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Vaughn RM, Gangwani R, Mark JI, Fletcher K, Baratta JM, Cassidy JM. Predictive utility of self-efficacy in early stroke rehabilitation. Top Stroke Rehabil 2024:1-9. [PMID: 39292651 DOI: 10.1080/10749357.2024.2403806] [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: 12/11/2023] [Accepted: 09/07/2024] [Indexed: 09/20/2024]
Abstract
INTRODUCTION A biopsychosocial approach entailing person-centered factors provides valuable insight to post-stroke rehabilitation potential. The consideration of an individual's belief in their capabilities, known as self-efficacy, may prove especially informative in the inpatient rehabilitation setting where motor learning often occurs. OBJECTIVE To assess the predictive utility of self-efficacy in functional independence status change during inpatient rehabilitation. METHODS Individuals with stroke admitted to an inpatient rehabilitation facility (IRF) completed an assessment battery near IRF admission and discharge involving motor assessments, participant-reported self-efficacy (Stroke Self-Efficacy Questionnaire), and functional independence status evaluation (sum of self-care and mobility Quality Indicators (QI) from the IRF-Patient Assessment Instrument). Linear regression was performed to determine the predictive performance of self-efficacy on QI change during IRF stay while accounting for age, time post-stroke, and IRF length of stay. Regression procedures were repeated for separate subgroups based on initial motor impairment level. RESULTS Thirty individuals with stroke (14 females, age = 67.0 ± 9.80 years, 10.4 ± 3.46 days post-stroke) were enrolled. Self-efficacy at IRF admission explained a significant percentage of variance in QI Change for the cohort (R2 = 30.7%, p = .001) and for the moderate to severe motor impairment subgroup (n = 12; R2 = 49.9%, p = .010). After accounting for confounders, self-efficacy remained a significant predictor for the cohort (n = 30) model. DISCUSSION Findings generated from this work support the predictive utility of self-efficacy in early post-stroke motor recovery. The inclusion of self-efficacy in a multi-faceted evaluation framework may therefore optimize rehabilitation outcomes by providing therapists with additional knowledge to better tailor an individual's care.
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Affiliation(s)
- Rachel M Vaughn
- Department of Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rachana Gangwani
- Department of Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jasper I Mark
- Department of Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - John M Baratta
- UNC Health, Chapel Hill, NC, USA
- Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jessica M Cassidy
- Department of Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Yue Z, Xiao P, Wang J, Tong RKY. Brain oscillations in reflecting motor status and recovery induced by action observation-driven robotic hand intervention in chronic stroke. Front Neurosci 2023; 17:1241772. [PMID: 38146541 PMCID: PMC10749335 DOI: 10.3389/fnins.2023.1241772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 11/14/2023] [Indexed: 12/27/2023] Open
Abstract
Hand rehabilitation in chronic stroke remains challenging, and finding markers that could reflect motor function would help to understand and evaluate the therapy and recovery. The present study explored whether brain oscillations in different electroencephalogram (EEG) bands could indicate the motor status and recovery induced by action observation-driven brain-computer interface (AO-BCI) robotic therapy in chronic stroke. The neurophysiological data of 16 chronic stroke patients who received 20-session BCI hand training is the basis of the study presented here. Resting-state EEG was recorded during the observation of non-biological movements, while task-stage EEG was recorded during the observation of biological movements in training. The motor performance was evaluated using the Action Research Arm Test (ARAT) and upper extremity Fugl-Meyer Assessment (FMA), and significant improvements (p < 0.05) on both scales were found in patients after the intervention. Averaged EEG band power in the affected hemisphere presented negative correlations with scales pre-training; however, no significant correlations (p > 0.01) were found both in the pre-training and post-training stages. After comparing the variation of oscillations over training, we found patients with good and poor recovery presented different trends in delta, low-beta, and high-beta variations, and only patients with good recovery presented significant changes in EEG band power after training (delta band, p < 0.01). Importantly, motor improvements in ARAT correlate significantly with task EEG power changes (low-beta, c.c = 0.71, p = 0.005; high-beta, c.c = 0.71, p = 0.004) and task/rest EEG power ratio changes (delta, c.c = -0.738, p = 0.003; low-beta, c.c = 0.67, p = 0.009; high-beta, c.c = 0.839, p = 0.000). These results suggest that, in chronic stroke, EEG band power may not be a good indicator of motor status. However, ipsilesional oscillation changes in the delta and beta bands provide potential biomarkers related to the therapeutic-induced improvement of motor function in effective BCI intervention, which may be useful in understanding the brain plasticity changes and contribute to evaluating therapy and recovery in chronic-stage motor rehabilitation.
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Affiliation(s)
- Zan Yue
- Institute of Robotics and Intelligent Systems, Xi’an Jiaotong University, Xi’an, China
- Neurorehabilitation Robotics Research Institute, Xi’an Jiaotong University, Xi’an, China
| | - Peng Xiao
- Institute of Robotics and Intelligent Systems, Xi’an Jiaotong University, Xi’an, China
- Neurorehabilitation Robotics Research Institute, Xi’an Jiaotong University, Xi’an, China
| | - Jing Wang
- Institute of Robotics and Intelligent Systems, Xi’an Jiaotong University, Xi’an, China
- Neurorehabilitation Robotics Research Institute, Xi’an Jiaotong University, Xi’an, China
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Raymond Kai-yu Tong
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
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Abstract
INTRODUCTION Telerehabilitation (TR) may be useful for rehabilitation therapy after stroke. However, stroke is a heterogeneous condition, and not all patients can be expected to derive the same benefit from TR, underscoring the need to identify predictors of response to TR. METHODS A prior trial provided patients with 6 weeks of intensive rehabilitation therapy targeting arm movement, randomly assigned to be provided in the home via TR (current focus) or in clinic. Eligible patients had moderate arm motor deficits and were in the subacute-chronic stage post stroke. Behavioral gains were measured as change in the arm motor Fugl-Meyer score from baseline to 30 days post therapy. To delineate predictors of TR response, multivariable linear regression was performed, advancing the most significant predictor from each of eight categories: patient demographics, stroke characteristics, medical history, rehabilitation therapy outside of study procedures, motivation, sensorimotor impairment, cognitive/affective deficits, and functional status. RESULTS The primary focus was on patients starting TR >90 days post stroke onset (n = 44), among whom female sex, less spasticity, and less visual field defects predicted greater motor gains. This model explained 39.3% of the variance in treatment-related gains. In secondary analysis that also included TR patients enrolled ≤90 days post stroke (total n = 59), only female sex was a predictor of treatment gains. A separate secondary analysis examined patients >90 days post stroke (n = 34) randomized to in-clinic therapy, among whom starting therapy earlier post stroke and less ataxia predicted greater motor gains. DISCUSSION Response to TR varies across patients, emphasizing the need to identify characteristics that predict treatment-related behavioral gain. The current study highlights factors that might be important to patient selection for home-based TR after stroke.
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Affiliation(s)
- Sang Min Paik
- Ewha Woman's University College of Medicine, Republic of Korea
| | - Steven C Cramer
- Department of Neurology, University of California Los Angeles, USA
- California Rehabilitation Institute, USA
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Cassidy JM, Mark JI, Cramer SC. Functional connectivity drives stroke recovery: shifting the paradigm from correlation to causation. Brain 2022; 145:1211-1228. [PMID: 34932786 PMCID: PMC9630718 DOI: 10.1093/brain/awab469] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 11/20/2021] [Accepted: 11/26/2021] [Indexed: 11/14/2022] Open
Abstract
Stroke is a leading cause of disability, with deficits encompassing multiple functional domains. The heterogeneity underlying stroke poses significant challenges in the prediction of post-stroke recovery, prompting the development of neuroimaging-based biomarkers. Structural neuroimaging measurements, particularly those reflecting corticospinal tract injury, are well-documented in the literature as potential biomarker candidates of post-stroke motor recovery. Consistent with the view of stroke as a 'circuitopathy', functional neuroimaging measures probing functional connectivity may also prove informative in post-stroke recovery. An important step in the development of biomarkers based on functional neural network connectivity is the establishment of causality between connectivity and post-stroke recovery. Current evidence predominantly involves statistical correlations between connectivity measures and post-stroke behavioural status, either cross-sectionally or serially over time. However, the advancement of functional connectivity application in stroke depends on devising experiments that infer causality. In 1965, Sir Austin Bradford Hill introduced nine viewpoints to consider when determining the causality of an association: (i) strength; (ii) consistency; (iii) specificity; (iv) temporality; (v) biological gradient; (vi) plausibility; (vii) coherence; (viii) experiment; and (ix) analogy. Collectively referred to as the Bradford Hill Criteria, these points have been widely adopted in epidemiology. In this review, we assert the value of implementing Bradford Hill's framework to stroke rehabilitation and neuroimaging. We focus on the role of neural network connectivity measurements acquired from task-oriented and resting-state functional MRI, EEG, magnetoencephalography and functional near-infrared spectroscopy in describing and predicting post-stroke behavioural status and recovery. We also identify research opportunities within each Bradford Hill tenet to shift the experimental paradigm from correlation to causation.
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Affiliation(s)
- Jessica M Cassidy
- Department of Allied Health Sciences, Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jasper I Mark
- Department of Allied Health Sciences, Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Steven C Cramer
- Department of Neurology, University of California, Los Angeles; and California Rehabilitation Institute, Los Angeles, CA, USA
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Saverino A, Sonabend R, Wong S, Symeon C. The Wolfson Assessment Matrix: a potential tool to support clinicians in establishing access to specialized neuro rehabilitation by capturing important prognostic factors. Sharing more equitable and transparent criteria. Eur J Phys Rehabil Med 2022; 58:161-170. [PMID: 34823336 PMCID: PMC9981235 DOI: 10.23736/s1973-9087.21.07022-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Specialized Rehabilitation Services (SRSs) are designed to offer intensive multidisciplinary rehabilitation to patients with complex needs, who are expected to make significant functional gains in their ADLs over a relatively limited period of time. Although national guidelines offer a guidance on how to band patients by complexity, there is no consensus on how to screen patients with regard to rehabilitation prognosis. AIM The aim of this study was to improve the selection of patients admitted to an SRS, defining transparent and equitable prognostic criteria to guide clinicians' decision making. DESIGN This is a retrospective observational study SETTING: an SRS in the UK. POPULATION We included 121 patients affected by a neurological condition consecutively admitted for multidisciplinary rehabilitation. METHODS Rehabilitation Complexity Scale Extended is used to describe rehabilitation complexity. A short list of potential barriers to rehabilitation was analysed to predict the functional outcome measured by the Functional Independent Measure and the Barthel Index. RESULTS Older age, a heavier burden of co-morbidities, pre-morbid cognitive difficulties or dementia and a lower function level at admission were the most important variables to predict a lower functional gain. CONCLUSIONS We have used this list of barriers to create the Wolfson Assessment Matrix as a potential support tool to guide clinicians navigating through the different rehabilitation service options when assessing complex patients for eligibility to an SRS. CLINICAL REHABILITATION IMPACT SRSs are highly expensive services representing a possible step along the rehabilitation pathway for patients with complex needs. A tool such as the Wolfson Assessment Matrix would represent a step forward to help consistency in decision making regarding appropriateness for SRSs. It would also help to set realistic long-term goals with patients and families and support Health Services in the further development of alternative rehabilitation settings.
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Affiliation(s)
- Alessia Saverino
- Wolfson Neuro Rehabilitation Center, St George's Hospital, London, UK - .,Maugeri Clinical Scientific Institute, Genoa, Italy -
| | - Raphael Sonabend
- Department of Statistical Science, University College London, London, UK
| | - Sancho Wong
- Wolfson Neuro Rehabilitation Center, St George's Hospital, London, UK
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Vaughan M, McMullen T, Palmer L, Kwon S, Ingber MJ. The Change in Mobility Quality Measure for Inpatient Rehabilitation Facilities: Exclusion Criteria and the Risk Adjustment Model. Arch Phys Med Rehabil 2022; 103:1096-1104. [DOI: 10.1016/j.apmr.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 02/03/2022] [Accepted: 03/01/2022] [Indexed: 11/29/2022]
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Deutsch A, McMullen T, Vaughan M, Palmer L, Kwon S, Ingber MJ. The Change in Self-Care Quality Measure for Inpatient Rehabilitation Facilities: Exclusion Criteria and Risk-Adjustment Model. Arch Phys Med Rehabil 2022; 103:1085-1095. [DOI: 10.1016/j.apmr.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 01/31/2022] [Accepted: 02/14/2022] [Indexed: 11/16/2022]
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Liew S, Zavaliangos‐Petropulu A, Jahanshad N, Lang CE, Hayward KS, Lohse KR, Juliano JM, Assogna F, Baugh LA, Bhattacharya AK, Bigjahan B, Borich MR, Boyd LA, Brodtmann A, Buetefisch CM, Byblow WD, Cassidy JM, Conforto AB, Craddock RC, Dimyan MA, Dula AN, Ermer E, Etherton MR, Fercho KA, Gregory CM, Hadidchi S, Holguin JA, Hwang DH, Jung S, Kautz SA, Khlif MS, Khoshab N, Kim B, Kim H, Kuceyeski A, Lotze M, MacIntosh BJ, Margetis JL, Mohamed FB, Piras F, Ramos‐Murguialday A, Richard G, Roberts P, Robertson AD, Rondina JM, Rost NS, Sanossian N, Schweighofer N, Seo NJ, Shiroishi MS, Soekadar SR, Spalletta G, Stinear CM, Suri A, Tang WKW, Thielman GT, Vecchio D, Villringer A, Ward NS, Werden E, Westlye LT, Winstein C, Wittenberg GF, Wong KA, Yu C, Cramer SC, Thompson PM. The ENIGMA Stroke Recovery Working Group: Big data neuroimaging to study brain-behavior relationships after stroke. Hum Brain Mapp 2022; 43:129-148. [PMID: 32310331 PMCID: PMC8675421 DOI: 10.1002/hbm.25015] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 04/03/2020] [Accepted: 04/08/2020] [Indexed: 01/28/2023] Open
Abstract
The goal of the Enhancing Neuroimaging Genetics through Meta-Analysis (ENIGMA) Stroke Recovery working group is to understand brain and behavior relationships using well-powered meta- and mega-analytic approaches. ENIGMA Stroke Recovery has data from over 2,100 stroke patients collected across 39 research studies and 10 countries around the world, comprising the largest multisite retrospective stroke data collaboration to date. This article outlines the efforts taken by the ENIGMA Stroke Recovery working group to develop neuroinformatics protocols and methods to manage multisite stroke brain magnetic resonance imaging, behavioral and demographics data. Specifically, the processes for scalable data intake and preprocessing, multisite data harmonization, and large-scale stroke lesion analysis are described, and challenges unique to this type of big data collaboration in stroke research are discussed. Finally, future directions and limitations, as well as recommendations for improved data harmonization through prospective data collection and data management, are provided.
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Affiliation(s)
- Sook‐Lei Liew
- Chan Division of Occupational Science and Occupational TherapyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
- Department of NeurologyUSC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern CaliforniaLos AngelesCaliforniaUSA
- Department of Biomedical Engineering, University of Southern CaliforniaLos AngelesCaliforniaUSA
- Neuroscience Graduate ProgramUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Artemis Zavaliangos‐Petropulu
- Department of NeurologyUSC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern CaliforniaLos AngelesCaliforniaUSA
- Neuroscience Graduate ProgramUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
- Imaging Genetics CenterUSC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Neda Jahanshad
- Department of NeurologyUSC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern CaliforniaLos AngelesCaliforniaUSA
- Imaging Genetics CenterUSC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Catherine E. Lang
- Program in Physical TherapyWashington University School of MedicineSt. LouisMissouriUSA
| | - Kathryn S. Hayward
- Department of Physiotherapyand Florey Institute of Neuroscience and Mental Health, University of MelbourneParkvilleVictoriaAustralia
- NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, University of MelbourneParkvilleVictoriaAustralia
| | - Keith R. Lohse
- Department of Health, Kinesiology, and RecreationUniversity of UtahSalt Lake CityUtahUSA
- Department of Physical Therapy and Athletic TrainingUniversity of UtahSalt Lake CityUtahUSA
| | - Julia M. Juliano
- Neuroscience Graduate ProgramUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Francesca Assogna
- Laboratory of Neuropsychiatry, Department of Clinical and Behavioral NeurologyIRCCS Santa Lucia FoundationRomeItaly
| | - Lee A. Baugh
- Division of Basic Biomedical Sciences, Sanford School of Medicine, University of South DakotaVermillionSouth DakotaUSA
- Sioux Falls VA Health Care SystemSioux FallsSouth DakotaUSA
| | - Anup K. Bhattacharya
- Mallinckrodt Institute of Radiology, Washington University School of MedicineSt. LouisMissouriUSA
| | - Bavrina Bigjahan
- Department of NeurologyUSC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern CaliforniaLos AngelesCaliforniaUSA
- Department of Radiology, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Michael R. Borich
- Department of Rehabilitation MedicineEmory UniversityAtlantaGeorgiaUSA
| | - Lara A. Boyd
- Department of Physical Therapy, Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- Djavad Mowafaghian Centre for Brain HealthVancouverBritish ColumbiaCanada
| | - Amy Brodtmann
- Florey Institute for Neuroscience and Mental Health, University of MelbourneParkvilleVictoriaAustralia
| | - Cathrin M. Buetefisch
- Department of Rehabilitation MedicineEmory UniversityAtlantaGeorgiaUSA
- Department of NeurologyEmory UniversityAtlantaGeorgiaUSA
| | - Winston D. Byblow
- Department of Exercise Sciences, Centre for Brain ResearchUniversity of AucklandAucklandNew Zealand
| | - Jessica M. Cassidy
- Division of Physical Therapy, Department Allied Health SciencesUniversity of North Carolina, Chapel HillChapel HillNorth CarolinaUSA
| | - Adriana B. Conforto
- Neurology Clinical Division, Hospital das Clínicas/São Paulo UniversitySão PauloBrazil
- Hospital Israelita Albert EinsteinSão PauloBrazil
| | - R. Cameron Craddock
- Department of Diagnostic MedicineThe University of Texas at Austin Dell Medical SchoolAustinTexasUSA
| | - Michael A. Dimyan
- Department of Neurology and Neurorehabilitation, School of MedicineUniversity of Maryland, BaltimoreBaltimoreMarylandUSA
- VA Maryland Health Care SystemBaltimoreMarylandUSA
| | - Adrienne N. Dula
- Department of Diagnostic MedicineThe University of Texas at Austin Dell Medical SchoolAustinTexasUSA
- Department of NeurologyDell Medical School at University of Texas at AustinAustinTexasUSA
| | - Elsa Ermer
- Department of Neurology and Neurorehabilitation, School of MedicineUniversity of Maryland, BaltimoreBaltimoreMarylandUSA
| | - Mark R. Etherton
- Department of NeurologyMassachusetts General HospitalBostonMassachusettsUSA
- J. Philip Kistler Stroke Research CenterHarvard Medical SchoolBostonMassachusettsUSA
| | - Kelene A. Fercho
- Division of Basic Biomedical Sciences, Sanford School of Medicine, University of South DakotaVermillionSouth DakotaUSA
- Federal Aviation Administration, Civil Aerospace Medical InstituteOklahoma CityOklahomaUSA
| | - Chris M. Gregory
- Department of Health Sciences and ResearchMedical University of South CarolinaCharlestonSouth CarolinaUSA
| | - Shahram Hadidchi
- Department of RadiologyWayne State University/Detroit Medical CenterDetroitMichiganUSA
- Department of Internal MedicineWayne State University/Detroit Medical CenterDetroitMichiganUSA
| | - Jess A. Holguin
- Chan Division of Occupational Science and Occupational TherapyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Darryl H. Hwang
- Department of Radiology, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Simon Jung
- Department of Neurology, University of BernBernSwitzerland
| | - Steven A. Kautz
- Department of Health Sciences and ResearchMedical University of South CarolinaCharlestonSouth CarolinaUSA
- Ralph H Johnson VA Medical CenterCharlestonSouth CarolinaUSA
| | - Mohamed Salah Khlif
- Florey Institute for Neuroscience and Mental Health, University of MelbourneParkvilleVictoriaAustralia
| | - Nima Khoshab
- Department of Anatomy and NeurobiologyUniversity of CaliforniaIrvineCaliforniaUSA
| | - Bokkyu Kim
- Department of Physical Therapy EducationState University of New York Upstate Medical UniversitySyracuseNew YorkUSA
- Division of Biokinesiology and Physical TherapyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Hosung Kim
- Department of NeurologyUSC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Amy Kuceyeski
- Department of RadiologyWeill Cornell MedicineNew YorkNew YorkUSA
- Brain and Mind Research Institute, Weill Cornell MedicineNew YorkNew YorkUSA
| | - Martin Lotze
- Functional Imaging Unit, Center for Diagnostic RadiologySchool of Medicine, University of GreifswaldGreifswaldGermany
| | - Bradley J. MacIntosh
- Department of Medical BiophysicsUniversity of TorontoTorontoOntarioCanada
- Physical Sciences Platform, Brain Sciences ProgramSunnybrook Research InstituteTorontoOntarioCanada
| | - John L. Margetis
- Chan Division of Occupational Science and Occupational TherapyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Feroze B. Mohamed
- Department of RadiologyThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Fabrizio Piras
- Laboratory of Neuropsychiatry, Department of Clinical and Behavioral NeurologyIRCCS Santa Lucia FoundationRomeItaly
| | - Ander Ramos‐Murguialday
- TECNALIA, Basque Research and Technology Alliance (BRTA), Neurotechnology LaboratoryDerioSpain
- Institute of Medical Psychology and Behavioural Neurobiology, University of TubingenTübingenGermany
| | - Geneviève Richard
- Department of PsychologyUniversity of OsloOsloNorway
- NORMENT, Division of Mental Health and AddictionOslo University HospitalOsloNorway
- Institute of Clinical Medicine, University of OsloOsloNorway
| | - Pamela Roberts
- Department of Physical Medicine and RehabilitationCedars‐SinaiLos AngelesCaliforniaUSA
| | - Andrew D. Robertson
- Department of KinesiologyUniversity of WaterlooWaterlooOntarioCanada
- Schlegel‐UW Research Institute for Aging, University of WaterlooWaterlooOntarioCanada
| | - Jane M. Rondina
- Department of Clinical and Movement NeurosciencesUCL Queen Square Institute of Neurology, University College LondonLondonUK
| | - Natalia S. Rost
- Stroke Division, Department of NeurologyMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Nerses Sanossian
- Division of Neurocritical Care and Stroke, Department of Neurology, Keck School of Medicine, University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Nicolas Schweighofer
- Division of Biokinesiology and Physical Therapy, University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Na Jin Seo
- Department of Health Sciences and ResearchMedical University of South CarolinaCharlestonSouth CarolinaUSA
- Ralph H Johnson VA Medical CenterCharlestonSouth CarolinaUSA
- Division of Occupational Therapy, Department of Health Professions, Medical University of South CarolinaCharlestonSouth CarolinaUSA
| | - Mark S. Shiroishi
- Division of Neuroradiology, Department of RadiologyKeck School of Medicine, University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Surjo R. Soekadar
- Department of Psychiatry and Psychotherapy, Clinical Neurotechnology LaboratoryCharité ‐ University Medicine BerlinBerlinGermany
- Applied Neurotechnology Laboratory, Department of Psychiatry and PsychotherapyUniversity of TübingenTübingenGermany
| | - Gianfranco Spalletta
- Laboratory of Neuropsychiatry, Department of Clinical and Behavioral NeurologyIRCCS Santa Lucia FoundationRomeItaly
- Division of Neuropsychiatry, Menninger Department of Psychiatry and Behavioral SciencesBaylor College of MedicineHoustonTexasUSA
| | | | - Anisha Suri
- Department of Electrical and Computer EngineeringUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Wai Kwong W. Tang
- Department of PsychiatryThe Chinese University of Hong KongHong KongPeople's Republic of China
| | - Gregory T. Thielman
- Physical Therapy and Neuroscience, University of the SciencesPhiladelphiaPennsylvaniaUSA
- Samson CollegeQuezon CityPhilippines
| | - Daniela Vecchio
- Laboratory of Neuropsychiatry, Department of Clinical and Behavioral NeurologyIRCCS Santa Lucia FoundationRomeItaly
| | - Arno Villringer
- Department of NeurologyMax Planck Institute for Human Cognitive and Brain SciencesLeipzigGermany
- Department of Cognitive NeurologyUniversity Hospital LeipzigLeipzigGermany
- Center for Stroke Research, Charité‐Universitätsmedizin BerlinBerlinGermany
| | - Nick S. Ward
- UCL Queen Square Institute of Neurology, University College LondonLondonUK
| | - Emilio Werden
- Florey Institute for Neuroscience and Mental Health, University of MelbourneParkvilleVictoriaAustralia
| | - Lars T. Westlye
- Department of PsychologyUniversity of OsloOsloNorway
- NORMENT, Division of Mental Health and AddictionOslo University HospitalOsloNorway
| | - Carolee Winstein
- Division of Biokinesiology and Physical Therapy, University of Southern CaliforniaLos AngelesCaliforniaUSA
- Department of NeurologyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - George F. Wittenberg
- Department of NeurologyUniversity of PittsburghPittsburghPennsylvaniaUSA
- Department of Veterans AffairsUniversity Drive CampusPittsburghPennsylvaniaUSA
| | - Kristin A. Wong
- Department of Physical Medicine and RehabilitationDell Medical School, University of Texas AustinAustinTexasUSA
| | - Chunshui Yu
- Department of RadiologyTianjin Medical University General HospitalTianjinChina
- Tianjin Key Laboratory of Functional ImagingTianjin Medical University General HospitalTianjinChina
| | - Steven C. Cramer
- Department of NeurologyUCLA and California Rehabilitation InstituteLos AngelesCaliforniaUSA
| | - Paul M. Thompson
- Department of NeurologyUSC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern CaliforniaLos AngelesCaliforniaUSA
- Imaging Genetics CenterUSC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern CaliforniaLos AngelesCaliforniaUSA
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Martinez G, Katz JM, Pandya A, Wang JJ, Boltyenkov A, Malhotra A, Mushlin AI, Sanelli PC. Cost-Effectiveness Study of Initial Imaging Selection in Acute Ischemic Stroke Care. J Am Coll Radiol 2021; 18:820-833. [PMID: 33387454 PMCID: PMC8186007 DOI: 10.1016/j.jacr.2020.12.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/04/2020] [Accepted: 12/06/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE National guidelines recommend prompt identification of candidates for acute ischemic stroke (AIS) treatment, requiring timely neuroimaging with CT and/or MRI. CT is often preferred because of its widespread availability and rapid acquisition. Despite higher diagnostic accuracy of MRI, it commonly involves complex workflows that could potentially cause treatment time delays. The purpose of this study was to analyze the impact on outcomes of imaging utilization before treatment decisions at comprehensive stroke centers for patients presenting with suspected AIS in the anterior circulation with last-known-well-to-arrival time 0 to 24 hours. METHODS A decision simulation model based on the American Heart Association's recommendations for AIS care pathways was developed from a health care perspective to compare initial imaging strategies: (1) stepwise-CT: noncontrast CT (NCCT) at the time of presentation, with CT angiography (CTA) ± CT perfusion (CTP) only in select patients (initial imaging to exclude hemorrhage and extensive ischemia) for mechanical thrombectomy (MT) evaluation; (2) stepwise-hybrid: NCCT at the time of presentation, with MR angiography (MRA) ± MR perfusion (MRP) only for MT evaluation; (3) stepwise-advanced: NCCT + CTA at presentation, with MR diffusion-weighted imaging (MR DWI) + MRP only for MT evaluation; (4) comprehensive-CT: NCCT + CTA + CTP at the time of presentation; and (5) comprehensive-MR: MR DWI + MRA + MRP at the time of presentation. Model parameters were defined using evidence-based data. Cost-effectiveness and sensitivity analyses were performed. RESULTS The cost-effectiveness analyses revealed that comprehensive-CT and comprehensive-MR yield the highest lifetime quality-adjusted life-years (QALYs) (4.81 and 4.82, respectively). However, the incremental cost-effectiveness ratio of comprehensive-MR is $233,000/QALY compared with comprehensive-CT. Stepwise-CT, stepwise-hybrid, and stepwise-advanced strategies are dominated, yielding lower QALYs and higher costs compared with comprehensive-CT. CONCLUSIONS Performing comprehensive-CT at presentation is the most cost-effective initial imaging strategy at comprehensive stroke centers.
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Affiliation(s)
- Gabriela Martinez
- Siemens Healthineers, Malvern, Pennsylvania; Department of Radiology, Northwell Health, Manhasset, New York; Feinstein Institutes for Medical Research, Manhasset, New York.
| | - Jeffrey M Katz
- Chief, Neurovascular Services and Director Comprehensive Stroke Center at North Shore University Hospital, Department of Neurology, North Shore University Hospital, Manhasset, New York; Director of Neuroendovascular surgery, Neurology Service Line, Northwell Health, Manhasset, New York; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Ankur Pandya
- T. H. Trustee (unpaid), Society for Medical Decision Making, T.H Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Jason J Wang
- Feinstein Institutes for Medical Research, Manhasset, New York; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Artem Boltyenkov
- Siemens Healthineers, Malvern, Pennsylvania; Department of Radiology, Northwell Health, Manhasset, New York; Feinstein Institutes for Medical Research, Manhasset, New York
| | - Ajay Malhotra
- Radiology & Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Alvin I Mushlin
- Healthcare Policy and Research, Weill Cornell Medical College, New York, New York
| | - Pina C Sanelli
- Department of Radiology, Northwell Health, Manhasset, New York; Feinstein Institutes for Medical Research, Manhasset, New York; Radiology & Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut; Healthcare Policy and Research, Weill Cornell Medical College, New York, New York; Vice Chair of Research, Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
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10
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Boltzmann M, Schmidt SB, Gutenbrunner C, Krauss JK, Stangel M, Höglinger GU, Wallesch CW, Rollnik JD. The influence of the CRS-R score on functional outcome in patients with severe brain injury receiving early rehabilitation. BMC Neurol 2021; 21:44. [PMID: 33514337 PMCID: PMC7847163 DOI: 10.1186/s12883-021-02063-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 01/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background The aim of the study was to determine the role of the Coma Recovery Scale-Revised (CRS-R) in the prediction of functional status at the end of neurological early rehabilitative treatment. Methods Patients consecutively admitted to intensive or intermediate care units of a neurological rehabilitation center were enrolled in the study. Consciousness and functional status were assessed with the Coma Recovery Scale-Revised (CRS-R) and the Early Rehabilitation Barthel Index (ERBI), respectively. Both assessments were carried out weekly within the first month and at the end of early rehabilitation. Patient and clinical data were entered into a binary logistic regression model to predict functional status at discharge. Results 327 patients (112 females, 215 males) with a median age of 63 years (IQR = 53–75) and a median disease duration of 18 days (IQR = 12–28) were included. Most patients suffered from stroke (59 %), followed by traumatic brain injury (31 %), and hypoxic ischemic encephalopathy (10 %). Upon admission, 12 % were diagnosed as comatose, 31 % as unresponsive wakefulness syndrome (UWS), 35 % as minimally conscious state (MCS) and 22 % already emerged from MCS (eMCS). Of all patients undergoing complete early rehabilitative treatment (n = 180), 72 % showed improvements in level of consciousness (LOC). In this group, age, initial CRS-R score and gains in CRS-R score after four weeks independently predicted functional outcome at discharge. Conclusions The study confirms the relevance of the CRS-R score for functional outcome prediction. High CRS-R scores and young age facilitate functional improvements and increase the probability to continue treatment in subsequent rehabilitation phases. Moreover, results indicate that recovery might occur over a period of time that extends beyond acute care.
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Affiliation(s)
- Melanie Boltzmann
- Institute for Neurorehabilitative Research, Associated Institute of the Hannover Medical School, BDH-Clinic Hessisch Oldendorf, Hessisch Oldendorf, Germany.
| | - Simone B Schmidt
- Institute for Neurorehabilitative Research, Associated Institute of the Hannover Medical School, BDH-Clinic Hessisch Oldendorf, Hessisch Oldendorf, Germany
| | | | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Martin Stangel
- Department of Neurology, Section of Clinical Neuroimmunology and Neurochemistry, Hannover Medical School, Hannover, Germany
| | | | | | - Jens D Rollnik
- Institute for Neurorehabilitative Research, Associated Institute of the Hannover Medical School, BDH-Clinic Hessisch Oldendorf, Hessisch Oldendorf, Germany
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11
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The Controlling Nutritional Status score as a functional prognostic marker in patients with acute stroke: A multicenter retrospective cohort study. Nutrition 2020; 79-80:110889. [DOI: 10.1016/j.nut.2020.110889] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/01/2020] [Accepted: 05/07/2020] [Indexed: 11/21/2022]
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12
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Farinelli M, Cevolani D, Gestieri L, Romaniello C, Maffei M, Agati R, Leo MR, Huang Z, Pedone V, Northoff G. Brain and behaviour in post-acute stroke: Reduction in seeking and posterior cingulate neuronal variability. J Clin Exp Neuropsychol 2020; 42:584-601. [PMID: 32605471 DOI: 10.1080/13803395.2020.1780417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Stroke is a complex event on both behavioral and neuronal grounds. Recent investigations evidence the central role of subcortical damage on the post-stroke brain and behavior reorganization. We have conducted an exploratory study combining anatomical lesion analysis, functional analysis of resting state fMRI, and behavioral assessment with focus on exploration as represented by SEEKING. METHOD 24 stroke inpatients were studied immediately after their clinical stabilization post-stroke; neuronal variability in fMRI along with behavioral outcomes were assessed. These outcomes were compared with a control group of 22 healthy subjects. RESULTS First, we observed predominant subcortical lesions in our sample with all stroke patients showing subcortical lesions and only some exhibiting additional cortical lesions. Second, we observed significantly reduced neuronal variability in the posterior cingulate cortex (PCC) that did not show any structural damage. Third, our stroke subjects showed reduced SEEKING which was related to reduced PCC neuronal variability in an abnormal way (compared to healthy subjects). This last outcome was assessed by considering the subset of 11 stroke subjects for which fMRI and behavioral outcomes were jointly measured. CONCLUSIONS Taken together, our findings suggest that damage in subcortical regions may play a central role in abnormalities in both cortical activity (PCC) and associated behavior of post-stroke reorganization. Accounting for these aspects may have significant implications to optimize multidisciplinary rehabilitation processes, particularly during the early steps of recovery, reducing the impact of stroke on the patient and caregiver quality of life.
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Affiliation(s)
- Marina Farinelli
- Clinical Psychology Service, "Villa Bellombra" Rehabilitation Hospital - "Consorzio Colibri" , Bologna, Italy
| | - Daniela Cevolani
- Neuroradiology Unit, "Bellaria" Hospital, University of Bologna , Bologna, Italy
| | - Laura Gestieri
- Clinical Psychology Service, "Villa Bellombra" Rehabilitation Hospital - "Consorzio Colibri" , Bologna, Italy
| | - Caterina Romaniello
- Clinical Psychology Service, "Villa Bellombra" Rehabilitation Hospital - "Consorzio Colibri" , Bologna, Italy
| | - Monica Maffei
- Neuroradiology Unit, "Bellaria" Hospital, IRCCS Institute of Neurological Sciences , Bologna, Italy
| | - Raffaele Agati
- Neuroradiology Unit, "Bellaria" Hospital, IRCCS Institute of Neurological Sciences , Bologna, Italy
| | - Maria Rosaria Leo
- "Villa Bellombra" Rehabilitation Hospital - "Consorzio Colibri" , Bologna, Italy
| | - Zirui Huang
- Mind, Brain Imaging and Neuroethics Unit, Institute of Mental Health Research, University of Ottawa , Ottawa, ON, Canada
| | - Vincenzo Pedone
- "Villa Bellombra" Rehabilitation Hospital - "Consorzio Colibri" , Bologna, Italy
| | - Georg Northoff
- Mind, Brain Imaging and Neuroethics Unit, Institute of Mental Health Research, University of Ottawa , Ottawa, ON, Canada
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13
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Mane R, Chew E, Phua KS, Ang KK, Robinson N, Vinod AP, Guan C. Prognostic and Monitory EEG-Biomarkers for BCI Upper-Limb Stroke Rehabilitation. IEEE Trans Neural Syst Rehabil Eng 2019; 27:1654-1664. [PMID: 31247558 DOI: 10.1109/tnsre.2019.2924742] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
With the availability of multiple rehabilitative interventions, identifying the one that elicits the best motor outcome based on the unique neuro-clinical profile of the stroke survivor is a challenging task. Predicting the potential of recovery using biomarkers specific to an intervention hence becomes important. To address this, we investigate intervention-specific prognostic and monitory biomarkers of motor function improvements using quantitative electroencephalography (QEEG) features in 19 chronic stroke patients following two different upper extremity rehabilitative interventions viz. Brain-computer interface (BCI) and transcranial direct current stimulation coupled BCI (tDCS-BCI). Brain symmetry index was found to be the best prognostic QEEG for clinical gains following BCI intervention ( r = -0.80 , p = 0.02 ), whereas power ratio index (PRI) was observed to be the best predictor for tDCS-BCI ( r = -0.96 , p = 0.004 ) intervention. Importantly, statistically significant between-intervention differences observed in the predictive capabilities of these features suggest that intervention-specific biomarkers can be identified. This approach can be further pursued to distinctly predict the expected response of a patient to available interventions. The intervention with the highest predicted gains may then be recommended to the patient, thereby enabling a personalized rehabilitation regime.
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Rozanski GM, Wong JS, Inness EL, Patterson KK, Mansfield A. Longitudinal change in spatiotemporal gait symmetry after discharge from inpatient stroke rehabilitation. Disabil Rehabil 2019; 42:705-711. [DOI: 10.1080/09638288.2018.1508508] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Gabriela M. Rozanski
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Jennifer S. Wong
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Elizabeth L. Inness
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Kara K. Patterson
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Avril Mansfield
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
- Evaluative Clinical Sciences, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
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15
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Kokura Y, Wakabayashi H, Nishioka S, Maeda K. Nutritional intake is associated with activities of daily living and complications in older inpatients with stroke. Geriatr Gerontol Int 2018; 18:1334-1339. [DOI: 10.1111/ggi.13467] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 03/26/2018] [Accepted: 05/27/2018] [Indexed: 02/05/2023]
Affiliation(s)
- Yoji Kokura
- Department of Clinical Nutrition; Keiju Medical Center and Noto Liaison Council for Cerebral Stroke; Nanao City Japan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine; Yokohama City University Medical Center; Yokohama City Japan
| | - Shinta Nishioka
- Department of Clinical Nutrition and Food Services; Nagasaki Rehabilitation Hospital; Nagasaki City Japan
| | - Keisuke Maeda
- Palliative Care Center; Aichi Medical University; Nagakute City Japan
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Kushner DS, Johnson-Greene D. Association of Urinary Incontinence with Cognition, Transfers and Discharge Destination in Acute Stroke Inpatient Rehabilitation. J Stroke Cerebrovasc Dis 2018; 27:2677-2682. [PMID: 29941393 DOI: 10.1016/j.jstrokecerebrovasdis.2018.05.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 05/22/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Acute-stroke prognostic indicators remain controversial including relationship of urinary incontinence with outcomes in cognition, transfers, and discharge destination. OBJECTIVE To examine if urinary incontinence is associated with inpatient-rehabilitation (IR) outcomes in cognition, transfers, and discharge destinations. DESIGN Retrospective observational study of 303 of 579(52%) acute-stroke patients admitted to IR 2012-2015 with complete urinary incontinence (total assistance for bladder management). Discharge Functional Independence Measure (FIM) scores were correlated for continence, cognition, transfers-(bed/chair/wheelchair), and discharge destination. RESULTS Patients were admitted to IR on average 7.4 days after acute stroke. Average length-of-stay in IR was 14 days. At discharge 118 of 303(39%) remained urinary incontinent (total assistance). Continence/bladder-management FIM scores at discharge were associated with cognition FIM scores at discharge (chi square =105.8; P < .0001), and associated with transfer FIM scores at discharge (chi square = 153.1; P < .0001). Patients total to moderate assistance for continence at discharge included greater percentage that were dependent to moderate assistance for cognition and transfers than those minimal assistance to independent for continence. Continence/bladder-management FIM scores at discharge were associated with discharge disposition destinations (chi square = 29.98; P < .002). Patients total to moderate assistance for continence at discharge included greater percentage of acute care transfers, and skilled-nursing-facility dispositions, than patients that recovered to minimal assist to independent for continence. Urinary-incontinence recovery to minimal assistance to independent was associated with a home/community disposition rate of 82%. CONCLUSIONS 52% stroke patients were total assistance with bladder management for urinary incontinence on IR admission. Partial to complete continence recovery occurred in 61%. Continence/bladder-management FIM scores at discharge were associated with cognition and transfer FIM scores, and discharge destinations.
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Affiliation(s)
- David S Kushner
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida.
| | - Doug Johnson-Greene
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida.
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17
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Bindawas SM, Vennu V, Mawajdeh H, Alhaidary HM, Moftah E. Length of Stay and Functional Outcomes Among Patients with Stroke Discharged from an Inpatient Rehabilitation Facility in Saudi Arabia. Med Sci Monit 2018; 24:207-214. [PMID: 29321468 PMCID: PMC5772339 DOI: 10.12659/msm.907452] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background In many countries, the length of stay (LOS) for inpatient rehabilitation following stroke has gradually decreased. It is unclear whether this trend is associated with differences in functional outcomes, especially in developing countries. This study aimed to examine associations between LOS and functional outcomes among patients with stroke discharged from an inpatient rehabilitation facility in Saudi Arabia. Material/Methods This retrospective study included all patients (N=409) aged ≥18 years who were admitted to an inpatient rehabilitation for stroke during 2008–2014. There were no deaths in the cohort during the study period. Patients were divided into 4 groups according to days of rehabilitation: ≤30 days (n=114), 31–60 days (n=199), 61–90 days (n=72), and >90 days (n=24). Multivariate regression analyses were used to evaluate functional outcomes using the functional independence measure (FIM). Results The fully adjusted model showed that higher total and subscale FIM scores were significantly associated with a LOS ≤30 days (total β: 18.2, standard error [SE]=4.43, P≤0.0001; motor-FIM: β=13.9, SE=3.70, P=0.0002; cognitive-FIM: β=4.3, SE=1.29, P=0.001), and 31–60 days (total β: 11.3, SE=4.07, P=0.005; motor-FIM: β=8.8, SE=3.40, P=0.009; cognitive-FIM: β=2.4, SE=1.19, P=0.038) compared with >90 days. Conclusions A short or intermediate LOS is not necessarily associated with worse outcomes, assuming adequate care is provided.
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Affiliation(s)
- Saad M Bindawas
- Department of Rehabilitation Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Vishal Vennu
- Department of Rehabilitation Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Hussam Mawajdeh
- Rehabilitation Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | - Emad Moftah
- Department of Rehabilitation Sciences, King Saud University, Riyadh, Saudi Arabia.,Department of Rehabilitation, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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18
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Lanyon L, Worrall L, Rose M. “It’s not really worth my while”: understanding contextual factors contributing to decisions to participate in community aphasia groups. Disabil Rehabil 2018; 41:1024-1036. [DOI: 10.1080/09638288.2017.1419290] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Lucette Lanyon
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | - Linda Worrall
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Miranda Rose
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
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Impact of Thyroid Hormone Levels on Functional Outcome in Neurological and Neurosurgical Early Rehabilitation Patients. BIOMED RESEARCH INTERNATIONAL 2017; 2017:4719279. [PMID: 28900623 PMCID: PMC5576392 DOI: 10.1155/2017/4719279] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 07/12/2017] [Indexed: 11/18/2022]
Abstract
Background Neurological and neurosurgical early rehabilitation (NNER) is a specialized treatment option for patients with severe neurological disorders. The present study investigated whether thyroid hormone levels on admission have an impact on the outcome of NNER patients. Method The study included 500 NNER patients who were admitted to the BDH-Clinic Hessisch Oldendorf between 2009 and 2010. Data such as age, sex, diagnoses, comorbidities, Glasgow Coma Scale score, length of stay, and thyroid hormone levels (obtained as part of clinical routine care) were analyzed retrospectively. Improvement in the Early Rehabilitation Barthel Index (ERBI) at the end of the NNER treatment was defined as outcome parameter. Results Most patients made functional progress during treatment, as reflected in significant enhancements of the ERBI. Approximately half of the patients were transferred to further rehabilitation treatment. Young age, early onset of NNER treatment, low functional impairment on admission, and, in particular, low total T3 levels were independently associated with a good outcome. Conclusion Age, severity of disease, and time between injury and admission are known to predict outcome. The present study confirms the influence of these general factors. In addition, an association between thyroid hormones and functional outcome was demonstrated for NNER patients.
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21
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Juth V, Holman EA, Chan MK, Cramer SC. Genetics as a molecular window into recovery, its treatment, and stress responses after stroke. J Investig Med 2016; 64:983-8. [PMID: 27045100 PMCID: PMC4942179 DOI: 10.1136/jim-2016-000126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2016] [Indexed: 01/13/2023]
Abstract
Stroke remains a major source of adult disability in the USA and worldwide. Most patients show some recovery during the weeks to months following a stroke, but this is generally incomplete. An emerging branch of therapeutics targets the processes underlying this behavioral recovery from stroke toward the goal of reducing long-term disability. A key factor hampering these efforts is the very large degree of variability between stroke survivors. Available data suggest that genetic differences could explain an important fraction of the differences between subjects. The current review considers this from several angles, including genetic differences in relation to drugs that promote recovery. Genetic factors related to physiological and psychological stress responses may also be critically important to understanding recovery after stroke and its treatment. The studies reviewed provide insights into recovery and suggest directions for further research to improve clinical decision-making in this setting. Genetic differences between patients might be used to help clinical trials select specific patient subgroups, on a biological basis, in order to sharpen the precision with which new treatments are evaluated. Pharmacogenomic factors might also provide insights into inter-subject differences in treatment side effects for pharmacological prescriptions, and behavioral interventions, and others. These efforts must be conducted with the strictest ethical standards given the highly sensitive nature of genetic data. Understanding the effect of selected genetic measures could improve a clinician's ability to predict the risk and efficacy of a restorative therapy and to make maximally informed decisions, and in so doing, facilitate individual patient care.
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Affiliation(s)
- Vanessa Juth
- Program in Nursing Science, UC Irvine, Irvine, California, USA
| | - E Alison Holman
- Program in Nursing Science, UC Irvine, Irvine, California, USA
| | - Michelle K Chan
- Program in Nursing Science, UC Irvine, Irvine, California, USA
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Cassidy JM, Cramer SC. Spontaneous and Therapeutic-Induced Mechanisms of Functional Recovery After Stroke. Transl Stroke Res 2016; 8:33-46. [PMID: 27109642 DOI: 10.1007/s12975-016-0467-5] [Citation(s) in RCA: 163] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 04/13/2016] [Accepted: 04/18/2016] [Indexed: 01/05/2023]
Abstract
With increasing rates of survival throughout the past several years, stroke remains one of the leading causes of adult disability. Following the onset of stroke, spontaneous mechanisms of recovery at the cellular, molecular, and systems levels ensue. The degree of spontaneous recovery is generally incomplete and variable among individuals. Typically, the best recovery outcomes entail the restitution of function in injured but surviving neural matter. An assortment of restorative therapies exists or is under development with the goal of potentiating restitution of function in damaged areas or in nearby ipsilesional regions by fostering neuroplastic changes, which often rely on mechanisms similar to those observed during spontaneous recovery. Advancements in stroke rehabilitation depend on the elucidation of both spontaneous and therapeutic-driven mechanisms of recovery. Further, the implementation of neural biomarkers in research and clinical settings will enable a multimodal approach to probing brain state and predicting the extent of post-stroke functional recovery. This review will discuss spontaneous and therapeutic-induced mechanisms driving post-stroke functional recovery while underscoring several potential restorative therapies and biomarkers.
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Affiliation(s)
- Jessica M Cassidy
- Department of Neurology, University of California, Irvine Medical Center, 200 S. Manchester Ave, Suite 206, Orange, CA, 92868-4280, USA
| | - Steven C Cramer
- Department of Neurology, University of California, Irvine Medical Center, 200 S. Manchester Ave, Suite 206, Orange, CA, 92868-4280, USA. .,Department of Anatomy & Neurobiology, University of California, Irvine, Irvine, CA, 92697, USA. .,Department of Physical Medicine & Rehabilitation, University of California, Irvine Medical Center, 200 S. Manchester Ave, Suite 210, Orange, CA, 92868-5397, USA. .,Sue & Bill Gross Stem Cell Research Center, University of California, Irvine, 845 Health Sciences Rd, Irvine, 92697, CA, USA.
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