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Colamarino E, Morone G, Toppi J, Riccio A, Cincotti F, Mattia D, Pichiorri F. A Scoping Review of Technology-Based Approaches for Upper Limb Motor Rehabilitation after Stroke: Are We Really Targeting Severe Impairment? J Clin Med 2024; 13:5414. [PMID: 39336901 PMCID: PMC11432574 DOI: 10.3390/jcm13185414] [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: 08/12/2024] [Revised: 09/05/2024] [Accepted: 09/08/2024] [Indexed: 09/30/2024] Open
Abstract
Technology-based approaches for upper limb (UL) motor rehabilitation after stroke are mostly designed for severely affected patients to increase their recovery chances. However, the available randomized controlled trials (RCTs) focused on the efficacy of technology-based interventions often include patients with a wide range of motor impairment. This scoping review aims at overviewing the actual severity of stroke patients enrolled in RCTs that claim to specifically address UL severe motor impairment. The literature search was conducted on the Scopus and PubMed databases and included articles from 2008 to May 2024, specifically RCTs investigating the impact of technology-based interventions on UL motor functional recovery after stroke. Forty-eight studies were selected. They showed that, upon patients' enrollment, the values of the UL Fugl-Meyer Assessment and Action Research Arm Test covered the whole range of both scales, thus revealing the non-selective inclusion of severely impaired patients. Heterogeneity in terms of numerosity, characteristics of enrolled patients, trial design, implementation, and reporting was present across the studies. No clear difference in the severity of the included patients according to the intervention type was found. Patient stratification upon enrollment is crucial to best direct resources to those patients who will benefit the most from a given technology-assisted approach (personalized rehabilitation).
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Affiliation(s)
- Emma Colamarino
- Department of Computer, Control, and Management Engineering “Antonio Ruberti”, Sapienza University of Rome, 00185 Rome, Italy; (E.C.); (J.T.); (F.C.)
- IRCCS Fondazione Santa Lucia, 00179 Rome, Italy; (A.R.); (D.M.); (F.P.)
| | - Giovanni Morone
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Jlenia Toppi
- Department of Computer, Control, and Management Engineering “Antonio Ruberti”, Sapienza University of Rome, 00185 Rome, Italy; (E.C.); (J.T.); (F.C.)
- IRCCS Fondazione Santa Lucia, 00179 Rome, Italy; (A.R.); (D.M.); (F.P.)
| | - Angela Riccio
- IRCCS Fondazione Santa Lucia, 00179 Rome, Italy; (A.R.); (D.M.); (F.P.)
| | - Febo Cincotti
- Department of Computer, Control, and Management Engineering “Antonio Ruberti”, Sapienza University of Rome, 00185 Rome, Italy; (E.C.); (J.T.); (F.C.)
- IRCCS Fondazione Santa Lucia, 00179 Rome, Italy; (A.R.); (D.M.); (F.P.)
| | - Donatella Mattia
- IRCCS Fondazione Santa Lucia, 00179 Rome, Italy; (A.R.); (D.M.); (F.P.)
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Prados-Román E, Cabrera-Martos I, Martín-Nuñez J, Valenza-Peña G, Granados-Santiago M, Valenza MC. Effectiveness of self-management interventions during the peri-hospitalization period in patients with stroke: A systematic review and meta-analysis. Clin Rehabil 2024; 38:34-46. [PMID: 37551095 DOI: 10.1177/02692155231193563] [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: 08/09/2023]
Abstract
OBJECTIVE To synthesize the evidence of the effectiveness of self-management interventions during the peri-hospitalization period. DATA SOURCES Three databases (i.e. PubMed, Web of Science, and Scopus) were systematically searched. REVIEW METHODS Full-text randomized controlled studies that assessed the effects of self-management interventions initiated during the peri-hospitalization period in patients with stroke were included. Two independent reviewers performed data extraction. A third reviewer was available for discrepancies. The methodological quality was evaluated using version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB-2). Data were pooled and a meta-analysis was performed. RESULTS Eight studies comprising 1030 participants were included. The self-management interventions showed considerable heterogeneity in their protocols, although most of them included an individualized plan based on the patient's needs. The meta-analysis was performed with data from the self-efficacy domains. The pooled results showed a trend towards the self-management intervention on quality of life (1.07, 95% confidence interval [CI] 0.52 to 1.63; P = 0.0002) but neither in dependence (0.80, 95% CI -0.14 to 1.74; P = 0.10) nor in self-efficacy (0.77, 95% CI -0.44 to 1.98; P = 0.21). CONCLUSION Most of the studies reviewed suggest that self-management interventions had an impact on dependency, quality of life and self-efficacy when compared with usual care, written materials about stroke, or post-discharge rehabilitation recommended by a physician. However, the evidence in this review neither supports nor refutes self-management interventions used in addition to usual care, or other interventions, to improve dependency, quality of life and/or self-efficacy in patients' post-stroke.
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Li S, Cai W, Zhu P, He W, Zheng J, Fang F, Yu H. Research on multi-dimensional intelligent quantitative assessment of upper limb function based on kinematic parameters. Technol Health Care 2024; 32:2293-2306. [PMID: 38759031 DOI: 10.3233/thc-231076] [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: 05/19/2024]
Abstract
BACKGROUND Rehabilitation assessment is a critical component of rehabilitation treatment. OBJECTIVE This study focuses on a comprehensive analysis of patients' movement performance using the upper limb rehabilitation robot. It quantitatively assessed patients' motor control ability and constructed an intelligent grading model of functional impairments. These findings contribute to a deeper understanding of patients' motor ability and provide valuable insights for personalized rehabilitation interventions. METHODS Patients at different Brunnstrom stages underwent rehabilitation training using the upper limb rehabilitation robot, and data on the distal movement positions of the patients' upper limbs were collected. A total of 22 assessment metrics related to movement efficiency, smoothness, and accuracy were extracted. The performance of these assessment metrics was measured using the Mann-Whitney U test and Pearson correlation analysis. Due to the issue of imbalanced sample categories, data augmentation was performed using the Synthetic Minority Over-sampling Technique (SMOTE) algorithm based on weighted sampling, and an intelligent grading model of functional impairment based on the Extreme Gradient Boosting Tree (XGBoost) algorithm was constructed. RESULTS Sixteen assessment metrics were screened. These metrics were effectively normalized to their maximum values, enabling the derivation of quantitative assessment scores for motor control ability across the three dimensions through a weighted fusion approach. Notably, when applied to the data-enhanced dataset, the intelligent grading model exhibited remarkable improvement, achieving an accuracy rate exceeding 0.98. Moreover, significant enhancements were observed in terms of precision, recall, and f1-score. CONCLUSION The research findings demonstrate that this study enables the quantitative assessment of patients' motor control ability and intelligent grading of functional impairments, thereby contributing to the efficiency enhancement of clinical rehabilitation assessment. Moreover, this method resolves the issues associated with the subjectivity and prolonged periods of traditional rehabilitation assessment methods.
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Affiliation(s)
- Sujiao Li
- Institute of Rehabilitation Engineering and Technology, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, University of Shanghai for Science and Technology, Shanghai, China
| | - Wenqian Cai
- Institute of Rehabilitation Engineering and Technology, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, University of Shanghai for Science and Technology, Shanghai, China
| | - Pei Zhu
- Changhai Hospital, Shanghai, China
| | - Wanying He
- Institute of Rehabilitation Engineering and Technology, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Third Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Jinyu Zheng
- Institute of Rehabilitation Engineering and Technology, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, University of Shanghai for Science and Technology, Shanghai, China
| | | | - Hongliu Yu
- Institute of Rehabilitation Engineering and Technology, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, University of Shanghai for Science and Technology, Shanghai, China
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Embrechts E, McGuckian TB, Rogers JM, Dijkerman CH, Steenbergen B, Wilson PH, Nijboer TCW. Cognitive and Motor Therapy After Stroke Is Not Superior to Motor and Cognitive Therapy Alone to Improve Cognitive and Motor Outcomes: New Insights From a Meta-analysis. Arch Phys Med Rehabil 2023; 104:1720-1734. [PMID: 37295704 DOI: 10.1016/j.apmr.2023.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/18/2023] [Accepted: 05/04/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To evaluate whether cognitive and motor therapy (CMT) is more effective than no therapy, motor therapy, or cognitive therapy on motor and/or cognitive outcomes after stroke. Additionally, this study evaluates whether effects are lasting and which CMT approach is most effective. DATA SOURCES AMED, EMBASE, MEDLINE/PubMed, and PsycINFO databases were searched in October 2022. STUDY SELECTION Twenty-six studies fulfilled the inclusion criteria: randomized controlled trials published in peer-reviewed journals since 2010 that investigated adults with stroke, delivered CMT, and included at least 1 motor, cognitive, or cognitive-motor outcome. Two CMT approaches exist: CMT dual-task ("classical" dual-task where the secondary cognitive task has a distinct goal) and CMT integrated (where cognitive components of the task are integrated into the motor task). DATA EXTRACTION Data on study design, participant characteristics, interventions, outcome measures (cognitive/motor/cognitive-motor), results and statistical analysis were extracted. Multilevel random effects meta-analysis was conducted. DATA SYNTHESIS CMT demonstrated positive effects compared with no therapy on motor outcomes (g=0.49; 95% confidence interval [CI], 0.10, 0.88) and cognitive-motor outcomes (g=0.29; 95% CI, 0.03, 0.54). CMT showed no significant effects compared with motor therapy on motor, cognitive, and cognitive-motor outcomes. A small positive effect of CMT compared with cognitive therapy on cognitive outcomes (g=0.18; 95% CI, 0.01, 0.36) was found. CMT demonstrated no follow-up effect compared with motor therapy (g=0.07; 95% CI, -0.04, 0.18). Comparison of CMT dual-task and integrated revealed no significant difference for motor (F1,141=0.80; P=.371) or cognitive outcomes (F1,72=0.61, P=.439). CONCLUSIONS CMT was not superior to monotherapies in improved outcomes after stroke. CMT approaches were equally effective, suggesting that training that enlists a cognitive load per se may benefit outcomes.
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Affiliation(s)
- Elissa Embrechts
- Rehabilitation Sciences and Physical Therapy, Research group MOVANT, University of Antwerp, Belgium; Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands.
| | - Thomas B McGuckian
- Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Jeffrey M Rogers
- Faculty of Health Sciences, University of Sydney, New South Wales, Australia
| | - Chris H Dijkerman
- Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands
| | - Bert Steenbergen
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Peter H Wilson
- Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Tanja C W Nijboer
- Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands; Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands; Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht, The Netherlands
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Clinically Applicable Experimental Design and Considerations for Stroke Recovery Preclinical Studies. Methods Mol Biol 2023; 2616:369-377. [PMID: 36715946 DOI: 10.1007/978-1-0716-2926-0_25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Development of stroke recovery therapies is an active field of research and represents an opportunity to reduce the global impact of stroke as the leading cause of acquired, long-term disability in adults. The negative outcomes of recent large-scale clinical trials have highlighted deficiencies in the translational process and endanger the trajectory of post-stroke recovery research. Because of this, a number of strategies have been recommended by experts to better navigate the translational pipeline. To assist the field in advancing to the next stage for successful clinical translation, the goal of this chapter is to discuss concepts relevant to the experimental design of in vivo preclinical pharmacological studies to make them clinically relevant and informative for future trials.
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Nozoe M, Inoue T, Ishida M, Yamamoto K, Kanai M. Malnutrition on admission is associated with trunk function recovery but not with lower limb muscle strength recovery in patients with acute stroke: an observational cohort study. Nutrition 2023; 109:111971. [PMID: 36745968 DOI: 10.1016/j.nut.2023.111971] [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: 11/14/2022] [Revised: 12/26/2022] [Accepted: 01/01/2023] [Indexed: 01/09/2023]
Abstract
OBJECTIVES The aim of this study was to determine the effects of malnutrition on trunk function and lower leg muscle strength in patients with acute stroke upon hospitalization. METHODS This prospective cohort study included hospitalized patients with acute stroke. Nutritional status was assessed using the Global Leadership Initiative on Malnutrition criteria. Trunk function and lower leg muscle strength were assessed using the trunk control test (TCT) and Motricity Index (MI), respectively, on admission and at discharge. Logistic regression analysis was performed to examine the relationship between malnutrition and poor improvement in TCT and MI scores at discharge. RESULTS Patients (N = 241) with acute stroke (median age 79 y) were included in this study. In adjusted logistic regression analysis, malnutrition was independently associated with poor TCT score improvement (adjusted odds ratio, 3.82; 95% confidence interval, 1.11-13.20; P = 0.03). In contrast, malnutrition was not independently associated with poor MI score improvement (adjusted odds ratio, 0.86; 95% confidence interval, 0.30-2.52; P = 0.79). CONCLUSION Malnutrition on admission leads to poor trunk function, but not lower leg muscle strength, in patients with acute stroke.
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Affiliation(s)
- Masafumi Nozoe
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women's University, Kobe, Japan.
| | - Tatsuro Inoue
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan
| | - Mitsuru Ishida
- Department of Rehabilitation, Konan Medical Center, Kobe, Japan
| | - Kenta Yamamoto
- Department of Rehabilitation, Konan Medical Center, Kobe, Japan
| | - Masashi Kanai
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women's University, Kobe, Japan
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Comellas M, Chan V, Zondervan DK, Reinkensmeyer DJ. A Dynamic Wheelchair Armrest for Promoting Arm Exercise and Mobility After Stroke. IEEE Trans Neural Syst Rehabil Eng 2022; 30:1829-1839. [PMID: 35776829 PMCID: PMC9354471 DOI: 10.1109/tnsre.2022.3187755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Arm movement recovery after stroke can improve with sufficient exercise. However, rehabilitation therapy sessions are typically not enough. To address the need for effective methods of increasing arm exercise outside therapy sessions we developed a novel armrest, called Boost. It easily attaches to a standard manual wheelchair just like a conventional armrest and enables users to exercise their arm in a linear forward-back motion. This paper provides a detailed design description of Boost, the biomechanical analysis method to evaluate the joint torques required to operate it, and the results of pilot testing with five stroke patients. Biomechanics results show the required shoulder flexion and elbow extension torques range from −25% to +36% of the torques required to propel a standard pushrim wheelchair, depending on the direction of applied force. In pilot testing, all five participants were able to exercise the arm with Boost in stationary mode (with lower physical demand). Three achieved overground ambulation (with higher physical demand) exceeding 2 m/s after 2–5 practice trials; two of these could not propel their wheelchair with the pushrim. This simple to use, dynamic armrest provides people with hemiparesis a way to access repetitive arm exercise outside of therapy sessions, independently right in their wheelchair. Significantly, Boost removes the requirements to reach, grip, and release the pushrim to propel a wheelchair, an action many individuals with stroke cannot complete.
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Ramos-Castaneda JA, Barreto-Cortes CF, Losada-Floriano D, Sanabria-Barrera SM, Silva-Sieger FA, Garcia RG. Efficacy and Safety of Vagus Nerve Stimulation on Upper Limb Motor Recovery After Stroke. A Systematic Review and Meta-Analysis. Front Neurol 2022; 13:889953. [PMID: 35847207 PMCID: PMC9283777 DOI: 10.3389/fneur.2022.889953] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 06/13/2022] [Indexed: 12/28/2022] Open
Abstract
Background Upper limb motor impairment is one of the main complications of stroke, affecting quality of life both for the patient and their family. The aim of this systematic review was to summarize the scientific evidence on the safety and efficacy of Vagus Nerve Stimulation (VNS) on upper limb motor recovery after stroke. Methods A systematic review and meta-analysis of studies that have evaluated the efficacy or safety of VNS in stroke patients was performed. The primary outcome was upper limb motor recovery. A search of articles published on MEDLINE, CENTRAL, EBSCO and LILACS up to December 2021 was performed, and a meta-analysis was developed to calculate the overall effects. Results Eight studies evaluating VNS effects on motor function in stroke patients were included, of which 4 used implanted and 4 transcutaneous VNS. It was demonstrated that VNS, together with physical rehabilitation, increased upper limb motor function on average 7.06 points (95%CI 4.96; 9.16) as assessed by the Fugl-Meyer scale. Likewise, this improvement was significantly greater when compared to a control intervention (mean difference 2.48, 95%CI 0.98; 3.98). No deaths or serious adverse events related to the intervention were reported. The most frequent adverse events were dysphonia, dysphagia, nausea, skin redness, dysgeusia and pain related to device implantation. Conclusion VNS, together with physical rehabilitation, improves upper limb motor function in stroke patients. Additionally, VNS is a safe intervention.
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Affiliation(s)
- Jorge A. Ramos-Castaneda
- Fundación Cardiovascular de Colombia, Bucaramanga, Colombia
- Research Group Innovación y Cuidado, Faculty of Nursing, Universidad Antonio Nariño, Neiva, Colombia
- *Correspondence: Jorge A. Ramos-Castaneda
| | | | | | | | | | - Ronald G. Garcia
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- School of Medicine, Universidad de Santander, Bucaramanga, Colombia
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A register-based study on associations between pre-stroke physical activity and cognition early after stroke (part of PAPSIGOT). Sci Rep 2022; 12:5779. [PMID: 35388045 PMCID: PMC8986803 DOI: 10.1038/s41598-022-09520-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/23/2022] [Indexed: 01/02/2023] Open
Abstract
The objective was to investigate if pre-stroke physical activity is associated with intact cognition early after stroke. The study design was a cross-sectional, register-based study. The study sample included 1111 adults with first stroke (mild or moderate severity) admitted to three Swedish stroke units. The main outcome was cognition. The associations of pre-stroke physical activity, age, sex, smoking, diabetes, atrial fibrillation, previous TIA, statin treatment, hypertension treatment, reperfusion therapies, stroke severity, and education on the outcome cognition were analyzed using binary logistic regression. Physical activity was assessed within 48 h of admittance, and cognition was screened during stroke unit care. The results were: mean age 70 years, 40% women, 61% pre-stroke physically active, and 53% with post-stroke cognitive impairment. Patients with pre-stroke light or moderate physical activity have higher odds for intact cognition compared to inactive: odds ratio (95% confidence interval) 1.32 (0.97-1.80) and 2.04 (1.18-3.53), respectively. In addition to pre-stroke physical activity, people with younger age, a higher level of education, less severe stroke (more mild than moderate), being non-diabetic, and non-smoking have higher odds for intact cognition. In conclusion physical activity before stroke is associated with intact cognition in patients with mild and moderate stroke.
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Li J, Cheng L, Chen S, Zhang J, Liu D, Liang Z, Li H. Functional Connectivity Changes in Multiple-Frequency Bands in Acute Basal Ganglia Ischemic Stroke Patients: A Machine Learning Approach. Neural Plast 2022; 2022:1560748. [PMID: 35356364 PMCID: PMC8958111 DOI: 10.1155/2022/1560748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/07/2022] [Accepted: 02/21/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose Several functional magnetic resonance imaging (fMRI) studies have investigated the resting-state functional connectivity (rs-FC) changes in the primary motor cortex (M1) in patients with acute basal ganglia ischemic stroke (BGIS). However, the frequency-specific FC changes of M1 in acute BGIS patients are still unclear. Our study was aimed at exploring the altered FC of M1 in three frequency bands and the potential features as biomarkers for the identification by using a support vector machine (SVM). Methods We included 28 acute BGIS patients and 42 healthy controls (HCs). Seed-based FC of two regions of interest (ROI, bilateral M1s) were calculated in conventional, slow-5, and slow-4 frequency bands. The abnormal voxel-wise FC values were defined as the features for SVM in different frequency bands. Results In the ipsilesional M1, the acute BGIS patients exhibited decreased FC with the right lingual gyrus in the conventional and slow-4 frequency band. Besides, the acute BGIS patients showed increased FC with the right medial superior frontal gyrus (SFGmed) in the conventional and slow-5 frequency band and decreased FC with the left lingual gyrus in the slow-5 frequency band. In the contralesional M1, the BGIS patients showed lower FC with the right SFGmed in the conventional frequency band. The higher FC values with the right lingual gyrus and left SFGmed were detected in the slow-4 frequency band. In the slow-5 frequency band, the BGIS patients showed decreased FC with the left calcarine sulcus. SVM results showed that the combined features (slow-4+slow-5) had the highest accuracy in classification prediction of acute BGIS patients, with an area under curve (AUC) of 0.86. Conclusion Acute BGIS patients had frequency-specific alterations in FC; SVM is a promising method for exploring these frequency-dependent FC alterations. The abnormal brain regions might be potential targets for future researchers in the rehabilitation and treatment of stroke patients.
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Affiliation(s)
- Jie Li
- Research Center of Brain and Cognitive Neuroscience, Liaoning Normal University, Dalian, China
- Key Laboratory of Brain and Cognitive Neuroscience, Liaoning Province, China
| | - Lulu Cheng
- School of Foreign Studies, China University of Petroleum (East China), Qingdao, China
- Shanghai Center for Research in English Language Education, Shanghai International Studies University, Shanghai, China
| | - Shijian Chen
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jian Zhang
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Dongqiang Liu
- Research Center of Brain and Cognitive Neuroscience, Liaoning Normal University, Dalian, China
- Key Laboratory of Brain and Cognitive Neuroscience, Liaoning Province, China
| | - Zhijian Liang
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Huayun Li
- College of Teacher Education, Zhejiang Normal University, Jinhua, China
- Key Laboratory of Intelligent Education Technology and Application, Zhejiang Normal University, Jinhua, China
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Feldman PH, McDonald MV, Onorato N, Stein J, Williams O. Feasibility of deploying peer coaches to mentor frontline home health aides and promote mobility among individuals recovering from a stroke: pilot test of a randomized controlled trial. Pilot Feasibility Stud 2022; 8:22. [PMID: 35101133 PMCID: PMC8801561 DOI: 10.1186/s40814-022-00979-4] [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: 01/25/2021] [Accepted: 01/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Each year, approximately 100,000 individuals receive home health services after a stroke. Evidence has shown the benefits of home-based stroke rehabilitation, but little is known about resource-efficient ways to enhance its effectiveness, nor has anyone explored the value of leveraging low-cost home health aides (HHAs) to reinforce repetitive task training, a key component of home-based rehabilitation. We developed and piloted a Stroke Homehealth Aide Recovery Program (SHARP) that deployed specially trained HHAs as "peer coaches" to mentor frontline aides and help individuals recovering from stroke increase their mobility through greater adherence to repetitive exercise regimens. We assessed the feasibility of SHARP and its readiness for a full-scale randomized controlled trial (RCT). Specifically, we examined (1) the practicability of recruitment and randomization procedures, (2) program acceptability, (3) intervention fidelity, and (4) the performance of outcome measures. METHODS This was a feasibility study including a pilot RCT. Target enrollment was 60 individuals receiving post-stroke home health services, who were randomized to SHARP + usual home care or usual care only. The protocol specified a 30-day intervention with four planned in-home coach visits, including one joint coach/physical therapist visit. The primary participant outcome was 60-day change in mobility, using the performance-based Timed Up and Go and 4-Meter Walk Gait Speed tests. Interviews with participants, coaches, physical therapists, and frontline aides provided acceptability data. Enrollment figures, visit tracking reports, and audio recordings provided intervention fidelity data. Mixed methods included thematic analysis of qualitative data and quantitative analysis of structured data to examine the intervention feasibility and performance of outcome measures. RESULTS Achieving the 60-participant enrollment target required modifying participant eligibility criteria to accommodate a decline in the receipt of HHA services among individuals receiving home care after a stroke. This modification entailed intervention redesign. Acceptability was high among coaches and participants but lower among therapists and frontline aides. Intervention fidelity was mixed: 87% of intervention participants received all four planned coach visits; however, no joint coach/therapist visits occurred. Sixty-day follow-up retention was 78%. However, baseline and follow-up performance-based primary outcome mobility assessments could be completed for only 55% of participants. CONCLUSIONS The trial was not feasible in its current form. Before progressing to a definitive trial, significant program redesign would be required to address issues affecting enrollment, coach/HHA/therapist coordination, and implementation of performance-based outcome measures. TRIAL REGISTRATION ClinicalTrials.gov, NCT04840407 . Retrospectively registered on 9 April 2021.
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Affiliation(s)
- Penny H Feldman
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, 220 East 42nd Street, New York, NY, 10017, USA
| | - Margaret V McDonald
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, 220 East 42nd Street, New York, NY, 10017, USA.
| | - Nicole Onorato
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, 220 East 42nd Street, New York, NY, 10017, USA
| | - Joel Stein
- Department of Rehabilitation and Regenerative Medicine, Columbia University Vagelos College of Physicians and Surgeons, Department of Rehabilitation Medicine, Weill Cornell Medicine, New York-Presbyterian Hospital, 180 Ft. Washington Ave., Harkness Pavilion Room 1-165, New York, NY, 10032, USA
| | - Olajide Williams
- Department of Neurology, Columbia University, 710 West 168th Street, New York, NY, 10032, USA
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Oliveira I, Couto G, Santos R, Campolargo A, Lima C, Ferreira P. Best Practice Recommendations for Dysphagia Management in Stroke Patients: A Consensus from a Portuguese Expert Panel. PORTUGUESE JOURNAL OF PUBLIC HEALTH 2022. [DOI: 10.1159/000520505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Dysphagia is frequent after stroke, and it increases the risk of respiratory infection, dehydration and malnutrition, resulting in worse outcomes. Different clinical guidelines present recommendations for the assessment and management of dysphagia in stroke patients in a scattered way. These best practice recommendations address seven clinical questions on the assessment and management of dysphagia in stroke patients, gathering the best-updated evidence. A systematic literature review using the PICO strategy was performed. The recommendations draft was then appraised by a multidisciplinary panel of experts (nutritionists, physiatrists, speech-language pathologists and rehabilitation nurses) in a total of 3 Delphi rounds. A minimum of 80% consensus was established, and the final version offers a total of 21 recommendations for use in clinical practice for stroke patients. These clinical recommendations are an overview of the most recent evidence combined with experts’ consensus and translated into clinically relevant statements. In implementing recommendations at the local level, health professionals should identify facilitators and barriers to evidence-based practice within their contexts and determine the best strategies to address local needs. Where the change is needed, initial and continuing training on all recommendations is essential and relevant.
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Zhang C, Huang MZ, Kehs GJ, Braun RG, Cole JW, Zhang LQ. Intensive In-Bed Sensorimotor Rehabilitation of Early Subacute Stroke Survivors With Severe Hemiplegia Using a Wearable Robot. IEEE Trans Neural Syst Rehabil Eng 2021; 29:2252-2259. [PMID: 34665733 PMCID: PMC8843010 DOI: 10.1109/tnsre.2021.3121204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Rehabilitation for stroke survivors with severe motor impairment remains challenging. Early motor rehabilitation is critical for improving mobility function post stroke, but it is often delayed due to limited resources in clinical practice. The objectives of this study were to investigate the feasibility and effectiveness of early in-bed sensorimotor rehabilitation on acute stroke survivors with severe hemiplegia using a wearable ankle robot. Eighteen patients (9 in the study group and 9 in the control group) with severe hemiplegia and no active ankle movement were enrolled in acute/subacute phase post stroke. During a typical 3-week hospital stay, patients in the study group received ankle robot-guided in-bed training (50 minutes/session, 5 sessions/week), including motor relearning under real-time visual feedback of re-emerging motor output, strong passive stretching under intelligent control, and game-based active movement training with robotic assistance. Whereas the control group received passive ankle movement in the mid-range of motion and attempted active ankle movement without robotic assistance. After multi-session training, the study group achieved significantly greater improvements in Fugl-Meyer Lower Extremity motor score (p = 0.007), plantarflexor strength (p = 0.009), and active range of motion (p = 0.011) than controls. The study group showed earlier motor recovery for plantarflexion and dorsiflexion than the control group (p < 0.05). This study showed that in-bed sensorimotor rehabilitation guided by a wearable ankle robot through combining motor relearning in real-time feedback, strong passive stretching, and active movement training facilitated early motor recovery for stroke survivors with severe hemiplegia in the acute/subacute phase.
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14
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Papazian C, Baicoianu NA, Peters KM, Feldner HA, Steele KM. Electromyography Recordings Detect Muscle Activity Before Observable Contractions in Acute Stroke Care. Arch Rehabil Res Clin Transl 2021; 3:100136. [PMID: 34589686 PMCID: PMC8463445 DOI: 10.1016/j.arrct.2021.100136] [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] [Indexed: 10/30/2022] Open
Abstract
OBJECTIVE To evaluate muscle activity in the arms of adult stroke survivors with limited or no arm movement during acute care. DESIGN Prospective observational study. SETTING Acute care regional stroke center. PARTICIPANTS We recruited adults (N=21) who had a stroke within the previous 5 days who were admitted to a level 1 trauma hospital and had a National Institutes of Health Stroke Scale score >1 for arm function at the time of recruitment. A total of 21 adults (13 men, 8 women) with an average age of 60±15 years were recruited an average of 3±1 days after their stroke. Eleven (7 men, 4 women; age, 56±11y) had no observable or palpable arm muscle activity (Manual Muscle Test [MMT]=0) and 10 (6 men, 4 women; age, 64±1y) had detectable activity (MMT>0). INTERVENTIONS Dual mode sensors (electromyography and accelerometry) were placed on the anterior deltoid, biceps, triceps, wrist extensors, and wrist flexors of the impaired arm. MAIN OUTCOME MEASURES The number of muscle contractions, as well as average duration, amplitude, and co-contraction patterns were evaluated for each participant. RESULTS Muscle contractions were observed in all 5 muscles for all participants using electromyography (EMG) recordings. Contractions were easily identified from 30 minutes of monitoring for participants with an MMT >0, but up to 3 hours of monitoring was required for participants with an MMT=0 to detect contractions in all 5 muscles during standard care. Only the wrist extensors demonstrated significantly larger amplitude contractions for participants with an MMT>0 than those with an MMT=0. Co-contraction was rare, involving less than 10% of contractions. Co-contraction of 2 muscles most commonly aligned with the flexor synergy pattern commonly observed after stroke. For participants with an MMT=0, the number of contractions and maximum amplitude were moderately correlated with MMT scores at follow-up. CONCLUSIONS Muscle activity was detected with surface EMG recordings during standard acute care, even for individuals with no observable activity by clinical examination. Wearable sensors may be useful for monitoring early muscle activity and movement after stroke.
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Affiliation(s)
- Christina Papazian
- Department of Mechanical Engineering, University of Washington, Seattle, WA
| | - Nick A. Baicoianu
- Department of Mechanical Engineering, University of Washington, Seattle, WA
| | - Keshia M. Peters
- Department of Mechanical Engineering, University of Washington, Seattle, WA
| | - Heather A. Feldner
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
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Hammerbeck U, Hargreaves M, Hollands KL, Tyson S. Stroke survivors' perceptions of participating in a high repetition arm training trial early after stroke. Disabil Rehabil 2021; 44:6026-6033. [PMID: 34372752 DOI: 10.1080/09638288.2021.1955984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE The study explored the acceptability of high repetition arm training as part of a randomised controlled trial, early after stroke, when fatigue levels and emotional strain are often high. MATERIALS AND METHODS 36 sub-acute stroke survivors (61 years+/-15) attended for assessment sessions at 3, 6, and 12 weeks after stroke. Individuals were randomised to receive 6 high repetition arm training sessions between 3 and 6 weeks (intervention) or the control group. Semi-structured interviews were conducted at trial completion. Interview transcripts were analysed through framework analysis conducted independently by 2 researchers. RESULTS Stroke survivors participated despite high levels of fatigue because they hoped for personal benefit or to potentially benefit future patients. Benefits reported from participation included physical improvements, psychological benefit, improved understanding of their condition as well as a feeling of hope and distraction. The arm training at three weeks after stroke, aiming for 420 movement repetitions was not considered to be too intensive or too early, and most individuals felt lucky to have been, or would have preferred to be in the early training group. CONCLUSION High repetition arm training early after stroke was acceptable to participants. Study participation was generally viewed as a positive experience, suggesting that early intervention may not only be physically beneficial but also psychologically.Implications for rehabilitationStroke survivors report that high repetition arm training early after stroke is acceptable.Participation in rehabilitation research early after stroke provides stroke survivors with hope and meaning despite the high prevalence of fatigue.Complex information needs to be repeated and provided in a number of formats early after stroke.
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Affiliation(s)
- Ulrike Hammerbeck
- School of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK.,Division of Cardiovascular Sciences, University of Manchester, Manchester, UK.,Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance & Greater Manchester Universities, Manchester, UK
| | - Mary Hargreaves
- Division of Cardiovascular Sciences, University of Manchester, Manchester, UK.,Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance & Greater Manchester Universities, Manchester, UK
| | - Kristen L Hollands
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance & Greater Manchester Universities, Manchester, UK.,School of Health Sciences, University of Salford, Salford, UK
| | - Sarah Tyson
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance & Greater Manchester Universities, Manchester, UK.,School of Health Sciences, University of Manchester, Manchester, UK
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Koiler R, Bakhshipour E, Glutting J, Lalime A, Kofa D, Getchell N. Repurposing an EMG Biofeedback Device for Gait Rehabilitation: Development, Validity and Reliability. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6460. [PMID: 34203676 PMCID: PMC8296262 DOI: 10.3390/ijerph18126460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/09/2021] [Accepted: 06/11/2021] [Indexed: 11/17/2022]
Abstract
Gait impairment often limits physical activity and negatively impacts quality of life. EMG-Biofeedback (EMG-BFB), one of the more effective interventions for improving gait impairment, has been limited to laboratory use due to system costs and technical requirements, and has therefore not been tested on a larger scale. In our research, we aimed to develop and validate a cost-effective, commercially available EMG-BFB device for home- and community-based use. We began by repurposing mTrigger® (mTrigger LLC, Newark, DE, USA), a cost-effective, portable EMG-BFB device, for gait application. This included developing features in the cellphone app such as step feedback, success rate, muscle activity calibration, and cloud integration. Next, we tested the validity and reliability of the mTrigger device in healthy adults by comparing it to a laboratory-grade EMG system. While wearing both devices, 32 adults walked overground and on a treadmill at four speeds (0.3, 0.6, 0.9, and 1.2 m/s). Statistical analysis revealed good to excellent test-retest reliability (r > 0.89) and good to excellent agreement in the detection of steps (ICC > 0.85) at all speeds between two systems for treadmill walking. Our results indicated that mTrigger compared favorably to a laboratory-grade EMG system in the ability to assess muscular activity and to provide biofeedback during walking in healthy adults.
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Affiliation(s)
- Reza Koiler
- Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, DE 19716, USA; (E.B.); (N.G.)
| | - Elham Bakhshipour
- Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, DE 19716, USA; (E.B.); (N.G.)
| | - Joseph Glutting
- School of Education, University of Delaware, Newark, DE 19716, USA;
| | - Amy Lalime
- Product & Marketing Manager, mTrigger, LLC, Newark, DE 19713, USA;
| | - Dexter Kofa
- Dexter Kofa, Mobile App Developer, Philadelphia, PA 19120, USA;
| | - Nancy Getchell
- Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, DE 19716, USA; (E.B.); (N.G.)
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE 19716, USA
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17
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Spencer J, Wolf SL, Kesar TM. Biofeedback for Post-stroke Gait Retraining: A Review of Current Evidence and Future Research Directions in the Context of Emerging Technologies. Front Neurol 2021; 12:637199. [PMID: 33859607 PMCID: PMC8042129 DOI: 10.3389/fneur.2021.637199] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/05/2021] [Indexed: 12/26/2022] Open
Abstract
Real-time gait biofeedback is a promising rehabilitation strategy for improving biomechanical deficits in walking patterns of post-stroke individuals. Because wearable sensor technologies are creating avenues for novel applications of gait biofeedback, including use in tele-health, there is a need to evaluate the state of the current evidence regarding the effectiveness of biofeedback for post-stroke gait training. The objectives of this review are to: (1) evaluate the current state of biofeedback literature pertaining to post-stroke gait training; and (2) determine future research directions related to gait biofeedback in context of evolving technologies. Our overall goal was to determine whether gait biofeedback is effective at improving stroke gait deficits while also probing why and for whom gait biofeedback may be an efficacious treatment modality. Our literature review showed that the effects of gait biofeedback on post-stroke walking dysfunction are promising but are inconsistent in methodology and therefore results. We summarize sources of methodological heterogeneity in previous literature, such as inconsistencies in feedback target, feedback mode, dosage, practice structure, feedback structure, and patient characteristics. There is a need for larger-sample studies that directly compare different feedback parameters, employ more uniform experimental designs, and evaluate characteristics of potential responders. However, as these uncertainties in existing literature are resolved, the application of gait biofeedback has potential to extend neurorehabilitation clinicians' cues to individuals with post-stroke gait deficits during ambulation in clinical, home, and community settings, thereby increasing the quantity and quality of skilled repetitions during task-oriented stepping training. In addition to identifying gaps in previous research, we posit that future research directions should comprise an amalgam of mechanism-focused and clinical research studies, to develop evidence-informed decision-making guidelines for gait biofeedback strategies that are tailored to individual-specific gait and sensorimotor impairments. Wearable sensor technologies have the potential to transform gait biofeedback and provide greater access and wider array of options for clinicians while lowering rehabilitation costs. Novel sensing technologies will be particularly valuable for telehealth and home-based stepping exercise programs. In summary, gait biofeedback is a promising intervention strategy that can enhance efficacy of post-stroke gait rehabilitation in both clinical and tele-rehabilitation settings and warrants more in-depth research.
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Affiliation(s)
- Jacob Spencer
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Steven L. Wolf
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, United States
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
- Department of Cell Biology, Emory University School of Medicine, Atlanta, GA, United States
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Health Care System, Decatur, GA, United States
| | - Trisha M. Kesar
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, United States
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18
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Krakauer JW, Kitago T, Goldsmith J, Ahmad O, Roy P, Stein J, Bishop L, Casey K, Valladares B, Harran MD, Cortés JC, Forrence A, Xu J, DeLuzio S, Held JP, Schwarz A, Steiner L, Widmer M, Jordan K, Ludwig D, Moore M, Barbera M, Vora I, Stockley R, Celnik P, Zeiler S, Branscheidt M, Kwakkel G, Luft AR. Comparing a Novel Neuroanimation Experience to Conventional Therapy for High-Dose Intensive Upper-Limb Training in Subacute Stroke: The SMARTS2 Randomized Trial. Neurorehabil Neural Repair 2021; 35:393-405. [PMID: 33745372 DOI: 10.1177/15459683211000730] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Evidence from animal studies suggests that greater reductions in poststroke motor impairment can be attained with significantly higher doses and intensities of therapy focused on movement quality. These studies also indicate a dose-timing interaction, with more pronounced effects if high-intensity therapy is delivered in the acute/subacute, rather than chronic, poststroke period. OBJECTIVE To compare 2 approaches of delivering high-intensity, high-dose upper-limb therapy in patients with subacute stroke: a novel exploratory neuroanimation therapy (NAT) and modified conventional occupational therapy (COT). METHODS A total of 24 patients were randomized to NAT or COT and underwent 30 sessions of 60 minutes time-on-task in addition to standard care. The primary outcome was the Fugl-Meyer Upper Extremity motor score (FM-UE). Secondary outcomes included Action Research Arm Test (ARAT), grip strength, Stroke Impact Scale hand domain, and upper-limb kinematics. Outcomes were assessed at baseline, and days 3, 90, and 180 posttraining. Both groups were compared to a matched historical cohort (HC), which received only 30 minutes of upper-limb therapy per day. RESULTS There were no significant between-group differences in FM-UE change or any of the secondary outcomes at any timepoint. Both high-dose groups showed greater recovery on the ARAT (7.3 ± 2.9 points; P = .011) but not the FM-UE (1.4 ± 2.6 points; P = .564) when compared with the HC. CONCLUSIONS Neuroanimation may offer a new, enjoyable, efficient, and scalable way to deliver high-dose and intensive upper-limb therapy.
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Affiliation(s)
| | - Tomoko Kitago
- Burke Neurological Institute, White Plains, NY, USA.,Weill Cornell Medicine, New York, NY, USA.,Columbia University, New York, NY, USA
| | - Jeff Goldsmith
- Columbia University Mailman School of Public Health, New York, NY, USA
| | - Omar Ahmad
- Johns Hopkins University, Baltimore, MD, USA
| | - Promit Roy
- Johns Hopkins University, Baltimore, MD, USA
| | - Joel Stein
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Lauri Bishop
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Kelly Casey
- Johns Hopkins University, Baltimore, MD, USA
| | - Belen Valladares
- cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland.,University Hospital and University of Zurich, Switzerland
| | | | - Juan Camilo Cortés
- Johns Hopkins University, Baltimore, MD, USA.,Columbia University, New York, NY, USA
| | | | - Jing Xu
- Johns Hopkins University, Baltimore, MD, USA
| | | | - Jeremia P Held
- University Hospital and University of Zurich, Switzerland
| | - Anne Schwarz
- University Hospital and University of Zurich, Switzerland
| | - Levke Steiner
- University Hospital and University of Zurich, Switzerland
| | - Mario Widmer
- cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | | | | | | | | | - Isha Vora
- Johns Hopkins University, Baltimore, MD, USA
| | | | | | | | | | - Gert Kwakkel
- Vrije Universiteit Amsterdam, Netherlands.,Amsterdam Rehabilitation Research Centre, Reade, Netherlands
| | - Andreas R Luft
- cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland.,University Hospital and University of Zurich, Switzerland
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19
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20
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Merians AS, Fluet GG, Qiu Q, Yarossi M, Patel J, Mont AJ, Saleh S, Nolan KJ, Barrett AM, Tunik E, Adamovich SV. Hand Focused Upper Extremity Rehabilitation in the Subacute Phase Post-stroke Using Interactive Virtual Environments. Front Neurol 2020; 11:573642. [PMID: 33324323 PMCID: PMC7726202 DOI: 10.3389/fneur.2020.573642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 10/14/2020] [Indexed: 01/14/2023] Open
Abstract
Introduction: Innovative motor therapies have attempted to reduce upper extremity impairment after stroke but have not made substantial improvement as over 50% of people post-stroke continue to have sensorimotor deficits affecting their self-care and participation in daily activities. Intervention studies have focused on the role of increased dosing, however recent studies have indicated that timing of rehabilitation interventions may be as important as dosing and importantly, that dosing and timing interact in mediating effectiveness. This study is designed to empirically test dosing and timing. Methods and Analysis: In this single-blinded, interventional study, subjects will be stratified on two dimensions, impairment level (Fugl-Meyer Upper Extremity Assessment (FM) and presence or absence of Motor Evoked Potentials (MEPs) as follows; (1) Severe, FM score 10-19, MEP+, (2) Severe, FM score 10-19, MEP-, (3) Moderate, FM score 20-49, MEP+, (4) Moderate, FM score 20-49, MEP-. Subjects not eligible for TMS will be assigned to either group 2 (if severe) or group 3 (if moderate). Stratified block randomization will then be used to achieve a balanced assignment. Early Robotic/VR Therapy (EVR) experimental group will receive in-patient usual care therapy plus an extra 10 h of intensive upper extremity therapy focusing on the hand using robotically facilitated rehabilitation interventions presented in virtual environments and initiated 5-30 days post-stroke. Delayed Robotic/VR Therapy (DVR) experimental group will receive the same intervention but initiated 30-60 days post-stroke. Dose-matched usual care group (DMUC) will receive an extra 10 h of usual care initiated 5-30 days post-stroke. Usual Care Group (UC) will receive the usual amount of physical/occupational therapy. Outcomes: There are clinical, neurophysiological, and kinematic/kinetic measures, plus measures of daily arm use and quality of life. Primary outcome is the Action Research Arm Test (ARAT) measured at 4 months post-stroke. Discussion: Outcome measures will be assessed to determine whether there is an early time period in which rehabilitation will be most effective, and whether there is a difference in the recapture of premorbid patterns of movement vs. the development of an efficient, but compensatory movement strategy. Ethical Considerations: The IRBs of New Jersey Institute of Technology, Rutgers University, Northeastern University, and Kessler Foundation reviewed and approved all study protocols. Study was registered in https://ClinicalTrials.gov (NCT03569059) prior to recruitment. Dissemination will include submission to peer-reviewed journals and professional presentations.
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Affiliation(s)
- Alma S. Merians
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, United States
| | - Gerard G. Fluet
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, United States
| | - Qinyin Qiu
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, United States
| | - Mathew Yarossi
- Movement Neuroscience Laboratory, Department of Physical Therapy, Movement and Rehabilitation Science, Bouve College of Health Sciences, Northeastern University, Boston, MA, United States
- SPIRAL Group, Department of Electrical and Computer Engineering, Northeastern University, Boston, MA, United States
| | - Jigna Patel
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, United States
| | - Ashley J. Mont
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, United States
| | - Soha Saleh
- Center for Mobility and Rehabilitation Engineering Research, Kessler Foundation, West Orange, NJ, United States
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Karen J. Nolan
- Center for Mobility and Rehabilitation Engineering Research, Kessler Foundation, West Orange, NJ, United States
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, United States
| | - AM Barrett
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, United States
- Center for Stroke Rehabilitation Research, Kessler Foundation, West Orange, NJ, United States
| | - Eugene Tunik
- Movement Neuroscience Laboratory, Department of Physical Therapy, Movement and Rehabilitation Science, Bouve College of Health Sciences, Northeastern University, Boston, MA, United States
- Department of Bioengineering, College of Engineering, Northeastern University, Boston, MA, United States
- Department of Electrical and Computer Engineering, College of Engineering, Northeastern University, Boston, MA, United States
| | - Sergei V. Adamovich
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, United States
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, United States
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21
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Kuo IJ, Tang CW, Tsai YA, Tang SC, Lin CJ, Hsu SP, Liang WK, Juan CH, Zich C, Stagg CJ, Lee IH. Neurophysiological signatures of hand motor response to dual-transcranial direct current stimulation in subacute stroke: a TMS and MEG study. J Neuroeng Rehabil 2020; 17:72. [PMID: 32527268 PMCID: PMC7291576 DOI: 10.1186/s12984-020-00706-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 06/01/2020] [Indexed: 11/11/2022] Open
Abstract
Background Dual transcranial direct current stimulation (tDCS) to the bilateral primary motor cortices (M1s) has potential benefits in chronic stroke, but its effects in subacute stroke, when behavioural effects might be expected to be greater, have been relatively unexplored. Here, we examined the neurophysiological effects and the factors influencing responsiveness of dual-tDCS in subacute stroke survivors. Methods We conducted a randomized sham-controlled crossover study in 18 survivors with first-ever, unilateral subcortical ischaemic stroke 2–4 weeks after stroke onset and 14 matched healthy controls. Participants had real dual-tDCS (with an ipsilesional [right for controls] M1 anode and a contralesional M1 [left for controls] cathode; 2 mA for 20mins) and sham dual-tDCS on separate days, with concurrent paretic [left for controls] hand exercise. Using transcranial magnetic stimulation (TMS) and magnetoencephalography (MEG), we recorded motor evoked potentials (MEPs), the ipsilateral silent period (iSP), short-interval intracortical inhibition, and finger movement-related cortical oscillations before and immediately after tDCS. Results Stroke survivors had decreased excitability in ipsilesional M1 with a relatively excessive transcallosal inhibition from the contralesional to ipsilesional hemisphere at baseline compared with controls, as quantified by decreased MEPs and increased iSP duration. Dual-tDCS led to increased MEPs and decreased iSP duration in ipsilesional M1. The magnitude of the tDCS-induced MEP increase in stroke survivors was predicted by baseline contralesional-to-ipsilesional transcallosal inhibition (iSP) ratio. Baseline post-movement synchronization in α-band activity in ipsilesional M1 was decreased after stroke compared with controls, and its tDCS-induced increase correlated with upper limb score in stroke survivors. No significant adverse effects were observed during or after dual-tDCS. Conclusions Task-concurrent dual-tDCS in subacute stroke can safely and effectively modulate bilateral M1 excitability and inter-hemispheric imbalance and also movement-related α-activity.
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Affiliation(s)
- I-Ju Kuo
- Institute of Brain Science, Brain Research Center, National Yang-Ming University, No.155, Sec. 2, Linong St., Beitou Dist, Taipei City, 112, Taiwan.,Department of Neurosurgery, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou Dist, Taipei City, 112, Taiwan
| | - Chih-Wei Tang
- Institute of Brain Science, Brain Research Center, National Yang-Ming University, No.155, Sec. 2, Linong St., Beitou Dist, Taipei City, 112, Taiwan.,Department of Neurology, Far Eastern Memorial Hospital, No.21, Sec. 2, Nanya S. Rd., Banqiao Dist, New Taipei City, 220, Taiwan
| | - Yun-An Tsai
- Department of Neurosurgery, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou Dist, Taipei City, 112, Taiwan
| | - Shuen-Chang Tang
- Department of Neurosurgery, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou Dist, Taipei City, 112, Taiwan
| | - Chun-Jen Lin
- Institute of Brain Science, Brain Research Center, National Yang-Ming University, No.155, Sec. 2, Linong St., Beitou Dist, Taipei City, 112, Taiwan.,Division of Cerebrovascular Diseases, Neurological Institute, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou Dist, Taipei City, 112, Taiwan
| | - Shih-Pin Hsu
- Institute of Brain Science, Brain Research Center, National Yang-Ming University, No.155, Sec. 2, Linong St., Beitou Dist, Taipei City, 112, Taiwan
| | - Wei-Kuang Liang
- Institute of Cognitive Neuroscience, National Central University, No.300, Zhongda Rd., Zhongli Dist, Taoyuan City, 320, Taiwan
| | - Chi-Hung Juan
- Institute of Cognitive Neuroscience, National Central University, No.300, Zhongda Rd., Zhongli Dist, Taoyuan City, 320, Taiwan
| | - Catharina Zich
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK.,Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, Department of Psychiatry, University of Oxford, Oxford, OX3 7JX, UK.,MRC Brain Network Dynamics Unit, University of Oxford, Oxford, OX1 3TH, UK
| | - Charlotte J Stagg
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK.,Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, Department of Psychiatry, University of Oxford, Oxford, OX3 7JX, UK.,MRC Brain Network Dynamics Unit, University of Oxford, Oxford, OX1 3TH, UK
| | - I-Hui Lee
- Institute of Brain Science, Brain Research Center, National Yang-Ming University, No.155, Sec. 2, Linong St., Beitou Dist, Taipei City, 112, Taiwan. .,Division of Cerebrovascular Diseases, Neurological Institute, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou Dist, Taipei City, 112, Taiwan.
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Effect of Early and Intensive Rehabilitation after Ischemic Stroke on Functional Recovery of the Lower Limbs: A Pilot, Randomized Trial. J Stroke Cerebrovasc Dis 2020; 29:104649. [DOI: 10.1016/j.jstrokecerebrovasdis.2020.104649] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 11/25/2019] [Accepted: 01/06/2020] [Indexed: 01/16/2023] Open
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Sheehy L, Taillon-Hobson A, Sveistrup H, Bilodeau M, Yang C, Finestone H. Sitting Balance Exercise Performed Using Virtual Reality Training on a Stroke Rehabilitation Inpatient Service: A Randomized Controlled Study. PM R 2020; 12:754-765. [PMID: 31970898 DOI: 10.1002/pmrj.12331] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 01/10/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND Virtual reality training (VRT) is engaging and may enhance rehabilitation intensity. Only one previous study has looked at its use to improve sitting balance after stroke. OBJECTIVE To determine if supplemental sitting balance exercises, administered via VRT, improve control of sitting balance and upper extremity function in stroke rehabilitation inpatients. DESIGN Assessor-blinded, placebo-controlled randomized controlled trial. SETTING Stroke inpatient rehabilitation unit. PARTICIPANTS Seventy-six participants (out of 130 approached) with subacute stroke who could not stand independently were randomized to experimental and control groups. Sixty-nine completed the study. INTERVENTIONS The experimental group did VRT that required leaning and reaching, whereas the control group had their trunk restrained and performed VRT that involved only small upper extremity movements to minimize trunk movement. Both groups performed 10-12 sessions of 30-45 minutes. Participants were assessed pre, post, and 1 month after the sessions by a blinded examiner. OUTCOME MEASURES Function in Sitting Test (FIST, primary outcome measure); Ottawa Sitting Scale; Reaching Performance Scale; Wolf Motor Function Test (WMFT). RESULTS Thirty-three participants completed the experimental intervention and 36 the control. Pre/post differences for FIST were 3.4 (confidence interval [CI] 0.5;6.3) for the experimental group and 5.3 (2.9;7.7) for the control group. There was a significant improvement over time (adjusted for multiple comparisons, P < .006) on most outcome measures except the WMFT Performance Time Scale (control group; P = .007) and grip strength (P = .008); there were no differences between groups (P > .006). CONCLUSIONS Siting balance outcomes were similar for both groups; therefore, this study does not support the use of sitting balance exercises provided via VRT for the rehabilitation of sitting balance after stroke. However, because it is only the second study to investigate VRT for sitting balance and upper extremity function, more research, using more challenging exercises and a greater treatment intensity, is required before definitive conclusions are made.
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Affiliation(s)
- Lisa Sheehy
- Bruyère Research Institute, Ottawa, Ontario, Canada.,School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Heidi Sveistrup
- Bruyère Research Institute, Ottawa, Ontario, Canada.,School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.,School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Martin Bilodeau
- Bruyère Research Institute, Ottawa, Ontario, Canada.,School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.,School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Christine Yang
- Stroke Rehabilitation, Bruyère Continuing Care, Ottawa, Ontario, Canada.,Division of Physical Medicine and Rehabilitation, Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Hillel Finestone
- Stroke Rehabilitation, Bruyère Continuing Care, Ottawa, Ontario, Canada.,Division of Physical Medicine and Rehabilitation, Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Chin LF, Hayward KS, Brauer S. Upper limb use differs among people with varied upper limb impairment levels early post-stroke: a single-site, cross-sectional, observational study. Top Stroke Rehabil 2019; 27:224-235. [DOI: 10.1080/10749357.2019.1690796] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Lay Fong Chin
- Rehabilitation Centre, Tan Tock Seng Hospital, Singapore
- Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
- NMRC Singapore, Ministry of Health Singapore, Singapore
| | - Kathryn S. Hayward
- Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
- Stroke Theme, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia
- NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Melbourne, Australia
- Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Parkville, Australia
| | - Sandra Brauer
- Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
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25
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Malone LA, Sun LR. Transcranial Magnetic Stimulation for the Treatment of Pediatric Neurological Disorders. Curr Treat Options Neurol 2019; 21:58. [PMID: 31720969 DOI: 10.1007/s11940-019-0600-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW Repetitive transcranial magnetic stimulation (rTMS) is a form of noninvasive brain stimulation that is used for the treatment of migraine and major depression in adults and is now being evaluated for use in other disorders. The purpose of this review is to summarize the physiology underlying TMS, the safety and tolerability in pediatric patients, and the evidence for TMS efficacy in the treatment of pediatric neurologic disorders. RECENT FINDINGS Studies investigating rTMS for adolescent depression, hemiparesis due to pediatric stroke, autism, and tics/Tourette syndrome have demonstrated some therapeutic benefit. rTMS has been insufficiently studied for migraine in children despite benefits demonstrated for adult migraine. Evidence for rTMS in childhood epilepsy and ADHD remains mixed. Repetitive transcranial magnetic stimulation is emerging as a safe, tolerable, and potentially effective therapeutic strategy in a number of pediatric neurological disorders, though high-quality, randomized controlled trials are needed. Ongoing studies should focus on optimization of treatment protocols, development of biomarkers to identify children who will benefit from the technique, and identification of the most appropriate indicators of response.
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Affiliation(s)
- Laura A Malone
- Department of Neurology, Johns Hopkins University School of Medicine, 200 N. Wolfe Street, Suite 2158, Baltimore, MD, 21287, USA
| | - Lisa R Sun
- Department of Neurology, Johns Hopkins University School of Medicine, 200 N. Wolfe Street, Suite 2158, Baltimore, MD, 21287, USA.
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26
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Straudi S, Baroni A, Mele S, Craighero L, Manfredini F, Lamberti N, Maietti E, Basaglia N. Effects of a Robot-Assisted Arm Training Plus Hand Functional Electrical Stimulation on Recovery After Stroke: A Randomized Clinical Trial. Arch Phys Med Rehabil 2019; 101:309-316. [PMID: 31678222 DOI: 10.1016/j.apmr.2019.09.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 08/04/2019] [Accepted: 09/27/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To compare the effects of unilateral, proximal arm robot-assisted therapy combined with hand functional electrical stimulation with intensive conventional therapy for restoring arm function in survivors of subacute stroke. DESIGN This was a single-blinded, randomized controlled trial. SETTING Inpatient rehabilitation university hospital. PARTICIPANTS Patients (N=40) diagnosed as having ischemic stroke (time since stroke <8wk) and upper limb impairment were enrolled. INTERVENTIONS Participants randomized to the experimental group received 30 sessions (5 sessions/wk) of robot-assisted arm therapy and hand functional electrical stimulation (RAT+FES). Participants randomized to the control group received a time-matched intensive conventional therapy. MAIN OUTCOME MEASURES The primary outcome was arm motor recovery measured with the Fugl-Meyer Motor Assessment. Secondary outcomes included motor function, arm spasticity, and activities of daily living. Measurements were performed at baseline, after 3 weeks, at the end of treatment, and at 6-month follow-up. Presence of motor evoked potentials (MEPs) was also measured at baseline. RESULTS Both groups significantly improved all outcome measures except for spasticity without differences between groups. Patients with moderate impairment and presence of MEPs who underwent early rehabilitation (<30d post stroke) demonstrated the greatest clinical improvements. CONCLUSIONS RAT+FES was no more effective than intensive conventional arm training. However, at the same level of arm impairment and corticospinal tract integrity, it induced a higher level of arm recovery.
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Affiliation(s)
- Sofia Straudi
- Neuroscience and Rehabilitation Department, Ferrara University Hospital, Ferrara, Italy.
| | - Andrea Baroni
- Neuroscience and Rehabilitation Department, Ferrara University Hospital, Ferrara, Italy; Doctoral Program in Translational Neurosciences and Neurotechnologies, Ferrara University, Ferrara, Italy
| | - Sonia Mele
- Biomedical and Specialty Surgical Sciences Department, Ferrara University, Ferrara, Italy
| | - Laila Craighero
- Biomedical and Specialty Surgical Sciences Department, Ferrara University, Ferrara, Italy
| | - Fabio Manfredini
- Neuroscience and Rehabilitation Department, Ferrara University Hospital, Ferrara, Italy; Biomedical and Specialty Surgical Sciences Department, Ferrara University, Ferrara, Italy
| | - Nicola Lamberti
- Neuroscience and Rehabilitation Department, Ferrara University Hospital, Ferrara, Italy; Biomedical and Specialty Surgical Sciences Department, Ferrara University, Ferrara, Italy
| | - Elisa Maietti
- Medical Science Department, Center for Clinical Epidemiology, Ferrara University, Ferrara, Italy; Department of Biomedical and Neuromotor Sciences, Bologna University, Bologna, Italy
| | - Nino Basaglia
- Neuroscience and Rehabilitation Department, Ferrara University Hospital, Ferrara, Italy; Biomedical and Specialty Surgical Sciences Department, Ferrara University, Ferrara, Italy
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27
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Borschmann KN, Hayward KS. Recovery of upper limb function is greatest early after stroke but does continue to improve during the chronic phase: a two-year, observational study. Physiotherapy 2019; 107:216-223. [PMID: 32026823 DOI: 10.1016/j.physio.2019.10.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Investigate upper limb (UL) capacity and performance from <14-days to 24-months post stroke. DESIGN Longitudinal study of participants with acute stroke, assessed ≤14-days, 6-weeks, 3-, 6-, 12-, 18-, and 24-months post stroke. SETTING Two acute stroke units. MAIN OUTCOME MEASURES Examination of UL capacity using Chedoke McMaster Stroke Assessment (combined arm and hand scores, 0-14), performance using Motor Activity Log (amount of movement and quality of movement, scored 0-5), and grip strength (kg) using Jamar dynamometer. Random effects regression models were performed to explore the change in outcomes at each time point. Routine clinical imaging was used to describe stroke location as cortical, subcortical or mixed. RESULTS Thirty-four participants were enrolled: median age 67.7 years (IQR 60.7-76.2), NIHSS 11.5 (IQR 8.5-16), female n=10 (36%). The monthly rate of change for all measures was consistently greatest in the 6-weeks post baseline. On average, significant improvements were observed to 12-months in amount of use (median improvement 1.81, 95% CI 1.35 to 2.27) and strength (median improvement 8.29, 95% CI 5.90 to 10.67); while motor capacity (median improvement 4.70, 95% CI 3.8 to 5.6) and quality of movement (median improvement 1.83, 95% CI 1.37 to 2.3) improved to 18-months post stroke. Some individuals were still demonstrating gains at 24-months post stroke within each stroke location group. CONCLUSION This study highlights that the greatest rate of improvement of UL capacity and performance occurs early post stroke. At the group level, improvements were evident at 12- to 18-months post stroke, but at the individual level improvements were observed at 24-months. CLINICAL TRIAL REGISTRATION ACTRN12612000123842.
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Affiliation(s)
- Karen N Borschmann
- School of Allied Health, La Trobe University, Bundoora, Australia; AVERT Early Rehabilitation Research Group, Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia; NHMRC Centre of Research Excellence Stroke Rehabilitation and Brain Repair, Australia; St Vincent's Hospital, Melbourne, Australia.
| | - Kathryn S Hayward
- AVERT Early Rehabilitation Research Group, Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia; NHMRC Centre of Research Excellence Stroke Rehabilitation and Brain Repair, Australia; Department of Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Parkville, Australia. https://twitter.com/@karenborschmann
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28
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Bonin Pinto C, Morales-Quezada L, de Toledo Piza PV, Zeng D, Saleh Vélez FG, Ferreira IS, Lucena PH, Duarte D, Lopes F, El-Hagrassy MM, Rizzo LV, Camargo EC, Lin DJ, Mazwi N, Wang QM, Black-Schaffer R, Fregni F. Combining Fluoxetine and rTMS in Poststroke Motor Recovery: A Placebo-Controlled Double-Blind Randomized Phase 2 Clinical Trial. Neurorehabil Neural Repair 2019; 33:643-655. [PMID: 31286828 DOI: 10.1177/1545968319860483] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background. Although recent evidence has shown a new role of fluoxetine in motor rehabilitation, results are mixed. We conducted a randomized clinical trial to evaluate whether combining repetitive transcranial magnetic stimulation (rTMS) with fluoxetine increases upper limb motor function in stroke. Methods. Twenty-seven hemiparetic patients within 2 years of ischemic stroke were randomized into 3 groups: Combined (active rTMS + fluoxetine), Fluoxetine (sham rTMS + fluoxetine), or Placebo (sham rTMS + placebo fluoxetine). Participants received 18 sessions of 1-Hz rTMS in the unaffected primary motor cortex and 90 days of fluoxetine (20 mg/d). Motor function was assessed using Jebsen-Taylor Hand Function (JTHF) and Fugl-Meyer Assessment (FMA) scales. Corticospinal excitability was assessed with TMS. Results. After adjusting for time since stroke, there was significantly greater improvement in JTHF in the combined rTMS + fluoxetine group (mean improvement: -214.33 seconds) than in the placebo (-177.98 seconds, P = 0.005) and fluoxetine (-50.16 seconds, P < 0.001) groups. The fluoxetine group had less improvement than placebo on both scales (respectively, JTHF: -50.16 vs -117.98 seconds, P = 0.038; and FMA: 6.72 vs 15.55 points, P = 0.039), suggesting that fluoxetine possibly had detrimental effects. The unaffected hemisphere showed decreased intracortical inhibition in the combined and fluoxetine groups, and increased intracortical facilitation in the fluoxetine group. This facilitation was negatively correlated with motor function improvement (FMA, r2 = -0.398, P = 0.0395). Conclusion. Combined fluoxetine and rTMS treatment leads to better motor function in stroke than fluoxetine alone and placebo. Moreover, fluoxetine leads to smaller improvements than placebo, and fluoxetine's effects on intracortical facilitation suggest a potential diffuse mechanism that may hinder beneficial plasticity on motor recovery.
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Affiliation(s)
- Camila Bonin Pinto
- 1 Harvard Medical School, Boston, MA, USA.,2 University of Sao Paulo, Sao Paulo, Brazil.,3 Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Leon Morales-Quezada
- 1 Harvard Medical School, Boston, MA, USA.,3 Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Polyana Vulcano de Toledo Piza
- 1 Harvard Medical School, Boston, MA, USA.,3 Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA.,6 Albert Einstein Hospital, Sao Paulo, Brazil
| | - Dian Zeng
- 1 Harvard Medical School, Boston, MA, USA.,3 Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Faddi Ghassan Saleh Vélez
- 1 Harvard Medical School, Boston, MA, USA.,3 Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA.,4 University of Chicago Medical Center, Chicago, IL, USA
| | - Isadora Santos Ferreira
- 1 Harvard Medical School, Boston, MA, USA.,3 Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Pedro Henrique Lucena
- 1 Harvard Medical School, Boston, MA, USA.,3 Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Dante Duarte
- 1 Harvard Medical School, Boston, MA, USA.,3 Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Fernanda Lopes
- 1 Harvard Medical School, Boston, MA, USA.,3 Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Mirret M El-Hagrassy
- 1 Harvard Medical School, Boston, MA, USA.,3 Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Luiz Vicente Rizzo
- 3 Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Erica C Camargo
- 1 Harvard Medical School, Boston, MA, USA.,5 Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - David J Lin
- 1 Harvard Medical School, Boston, MA, USA.,5 Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Nicole Mazwi
- 1 Harvard Medical School, Boston, MA, USA.,3 Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA.,5 Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Qing Mei Wang
- 1 Harvard Medical School, Boston, MA, USA.,5 Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,6 Albert Einstein Hospital, Sao Paulo, Brazil.,7 Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Randie Black-Schaffer
- 1 Harvard Medical School, Boston, MA, USA.,3 Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA.,5 Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Felipe Fregni
- 1 Harvard Medical School, Boston, MA, USA.,3 Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA.,5 Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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29
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Held JPO, van Duinen J, Luft AR, Veerbeek JM. Eligibility Screening for an Early Upper Limb Stroke Rehabilitation Study. Front Neurol 2019; 10:683. [PMID: 31312170 PMCID: PMC6614516 DOI: 10.3389/fneur.2019.00683] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 06/12/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction: Stroke rehabilitation should start early in order to optimize patients' outcomes, but most trials include subacute or chronic patients. Although suggested that early stroke rehabilitation trials face difficulties regarding patient recruitment with corresponding low recruitment rates, no systematically collected information regarding screening and associated costs has been published. Such knowledge is essential for optimizing enrollment. Therefore, this study evaluated screening procedures for an early upper limb rehabilitation study including first-ever ischemic stroke patients <48 h after onset. Methods: Screening data for a monocentric longitudinal observational cohort study was prospectively collected. Researchers screened health-care records, during the morning round and face-to-face at the stroke-unit on working days. Outcomes were the recruitment rate, reasons for non-enrollment, and screening costs. Results: Over 15 months, 27 out of 845 screened ischemic stroke patients were enrolled, equaling a recruitment rate of 1.8/month. Main reasons for non-enrollment were no upper limb paresis (N = 456), >48 h post-stroke (N = 257), general comorbidity (N = 150), unable to follow commands (N = 148), and recurrent stroke (N = 146). Four patients were missed due to time constraints of the personnel or patient. The recruitment rate would have been 1.2 higher if also patients with recurrent strokes but without residual motor deficits or pre-stroke mRS ≥2 were considered eligible. Screening costed € 7.48 per patient. Discussion: Screening at working days is sufficient to enroll patients in early stroke rehabilitation trials. Inclusion criteria regarding recurrent strokes should be less stringent to boost recruitment rates without increasing bias. Multicenter collaborations are needed to finish well-powered early stroke rehabilitation studies within a reasonable time. Ethics and Study Registration: Authorization from the local ethical committee was not required, as this study does not fall within the scope of the Human Research Act (BASEC Identifier: Req-2017-00844). The project was registered at http://www.clinicaltrials.gov (Identifier: NCT03633422).
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Affiliation(s)
- Jeremia P O Held
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Jannie van Duinen
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Andreas R Luft
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University of Zurich and University Hospital Zurich, Zurich, Switzerland.,Cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Janne M Veerbeek
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University of Zurich and University Hospital Zurich, Zurich, Switzerland
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30
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Bulboaca1 AE, Bulboaca A, Stanescu I, Boarescu PM, Chirilă I, Bulboaca A, Dogaru G. Homonymous hemianopsia versus unilateral spatial neglect rehabilitation strategies in stroke patients. BALNEO RESEARCH JOURNAL 2019. [DOI: 10.12680/balneo.2019.242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract Visual rehabilitation therapy is one of the most problematic issue in stroke rehabilitation. The difficulties consist in specific assessment of visual deficit and poor results reports by the authors of the clinical studies. Opposite, experimental studies reports encouraging results that give hopes in this specific rehabilitation therapy. There are still difficult to analyze different aquisitions concerning various visual residual deficits after stroke, the main rehabilitation targgets being motor rehabilitation in order to ensure at least a partial autonomy in day by day life. All the studies that proved there are chances for a better quality of life if there is an improvement of visual abilities together with motor and cognitive skills with a better rehabilitation prognosis. The aim of this paper is to make a brief report regarding two of the most important visual deficits after stroke as are homonymous hemianopsia and neglect. Starting with differential diagnosis, neuroplasticity and specific rehabilitation available method, the main issues are discussed. a better understanding of phenomena that are associated with spontaneous rehabilitation, or enhancing the progress of recuperation by various method, could be able to bring a new light and hopefully better results in rehabilitation for these patients Key words: stroke, visual impairment, visual rehabilitation, neuroplasticity, homonymous hemianopsia,
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Affiliation(s)
| | - Angelo Bulboaca
- "Iuliu-Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania 2. Clinical Rehabilitation Hospital, Cluj-Napoca, Romania
| | - Ioana Stanescu
- 1. "Iuliu-Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania 2. Clinical Rehabilitation Hospital, Cluj-Napoca, Romania
| | - Paul-Mihai Boarescu
- 1. "Iuliu-Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ioana Chirilă
- County Clinical Emergency Hospital, Cluj-Napoca, Romania
| | - Alexandra Bulboaca
- 1. "Iuliu-Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Gabriela Dogaru
- 1. "Iuliu-Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania 2. Clinical Rehabilitation Hospital, Cluj-Napoca, Romania
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31
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Yarossi M, Patel J, Qiu Q, Massood S, Fluet G, Merians A, Adamovich S, Tunik E. The Association Between Reorganization of Bilateral M1 Topography and Function in Response to Early Intensive Hand Focused Upper Limb Rehabilitation Following Stroke Is Dependent on Ipsilesional Corticospinal Tract Integrity. Front Neurol 2019; 10:258. [PMID: 30972004 PMCID: PMC6443957 DOI: 10.3389/fneur.2019.00258] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 02/26/2019] [Indexed: 01/12/2023] Open
Abstract
Transcranial magnetic stimulation (TMS) induced motor evoked potentials (MEPs) are an established proxy of corticospinal excitability. As a binary measure, the presence (MEP+) or absence (MEP-) of ipsilesional hemisphere MEPs early following stroke is a robust indicator of long-term recovery, however this measure does not provide information about spatial cortical reorganization. MEPs have been systematically acquired over the sensorimotor cortex to "map" motor topography. In this investigation we compared the degree to which functional improvements resulting from early (<3 months post-stroke) intensive hand focused upper limb rehabilitation correlate with changes in motor topography between MEP+ and MEP- individuals. Following informed consent, 17 individuals (4 Female, 60.3 ± 9.4 years, 24.6 ± 24.01 days post first time stroke) received 8 one hour-sessions of training with virtual reality (VR)/Robotic simulations. Clinical tests [Box and Blocks Test (BBT), Wolf Motor Function Test (WMFT), Upper Extremity Fugl-Meyer (UEFMA)], kinematic and kinetic assessments [finger Active Range of Motion (finger AROM), Maximum Pinch Force (MPF)], and bilateral TMS mapping of 5 hand muscles were performed prior to (PRE), directly following (POST), and 1 month following (1M) training. Participants were divided into two groups (MEP+, MEP-) based on whether an MEP was present in the affected first dorsal interosseous (FDI) at any time point. MEP+ individuals improved significantly more than MEP- individuals from PRE to 1M on the WMFT, BBT, and finger AROM scores. Ipsilesional hemisphere FDI area increased significantly with time in the MEP+ group. FDI area of the contralesional hemisphere was not significantly different across time points or groups. In the MEP+ group, significant correlations were observed between PRE-1M changes in ipsilesional FDI area and WMFT, BBT, and finger AROM, and contralesional FDI area and UEFMA and MPF. In the MEP- group, no significant correlations were found between changes in contralesional FDI area and functional outcomes. We report preliminary evidence in a small sample that patterns of recovery and the association of recovery to bilateral changes in motor topography may depend on integrity of the ipsilesional cortical spinal tract as assessed by the presence of TMS evoked MEPs.
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Affiliation(s)
- Mathew Yarossi
- Movement Neuroscience Laboratory, Department of Physical Therapy, Movement and Rehabilitation Science, Bouve College of Health Sciences, Northeastern University, Boston, MA, United States.,SPIRAL Group, Department of Electrical and Computer Engineering, Northeastern University, Boston, MA, United States
| | - Jigna Patel
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, United States
| | - Qinyin Qiu
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, United States
| | - Supriya Massood
- Brookdale Rehabilitation - North Campus, Naples Community Hospital, Naples, FL, United States
| | - Gerard Fluet
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, United States
| | - Alma Merians
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, United States
| | - Sergei Adamovich
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, United States.,Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, United States
| | - Eugene Tunik
- Movement Neuroscience Laboratory, Department of Physical Therapy, Movement and Rehabilitation Science, Bouve College of Health Sciences, Northeastern University, Boston, MA, United States.,Department of Bioengineering, College of Engineering, Northeastern University, Boston, MA, United States.,Department of Electrical and Computer Engineering, College of Engineering, Northeastern University, Boston, MA, United States
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32
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Mazzoleni S, Tran VD, Dario P, Posteraro F. Wrist Robot-assisted Rehabilitation Treatment in Subacute and Chronic Stroke Patients: from Distal to Proximal Motor Recovery. IEEE Trans Neural Syst Rehabil Eng 2018; 26:1889-1896. [PMID: 30106736 DOI: 10.1109/tnsre.2018.2864935] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In this study, the recovery of proximal and distal segments in stroke patients who received distal training alone was investigated. Forty (20 subacute and 20 chronic) stroke patients were recruited to perform wrist robot-assisted rehabilitation training. The upper extremity, shoulder-elbow and wrist subsections of the Fugl-Meyer Assessment Scale were used to assess the motor recovery of distal and proximal segments. In addition, the Modified Ashworth Scale, the Motricity Index and the Box & Block test were used as clinical outcome measures together with kinematic parameters to evaluate the effects of the training. Significant increases in the wrist and shoulder-elbow subsections of the Fugl-Meyer Assessment Scale, Motricity Index and Box & Block test were found in both groups. Average changes in shoulder-elbow and upper extremity subsections of the Fugl-Meyer Assessment Scale in the subacute group (6.10 ± 6.60 and 15.65 ± 14.04) were significantly higher (p < 0.05) than those in the chronic group (2.30 ± 2.76 and 6.60 ± 4.64). In addition, significant increases in the movement velocity, movement smoothness and movement quality were observed in the subacute group. Our findings provide evidence that following a robot-assisted rehabilitation treatment there is a distal-to-proximal generalization in subacute stroke patients.
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33
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Li J, Zuo Z, Zhang X, Shao X, Lu J, Xue R, Fan Y, Guan Y, Zhang W. Excitatory Repetitive Transcranial Magnetic Stimulation Induces Contralesional Cortico-Cerebellar Pathways After Acute Ischemic Stroke: A Preliminary DTI Study. Front Behav Neurosci 2018; 12:160. [PMID: 30140207 PMCID: PMC6094967 DOI: 10.3389/fnbeh.2018.00160] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 07/09/2018] [Indexed: 12/19/2022] Open
Abstract
Background: Repetitive transcranial magnetic stimulation (rTMS) is proved to be effective in facilitating stroke recovery. However, its therapeutic mechanism remains unclear. The present study aimed to investigate changes in white matter fractional anisotropy (FA) after excitatory rTMS to better understand its role in motor rehabilitation. Materials and Methods: Acute stroke patients with unilateral subcortical infarction in the middle cerebral artery territory were recruited. The patients were randomly divided into an rTMS treatment group and a sham group. The treatment group received a 10-day 5 HZ rTMS applied over the ipsilesional primary motor area beginning at about 4 days after stroke onset. The sham group received sham rTMS. Diffusion tensor imaging (DTI) data were collected in every patient before and after the rTMS or sham rTMS. Voxel-based analysis was used to study the difference in FA between the two groups. The trial of this article has been registered on the ClinicalTrials.gov and the identifier is NCT03163758. Results: Before the rTMS, there is no significant difference in FA between the two groups. Differently, after the treatment, the rTMS group showed increased FA in the contralesional corticospinal tract, the pontine crossing tract, the middle cerebellar peduncle, the contralesional superior cerebellar peduncle, the contralesional medial lemniscus, and the ipsilesional inferior cerebellar peduncle. These fasciculi comprise the cortex-pontine-cerebellum-cortex loop. Increased FA was also found in the body of corpus callosum and the contralesional cingulum of the treatment group compared with the sham. Conclusion: The greater connectivity of contralesional cortico-cerebellar loop and the strengthening of interhemispheric connection may reflect contralesional compensation facilitated by the excitatory rTMS, which gives us a clue to understand the therapeutic mechanism of rTMS.
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Affiliation(s)
- Jing Li
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Zhentao Zuo
- State Key Laboratory of Brain and Cognitive Science, Beijing MR Center for Brain Research, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
| | - Xuewei Zhang
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China.,Department of Interventional Radiology, China Meitan General Hospital, Beijing, China
| | - Xiali Shao
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Jie Lu
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Rong Xue
- State Key Laboratory of Brain and Cognitive Science, Beijing MR Center for Brain Research, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
| | - Yong Fan
- Department of Radiology, School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Yuzhou Guan
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Weihong Zhang
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
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Krakauer JW, Cortés JC. A non-task-oriented approach based on high-dose playful movement exploration for rehabilitation of the upper limb early after stroke: A proposal. NeuroRehabilitation 2018; 43:31-40. [DOI: 10.3233/nre-172411] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- John W. Krakauer
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
- Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA
- Neuroscience, Johns Hopkins University, Baltimore, MD, USA
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Kang JI, Moon YJ, Jeong DK, Choi H, Park JS, Choi HH, Song YK. Effects of dynamic neural mobilization on cerebral cortical activity in patients with stroke. J Phys Ther Sci 2018; 30:906-909. [PMID: 30034094 PMCID: PMC6047958 DOI: 10.1589/jpts.30.906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 04/13/2018] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The current study aimed to identify the effects of dynamic neural mobilization on cerebral cortical activity in patients with stroke, and to present efficient intervention methods for stroke management. [Subjects and Methods] A total of 20 hemiplegic patients diagnosed with stroke over the past 6 months were sampled, and randomly divided into groups I (n=10) and II (n=10). Groups I and II underwent neural mobilization and dynamic neural mobilization, respectively, on the paralyzed arm. Both interventions were administered for 30 min, once a day, for 4 days a week, over a course of 4 weeks. β-waves and μ-rhythms in the C3 and C4 areas of the cerebral cortex were measured using electroencephalography, both before and after the intervention. [Results] After the intervention, both groups showed significant changes in the β-waves and μ-rhythms in the C3 area alone. Further, significant inter-group differences in the β-waves and μ-rhythms were only present in the C3 area. [Conclusion] Dynamic neural mobilization is an efficient intervention because it increases β-waves and μ-rhythms in the cerebral cortex. Therefore, the effects of continuous intervention programs involving dynamic neural mobilization in patients with stroke should be investigated in the future.
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Affiliation(s)
- Jeong-Il Kang
- Department of Physical Therapy, Sehan University, Republic of Korea
| | - Young-Jun Moon
- Department of Physical Therapy, Mokpo Jung-Ang Hospital: 815-8 Seokhyeon-dong, Mokpo-si, Jeonnam 586-15, Republic of Korea
| | - Dae-Keun Jeong
- Department of Physical Therapy, Sehan University, Republic of Korea
| | - Hyun Choi
- Department of Physical Therapy, Mokpo Mirae Hospital, Republic of Korea
| | - Joon-Su Park
- Department of Physical Therapy, Sehan University, Republic of Korea
| | - Hyun-Ho Choi
- Department of Physical Therapy, Sehan University, Republic of Korea
| | - Young-Kee Song
- Department of Neurosurgery, Mokpo Hankook Hospital, Republic of Korea
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Bernhardt J, Hayward KS, Kwakkel G, Ward NS, Wolf SL, Borschmann K, Krakauer JW, Boyd LA, Carmichael ST, Corbett D, Cramer SC. Agreed Definitions and a Shared Vision for New Standards in Stroke Recovery Research: The Stroke Recovery and Rehabilitation Roundtable Taskforce. Neurorehabil Neural Repair 2018; 31:793-799. [PMID: 28934920 DOI: 10.1177/1545968317732668] [Citation(s) in RCA: 171] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The first Stroke Recovery and Rehabilitation Roundtable established a game changing set of new standards for stroke recovery research. Common language and definitions were required to develop an agreed framework spanning the four working groups: translation of basic science, biomarkers of stroke recovery, measurement in clinical trials and intervention development and reporting. This paper outlines the working definitions established by our group and an agreed vision for accelerating progress in stroke recovery research.
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Affiliation(s)
- Julie Bernhardt
- 1 Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia.,2 NHMRC Centre of Research Excellence Stroke Rehabilitation and Brain Recovery, Melbourne, Australia
| | - Kathryn S Hayward
- 1 Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia.,2 NHMRC Centre of Research Excellence Stroke Rehabilitation and Brain Recovery, Melbourne, Australia.,3 Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Gert Kwakkel
- 4 Department Rehabilitation Medicine, MOVE Research Institute, Neuroscience Campus Amsterdam, VU University Medical Centre, Amsterdam, the Netherlands.,5 Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University Chicago, Evanston, IL, USA
| | - Nick S Ward
- 6 Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, UK.,7 The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Steven L Wolf
- 8 Department of Rehabilitation Medicine, Department of Medicine, and Department of Cell Biology, Division of Physical Therapy, Emory University School of Medicine, Atlanta, GA, USA.,9 Atlanta VA Center for Visual and Neurocognitive Rehabilitation, Atlanta, GA, USA
| | - Karen Borschmann
- 1 Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia.,2 NHMRC Centre of Research Excellence Stroke Rehabilitation and Brain Recovery, Melbourne, Australia
| | - John W Krakauer
- 10 Departments of Neurology, Neuroscience, and Physical Medicine & Rehabilitation, Johns Hopkins University, Baltimore, MD, USA
| | - Lara A Boyd
- 3 Department of Physical Therapy, University of British Columbia, Vancouver, Canada.,11 The Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver Canada
| | - S Thomas Carmichael
- 12 Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Dale Corbett
- 13 Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Canada.,14 Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Ottawa, Canada
| | - Steven C Cramer
- 15 Departments of Neurology, Anatomy & Neurobiology, and Physical Medicine & Rehabilitation, University of California, Irvine, CA, USA
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Bernhardt J, Hayward KS, Kwakkel G, Ward NS, Wolf SL, Borschmann K, Krakauer JW, Boyd LA, Carmichael ST, Corbett D, Cramer SC. Agreed definitions and a shared vision for new standards in stroke recovery research: The Stroke Recovery and Rehabilitation Roundtable taskforce. Int J Stroke 2018; 12:444-450. [PMID: 28697708 DOI: 10.1177/1747493017711816] [Citation(s) in RCA: 542] [Impact Index Per Article: 90.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The first Stroke Recovery and Rehabilitation Roundtable established a game changing set of new standards for stroke recovery research. Common language and definitions were required to develop an agreed framework spanning the four working groups: translation of basic science, biomarkers of stroke recovery, measurement in clinical trials and intervention development and reporting. This paper outlines the working definitions established by our group and an agreed vision for accelerating progress in stroke recovery research.
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Affiliation(s)
- Julie Bernhardt
- 1 Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia.,2 NHMRC Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Melbourne, Australia
| | - Kathryn S Hayward
- 1 Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia.,2 NHMRC Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Melbourne, Australia.,3 Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Gert Kwakkel
- 4 Department Rehabilitation Medicine, MOVE Research Institute, Neuroscience Campus Amsterdam, VU University Medical Centre, Amsterdam, the Netherlands.,5 Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University Chicago, Evanston, IL, USA
| | - Nick S Ward
- 6 Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, UK.,7 The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Steven L Wolf
- 8 Department of Rehabilitation Medicine, Department of Medicine, and Department of Cell Biology, Division of Physical Therapy, Emory University School of Medicine, Atlanta, GA, USA.,9 Atlanta VA Center for Visual and Neurocognitive Rehabilitation, Atlanta, GA, USA
| | - Karen Borschmann
- 1 Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia.,2 NHMRC Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Melbourne, Australia
| | - John W Krakauer
- 10 Departments of Neurology, Neuroscience, and Physical Medicine & Rehabilitation, Johns Hopkins University, Baltimore, MD, USA
| | - Lara A Boyd
- 3 Department of Physical Therapy, University of British Columbia, Vancouver, Canada.,11 The Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver Canada
| | - S Thomas Carmichael
- 12 Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Dale Corbett
- 13 Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Canada.,14 Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Ottawa, Canada
| | - Steven C Cramer
- 15 Departments of Neurology, Anatomy & Neurobiology, and Physical Medicine & Rehabilitation, University of California, Irvine, CA, USA
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Harrison SL, Laver KE, Ninnis K, Rowett C, Lannin NA, Crotty M. Effectiveness of external cues to facilitate task performance in people with neurological disorders: a systematic review and meta-analysis. Disabil Rehabil 2018. [PMID: 29523022 DOI: 10.1080/09638288.2018.1448465] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Purpose: To examine in people with neurological disorders, which method/s of providing external cues to improve task performance are most effective. Methods: Medline, EMBASE, and PsycINFO were systematically searched. Two reviewers independently screened, extracted data, and assessed the quality of the evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results: Twenty six studies were included. Studies examined a wide-range of cues including visual, tactile, auditory, verbal, and multi-component cues. Cueing (any type) improved walking speed when comparing cues to no cues (mean difference (95% confidence interval): 0.08 m/s (0.06-0.10), I2 = 68%, low quality of evidence). Remaining evidence was analysed narratively; evidence that cueing improves activity-related outcomes was inconsistent and rated as very low quality. It was not possible to determine which form of cueing may be more effective than others. Conclusion: Providing cues to encourage successful task performance is a core component of rehabilitation, however there is limited evidence on the type of cueing or which tasks benefit most from external cueing. Low-quality evidence suggests there may be a beneficial effect of cueing (any type) on walking speed. Sufficiently powered randomised controlled trials are needed to inform therapists of the most effective cueing strategies to improve activity performance in populations with a neurological disorder. Implications for rehabilitation Providing cues is a core component of rehabilitation and may improve successful task performance and activities in people with neurological conditions including stroke, Parkinson's disease, Alzheimer's disease, traumatic brain injury, and multiple sclerosis, but evidence is limited for most neurological conditions with much research focusing on stroke and Parkinson's disease. Therapists should consider using a range of different types of cues depending on the aims of treatment and the neurological condition. There is currently insufficient evidence to suggest one form of cueing is superior to other forms. Therapists should appreciate that responding optimally to cues may take many sessions to have an effect on activities such as walking. Further studies should be conducted over a longer timeframe to examine the effects of different types of cues towards task performance and activities in people with neurological conditions.
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Affiliation(s)
- Stephanie L Harrison
- a Department of Rehabilitation, Aged and Extended Care , Flinders University , Adelaide , Australia.,b NHMRC Cognitive Decline Partnership Centre , University of Sydney , Sydney , Australia
| | - Kate E Laver
- a Department of Rehabilitation, Aged and Extended Care , Flinders University , Adelaide , Australia
| | - Kayla Ninnis
- a Department of Rehabilitation, Aged and Extended Care , Flinders University , Adelaide , Australia
| | - Cherie Rowett
- c Discipline of Occupational Therapy , Flinders University , Adelaide , Australia
| | - Natasha A Lannin
- d Department of Community and Clinical Allied Health , La Trobe University , Melbourne , Australia.,e Occupational Therapy Department , Alfred Health , Melbourne , Australia
| | - Maria Crotty
- a Department of Rehabilitation, Aged and Extended Care , Flinders University , Adelaide , Australia.,b NHMRC Cognitive Decline Partnership Centre , University of Sydney , Sydney , Australia
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Tran VD, Dario P, Mazzoleni S. Kinematic measures for upper limb robot-assisted therapy following stroke and correlations with clinical outcome measures: A review. Med Eng Phys 2018; 53:13-31. [PMID: 29361407 DOI: 10.1016/j.medengphy.2017.12.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 11/10/2017] [Accepted: 12/24/2017] [Indexed: 10/18/2022]
Abstract
AIM OF THE STUDY This review classifies the kinematic measures used to evaluate post-stroke motor impairment following upper limb robot-assisted rehabilitation and investigates their correlations with clinical outcome measures. METHODS An online literature search was carried out in PubMed, MEDLINE, Scopus and IEEE-Xplore databases. Kinematic parameters mentioned in the studies included were categorized into the International Classification of Functioning, Disability and Health (ICF) domains. The correlations between these parameters and the clinical scales were summarized. RESULTS Forty-nine kinematic parameters were identified from 67 articles involving 1750 patients. The most frequently used parameters were: movement speed, movement accuracy, peak speed, number of speed peaks, and movement distance and duration. According to the ICF domains, 44 kinematic parameters were categorized into Body Functions and Structure, 5 into Activities and no parameters were categorized into Participation and Personal and Environmental Factors. Thirteen articles investigated the correlations between kinematic parameters and clinical outcome measures. Some kinematic measures showed a significant correlation coefficient with clinical scores, but most were weak or moderate. CONCLUSIONS The proposed classification of kinematic measures into ICF domains and their correlations with clinical scales could contribute to identifying the most relevant ones for an integrated assessment of upper limb robot-assisted rehabilitation treatments following stroke. Increasing the assessment frequency by means of kinematic parameters could optimize clinical assessment procedures and enhance the effectiveness of rehabilitation treatments.
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Affiliation(s)
- Vi Do Tran
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Polo Sant'Anna Valdera, V.le R. Piaggio 34-56025 Pontedera, Italy; Rehabilitation Bioengineering Laboratory, Volterra, Italy
| | - Paolo Dario
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Polo Sant'Anna Valdera, V.le R. Piaggio 34-56025 Pontedera, Italy
| | - Stefano Mazzoleni
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Polo Sant'Anna Valdera, V.le R. Piaggio 34-56025 Pontedera, Italy; Rehabilitation Bioengineering Laboratory, Volterra, Italy.
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Hunter SM, Johansen-Berg H, Ward N, Kennedy NC, Chandler E, Weir CJ, Rothwell J, Wing AM, Grey MJ, Barton G, Leavey NM, Havis C, Lemon RN, Burridge J, Dymond A, Pomeroy VM. Functional Strength Training and Movement Performance Therapy for Upper Limb Recovery Early Poststroke-Efficacy, Neural Correlates, Predictive Markers, and Cost-Effectiveness: FAST-INdiCATE Trial. Front Neurol 2018; 8:733. [PMID: 29472884 PMCID: PMC5810279 DOI: 10.3389/fneur.2017.00733] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 12/19/2017] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Variation in physiological deficits underlying upper limb paresis after stroke could influence how people recover and to which physical therapy they best respond. OBJECTIVES To determine whether functional strength training (FST) improves upper limb recovery more than movement performance therapy (MPT). To identify: (a) neural correlates of response and (b) whether pre-intervention neural characteristics predict response. DESIGN Explanatory investigations within a randomised, controlled, observer-blind, and multicentre trial. Randomisation was computer-generated and concealed by an independent facility until baseline measures were completed. Primary time point was outcome, after the 6-week intervention phase. Follow-up was at 6 months after stroke. PARTICIPANTS With some voluntary muscle contraction in the paretic upper limb, not full dexterity, when recruited up to 60 days after an anterior cerebral circulation territory stroke. INTERVENTIONS Conventional physical therapy (CPT) plus either MPT or FST for up to 90 min-a-day, 5 days-a-week for 6 weeks. FST was "hands-off" progressive resistive exercise cemented into functional task training. MPT was "hands-on" sensory/facilitation techniques for smooth and accurate movement. OUTCOMES The primary efficacy measure was the Action Research Arm Test (ARAT). Neural measures: fractional anisotropy (FA) corpus callosum midline; asymmetry of corticospinal tracts FA; and resting motor threshold (RMT) of motor-evoked potentials. ANALYSIS Covariance models tested ARAT change from baseline. At outcome: correlation coefficients assessed relationship between change in ARAT and neural measures; an interaction term assessed whether baseline neural characteristics predicted response. RESULTS 288 Participants had: mean age of 72.2 (SD 12.5) years and mean ARAT 25.5 (18.2). For 240 participants with ARAT at baseline and outcome the mean change was 9.70 (11.72) for FST + CPT and 7.90 (9.18) for MPT + CPT, which did not differ statistically (p = 0.298). Correlations between ARAT change scores and baseline neural values were between 0.199, p = 0.320 for MPT + CPT RMT (n = 27) and -0.147, p = 0.385 for asymmetry of corticospinal tracts FA (n = 37). Interaction effects between neural values and ARAT change between baseline and outcome were not statistically significant. CONCLUSIONS There was no significant difference in upper limb improvement between FST and MPT. Baseline neural measures did not correlate with upper limb recovery or predict therapy response. TRIAL REGISTRATION Current Controlled Trials: ISRCT 19090862, http://www.controlled-trials.com.
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Affiliation(s)
- Susan M. Hunter
- School of Health and Rehabilitation, Institute for Applied Clinical Sciences, Keele University, Keele, United Kingdom
| | - Heidi Johansen-Berg
- Wellcome Centre for Integrative Neuroimaging, Functional MRI of the Brain (FMRIB), University of Oxford, Nuffield Department of Clinical neurosciences, John Radcliffe Hospital, Oxford, United Kingdom
| | - Nick Ward
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, United Kingdom
| | - Niamh C. Kennedy
- School of Psychology, Ulster University, Coleraine, United Kingdom
| | - Elizabeth Chandler
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
| | - Christopher John Weir
- Edinburgh Clinical Trials Unit, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - John Rothwell
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, United Kingdom
| | - Alan M. Wing
- School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Michael J. Grey
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
| | - Garry Barton
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
| | - Nick Malachy Leavey
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
| | - Claire Havis
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
| | - Roger N. Lemon
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, United Kingdom
| | - Jane Burridge
- Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Amy Dymond
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
| | - Valerie M. Pomeroy
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
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Towards Upright Pedalling to drive recovery in people who cannot walk in the first weeks after stroke: movement patterns and measurement. Physiotherapy 2017; 103:400-406. [DOI: 10.1016/j.physio.2016.10.392] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 10/27/2016] [Indexed: 11/15/2022]
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Coleman ER, Moudgal R, Lang K, Hyacinth HI, Awosika OO, Kissela BM, Feng W. Early Rehabilitation After Stroke: a Narrative Review. Curr Atheroscler Rep 2017; 19:59. [PMID: 29116473 PMCID: PMC5802378 DOI: 10.1007/s11883-017-0686-6] [Citation(s) in RCA: 182] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW Despite current rehabilitative strategies, stroke remains a leading cause of disability in the USA. There is a window of enhanced neuroplasticity early after stroke, during which the brain's dynamic response to injury is heightened and rehabilitation might be particularly effective. This review summarizes the evidence of the existence of this plastic window, and the evidence regarding safety and efficacy of early rehabilitative strategies for several stroke domain-specific deficits. RECENT FINDINGS Overall, trials of rehabilitation in the first 2 weeks after stroke are scarce. In the realm of very early mobilization, one large and one small trial found potential harm from mobilizing patients within the first 24 h after stroke, and only one small trial found benefit in doing so. For the upper extremity, constraint-induced movement therapy appears to have benefit when started within 2 weeks of stroke. Evidence for non-invasive brain stimulation in the acute period remains scant and inconclusive. For aphasia, the evidence is mixed, but intensive early therapy might be of benefit for patients with severe aphasia. Mirror therapy begun early after stroke shows promise for the alleviation of neglect. Novel approaches to treating dysphagia early after stroke appear promising, but the high rate of spontaneous improvement makes their benefit difficult to gauge. The optimal time to begin rehabilitation after a stroke remains unsettled, though the evidence is mounting that for at least some deficits, initiation of rehabilitative strategies within the first 2 weeks of stroke is beneficial. Commencing intensive therapy in the first 24 h may be harmful.
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Affiliation(s)
- Elisheva R Coleman
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati Gardner Neuroscience Institute, 260 Stetson St., Suite 2300, Cincinnati, OH, 45267-0525, USA.
| | - Rohitha Moudgal
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Kathryn Lang
- Department of Rehabilitation Services, University of Cincinnati, Cincinnati, OH, USA
| | - Hyacinth I Hyacinth
- Aflac Cancer and Blood Disorder Center of Children's Healthcare of Atlanta and Emory University Department of Pediatrics, Atlanta, GA, USA
| | - Oluwole O Awosika
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati Gardner Neuroscience Institute, 260 Stetson St., Suite 2300, Cincinnati, OH, 45267-0525, USA
| | - Brett M Kissela
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati Gardner Neuroscience Institute, 260 Stetson St., Suite 2300, Cincinnati, OH, 45267-0525, USA
| | - Wuwei Feng
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
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Stinear CM. Prediction of motor recovery after stroke: advances in biomarkers. Lancet Neurol 2017; 16:826-836. [DOI: 10.1016/s1474-4422(17)30283-1] [Citation(s) in RCA: 158] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 07/10/2017] [Accepted: 07/11/2017] [Indexed: 12/13/2022]
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Patel J, Qiu Q, Yarossi M, Merians A, Massood S, Tunik E, Adamovich S, Fluet G. Exploring the impact of visual and movement based priming on a motor intervention in the acute phase post-stroke in persons with severe hemiparesis of the upper extremity. Disabil Rehabil 2017; 39:1515-1523. [PMID: 27636200 PMCID: PMC5355001 DOI: 10.1080/09638288.2016.1226419] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Explore the potential benefits of using priming methods prior to an active hand task in the acute phase post-stroke in persons with severe upper extremity hemiparesis. METHODS Five individuals were trained using priming techniques including virtual reality (VR) based visual mirror feedback and contralaterally controlled passive movement strategies prior to training with an active pinch force modulation task. Clinical, kinetic, and neurophysiological measurements were taken pre and post the training period. Clinical measures were taken at six months post training. RESULTS The two priming simulations and active training were well tolerated early after stroke. Priming effects were suggested by increased maximal pinch force immediately after visual and movement based priming. Despite having no clinically observable movement distally, the subjects were able to volitionally coordinate isometric force and muscle activity (EMG) in a pinch tracing task. The Root Mean Square Error (RMSE) of force during the pinch trace task gradually decreased over the training period suggesting learning may have occurred. Changes in motor cortical neurophysiology were seen in the unaffected hemisphere using Transcranial Magnetic Stimulation (TMS) mapping. Significant improvements in motor recovery as measured by the Action Research Arm Test (ARAT) and the Upper Extremity Fugl Meyer Assessment (UEFMA) were demonstrated at six months post training by three of the five subjects. CONCLUSION This study suggests that an early hand-based intervention using visual and movement based priming activities and a scaled motor task allows participation by persons without the motor control required for traditionally presented rehabilitation and testing. Implications for Rehabilitation Rehabilitation of individuals with severely paretic upper extremities after stroke is challenging due to limited movement capacity and few options for therapeutic training. Long-term functional recovery of the arm after stroke depends on early return of active hand control, establishing a need for acute training methods focused distally. This study demonstrates the feasibility of an early hand-based intervention using virtual reality based priming and scaled motor activities which can allow for participation by persons without the motor control required for traditionally presented rehabilitation and testing.
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Affiliation(s)
- Jigna Patel
- Department of Rehabilitation & Movement Sciences, Rutgers The State University of New Jersey, Newark, NJ, USA
| | - Qinyin Qiu
- Department of Rehabilitation & Movement Sciences, Rutgers The State University of New Jersey, Newark, NJ, USA
| | - Mathew Yarossi
- Department of Rehabilitation & Movement Sciences, Rutgers The State University of New Jersey, Newark, NJ, USA
| | - Alma Merians
- Department of Rehabilitation & Movement Sciences, Rutgers The State University of New Jersey, Newark, NJ, USA
| | - Supriya Massood
- Acute Rehabilitation Unit, Saint Joseph’s Wayne Hospital, Wayne, NJ, USA
| | - Eugene Tunik
- Department of Physical Therapy, Movement, and Rehabilitation Science, Bouve College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Sergei Adamovich
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, USA
| | - Gerard Fluet
- Department of Rehabilitation & Movement Sciences, Rutgers The State University of New Jersey, Newark, NJ, USA
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Nikamp CDM, Buurke JH, van der Palen J, Hermens HJ, Rietman JS. Six-month effects of early or delayed provision of an ankle-foot orthosis in patients with (sub)acute stroke: a randomized controlled trial. Clin Rehabil 2017; 31:1616-1624. [DOI: 10.1177/0269215517709052] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Corien DM Nikamp
- Roessingh Research and Development, Enschede, The Netherlands
- Department of Biomechanical Engineering, MIRA – Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Jaap H Buurke
- Roessingh Research and Development, Enschede, The Netherlands
- Department of Biomedical Signals and Systems, MIRA – Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Job van der Palen
- Medisch Spectrum Twente, Medical School Twente, Enschede, The Netherlands
- Department of Research Methodology, Measurement and Data Analysis, University of Twente, Enschede, The Netherlands
| | - Hermie J Hermens
- Roessingh Research and Development, Enschede, The Netherlands
- Department of Biomedical Signals and Systems, MIRA – Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Johan S Rietman
- Roessingh Research and Development, Enschede, The Netherlands
- Department of Biomechanical Engineering, MIRA – Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
- Department of Amputation and Orthopedics, Roessingh Centre for Rehabilitation, Enschede, The Netherlands
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Puig J, Blasco G, Schlaug G, Stinear CM, Daunis-I-Estadella P, Biarnes C, Figueras J, Serena J, Hernández-Pérez M, Alberich-Bayarri A, Castellanos M, Liebeskind DS, Demchuk AM, Menon BK, Thomalla G, Nael K, Wintermark M, Pedraza S. Diffusion tensor imaging as a prognostic biomarker for motor recovery and rehabilitation after stroke. Neuroradiology 2017; 59:343-351. [PMID: 28293701 DOI: 10.1007/s00234-017-1816-0] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 03/01/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE Despite improved acute treatment and new tools to facilitate recovery, most patients have motor deficits after stroke, often causing disability. However, motor impairment varies considerably among patients, and recovery in the acute/subacute phase is difficult to predict using clinical measures alone, particularly in severely impaired patients. Accurate early prediction of recovery would help rationalize rehabilitation goals and improve the design of trials testing strategies to facilitate recovery. METHODS We review the role of diffusion tensor imaging (DTI) in predicting motor recovery after stroke, in monitoring treatment response, and in evaluating white matter remodeling. We critically appraise DTI studies and discuss their limitations, and we explore directions for future study. RESULTS Growing evidence suggests that combining clinical scores with information about corticospinal tract (CST) integrity can improve predictions about motor outcome. The extent of CST damage on DTI and/or the overlap between the CST and a lesion are key prognostic factor that determines motor performance and outcome. Three main strategies to quantify stroke-related CST damage have been proposed: (i) measuring FA distal to the stroke area, (ii) measuring the number of fibers that go through the stroke with tractography, and (iii) measuring the overlap between the stroke and a CST map derived from healthy age- and gender-matched controls. CONCLUSION Recovery of motor function probably involves remodeling of the CST proper and/or a greater reliance on alternative motor tracts through spontaneous and treatment-induced plasticity. DTI-metrics represent promising clinical biomarkers to predict motor recovery and to monitor and predict the response to neurorehabilitative interventions.
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Affiliation(s)
- Josep Puig
- Institute of Diagnostic Imaging (IDI) - Research Unit (IDIR), Parc Sanitari Pere Virgili, Barcelona, Spain. .,Girona Biomedical Research Institute (IDIBGI) - Medical Imaging, Hospital Universitari de Girona Dr. Josep Trueta, 17007, Girona, Spain.
| | - Gerard Blasco
- Institute of Diagnostic Imaging (IDI) - Research Unit (IDIR), Parc Sanitari Pere Virgili, Barcelona, Spain.,Girona Biomedical Research Institute (IDIBGI) - Medical Imaging, Hospital Universitari de Girona Dr. Josep Trueta, 17007, Girona, Spain
| | - Gottfried Schlaug
- Neuroimaging and Stroke Recovery Laboratory, Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Cathy M Stinear
- Department of Medicine, Centre for Brain Research, University of Auckland, Auckland, New Zealand
| | - Pepus Daunis-I-Estadella
- Department of Computer Science, Applied Mathematics and Statistics, University of Girona, Girona, Spain
| | - Carles Biarnes
- Girona Biomedical Research Institute (IDIBGI) - Medical Imaging, Hospital Universitari de Girona Dr. Josep Trueta, 17007, Girona, Spain
| | - Jaume Figueras
- Department of Rehabilitation, Dr. Josep Trueta University Hospital, Girona, Spain
| | - Joaquín Serena
- Department of Neurology, Dr. Josep Trueta University Hospital, Girona, Spain
| | | | | | - Mar Castellanos
- Department of Neurology, A Coruña University Hospital, La Coruña, Spain
| | | | - Andrew M Demchuk
- Calgary Stroke Program, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Bijoy K Menon
- Calgary Stroke Program, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kambiz Nael
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Max Wintermark
- Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA, USA
| | - Salvador Pedraza
- Girona Biomedical Research Institute (IDIBGI) - Medical Imaging, Hospital Universitari de Girona Dr. Josep Trueta, 17007, Girona, Spain.,Institute of Diagnostic Imaging (IDI), Dr. Josep Trueta University Hospital, Girona, Spain
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Carey JR, Chappuis DM, Finkelstein MJ, Frost KL, Leuty LK, McNulty AL, Oddsson LIE, Seifert EM, Kimberley TJ. Importance and Difficulties of Pursuing rTMS Research in Acute Stroke. Phys Ther 2017; 97:310-319. [PMID: 28426872 PMCID: PMC5803765 DOI: 10.1093/ptj/pzx005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 12/11/2016] [Indexed: 12/19/2022]
Abstract
Although much research has been done on repetitive transcranial magnetic stimulation (rTMS) in chronic stroke, only sparse research has been done in acute stroke despite the particularly rich potential for neuroplasticity in this stage. We attempted a preliminary clinical trial in one active, high-quality inpatient rehabilitation facility (IRF) in the -United States. But after enrolling only 4 patients in the grant period, the study was stopped because of low enrollment. The purpose of this paper is to offer a perspective describing the important physiologic rationale for including rTMS in the early phase of stroke, the reasons for our poor patient enrollment in our attempted study, and recommendations to help future studies succeed. We conclude that, if scientists and clinicians hope to enhance stroke outcomes, more attention must be directed to leveraging conventional rehabilitation with neuromodulation in the acute phase of stroke when the capacity for neuroplasticity is optimal. Difficulties with patient enrollment must be addressed by reassessing traditional inclusion and exclusion criteria. Factors that shorten patients' length of stay in the IRF must also be reassessed at all policy-making levels to make ethical decisions that promote higher functional outcomes while retaining cost consciousness.
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Affiliation(s)
- James R. Carey
- J. R. Carey, PT, PhD, Division of Physical Therapy and Division of Rehabilitation Science, University of Minnesota, 420 Delaware St SE, Minneapolis, MN 55455 (USA). Address all correspondence to Dr Carey at:
| | - Diane M. Chappuis
- D. M. Chappuis, MD, Physical Medicine and Rehabilitation, Courage Kenny Rehabilitation Institute, Minneapolis, Minnesota
| | | | - Kate L. Frost
- K. L. Frost, Graduate Program in Rehabilitation Science, University of Minnesota
| | - Lynette K. Leuty
- L. K. Leuty, PT, DPT, Physical Medicine and Rehabilitation, Courage Kenny Rehabilitation Institute
| | - Allison L. McNulty
- A. L. McNulty, PT, DPT, Physical Medicine and Rehabilitation, Courage Kenny Rehabilitation Institute
| | - Lars I. E. Oddsson
- L.I.E. Oddsson, PhD, Division of -Rehabilitation Science, University of -Minnesota
| | - Erin M. Seifert
- E. M. Seifert, PT, DPT, Physical Medicine and Rehabilitation, Courage Kenny Rehabilitation Institute
| | - Teresa J. Kimberley
- T. J. Kimberley, PT, PhD, Division of Physical Therapy and Division of Rehabilitation Science, University of Minnesota
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48
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Hugues A, Di Marco J, Janiaud P, Xue Y, Pires J, Khademi H, Cucherat M, Bonan I, Gueyffier F, Rode G. Efficiency of physical therapy on postural imbalance after stroke: study protocol for a systematic review and meta-analysis. BMJ Open 2017; 7:e013348. [PMID: 28137928 PMCID: PMC5293873 DOI: 10.1136/bmjopen-2016-013348] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 11/11/2016] [Accepted: 01/03/2017] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Stroke frequently results in balance disorders, leading to lower levels of activity and a diminution in autonomy. Current physical therapies (PT) aiming to reduce postural imbalance have shown a large variety of effects with low levels of evidence. The objectives are to determine the efficiency of PT in recovering from postural imbalance in patients after a stroke and to assess which PT is more effective. METHODS AND ANALYSIS We will search several databases from inception to October 2015. Only randomised controlled trials assessing PT to recover from poststroke postural imbalance in adults will be considered.Outcome measures will be the Berg Balance Scale (BBS), the Postural Assessment Scale for Stroke (PASS), the 'weight-bearing asymmetry' (WBA), the 'centre of pressure' (COP) and the 'limit of stability' (LOS). WBA, COP and LOS are measured by a (sitting or standing) static evaluation on force plate or another device.Two independent reviewers will screen titles, abstracts and full-text articles, evaluate the risk of bias and will perform data extraction. In addition to the outcomes, measures of independence will be analysed. This study will aim at determining the effects of PT on the function (WBA, COP, LOS), the activity (BBS, PASS) and the independence of patients. Subgroup analyses will be planned according to the location of brain lesion (hemispheric, brainstem or cerebellum), the time since stroke (early, late, chronic), the PT (type, main aim (direct effect or generalisation), overall duration), the type of approaches (top-down or bottom-up) and the methodological quality of studies. ETHICS AND DISSEMINATION No ethical statement will be required. The results will be published in a peer-reviewed journal. This meta-analysis aims at managing the rehabilitation after postural imbalance by PT after a stroke. TRIAL REGISTRATION NUMBER Prospero CRD42016037966;Pre-results.
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Affiliation(s)
- A Hugues
- Service de médecine physique et réadaptation, Hôpital Henry-Gabrielle, Hospices Civils de Lyon, Saint-Genis-Laval, France
- Inserm UMR-S 1028, CNRS UMR 5292, ImpAct, Centre de Recherche en Neurosciences de Lyon, Université Lyon, Bron, France
- Plate-forme Mouvement et Handicap, Hôpital Henry-Gabrielle, Hospices Civils de Lyon, Saint-Genis-Laval, France
| | - J Di Marco
- Service de médecine physique et réadaptation, Hôpital Raymond Poincaré, Assistance Publique des Hôpitaux de Paris, Garches, France
| | - P Janiaud
- UMR 5558 CNRS Lyon, Université de Lyon 1, Lyon, France
| | - Y Xue
- Pôle Information Médicale Évaluation Recherche, Hospices Civils de Lyon, Lyon, France
| | - J Pires
- Rovisco Pais Rehabilitation Centre, Tocha, Portugal
- Medicine Faculty of Oporto University, Oporto, Portugal
| | - H Khademi
- International Agency of Research on Cancer, World Health Organisation, Lyon, France
| | - M Cucherat
- UMR 5558 CNRS Lyon, Université de Lyon 1, Lyon, France
| | - I Bonan
- Service de médecine physique et de réadaptation, CHU Rennes, Rennes, France
| | - F Gueyffier
- UMR 5558 CNRS Lyon, Université de Lyon 1, Lyon, France
- Service de Pharmacologie Toxicologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France
| | - G Rode
- Service de médecine physique et réadaptation, Hôpital Henry-Gabrielle, Hospices Civils de Lyon, Saint-Genis-Laval, France
- Inserm UMR-S 1028, CNRS UMR 5292, ImpAct, Centre de Recherche en Neurosciences de Lyon, Université Lyon, Bron, France
- Plate-forme Mouvement et Handicap, Hôpital Henry-Gabrielle, Hospices Civils de Lyon, Saint-Genis-Laval, France
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Sen CK, Khanna S, Harris H, Stewart R, Balch M, Heigel M, Teplitsky S, Gnyawali S, Rink C. Robot-assisted mechanical therapy attenuates stroke-induced limb skeletal muscle injury. FASEB J 2016; 31:927-936. [PMID: 27895105 DOI: 10.1096/fj.201600437r] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 11/14/2016] [Indexed: 12/30/2022]
Abstract
The efficacy and optimization of poststroke physical therapy paradigms is challenged in part by a lack of objective tools available to researchers for systematic preclinical testing. This work represents a maiden effort to develop a robot-assisted mechanical therapy (RAMT) device to objectively address the significance of mechanical physiotherapy on poststroke outcomes. Wistar rats were subjected to right hemisphere middle-cerebral artery occlusion and reperfusion. After 24 h, rats were split into control (RAMT-) or RAMT+ groups (30 min daily RAMT over the stroke-affected gastrocnemius) and were followed up to poststroke d 14. RAMT+ increased perfusion 1.5-fold in stroke-affected gastrocnemius as compared to RAMT- controls. Furthermore, RAMT+ rats demonstrated improved poststroke track width (11% wider), stride length (21% longer), and travel distance (61% greater), as objectively measured using software-automated testing platforms. Stroke injury acutely increased myostatin (3-fold) and lowered brain-derived neurotrophic factor (BDNF) expression (0.6-fold) in the stroke-affected gastrocnemius, as compared to the contralateral one. RAMT attenuated the stroke-induced increase in myostatin and increased BDNF expression in skeletal muscle. Additional RAMT-sensitive myokine targets in skeletal muscle (IL-1ra and IP-10/CXCL10) were identified from a cytokine array. Taken together, outcomes suggest stroke acutely influences signal transduction in hindlimb skeletal muscle. Regimens based on mechanical therapy have the clear potential to protect hindlimb function from such adverse influence.-Sen, C. K., Khanna, S., Harris, H., Stewart, R., Balch, M., Heigel, M., Teplitsky, S., Gnyawali, S., Rink, C. Robot-assisted mechanical therapy attenuates stroke-induced limb skeletal muscle injury.
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Affiliation(s)
- Chandan K Sen
- Department of Surgery, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Savita Khanna
- Department of Surgery, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Hallie Harris
- Department of Surgery, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Richard Stewart
- Department of Surgery, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Maria Balch
- Department of Surgery, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Mallory Heigel
- Department of Surgery, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Seth Teplitsky
- Department of Surgery, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Surya Gnyawali
- Department of Surgery, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Cameron Rink
- Department of Surgery, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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50
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Orihuela-Espina F, Roldán GF, Sánchez-Villavicencio I, Palafox L, Leder R, Sucar LE, Hernández-Franco J. Robot training for hand motor recovery in subacute stroke patients: A randomized controlled trial. J Hand Ther 2016; 29:51-7; quiz 57. [PMID: 26847320 DOI: 10.1016/j.jht.2015.11.006] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 10/17/2015] [Accepted: 11/15/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND Evidence of superiority of robot training for the hand over classical therapies in stroke patients remains controversial. During the subacute stage, hand training is likely to be the most useful. AIM To establish whether robot active assisted therapies provides any additional motor recovery for the hand when administered during the subacute stage (<4 months from event) in a Mexican adult population diagnosed with stroke. HYPOTHESIS Compared to classical occupational therapy, robot based therapies for hand recovery will show significant differences at subacute stages. TRIAL DESIGN A randomized clinical trial. METHODS A between subjects randomized controlled trial was carried out on subacute stroke patients (n = 17) comparing robot active assisted therapy (RT) with a classical occupational therapy (OT). Both groups received 40 sessions ensuring at least 300 repetitions per session. Treatment duration was (mean ± std) 2.18 ± 1.25 months for the control group and 2.44 ± 0.88 months for the study group. The primary outcome was motor dexterity changes assessed with the Fugl-Meyer (FMA) and the Motricity Index (MI). RESULTS Both groups (OT: n = 8; RT: n = 9) exhibited significant improvements over time (Non-parametric Cliff's delta-within effect sizes: dwOT-FMA = 0.5, dwOT-MI = 0.5, dwRT-FMA = 1, dwRT-MI = 1). Regarding differences between the therapies; the Fugl-Meyer score indicated a significant advantage for the hand training with the robot (FMA hand: WRS: W = 8, p <0.01), whilst the Motricity index suggested a greater improvement (size effect) in hand prehension for RT with respect to OT but failed to reach significance (MI prehension: W = 17.5, p = 0.080). No harm occurred. CONCLUSIONS Robotic therapies may be useful during the subacute stages of stroke - both endpoints (FM hand and MI prehension) showed the expected trend with bigger effect size for the robotic intervention. Additional benefit of the robotic therapy over the control therapy was only significant when the difference was measured with FM, demanding further investigation with larger samples. Implications of this study are important for decision making during therapy administration and resource allocation.
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Affiliation(s)
| | | | | | - Lorena Palafox
- National Institute of Neurology and Neurosurgery (INNN), Mexico City, Mexico
| | - Ronald Leder
- National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | - Luis Enrique Sucar
- National Institute for Astrophysics, Optics and Electronics (INAOE), Puebla, Mexico
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