Evidence of chronic stroke rehabilitation interventions in activities and participation outcomes: systematic review of meta-analyses of randomized controlled trials

The Use of Portable Devices for the Instrumental Assessment of Balance in Patients with Chronic Stroke: A Systematic Review

BACKGROUND

Improving balance remains a challenge in stroke rehabilitation. The technological development has allowed the design of more accessible and user-friendly systems for assessing postural control.

OBJECTIVES

The aim of this review was to analyze portable devices for the instrumental assessment of balance in patients with chronic stroke.

METHODS

PRISMA guidelines were used to carry out the systematic review. The literature search was restricted to articles written in English or Spanish published from 2013 to December 2022 in Pubmed, Web of Science, Scopus, PEDro, and CINAHL. Of the 309 search results, 229 unique references were reviewed after duplicates were removed. The PEDro scale was applied to evaluate the methodological quality of the included papers, and the degree of evidence and level of recommendation were determined through the Oxford Centre for Evidence-Based Medicine.

RESULTS

A total of seven articles reporting on five different balance testing devices were included in this systematic review; they regarded BIORescue, a smartphone application, and the Biodex-BioSway Balance System for the evaluation of standing balance, and SwayStar Balance and Xsens ForceShoes™ for the evaluation of dynamic balance during walking.

CONCLUSIONS

The use of portable devices that assess balance in adult patients with chronic stroke is scarce.

Changes in stroke rehabilitation during the SARS-CoV-2 shutdown in Switzerland

Introduction

Many stroke survivors require continuous outpatient rehabilitation therapy to maintain or improve their neurological functioning, independence, and quality of life. In Switzerland and many other countries, the shutdown to contain SARS-CoV-2 infections led to mobility restrictions and a decrease in therapy delivery. This study investigated the impact of the COVID-19 shutdown on stroke survivors’ access to therapy, physical activity, functioning and mood.

Methods

A prospective observational cohort study in stroke subjects. At 4 time-points (before, during, after the shutdown, and at 3-month follow-up), the amount of therapy, physical activities, motor function, anxiety, and depression were assessed.

Results

Thirty-six community-dwelling stroke subjects (median 70 years of age, 10 months post-stroke) were enrolled. Therapy reductions related to the shutdown were reported in 72% of subjects. This decrease was associated with significantly extended sedentary time and minimal deterioration in physical activity during the shutdown. Both parameters improved between reopening and 3-month follow-up. Depressive symptoms increased slightly during the observation period. Patients more frequently reported on self-directed training during shutdown.

Conclusion

The COVID-19 shutdown had measurable immediate, but no persistent, effects on post-stroke outcomes, except for depression. Importantly, a 2-month reduction in therapy may trigger improvements when therapy is fully re-initiated thereafter.

Wireless Motion Capture System for Upper Limb Rehabilitation

This work is devoted to the presentation of a Wireless Sensor System implementation for upper limb rehabilitation to function as a complementary system for a patient’s progress supervision during rehabilitation exercises. A cost effective motion capture sensor node composed by a 9 Degrees-of-Freedom (DoF) Inertial Measurement Unit (IMU) is mounted on the patient’s upper limb segments and sends wirelessly the corresponding measured signals to a base station. The sensor orientation and the upper limb individual segments movement in 3-Dimensional (3D) space are derived by processing the sensors’ raw data. For the latter purpose, a biomechanical model which resembles that of a kinematic model of a robotic arm based on the Denavit-Hartenberg (DH) configuration is used to approximate in real time the upper limb movements. The joint angles of the upper limb model are estimated from the extracted sensor node’s orientation angles. The experimental results of a human performing common rehabilitation exercises using the proposed motion capture sensor node are compared with the ones using an off-the-shelf sensor. This comparison results to very low error rates with the root mean square error (RMSE) being about 0.02 m.

Enriched Music-supported Therapy for chronic stroke patients: a study protocol of a randomised controlled trial

BACKGROUND

Residual motor deficits of the upper limb in patients with chronic stroke are common and have a negative impact on autonomy, participation and quality of life. Music-Supported Therapy (MST) is an effective intervention to enhance motor and cognitive function, emotional well-being and quality of life in chronic stroke patients. We have adapted the original MST training protocol to a home-based intervention, which incorporates increased training intensity and variability, group sessions, and optimisation of learning to promote autonomy and motivation.

METHODS

A randomised controlled trial will be conducted to test the effectiveness of this enriched MST (eMST) protocol in improving motor functions, cognition, emotional well-being and quality of life of chronic stroke patients when compared to a program of home-based exercises utilizing the Graded Repetitive Arm Supplementary Program (GRASP). Sixty stroke patients will be recruited and randomly allocated to an eMST group (n = 30) or a control GRASP intervention group (n = 30). Patients will be evaluated before and after a 10-week intervention, as well as at 3-month follow-up. The primary outcome of the study is the functionality of the paretic upper limb measured with the Action Research Arm Test. Secondary outcomes include other motor and cognitive functions, emotional well-being and quality of life measures as well as self-regulation and self-efficacy outcomes.

DISCUSSION

We hypothesize that patients treated with eMST will show larger improvements in their motor and cognitive functions, emotional well-being and quality of life than patients treated with a home-based GRASP intervention.

TRIAL REGISTRATION

The trial has been registered at ClinicalTrials.gov and identified as NCT04507542 on 8 August 2020.

Health-Related Rehabilitation after the 2008 Great Wenchuan Earthquake in China: A Ten Year Retrospective Systematic Review

Being one of the world's seismically hazard-prone countries, the People's Republic of China (PRC) witnessed an 8.0-magnitude earthquake on May 12th 2008-which was reported as one of the most destructive disasters since its founding. Following this earthquake, rehabilitation was greatly required for survivors to enable them to achieve and maintain optimal independence; functioning; full physical, mental and social ability; inclusion; and participation in all aspects of life and environments. We conducted a systematic review based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to retrospectively identify, in five English databases/sources, the existing evidence about the Health-Related Rehabilitation (HRR) that was rendered to the survivors of the 2008 Wenchuan earthquake between 2008 and 2018. Only 11 studies out of 828 initial studies retrieved were included in our study and reported the survivors of the 2008 Wenchuan earthquake to have been aged between 10.5 and 55.7, and predominantly diagnosed with posttraumatic stress disorders. Their HRR was mainly premised on physical and physiological therapies, as well as traditional Chinese medicine and digital technologies. Although all HRR interventions used were reported to be effective, none was identified as much more effective than the others in the post-earthquake era -which calls for more robust research to build upon our systematic review.