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Li X, Chen D, Chen X, Jiang C, Guo Y, Hang J, Tao L, Li Y, Yu H. Study on the correlation between serum indole-3-propionic acid levels and the progression and prognosis of acute ischemic stroke. J Stroke Cerebrovasc Dis 2024; 33:107680. [PMID: 38508478 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/04/2024] [Accepted: 03/14/2024] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVE This study aimed to explore the correlation between the serum level of indole-3-propionic acid (IPA) and the progression and prognosis of acute cerebral infarction (ACI). METHODS This study enrolled 197 patients with ACI, and 53 participants from a community-based stroke screening program during the same period were included as the control group. The patients with ACI were divided into quartiles of serum IPA. A logistic regression model was used for comparison. Receiver operating characteristic (ROC) curves were drawn to evaluate the predictive value of the IPA. RESULTS Compared with the healthy control group, the ACI group had lower serum IPA (P < 0.05). The serum IPA was an independent factor for acute ischemic stroke (OR=0.992, 95% CI: 0.984-0.999, P=0.035). The serum IPA was lower in patients with progressive stroke or poor prognosis than in patients with stable stroke or good prognosis (P < 0.05). Patients with ACI with low serum IPA are prone to progression and poor prognosis. The best cutoff value for predicting progression was 193.62 pg/mL (sensitivity, 67.5%; specificity 83.7%), and that for poor prognosis was 193.77 pg/mL (sensitivity, 71.1%; specificity, 72.5%). CONCLUSION The serum level of IPA was an independent predictor of ACI and had certain clinical value for predicting stroke progression and prognosis in patients with ACI.
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Affiliation(s)
- Xiaobo Li
- Clinical Medical College of Yangzhou University, Yangzhou, 225001, China; Department of Neurology, Northern Jiangsu People's Hospital, Yangzhou, 225001, China
| | - Danni Chen
- Clinical Medical College of Yangzhou University, Yangzhou, 225001, China; Department of Neurology, Northern Jiangsu People's Hospital, Yangzhou, 225001, China
| | - Xin Chen
- Clinical Medical College of Yangzhou University, Yangzhou, 225001, China; Department of Neurology, Northern Jiangsu People's Hospital, Yangzhou, 225001, China; Department of Neuro Intensive Care Unit, Northern Jiangsu People's Hospital, Yangzhou, 225001, China
| | - Chao Jiang
- Clinical Medical College of Yangzhou University, Yangzhou, 225001, China; Department of Neurology, Northern Jiangsu People's Hospital, Yangzhou, 225001, China
| | - Yiming Guo
- Clinical Medical College of Yangzhou University, Yangzhou, 225001, China; Department of Neurology, Northern Jiangsu People's Hospital, Yangzhou, 225001, China
| | - Jing Hang
- Clinical Medical College of Yangzhou University, Yangzhou, 225001, China; Department of Neurology, Northern Jiangsu People's Hospital, Yangzhou, 225001, China; Department of Neuro Intensive Care Unit, Northern Jiangsu People's Hospital, Yangzhou, 225001, China
| | - Luhang Tao
- Clinical Medical College of Yangzhou University, Yangzhou, 225001, China; Department of Neurology, Northern Jiangsu People's Hospital, Yangzhou, 225001, China; Department of Neuro Intensive Care Unit, Northern Jiangsu People's Hospital, Yangzhou, 225001, China
| | - Yuping Li
- Clinical Medical College of Yangzhou University, Yangzhou, 225001, China; Department of Neuro Intensive Care Unit, Northern Jiangsu People's Hospital, Yangzhou, 225001, China; Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, 225001, China
| | - Hailong Yu
- Clinical Medical College of Yangzhou University, Yangzhou, 225001, China; Department of Neurology, Northern Jiangsu People's Hospital, Yangzhou, 225001, China; Department of Neuro Intensive Care Unit, Northern Jiangsu People's Hospital, Yangzhou, 225001, China.
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Ackerley S, Smith MC, Jordan H, Stinear CM. Biomarkers of Motor Outcomes After Stroke. Phys Med Rehabil Clin N Am 2024; 35:259-276. [PMID: 38514217 DOI: 10.1016/j.pmr.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Predicting motor outcomes after stroke based on clinical judgment alone is often inaccurate and can lead to inefficient and inequitable allocation of rehabilitation resources. Prediction tools are being developed so that clinicians can make evidence-based, accurate, and reproducible prognoses for individual patients. Biomarkers of corticospinal tract structure and function can improve prediction tool performance, particularly for patients with initially moderate to severe motor impairment. Being able to make accurate predictions for individual patients supports rehabilitation planning and communication with patients and families.
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Affiliation(s)
- Suzanne Ackerley
- School of Sport and Health Sciences, University of Central Lancashire, Preston, PR1 2HE, UK
| | - Marie-Claire Smith
- Department of Exercise Sciences, University of Auckland, Private Bag 92019, Auckland 1023, New Zealand
| | - Harry Jordan
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland 1023, New Zealand
| | - Cathy M Stinear
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland 1023, New Zealand.
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Takahashi A, Kitsunai S, Kawana H, Saito N, Yoshihara A, Furukawa K. Physiotherapy management focusing on proprioceptive impairment in a patient with gait and balance impairments following stroke: A case report. Physiother Theory Pract 2024:1-15. [PMID: 38516762 DOI: 10.1080/09593985.2024.2332792] [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: 09/07/2023] [Accepted: 03/11/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Proprioceptive impairment contributes to gait and balance impairments in patients with stroke. Diagnosis functional impairments and evaluation treatment efficacy require quantitative proprioception assessment. However, proprioception assessment has remained limited to ordinal scale measurement, with a lack of ratio scale measurements. PURPOSE This case report describes a physiotherapy management program focusing on proprioceptive impairment in patients with stroke using quantitative tests such as Threshold to Detect Passive Motion (TDPM) and Joint Position Sense (JPS). CASE DESCRIPTION A63-year-old male patient with an acute pontine lacunar infarction was admitted to our hospital. His muscle strength, selective movement, and trunk activity were preserved. However, the Berg Balance Scale (BBS) and Gait Assessment andIntervention Tool (GAIT) score were 42 and 9 points, observing balance impairment and the buckling knee pattern with hip ataxia during gait. Based on these, TDPM and JPS using image capture were performed. In physiotherapeuticdiagnosis, proprioceptive impairments in the hip and knee joints were the primary functional impairments related to balance and gait. To address these proprioceptive impairments, a 13-day treatment protocol incorporating transcutaneous electrical nerve stimulation (intensity: sensory threshold, frequency: 100 Hz) targeting the quadriceps femoris was performed. OUTCOMES The patient was discharged after achieving independent ambulation and improvement in BBS (56 points) and GAIT (2 points) scores, exceeding the minimum clinically important difference. Recovery of proprioceptive impairment corresponded withimproved balance and gait ability. CONCLUSION Quantitatively evaluating proprioceptive impairments may provide novel rehabilitation for patients with stroke who have proprioceptive impairments and contribute to clinical decision-making.
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Affiliation(s)
- Aisuke Takahashi
- Department of Medical Rehabilitation, Ohara General Hospital, Fukushima, Japan
| | - Shun Kitsunai
- Department of Medical Rehabilitation, Ohara General Hospital, Fukushima, Japan
| | - Hikaru Kawana
- Department of Medical Rehabilitation, Ohara General Hospital, Fukushima, Japan
| | - Naoshi Saito
- Department of Neurology, Ohara General Hospital, Fukushima, Japan
| | - Akioh Yoshihara
- Department of Neurology, Ohara General Hospital, Fukushima, Japan
| | - Katsuhiro Furukawa
- Department of Physical Therapy, Faculty of Health Sciences, Iryo Sosei University, Fukushima, Japan
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Smith MC, Scrivener BJ, Stinear CM. Do lower limb motor-evoked potentials predict walking outcomes post-stroke? J Neurol Neurosurg Psychiatry 2024; 95:348-355. [PMID: 37798093 DOI: 10.1136/jnnp-2023-332018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/14/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND This observational study examined whether lower limb (LL) motor-evoked potentials (MEPs) 1 week post-stroke predict recovery of independent walking, use of ankle-foot orthosis (AFO) or walking aid, at 3 and 6 months post-stroke. METHODS Non-ambulatory participants were recruited 5 days post-stroke. Transcranial magnetic stimulation was used to determine tibialis anterior MEP status and clinical assessments (age, National Institutes of Health Stroke Scale (NIHSS), ankle dorsiflexion strength, LL motricity index, Berg Balance Test) were completed 1 week post-stroke. Functional Ambulation Category (FAC), use of AFO and walking aid were assessed 3 months and 6 months post-stroke. MEP status, alone and combined with clinical measures, and walking outcomes at 3 and 6 months were analysed with Pearson χ2 and multivariate binary logistic regression. RESULTS Ninety participants were included (median age 72 years (38-97 years)). Most participants (81%) walked independently (FAC ≥ 4), 17% used an AFO, and 49% used a walking aid 3 months post-stroke with similar findings at 6 months. Independent walking was better predicted by age, LL strength and Berg Balance Test (accuracy 92%, 95% CI 85% to 97%) than MEP status (accuracy 73%, 95% CI 63% to 83%). AFO use was better predicted by NIHSS and MEP status (accuracy 88%, 95% CI 79% to 94%) than MEP status alone (accuracy 76%, 95% CI 65% to 84%). No variables predicted use of walking aids. CONCLUSIONS The presence of LL MEPs 1-week post-stroke predicts independent walking at 3 and 6 months post-stroke. However, the absence of MEPs does not preclude independent walking. Clinical factors, particularly age, balance and stroke severity, more strongly predict independent walking than MEP status. LL MEP status adds little value as a biomarker for walking outcomes.
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Affiliation(s)
- Marie-Claire Smith
- Department of Exercise Sciences, The University of Auckland, Auckland, New Zealand
- Department of Medicine, The University of Auckland, Auckland, New Zealand
| | - Benjamin J Scrivener
- Department of Medicine, The University of Auckland, Auckland, New Zealand
- Neurology, Auckland City Hospital, Auckland, New Zealand
| | - Cathy M Stinear
- Department of Medicine, The University of Auckland, Auckland, New Zealand
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5
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Embrechts E, Schröder J, Nijboer TCW, van der Waal C, Lafosse C, Truijen S, Saeys W. Does visuospatial neglect contribute to standing balance within the first 12 weeks post-stroke? A prospective longitudinal cohort study. BMC Neurol 2024; 24:37. [PMID: 38254026 PMCID: PMC10801963 DOI: 10.1186/s12883-023-03475-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 11/24/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Visuospatial neglect (VSN) has been suggested to limit standing balance improvement post-stroke. However, studies investigating this association longitudinally by means of repeated within-subject measurements early post-stroke are lacking. This prospective longitudinal cohort study evaluates the longitudinal association of egocentric and allocentric VSN severity with 1) standing balance independence and 2) postural control and weight-bearing asymmetry (WBA) during quiet standing, in the first 12 weeks post-stroke. METHODS Thirty-six hemiplegic individuals after a first-ever unilateral stroke were evaluated at weeks 3, 5, 8 and 12 post-stroke. Egocentric and allocentric VSN severity were evaluated using the Broken Hearts Test. The standing unperturbed item of the Berg Balance Scale (BBS-s) was used to clinically evaluate standing independence. Posturographic measures included measures of postural control (mediolateral (ML)/anteroposterior (AP) net center-of-pressure velocities (COPvel)) and WBA during quiet standing. A linear mixed model was used to examine longitudinal associations between egocentric and allocentric VSN, and BBS-s, COPvel-ML, COPvel-AP and WBA within the first 12 weeks post-stroke. RESULTS Egocentric (β = -0.08, 95%CI[-0.15;-0.01], P = .029) and allocentric VSN severity (β = -0.09, 95%CI[-0.15; -0.04], P = .002) were significant independent factors for BBS-s scores in the first 12 weeks post-stroke. Egocentric and allocentric VSN were no significant independent factors for COPvel-ML, COPvel-AP and WBA in the first 12 weeks post-stroke. CONCLUSIONS Allocentric and egocentric VSN severity were significantly associated with decreased standing independence, but not impaired postural control or greater asymmetric weight-bearing, in the early subacute post-stroke phase. This may involve traditional VSN measures being not sensitive enough to detect fine-grained VSN deficits due to a ceiling effect between 5 and 8 weeks post-stroke, once the individual regains standing ability. Future studies may require more sensitive VSN measurements to detect such deficits. Trial registration Clinicaltrials.gov. unique identifier NCT05060458.
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Affiliation(s)
- Elissa Embrechts
- Department of Rehabilitation Sciences and Physiotherapy (REVAKI), Research Group MOVANT, University of Antwerp, Wilrijk, Belgium.
- Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands.
| | - Jonas Schröder
- Department of Rehabilitation Sciences and Physiotherapy (REVAKI), Research Group MOVANT, University of Antwerp, Wilrijk, Belgium
| | - Tanja C W Nijboer
- Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands
- Center of Excellence for Rehabilitation Medicine, UMC Brain Center, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Charlotte van der Waal
- Department of Rehabilitation Sciences and Physiotherapy (REVAKI), Research Group MOVANT, University of Antwerp, Wilrijk, Belgium
| | - Christophe Lafosse
- Department of Neurorehabilitation, RevArte Rehabilitation Hospital, Edegem, Belgium
| | - Steven Truijen
- Department of Rehabilitation Sciences and Physiotherapy (REVAKI), Research Group MOVANT, University of Antwerp, Wilrijk, Belgium
| | - Wim Saeys
- Department of Rehabilitation Sciences and Physiotherapy (REVAKI), Research Group MOVANT, University of Antwerp, Wilrijk, Belgium
- Department of Neurorehabilitation, RevArte Rehabilitation Hospital, Edegem, Belgium
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Lanotte F, O’Brien MK, Jayaraman A. AI in Rehabilitation Medicine: Opportunities and Challenges. Ann Rehabil Med 2023; 47:444-458. [PMID: 38093518 PMCID: PMC10767220 DOI: 10.5535/arm.23131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/23/2023] [Indexed: 01/03/2024] Open
Abstract
Artificial intelligence (AI) tools are increasingly able to learn from larger and more complex data, thus allowing clinicians and scientists to gain new insights from the information they collect about their patients every day. In rehabilitation medicine, AI can be used to find patterns in huge amounts of healthcare data. These patterns can then be leveraged at the individual level, to design personalized care strategies and interventions to optimize each patient's outcomes. However, building effective AI tools requires many careful considerations about how we collect and handle data, how we train the models, and how we interpret results. In this perspective, we discuss some of the current opportunities and challenges for AI in rehabilitation. We first review recent trends in AI for the screening, diagnosis, treatment, and continuous monitoring of disease or injury, with a special focus on the different types of healthcare data used for these applications. We then examine potential barriers to designing and integrating AI into the clinical workflow, and we propose an end-to-end framework to address these barriers and guide the development of effective AI for rehabilitation. Finally, we present ideas for future work to pave the way for AI implementation in real-world rehabilitation practices.
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Affiliation(s)
- Francesco Lanotte
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, United States
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, United States
| | - Megan K. O’Brien
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, United States
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, United States
| | - Arun Jayaraman
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, United States
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, United States
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7
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Kwakkel G, Stinear C, Essers B, Munoz-Novoa M, Branscheidt M, Cabanas-Valdés R, Lakičević S, Lampropoulou S, Luft AR, Marque P, Moore SA, Solomon JM, Swinnen E, Turolla A, Alt Murphy M, Verheyden G. Motor rehabilitation after stroke: European Stroke Organisation (ESO) consensus-based definition and guiding framework. Eur Stroke J 2023; 8:880-894. [PMID: 37548025 PMCID: PMC10683740 DOI: 10.1177/23969873231191304] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
PURPOSE To propose a consensus-based definition and framework for motor rehabilitation after stroke. METHODS An expert European working group reviewed the literature, attaining internal consensus after external feedback. FINDINGS Motor rehabilitation is defined as a process that engages people with stroke to benefit their motor function, activity capacity and performance in daily life. It is necessary for people with residual motor disability whose goal is to enhance their functioning, independence and participation. Motor rehabilitation operates through learning- and use-dependent mechanisms. The trajectory of motor recovery varies across patients and stages of recovery. Early behavioral restitution of motor function depends on spontaneous biological mechanisms. Further improvements in activities of daily living are achieved by compensations. Motor rehabilitation is guided by regular assessment of motor function and activity using consensus-based measures, including patient-reported outcomes. Results are discussed with the patient and their carers to set personal goals. During motor rehabilitation patients learn to optimize and adapt their motor, sensory and cognitive functioning through appropriately dosed repetitive, goal-oriented, progressive, task- and context-specific training. Motor rehabilitation supports people with stroke to maximize health, well-being and quality of life. The framework describes the International Classification of Functioning, Disability and Health in the context of stroke, describes neurobiological mechanisms of behavioral restitution and compensation, and summarizes recommendations for clinical assessment, prediction tools, and motor interventions with strong recommendations from clinical practice guidelines (2016-2022). CONCLUSIONS This definition and framework may guide clinical educators, inform clinicians on current recommendations and guidelines, and identify gaps in the evidence base.
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Affiliation(s)
- Gert Kwakkel
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam Neuroscience, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
- Department Acquired Brain Injuries, Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands
| | - Cathy Stinear
- Department of Medicine, Waipapa Taumata Rau University of Auckland, Aotearoa, New Zealand
| | - Bea Essers
- Department of Rehabilitation Sciences, KU Leuven – University of Leuven, Leuven, Belgium
| | - Maria Munoz-Novoa
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Meret Branscheidt
- Department of Neurology, University Hospital of Zurich, and Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Rosa Cabanas-Valdés
- Department of Physiotherapy, Faculty of Medicine and Health Science, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Sandra Lakičević
- Department of Neurology, Stroke Unit, University Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Sofia Lampropoulou
- Physiotherapy Department, School of Health Rehabilitation Sciences, University of Patras, Rio, Greece
| | - Andreas R Luft
- Department of Neurology, University Hospital of Zurich, and Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Philippe Marque
- Service de médecine physique et réadaptation, CHU de Toulouse, Toulouse, France
| | - Sarah A Moore
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Science, Northumbria University, Newcastle upon Tyne, UK
- Stroke Research Group, Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - John M Solomon
- Centre for Comprehensive Stroke Rehabilitation and Research, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Eva Swinnen
- Rehabilitation Research Group, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Andrea Turolla
- Department of Biomedical and Neuromotor Sciences, Alma Mater University of Bologna, Bologna, Italy
- Unit of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Margit Alt Murphy
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Geert Verheyden
- Department of Rehabilitation Sciences, KU Leuven – University of Leuven, Leuven, Belgium
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Elameer M, Lumley H, Moore SA, Marshall K, Alton A, Smith FE, Gani A, Blamire A, Rodgers H, Price CIM, Mitra D. A prospective study of MRI biomarkers in the brain and lower limb muscles for prediction of lower limb motor recovery following stroke. Front Neurol 2023; 14:1229681. [PMID: 37941576 PMCID: PMC10628497 DOI: 10.3389/fneur.2023.1229681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/26/2023] [Indexed: 11/10/2023] Open
Abstract
The aim of this prospective observational longitudinal study was to explore and decipher the predictive value of prospective MRI biomarkers in the brain and lower limb muscles for 3-month lower limb motor recovery following stroke. In the brain, we measured the integrity of the corticospinal tract (fractional anisotropy/"FA"). In the muscles, we measured volume, fatty replacement (fat fraction analysis and proton spectroscopy) and oedema. Measurements were taken at two time points: (1) within 4 weeks of stroke (baseline measurement, clinical and imaging) and (2) 3 months following stroke (follow up measurement, clinical only). Clinical measurements consisted of assessments of functional ability and strength (Fugl-Meyer score, motor NIHSS, Functional Ambulation Category/"FAC", and muscle dynamometry). Twenty-three patients completed imaging and clinical assessments at baseline and follow-up; five patients had partial imaging assessment. The results provided some evidence that damage to the corticospinal tract would result in less motor recovery: recovery of the Fugl-Meyer score and dynamometric ankle plantarflexion, ankle dorsiflexion, and knee extension correlated positively and significantly with fractional anisotropy (0.406-0.457; p = 0.034-p = 0.016). However, fractional anisotropy demonstrated a negative correlation with recovery of the Functional Ambulation Category (-0.359, p = 0.046). For the muscle imaging, significant inverse correlation was observed between vastus lateralis fat fraction vs. NIHSS recovery (-0.401, p = 0.04), and a strong positive correlation was observed between ratio of intra- to extra-myocellular lipid concentrations and the recovery of knee flexion (0.709, p = 0.007). This study supports previous literature indicating a positive correlation between the integrity of the corticospinal tract and motor recovery post-stroke, expanding the limited available literature describing this relationship specifically for the lower limb. However, recovery of functional ambulation behaved differently to other clinical recovery markers by demonstrating an inverse relationship with corticospinal tract integrity. The study also introduces some muscle imaging biomarkers as potentially valuable in the prediction of 3-month lower limb motor recovery following stroke.
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Affiliation(s)
- Mat Elameer
- Department of Neuroradiology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
- Stroke Research Group, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Hannah Lumley
- Stroke Research Group, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Sarah A. Moore
- Stroke Research Group, Newcastle University, Newcastle upon Tyne, United Kingdom
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Katie Marshall
- Department of Medical Physics, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Abi Alton
- Stroke Research Group, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Fiona E. Smith
- Department of Neuroscience, Manchester Metropolitan University, Manchester, United Kingdom
| | - Akif Gani
- Department of Stroke Medicine, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Andrew Blamire
- Newcastle Magnetic Resonance Centre, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Helen Rodgers
- Stroke Research Group, Newcastle University, Newcastle upon Tyne, United Kingdom
| | | | - Dipayan Mitra
- Department of Neuroradiology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
- Stroke Research Group, Newcastle University, Newcastle upon Tyne, United Kingdom
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9
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Cf G, Mg G, L B, Mj R. Association between balance recovery during inpatient rehabilitation and gait without physical assistance in severe subacute post-stroke patients. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2023; 28:e2029. [PMID: 37330694 DOI: 10.1002/pri.2029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/12/2023] [Accepted: 06/06/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND AND PURPOSE Studies that analyze gait without physical assistance recovery post-stroke are scarce. There are few of the studies that analyze longitudinally the recovery of balance during the subacute post-stroke inpatient rehabilitation. The aim of the study was to analyze the association between balance recovery during subacute stroke inpatient rehabilitation and gait without physical assistance achievement. Secondarily, to analyze the association between balance at admission of inpatient rehabilitation and gait without physical assistance achievement. METHODS An observational, longitudinal, and retrospective cohort study was conducted. Subacute stroke subjects with an admission Berg Balance Scale below or equal to 4 points were included (n = 164). Two logistic regression models were developed. Model 1 analyzes the association between balance recovery during inpatient rehabilitation and gait without physical assistance at discharge. Model 2 analyzes the association between balance at the admission and gait without physical assistance at discharge. RESULTS Of 164 severe post-stroke patients, 60 (36.5%) achieved gait without physical assistance. Although the two models developed a statistically significant association (p < 0.001), Model 1 evinced better discrimination performance (Model 1: area below the curve was of 0.987 -CI 95%: 0.975-0.998- vs. Model 2: area below the curve 2 was of 0.705 -CI 95%: 0.789-0.601-). DISCUSSION Balance recovery during rehabilitation was strongly associated with gait without physical assistance achievement at the time of discharge in severe subacute post-stroke patients. IMPLICATIONS FOR PHYSIOTHERAPY PRACTICE The longitudinal analysis of motor recovery in severe subacute post-stroke patients may be helpful in the decision making process during inpatient rehabilitation.
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Affiliation(s)
| | - Gianella Mg
- Physical Therapy Unit, Belen de Escobar, Argentina
| | - Bonamico L
- Departament of Rehabilitation Medicine, Belen de Escobar, Argentina
| | - Russo Mj
- Departament of Rehabilitation Medicine, Belen de Escobar, Argentina
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10
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Schröder J, Saeys W, Embrechts E, Hallemans A, Yperzeele L, Truijen S, Kwakkel G. Recovery of Quiet Standing Balance and Lower Limb Motor Impairment Early Poststroke: How Are They Related? Neurorehabil Neural Repair 2023; 37:530-544. [PMID: 37596887 DOI: 10.1177/15459683231186983] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/21/2023]
Abstract
BACKGROUND Recovery of quiet standing balance early poststroke has been poorly investigated using repeated measurements. OBJECTIVE To investigate (1) the time course of steady-state balance in terms of postural stability and inter-limb symmetry, and (2) longitudinal associations with lower limb motor recovery in the first 3 months poststroke. METHODS Forty-eight hemiparetic subjects (age: 58.9 ± 16.1 years) were evaluated at weeks 3, 5, 8, and 12 poststroke. Motor impairments concerned the Fugl-Meyer assessment (FM-LE) and Motricity Index total score (MI-LE) or ankle item separately (MI-ankle). Postural stability during quiet 2-legged stance was calculated as the net center-of-pressure area (COPArea) and direction-dependent velocities (COPVel-ML and COPVel-AP). Dynamic control asymmetry (DCA) and weight-bearing asymmetry (WBA) estimated inter-limb symmetries in balance control and loading. Linear mixed models determined (1) time-dependent change and (2) the between- and within-subject associations between motor impairments and postural stability or inter-limb symmetry. RESULTS Time-dependent improvements were significant for FM-LE, MI-LE, MI-ankle, COPArea, COPVel-ML, and COPVel-AP, and tended to plateau by week 8. DCA and WBA did not exhibit significant change. Between-subject analyses yielded significant regression coefficients for FM-LE, MI-LE, and MI-ankle scores with COPArea, COPVel-ML, and COPVel-AP up until week 8, and with WBA until week 12. Within-subject regression coefficients of motor recovery with change in COPArea, COPVel-ML, COPVel-AP, DCA, or WBA were generally non-significant. CONCLUSIONS Postural stability improved significantly in the first 8 weeks poststroke, independent of lower limb motor recovery at the most affected side within subjects. Our findings suggest that subjects preferred to compensate with their less affected side, making metrics reflecting inter-limb asymmetries in balance invariant for change early poststroke.Clinical Trial Registration: Clinicaltrials.gov. unique identifier NCT03728036.
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Affiliation(s)
- Jonas Schröder
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Antwerp, Belgium
| | - Wim Saeys
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Antwerp, Belgium
- Department of Neurorehabilitation, RevArte Rehabilitation Hospital, Edegem, Belgium
| | - Elissa Embrechts
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Antwerp, Belgium
| | - Ann Hallemans
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Antwerp, Belgium
| | - Laetitia Yperzeele
- Neurovascular Center Antwerp and Stroke Unit, Department of Neurology, Antwerp University Hospital, Antwerp, Belgium
- Research Group on Translational Neurosciences, University of Antwerp, Antwerp, Belgium
| | - Steven Truijen
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Antwerp, Belgium
| | - Gert Kwakkel
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
- Amsterdam Rehabilitation Research Centre Reade, Amsterdam, The Netherlands
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Nomoto M, Miyata K, Kohno Y. White matter hyperintensity predicts independent walking function at 6 months after stroke: A retrospective cohort study. NeuroRehabilitation 2023; 53:557-565. [PMID: 38143395 DOI: 10.3233/nre-230225] [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: 12/26/2023]
Abstract
BACKGROUND White matter hyperintensity (WMH) is reported to have a potential prevalence in healthy people and is a predictor of walking disability. However, WMH has not been adequately considered as a predictor of independent walking after stroke. OBJECTIVE To investigate the effects of WMH severity on walking function in patients with acute stroke. METHODS The retrospective cohort study included 422 patients with acute stroke. The WMH severity from magnetic resonance images was evaluated using the Fazekas scale. Age, type of stroke, Fazekas scale, Brunnstrom motor recovery stage, Motricity Index, and Mini-Mental State Examination were used as independent variables. Multivariable logistic regression analysis was conducted on the factors of independent walking at discharge and 6 months after onset, respectively. RESULTS Multivariable analysis revealed that the Fazekas scale is not a predictive factor of independent walking at discharge (odds ratio [OR] = 0.89, 95% confidence intervals [CI] = 0.65-1.22), but at 6 months (OR = 0.54, 95% CI = 0.34-0.86). CONCLUSION The WMH severity was a predictive factor of independent walking in patients with acute stroke after 6 months. WMH is a factor that should be considered to improve the accuracy of predicting long-term walking function in patients with stroke.
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Affiliation(s)
- Masahiro Nomoto
- Department of Rehabilitation, Nerima Hikarigaoka Hospital, Tokyo, Japan
- Graduate School of Health Sciences, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
| | - Kazuhiro Miyata
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
| | - Yutaka Kohno
- Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
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