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Meng L, Ge Y, Tsang RCC, Zhang W, Liu X, Li S, Zhao J, Zhang X, Wei Q. rTMS for Poststroke Pusher Syndrome: A Randomized, Patient-Blinded Controlled Clinical Trial. Neurorehabil Neural Repair 2024:15459683241268537. [PMID: 39104197 DOI: 10.1177/15459683241268537] [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: 08/07/2024]
Abstract
BACKGROUND Patients with poststroke pusher syndrome (PS) require longer duration of rehabilitation and more supplemental care after discharge. Effective treatment of PS remains a challenge. The role of repetitive transcranial magnetic stimulation (rTMS) for PS has not been examined. OBJECTIVE Assess the efficacy of rTMS for patients with poststroke PS in reducing pushing behavior, enhancing motor recovery and improving mobility. METHODS A randomized, patient- and assessor-blinded sham-controlled trial with intention-to-treat analysis was conducted. Thirty-four eligible patients with poststroke PS were randomly allocated to receive either rTMS or sham rTMS for 2 weeks. Pushing behavior on the Burke lateropulsion scale and scale for contraversive pushing, motor function on Fugl-Meyer assessment scale-motor domain (FMA-m) and mobility on modified Rivermead mobility index were measured at baseline, 1 and 2 weeks after intervention. Repeated-measures analysis of covariance was used for data analysis. RESULTS There was no significant interaction between intervention and time on Burke lateropulsion scale (F = 2.747, P = .076), scale for contraversive pushing (F = 1.583, P = .214), or change of modified Rivermead mobility index (F = 1.183, P = .297). However, a significant interaction between intervention and time was observed for FMA-m (F = 5.464, P = .019). Post hoc comparisons of FMA-m show better improvement in rTMS group with mean differences of 12.7 (95% CI -7.3 to 32.7) and 15.7 (95% CI -4.6 to 36.0) at post-treatment week 1 and week 2 respectively. CONCLUSIONS rTMS did not demonstrate significant efficacy in improving pushing behavior and mobility in patients with PS. However, rTMS might have potential effect in enhancing motor function for patients with PS. REGISTRATION The study was registered in the Chinese Clinical Trial Registry (registration No. ChiCTR2200058015 at http://www.chictr.org.cn/searchprojen.aspx) on March 26, 2022.
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Affiliation(s)
- Lijiao Meng
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yanlei Ge
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Raymond C C Tsang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
| | - Wenyue Zhang
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xingyu Liu
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Siyi Li
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jingyu Zhao
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaoyue Zhang
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qingchuan Wei
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Gomez-Risquet M, Hochsprung A, Magni E, Luque-Moreno C. Feedback Interventions in Motor Recovery of Lateropulsion after Stroke: A Literature Review and Case Series. Brain Sci 2024; 14:682. [PMID: 39061422 PMCID: PMC11275014 DOI: 10.3390/brainsci14070682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 06/26/2024] [Accepted: 07/04/2024] [Indexed: 07/28/2024] Open
Abstract
Lateropulsion is a post-stroke phenomenon marked by an active push of the body across the midline towards the more affected side and/or a resistance of the weight shift towards the less affected side. Within the mechanisms of treatment, feedback systems have been shown to be effective. The aim of the present study was to create a body of knowledge by performing a literature review on the use of feedback mechanisms in the treatment of lateropulsion and to report two cases of lateropulsion patients who had undergone feedback-based treatment. METHODS The review was performed across five different databases (Embase, Medline/PubMed, Scopus, Web of Science, and PEDro) up to February 2024, and haptic feedback intervention was incorporated into the case series (with lateropulsion and ambulation capacity as the main variables). RESULTS In total, 211 records were identified and 6 studies were included after the review of the literature. The most used feedback modality was visual feedback. In the case series, positive results were observed from the intervention, particularly in the recovery of lateropulsion and balance, as well as in the improvement of gait for one patient. Patients demonstrated good adherence to the intervention protocol without adverse effects. CONCLUSIONS Visual feedback is the most commonly used feedback modality in lateropulsion patients but other mechanisms such as haptic feedback also are feasible and should be taken into account. Larger sample sizes, extended follow-up periods, and the isolation of feedback mechanisms must be established to clarify evidence.
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Affiliation(s)
- Maria Gomez-Risquet
- Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, 41009 Seville, Spain;
| | - Anja Hochsprung
- Unidad de Neurología, Hospital Universitario Virgen Macarena, 41009 Seville, Spain;
| | - Eleonora Magni
- Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, 41009 Seville, Spain;
| | - Carlos Luque-Moreno
- Instituto de Biomedicina de Sevilla (IBiS), Departamento de Fisioterapia, Universidad de Sevilla, 41009 Seville, Spain
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Nolan J, Jacques A, Godecke E, Bynevelt M, Dharsono F, Singer B. Lateropulsion resolution and outcomes up to one year post-stroke: a prospective, longitudinal cohort study. Top Stroke Rehabil 2024:1-12. [PMID: 38526999 DOI: 10.1080/10749357.2024.2333186] [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: 01/17/2024] [Accepted: 03/17/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Post-stroke lateropulsion is prevalent and associated with poor rehabilitation outcomes; however, data regarding long-term function associated with lateropulsion are lacking. OBJECTIVES This study aimed to explore lateropulsion resolution and associations between lateropulsion, functional outcomes, and fall occurrence up to 12 months post-stroke. METHODS Participants for this prospective, longitudinal cohort study were recruited from a Stroke Rehabilitation Unit (SRU). Assessments were conducted at SRU admission, at discharge, and at three, six, nine, and twelve months post-stroke. Outcomes included the Four-Point Pusher Score (4PPS), Functional Independence Measure (FIM), and fall occurrence. Longitudinal outcomes were modeled using generalized linear mixed-effects models. RESULTS The final analyses included data from 144 participants. Eighty-two participants (56.9) had lateropulsion (4PPS ≥ 1) on admission. Odds of resolved lateropulsion (4PPS = 0) increased longitudinally from discharge for people who participated in rehabilitation physiotherapy (OR: 9.7, 28.1, 43.1, 81.3: <0.001 at three, six, nine, and twelve months respectively). The greatest FIM improvement among participants in all 4PPS categories occurred during the SRU inpatient phase. The probability of falls post-discharge was greatest among participants with 4PPS = 1 at three months, when compared with 4PPS = 0 (p= 0.022). CONCLUSIONS This study showed that lateropulsion can continue to resolve up to one year post-stroke. Earlier lateropulsion resolution was associated with ongoing rehabilitation physiotherapy participation. Long-term functional gains were maintained among people discharged home, whereas functional status deteriorated after six months among those in residential care. Study findings will allow rehabilitation and service providers to better plan for and accommodate the long-term rehabilitation and care needs of people with post-stroke lateropulsion.
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Affiliation(s)
- Jessica Nolan
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
- School of Health Sciences, The University of Notre Dame Australia, Fremantle, Australia
- Physiotherapy Department, Sir Charles Gairdner Osborne Park Health Care Group, Nedlands, Australia
| | - Angela Jacques
- The Institute for Health Research, The University of Notre Dame Australia, Fremantle, Australia
- Department of Research, Sir Charles Gairdner Osborne Park Health Care Group, Nedlands, Australia
| | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
- Allied Health Research, Sir Charles Gairdner Osborne Park Health Care Group, Nedlands, Australia
- Centre of Research Excellence in Aphasia Rehabilitation, La Trobe University, Melbourne, Australia
| | - Michael Bynevelt
- The Neurological Intervention and Imaging Service of Western Australia, Nedlands, Australia
| | - Ferry Dharsono
- The Neurological Intervention and Imaging Service of Western Australia, Nedlands, Australia
| | - Barbara Singer
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
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Ghazavi Dozin SM, Mohammad Rahimi N, Aminzadeh R. Wii Fit-Based Biofeedback Rehabilitation Among Post-Stroke Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trial. Biol Res Nurs 2024; 26:5-20. [PMID: 37247514 DOI: 10.1177/10998004231180316] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Stroke is one of the most widespread reasons for acquired adult disability. Recent experimental studies have reported the beneficial influence of Wii Fit-based feedback on improving overall balance and gait for stroke survivors. METHODS We conducted a systematic review of the literature using the following keywords to retrieve the data: feedback, biofeedback, stroke, visual, auditory, tactile, virtual reality, videogame rehabilitation, Nintendo Wii stroke, videogame stroke, exergame stroke, Nintendo Wii rehabilitation, balance, and gait. A review and meta-analysis of RCTs regarding Wii Fit-based rehabilitation accompanied by conventional therapy effects on Berg Balance Scale (BBS), Timed Up and Go (TUG), functional reach test, and gait (speed) in stroke survivors was conducted. OBJECTIVE To determine the impacts of Wii Fit-based feedback combined with traditional therapy on balance and gait in stroke survivors. RESULTS 22 studies were included. The meta-analysis results revealed statistically significant improvements in functional ambulation measured using TUG (p < 0.0001), balance measured using BBS (p = 0.0001), and functional reach test (p = 0.01), but not in gait speed (p = 0.32) following Wii Fit-based feedback. Regarding the types of feedback, significant differences were found in BBS scores when mixed visual and auditory feedback was used. CONCLUSION Wii Fit-based feedback has desired effects on improving balance in stroke patients, making it a suitable adjunct to physical therapy.
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Affiliation(s)
| | | | - Reza Aminzadeh
- Department of Sports Sciences, Imam Reza International University, Mashhad, Iran
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Nolan J, Jacques A, Godecke E, Abe H, Babyar S, Bergmann J, Birnbaum M, Dai S, Danells C, Edwards TGS, Gandolfi M, Jahn K, Koter R, Mansfield A, Nakamura J, Pardo V, Perennou D, Piscicelli C, Punt D, Romick-Sheldon D, Saeys W, Smania N, Vaes N, Whitt AL, Singer B. Clinical practice recommendations for management of lateropulsion after stroke determined by a Delphi expert panel. Clin Rehabil 2023; 37:1559-1574. [PMID: 37122265 PMCID: PMC10492423 DOI: 10.1177/02692155231172012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 04/10/2023] [Indexed: 05/02/2023]
Abstract
OBJECTIVE People exhibiting post-stroke lateropulsion actively push their body across the midline to the more affected side and/or resist weight shift toward the less affected side. Despite its prevalence and associated negative rehabilitation outcomes, no clinical practice guidelines exist for the rehabilitation of post-stroke lateropulsion. We aimed to develop consensus-based clinical practice recommendations for managing post-stroke lateropulsion using an international expert panel. DESIGN This Delphi panel process conformed with Guidance on Conducting and Reporting Delphi Studies recommendations. PARTICIPANTS Panel members had demonstrated clinical and/or scientific background in the rehabilitation of people with post-stroke lateropulsion. MAIN MEASURES The process consisted of four electronic survey rounds. Round One consisted of 13 open questions. Subsequent rounds ascertained levels of agreement with statements derived from Round One. Consensus was defined a priori as ≥75% agreement (agree or strongly agree), or ≥70% agreement after excluding 'unsure' responses. RESULTS Twenty participants completed all four rounds. Consensus was achieved regarding a total of 119 recommendations for rehabilitation approaches and considerations for rehabilitation delivery, positioning, managing fear of falling and fatigue, optimal therapy dose, and discharge planning. Statements for which 'some agreement' (50%-74% agreement) was achieved and those for which recommendations remain to be clarified were recorded. CONCLUSIONS These recommendations build on existing evidence to guide the selection of interventions for post-stroke lateropulsion. Future research is required to elaborate specific rehabilitation strategies, consider the impact of additional cognitive and perceptual impairments, describe positioning options, and detail optimal therapy dose for people with lateropulsion.
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Affiliation(s)
- Jessica Nolan
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
- School of Health Sciences and Physiotherapy, The University of Notre Dame Australia, Fremantle, Australia
- Osborne Park Hospital, Stirling, Australia
| | - Angela Jacques
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Australia
- Department of Research, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
- Allied Health Research, Sir Charles Gairdner Hospital, Nedlands, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
| | - Hiroaki Abe
- School of Health Sciences, Fukushima Medical University, Fukushima, Japan
| | - Suzanne Babyar
- Department of Physical Therapy, Hunter College, New York, NY, USA
- Department of Neurology, Stroke Unit, Burke Rehabilitation Hospital, White Plains, NY, USA
| | - Jeannine Bergmann
- Schoen Clinic Bad Aibling, Schoen Clinic, Bad Aibling, Germany
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians University of Munich, Munchen, Germany
| | - Melissa Birnbaum
- Department of Physiotherapy, St Vincent's Hospital, Melbourne, Australia
| | - Shenhao Dai
- Department of NeuroRehabilitation South Hospital, CHU Grenoble Alpes, UMR CNRS 5105 Neuropsychology and NeuroCognition, University of Grenoble Alpes, Grenoble, France
| | - Cynthia Danells
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Taiza GS Edwards
- Department of Neurosciences and Behavioral Sciences, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirão Preto, Brazil
| | - Marialuisa Gandolfi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- Neuromotor and Cognitive Rehabilitation Research Centre (CRRNC), University of Verona, Verona, Italy
| | - Klaus Jahn
- Schoen Clinic Bad Aibling, Schoen Clinic, Bad Aibling, Germany
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians University of Munich, Munchen, Germany
| | - Ryan Koter
- Department of Physical Therapy, Shepherd Center, Atlanta, GA, USA
| | - Avril Mansfield
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Sunnybrook Research Institute, Toronto, Canada
| | - Junji Nakamura
- Department of Rehabilitation, Nishiyamato Rehabilitation Hospital, Nara, Japan
- Graduate School of Health Sciences, Kio University, Nara, Japan
| | - Vicky Pardo
- Physical Therapy/Health Care Sciences, Wayne State University, Detroit, MI, USA
| | - Dominic Perennou
- CHU Grenoble Alpes, Neuropsychology and NeuroCognition, University of Grenoble Alpes, Grenoble, France
| | - Celine Piscicelli
- Department of NeuroRehabilitation South Hospital, CHU Grenoble Alpes, UMR CNRS 5105 Neuropsychology and NeuroCognition, University of Grenoble Alpes, Grenoble, France
| | - David Punt
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Devra Romick-Sheldon
- Department of Physical Therapy, Schwab Rehabilitation Hospital, Chicago, IL, USA
| | - Wim Saeys
- Rehabilitation Sciences and Physiotherapy, University of Antwerp, Wilrijk, Belgium
| | - Nicola Smania
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- Neurorehabilitation Unit, AOUI Verona, Neuromotor and Cognitive Rehabilitation Research Center (CRRNC)
| | - Nathalie Vaes
- Medicine and Health Sciences, Rehabilitation Hospital RevArte, Antwerp, Belgium
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Abigail L Whitt
- Department of Physical Therapy, ALL Whitt Physical Therapy, Alexandria, VA, USA
| | - Barbara Singer
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
- Training Centre in Subacute Care, South Metropolitan Health Service, Fremantle Hospital, Fremantle, Australia
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Nolan J, Godecke E, Spilsbury K, Singer B. Post-Stroke Lateropulsion: Resolution and Function After Discharge From Inpatient Rehabilitation - A Cohort Study. Physiother Can 2023; 75:264-268. [PMID: 37736404 PMCID: PMC10510537 DOI: 10.3138/ptc-2021-0078] [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: 07/26/2021] [Revised: 10/28/2021] [Accepted: 10/29/2021] [Indexed: 09/23/2023]
Abstract
Purpose A person with post-stroke lateropulsion pushes their body toward their hemiparetic side and/or resists accepting weight onto their nonparetic side. Research findings regarding long-term persistence of lateropulsion and its association with function are lacking. This study reports associations between lateropulsion severity (Four Point Pusher Score - 4PPS) and functional outcome (Functional Independence Measure - FIM) at three months after discharge. Methods This prospective cohort study included 41 consecutive admissions to a stroke rehabilitation unit. Lateropulsion severity and FIM were measured at admission, discharge and three-month follow-up. Lateropulsion status at discharge, stroke laterality, ongoing physiotherapy after discharge, and demographic variables (age and sex) were tested for association with FIM change over the follow-up period. Results Complete data were available for 38 participants. Among these, 17 (44.7%) showed lateropulsion (4PPS ≥ 1) on admission, 9 (23.7%) showed persistent lateropulsion on discharge, and 7 (18.4%) showed persistent lateropulsion at three month follow-up. Improved functional status (FIM score) was seen at follow-up in those discharged with lateropulsion who had right-sided lesions but not in those with left-sided lesions. Conclusions Lateropulsion can continue to resolve after discharge from inpatient rehabilitation. Larger cohort studies are needed to further explore associations between persistent lateropulsion and long-term outcomes.
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Affiliation(s)
- Jessica Nolan
- From the:
School of Medical and Health Sciences, Edith Cowan University, Joondalup, W.A., Australia
- Osborne Park Hospital, Stirling, W.A., Australiea
| | - Erin Godecke
- From the:
School of Medical and Health Sciences, Edith Cowan University, Joondalup, W.A., Australia
- Sir Charles Gairdner Hospital, Nedlands, W.A., Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Vict., Australia
| | - Katrina Spilsbury
- Institute for Health Research, University of Notre Dame Australia, Fremantle, W.A., Australia
| | - Barbara Singer
- Training Centre in Subacute Care, South Metropolitan Health Service, Fremantle Hospital, Fremantle, W.A., Australia
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Paci M, Macchioni G, Ferrarello F. Treatment approaches for pusher behaviour: a scoping review. Top Stroke Rehabil 2023; 30:119-136. [PMID: 35156566 DOI: 10.1080/10749357.2021.2016098] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Some individuals with hemiplegia show a postural disorder called pusher behavior. Various underlying theoretical mechanisms have been proposed, thus leading to various treatment approaches. OBJECTIVES The aim of this scoping review is to identify and analyze the available evidence on the treatment approaches for pusher behavior. METHODS Two independent reviewers conducted a literature search for original studies reporting on treatments for pusher behavior. Studies were searched in PubMed, Scopus, Web of Science, CINAHL and PEDro from their inception to December 2020. Treatment approaches were grouped in homogeneous areas based on the supposed underlying mechanism. To assess the reporting of the interventions, the Template for Intervention Description and Replication (TIDieR) was used. RESULTS Thirty-one papers describing 45 interventions were included in the review. Most of the studies were case reports (i.e. including 1 person) (n = 16), followed by randomized controlled trials (n = 5), single subject design trials (n = 5), non-randomized controlled trials (n = 3), and case series (i.e. including more than 1 person) (n = 2). Treatment approaches were grouped into five categories: visual feedback, somatosensory cues, visual-somatosensory integration, brain stimulation, and other nonspecific treatments. The median number of TIDIeR items reported was 7 (range 4 to 10). CONCLUSION Pusher behavior is still little-known. Five main categories of treatment approaches based on the alleged etiological underlying mechanisms have been identified. Most of studies are case reports; controlled trials should be further conducted. Intervention reporting should be improved to allow treatment replication in larger trials.
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Affiliation(s)
- Matteo Paci
- Department of Allied Health Professions, Unit of Functional Rehabilitation, Azienda Usl Toscana Centro, Florence, Italy
| | | | - Francesco Ferrarello
- Department of Allied Health Professions, Unit of Functional Rehabilitation, Azienda Usl Toscana Centro, Prato, Italy
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Hazelton C, Thomson K, Todhunter-Brown A, Campbell P, Chung CS, Dorris L, Gillespie DC, Hunter SM, McGill K, Nicolson DJ, Williams LJ, Brady MC. Interventions for perceptual disorders following stroke. Cochrane Database Syst Rev 2022; 11:CD007039. [PMID: 36326118 PMCID: PMC9631864 DOI: 10.1002/14651858.cd007039.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Perception is the ability to understand information from our senses. It allows us to experience and meaningfully interact with our environment. A stroke may impair perception in up to 70% of stroke survivors, leading to distress, increased dependence on others, and poorer quality of life. Interventions to address perceptual disorders may include assessment and screening, rehabilitation, non-invasive brain stimulation, pharmacological and surgical approaches. OBJECTIVES To assess the effectiveness of interventions aimed at perceptual disorders after stroke compared to no intervention or control (placebo, standard care, attention control), on measures of performance in activities of daily living. SEARCH METHODS: We searched the trials registers of the Cochrane Stroke Group, CENTRAL, MEDLINE, Embase, and three other databases to August 2021. We also searched trials and research registers, reference lists of studies, handsearched journals, and contacted authors. SELECTION CRITERIA We included randomised controlled trials (RCTs) of adult stroke survivors with perceptual disorders. We defined perception as the specific mental functions of recognising and interpreting sensory stimuli and included hearing, taste, touch, smell, somatosensation, and vision. Our definition of perception excluded visual field deficits, neglect/inattention, and pain. DATA COLLECTION AND ANALYSIS One review author assessed titles, with two review authors independently screening abstracts and full-text articles for eligibility. One review author extracted, appraised, and entered data, which were checked by a second author. We assessed risk of bias (ROB) using the ROB-1 tool, and quality of evidence using GRADE. A stakeholder group, comprising stroke survivors, carers, and healthcare professionals, was involved in this review update. MAIN RESULTS We identified 18 eligible RCTs involving 541 participants. The trials addressed touch (three trials, 70 participants), somatosensory (seven trials, 196 participants) and visual perception disorders (seven trials, 225 participants), with one (50 participants) exploring mixed touch-somatosensory disorders. None addressed stroke-related hearing, taste, or smell perception disorders. All but one examined the effectiveness of rehabilitation interventions; the exception evaluated non-invasive brain stimulation. For our main comparison of active intervention versus no treatment or control, one trial reported our primary outcome of performance in activities of daily living (ADL): Somatosensory disorders: one trial (24 participants) compared an intervention with a control intervention and reported an ADL measure. Touch perception disorder: no trials measuring ADL compared an intervention with no treatment or with a control intervention. Visual perception disorders: no trials measuring ADL compared an intervention with no treatment or control. In addition, six trials reported ADL outcomes in a comparison of active intervention versus active intervention, relating to somatosensation (three trials), touch (one trial) and vision (two trials). AUTHORS' CONCLUSIONS: Following a detailed, systematic search, we identified limited RCT evidence of the effectiveness of interventions for perceptual disorders following stroke. There is insufficient evidence to support or refute the suggestion that perceptual interventions are effective. More high-quality trials of interventions for perceptual disorders in stroke are needed. They should recruit sufficient participant numbers, include a 'usual care' comparison, and measure longer-term functional outcomes, at time points beyond the initial intervention period. People with impaired perception following a stroke should continue to receive neurorehabilitation according to clinical guidelines.
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Affiliation(s)
- Christine Hazelton
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Katie Thomson
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
- Department of Occupational Therapy, Human Nutrition & Dietetics, Glasgow Caledonian University, Glasgow, UK
| | - Alex Todhunter-Brown
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Pauline Campbell
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Charlie Sy Chung
- Rehabilitation Services, Fife Health and Social Care Partnership, Dunfermline, UK
| | - Liam Dorris
- Paediatric Neurosciences, Royal Hospital for Children, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - David C Gillespie
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Susan M Hunter
- School of Allied Health Professions, Faculty of Medicine and Health Sciences, Keele University, Keele, UK
| | - Kris McGill
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | | | - Linda J Williams
- Usher Institute, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
| | - Marian C Brady
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
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Nestmann S, Röhrig L, Müller B, Ilg W, Karnath HO. Tilted 3D visual scenes influence lateropulsion: A single case study of pusher syndrome. J Clin Exp Neuropsychol 2022; 44:478-486. [DOI: 10.1080/13803395.2022.2121382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Sophia Nestmann
- Division of Neuropsychology, Center of Neurology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Lisa Röhrig
- Division of Neuropsychology, Center of Neurology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Björn Müller
- Section for Computational Sensomotorics, Hertie-Institute for Clinical Brain Research & Centre for Integrative Neuroscience, University of Tübingen, Tübingen, Germany
| | - Winfried Ilg
- Section for Computational Sensomotorics, Hertie-Institute for Clinical Brain Research & Centre for Integrative Neuroscience, University of Tübingen, Tübingen, Germany
| | - Hans-Otto Karnath
- Division of Neuropsychology, Center of Neurology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- Department of Psychology, University of South Carolina, Columbia, SC, USA
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Meng L, Tsang RCC, Ge Y, Guo Q, Gao Q. rTMS for poststroke pusher syndrome: study protocol for a randomised, patient-blinded controlled clinical trial. BMJ Open 2022; 12:e064905. [PMID: 35948377 PMCID: PMC9379536 DOI: 10.1136/bmjopen-2022-064905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Poststroke pusher syndrome (PS) prevalence is high. Patients with PS require longer rehabilitation with prolonged length of stay. Effective treatment of PS remains a challenge for rehabilitation professionals. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive neuromodulation technique that is effective and recommended in the clinical guidelines of stroke rehabilitation. However, the role of rTMS for PS has not been examined. The study is to assess the efficacy of a specific rTMS programme for patients with PS in reducing pushing behaviour, enhancing motor recovery and improving mobility, as well as testing the safety of rTMS for patients with PS. METHODS AND ANALYSIS A randomised, patient and assessor blinded sham-controlled trial with two parallel groups will be conducted. Thirty-four eligible patients with PS will be randomly allocated to receive either rTMS or sham rTMS for 3 weeks. The primary assessment outcome is the pushing behaviour measured by the Burke Lateropulsion Scale and Scale for Contraversive Pushing. The secondary outcomes are the motor functions and mobility measured by the Fugl-Meyer Assessment Scale (motor domain) and Modified Rivermead Mobility Index, and any adverse events. Assessment will be performed at baseline and 1 week, 2 weeks and 3 weeks after intervention. Repeated-measures analysis of variance will be used for data analysis with the level of significance level set at 0.05. ETHICS AND DISSEMINATION The protocol has been approved by the Biomedical Ethics Committee of West China Hospital, Sichuan University on 23 March 2022 (2022-133). The trial findings will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER Chinese Clinical Trial Registry (ChiCTR2200058015).
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Affiliation(s)
- Lijiao Meng
- Rehabilitation Medicine Center, Sichuan University West China Hospital, Chengdu, Sichuan, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Raymond C C Tsang
- Physiotherapy Department, MacLehose Medical Rehabilitation Centre, Hong Kong, China
| | - Yanlei Ge
- Rehabilitation Medicine Center, Sichuan University West China Hospital, Chengdu, Sichuan, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Qifan Guo
- Department of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Qiang Gao
- Rehabilitation Medicine Center, Sichuan University West China Hospital, Chengdu, Sichuan, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Sichuan University West China Hospital, Chengdu, Sichuan, China
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11
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Improvements of Physical Activity Performance and Motivation in Adult Men through Augmented Reality Approach: A Randomized Controlled Trial. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2022; 2022:3050424. [PMID: 35855818 PMCID: PMC9288278 DOI: 10.1155/2022/3050424] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 05/22/2022] [Accepted: 06/21/2022] [Indexed: 11/25/2022]
Abstract
The COVID-19 pandemic had a global impact, increasing the prevalence of physical inactivity, which is mostly due to the lockdown and social distancing measures adopted during the pandemic. Hence, this study aimed to compare the efficacy of augmented reality-based training on physical activity performance and motivation in healthy adults to mirror visual feedback training and conventional physical therapy. This study used the randomized control trial pretest-posttest research design. Forty-eight healthy men aged 18–35 years who were engaged in recreational physical activities were enrolled and randomly divided into four groups: augmented reality-based training reality (ART), mirror visual feedback training (MVFT), therapist-based training (TBT), and control group. The total training program was held for four weeks. The isokinetic dynamometer, sit-and-reach test, Y balance test, and the intrinsic motivation inventory-22 were used to measure the outcomes before and after the intervention. Paired sample t-test was used to compare the changes before and after the intervention within groups, while the one-way ANOVA was used for the comparison between the groups. Results of the study showed that, after four weeks of intervention, balance, muscle strength, and muscle endurance in all groups significantly improved except for the control group. The ART group showed the highest increase in muscle strength, muscle endurance, and balance compared to the other groups. The motivation level increased in all three feedback groups and was observed in the following order: ART group > MVFT group > TBT group > control group. This study highlighted the most effective method that may be applied for home training during and after this period of the pandemic. The findings revealed that training while receiving real-time feedback via AR devices improves both physical performance and motivation. Augmented reality-based training can be used as an effective training option for improving physical activity and motivation and can be suggested for home training programs.
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12
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Zhang Q, Zhang L, He W, Zheng X, Zhao Z, Li Y, Xu S, Zheng J, Zhuang X, Jia W, Zhu C, Xu H, Shan C, Chen W, Zhao J, Chen S. Case Report: Visual Deprivation in Pusher Syndrome Complicated by Hemispatial Neglect After Basal Ganglia Stroke. Front Neurol 2021; 12:706611. [PMID: 34630282 PMCID: PMC8494178 DOI: 10.3389/fneur.2021.706611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/05/2021] [Indexed: 12/03/2022] Open
Abstract
We aimed to explore whether motor function and activities of daily life (ADL) could be improved with the application of visual deprivation in two patients with Pusher syndrome complicated by hemispatial neglect after right basal ganglia stroke. We assessed two stroke patients suffering from severe motor disturbances, both tilting heavily to the left, with diagnoses of Pusher syndrome and left hemispatial neglect. Vision in the left eye was deprived using patches during clinical rehabilitation. Motor function promotion was confirmed using the Burke Lateropulsion Scale (BLS), Fugl–Meyer Balance Scale (FMBS), and Holden grade (HG), while the Barthel index (BI) assessed ADL immediately and 1 week after intervention. Both patients regained standing balance immediately using visual deprivation, as well as walking ability, although both scored 0 on the FMBS and HG. After 1 week of treatment, one patient increased to 11 and 3 on the FMBS and HG, respectively, while the BLS score decreased from 12 to 2, and the ADL increased from 23 to 70. The other patient demonstrated increases to 10 and 3 on the FMBS and HG, respectively, with the BLS decreasing from 13 to 3, and the ADL increasing from 25 to 60. Therefore, in the rehabilitation treatment of Pusher syndrome complicated by hemispatial neglect due to basal ganglia stroke, visual deprivation can significantly improve motor function and shorten the treatment course.
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Affiliation(s)
- Qian Zhang
- Rehabilitation Department, The Geriatric Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Lixia Zhang
- Rehabilitation Department, The Geriatric Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Wei He
- Rehabilitation Department, Rehabilitation Hospital Affiliated to Nanjing Institute of Physical Education, Wuxi, China
| | - Xuemei Zheng
- Rehabilitation Department, Xinjiang Korla Bazhou People's Hospital, Korla, China
| | - Zhengrui Zhao
- Rehabilitation Department, The Geriatric Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Yuanli Li
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China
| | - Shutian Xu
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China
| | - Juan Zheng
- Rehabilitation Department, The Geriatric Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Xin Zhuang
- Rehabilitation Department, The Geriatric Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Wenting Jia
- Rehabilitation Department, The Geriatric Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Chengyuan Zhu
- Rehabilitation Department, The Geriatric Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Hua Xu
- Rehabilitation Department, The Geriatric Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Chunlei Shan
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China.,Center of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, China
| | - Wenhua Chen
- Rehabilitation Department, The First People's Hospital Affiliated With Shanghai Jiao Tong University, Shanghai, China
| | - Jingpu Zhao
- Rehabilitation Department, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Sijing Chen
- Rehabilitation Department, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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13
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Inoue M, Fujino Y, Sugimoto S, Amimoto K, Fukata K, Miura K, Matsuda T, Makita S, Takahashi H. Effects of dynamic supported standing training in a patient with pusher behavior: a case report. Physiother Theory Pract 2021; 38:3241-3247. [PMID: 34498984 DOI: 10.1080/09593985.2021.1978119] [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: 10/20/2022]
Abstract
BACKGROUND The effects of task-specific and voluntary exercise in upright positions for pusher behavior remain unclear. In this report, we aimed to describe the effects of dynamic supported standing training using a modified standing frame to correct the alignment in a patient with severe pusher behavior. CASE DESCRIPTION A 76-year-old man with cardioembolic ischemic stroke demonstrated pusher behavior. The patient underwent 3 days of dynamic supported standing training using a modified standing frame. The Scale for Contraversive Pushing, the Burke Lateropulsion Scale, and the Trunk Control Test were used to assess changes. OUTCOMES Immediate improvements in sitting balance were observed after the intervention, and the effects persisted to 8 days later. CONCLUSION Dynamic supported standing training using a modified standing frame may improve pusher behavior with short-term training. The collapsed posture of the patient in the present case was corrected using the modified standing frame. This neutral standing position could have a positive effect on motor learning with respect to holding one's posture.
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Affiliation(s)
- Masahide Inoue
- Department of Rehabilitation, Saitama Medical University International Medical Center, Saitama, Japan.,Department of Physical Therapy, Tokyo Metropolitan University, Tokyo, Japan
| | - Yuji Fujino
- Department of Physical Therapy, Juntendo University, Tokyo, Japan
| | - Satoshi Sugimoto
- Department of Physical Therapy, Tokyo International University, Saitama, Japan
| | - Kazu Amimoto
- Department of Physical Therapy, Tokyo Metropolitan University, Tokyo, Japan
| | - Kazuhiro Fukata
- Department of Rehabilitation, Saitama Medical University International Medical Center, Saitama, Japan
| | - Kohei Miura
- Department of Rehabilitation, Saitama Medical University International Medical Center, Saitama, Japan
| | | | - Shigeru Makita
- Department of Rehabilitation, Saitama Medical University International Medical Center, Saitama, Japan
| | - Hidetoshi Takahashi
- Department of Rehabilitation, Saitama Medical University International Medical Center, Saitama, Japan
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Jung J, Choi W, Lee S. Immediate augmented real-time forefoot weight bearing using visual feedback improves gait symmetry in chronic stroke. Technol Health Care 2021; 28:733-741. [PMID: 32444583 DOI: 10.3233/thc-192016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Symmetry of gait is an important component of rehabilitation in stroke patients. Insufficient weight-bearing causes gait asymmetry. OBJECTIVE This study aimed to identify the immediate effects of sufficient weight-bearing on the forefoot during the stance phase using visual feedback. METHODS Twenty-seven individuals with stroke enrolled in this study. All patients were evaluated for gait parameters with and without visual feedback. Visual feedback was provided through a smart application and a beam projector screen that showed a weight shift as a change in color. Spatiotemporal gait parameters were evaluated, resulting in values for a calculated symmetry index, in addition to heel % and toe % temporal values. RESULTS Velocity and cadence were significantly decreased when visual feedback was provided (p< 0.05). Spatiotemporal parameters, except for bilateral step length, swing time of affected side, and single-limb support of less affected side, showed significant improvement (p< 0.05). The gait pattern of subjects was more symmetrical with visual feedback compared to non-visual feedback (p< 0.05). The toe-on time significantly improved on the affected side with visual feedback (p< 0.05). CONCLUSION This study suggests that visual feedback aids in the improvement of gait symmetry, forefoot weight-bearing on the affected side, and spatiotemporal parameters.
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Affiliation(s)
- Jihye Jung
- Department of Physical Therapy, The Graduate School of Sahmyook University, Seoul, Korea
| | - Wonjae Choi
- Institute of the SMART Rehabilitation, Sahmyook University, Seoul, Korea
| | - Seungwon Lee
- Department of Physical Therapy, Sahmyook University, Seoul, Korea
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15
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Gomes-Osman J, Kloos A. Lateropulsion: An Overlooked Driver of Balance and Gait Deficits in Stroke? Neurology 2021; 96:779-780. [PMID: 33177225 DOI: 10.1212/wnl.0000000000011156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Joyce Gomes-Osman
- From the Departments of Physical Therapy (J.G.-O.) and Neurology (J.G.-O), University of Miami Miller School of Medicine, FL; and School of Health and Rehabilitation Sciences (A.K.), Division of Physical Therapy, The Ohio State University, Columbus.
| | - Anne Kloos
- From the Departments of Physical Therapy (J.G.-O.) and Neurology (J.G.-O), University of Miami Miller School of Medicine, FL; and School of Health and Rehabilitation Sciences (A.K.), Division of Physical Therapy, The Ohio State University, Columbus
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16
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Jian C, Deng L, Liu H, Yan T, Wang X, Song R. Modulating and restoring inter-muscular coordination in stroke patients using two-dimensional myoelectric computer interface: a cross-sectional and longitudinal study. J Neural Eng 2021; 18. [DOI: 10.1088/1741-2552/abc29a] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 10/19/2020] [Indexed: 12/11/2022]
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17
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Fukata K, Amimoto K, Inoue M, Shida K, Kurosawa S, Inoue M, Fujino Y, Makita S, Takahashi H. Effects of performing a lateral-reaching exercise while seated on a tilted surface for severe post-stroke pusher behavior: A case series. Top Stroke Rehabil 2020; 28:606-613. [PMID: 33345722 DOI: 10.1080/10749357.2020.1861718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: For patients with severe post-stroke pusher behavior (PB), acquiring a vertical posture involves correcting paretic-sided body tilt to the non-paretic side. Active lateral sitting training may facilitate improvement in postural orientation for patients with PB. However, its effect on patients with severe PB remains unclear.Objective: To determine the effect of performing a lateral-reaching exercise in patients with severe PB seated on a tilted surfaceMethods: Three patients with severe PB due to right hemispheric stroke participated in our study. Using a single-case design, the intervention's effect was verified using the applied behavior analysis method. Conventional physical therapy was performed for 1 h at baseline and at follow-up. During the intervention, lateral sitting training on a tilted surface was performed 40 times per session (total, 2 sessions). PB was assessed using the Scale for Contraversive Pushing and the Burke Lateropulsion Scale, and patient-reported fear of falling. The Function in Sitting Test (FIST) and the Trunk Control Test (TCT) were administered.Results: PB improved in all patients post-intervention and persisted at follow-up. Fear of falling during the passive sitting task while moving toward the non-paretic side disappeared post-intervention and at follow-up. FIST and TCT scores improved in 2 patients.Conclusion: The lateral sitting exercise reduced severe PB in all patients; however, sitting balance and trunk performance did not improve in 1 patient. Future studies to examine the adaptability of this task and long-term effects are needed.
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Affiliation(s)
- Kazuhiro Fukata
- Department of Rehabilitation Center, Saitama Medical University International Medical Center, Saitama, Japan
| | - Kazu Amimoto
- Department of Physical Therapy, Tokyo Metropolitan University, Tokyo, Japan
| | - Mamiko Inoue
- Department of Rehabilitation Center, Saitama Medical University International Medical Center, Saitama, Japan
| | - Kohei Shida
- Department of Rehabilitation Center, Saitama Medical University International Medical Center, Saitama, Japan.,Department of Physical Therapy, Tokyo Metropolitan University, Tokyo, Japan
| | - Saki Kurosawa
- Department of Rehabilitation Center, Saitama Medical University International Medical Center, Saitama, Japan
| | - Masahide Inoue
- Department of Rehabilitation Center, Saitama Medical University International Medical Center, Saitama, Japan.,Department of Physical Therapy, Tokyo Metropolitan University, Tokyo, Japan
| | - Yuji Fujino
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan
| | - Shigeru Makita
- Department of Rehabilitation, Saitama Medical University International Medical Center, Saitama, Japan
| | - Hidetoshi Takahashi
- Department of Rehabilitation, Saitama Medical University International Medical Center, Saitama, Japan
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18
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Lee G, Choi W, Jo H, Park W, Kim J. Analysis of motor control strategy for frontal and sagittal planes of circular tracking movements using visual feedback noise from velocity change and depth information. PLoS One 2020; 15:e0241138. [PMID: 33175910 PMCID: PMC7657550 DOI: 10.1371/journal.pone.0241138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 10/08/2020] [Indexed: 11/19/2022] Open
Abstract
We aim to investigate a control strategy for the circular tracking movement in a three-dimensional (3D) space based on the accuracy of the visual information. After setting the circular orbits for the frontal and sagittal planes in the 3D virtual space, the subjects track a target moving at a constant velocity. The analysis is applied to two parameters of the polar coordinates, namely, ΔR (the difference in the distance from the center of a circular orbit) and Δω (the difference in the angular velocity). The movement in the sagittal plane provides different depth information depending on the position of the target in orbit, unlike the task of the frontal plane. Therefore, the circular orbit is divided into four quadrants for a statistical analysis of ΔR. In the sagittal plane, the error was two to three times larger in quadrants 1 and 4 than in quadrants 2 and 3 close to the subject. Here, Δω is estimated using a frequency analysis; the lower the accuracy of the visual information, the greater the periodicity. When comparing two different planes, the periodicity in the sagittal plane was approximately 1.7 to 2 times larger than that of the frontal plane. In addition, the average angular velocity of the target and tracer was within 0.6% during a single cycle. We found that if the amount of visual information is reduced, an optimal feedback control strategy can be used to reduce the positional error within a specific area.
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Affiliation(s)
- Geonhui Lee
- Department of Mechanical and Control Engineering, Handong Global University, Pohang, Republic of Korea
| | - Woong Choi
- Department of Information and Computer Engineering, National Institute of Technology, Gunma College, Maebashi, Japan
- * E-mail: (WC); (JK)
| | - Hanjin Jo
- Department of Mechanical and Control Engineering, Handong Global University, Pohang, Republic of Korea
| | - Wookhyun Park
- Department of Mechanical and Control Engineering, Handong Global University, Pohang, Republic of Korea
| | - Jaehyo Kim
- Department of Mechanical and Control Engineering, Handong Global University, Pohang, Republic of Korea
- * E-mail: (WC); (JK)
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Paci M, Prestera C, Ferrarello F. Generalizability of Results from Randomized Controlled Trials in Post-Stroke Physiotherapy. Physiother Can 2020; 72:382-393. [PMID: 35110812 PMCID: PMC8781507 DOI: 10.3138/ptc-2018-0117] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Purpose: The randomized controlled trial (RCT) is considered a reliable experimental design, able to detect the effect of an intervention. However, a criticism frequently levelled at RCTs by clinicians is their lack of generalizability. This study aimed to evaluate the generalizability of findings from RCTs of physiotherapy interventions for individuals with stroke. Method: A sample of RCTs of physiotherapy interventions after stroke indexed in the PEDro database was selected, and the reported inclusion and exclusion criteria were analyzed. Results: We reviewed 100 articles, which included 7,366 participants (41.6% women, with a mean weighted age of 65.5 years). The most frequent criteria for exclusion were comorbidity (83%), cognitive impairments (69%), communication skills (55%), recurrent stroke (53%), low functional level (47%) and being elderly (25%). Conclusions: A variety of cohorts of individuals who have had a stroke are excluded from RCTs published in the field of physiotherapy. Because they represent a substantial proportion of the real-world population with stroke, and consequently treated in clinical practice, more vulnerable cohorts of participants should be included in RCTs.
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Affiliation(s)
- Matteo Paci
- Unit of Functional Recovery, Azienda USL Toscana Centro, Florence
| | - Claudia Prestera
- Rehabilitation Center, Fondazione Filippo Turati Onlus, Gavinana, Pistoia, Italy
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20
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Effect of postural training using a whole-body tilt apparatus in subacute stroke patients with lateropulsion: A single-blinded randomized controlled trial. Ann Phys Rehabil Med 2020; 64:101393. [PMID: 32450273 DOI: 10.1016/j.rehab.2020.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 05/02/2020] [Accepted: 05/03/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Lateropulsion after stroke is defined as a postural bias toward the paretic side and push away from the non-paretic side. New rehabilitation techniques and programs should be designed to attenuate lateropulsion and improve functions of balance and gait. OBJECTIVE This study aimed to determine the effects of whole-body tilting postural training (WTPT) using a Spine Balance 3D on lateropulsion and postural control as compared with general postural training (GPT). Postural training was performed and involved a whole-body tilt apparatus that enables postural training in the tilted position, in multiple directions. METHODS This was a pragmatic, single-blind, randomized controlled trial conducted between June 2018 and May 2019. We randomly allocated 30 patients with subacute stroke and lateropulsion based on the Scale of Contraversive Pushing (SCP score>0) to experimental (n=15) and control (n=15) groups. The experimental group received WTPT with a whole-body tilt apparatus, and the control group GPT. WTPT was performed with the Spine Balance 3D and GPT with postural training commonly applied in the clinic. All participants received treatment for 30min/session, 2 times/day, 5 days/week for 3 weeks. The primary outcome measure was lateropulsion assessed with the Burke Lateropulsion Scale (BLS). Secondary outcome measures were postural control ability, activities of daily living, Postural Assessment Scale for Stroke (PASS) score, Berg Balance Scale (BBS) score, Korea-modified Barthel index (K-MBI), and Fugl-Meyer Motor Assessment-Lower Extremity (FMA-L) score. RESULTS For the primary outcome, after training, BLS scores were decreased more for the experimental than control group (Δ=-5.8 vs. Δ=-4.2, P=0.002). For secondary outcomes, scores were improved more for the experimental than control group: PASS (Δ=13.8 vs. Δ=8.5, P<0.001), BBS (Δ=20.1 vs. Δ=11.1, P=0.001), K-MBI (Δ=27.0 vs. Δ=20.1, P=0.005), and FMA-L (Δ=10.2 vs. Δ=6.3, P=0.002). CONCLUSIONS WTPT is a potentially effective therapeutic intervention for lateropulsion recovery in patients with subacute stroke. It may be useful for improving postural control and activities of daily living.
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Exergames for balance dysfunction in neurological disability: a meta-analysis with meta-regression. J Neurol 2020; 268:3223-3237. [PMID: 32447551 DOI: 10.1007/s00415-020-09918-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/11/2020] [Accepted: 05/13/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate systematically the efficacy of exergames for balance dysfunction in neurological conditions and to identify factors of exergaming protocols that may influence their effects. METHODS We searched electronic databases for randomized clinical trials investigating the effect of commercial exergames versus alternative interventions on balance dysfunction as assessed by standard clinical scales in adults with acquired neurological disabilities. Standardized mean differences (Hedge's g) were calculated with random-effects models. Subgroup analyses and meta-regression were run to explore potential modifiers of effect size. RESULTS Out of 106 screened articles, 41 fulfilled criteria for meta-analysis, with a total of 1223 patients included. Diseases under investigation were stroke, Parkinson's disease, multiple sclerosis, mild cognitive impairment or early Alzheimer's disease, traumatic brain injury, and myelopathy. The pooled effect size of exergames on balance was moderate (g = 0.43, p < 0.001), with higher frequency (number of sessions per week) associated with larger effect (β = 0.24, p = 0.01). There was no effect mediated by the overall duration of the intervention and intensity of a single session. The beneficial effect of exergames could be maintained for at least 4 weeks after discontinuation, but their retention effect was specifically explored in only 11 studies, thus requiring future investigation. Mild to moderate adverse events were reported in a minority of studies. We estimated a low risk of bias, mainly attributable to the lack of double-blindness and not reporting intention-to-treat analysis. CONCLUSIONS The pooled evidence suggests that exergames improve balance dysfunction and are safe in several neurological conditions. The findings of high-frequency interventions associated with larger effect size, together with a possible sustained effect of exergaming, may guide treatment decisions and inform future research.
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22
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Gandhi DB, Sterba A, Khatter H, Pandian JD. Mirror Therapy in Stroke Rehabilitation: Current Perspectives. Ther Clin Risk Manag 2020; 16:75-85. [PMID: 32103968 PMCID: PMC7012218 DOI: 10.2147/tcrm.s206883] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/16/2020] [Indexed: 12/30/2022] Open
Abstract
In contrast to varied therapy approaches, mirror therapy (MT) can be used even in completely plegic stroke survivors, as it uses visual stimuli for producing a desired response in the affected limb. MT has been studied to have effects not just on motor impairments but also on sensations, visuospatial neglect, and pain after stroke. This paper attempts to systematically review and present the current perspectives on mirror therapy and its application in stroke rehabilitation, and dosage, feasibility and acceptability in stroke rehabilitation. An electronic database search across Google, PubMed, Web of Science, etc., generated 3871 results. After screening them based on the inclusion and exclusion criteria, we included 28 studies in this review. The data collected were divided on the basis of application in stroke rehabilitation, modes of intervention delivery, and types of control and outcome assessment. We found that most studies intervened for upper limb motor impairments post stroke. Studies were equally distributed between intervention in chronic and acute phases post stroke with therapy durations lasting between 1 and 8 weeks. MT showed definitive motor and sensory improvements although the extent of improvements in sensory impairments and hemineglect is limited. MT proves to be an effective and feasible approach to rehabilitate post-stroke survivors in the acute, sub-acute, and chronic phases of stroke, although its long-term effects and impact on activities of daily living need to be analysed extensively.
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Affiliation(s)
- Dorcas Bc Gandhi
- College of Physiotherapy, Christian Medical College & Hospital Ludhiana, Ludhiana, Punjab, India.,Faculty of Medicine, Masaryk University, Stroke Brno, International Clinical Research Center, St. Anne´s University Hospital, Brno, Czech Republic
| | - Albert Sterba
- Department of Neurology, Christian Medical College & Hospital Ludhiana, Ludhiana, Punjab, India
| | - Himani Khatter
- Faculty of Medicine, Masaryk University, Stroke Brno, International Clinical Research Center, St. Anne´s University Hospital, Brno, Czech Republic
| | - Jeyaraj D Pandian
- Faculty of Medicine, Masaryk University, Stroke Brno, International Clinical Research Center, St. Anne´s University Hospital, Brno, Czech Republic
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Day KA, Bastian AJ. Providing low-dimensional feedback of a high-dimensional movement allows for improved performance of a skilled walking task. Sci Rep 2019; 9:19814. [PMID: 31875040 PMCID: PMC6930294 DOI: 10.1038/s41598-019-56319-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 11/30/2019] [Indexed: 12/28/2022] Open
Abstract
Learning a skilled movement often requires changing multiple dimensions of movement in a coordinated manner. Serial training is one common approach to learning a new movement pattern, where each feature is learned in isolation from the others. Once one feature is learned, we move on to the next. However, when learning a complex movement pattern, serial training is not only laborious but can also be ineffective. Often, movement features are linked such that they cannot simply be added together as we progress through training. Thus, the ability to learn multiple features in parallel could make training faster and more effective. When using visual feedback as the tool for changing movement, however, such parallel training may increase the attentional load of training and impair performance. Here, we developed a novel visual feedback system that uses principal component analysis to weight four features of movement to create a simple one-dimensional 'summary' of performance. We used this feedback to teach healthy, young participants a modified walking pattern and compared their performance to those who received four concurrent streams of visual information to learn the same goal walking pattern. We demonstrated that those who used the principal component-based visual feedback improved their performance faster and to a greater extent compared to those who received concurrent feedback of all features. These results suggest that our novel principal component-based visual feedback provides a method for altering multiple features of movement toward a prescribed goal in an intuitive, low-dimensional manner.
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Affiliation(s)
- Kevin A Day
- Center for Movement Studies, Kennedy Krieger Institute, Baltimore, MD, 21205, USA
- Department of Biomedical Engineering, The Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Amy J Bastian
- Center for Movement Studies, Kennedy Krieger Institute, Baltimore, MD, 21205, USA.
- Department of Neuroscience, The Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA.
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Day KA, Cherry-Allen KM, Bastian AJ. Individualized feedback to change multiple gait deficits in chronic stroke. J Neuroeng Rehabil 2019; 16:158. [PMID: 31870390 PMCID: PMC6929463 DOI: 10.1186/s12984-019-0635-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 12/13/2019] [Indexed: 11/17/2022] Open
Abstract
Background Walking deficits in people post-stroke are often multiple and idiosyncratic in nature. Limited patient and therapist resources necessitate prioritization of deficits such that some may be left unaddressed. More efficient delivery of therapy may alleviate this challenge. Here, we look to determine the utility of a novel principal component-based visual feedback system that targets multiple, patient-specific features of gait in people post-stroke. Methods Ten individuals with stroke received two sessions of visual feedback to attain a walking goal. This goal consisted of bilateral knee and hip joint angles of a typical ‘healthy’ walking pattern. The feedback system uses principal component analysis (PCA) to algorithmically weight each of the input features so that participants received one stream of performance feedback. In the first session, participants had to explore different patterns to achieve the goal, and in the second session they were informed of the goal walking pattern. Ten healthy, age-matched individuals received the same paradigm, but with a hemiparetic goal (i.e. to produce the pattern of an exemplar stroke participant). This was to distinguish the extent to which performance limitations in stroke were due neurological injury or the PCA based visual feedback itself. Results Principal component-based visual feedback can differentially bias multiple features of walking toward a prescribed goal. On average, individuals with stroke typically improved performance via increased paretic knee and hip flexion, and did not perform better with explicit instruction. In contrast, healthy people performed better (i.e. could produce the desired exemplar stroke pattern) in both sessions, and were best with explicit instruction. Importantly, the feedback for stroke participants accommodated a heterogeneous set of walking deficits by individually weighting each feature based on baseline walking. Conclusions People with and without stroke are able to use this novel visual feedback to train multiple, specific features of gait. Important for stroke, the PCA feedback allowed for targeting of patient-specific deficits. This feedback is flexible to any feature of walking in any plane of movement, thus providing a potential tool for therapists to simultaneously target multiple aberrant features of gait.
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Affiliation(s)
- Kevin A Day
- Center for Movement Studies, Kennedy Krieger Institute, Baltimore, MD, USA. .,Department of Biomedical Engineering, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Kendra M Cherry-Allen
- Center for Movement Studies, Kennedy Krieger Institute, Baltimore, MD, USA.,Department of Physical Medicine and Rehabilitation, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amy J Bastian
- Center for Movement Studies, Kennedy Krieger Institute, Baltimore, MD, USA.,Department of Neuroscience, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Fujino Y, Takahashi H, Fukata K, Inoue M, Shida K, Matsuda T, Makita S, Amimoto K. Electromyography-guided electrical stimulation therapy for patients with pusher behavior: A case series. NeuroRehabilitation 2019; 45:537-545. [PMID: 31868696 DOI: 10.3233/nre-192911] [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: 11/15/2022]
Abstract
BACKGROUND Pusher behavior (PB) is a posture disorder due to a subjective bias in verticality perception. However, muscle activity characteristics in this disorder and the effective treatments are not known. OBJECTIVE To investigate electromyographic (EMG) activity and the effect of electrical stimulation (ES) in PB. METHODS Two PB patients were enrolled. The EMG activity was measured over the upper and lower limb muscles on the non-paretic side, and over the trunk muscles on both sides during sitting. We used a modified ABA single-case design consisting of consecutive baseline, intervention, and follow-up, each phase lasting 2 d. During the intervention, together with conventional treatment, the patient received ES for 5 min/d on the muscle antagonist to the muscle where excessive activity was observed. PB was assessed before and after each phase using the scale for contraversive pushing and the Burke lateropulsion scale. Truncal balance was evaluated using the trunk control test. RESULTS In both patients, electromyography of the non-paretic triceps brachii muscle revealed excessive activity. To inhibit the excessive activity, ES was applied to the non-paretic biceps muscle. All scores improved after the intervention and follow-up phases. CONCLUSION ES based on EMG activity is therapeutic for PB.
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Affiliation(s)
- Yuji Fujino
- Department of Rehabilitation, Juntendo University, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Hidetoshi Takahashi
- Department of Rehabilitation, Saitama Medical University International Medical Center, Yamane, Hidaka, Saitama, Japan
| | - Kazuhiro Fukata
- Department of Rehabilitation, Saitama Medical University International Medical Center, Yamane, Hidaka, Saitama, Japan
| | - Masahide Inoue
- Department of Rehabilitation, Saitama Medical University International Medical Center, Yamane, Hidaka, Saitama, Japan
| | - Kohei Shida
- Department of Rehabilitation, Saitama Medical University International Medical Center, Yamane, Hidaka, Saitama, Japan
| | - Tadamitsu Matsuda
- Department of Rehabilitation, Juntendo University, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Shigeru Makita
- Department of Rehabilitation, Saitama Medical University International Medical Center, Yamane, Hidaka, Saitama, Japan
| | - Kazu Amimoto
- Department of Physical Therapy, Tokyo Metropolitan University, Higashi-Ogu, Arakawa-ku, Tokyo, Japan
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Pardo V, Galen S. Treatment interventions for pusher syndrome: A case series. NeuroRehabilitation 2019; 44:131-140. [DOI: 10.3233/nre-182549] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Vicky Pardo
- Eugene Applebaum College of Pharmacy and Health Science, Wayne State University, Detroit, MI, USA
| | - Sujay Galen
- Department of Physical Therapy, Georgia State University, GA, USA
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Yun N, Joo MC, Kim SC, Kim MS. Robot-assisted gait training effectively improved lateropulsion in subacute stroke patients: a single-blinded randomized controlled trial. Eur J Phys Rehabil Med 2018; 54:827-836. [PMID: 30507899 DOI: 10.23736/s1973-9087.18.05077-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Some stroke patients are known to use nonparetic extremities to push toward the paretic side, a movement known as lateropulsion. Lateropulsion impairs postural balance and interferes with rehabilitation. AIM The aim of the present study was to investigate the effect of robot-assisted gait training (RAGT) on recovery from lateropulsion compared with conventional physical therapy (CPT). DESIGN This was a single-blinded, randomized controlled trial. SETTING Participants were recruited from a rehabilitation department of a tertiary hospital. POPULATION Patients diagnosed with lateropulsion after a stroke. METHODS Thirty-six subacute stroke patients with lateropulsion were recruited. RAGT was performed in the experimental group (N.=18), and CPT was performed in the control group (N.=18). The participants received treatment for 3 weeks, 30 minutes per day, 5 days per week. Outcomes were assessed before the intervention (T0), immediately after the intervention (T1), and 4 weeks after the intervention (T2). The Burke Lateropulsion Scale (BLS) was evaluated as a primary outcome to assess the severity of lateropulsion. The secondary outcome measures were the Berg Balance Scale (BBS), the Postural Assessment Scale for Stroke (PASS), and Somatosensory Evoked Potentials (SSEP). RESULTS After intervention, the experimental group showed greater improvement in the BLS score at T1 (experimental group: Δ=-1.9, control group: Δ=-1.1, P=0.032) and T2 (experimental group: Δ=-2.8, control group: Δ=-6.5, P<0.001) than the control group. In addition, the BBS was significantly improved in the experimental group at T1 (experimental group: Δ=+7.1, control group: Δ=+1.9, P<0.001) and T2 (experimental group: Δ=+13.0, control group: Δ=+6.1, P<0.001). There were significant between-group differences in the PASS at T1 (experimental group: Δ=+3.2, control group: Δ=+1.6, P=0.014) and T2 (experimental group: Δ=+8.8, control group: Δ=+4.3, P<0.001). CONCLUSIONS RAGT ameliorated lateropulsion and balance function more effectively than CPT in subacute stroke patients. CLINICAL REHABILITATION IMPACT Early RAGT may be recommended for patients with lateropulsion after stroke.
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Affiliation(s)
- Nari Yun
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - Min C Joo
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - Seung-Chan Kim
- Department of Statistics, Pukyong National University, Busan, Republic of Korea
| | - Min-Su Kim
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, Republic of Korea -
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Darbois N, Guillaud A, Pinsault N. Do Robotics and Virtual Reality Add Real Progress to Mirror Therapy Rehabilitation? A Scoping Review. Rehabil Res Pract 2018; 2018:6412318. [PMID: 30210873 PMCID: PMC6120256 DOI: 10.1155/2018/6412318] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 08/06/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Mirror therapy has been used in rehabilitation for multiple indications since the 1990s. Current evidence supports some of these indications, particularly for cerebrovascular accidents in adults and cerebral palsy in children. Since 2000s, computerized or robotic mirror therapy has been developed and marketed. OBJECTIVES To map the extent, nature, and rationale of research activity in robotic or computerized mirror therapy and the type of evidence available for any indication. To investigate the relevance of conducting a systematic review and meta-analysis on these therapies. METHOD Systematic scoping review. Searches were conducted (up to May 2018) in the Cochrane Library, Google Scholar, IEEE Xplore, Medline, Physiotherapy Evidence Database, and PsycINFO databases. References from identified studies were examined. RESULTS In sum, 75 articles met the inclusion criteria. Most studies were publicly funded (57% of studies; n = 43), without disclosure of conflict of interest (59% of studies; n = 44). The main outcomes assessed were pain, satisfaction on the device, and body function and activity, mainly for stroke and amputees patients and healthy participants. Most design studies were case reports (67% of studies; n = 50), with only 12 randomized controlled trials with 5 comparing standard mirror therapy versus virtual mirror therapy, 5 comparing second-generation mirror therapy versus conventional rehabilitation, and 2 comparing other interventions. CONCLUSION Much of the research on second-generation mirror therapy is of very low quality. Evidence-based rationale to conduct such studies is missing. It is not relevant to recommend investment by rehabilitation professionals and institutions in such devices.
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Affiliation(s)
- Nelly Darbois
- Critical Thinking Research Federation FED 4276, University Grenoble-Alpes, Grenoble, France
- Cortecs team, Grenoble, France
- School of Physiotherapy, Grenoble-Alpes University Hospital, Grenoble, France
| | - Albin Guillaud
- Critical Thinking Research Federation FED 4276, University Grenoble-Alpes, Grenoble, France
- Cortecs team, Grenoble, France
- ThEMAS team, TIMC-IMAG Laboratory, UMR CNRS-UGA 5525, Grenoble, France
| | - Nicolas Pinsault
- Critical Thinking Research Federation FED 4276, University Grenoble-Alpes, Grenoble, France
- School of Physiotherapy, Grenoble-Alpes University Hospital, Grenoble, France
- ThEMAS team, TIMC-IMAG Laboratory, UMR CNRS-UGA 5525, Grenoble, France
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Jang SH, Lee HD. Recovery of an injured medial lemniscus with concurrent recovery of pusher syndrome in a stroke patient: a case report. Medicine (Baltimore) 2018; 97:e10963. [PMID: 29851845 PMCID: PMC6392885 DOI: 10.1097/md.0000000000010963] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE A 67-year-old, right-handed male patient underwent craniotomy and drainage for hematoma removal related to an intracerebral hemorrhage (ICH) in the right thalamus and basal ganglia at the neurosurgery department of a university hospital. PATIENT CONCERNS He presented with severe motor weakness of left extremities, impairment of proprioception, and severe pusher syndrome at the start of rehabilitation. DIAGNOSES He was diagnosed as ICH in the right thalamus and basal ganglia. INTERVENTIONS The patient received comprehensive rehabilitative therapy, movement therapy, and somatosensory stimulation. OUTCOMES Four months after onset, left leg motor function (Motricity Index [MI] = 51) did not show significant recovery from that at two months after onset (MI = 41); however, in the same period, Nottingham Sensory Assessment and scale for contraversive pushing significantly improved. At four months, the patient was able to stand independently but required manual contact of one person during independent walking on an even floor. At seven months after onset, he was able to walk independently on an even floor. LESSONS Recovery of a severely injured medial lemniscus with concurrent recovery of impaired proprioception and pusher syndrome.
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Stanton R, Ada L, Dean CM, Preston E. Biofeedback improves performance in lower limb activities more than usual therapy in people following stroke: a systematic review. J Physiother 2017; 63:11-16. [PMID: 27989731 DOI: 10.1016/j.jphys.2016.11.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 08/11/2016] [Accepted: 11/07/2016] [Indexed: 10/20/2022] Open
Abstract
QUESTION Is biofeedback during the practice of lower limb activities after stroke more effective than usual therapy in improving those activities, and are any benefits maintained beyond the intervention? DESIGN Systematic review with meta-analysis of randomised trials with a PEDro score > 4. PARTICIPANTS People who have had a stroke. INTERVENTION Biofeedback (any type delivered by any signal or sense) delivered concurrently during practice of sitting, standing up, standing or walking compared with the same amount of practice without biofeedback. OUTCOME MEASURES Measures of activity congruent with the activity trained. RESULTS Eighteen trials including 429 participants met the inclusion criteria. The quality of the included trials was moderately high, with a mean PEDro score of 6.2 out of 10. The pooled effect size was calculated as a standardised mean difference (SMD) because different outcome measures were used. Biofeedback improved performance of activities more than usual therapy (SMD 0.50, 95% CI 0.30 to 0.70). CONCLUSION Biofeedback is more effective than usual therapy in improving performance of activities. Further research is required to determine the long-term effect on learning. Given that many biofeedback machines are relatively inexpensive, biofeedback could be utilised widely in clinical practice. [Stanton R, Ada L, Dean CM, Preston E (2016) Biofeedback improves performance in lower limb activities more than usual therapy in people following stroke: a systematic review.Journal of Physiotherapy63: 11-16].
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Affiliation(s)
| | - Louise Ada
- Discipline of Physiotherapy, The University of Sydney
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Fujino Y, Amimoto K, Sugimoto S, Fukata K, Inoue M, Takahashi H, Makita S. Prone positioning reduces severe pushing behavior: three case studies. J Phys Ther Sci 2016; 28:2690-2693. [PMID: 27799722 PMCID: PMC5080204 DOI: 10.1589/jpts.28.2690] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 05/31/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Pushing behavior is classically described as a disorder of body orientation in
the coronal plane. Most interventions for pushing behavior have focused on correcting the
deviation in vertical perception. However, pushing behavior seems to involve erroneous
movements associated with excessive motor output by the non-paretic limbs and trunk. The
present study aimed to inhibit muscular hyper-activity by placing the non-paretic limbs
and trunk in the prone position. [Subjects and Methods] The subjects of the present study
were 3 acute stroke patients with severe pushing behavior. The study consisted of the
following 3 phases: baseline, intervention, and follow-up. In addition to conventional
therapy, patients received relaxation therapy in the prone position for 10 minutes a day
over 2 days. The severity of pushing behavior was assessed using the scale for
contraversive pushing, and truncal balance was evaluated using the trunk control test.
These assessments were performed before and after the baseline phase, and after the
intervention and follow-up phases. [Results] At the baseline phase, both scores were poor.
Both scores improved after the intervention and follow-up phases, and all the patients
could sit independently. [Conclusion] Relaxation therapy in the prone position might
ameliorate pushing behavior and impaired truncal balance.
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Affiliation(s)
- Yuji Fujino
- Department of Rehabilitation, Saitama Medical University International Medical Center, Japan
| | - Kazu Amimoto
- Department of Physical Therapy, Tokyo Metropolitan University, Japan
| | - Satoshi Sugimoto
- Department of Physical Therapy, University of Tokyo Health Sciences, Japan
| | - Kazuhiro Fukata
- Department of Rehabilitation, Saitama Medical University International Medical Center, Japan
| | - Masahide Inoue
- Department of Rehabilitation, Saitama Medical University International Medical Center, Japan
| | - Hidetoshi Takahashi
- Department of Rehabilitation, Saitama Medical University International Medical Center, Japan
| | - Shigeru Makita
- Department of Rehabilitation, Saitama Medical University International Medical Center, Japan
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Hartman K, Altschuler EL. Mirror Therapy for Hemiparesis Following Stroke: A Review. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2016. [DOI: 10.1007/s40141-016-0131-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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