel approach to education, including mass media, culturally tailored community education, and professional education. The mobile stroke unit is an organizational intervention that has the potential to provide more equitable access to timely thrombolysis and thrombectomy treatments. In the hospital setting, interventions to address implicit biases among health care providers in acute stroke care decision-making are urgently needed as part of a multifaceted approach to advance stroke equity. Implementing stroke systems of care interventions, such as evidence-based stroke care protocols at designated stroke centers, can have a broader public health impact and may help reduce geographic, racial, and ethnic disparities in stroke care, although further research is needed. The long-term impact of disparities in acute stroke care cannot be underestimated. The consistent trend of longer time to treatment for Black and Hispanic people experiencing stroke has direct implications on long-term disability and independence after stroke. A learning health system model may help expedite the translation of evidence-based interventions into clinical practice to reduce disparities in stroke care.
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Affiliation(s)
- M. Carter Denny
- Department of NeurologyGeorgetown University School of MedicineWashingtonDCUSA
- Department of Neurology, MedStar HealthWashingtonDCUSA
| | - Nicole Rosendale
- Department of NeurologyUniversity of California San FranciscoSan FranciscoCAUSA
- Weill Institute for Neurosciences, University of California San FranciscoSan FranciscoCAUSA
| | - Nicole R. Gonzales
- Department of NeurologyUniversity of Colorado Anschutz Medical CampusAuroraCOUSA
| | | | - Sandy Middleton
- Nursing Research Institute, St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne and Australian Catholic UniversityDarlinghurstAustralia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic UniversityDarlinghurstAustralia
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25
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Ko N, Lee HH, Sohn MK, Kim DY, Shin YI, Oh GJ, Lee YS, Joo MC, Lee SY, Song MK, Han J, Ahn J, Chang WH, Lee J, Kim YH. Incidence of Altered Level of Consciousness in Hemorrhagic Stroke Survivors: Associated Factors From a Korean Nationwide Study. Am J Phys Med Rehabil 2024; 103:325-332. [PMID: 37903631 DOI: 10.1097/phm.0000000000002351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
OBJECTIVE This study aimed to demonstrate the incidence of altered level of consciousness after hemorrhagic stroke and identify factors associated with altered level of consciousness at 3 mos after stroke. DESIGN This study used data from a prospective multicenter cohort study conducted in nine hospitals in Korea and included 1677 patients with first-ever hemorrhagic stroke. Patients were dichotomized into those with and without altered level of consciousness at 3 mos after stroke. Multivariate logistic regression analysis was performed to identify factors associated with subacute to chronic stage altered level of consciousness. RESULTS Among patients with hemorrhagic stroke (age: 20-99 yrs, female 50.21%), the prevalence of altered level of consciousness at admission was 38.58% (25.4% [drowsy], 6.38% [stupor], and 6.8% [coma]) and 17.29% 3 mos after stroke. Multivariate logistic regression analysis revealed that independent factors associated with altered level of consciousness at 3 mos after stroke included late seizure (odds ratio [95% confidence interval], 5.93 [1.78-20.00]), stroke progression (3.84 [1.48-9.64]), craniectomy (2.19 [1.19-4.00]), history of complications (1.74 [1.18-2.55]), age at stroke onset (1.08 [1.07-1.10]), and initial Glasgow Coma Scale score category (0.36 [0.30-0.44]). CONCLUSIONS The factors associated with altered level of consciousness at 3 mos after stroke should be considered when explaining long-term consciousness status and focused management of modifiable factors in acute care hospitals could help ameliorate altered level of consciousness and promote recovery after stroke.
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Affiliation(s)
- Nayeon Ko
- From the Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea (NK, HHL, JL); Department of Rehabilitation Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea (MKS); Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea (DYK); Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea (Y-IS); Department of Preventive Medicine, Wonkwang University, School of Medicine, Iksan, Republic of Korea (G-JO); Department of Rehabilitation Medicine, Kyungpook National University School of Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea (Y-SL); Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, Republic of Korea (MCJ); Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju City, Republic of Korea (SYL); Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea (M-KS); Department of Statistics, Hallym University, Chuncheon, Republic of Korea (JH); Department of Health Convergence, Ewha Womans University, Seoul, Republic of Korea (JA); Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (WHC, Y-HK); and Departments of Health Science and Technology, Medical Devices Management and Research, and Digital Healthcare, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea (Y-HK)
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26
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Erdoğan MŞ, Arpak ES, Keles CSK, Villagra F, Işık EÖ, Afşar N, Yucesoy CA, Mur LAJ, Akanyeti O, Saybaşılı H. Biochemical, biomechanical and imaging biomarkers of ischemic stroke: Time for integrative thinking. Eur J Neurosci 2024; 59:1789-1818. [PMID: 38221768 DOI: 10.1111/ejn.16245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/12/2023] [Accepted: 12/16/2023] [Indexed: 01/16/2024]
Abstract
Stroke is one of the leading causes of adult disability affecting millions of people worldwide. Post-stroke cognitive and motor impairments diminish quality of life and functional independence. There is an increased risk of having a second stroke and developing secondary conditions with long-term social and economic impacts. With increasing number of stroke incidents, shortage of medical professionals and limited budgets, health services are struggling to provide a care that can break the vicious cycle of stroke. Effective post-stroke recovery hinges on holistic, integrative and personalized care starting from improved diagnosis and treatment in clinics to continuous rehabilitation and support in the community. To improve stroke care pathways, there have been growing efforts in discovering biomarkers that can provide valuable insights into the neural, physiological and biomechanical consequences of stroke and how patients respond to new interventions. In this review paper, we aim to summarize recent biomarker discovery research focusing on three modalities (brain imaging, blood sampling and gait assessments), look at some established and forthcoming biomarkers, and discuss their usefulness and complementarity within the context of comprehensive stroke care. We also emphasize the importance of biomarker guided personalized interventions to enhance stroke treatment and post-stroke recovery.
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Affiliation(s)
| | - Esra Sümer Arpak
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey
| | - Cemre Su Kaya Keles
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey
- Institute of Structural Mechanics and Dynamics in Aerospace Engineering, University of Stuttgart, Stuttgart, Germany
| | - Federico Villagra
- Department of Life Sciences, Aberystwyth University, Aberystwyth, Wales, UK
| | - Esin Öztürk Işık
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey
| | - Nazire Afşar
- Neurology, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Turkey
| | - Can A Yucesoy
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey
| | - Luis A J Mur
- Department of Life Sciences, Aberystwyth University, Aberystwyth, Wales, UK
| | - Otar Akanyeti
- Department of Computer Science, Llandinam Building, Aberystwyth University, Aberystwyth, UK
| | - Hale Saybaşılı
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey
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27
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Traxler K, Baum E, Klotz E, Reindl M, Schinabeck F, Seebacher B. Combining specific task-oriented training with manual therapy to improve balance and mobility in patients after stroke: a mixed methods pilot randomised controlled trial. Disabil Rehabil 2024; 46:1318-1329. [PMID: 37051907 DOI: 10.1080/09638288.2023.2193432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 03/16/2023] [Indexed: 04/14/2023]
Abstract
PURPOSE In absence of existing studies, to describe changes in balance and mobility, following specific task-oriented training (TOT), its combination with talocrural manual therapy (MT-TOT) or no intervention, in chronic stroke patients. To explore the feasibility of a full-scale randomised controlled trial (RCT) based on criteria of recruitment, retention and adherence rates, adverse events, falls and acceptability of the intervention. MATERIALS AND METHODS Using an assessor-blinded pilot RCT, 36 stroke patients were allocated to either MT-TOT, TOT, or controls. Supervised interventions were performed 45 min, 2×/weekly, for 4 weeks, and home-based practice 20 min, 4x/weekly for 4 weeks. Qualitative interviews evaluated intervention acceptability. Outcomes of balance, mobility, ankle dorsiflexion range of motion (ROM), falls and health-related quality of life (HRQoL) were assessed at baseline, post-intervention and 4-week follow-up. RESULTS Preliminary efficacy of MT-TOT and TOT was shown in improving balance (effect size 0.714), walking speed (0.683), mobility (0.265), dual-tasking mobility (0.595), falls (0.037), active and passive talocrural ROM (0.603; 0.751) and activities and social participation related HRQoL domains (0.332-0.784) in stroke patients. The feasibility of a larger RCT was confirmed. CONCLUSIONS Specific MT-TOT and TOT appeared effective and are feasible in stroke patients. A larger RCT is needed to validate the results.Trial Registration: German Clinical Trials Register, DRKS00023068. Registered on 21.09.2020, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00023068.
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Affiliation(s)
- Kristina Traxler
- Therapiezentrum Kinema, Neukirchen b. hl. Blut, Germany
- Department for Health Sciences, Medicine and Research, Danube University Krems, Austria
| | - Eva Baum
- Therapiezentrum Kinema, Neukirchen b. hl. Blut, Germany
| | | | - Markus Reindl
- Clinical Department of Neurology, Medical University of Innsbruck, Austria
| | - Franz Schinabeck
- Überörtliche Gemeinschaftspraxis Hohenwarth/Lam, Hohenwarth, Germany
| | - Barbara Seebacher
- Clinical Department of Neurology, Medical University of Innsbruck, Austria
- VASCage, Research Centre on Vascular Ageing and Stroke, Innsbruck, Austria
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28
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Gangaram-Panday SG, Zhou Y, Gillebert CR. Screening for post-stroke neurocognitive disorders in diverse populations: A systematic review. Clin Neuropsychol 2024; 38:588-611. [PMID: 37480233 DOI: 10.1080/13854046.2023.2237676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 07/12/2023] [Indexed: 07/23/2023]
Abstract
Objective: Although neurocognitive disorders (NCD) are common post-stroke, many populations do not have adapted cognitive screens and cut-offs. We therefore reviewed the appropriateness of the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA) and Oxford Cognitive Screen (OCS) for diagnosing NCD in culturally diverse stroke populations. Method: Using an extensive search string, diagnostic accuracy studies for MMSE, MoCA and OCS in the stroke population were retrieved from four databases. We compared translations and adaptations, adjustments in scores and cut-offs, and their diagnostic accuracy. Results: The search resulted in 28 MMSE, 39 MoCA and 5 OCS-studies in 13 western, educated, industrialized, rich and democratic (WEIRD) and 4 other countries. There was a lack of studies on South-American, African, and non-Chinese-Asian populations. All three tests needed adaptation for less WEIRD populations and populations with languages with non-Latin features. Optimal MMSE and OCS subtest cut-offs were similar across WEIRD and less WEIRD populations, whereas optimal MoCA cut-offs appeared lower for less WEIRD populations. The use of adjusted scores resulted in different optimal cut-offs or similar cut-offs with better accuracy. Conclusions: MoCA, MMSE and OCS are promising tools for diagnosing post-stroke-NCD. For culturally diverse populations, translation, adaptation and adjusted scores or cut-offs are necessary for diagnostic accuracy. Available studies report scarcely about their sample's cultural background and there is a lack of diagnostic accuracy studies in less WEIRD or culturally diverse populations. Future studies should report more cultural characteristics of their sample to provide better insight into the tests' accuracy in culturally diverse populations.
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Affiliation(s)
- Shonimá G Gangaram-Panday
- Brain and Cognition, Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Psychology, Anton de Kom University of Suriname, Paramaribo, Suriname
| | - Yanyao Zhou
- Psychology, University of Hong Kong, Hong Kong
| | - Céline R Gillebert
- Brain and Cognition, Leuven Brain Institute, KU Leuven, Leuven, Belgium
- TRACE Center for Translational Health Research, KU Leuven, Leuven, Belgium
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29
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Unger T, de Sousa Ribeiro R, Mokni M, Weikert T, Pohl J, Schwarz A, Held J, Sauerzopf L, Kühnis B, Gavagnin E, Luft A, Gassert R, Lambercy O, Awai Easthope C, Schönhammer J. Upper limb movement quality measures: comparing IMUs and optical motion capture in stroke patients performing a drinking task. Front Digit Health 2024; 6:1359776. [PMID: 38606036 PMCID: PMC11006959 DOI: 10.3389/fdgth.2024.1359776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/13/2024] [Indexed: 04/13/2024] Open
Abstract
Introduction Clinical assessment of upper limb sensorimotor function post-stroke is often constrained by low sensitivity and limited information on movement quality. To address this gap, recent studies proposed a standardized instrumented drinking task, as a representative daily activity combining different components of functional arm use. Although kinematic movement quality measures for this task are well-established, and optical motion capture (OMC) has proven effective in their measurement, its clinical application remains limited. Inertial Measurement Units (IMUs) emerge as a promising low-cost and user-friendly alternative, yet their validity and clinical relevance compared to the gold standard OMC need investigation. Method In this study, we conducted a measurement system comparison between IMUs and OMC, analyzing 15 established movement quality measures in 15 mild and moderate stroke patients performing the drinking task, using five IMUs placed on each wrist, upper arm, and trunk. Results Our findings revealed strong agreement between the systems, with 12 out of 15 measures demonstrating clinical applicability, evidenced by Limits of Agreement (LoA) below the Minimum Clinically Important Differences (MCID) for each measure. Discussion These results are promising, suggesting the clinical applicability of IMUs in quantifying movement quality for mildly and moderately impaired stroke patients performing the drinking task.
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Affiliation(s)
- T. Unger
- DART Lab, Lake Lucerne Institute, Vitznau, Switzerland
- Rehabilitation Engineering Laboratory, ETH Zurich, Zurich, Switzerland
| | | | - M. Mokni
- DART Lab, Lake Lucerne Institute, Vitznau, Switzerland
| | - T. Weikert
- DART Lab, Lake Lucerne Institute, Vitznau, Switzerland
| | - J. Pohl
- DART Lab, Lake Lucerne Institute, Vitznau, Switzerland
| | - A. Schwarz
- Department of Neurology, UCLA, Los Angeles, CA, United States
- California Rehabilitation Institute, Los Angeles, CA, United States
| | - J.P.O. Held
- Ambulante Reha Triemli Zurich, Zurich, Switzerland
| | - L. Sauerzopf
- ZHAW School of Health Sciences, Institute of Occupational Therapy, Winterthur, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - B. Kühnis
- ZHAW School of Management and Law, Institute of Business Information Technology, Winterthur, Switzerland
| | - E. Gavagnin
- ZHAW School of Management and Law, Institute of Business Information Technology, Winterthur, Switzerland
- ZHAW School of Engineering, Centre for Artificial Intelligence, Winterthur, Switzerland
| | - A.R. Luft
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology and Clinical Neuroscience Center, University of Zurich and University Hospital Zurich, Zurich, Switzerland
- cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - R. Gassert
- Rehabilitation Engineering Laboratory, ETH Zurich, Zurich, Switzerland
| | - O. Lambercy
- Rehabilitation Engineering Laboratory, ETH Zurich, Zurich, Switzerland
| | | | - J.G. Schönhammer
- DART Lab, Lake Lucerne Institute, Vitznau, Switzerland
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology and Clinical Neuroscience Center, University of Zurich and University Hospital Zurich, Zurich, Switzerland
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30
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Zhang J, Wang M, Alam M, Zheng YP, Ye F, Hu X. Effects of non-invasive cervical spinal cord neuromodulation by trans-spinal electrical stimulation on cortico-muscular descending patterns in upper extremity of chronic stroke. Front Bioeng Biotechnol 2024; 12:1372158. [PMID: 38576448 PMCID: PMC10991759 DOI: 10.3389/fbioe.2024.1372158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/11/2024] [Indexed: 04/06/2024] Open
Abstract
Background: Trans-spinal electrical stimulation (tsES) to the intact spinal cord poststroke may modulate the cortico-muscular control in stroke survivors with diverse lesions in the brain. This work aimed to investigate the immediate effects of tsES on the cortico-muscular descending patterns during voluntary upper extremity (UE) muscle contractions by analyzing cortico-muscular coherence (CMCoh) and electromyography (EMG) in people with chronic stroke. Methods: Twelve chronic stroke participants were recruited to perform wrist-hand extension and flexion tasks at submaximal levels of voluntary contraction for the corresponding agonist flexors and extensors. During the tasks, the tsES was delivered to the cervical spinal cord with rectangular biphasic pulses. Electroencephalography (EEG) data were collected from the sensorimotor cortex, and the EMG data were recorded from both distal and proximal UE muscles. The CMCoh, laterality index (LI) of the peak CMCoh, and EMG activation level parameters under both non-tsES and tsES conditions were compared to evaluate the immediate effects of tsES on the cortico-muscular descending pathway. Results: The CMCoh and LI of peak CMCoh in the agonist distal muscles showed significant increases (p < 0.05) during the wrist-hand extension and flexion tasks with the application of tsES. The EMG activation levels of the antagonist distal muscle during wrist-hand extension were significantly decreased (p < 0.05) with tsES. Additionally, the proximal UE muscles exhibited significant decreases (p < 0.05) in peak CMCoh and EMG activation levels by applying tsES. There was a significant increase (p < 0.05) in LI of peak CMCoh of proximal UE muscles during tsES. Conclusion: The cervical spinal cord neuromodulation via tsES enhanced the residual descending excitatory control, activated the local inhibitory circuits within the spinal cord, and reduced the cortical and proximal muscular compensatory effects. These results suggested the potential of tsES as a supplementary input for improving UE motor functions in stroke rehabilitation.
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Affiliation(s)
- Jianing Zhang
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Kowloon, China
| | - Maner Wang
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Kowloon, China
| | - Monzurul Alam
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Kowloon, China
| | - Yong-Ping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Kowloon, China
| | - Fuqiang Ye
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Kowloon, China
| | - Xiaoling Hu
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Kowloon, China
- Research Institute for Smart Ageing (RISA), Hong Kong SAR, China
- Research Centre of Data Science and Artificial Intelligence (RC-DSAI), Hong Kong SAR, China
- Joint Research Centre for Biosensing and Precision Theranostics, Hong Kong SAR, China
- University Research Facility in Behavioral and Systems Neuroscience (UBSN), The Hong Kong Polytechnic University, Hong Kong SAR, China
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31
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Tomita Y, Mullick AA, Feldman AG, Levin MF. Altered Anticipatory Postural Adjustments During Whole-Body Reaching in Subjects With Stroke. Neurorehabil Neural Repair 2024; 38:176-186. [PMID: 38347695 DOI: 10.1177/15459683241231528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2024]
Abstract
BACKGROUND Coordination between arm movements and postural adjustments is crucial for reaching-while-stepping tasks involving both anticipatory postural adjustments (APAs) and compensatory movements to effectively propel the whole-body forward so that the hand can reach the target. Stroke impairs the ability to coordinate the action of multiple body segments but the underlying mechanisms are unclear. Objective. To determine the effects of stroke on reaching performance and APAs during whole-body reaching. METHODS We tested arm reaching in standing (stand-reach) and reaching-while-stepping (step-reach; 15 trials/condition) in individuals with chronic stroke (n = 18) and age-matched healthy subjects (n = 13). Whole-body kinematics and kinetic data were collected during the tasks. The primary outcome measure for step-reach was "gain" (g), defined as the extent to which the hip displacement contributing to hand motion was neutralized by appropriate changes in upper limb movements (g = 1 indicates complete compensation) and APAs measured as spatio-temporal profiles of the center-of-pressure shifts preceding stepping. RESULTS Individuals with stroke had lower gains and altered APAs compared to healthy controls. In addition, step onset was delayed, and the timing of endpoint, trunk, and foot movement offset was prolonged during step-reach compared to healthy controls. Those with milder sensorimotor impairment and better balance function had higher gains. Altered APAs were also related to reduced balance function. CONCLUSIONS Altered APAs and prolonged movement offset in stroke may lead to a greater reliance on compensatory arm movements. Altered APAs in individuals with stroke may be associated with a reduced shift of referent body configuration during the movement.
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Affiliation(s)
- Yosuke Tomita
- Department of Physical Therapy, Faculty of Health Care, Takasaki University of Health and Welfare, Gunma, Japan
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Jewish Rehabilitation Hospital Site, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
| | - Aditi A Mullick
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Jewish Rehabilitation Hospital Site, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
| | - Anatol G Feldman
- Jewish Rehabilitation Hospital Site, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
- Department of Neuroscience, University of Montreal, Montreal, QC, Canada
| | - Mindy F Levin
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Jewish Rehabilitation Hospital Site, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
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Höhler C, Trigili E, Astarita D, Hermsdörfer J, Jahn K, Krewer C. The efficacy of hybrid neuroprostheses in the rehabilitation of upper limb impairment after stroke, a narrative and systematic review with a meta-analysis. Artif Organs 2024; 48:232-253. [PMID: 37548237 DOI: 10.1111/aor.14618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/30/2023] [Accepted: 07/17/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Paresis of the upper limb (UL) is the most frequent impairment after a stroke. Hybrid neuroprostheses, i.e., the combination of robots and electrical stimulation, have emerged as an option to treat these impairments. METHODS To give an overview of existing devices, their features, and how they are linked to clinical metrics, four different databases were systematically searched for studies on hybrid neuroprostheses for UL rehabilitation after stroke. The evidence on the efficacy of hybrid therapies was synthesized. RESULTS Seventy-three studies were identified, introducing 32 hybrid systems. Among the most recent devices (n = 20), most actively reinforce movement (3 passively) and are typical exoskeletons (3 end-effectors). If classified according to the International Classification of Functioning, Disability and Health, systems for proximal support are expected to affect body structures and functions, while the activity and participation level are targeted when applying Functional Electrical Stimulation distally plus the robotic component proximally. The meta-analysis reveals a significant positive effect on UL functions (p < 0.001), evident in a 7.8-point Mdiff between groups in the Fugl-Meyer assessment. This positive effect remains at the 3-month follow-up (Mdiff = 8.4, p < 0.001). CONCLUSIONS Hybrid neuroprostheses have a positive effect on UL recovery after stroke, with effects persisting at least three months after the intervention. Non-significant studies were those with the shortest intervention periods and the oldest patients. Improvements in UL functions are not only present in the subacute phase after stroke but also in long-term chronic stages. In addition to further technical development, more RCTs are needed to make assumptions about the determinants of successful therapy.
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Affiliation(s)
- Chiara Höhler
- Research Department, Schoen Clinic Bad Aibling, Bad Aibling, Germany
- Chair of Human Movement Science, Faculty of Sport and Health Science, Technical University Munich, Munich, Germany
| | - Emilio Trigili
- The Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Davide Astarita
- The Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Joachim Hermsdörfer
- Chair of Human Movement Science, Faculty of Sport and Health Science, Technical University Munich, Munich, Germany
| | - Klaus Jahn
- Research Department, Schoen Clinic Bad Aibling, Bad Aibling, Germany
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians University of Munich (LMU), Munich, Germany
| | - Carmen Krewer
- Research Department, Schoen Clinic Bad Aibling, Bad Aibling, Germany
- Chair of Human Movement Science, Faculty of Sport and Health Science, Technical University Munich, Munich, Germany
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Dalton EJ, Jamwal R, Augoustakis L, Hill E, Johns H, Thijs V, Hayward KS. Prevalence of Arm Weakness, Pre-Stroke Outcomes and Other Post-Stroke Impairments Using Routinely Collected Clinical Data on an Acute Stroke Unit. Neurorehabil Neural Repair 2024; 38:148-160. [PMID: 38340009 PMCID: PMC10878009 DOI: 10.1177/15459683241229676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
INTRODUCTION The prevalence of upper limb motor weakness early post-stroke may be changing, which can have clinical and research implications. Our primary aim was to describe the prevalence of upper limb motor weakness early post-stroke, with a secondary aim to contextualize this prevalence by describing pre-stroke outcomes, other post-stroke impairments, functional activities, and discharge destination. METHODS This cross-sectional observational study extracted clinical data from confirmed stroke patients admitted to a metropolitan stroke unit over 15-months. The primary upper limb weakness measure was Shoulder Abduction and Finger Extension (SAFE) score. Demographics (eg, age), clinical characteristics (eg, stroke severity), pre-stroke outcomes (eg, clinical frailty), other post-stroke impairments (eg, command following), functional activities (eg, ambulation), and discharge destination were also extracted. RESULTS A total of 463 participants had a confirmed stroke and SAFE score. One-third of patients received ≥1 acute medical intervention(s). Nearly one-quarter of patients were classified as frail pre-stroke. Upper limb weakness (SAFE≤8) was present in 35% [95% CI: 30%-39%] at a median of 1-day post-stroke, with 22% presenting with mild-moderate weakness (SAFE5-8). The most common other impairments were upper limb coordination (46%), delayed recall (41%), and upper limb sensation (26%). After a median 3-day acute stroke stay, 52% of the sample were discharged home. CONCLUSION Upper limb weakness was present in just over a third (35%) of the sample early post-stroke. Data on pre-stroke outcomes and the prevalence of other post-stroke impairments highlights the complexity and heterogeneity of stroke recovery. Further research is required to tease out meaningful recovery phenotypes and their implications.
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Affiliation(s)
- Emily J. Dalton
- Occupational Therapy Department, Austin Health, Heidelberg, VIC, Australia
- Department of Physiotherapy, University of Melbourne, Parkville, VIC, Australia
| | - Rebecca Jamwal
- Occupational Therapy Department, Austin Health, Heidelberg, VIC, Australia
| | - Lia Augoustakis
- Occupational Therapy Department, Austin Health, Heidelberg, VIC, Australia
| | - Emma Hill
- Occupational Therapy Department, Austin Health, Heidelberg, VIC, Australia
| | - Hannah Johns
- Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
| | - Vincent Thijs
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia
- Department of Neurology (Austin), Austin Health, Heidelberg, VIC, Australia
- Department of Medicine, University of Melbourne, Parkville, VIC, Australia
| | - Kathryn S. Hayward
- Department of Neurology (Austin), Austin Health, Heidelberg, VIC, Australia
- Departments of Physiotherapy, Medicine (RMH), and Florey Institute of Neuroscience and Mental Health, University of Melbourne, Carlton, VIC, Australia
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Lee TH, Uchiyama S, Kusuma Y, Chiu HC, Navarro JC, Tan KS, Pandian J, Guo L, Wong Y, Venketasubramanian N. A systematic-search-and-review of registered pharmacological therapies investigated to improve neuro-recovery after a stroke. Front Neurol 2024; 15:1346177. [PMID: 38356890 PMCID: PMC10866005 DOI: 10.3389/fneur.2024.1346177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 01/08/2024] [Indexed: 02/16/2024] Open
Abstract
Background Stroke burden is largely due to long-term impairments requiring prolonged care with loss of productivity. We aimed to identify and assess studies of different registered pharmacological therapies as treatments to improve post-stroke impairments and/or disabilities. Methods We performed a systematic-search-and-review of treatments that have been investigated as recovery-enhancing or recovery-promoting therapies in adult patients with stroke. The treatment must have received registration or market authorization in any country regardless of primary indication. Outcomes included in the review were neurological impairments and functional/disability assessments. "The best available studies" based on study design, study size, and/or date of publication were selected and graded for level of evidence (LOE) by consensus. Results Our systematic search yielded 7,801 citations, and we reviewed 665 full-text papers. Fifty-eight publications were selected as "the best studies" across 25 pharmacological classes: 31 on ischemic stroke, 21 on ischemic or hemorrhagic stroke, 4 on intracerebral hemorrhage, and 2 on subarachnoid hemorrhage (SAH). Twenty-six were systematic reviews/meta-analyses, 29 were randomized clinical trials (RCTs), and three were cohort studies. Only nimodipine for SAH had LOE A of benefit (systematic review and network meta-analysis). Many studies, some of which showed treatment effects, were assessed as LOE C-LD, mainly due to small sample sizes or poor quality. Seven interventions had LOE B-R (systematic review/meta-analysis or RCT) of treatment effects. Conclusion Only one commercially available treatment has LOE A for routine use in stroke. Further studies of putative neuroprotective drugs as adjunctive treatment to revascularization procedures and more confirmatory trials on recovery-promoting therapies will enhance the certainty of their benefit. The decision on their use must be guided by the clinical profile, neurological impairments, and target outcomes based on the available evidence. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=376973, PROSPERO, CRD42022376973.
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Affiliation(s)
- Tsong-Hai Lee
- Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shinichiro Uchiyama
- Clinical Research Center for Medicine, International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Medical Center, Tokyo, Japan
| | | | - Hou Chang Chiu
- Taipei Medical University-Shuang Ho Hospital, Taipei, Taiwan
| | | | - Kay Sin Tan
- University of Malaya Medical Center, Kuala Lumpur, Malaysia
| | | | - Liang Guo
- Singapore Clinical Research Institute, Consortium for Clinical Research and Innovation, Singapore, Singapore
| | - Yoko Wong
- Singapore Clinical Research Institute, Consortium for Clinical Research and Innovation, Singapore, Singapore
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Kilbride C, Butcher T, Warland A, Ryan J, Scott DJM, Cassidy E, Athanasiou DA, Singla-Buxarrais G, Baker K, Norris M. Rehabilitation via HOMe-Based gaming exercise for the Upper limb post Stroke (RHOMBUS): a qualitative analysis of participants' experience. BMJ Open 2024; 14:e075821. [PMID: 38245009 PMCID: PMC10806457 DOI: 10.1136/bmjopen-2023-075821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 11/08/2023] [Indexed: 01/22/2024] Open
Abstract
OBJECTIVE To report participants' experiences of trial processes and use of the Neurofenix platform for home-based rehabilitation following stroke. The platform, consisting of the NeuroBall device and Neurofenix app, is a non-immersive virtual reality tool to facilitate upper limb rehabilitation following stroke. The platform has recently been evaluated and demonstrated to be safe and effective through a non-randomised feasibility trial (RHOMBUS). DESIGN Qualitative approach using semistructured interviews. Interviews were audio recorded, transcribed verbatim and analysed using the framework method. SETTING Participants' homes, South-East England. PARTICIPANTS Purposeful sample of 18 adults (≥18 years), minimum 12 weeks following stroke, not receiving upper limb rehabilitation prior to the RHOMBUS trial, scoring 9-25 on the Motricity Index (elbow and shoulder), with sufficient cognitive and communicative abilities to participate. RESULTS Five themes were developed which explored both trial processes and experiences of using the platform. Factors that influenced participant's decision to take part in the trial, their perceptions of support provided during the trial and communication with the research team were found to be important contextual factors effecting participants' overall experience. Specific themes around usability and comfort of the NeuroBall device, factors motivating persistence and perceived effectiveness of the intervention were highlighted as being central to the usability and acceptability of the platform. CONCLUSION This study demonstrated the overall acceptability of the platform and identified areas for enhancement which have since been implemented by Neurofenix. The findings add to the developing literature on the interface between virtual reality systems and user experience. TRIAL REGISTRATION NUMBER ISRCTN60291412.
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Affiliation(s)
- Cherry Kilbride
- Department of Health Sciences, Brunel University London, Uxbridge, UK
| | - Tom Butcher
- Department of Health Sciences, Brunel University London, Uxbridge, UK
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - Alyson Warland
- Department of Health Sciences, Brunel University London, Uxbridge, UK
| | - Jennifer Ryan
- Department of Health Sciences, Brunel University London, Uxbridge, UK
- Public Health and Epidemiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Daniel J M Scott
- Department of Health Sciences, Brunel University London, Uxbridge, UK
- Neurofenix, London, UK
| | | | | | | | - Karen Baker
- Department of Health Sciences, Brunel University London, Uxbridge, UK
- Neurofenix, London, UK
| | - Meriel Norris
- Department of Health Sciences, Brunel University London, Uxbridge, UK
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Seo NJ, Coupland K, Finetto C, Scronce G. Wearable Sensor to Monitor Quality of Upper Limb Task Practice for Stroke Survivors at Home. SENSORS (BASEL, SWITZERLAND) 2024; 24:554. [PMID: 38257646 PMCID: PMC10821060 DOI: 10.3390/s24020554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 01/24/2024]
Abstract
Many stroke survivors experience persistent upper extremity impairment that limits performance in activities of daily living. Upper limb recovery requires high repetitions of task-specific practice. Stroke survivors are often prescribed task practices at home to supplement rehabilitation therapy. A poor quality of task practices, such as the use of compensatory movement patterns, results in maladaptive neuroplasticity and suboptimal motor recovery. There currently lacks a tool for the remote monitoring of movement quality of stroke survivors' task practices at home. The objective of this study was to evaluate the feasibility of classifying movement quality at home using a wearable IMU. Nineteen stroke survivors wore an IMU sensor on the paretic wrist and performed four functional upper limb tasks in the lab and later at home while videorecording themselves. The lab data served as reference data to classify home movement quality using dynamic time warping. Incorrect and correct movement quality was labeled by a therapist. The home task practice movement quality was classified with an accuracy of 92% and F1 score of 0.95 for all tasks combined. Movement types contributing to misclassification were further investigated. The results support the feasibility of a home movement quality monitoring system to assist with upper limb rehabilitation post stroke.
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Affiliation(s)
- Na Jin Seo
- Department of Rehabilitation Sciences, College of Health Professions, Medical University of South Carolina, Charleston, SC 29425, USA
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC 29425, USA; (K.C.); (C.F.); (G.S.)
- Ralph H. Johnson VA Health Care System, Charleston, SC 29401, USA
| | - Kristen Coupland
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC 29425, USA; (K.C.); (C.F.); (G.S.)
- Ralph H. Johnson VA Health Care System, Charleston, SC 29401, USA
| | - Christian Finetto
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC 29425, USA; (K.C.); (C.F.); (G.S.)
- Ralph H. Johnson VA Health Care System, Charleston, SC 29401, USA
| | - Gabrielle Scronce
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC 29425, USA; (K.C.); (C.F.); (G.S.)
- Ralph H. Johnson VA Health Care System, Charleston, SC 29401, USA
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Ti CHE, Hu C, Yuan K, Chu WCW, Tong RKY. Uncovering the Neural Mechanisms of Inter-Hemispheric Balance Restoration in Chronic Stroke Through EMG-Driven Robot Hand Training: Insights From Dynamic Causal Modeling. IEEE Trans Neural Syst Rehabil Eng 2024; 32:1-11. [PMID: 38051622 DOI: 10.1109/tnsre.2023.3339756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
EMG-driven robot hand training can facilitate motor recovery in chronic stroke patients by restoring the interhemispheric balance between motor networks. However, the underlying mechanisms of reorganization between interhemispheric regions remain unclear. This study investigated the effective connectivity (EC) between the ventral premotor cortex (PMv), supplementary motor area (SMA), and primary motor cortex (M1) using Dynamic Causal Modeling (DCM) during motor tasks with the paretic hand. Nineteen chronic stroke subjects underwent 20 sessions of EMG-driven robot hand training, and their Action Reach Arm Test (ARAT) showed significant improvement ( β =3.56, [Formula: see text]). The improvement was correlated with the reduction of inhibitory coupling from the contralesional M1 to the ipsilesional M1 (r=0.58, p=0.014). An increase in the laterality index was only observed in homotopic M1, but not in the premotor area. Additionally, we identified an increase in resting-state functional connectivity (FC) between bilateral M1 ( β =0.11, p=0.01). Inter-M1 FC demonstrated marginal positive relationships with ARAT scores (r=0.402, p=0.110), but its changes did not correlate with ARAT improvements. These findings suggest that the improvement of hand functions brought about by EMG-driven robot hand training was driven explicitly by task-specific reorganization of motor networks. Particularly, the restoration of interhemispheric balance was induced by a reduction in interhemispheric inhibition from the contralesional M1 during motor tasks of the paretic hand. This finding sheds light on the mechanistic understanding of interhemispheric balance and functional recovery induced by EMG-driven robot training.
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Lorenz EA, Su X, Skjæret-Maroni N. A review of combined functional neuroimaging and motion capture for motor rehabilitation. J Neuroeng Rehabil 2024; 21:3. [PMID: 38172799 PMCID: PMC10765727 DOI: 10.1186/s12984-023-01294-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 12/11/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Technological advancements in functional neuroimaging and motion capture have led to the development of novel methods that facilitate the diagnosis and rehabilitation of motor deficits. These advancements allow for the synchronous acquisition and analysis of complex signal streams of neurophysiological data (e.g., EEG, fNIRS) and behavioral data (e.g., motion capture). The fusion of those data streams has the potential to provide new insights into cortical mechanisms during movement, guide the development of rehabilitation practices, and become a tool for assessment and therapy in neurorehabilitation. RESEARCH OBJECTIVE This paper aims to review the existing literature on the combined use of motion capture and functional neuroimaging in motor rehabilitation. The objective is to understand the diversity and maturity of technological solutions employed and explore the clinical advantages of this multimodal approach. METHODS This paper reviews literature related to the combined use of functional neuroimaging and motion capture for motor rehabilitation following the PRISMA guidelines. Besides study and participant characteristics, technological aspects of the used systems, signal processing methods, and the nature of multimodal feature synchronization and fusion were extracted. RESULTS Out of 908 publications, 19 were included in the final review. Basic or translation studies were mainly represented and based predominantly on healthy participants or stroke patients. EEG and mechanical motion capture technologies were most used for biomechanical data acquisition, and their subsequent processing is based mainly on traditional methods. The system synchronization techniques at large were underreported. The fusion of multimodal features mainly supported the identification of movement-related cortical activity, and statistical methods were occasionally employed to examine cortico-kinematic relationships. CONCLUSION The fusion of motion capture and functional neuroimaging might offer advantages for motor rehabilitation in the future. Besides facilitating the assessment of cognitive processes in real-world settings, it could also improve rehabilitative devices' usability in clinical environments. Further, by better understanding cortico-peripheral coupling, new neuro-rehabilitation methods can be developed, such as personalized proprioceptive training. However, further research is needed to advance our knowledge of cortical-peripheral coupling, evaluate the validity and reliability of multimodal parameters, and enhance user-friendly technologies for clinical adaptation.
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Affiliation(s)
- Emanuel A Lorenz
- Department of Computer Science, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Xiaomeng Su
- Department of Computer Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Nina Skjæret-Maroni
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
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de Havenon A, Skolarus LE, Mac Grory B, Bangad A, Sheth KN, Burke JF, Creutzfeldt CJ. National- and State-Level Trends in Medicare Hospice Beneficiaries for Stroke During 2013 to 2019 in the United States. Stroke 2024; 55:131-138. [PMID: 38063013 PMCID: PMC10752263 DOI: 10.1161/strokeaha.123.045021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/10/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Stroke is the fifth leading cause of death in the United States, one of the leading contributors to Medicare cost, including through Medicare hospice benefits, and the rate of stroke mortality has been increasing since 2013. We hypothesized that hospice utilization among Medicare beneficiaries with stroke has increased over time and that the increase is associated with trends in stroke death rate. METHODS Using Medicare Part A claims data and Centers for Disease Control mortality data at a national and state level from 2013 to 2019, we report the proportion and count of Medicare hospice beneficiaries with stroke as well as the stroke death rate (per 100 000) in Medicare-eligible individuals aged ≥65 years. RESULTS From 2013 to 2019, the number of Medicare hospice beneficiaries with stroke as their primary diagnosis increased 104.1% from 78 812 to 160 884. The number of stroke deaths in the United States in individuals aged ≥65 years also increased from 109 602 in 2013 to 129 193 in 2019 (17.9% increase). In 2013, stroke was the sixth most common primary diagnosis for Medicare hospice, while in 2019 it was the third most common, surpassed only by cancer and dementia. The correlation between the change from 2013 to 2019 in state-level Medicare hospice for stroke and stroke death rate for Medicare-eligible adults was significant (Spearman ρ=0.5; P<0.001). In a mixed-effects model, the variance in the state-level proportion of Medicare hospice for stroke explained by the state-level stroke death rate was 48.2%. CONCLUSIONS From 2013 to 2019, the number of Medicare hospice beneficiaries with a primary diagnosis of stroke more than doubled and stroke jumped from the sixth most common indication for hospice to the third most common. While increases in stroke mortality in the Medicare-eligible population accounts for some of the increase of Medicare hospice beneficiaries, over half the variance remains unexplained and requires additional research.
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Affiliation(s)
- Adam de Havenon
- Department of Neurology, Center for Brain & Mind Health, Yale University, New Haven, CT (A.d.H., A.B., K.N.S.)
| | - Lesli E Skolarus
- Department of Neurology, Northwestern University, Chicago, IL (L.E.S.)
| | - Brian Mac Grory
- Department of Neurology, Duke University, Durham, NC (B.M.G.)
| | - Aaron Bangad
- Department of Neurology, Center for Brain & Mind Health, Yale University, New Haven, CT (A.d.H., A.B., K.N.S.)
| | - Kevin N Sheth
- Department of Neurology, Center for Brain & Mind Health, Yale University, New Haven, CT (A.d.H., A.B., K.N.S.)
| | - James F Burke
- Department of Neurology, Ohio State University, Columbus (J.F.B.)
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Jones Berkeley SB, Johnson AM, Mormer ER, Ressel K, Pastva AM, Wen F, Patterson CG, Duncan PW, Bushnell CD, Zhang S, Freburger JK. Referral to Community-Based Rehabilitation Following Acute Stroke: Findings From the COMPASS Pragmatic Trial. Circ Cardiovasc Qual Outcomes 2024; 17:e010026. [PMID: 38189125 PMCID: PMC10997162 DOI: 10.1161/circoutcomes.123.010026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 10/13/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Few studies on care transitions following acute stroke have evaluated whether referral to community-based rehabilitation occurred as part of discharge planning. Our objectives were to describe the extent to which patients discharged home were referred to community-based rehabilitation and identify the patient, hospital, and community-level predictors of referral. METHODS We examined data from 40 North Carolina hospitals that participated in the COMPASS (Comprehensive Post-Acute Stroke Services) cluster-randomized trial. Participants included adults discharged home following stroke or transient ischemic attack (N=10 702). In this observational analysis, COMPASS data were supplemented with hospital-level and county-level data from various sources. The primary outcome was referral to community-based rehabilitation (physical, occupational, or speech therapy) at discharge. Predictor variables included patient (demographic, stroke-related, medical history), hospital (structure, process), and community (therapist supply) measures. We used generalized linear mixed models with a hospital random effect and hierarchical backward model selection procedures to identify predictors of therapy referral. RESULTS Approximately, one-third (36%) of stroke survivors (mean age, 66.8 [SD, 14.0] years; 49% female, 72% White race) were referred to community-based rehabilitation. Rates of referral to physical, occupational, and speech therapists were 31%, 18%, and 10%, respectively. Referral rates by hospital ranged from 3% to 78% with a median of 35%. Patient-level predictors included higher stroke severity, presence of medical comorbidities, and older age. Female sex (odds ratio, 1.24 [95% CI, 1.12-1.38]), non-White race (2.20 [2.01-2.44]), and having Medicare insurance (1.12 [1.02-1.23]) were also predictors of referral. Referral was higher for patients living in counties with greater physical therapist supply. Much of the variation in referral across hospitals remained unexplained. CONCLUSIONS One-third of stroke survivors were referred to community-based rehabilitation. Patient-level factors predominated as predictors. Variation across hospitals was notable and presents an opportunity for further evaluation and possible targets for improved poststroke rehabilitative care. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT02588664.
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Affiliation(s)
- Sara B Jones Berkeley
- Department of Epidemiology, University of North Carolina at Chapel Hill, Gillings School of Global Public Health (S.B.J.B., A.M.J., F.W., S.Z.)
| | - Anna M Johnson
- Department of Epidemiology, University of North Carolina at Chapel Hill, Gillings School of Global Public Health (S.B.J.B., A.M.J., F.W., S.Z.)
| | - Elizabeth R Mormer
- Department of Physical Therapy, University of Pittsburgh, School of Health and Rehabilitation Sciences (E.R.M., K.R., C.G.P., J.K.F.)
| | - Kristin Ressel
- Department of Physical Therapy, University of Pittsburgh, School of Health and Rehabilitation Sciences (E.R.M., K.R., C.G.P., J.K.F.)
| | - Amy M Pastva
- Department of Orthopaedic Surgery, Doctor of Physical Therapy Division and Center for the Study of Aging and Human Development, Duke University School of Medicine (A.M.P.)
| | - Fang Wen
- Department of Epidemiology, University of North Carolina at Chapel Hill, Gillings School of Global Public Health (S.B.J.B., A.M.J., F.W., S.Z.)
| | - Charity G Patterson
- Department of Physical Therapy, University of Pittsburgh, School of Health and Rehabilitation Sciences (E.R.M., K.R., C.G.P., J.K.F.)
- Department of Neurology, Wake Forest School of Medicine (P.W.D., C.D.B.)
| | - Pamela W Duncan
- Department of Neurology, Wake Forest School of Medicine (P.W.D., C.D.B.)
| | | | - Shuqi Zhang
- Department of Epidemiology, University of North Carolina at Chapel Hill, Gillings School of Global Public Health (S.B.J.B., A.M.J., F.W., S.Z.)
| | - Janet K Freburger
- Department of Physical Therapy, University of Pittsburgh, School of Health and Rehabilitation Sciences (E.R.M., K.R., C.G.P., J.K.F.)
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Klaic M, Fong J, Crocher V, Davies K, Brock K, Sutton E, Oetomo D, Tan Y, Galea MP. Application of the extended technology acceptance model to explore clinician likelihood to use robotics in rehabilitation. Disabil Rehabil Assist Technol 2024; 19:52-59. [PMID: 35400278 DOI: 10.1080/17483107.2022.2060356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 03/26/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Evidence suggests that patients with upper limb impairment following a stroke do not receive recommended amounts of motor practice. Robotics provide a potential solution to address this gap, but clinical adoption is low. The aim of this study was to utilize the technology acceptance model as a framework to identify factors influencing clinician adoption of robotic devices into practice. MATERIALS AND METHOD Mixed methods including survey data and focus group discussions with allied health clinicians whose primary caseload was rehabilitation of the neurologically impaired upper limb. Surveys based on the technology acceptance measure were completed pre/post exposure to and use of a robotic device. Focus groups discussions based on the theory of planned behaviour were conducted at the conclusion of the study. RESULTS A total of 34 rehabilitation clinicians completed the surveys with pre-implementation data indicating that rehabilitation clinicians perceive robotic devices as complex to use, which influenced intention to use such devices in practice. The focus groups found that lack of experience and time to learn influenced confidence to implement robotic devices into practice. CONCLUSION This study found that perceived usefulness and perceived ease of use of a robotic device in clinical rehabilitation can be improved through experience, training and embedded technological support. However, training and embedded support are not routinely offered, suggesting there is a discordance between current implementation and the learning needs of rehabilitation clinicians.IMPLICATIONS FOR REHABILITATIONPatients do not receive adequate amounts of upper limb motor practice following a stroke, and although robotic devices have the potential to address this gap, clinical adoption is low.The technology acceptance model identified that clinicians perceive robotic devices to be complex to use with current implementation efforts failing to consider their training needs.Implementation adoption of robotic devices in rehabilitation should be supported with adequate training and technological support if sustainable practice change is to be achieved.
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Affiliation(s)
- Marlena Klaic
- Melbourne School of Health Sciences, University of Melbourne, Melbourne, Australia
- Allied Health Department, The Royal Melbourne Hospital, Melbourne, Australia
| | - Justin Fong
- Department of Mechanical Engineering, University of Melbourne & Fourier Intelligence Joint Laboratory, The University of Melbourne, Melbourne, Australia
| | - Vincent Crocher
- Department of Mechanical Engineering, University of Melbourne & Fourier Intelligence Joint Laboratory, The University of Melbourne, Melbourne, Australia
| | - Katie Davies
- The Neurological Rehabilitation Group, Melbourne, Australia
| | - Kim Brock
- St Vincent's Hospital, Melbourne, Australia
| | | | - Denny Oetomo
- Department of Mechanical Engineering, University of Melbourne & Fourier Intelligence Joint Laboratory, The University of Melbourne, Melbourne, Australia
| | - Ying Tan
- Department of Mechanical Engineering, University of Melbourne & Fourier Intelligence Joint Laboratory, The University of Melbourne, Melbourne, Australia
| | - Mary P Galea
- Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Melbourne, Australia
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Hoh JE, Borich MR, Kesar TM, Reisman DS, Semrau JA. Limitations in utilization and prioritization of standardized somatosensory assessments after stroke: A cross-sectional survey of neurorehabilitation clinicians. Top Stroke Rehabil 2024; 31:29-43. [PMID: 37061928 DOI: 10.1080/10749357.2023.2200304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 04/02/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND AND PURPOSE Somatosensory impairments are common after stroke, but receive limited evaluation and intervention during neurorehabilitation, despite negatively impacting functional movement and recovery. OBJECTIVES Our objective was to understand the scope of somatosensory assessments used by clinicians in stroke rehabilitation, and barriers to increasing use in clinical practice. METHODS An electronic survey was distributed to clinicians (physical therapists, occupational therapists, physicians, and nurses) who assessed at least one individual with stroke in the past 6 months. The survey included questions on evaluation procedures, type, and use of somatosensory assessments, as well as barriers and facilitators in clinical practice. RESULTS Clinicians (N = 431) indicated greater familiarity with non-standardized assessments, and greater utilization compared to standardized assessments (p < 0.0001). Components of tactile sensation were the most commonly assessed modality of somatosensation (25%), while proprioception was rarely assessed (1%). Overall, assessments of motor function were prioritized over assessments of somatosensory function (p < 0.0001). DISCUSSION Respondents reported assessing somatosensation less frequently than motor function and demonstrated a reliance on rapid and coarse non-standardized assessments that ineffectively capture multi-modal somatosensory impairments, particularly for proprioceptive deficits common post-stroke. In general, clinicians were not familiar with standardized somatosensory assessments, and this knowledge gap likely contributes to lack of translation of these assessments into practice. CONCLUSIONS Clinicians utilize somatosensory assessments that inadequately capture the multi-modal nature of somatosensory impairments in stroke survivors. Addressing barriers to clinical translation has the potential to increase utilization of standardized assessments to improve the characterization of somatosensory deficits that inform clinical decision-making toward enhancing stroke rehabilitation outcomes.
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Affiliation(s)
- Joanna Eskander Hoh
- Biomechanics and Movement Science Program, University of Delaware, Newark, USA
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, USA
| | - Michael R Borich
- Center for Physical Therapy and Movement Science, Emory University, Atlanta, GA, USA
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Trisha M Kesar
- Center for Physical Therapy and Movement Science, Emory University, Atlanta, GA, USA
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Darcy S Reisman
- Biomechanics and Movement Science Program, University of Delaware, Newark, USA
- Department of Physical Therapy, University of Delaware, Newark, USA
| | - Jennifer A Semrau
- Biomechanics and Movement Science Program, University of Delaware, Newark, USA
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, USA
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Isbel S, Holloway H, Greber C, Nguyen K, Frost J, Pearce C, D’Cunha NM. Virtual reality after stroke: Identifying important characteristics when designing experiences to improve engagement in upper limb rehabilitation. Digit Health 2024; 10:20552076241251634. [PMID: 38817838 PMCID: PMC11138195 DOI: 10.1177/20552076241251634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 04/12/2024] [Indexed: 06/01/2024] Open
Abstract
Objective Virtual reality (VR) has been used to improve upper limb function after stroke but there is little to guide product developers in building experiences that engage users in the sustained, repetitive training required. This research sought to understand the characteristics of VR scenarios best suited to engaging someone with a stroke during recovery to achieve therapeutic outcomes. Methods Five creative immersive VR scenarios were designed by an experienced VR content creator containing unique combinations of VR characteristics. The usefulness of the scenarios was reviewed by expert clinicians experienced in stroke rehabilitation. Following this review, seven stroke survivors participated in each experience and reported on their engagement and motivation. Outcome measures were the User Satisfaction Evaluation Questionnaire and the modified Intrinsic Motivation Inventory. Semi-structured interviews were conducted with five participants following their immersive VR experience and analysed thematically. Results Expert clinicians reported potential therapeutic value in the immersive VR scenarios by providing opportunities for repeated and graded practice of upper limb movements. Stroke survivors reported varied levels of enjoyment and engagement for each scenario. They recommended changes to the experiences, primarily relating to the tailoring of the scenarios to match varied upper limb capacities. Conclusion This study highlights the characteristics of immersive VR scenarios that are important in sustaining motivation and providing high-repetition task-specific movement experiences. Differences in the experience and preferences of stroke participants regarding the characteristics of immersive VR experiences indicate that a variety of experiences are necessary to engage and sustain participation in an immersive VR-related therapy programme.
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Affiliation(s)
- Stephen Isbel
- Faculty of Health, School of Exercise and Rehabilitation Sciences, University of Canberra, Canberra, ACT, Australia
- Faculty of Health, Centre for Ageing Research and Translation, University of Canberra, Bruce, ACT, Australia
| | - Helen Holloway
- Faculty of Health, School of Exercise and Rehabilitation Sciences, University of Canberra, Canberra, ACT, Australia
- Faculty of Health, Centre for Ageing Research and Translation, University of Canberra, Bruce, ACT, Australia
| | - Craig Greber
- Faculty of Health, School of Exercise and Rehabilitation Sciences, University of Canberra, Canberra, ACT, Australia
| | - Kelly Nguyen
- Faculty of Health, School of Exercise and Rehabilitation Sciences, University of Canberra, Canberra, ACT, Australia
| | - Jane Frost
- School of Nursing and Midwifery, Western Sydney University, Penrith South, New South Wales, Australia
| | - Claire Pearce
- Faculty of Health, School of Exercise and Rehabilitation Sciences, University of Canberra, Canberra, ACT, Australia
| | - Nathan M D’Cunha
- Faculty of Health, School of Exercise and Rehabilitation Sciences, University of Canberra, Canberra, ACT, Australia
- Faculty of Health, Centre for Ageing Research and Translation, University of Canberra, Bruce, ACT, Australia
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Summaka M, Nasser Z, Hannoun S, Daoud R, Zein H, Al-Thalaya Z, Hamadeh ZA, Koubaisy N, Jebahi F, Naim I, Harati H. The Radboud dysarthria assessment: validity and reliability of the Arabic version. Disabil Rehabil 2023:1-10. [PMID: 38149715 DOI: 10.1080/09638288.2023.2297809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 12/16/2023] [Indexed: 12/28/2023]
Abstract
PURPOSE To cross-culturally adapt and validate the Radboud Dysarthria Assessment (RDA) and the speech component of the Radboud Oral Motor inventory for Parkinson's disease (ROMP-speech) into the Arabic language among Lebanese subjects with dysarthria. MATERIALS AND METHODS This study included 50 participants with dysarthria. The Arabic versions of the RDA (A-RDA) and the ROMP-speech (A-ROMP-speech) were administered in addition to the Arabic Speech Intelligibility test, the Lebanese Voice Handicap Index-10 (VHI-10lb) and semantic verbal fluency tasks. The maximum performance tasks were analyzed using the Praat software. The A-RDA qualitative recording form and the A-ROMP-speech were assessed for construct validity and internal consistency. The convergent validity of the maximum performance tasks, the severity scale, and the A-ROMP-speech were evaluated. RESULTS Exploratory factor analysis of the qualitative recording form extracted 3 factors explaining 82.973% of the total variance, and it demonstrated high internal consistency (α = 0.912). The maximum performance tasks of the RDA correlated significantly with the corresponding Praat scores. The severity scale and the A-ROMP-speech correlated fairly to strongly with the Arabic Speech Intelligibility test (rs=-0.695 and -0.736, p < 0.001) and the VHI-10lb (r = 0.539 and 0.640, p < 0.001). CONCLUSION The A-RDA and the A-ROMP-speech are valid and reliable dysarthria tools among Lebanese subjects.
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Affiliation(s)
- Marwa Summaka
- Doctoral School of Sciences and Technology, Lebanese University, Hadath, Lebanon
| | - Zeina Nasser
- Neuroscience Research Center, Lebanese University, Hadath, Lebanon
| | - Salem Hannoun
- Medical Imaging Sciences Program, Division of Health Professions, American University of Beirut, Beirut, Lebanon
| | - Rama Daoud
- Department of Medical Sciences, Lebanese University, Hadath, Lebanon
| | - Hiba Zein
- Department of Rehabilitation, Health, Rehabilitation, Integration and Research Center (HRIR), Beirut, Lebanon
| | - Zahra Al-Thalaya
- Department of Speech Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Zainab A Hamadeh
- Department of Rehabilitation, Health, Rehabilitation, Integration and Research Center (HRIR), Beirut, Lebanon
| | - Nour Koubaisy
- Department of Rehabilitation, Health, Rehabilitation, Integration and Research Center (HRIR), Beirut, Lebanon
| | - Fatima Jebahi
- Department of Speech, Language, and Hearing Sciences, The University of Arizona, AZ, USA
| | - Ibrahim Naim
- Department of Rehabilitation, Health, Rehabilitation, Integration and Research Center (HRIR), Beirut, Lebanon
| | - Hayat Harati
- Neuroscience Research Center, Lebanese University, Hadath, Lebanon
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Lülsdorff K, Junker FB, Studer B, Wittenberg H, Pickenbrock H, Schmidt-Wilcke T. Neurorehabilitation of the upper extremity - immersive virtual reality vs. electromechanically assisted training. A comparative study. Front Neurol 2023; 14:1290637. [PMID: 38187150 PMCID: PMC10768030 DOI: 10.3389/fneur.2023.1290637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/07/2023] [Indexed: 01/09/2024] Open
Abstract
Background Severe paresis of the contralesional upper extremity is one of the most common and debilitating post-stroke impairments. The need for cost-effective high-intensity training is driving the development of new technologies, which can complement and extent conventional therapies. Apart from established methods using electromechanical devices, immersive virtual reality (iVR) systems hold promise to provide cost-efficient high-intensity arm training. Objective We investigated whether iVR-based arm training yields at least equivalent effects on upper extremity function as compared to an electromechanically assisted training in stroke patients with severe arm paresis. Methods 52 stroke patients with severe arm paresis received a total of ten daily group therapy sessions over a period of three weeks, which consisted of 20 min of conventional therapy and 20 min of either electromechanically assisted (ARMEOSpring®) or iVR-based (CUREO®) arm training. Changes in upper extremity function was assessed using the Action Research Arm Test (ARAT) and user acceptance was measured with the User Experience Questionnaire (UEQ). Results iVR-based training was not inferior to electromechanically assisted training. We found that 84% of patients treated with iVR and 50% of patients treated with electromechanically assisted arm training showed a clinically relevant improvement of upper extremity function. This difference could neither be attributed to differences between the groups regarding age, gender, duration after stroke, affected body side or ARAT scores at baseline, nor to differences in the total amount of therapy provided. Conclusion The present study results show that iVR-based arm training seems to be a promising addition to conventional therapy. Potential mechanisms by which iVR unfolds its effects are discussed.
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Affiliation(s)
- Kira Lülsdorff
- Mauritius Hospital and Neurorehabilitation Center Meerbusch, Meerbusch, Germany
| | - Frederick Benjamin Junker
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University Duesseldorf, Duesseldorf, Germany
| | - Bettina Studer
- Mauritius Hospital and Neurorehabilitation Center Meerbusch, Meerbusch, Germany
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University Duesseldorf, Duesseldorf, Germany
| | - Heike Wittenberg
- Mauritius Hospital and Neurorehabilitation Center Meerbusch, Meerbusch, Germany
| | - Heidrun Pickenbrock
- Mauritius Hospital and Neurorehabilitation Center Meerbusch, Meerbusch, Germany
| | - Tobias Schmidt-Wilcke
- Mauritius Hospital and Neurorehabilitation Center Meerbusch, Meerbusch, Germany
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University Duesseldorf, Duesseldorf, Germany
- Center of Neurology, District Hospital Mainkofen, Deggendorf, Germany
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Goodman GW, Do TH, Tan C, Ritzel RM. Drivers of Chronic Pathology Following Ischemic Stroke: A Descriptive Review. Cell Mol Neurobiol 2023; 44:7. [PMID: 38112809 DOI: 10.1007/s10571-023-01437-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/25/2023] [Indexed: 12/21/2023]
Abstract
Stroke is the third leading cause of death and long-term disability in the world. Considered largely a disease of aging, its global economic and healthcare burden is expected to rise as more people survive into advanced age. With recent advances in acute stroke management, including the expansion of time windows for treatment with intravenous thrombolysis and mechanical thrombectomy, we are likely to see an increase in survival rates. It is therefore critically important to understand the complete pathophysiology of ischemic stroke, both in the acute and subacute stages and during the chronic phase in the months and years following an ischemic event. One of the most clinically relevant aspects of the chronic sequelae of stroke is its extended negative effect on cognition. Cognitive impairment may be related to the deterioration and dysfunctional reorganization of white matter seen at later timepoints after stroke, as well as ongoing progressive neurodegeneration. The vasculature of the brain also undergoes significant insult and remodeling following stroke, undergoing changes which may further contribute to chronic stroke pathology. While inflammation and the immune response are well established drivers of acute stroke pathology, the chronicity and functional role of innate and adaptive immune responses in the post-ischemic brain and in the peripheral environment remain largely uncharacterized. In this review, we summarize the current literature on post-stroke injury progression, its chronic pathological features, and the putative secondary injury mechanisms underlying the development of cognitive impairment and dementia. We present findings from clinical and experimental studies and discuss the long-term effects of ischemic stroke on both brain anatomy and functional outcome. Identifying mechanisms that occur months to years after injury could lead to treatment strategies in the chronic phase of stroke to help mitigate stroke-associated cognitive decline in patients.
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Affiliation(s)
- Grant W Goodman
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Trang H Do
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Chunfeng Tan
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Rodney M Ritzel
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA.
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Vratsistas-Curto A, Downie A, McCluskey A, Sherrington C. Trajectories of arm recovery early after stroke: an exploratory study using latent class growth analysis. Ann Med 2023; 55:253-265. [PMID: 36594373 PMCID: PMC9815231 DOI: 10.1080/07853890.2022.2159062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
AIM To investigate trajectories of recovery of motor arm function after stroke during inpatient rehabilitation. MATERIALS AND METHODS Data were available from 74 consecutively-admitted stroke survivors receiving inpatient rehabilitation from an inception cohort study. Heterogeneity of arm recovery in the first 4-weeks was investigated using latent class analysis and weekly Box and Block Test (BBT) scores. Optimal number of clusters were determined; characterised and cluster associated factors explored. RESULTS A 4-cluster model was identified, including 19 participants with low baseline arm function and minimal recovery ('LOWstart/LOWprogress', 26%), 15 with moderate function and low recovery ('MODstart/LOWprogress', 20%), 15 with low function and high recovery ('LOWstart/HIGHprogress', 20%), and 25 with moderate function and recovery ('MODstart/MODprogress', 34%). Compared to LOWstart/LOWprogress: LOWstart/HIGHprogress presented earlier post-stroke (β, 95%CI) (-4.81 days, -8.94 to -0.69); MODstart/MODprogress had lower modified Rankin Scale scores (-0.74, -1.15 to -0.32); and MODstart/LOWprogress, LOWstart/HIGHprogress and MODstart/MODprogress had higher admission BBT (23.58, 18.82 to 28.34; 4.85, 0.85 to 9.61; 28.02, 23.82 to 32.21), Upper Limb-Motor Assessment Scale (9.60, 7.24 to 11.97; 3.34, 0.97 to 5.70; 10.86, 8.77 to 12.94), Action Research Arm Test (31.09, 22.86 to 39.33; 12.69, 4.46 to 20.93; 38.01, 30.76 to 45.27), and Manual Muscle Test scores (10.64, 7.07 to 14.21; 6.24, 2.67 to 9.81; 11.87, 8.72 to 15.01). CONCLUSIONS We found unique patterns of arm recovery with distinct characteristics for each cluster. Better understanding of patterns of arm recovery can guide future models and intervention development.KEY MESSAGESArm recovery early after stroke follows four distinct trajectories that relate to time post stroke, initial stroke severity and baseline level of motor arm function.Identification of recovery patterns gives insight into the uniqueness of individual's recovery.This study offers a novel approach on which to build and develop future models of arm recovery.
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Affiliation(s)
- Angela Vratsistas-Curto
- Institute of Musculoskeletal Health, School of Public Health, The University of Sydney, Sydney, Australia
| | - Aron Downie
- Institute of Musculoskeletal Health, School of Public Health, The University of Sydney, Sydney, Australia.,Health and Human Sciences, Faculty of Medicine, Macquarie University, Sydney, Australia
| | - Annie McCluskey
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,StrokeEd Collaboration, Sydney, Australia
| | - Catherine Sherrington
- Institute of Musculoskeletal Health, School of Public Health, The University of Sydney, Sydney, Australia
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Ishida S, Harashima H, Miyano S, Kawama K. Effect of rehabilitation motivation on improving activities of daily living in subacute stroke patients. J Stroke Cerebrovasc Dis 2023; 32:107385. [PMID: 37839300 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 09/12/2023] [Accepted: 09/20/2023] [Indexed: 10/17/2023] Open
Abstract
OBJECTIVES To determine the effect of rehabilitation motivation on activities of daily living improvement in subacute stroke patients starting intensive rehabilitation. MATERIALS AND METHODS This was a single-center cohort study involving patients with a subacute stroke who were admitted to or discharged from a Recovery Rehabilitation Unit between February 2021 and August 2022. Improvement in Activity of Daily Living was evaluated using the Functional Independence Measure. We calculated the corrected motor Functional Independence Measure effectiveness using its motor-related items at admission and discharge. The Behavioral Regulation in Exercise Questionnaire 2 was used to evaluate admission rehabilitation motivation, and the Relative Autonomy index was calculated. Hierarchical multiple regression analysis was used to examine the relationship between the corrected motor Functional Independence Measure effectiveness and the Relative Autonomy Index. RESULTS Eighty-six of the 231 patients (37.2 %) were included in the analysis. Hierarchical multiple regression analysis adjusted for demographic and clinical variables demonstrated that age, comorbidities, and Relative Autonomy Index were significantly associated with corrected motor Functional Independence Measure effectiveness (R2 = 0.423, p ≺ .001). CONCLUSION Motivation at intensive rehabilitation initiation in patients with a subacute stroke influences Activities of Daily Living improvement. These results may help develop rehabilitation programs aimed at improving Activities of Daily Living in patients with subacute strokes.
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Affiliation(s)
- Shinnosuke Ishida
- Department of Rehabilitation, Tokyo General Hospital, 3-15-2 Egota, Nakano-, ku, Tokyo 165-8906, Japan; Department of Graduate School of Comprehensive Human Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyouku, Tokyo 112-0012, Japan.
| | - Hiroaki Harashima
- Department of Rehabilitation, Tokyo General Hospital, 3-15-2 Egota, Nakano-, ku, Tokyo 165-8906, Japan
| | - Satoshi Miyano
- Department of Rehabilitation, Tokyo General Hospital, 3-15-2 Egota, Nakano-, ku, Tokyo 165-8906, Japan
| | - Kennosuke Kawama
- Department of Graduate School of Comprehensive Human Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyouku, Tokyo 112-0012, Japan
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Safdar A, Smith MC, Byblow WD, Stinear CM. Applications of Repetitive Transcranial Magnetic Stimulation to Improve Upper Limb Motor Performance After Stroke: A Systematic Review. Neurorehabil Neural Repair 2023; 37:837-849. [PMID: 37947106 PMCID: PMC10685705 DOI: 10.1177/15459683231209722] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
BACKGROUND Noninvasive brain stimulation (NIBS) is a promising technique for improving upper limb motor performance post-stroke. Its application has been guided by the interhemispheric competition model and typically involves suppression of contralesional motor cortex. However, the bimodal balance recovery model prompts a more tailored application of NIBS based on ipsilesional corticomotor function. OBJECTIVE To review and assess the application of repetitive transcranial magnetic stimulation (rTMS) protocols that aimed to improve upper limb motor performance after stroke. METHODS A PubMed search was conducted for studies published between 1st January 2005 and 1st November 2022 using rTMS to improve upper limb motor performance of human adults after stroke. Studies were grouped according to whether facilitatory or suppressive rTMS was applied to the contralesional hemisphere. RESULTS Of the 492 studies identified, 70 were included in this review. Only 2 studies did not conform to the interhemispheric competition model, and facilitated the contralesional hemisphere. Only 21 out of 70 (30%) studies reported motor evoked potential (MEP) status as a biomarker of ipsilesional corticomotor function. Around half of the studies (37/70, 53%) checked whether rTMS had the expected effect by measuring corticomotor excitability (CME) after application. CONCLUSION The interhemispheric competition model dominates the application of rTMS post-stroke. The majority of recent and current studies do not consider bimodal balance recovery model for the application of rTMS. Evaluating CME after the application rTMS could confirm that the intervention had the intended neurophysiological effect. Future studies could select patients and apply rTMS protocols based on ipsilesional MEP status.
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Affiliation(s)
- Afifa Safdar
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Marie-Claire Smith
- Department of Exercise Sciences, University of Auckland, Auckland, New Zealand
| | - Winston D. Byblow
- Department of Exercise Sciences, University of Auckland, Auckland, New Zealand
| | - Cathy M. Stinear
- Department of Medicine, University of Auckland, Auckland, New Zealand
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Verschure PFMJ, Páscoa Dos Santos F, Sharma V. Redefining stroke rehabilitation: Mobilizing the embodied goal-oriented brain. Curr Opin Neurobiol 2023; 83:102807. [PMID: 37980804 DOI: 10.1016/j.conb.2023.102807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/17/2023] [Accepted: 10/17/2023] [Indexed: 11/21/2023]
Abstract
Advancements in stroke rehabilitation remain limited and call for a reorientation. Based on recent results, this study proposes a network-centric perspective on stroke, positing that it not only causes localized deficits but also affects the brain's intricate network of networks, transiting it into a pathological state. Translating these system-level insights into interventions requires brain theory, and the Distributed Adaptive Control (DAC) theory offers such a framework. When applied in the rehabilitation gaming system, these principles demonstrate superior results over conventional methods. This impact stems from activating extensive brain networks, particularly the executive control network, focused motor learning, and maintaining excitatory-inhibitory balance, which is essential for neural repair and functional reorganization. The analysis stresses uniting preclinical and clinical research and placing the architecture of the embodied volitional brain at the centre of rehabilitation approaches.
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Affiliation(s)
- Paul F M J Verschure
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, the Netherlands.
| | - Francisco Páscoa Dos Santos
- Eodyne Systems SL, Barcelona, Spain; Department of Information and Communication Technologies, Universitat Pompeu Fabra (UPF), Barcelona, Spain. https://twitter.com/@francpsantos
| | - Vivek Sharma
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, the Netherlands
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