1
|
Kumar DS, Bodt BA, Galloway JC. Real-world environmental enrichment rehabilitation paradigm in people with severe traumatic brain injury: a pilot feasibility study. Brain Inj 2024; 38:742-749. [PMID: 38695288 DOI: 10.1080/02699052.2024.2347551] [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: 04/23/2023] [Accepted: 04/22/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND The use of Environmental Enrichment (EE) has been widely studied in animal models. However, the application of the same in humans is limited to rehabilitation settings. OBJECTIVE To investigate the feasibility of a community-based EE paradigm in adults with brain injury. METHODS Six individuals diagnosed with traumatic brain injury enrolled in the study. The Go Baby Go Café instrumented with a body weight harness system, provided physical and social enrichment as participants performed functional tasks for 2 hours, three times a week, for 2 months. Feasibility and safety outcomes were recorded throughout sessions. Clinical measures including 10-meter walk, timed up and go, jebsen hand function, 6-minute walk, and trail making tests were obtained pre and post intervention. RESULTS All participants completed the study. The attendance was 100% and adherence was 87%. Positive changes in clinical measures were statistically significant for the timed up and go (p = 0.0175), TUG-cognitive (p = 0.0064), 10-meter walk (p = 0.0428), six-minute walk (p = 0.0196), TMT-A (p = 0.034). Changes in JHFT were not significant (p = 0.0506), with one subject recording values counter to the trend. CONCLUSION The Café was a comprehensive EE-based intervention that was feasible, safe, and has the potential to enhance motor and cognitive function in individuals with brain injury.
Collapse
Affiliation(s)
- Devina S Kumar
- Burke Neurological Institute, White Plains, New York, USA
| | | | - James C Galloway
- University of Delaware, Newark, Delaware, USA
- Baylor University, Waco, Texas, USA
| |
Collapse
|
2
|
Abuatiq RA, Hoffman ME, LaForme Fiss A, Looper J, Feldner HA. Exploring the Efficacy of a Dynamic Harness System on Gross Motor Development and Motivation for Infants With Down Syndrome: A Pilot Study. Pediatr Phys Ther 2024:00001577-990000000-00099. [PMID: 39073058 DOI: 10.1097/pep.0000000000001130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
PURPOSE To explore the benefits of a Partial Body Weight Support (PBWS) harness system within a play enriched environment on gross motor development and mastery motivation of infants with Down Syndrome (DS). METHODS A randomized crossover study with 17 pre-walking infants with DS in two conditions-play with or without the harness engaged-each for 3×/week over 3 weeks with a 1-week washout. Assessments took place at baseline, crossover, and completion. RESULTS Statistically and clinically significant changes were evident on the Gross Motor Function Measure-88; however, there were no significant changes in parent-reported mastery motivation. CONCLUSION The combination of PBWS harness system support and high frequency-facilitated play within an enriched play environment positively affected gross motor development. The intervention did not impact mastery motivation skills, and the direct impact of the harness remains unclear.
Collapse
Affiliation(s)
- Reham A Abuatiq
- Department of Rehabilitation Medicine (Ms Abuatiq and Dr Feldner), University of Washington; Department of Mechanical Engineering (Ms Hoffman), University of Washington, Seattle, Washington State; School of Physical Therapy (Dr LaForme Fiss), Texas Woman's University, Dallas, Texas; Physical Therapy Department (Dr Looper), University of Puget Sound, Tacoma, Washington State
| | | | | | | | | |
Collapse
|
3
|
Subramanian SK, Morgan RT, Rasmusson C, Shepherd KM, Li CL. Genetic polymorphisms and post-stroke upper limb motor improvement - A systematic review and meta-analysis. J Cent Nerv Syst Dis 2024; 16:11795735241266601. [PMID: 39049838 PMCID: PMC11268047 DOI: 10.1177/11795735241266601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 06/10/2024] [Indexed: 07/27/2024] Open
Abstract
Background Post-stroke upper limb (UL) motor improvement is associated with adaptive neuroplasticity and motor learning. Both intervention-related (including provision of intensive, variable, and task-specific practice) and individual-specific factors (including the presence of genetic polymorphisms) influence improvement. In individuals with stroke, most commonly, polymorphisms are found in Brain Derived Neurotrophic Factor (BDNF), Apolipoprotein (APOE) and Catechol-O-Methyltransferase (COMT). These involve a replacement of cystine by arginine (APOEε4) or valines by 1 or 2 methionines (BDNF:val66met, met66met; COMT:val158met; met158met). However, the implications of these polymorphisms on post-stroke UL motor improvement specifically have not yet been elucidated. Objective Examine the influence of genetic polymorphism on post-stroke UL motor improvement. Design Systematic Review and Meta-Analysis. Methods We conducted a systematic search of the literature published in English language. The modified Downs and Black checklist helped assess study quality. We compared change in UL motor impairment and activity scores between individuals with and without the polymorphisms. Meta-analyses helped assess change in motor impairment (Fugl Meyer Assessment) scores based upon a minimum of 2 studies/time point. Effect sizes (ES) were quantified based upon the Rehabilitation Treatment Specification System as follows: small (0.08-0.18), medium (0.19 -0.40) and large (≥0.41). Results We retrieved 10 (4 good and 6 fair quality) studies. Compared to those with BDNF val66met and met66met polymorphism, meta-analyses revealed lower motor impairment (large ES) in those without the polymorphism at intervention completion (0.5, 95% CI: 0.11-0.88) and at retention (0.58, 95% CI:0.06-1.11). The presence of CoMT val158met or met158met polymorphism had similar results, with lower impairment (large ES ≥1.5) and higher activity scores (large ES ranging from 0.5-0.76) in those without the polymorphism. Presence of APOEε4 form did not influence UL motor improvement. Conclusion Polymorphisms with the presence of 1 or 2 met alleles in BDNF and COMT negatively influence UL motor improvement. Registration https://osf.io/wk9cf/.
Collapse
Affiliation(s)
- Sandeep K. Subramanian
- Department of Physical Therapy, School of Health Professions, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Department of Physician Assistant Studies, School of Health Professions, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Department of Rehabilitation Medicine, Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Center for Biomedical Neurosciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Riley T. Morgan
- Department of Physical Therapy, School of Health Professions, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Carl Rasmusson
- Department of Physical Therapy, School of Health Professions, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Kayla M. Shepherd
- Department of Physical Therapy, School of Health Professions, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Carol L. Li
- Department of Rehabilitation Medicine, Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Audie L. Murphy VA Hospital, South Texas Veterans Health Administration, Polytrauma Rehabilitation Center, San Antonio, TX, USA
| |
Collapse
|
4
|
Hussain T, Wang D, Li B. The influence of the COVID-19 pandemic on the adoption and impact of AI ChatGPT: Challenges, applications, and ethical considerations. Acta Psychol (Amst) 2024; 246:104264. [PMID: 38626597 DOI: 10.1016/j.actpsy.2024.104264] [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: 12/06/2023] [Revised: 04/08/2024] [Accepted: 04/09/2024] [Indexed: 04/18/2024] Open
Abstract
DESIGN/METHODOLOGY/APPROACH This article employs qualitative thematic modeling to gather insights from 30 informants. The study explores various aspects related to the impact of the COVID-19 pandemic on AI ChatGPT technologies. PURPOSE The purpose of this research is to examine how the COVID-19 pandemic has influenced the increased usage and adoption of AI ChatGPT. It aims to explore the pandemic's impact on AI ChatGPT and its applications in specific domains, as well as the challenges and opportunities it presents. FINDINGS The findings highlight that the pandemic has led to a surge in online activities, resulting in a heightened demand for AI ChatGPT. It has been widely used in areas such as healthcare, mental health support, remote collaboration, and personalized customer experiences. The article showcases examples of AI ChatGPT's application during the pandemic. STRENGTH OF STUDY This qualitative framework enables the study to delve deeply into the multifaceted dimensions of AI ChatGPT's role during the pandemic, capturing the diverse experiences and insights of users, practitioners, and experts. By embracing the qualitative nature of inquiry and this research offers a comprehensive understanding of the challenges, opportunities, and ethical considerations associated with the adoption and utilization of AI ChatGPT in crisis contexts. PRACTICAL IMPLICATIONS The insights from this research have practical implications for policymakers, developers, and researchers. This reserach emphasize the need for responsible and ethical implementation of AI ChatGPT to fully harness its potential in addressing societal needs during and beyond the pandemic. SOCIAL IMPLICATIONS The increased reliance on AI ChatGPT during the pandemic has led to changes in user behavior, expectations, and interactions. However, it has also unveiled ethical considerations and potential risks. Addressing societal and ethical concerns, such as user impact and autonomy, privacy and security, bias and fairness, and transparency and accountability, is crucial for the responsible deployment of AI ChatGPT. ORIGINALITY/VALUE This research contributes to the understanding of the novel role of AI ChatGPT in times of crisis, particularly in the era of COVID-19 pandemic. It highlights the necessity of responsible and ethical implementation of AI ChatGPT and provides valuable insights for the development and application of AI technology in the future.
Collapse
Affiliation(s)
- Talib Hussain
- School of Media and Communication, Shanghai Jiao Tong University, 800 Dongchuan Road, 2002240 Shanghai, China; Department of Media Management, University of Religions and Denominations, Qom 37491-13357, Iran.
| | - Dake Wang
- School of Media and Communication, Shanghai Jiao Tong University, 800 Dongchuan Road, 2002240 Shanghai, China.
| | - Benqian Li
- School of Media and Communication, Shanghai Jiao Tong University, 800 Dongchuan Road, 2002240 Shanghai, China.
| |
Collapse
|
5
|
Anåker A, Kevdzija M, Elf M. Enriched Environments in Stroke Units: Defining Characteristics and Limitations. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2024; 17:344-359. [PMID: 38494920 PMCID: PMC11080395 DOI: 10.1177/19375867231224972] [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: 03/19/2024]
Abstract
BACKGROUND Individuals with stroke rehabilitated in an enriched environment (EE) compared to a non-EE are more likely to participate in cognitive and social activities, promoting their rehabilitation and well-being. There is a need for a more comprehensive understanding of methods to implement EEs within complex health systems, particularly in stroke units. OBJECTIVE The aim of this systematic review was to compile the concept of an EE in stroke units. METHODS The literature was sourced from CINAHL, Embase, and Medline databases. A detailed screening and sifting process was used to identify relevant literature. Multiple reviewers independently appraised the identified literature using a Mixed-methods Appraisal Tool. After screening 336 studies, 11 were included. RESULTS This review reveals an EE is challenging to define and almost exclusively about activities based on access to individual and communal equipment. Generally, there are no common descriptions or conceptual agreements. CONCLUSIONS To the best of our knowledge, this is the first study to systematically review the concept of an EE in stroke units and shows that more studies on EEs are needed. The weak definitions and unclear theoretical backgrounds of an EE in the included studies could challenge operationalization. Future research should be based on more precise definitions of an EE and broader interventions that include changes to built and natural environments.
Collapse
Affiliation(s)
- Anna Anåker
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Maja Kevdzija
- TU Wien, Department of Building Theory by Design, Faculty of Architecture and Planning, Institute of Architecture and Design, Vienna, Austria
| | - Marie Elf
- School of Health and Welfare, Dalarna University, Falun, Sweden
| |
Collapse
|
6
|
Ribbe Kelso L, Stockton K, Mahendran N, Brauer SG, Rosbergen I. The influence of communal spaces on patient activity in rehabilitation: a mixed methods study. Disabil Rehabil 2024; 46:309-321. [PMID: 36587814 DOI: 10.1080/09638288.2022.2160834] [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: 03/18/2022] [Accepted: 12/16/2022] [Indexed: 01/03/2023]
Abstract
PURPOSE This study aimed to determine whether patients are more active in communal spaces compared to their bedrooms and explore patient perspectives on communal spaces for activity, rest, and wellbeing. MATERIALS AND METHODS A prospective study observed participants via behavioural mapping in a mixed inpatient rehabilitation unit for up to three days. Physical, social, and cognitive activity levels in communal spaces were compared with activity in bedrooms using independent t-tests. Three focus groups explored participants' perspectives on communal spaces for activity, rest and wellbeing using thematic analysis. RESULTS Thirty-three participants (age 71.6 ± 13years, 39%male) were observed, and a subset (n = 12) (age 67.3 ± 16.9, 50%male) participated in focus groups. Participants spent a greater proportion of time being physically active (mean difference 22.7%, 95%CI 8.7-36.6, p = 0.002) and socially active (mean difference 23.6%, 95%CI 9.1-38.1, p = 0.002) in communal spaces than bedrooms. No difference in cognitive activity was found. Participants perceived communal spaces to positively influence mood and activity. Reduced independence was a barrier, while visitors, activities, and an inviting design attracted people to communal areas. CONCLUSION Communal spaces may positively influence patient activity and mood during inpatient rehabilitation. Future studies should seek strategies to optimise engagement in communal environments.IMPLICATIONS FOR REHABILITATIONOptimising patient activity throughout the day in inpatient rehabilitation is important to support recovery.Communal spaces in inpatient rehabilitation hospitals can positively influence patient activity and mood.Strategies to promote use of communal spaces in the inpatient rehabilitation hospital are needed.
Collapse
Affiliation(s)
- Lucy Ribbe Kelso
- Department of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Kellie Stockton
- Department of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Surgical, Treatment and Rehabilitation Service (STARS), Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Niruthikha Mahendran
- Department of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Sandra G Brauer
- Department of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Ingrid Rosbergen
- Department of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Surgical, Treatment and Rehabilitation Service (STARS), Metro North Hospital and Health Service, Brisbane, Queensland, Australia
- Department of Physiotherapy, Faculty of Health, University of Applied Sciences Leiden, Leiden, The Netherlands
| |
Collapse
|
7
|
Nie L, He J, Wang J, Wang R, Huang L, Jia L, Kim YT, Bhawal UK, Fan X, Zille M, Jiang C, Chen X, Wang J. Environmental Enrichment for Stroke and Traumatic Brain Injury: Mechanisms and Translational Implications. Compr Physiol 2023; 14:5291-5323. [PMID: 38158368 DOI: 10.1002/cphy.c230007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Acquired brain injuries, such as ischemic stroke, intracerebral hemorrhage (ICH), and traumatic brain injury (TBI), can cause severe neurologic damage and even death. Unfortunately, currently, there are no effective and safe treatments to reduce the high disability and mortality rates associated with these brain injuries. However, environmental enrichment (EE) is an emerging approach to treating and rehabilitating acquired brain injuries by promoting motor, sensory, and social stimulation. Multiple preclinical studies have shown that EE benefits functional recovery, including improved motor and cognitive function and psychological benefits mediated by complex protective signaling pathways. This article provides an overview of the enriched environment protocols used in animal models of ischemic stroke, ICH, and TBI, as well as relevant clinical studies, with a particular focus on ischemic stroke. Additionally, we explored studies of animals with stroke and TBI exposed to EE alone or in combination with multiple drugs and other rehabilitation modalities. Finally, we discuss the potential clinical applications of EE in future brain rehabilitation therapy and the molecular and cellular changes caused by EE in rodents with stroke or TBI. This article aims to advance preclinical and clinical research on EE rehabilitation therapy for acquired brain injury. © 2024 American Physiological Society. Compr Physiol 14:5291-5323, 2024.
Collapse
Affiliation(s)
- Luwei Nie
- Department of Pain Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Human Anatomy, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan Province, China
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jinxin He
- Department of Pain Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Human Anatomy, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan Province, China
- Key Laboratory for Brain Science Research and Transformation in the Tropical Environment of Hainan Province, Hainan Medical University, Haikou, China
| | - Junmin Wang
- Department of Human Anatomy, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan Province, China
| | - Ruike Wang
- Department of Human Anatomy, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan Province, China
| | - Leo Huang
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Lin Jia
- Department of Human Anatomy, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan Province, China
| | - Yun Tai Kim
- Division of Functional Food Research, Korea Food Research Institute, Wanju-gun, Jeollabuk-do, Republic of Korea
- Department of Food Biotechnology, Korea University of Science & Technology, Daejeon, Republic of Korea
| | - Ujjal K Bhawal
- Research Institute of Oral Science, Nihon University School of Dentistry at Matsudo, Chiba, Japan
- Center for Global Health Research, Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India
| | - Xiaochong Fan
- Department of Pain Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Marietta Zille
- Department of Pharmaceutical Sciences, Division of Pharmacology and Toxicology, University of Vienna, Vienna, Austria
| | - Chao Jiang
- Department of Neurology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Xuemei Chen
- Department of Human Anatomy, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan Province, China
| | - Jian Wang
- Department of Pain Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Human Anatomy, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan Province, China
| |
Collapse
|
8
|
Chen X, Wang W, Li H, Zhang X. Enriched environment alleviates neurological deficits via downregulation of Cx43 after experimental stroke. Brain Res 2023; 1821:148619. [PMID: 37805009 DOI: 10.1016/j.brainres.2023.148619] [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: 06/08/2023] [Revised: 09/21/2023] [Accepted: 10/04/2023] [Indexed: 10/09/2023]
Abstract
While it has been demonstrated that enriched environment (EE) can protect against cerebral ischemia/reperfusion (I/R) injury, the underlying mechanism remains largely unknown. Connexin 43 (Cx43) is a key component of gap junctions, which may mediate cell-to-cell communication in neural cells. This study aimed to investigate the neuroprotective effects of EE against cerebral I/R injury in rats by modulating Cx43. A rat model of cerebral I/R injury was established by middle cerebral artery occlusion (MCAO)/reperfusion. Rats were randomly divided into the sham, MCAO, MCAO + EE, MCAO + Gap19, and MCAO + EE + Gap19 groups. The modified neurological severity score test and Morris water maze assay were used to assess neurological deficits. The infarct volume was measured using triphenyltetrazolium chloride (TTC) staining. Neuronal survival was detected by immunofluorescence. The indices of oxidative stress were determined using ELISA, and the reactive oxygen species levels were determined using a dihydroethidium probe. Cx43 and inflammation-related protein expression levels were also measured using western blotting and immunohistochemistry. EE and Gap19 treatment significantly improved neurological deficits, reduced infarct volumes, attenuated neuronal injury, and suppressed inflammatory cytokine expression and oxidative stress. Furthermore, EE and Gap19 treatment notably downregulated the expression of Cx43 and the inflammation-related pathway TLR4/MyD88/NF-κB in the ischemic penumbra. Gap19, a Cx43 inhibitor, markedly enhanced the neuroprotective effects of EE in rats with cerebral I/R injury. EE treatment protects against cerebral I/R injury in rats via Cx43 downregulation. Our findings may shed light on the mechanism underlying the protective efficacy of EE.
Collapse
Affiliation(s)
- Xiuping Chen
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wansong Wang
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Hui Li
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Ruijin 2rd, Shanghai 200025, China.
| | - Xin Zhang
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, 169 Donghu Street, Wuhan 430071, Hubei, China.
| |
Collapse
|
9
|
Nedergård H, Sandlund M, Häger CK, Palmcrantz S. Users' experiences of intensive robotic-assisted gait training post-stroke - "a push forward or feeling pushed around?". Disabil Rehabil 2023; 45:3861-3868. [PMID: 36342771 DOI: 10.1080/09638288.2022.2140848] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/17/2022] [Accepted: 10/23/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE Robotic-assisted gait training (RAGT) is suggested to improve walking ability after stroke. The purpose of this study was to describe experiences of robotic-assisted gait training as part of a gait training intervention among persons in the chronic phase after stroke. MATERIALS AND METHODS Semi-structured interviews were performed with 13 participants after a 6-week intervention including treadmill gait training with the Hybrid Assistive Limb® (HAL) exoskeleton. Data were analysed using qualitative content analysis. RESULTS Four categories emerged: (1) A rare opportunity for potential improvements describes the mindset before the start of the intervention; (2) Being pushed to the limit represents the experience of engaging in intensive gait training; (3) Walking with both resistance and constraints reveals barriers and facilitators during HAL training; (4) Reaching the end and taking the next step alone illustrates feelings of confidence or concern as the intervention ended. CONCLUSIONS The gait training intervention including RAGT was considered demanding but appreciated. Support and concrete, individual feedback was crucial for motivation, whilst the lack of variation was a barrier. Results encourage further development of exoskeletons that are comfortable to wear and stimulate active participation by enabling smoothly synchronised movements performed during task-specific activities in different environments. IMPLICATIONS FOR REHABILITATIONWhen provided in a suitable context, the mental and physical challenges of intensive robotic-assisted gait training can be both inspiring and motivating.Support and engagement along with informative feedback from therapists are suggested crucial for motivation.Intensive task-specific gait training may preferably be performed in an enriched environment and combined with other physiotherapy treatments to stimulate engagement.
Collapse
Affiliation(s)
- Heidi Nedergård
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Marlene Sandlund
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Charlotte K Häger
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Susanne Palmcrantz
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
10
|
Luo Q, Zheng J, Fan B, Liu J, Liao W, Zhang X. Enriched environment attenuates ferroptosis after cerebral ischemia/reperfusion injury by regulating iron metabolism. Brain Res Bull 2023; 203:110778. [PMID: 37812906 DOI: 10.1016/j.brainresbull.2023.110778] [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] [Received: 08/09/2023] [Revised: 09/20/2023] [Accepted: 10/06/2023] [Indexed: 10/11/2023]
Abstract
Preventing neuronal death after ischemic stroke (IS) is crucial for neuroprotective treatment, yet current management options are limited. Enriched environment (EE) is an effective intervention strategy that promotes the recovery of neurological function after cerebral ischemia/reperfusion (I/R) injury. Ferroptosis has been identified as one of the mechanisms of neuronal death during IS, and inhibiting ferroptosis can reduce cerebral I/R injury. Our previous research has demonstrated that EE reduced ferroptosis by inhibiting lipid peroxidation, but the underlying mechanism still needs to be investigated. This study aims to explore the potential molecular mechanisms by which EE modulates iron metabolism to reduce ferroptosis. The experimental animals were randomly divided into four groups based on the housing environment and the procedure the animals received: the sham-operated + standard environment (SSE) group, the sham-operated + enriched environment (SEE) group, the ischemia/reperfusion + standard environment (ISE) group, and the ischemia/reperfusion + enriched environment (IEE) group. The results showed that EE reduced IL-6 expression during cerebral I/R injury, hence reducing JAK2-STAT3 pathway activation and hepcidin expression. Reduced hepcidin expression led to decreased DMT1 expression and increased FPN1 expression in neurons, resulting in lower neuronal iron levels and alleviated ferroptosis. In addition, EE also reduced the expression of TfR1 in neurons. Our research suggested that EE played a neuroprotective role by modulating iron metabolism and reducing neuronal ferroptosis after cerebral I/R injury, which might be achieved by inhibiting inflammatory response and down-regulating hepcidin expression.
Collapse
Affiliation(s)
- Qihang Luo
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jun Zheng
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Bin Fan
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jingying Liu
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Weijing Liao
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.
| | - Xin Zhang
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.
| |
Collapse
|
11
|
Lavis H, van Vliet P, Tavener M. Stroke survivor, caregiver and therapist experiences of home-based stroke rehabilitation: a thematic synthesis of qualitative studies. PHYSICAL THERAPY REVIEWS 2023. [DOI: 10.1080/10833196.2023.2180710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Affiliation(s)
- Heidi Lavis
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
| | - Paulette van Vliet
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
| | - Meredith Tavener
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
| |
Collapse
|
12
|
Talhada D, Ruscher K. Performing Enriched Environment Studies to Improve Functional Recovery. Methods Mol Biol 2023; 2616:355-366. [PMID: 36715945 DOI: 10.1007/978-1-0716-2926-0_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Physical therapy and social interactions between the stroke patient and healthcare professionals or relatives facilitate the process of recovery and promote improvement of lost neurological function after stroke. These observations can be mimicked in an experimental setting by multimodal stimulation provided in the concept of enriched environment. The enriched environment is a housing condition combining social interactions and sensorimotor stimulation that improves lost neurological function without affecting the extent of brain damage after experimental stroke. This chapter provides a detailed protocol on how to perform enriched housing experiments including conceptual and technical considerations as a tool to investigate mechanisms of recovery after brain injury.
Collapse
Affiliation(s)
- Daniela Talhada
- Laboratory for Experimental Brain Research, Wallenberg Neuroscience Center, Lund University, Lund, Sweden
| | - Karsten Ruscher
- Laboratory for Experimental Brain Research, Wallenberg Neuroscience Center, Lund University, Lund, Sweden.
| |
Collapse
|
13
|
Chen X, Liu L, Zhong Y, Liu Y. Enriched environment promotes post-stroke angiogenesis through astrocytic interleukin-17A. Front Behav Neurosci 2023; 17:1053877. [PMID: 36873773 PMCID: PMC9979086 DOI: 10.3389/fnbeh.2023.1053877] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/01/2023] [Indexed: 02/18/2023] Open
Abstract
Objective Our previous studies have revealed that the protective effect of an enriched environment (EE) may be linked with astrocyte proliferation and angiogenesis. However, the relationship between astrocytes and angiogenesis under EE conditions still requires further study. The current research examined the neuroprotective effects of EE on angiogenesis in an astrocytic interleukin-17A (IL-17A)-dependent manner following cerebral ischemia/reperfusion (I/R) injury. Methods A rat model of ischemic stroke based on middle cerebral artery occlusion (MCAO) for 120 min followed by reperfusion was established, after which rats were housed in either EE or standard conditions. A set of behavior tests were conducted, including the modified neurological severity scores (mNSS) and the rotarod test. The infarct volume was evaluated by means of 2,3,5-Triphenyl tetrazolium chloride (TTC) staining. To evaluate the levels of angiogenesis, the protein levels of CD34 were examined by means of immunofluorescence and western blotting, while the protein and mRNA levels of IL-17A, vascular endothelial growth factor (VEGF), and the angiogenesis-associated factors interleukin-6 (IL-6), JAK2, and STAT3 were detected by western blotting and real-time quantitative PCR (RT-qPCR). Results We found that EE promoted functional recovery, reduced infarct volume, and enhanced angiogenesis compared to rats in standard conditions. IL-17A expression in astrocytes was also increased in EE rats. EE treatment increased the levels of microvascular density (MVD) and promoted the expression of CD34, VEGF, IL-6, JAK2, and STAT3 in the penumbra, while the intracerebroventricular injection of the IL-17A-neutralizing antibody in EE rats attenuated EE-mediated functional recovery and angiogenesis. Conclusion Our findings revealed a possible neuroprotective mechanism of astrocytic IL-17A in EE-mediated angiogenesis and functional recovery after I/R injury, which might provide the theoretical basis for EE in clinical practise for stroke patients and open up new ideas for the research on the neural repair mechanism mediated by IL-17A in the recovery phase of stroke.
Collapse
Affiliation(s)
- Xiuping Chen
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Lingling Liu
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yingjun Zhong
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yang Liu
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| |
Collapse
|
14
|
Zhou HY, Huai YP, Jin X, Yan P, Tang XJ, Wang JY, Shi N, Niu M, Meng ZX, Wang X. An enriched environment reduces hippocampal inflammatory response and improves cognitive function in a mouse model of stroke. Neural Regen Res 2022; 17:2497-2503. [PMID: 35535902 PMCID: PMC9120675 DOI: 10.4103/1673-5374.338999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
An enriched environment is used as a behavioral intervention therapy that applies sensory, motor, and social stimulation, and has been used in basic and clinical research of various neurological diseases. In this study, we established mouse models of photothrombotic stroke and, 24 hours later, raised them in a standard, enriched, or isolated environment for 4 weeks. Compared with the mice raised in a standard environment, the cognitive function of mice raised in an enriched environment was better and the pathological damage in the hippocampal CA1 region was remarkably alleviated. Furthermore, protein expression levels of tumor necrosis factor receptor-associated factor 6, nuclear factor κB p65, interleukin-6, and tumor necrosis factor α, and the mRNA expression level of tumor necrosis factor receptor-associated factor 6 were greatly lower, while the expression level of miR-146a-5p was higher. Compared with the mice raised in a standard environment, changes in these indices in mice raised in an isolated environment were opposite to mice raised in an enriched environment. These findings suggest that different living environments affect the hippocampal inflammatory response and cognitive function in a mouse model of stroke. An enriched environment can improve cognitive function following stroke through up-regulation of miR-146a-5p expression and a reduction in the inflammatory response.
Collapse
Affiliation(s)
- Hong-Yu Zhou
- Department of Rehabilitation Medicine, Northern Jiangsu People's Hospital Affiliated to Yangzhou University (Clinical Medical College, Yangzhou University), Yangzhou, Jiangsu Province, China
| | - Ya-Ping Huai
- Department of Rehabilitation Medicine, Shenzhen Longhua District Central Hospital, Shenzhen, Guangdong Province, China
| | - Xing Jin
- Department of Rehabilitation Medicine, Northern Jiangsu People's Hospital Affiliated to Yangzhou University (Clinical Medical College, Yangzhou University), Yangzhou, Jiangsu Province, China
| | - Ping Yan
- School of Nursing, Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Xiao-Jia Tang
- Department of Rehabilitation Medicine, Northern Jiangsu People's Hospital Affiliated to Yangzhou University (Clinical Medical College, Yangzhou University), Yangzhou, Jiangsu Province, China
| | - Jun-Ya Wang
- Department of Rehabilitation Medicine, Northern Jiangsu People's Hospital Affiliated to Yangzhou University (Clinical Medical College, Yangzhou University), Yangzhou, Jiangsu Province, China
| | - Nan Shi
- School of Nursing, Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Meng Niu
- Dalian Medical University, Dalian, Liaoning Province, China
| | - Zhao-Xiang Meng
- Department of Rehabilitation Medicine, Northern Jiangsu People's Hospital Affiliated to Yangzhou University (Clinical Medical College, Yangzhou University), Yangzhou, Jiangsu Province, China
| | - Xin Wang
- Department of Rehabilitation Medicine, Northern Jiangsu People's Hospital Affiliated to Yangzhou University (Clinical Medical College, Yangzhou University), Yangzhou, Jiangsu Province, China
| |
Collapse
|
15
|
Fulton S, Janssen H, Salih S, James A, Elphinston RA. Feasibility and acceptability of a mobile model of environmental enrichment for patients with mixed medical conditions receiving inpatient rehabilitation: a mixed methods study. BMJ Open 2022; 12:e061212. [PMID: 36115676 PMCID: PMC9486324 DOI: 10.1136/bmjopen-2022-061212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To investigate the feasibility and acceptability of a mobile model of environmental enrichment (EE), a paradigm that promotes activity engagement after stroke, in patients with mixed medical conditions receiving inpatient rehabilitation. DESIGN A mixed methods study design was used. An online qualitative survey assessed staff perspectives of acceptability of the mobile EE model including perceived barriers and enablers pre-implementation and post implementation. An A-B quasi-experimental case study of patient activity levels over a 2-week observational period provided feasibility data. This included recruitment and retention rates, completion of scheduled patient activity observations and validated baseline questionnaires, and number of adverse events. SETTING A 30-bed mixed medical ward in a public hospital that services Brisbane's southern bayside suburbs. The rehabilitation programme operates with patients co-located throughout the medical/surgical wards. PARTICIPANTS Nursing and allied health professionals working across the rehabilitation programme completed pre-implementation (n=19) and post implementation (n=16) qualitative questions. Patients admitted to the ward and who received the inpatient rehabilitation programme from June to November 2016 were also recruited. INTERVENTIONS The mobile EE intervention included activities to primarily promote social and cognitive stimulation (eg, puzzles, board games) delivered by hospital volunteers and was designed to be moved throughout the wards. RESULTS Four themes emerged from staff reports, suggesting that the role of patient, staff and intervention characteristics, and the ward environment were important barriers and enablers to implementation. Of the 12 eligible patients, six consented to the study, and five completed the intervention. All patients completed the baseline measures. No adverse events were reported. CONCLUSIONS As interest grows in human EE models, it will be important to tailor EE interventions to the unique demands of hospital rehabilitation services. A mobile EE model delivered in a small, mixed rehabilitation ward appears feasible and acceptable to study in a larger controlled feasibility trial.
Collapse
Affiliation(s)
- Sarah Fulton
- Speech Pathology Department, Redland Hospital, Metro South Hospital and Health Service, Brisbane, Queensland, Australia
| | - Heidi Janssen
- Hunter Stroke Service and Community and Aged Care Services, Community Stroke Team, Hunter New England Local Health District and Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Salih Salih
- Rehabilitation Unit, Redland Hospital, Metro South Hospital and Health Service, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Alecia James
- Speech Pathology Department, Redland Hospital, Metro South Hospital and Health Service, Brisbane, Queensland, Australia
| | - Rachel A Elphinston
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, Queensland, Australia
- National Health and Medical Research Council Centre of Research Excellence - Better Health Outcomes for Compensable Injury, The University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
16
|
Effect of prior exposure to enriched environment on cellular apoptosis after experimental stroke. Mol Biol Rep 2022; 49:6541-6551. [PMID: 35507114 DOI: 10.1007/s11033-022-07494-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/20/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Growing evidence, including our previous studies, has demonstrated that an enriched environment (EE) after cerebral ischemia/reperfusion (I/R) injury improves neurofunctional recovery in rats. However, whether EE exposure prior to injury could play a neuroprotective role in stroke has seldom been investigated. In this study, we examined the neuroprotective effects of prior exposure to EE and investigated the potential anti-apoptotic effect in rats after cerebral I/R injury. METHODS AND RESULTS Rats were housed in EE or standard conditions (SC) for four weeks and then randomly assigned to receive 120 min of right middle cerebral occlusion (MCAO) or sham operation. Based on the housing environment and the procedure they underwent, the rats were divided into the following three groups: preischemic EE + MCAO (PIEE), preischemic SC + MCAO (PISC) and preischemic SC + sham-operated (sham). Forty-eight hours after the operation, the rats were subjected to a series of assessments. We found that prior exposure to EE improved functional outcomes, reduced infarct volume and attenuated histological damage. The apoptotic cell numbers in the ischemic penumbra cortex decreased in PIEE group, as did the p53, PUMA, Bax and AIF expression levels. The protein expression of Bcl-2 and HSP70 was increased in the PIEE group compared with the PISC group. PIEE treatment also significantly increased the BDNF level in the ischemic penumbra. In addition, inhibition of cell apoptosis and upregulation of BDNF expression levels were correlated with the improved functional recovery of MCAO rats. CONCLUSIONS These findings suggest that EE preconditioning inhibited cell apoptosis and upregulated BDNF expression in the penumbra of MCAO rats, which may contribute to neurofunctional recovery after stroke.
Collapse
|
17
|
Flores-Ramos M, Yoldi-Negrete M, Guiza-Zayas R, Ramírez-Rodríguez GB, Montes-Castrejón A, Fresán A. An Indicator of environmental enrichment to measure physical, social and cognitive activities in human daily life. BMC Psychiatry 2022; 22:295. [PMID: 35468768 PMCID: PMC9040238 DOI: 10.1186/s12888-022-03952-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 04/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The concept of environmental enrichment (EE) encompasses complex physical, social, cognitive, motor, and somatosensory stimuli to which individuals are differentially exposed. An indicator of EE comprising these elements would facilitate the study of the impact of EE in diverse clinical settings by allowing an easy and comparable measurement. This study aimed to create and test such an EE indicator based on the Florida Cognitive Activities Scale (FCAS), the Multidimensional Social Integration in Later Life Scale (SILLS), and the International Physical Activity Questionnaire (IPAQ). METHODS Participants with major depression and control subjects were recruited in this cross-sectional comparative study. Depressive symptom severity was assessed with the Hamilton Depression Rating Scale (HAM-D). The EE indicator was used to evaluate cognitive, social, and physical activity. We divided the sample into three levels of cognitive and social activities to construct an EE indicator and compared the obtained scores between participants with major depression and control subjects. RESULTS 40 patients suffering from major depression and 50 control subjects were included. Higher HAM-D scores were associated with lower EE levels. Cognitive and social items exhibited adequate reliability. Control subjects reported higher scores in all three activities evaluated, except for some items of physical activities. This indicator of EE clearly differentiated between participants with major depression from control subjects. CONCLUSIONS FCAS, SILLS, and IPAQ used together are valid to evaluate EE. This EE indicator may be a useful tool during clinical practice. The cross-sectional design and the small sample size are limitations of the present study.
Collapse
Affiliation(s)
- Mónica Flores-Ramos
- grid.419154.c0000 0004 1776 9908Dirección de Enseñanza, Instituto Nacional de Psiquiatría “Ramón de la Fuente Muñiz”, Calzada México-Xochimilco 101, Col. San Lorenzo Huipulco, Tlalpan, C.P, 14370 Ciudad de México, Mexico
| | - María Yoldi-Negrete
- grid.419154.c0000 0004 1776 9908Laboratorio de Epidemiología Clínica, Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría “Ramón de la Fuente Muñiz”, Calzada México-Xochimilco 101, Col. San Lorenzo Huipulco, Tlalpan, C.P, 14370 Ciudad de México, Mexico
| | - Rodrigo Guiza-Zayas
- grid.419154.c0000 0004 1776 9908Dirección de Enseñanza, Instituto Nacional de Psiquiatría “Ramón de la Fuente Muñiz”, Calzada México-Xochimilco 101, Col. San Lorenzo Huipulco, Tlalpan, C.P, 14370 Ciudad de México, Mexico
| | - Gerardo-Bernabé Ramírez-Rodríguez
- grid.419154.c0000 0004 1776 9908Laboratorio de Neurogénesis, Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría “Ramón de la Fuente Muñiz”, Calzada México-Xochimilco 101, Col. San Lorenzo Huipulco, Tlalpan, C.P, 14370 Ciudad de México, Mexico
| | - Adolfo Montes-Castrejón
- grid.419154.c0000 0004 1776 9908Dirección de Enseñanza, Instituto Nacional de Psiquiatría “Ramón de la Fuente Muñiz”, Calzada México-Xochimilco 101, Col. San Lorenzo Huipulco, Tlalpan, C.P, 14370 Ciudad de México, Mexico
| | - Ana Fresán
- Laboratorio de Epidemiología Clínica, Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñiz", Calzada México-Xochimilco 101, Col. San Lorenzo Huipulco, Tlalpan, C.P, 14370, Ciudad de México, Mexico.
| |
Collapse
|
18
|
D'Souza S, Hersh D, Godecke E, Ciccone N, Janssen H, Armstrong E. Patients' experiences of a Communication Enhanced Environment model on an acute/slow stream rehabilitation and a rehabilitation ward following stroke: a qualitative description approach. Disabil Rehabil 2021; 44:6304-6313. [PMID: 34780322 DOI: 10.1080/09638288.2021.1965226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Patients in hospital following stroke express a desire to continue therapy tasks outside of treatment activities. However, they commonly describe experiences of boredom and inactivity. An enriched environment aims to provide opportunities for physical, cognitive and social activity and informed the development of a Communication Enhanced Environment (CEE) model to promote patient engagement in language activities. PURPOSE Explore patient perceptions of a CEE model, and barriers and facilitators to engagement in the model. METHODS A qualitative description study from a larger project that implemented a CEE model into acute and rehabilitation private hospital wards in Western Australia. Semi-structured interviews were conducted with seven patients, including four with aphasia, within 22 days post-stroke who had access to the CEE model. RESULTS Patients described variable experiences accessing different elements of the CEE model which were influenced by individual patient factors, staff factors, hospital features as well as staff time pressures. Those who were able to access elements of the CEE model described positive opportunities for engagement in language activities. CONCLUSIONS While findings are encouraging, further exploration of the feasibility of a CEE model in this complex setting is indicated to inform the development of this intervention.Implications for rehabilitationPatient access to a CEE model is challenging in a hospital setting.Patients who were able to access elements of the CEE model described positive opportunities for engagement in language activities.Patients' access to the CEE model was influenced by patient factors, staff factors, hospital features as well as staff time pressures.
Collapse
Affiliation(s)
- Sarah D'Souza
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia.,Centre for Aphasia Recovery and Rehabilitation Research, La Trobe University, Melbourne, Australia
| | - Deborah Hersh
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia.,Centre for Aphasia Recovery and Rehabilitation Research, La Trobe University, Melbourne, Australia
| | - Natalie Ciccone
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| | - Heidi Janssen
- School of Health Sciences, Hunter New England Local Health District, NSW Health, Australia
| | - Elizabeth Armstrong
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| |
Collapse
|
19
|
D'Souza S, Godecke E, Ciccone N, Hersh D, Armstrong E, Tucak C, Janssen H. Investigation of the implementation of a Communication Enhanced Environment model on an acute/slow stream rehabilitation and a rehabilitation ward: A before-and-after pilot study. Clin Rehabil 2021; 36:15-39. [PMID: 34749509 DOI: 10.1177/02692155211032655] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Develop and implement a Communication Enhanced Environment model and explore its effect on language activities for patients early after stroke. METHOD AND DESIGN Before-and-after pilot study. SETTING An acute/slow stream rehabilitation and a rehabilitation ward in a private hospital in Perth, Western Australia. PARTICIPANTS Fourteen patients recruited within 21 days of stroke. Seven recruited during the before-phase (control group: patients with aphasia = 3, patients without aphasia = 4) and seven recruited in the after-phase (intervention group: patients with aphasia = 4, patients without aphasia = 3). INTERVENTION The intervention group exposed to a Communication Enhanced Environment model had access to equipment, resources, planned social activities and trained communication partners. Both groups received usual stroke care. DATA COLLECTION Hospital site champions monitored the availability of the intervention. Behavioural mapping completed during the first minute of each 5-minute interval over 12 hours (between 7 am and 7 pm) determined patient engagement in language activities. RESULTS Seventy-one percent of the Communication Enhanced Environment model was available to the intervention group who engaged in higher, but not significant (95% CI), levels of language activities (600 of 816 observation time points, 73%) than the control group (551 of 835 observation time points, 66%). Unforeseen reorganisation of the acute ward occurred during the study. CONCLUSIONS Implementation of a Communication Enhanced Environment model was feasible in this specific setting and may potentially influence patients' engagement in language activities. The unforeseen contextual challenges that occurred during the study period demonstrate the challenging nature of the hospital environment and will be useful in future research planning.
Collapse
Affiliation(s)
- Sarah D'Souza
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia.,Centre for Aphasia Recovery and Rehabilitation Research, La Trobe University, Melbourne, VIC, Australia
| | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia.,Centre for Aphasia Recovery and Rehabilitation Research, La Trobe University, Melbourne, VIC, Australia
| | - Natalie Ciccone
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Deborah Hersh
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Elizabeth Armstrong
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Claire Tucak
- Hollywood Private Hospital, Nedlands, WA, Australia
| | - Heidi Janssen
- Hunter New England Local Health District, New Lambton Heights, NSW Health, NSW, Australia.,Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW, Australia
| |
Collapse
|
20
|
Lafiatoglou P, Ellis-Hill C, Gouva M, Ploumis A, Mantzoukas S. A systematic review of the qualitative literature on older individuals' experiences of care and well-being during physical rehabilitation for acquired brain injury. J Adv Nurs 2021; 78:377-394. [PMID: 34397112 PMCID: PMC9291982 DOI: 10.1111/jan.15016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/24/2021] [Accepted: 08/05/2021] [Indexed: 11/29/2022]
Abstract
Aims To acquire an in‐depth understanding of how older individuals diagnosed with acquired brain injury (ABI) experience their well‐being and care when undergoing physical rehabilitation. Design Systematic literature review. Data sources The electronic databases of PubMed, CINAHL, APA PsycInfo, ASSIA and SCOPUS were searched from 2005 to 2020. Extensive reference checking was also conducted. Review methods A systematic review was conducted following PRISMA guidelines, including predominantly qualitative studies. Studies’ quality was appraised using the critical apraisal skills programme (CASP) tool. Results Seventeen studies met the inclusion criteria. Following methods of thematic synthesis, four overarching interpretive themes were identified: (a) Rehabilitation processes and their impact on older individuals’ well‐being; (b) Identity and embodiment concerns of older individuals during rehabilitation; (c) Institutional factors affecting older individuals’ care and well‐being experiences; and (d) Older individuals’ participation in creative activities as part of rehabilitation. Conclusion Organizational and structural care deficiencies as well as health disparities can adversely impact older individuals’ autonomous decision‐making and goal‐setting potentials. The discrepancy between older individuals’ expectations and the reality of returning home along with the illusionary wish to return to a perceived normality, can further negatively affect older individuals’ sense of well‐being. Constructive communication, emotional support, family involvement in rehabilitation and creating a stimulating, enriching social environment can humanize and facilitate older individuals’ adjustment to their new reality following ABI. Impact There is a lack of qualitative research on older individuals’ ABI rehabilitation experiences, especially traumatic brain injury incidents. Further study should consider patients’ concerns over their involvement in decision‐making and goal setting about their care. Overall, this review reveals the need to examine further the significance of humanizing care and the factors that affect older individuals’ sense of well‐being.
Collapse
Affiliation(s)
| | | | - Mary Gouva
- Department of Nursing, University of Ioannina, Ioannina, Greece
| | - Avraam Ploumis
- Department of Medicine, University of Ioannina, Ioannina, Greece
| | | |
Collapse
|
21
|
Gresita A, Mihai R, Hermann DM, Amandei FS, Capitanescu B, Popa-Wagner A. Effect of environmental enrichment and isolation on behavioral and histological indices following focal ischemia in old rats. GeroScience 2021; 44:211-228. [PMID: 34382128 PMCID: PMC8811116 DOI: 10.1007/s11357-021-00432-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 08/04/2021] [Indexed: 01/27/2024] Open
Abstract
Stroke is a disease of aging. In stroke patients, the enriched group that received stimulating physical, eating, socializing, and group activities resulted in higher activity levels including spending more time on upper limb, communal socializing, listening and iPad activities. While environmental enrichment has been shown to improve the behavioral outcome of stroke in young animals, the effect of an enriched environment on behavioral recuperation and histological markers of cellular proliferation, neuroinflammation, and neurogenesis in old subjects is not known. We used behavioral testing and immunohistochemistry to assess the effect of environment on post-stroke recovery of young and aged rats kept either in isolation or stimulating social, motor, and sensory environment (( +)Env). We provide evidence that post-stroke animals environmental enrichment ( +)Env had a significant positive effect on recovery on the rotating pole, the inclined plane, and the labyrinth test. Old age exerted a small but significant effect on lesion size, which was independent of the environment. Further, a smaller infarct volume positively correlated with better recovery of spatial learning based on positive reinforcement, working and reference memory of young, and to a lesser extent, old animals kept in ( +)Env. Histologically, isolation/impoverishment was associated with an increased number of proliferating inflammatory cells expressing ED1 cells in the peri-infarcted area of old but not young rats. Further, ( +)Env and young age were associated with an increased number of neuroepithelial cells expressing nestin/BrdU as well as beta III tubulin cells in the damaged brain area which correlated with an increased performance on the inclined plane and rotating pole. Finally, ( +)Env and an increased number of neurons expressing doublecortin/BrdU cells exerted a significant effect on performance for working memory and performance on the rotating pole in both age groups. A stimulating social, motor and sensory environment had a limited beneficial effect on behavioral recovery (working memory and rotating pole) after stroke in old rats by reducing neuroinflammation and increasing the number of neuronal precursors expressing doublecortin. Old age however, exerted a small but significant effect on lesion size, which was independent of the environment.
Collapse
Affiliation(s)
- Andrei Gresita
- Doctoral School, University of Medicine and Pharmacy, Craiova, Romania
| | - Ruscu Mihai
- Doctoral School, University of Medicine and Pharmacy, Craiova, Romania
| | - Dirk M Hermann
- Department of Neurology Chair of Vascular Neurology and Dementia, University of Medicine Essen, Essen, Germany
| | | | | | - Aurel Popa-Wagner
- Department of Neurology Chair of Vascular Neurology and Dementia, University of Medicine Essen, Essen, Germany. .,Griffith University Menzies Health Institute of Queensland, Gold Coast Campus, Southport, QLD, 4222, Australia. .,Doctoral School, University of Medicine and Pharmacy, Craiova, Romania.
| |
Collapse
|
22
|
Lipson-Smith R, Pflaumer L, Elf M, Blaschke SM, Davis A, White M, Zeeman H, Bernhardt J. Built environments for inpatient stroke rehabilitation services and care: a systematic literature review. BMJ Open 2021; 11:e050247. [PMID: 34353805 PMCID: PMC8344318 DOI: 10.1136/bmjopen-2021-050247] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES To identify, appraise and synthesise existing design evidence for inpatient stroke rehabilitation facilities; to identify impacts of these built environments on the outcomes and experiences of people recovering from stroke, their family/caregivers and staff. DESIGN A convergent segregated review design was used to conduct a systematic review. DATA SOURCES Ovid MEDLINE, Scopus, Web of Science and Cumulative Index to Nursing and Allied Health Literature were searched for articles published between January 2000 and November 2020. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Qualitative, quantitative and mixed-methods studies investigating the impact of the built environment of inpatient rehabilitation facilities on stroke survivors, their family/caregivers and/or staff. DATA EXTRACTION AND SYNTHESIS Two authors separately completed the title, abstract, full-text screening, data extraction and quality assessment. Extracted data were categorised according to the aspect of the built environment explored and the outcomes reported. These categories were used to structure a narrative synthesis of the results from all included studies. RESULTS Twenty-four articles were included, most qualitative and exploratory. Half of the included articles investigated a particular aspect of the built environment, including environmental enrichment and communal areas (n=8), bedroom design (n=3) and therapy spaces (n=1), while the other half considered the environment in general. Findings related to one or more of the following outcome categories: (1) clinical outcomes, (2) patient activity, (3) patient well-being, (4) patient and/or staff safety and (5) clinical practice. Heterogeneous designs and variables of interest meant results could not be compared, but some repeated findings suggest that attractive and accessible communal areas are important for patient activity and well-being. CONCLUSIONS Stroke rehabilitation is a unique healthcare context where patient activity, practice and motivation are paramount. We found many evidence gaps that with more targeted research could better inform the design of rehabilitation spaces to optimise care. PROSPERO REGISTRATION NUMBER CRD42020158006.
Collapse
Affiliation(s)
- Ruby Lipson-Smith
- Stroke, Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Luis Pflaumer
- Stroke, Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Marie Elf
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Sarah-May Blaschke
- Stroke, Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Aaron Davis
- Stroke, Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Marcus White
- Centre for Design Innovation, The Swinburne University of Technology, Hawthorne, Melbourne, Australia
| | - Heidi Zeeman
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Meadowbrook, Queensland, Australia
| | - Julie Bernhardt
- Stroke, Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| |
Collapse
|
23
|
Kimura LF, Novaes LS, Picolo G, Munhoz CD, Cheung CW, Camarini R. How environmental enrichment balances out neuroinflammation in chronic pain and comorbid depression and anxiety disorders. Br J Pharmacol 2021; 179:1640-1660. [PMID: 34076891 DOI: 10.1111/bph.15584] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 04/05/2021] [Accepted: 05/17/2021] [Indexed: 11/30/2022] Open
Abstract
Depression and anxiety commonly occur in chronic pain states and the coexistence of these diseases worsens outcomes for both disorders and may reduce treatment adherence and response. Despite the advances in the knowledge of chronic pain mechanisms, pharmacological treatment is still unsatisfactory. Research based on exposure to environmental enrichment is currently under investigation and seems to offer a promising low-cost strategy with no side effects. In this review, we discuss the role of inflammation as a major biological substrate and aetiological factor of chronic pain and depression/anxiety and report a collection of preclinical evidence of the effects and mechanisms of environmental enrichment. As microglia participates in the development of both conditions, we also discuss microglia as a potential target underlying the beneficial actions of environmental enrichment in chronic pain and comorbid depression/anxiety. We also discuss how alternative interventions under clinical guidelines, such as environmental enrichment, may improve treatment compliance and patient outcomes.
Collapse
Affiliation(s)
- Louise F Kimura
- Laboratory of Pain and Signaling, Butantan Institute, São Paulo, Brazil
| | - Leonardo S Novaes
- Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Gisele Picolo
- Laboratory of Pain and Signaling, Butantan Institute, São Paulo, Brazil
| | - Carolina D Munhoz
- Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Chi W Cheung
- Department of Anesthesiology, University of Hong Kong, Hong Kong
| | - Rosana Camarini
- Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| |
Collapse
|
24
|
Jackson SM, Solomon SD, Barker RN. Recovering is about living my life, as it evolves: perspectives of stroke survivors in remote northwest Queensland. Disabil Rehabil 2021; 44:3843-3852. [PMID: 33625948 DOI: 10.1080/09638288.2021.1890242] [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: 10/22/2022]
Abstract
PURPOSE Recovering from stroke in remote Australia has rarely been considered, even though rehabilitation services are generally scarce. The primary purpose of this study was to explore stroke recovery, from the perspective of stroke survivors in remote northwest Queensland (NWQ), to explicate the lens through which they view recovering. The secondary purpose was to explore the role of technology to support stroke survivors in remote locations along their recovery journey. METHODS A qualitative study was undertaken using elements of constructivist grounded theory for data collection and analysis. Semi-structured interviews were conducted with fifteen stroke survivors and two partners living, working or travelling in remote NWQ. RESULTS From the participants' perspective, recovering in a remote area after stroke is about living my life, as it evolves by endeavouring to recover my way and navigating my recovery in my world. Technology was only considered helpful when it supported participants to recover their way in their world. CONCLUSION Recovering from stroke from the perspective of stroke survivors in remote NWQ is about living their life, as they want it to be, and as it unfolds within their own context. Technology only has a place when it can support them to recover their way in their world. These findings reinforce the importance of health professionals listening, learning about, and enabling stroke survivors along their recovery journey, within their remote context and support network.Implications for RehabilitationRecovering from the perspective of stroke survivors is about living their life as it evolves.To support stroke survivors from remote areas, health professionals need to listen to and learn from each stroke survivor about what matters to them, what works for them, and about their world; including the challenges (e.g., switching between services) and enablers (e.g., community support) as the stroke survivor perceives them.Finding ways to utilise the strengths within and around them, may improve the recovery process for the stroke survivor in a remote area, ensuring they can access care that meets their needs in their world.Working together with stroke survivors, health professionals need to consider how technology could help them to live their life, while recovering their way and in their world.
Collapse
Affiliation(s)
- Sarah M Jackson
- College of Healthcare Sciences, James Cook University, Townsville, Australia.,Murtupuni Centre for Rural and Remote Health, James Cook University, Mount Isa, Australia
| | - S D Solomon
- Murtupuni Centre for Rural and Remote Health, James Cook University, Mount Isa, Australia
| | - R N Barker
- Murtupuni Centre for Rural and Remote Health, James Cook University, Mount Isa, Australia.,College of Healthcare Sciences, James Cook University, Cairns, Australia
| |
Collapse
|
25
|
Last N, Packham TL, Gewurtz RE, Letts LJ, Harris JE. Exploring patient perspectives of barriers and facilitators to participating in hospital-based stroke rehabilitation. Disabil Rehabil 2021; 44:4201-4210. [PMID: 33569980 DOI: 10.1080/09638288.2021.1881830] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Patient participation is recognized as an important element of rehabilitation. However, few studies have used a qualitative lens to specifically examine factors influencing patient participation in stroke rehabilitation. AIM The purpose of this study was to investigate patient perspectives of barriers and facilitators to participating in hospital-based stroke rehabilitation. METHODS Semi-structured interviews were conducted with 11 patients, with confirmed diagnoses of stroke, recruited from three separate rehabilitation settings. Analysis of the interviews was guided by a process of interpretive description to identify key barriers and facilitators to participation in stroke rehabilitation. RESULTS Four main themes and corresponding sub-themes were constructed concerning participation in rehabilitation: (i) Environmental Factors, (ii) Components of Therapy, (iii) Physical and Emotional Well-Being, and (iv) Personal Motivators. An exploratory model of personalized rehabilitation emerged, integrating the themes emerging from the data. DISCUSSION Personalized rehabilitation can be considered in comparison to person-centred care principles. The barriers and enablers experienced by patients in this study contribute to the existing knowledge of the patient experience of stroke rehabilitation and may be used to inform clinical practices and future research.Implications for RehabilitationThe surrounding environments can facilitate participation in rehabilitation using strategies to reduce noise and disruption and also by encouraging social interactions among patients.Increasing the frequency and consistency of communication with patients about rehabilitation goals and progress could enhance participation.Designing interventions to include activities that are meaningful and focused on the resumption of valued life roles is key to participation.Therapy intensity, time spent sedentary, and the emotional impact of stroke are aspects of rehabilitation patient's feel are neglected.
Collapse
Affiliation(s)
- Nicole Last
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Tara L Packham
- School of Rehabilitation Science, McMaster University, Hamilton, Canada.,Regional Rehabilitation Program, Hamilton Health Sciences, Hamilton, Canada
| | - Rebecca E Gewurtz
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Lori J Letts
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Jocelyn E Harris
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| |
Collapse
|
26
|
Zhang P, Yang L, Li G, Jin Y, Wu D, Wang QM, Huang P. Agrin Involvement in Synaptogenesis Induced by Exercise in a Rat Model of Experimental Stroke. Neurorehabil Neural Repair 2020; 34:1124-1137. [PMID: 33135566 DOI: 10.1177/1545968320969939] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Agrin is a proteoglycan that aggregates nicotinic acetylcholine receptors (AChRs) on neuromuscular junctions and takes part in synaptogenesis in the development of the central nervous system. However, its effects on neural repair and synaptogenesis after stroke are still unclear. OBJECTIVE This study aimed to investigate the effects of agrin on neural repair and synaptogenesis after stroke and the effects of exercise on this process in vivo and in vitro. METHODS Exercise with gradually increased intensity was initiated at 1 day after middle cerebral artery occlusion (MCAO) for a maximum of 14 days. Neurological deficit scores and foot fault tests were used to assess the behavioral recovery. Western blotting, immunofluorescence, and electron microscopic images were used to detect the expression of agrin, synaptogenesis-related proteins, and synaptic density in vivo. In vitro, the ischemic neuron model was established via oxygen-glucose deprivation (OGD). The lentivirus overexpressed agrin and CREB inhibitor were used to investigate the mechanism by which agrin promoted synaptogenesis. RESULTS Exercise promoted behavioral recovery and this beneficial role was linked to the upregulated expression of agrin and increased synaptic density. Overexpressed agrin promoted synaptogenesis in OGD neuron, CREB inhibitor downregulated the expression of agrin and hampered synaptogenesis in cultured neurons. CONCLUSIONS These results indicated that exercise poststroke improved the recovery of behavioral function after stroke. Synaptogenesis was an important and beneficial factor, and agrin played a critical role in this process and could be a potential therapeutic target for the treatment of stroke and other nervous system diseases.
Collapse
Affiliation(s)
- Pengyue Zhang
- Yunnan University of Traditional Chinese Medicine, Kunming, China.,Kunming University of Science and Technology, Kunming, China
| | - Liqiang Yang
- Kunming University of Science and Technology, Kunming, China
| | - Guangxiang Li
- Kunming University of Science and Technology, Kunming, China
| | - Yaju Jin
- Yunnan University of Traditional Chinese Medicine, Kunming, China
| | - Danli Wu
- Yunnan University of Traditional Chinese Medicine, Kunming, China
| | - Qing Mei Wang
- Spaulding Rehabilitation Hospital, Charlestown, MA, USA
| | - Peidong Huang
- Yunnan University of Traditional Chinese Medicine, Kunming, China
| |
Collapse
|
27
|
YUAN M, ZHANG XX, FU XC, BI X. Enriched environment alleviates post-stroke cognitive impairment through enhancing α7-nAChR expression in rats. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 78:603-610. [DOI: 10.1590/0004-282x20200081] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 03/03/2020] [Indexed: 12/31/2022]
Abstract
ABSTRACT Background: Enriched environment (EE) is a simple and effective intervention to improve cognitive function in post-stroke cognitive impairment (PSCI), partly due to the rebalancing of the cholinergic signaling pathway in the hippocampus. α7-nicotinic acetylcholine receptor (α7-nAChR) is a cholinergic receptor whose activation inhibits inflammation and promotes the recovery of neurological function in PSCI patients. However, it is still unclear whether EE can regulate α7-nAChR and activate the cholinergic anti-inflammatory pathway (CAP) in PSCI. Objective: To investigate the effects of EE on cognitive impairment, and the role of α7-nAChR in PSCI. Methods: A PSCI rat model was induced by middle cerebral artery occlusion and reperfusion (MCAO/R) and were reared in standard environment (SE) or EE for 28d, control group with sham surgery. Cognitive function was determined by Morris water maze test. The long-term potentiation (LTP) was assessed by Electrophysiology. Histopathological methods were used to determine infarct volume, α7-nAChR expression and the cytokines and cholinergic proteins expression. Results: Compared with SE group, rats in EE group had better cognitive function, higher expression of α7-nAChR positive neurons in hippocampal CA1 region. In addition, EE attenuated unfavorable changes induced by MCAO/R in cytokines and cholinergic proteins, and also enhanced LTP promoted by nicotine and attenuated by α-BGT; but showed no significantly difference in infarct volume. Conclusions: EE markedly improves cognitive impairment and enhances neuroplasticity in PSCI rats, which may be closely related to enhancement of α7-nAChR expression.
Collapse
Affiliation(s)
- Mei YUAN
- Shanghai University of Sport, China
| | | | | | - Xia BI
- Shanghai University of Medicine & Health Sciences, China
| |
Collapse
|
28
|
Li M, Zhao Y, Zhan Y, Yang L, Feng X, Lu Y, Lei J, Zhao T, Wang L, Zhao H. Enhanced white matter reorganization and activated brain glucose metabolism by enriched environment following ischemic stroke: Micro PET/CT and MRI study. Neuropharmacology 2020; 176:108202. [DOI: 10.1016/j.neuropharm.2020.108202] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/09/2020] [Accepted: 06/12/2020] [Indexed: 12/13/2022]
|
29
|
Feldner HA, Papazian C, Peters K, Steele KM. "It's All Sort of Cool and Interesting…but What Do I Do With It?" A Qualitative Study of Stroke Survivors' Perceptions of Surface Electromyography. Front Neurol 2020; 11:1037. [PMID: 33041981 PMCID: PMC7527473 DOI: 10.3389/fneur.2020.01037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/10/2020] [Indexed: 12/28/2022] Open
Abstract
Background: Stroke is one of the most common neurologic injuries worldwide. Over decades, evidence-based neurorehabilitation research and advancements in wireless, wearable sensor design have supported the deployment of technologies to facilitate recovery after stroke. Surface electromyography (sEMG) is one such technology, however, clinical application remains limited. To understand this translational practice gap and improve clinical uptake, it is essential to include stakeholder voices in an analysis of neurorehabilitation practice, the acceptability of current sEMG technologies, and facilitators and barriers to sEMG use in the clinic and the community. The purpose of this study was to foreground the perspectives of stroke survivors to gain a better understanding of their experiences in neurorehabilitation, the technologies they have used during their recovery, and their opinions of lab-designed and commercially-available sEMG systems. Methods: A qualitative, phenomenological study was completed. In-depth, semi-structured interviews were conducted with eight stroke survivors (age range 49-78 years, 6 months to 12 years post-stroke) and two caregivers from a large metropolitan region. A demonstration of four sEMG systems was provided to gather perceptions of sensor design, features and function, and user interface. Interviews were audio-recorded, transcribed verbatim, and coded for analysis using constant comparison until data saturation was reached. Results: Three themes emerged from the data: (1) "Surface EMG has potential….but…" highlights the recognition of sEMG as a valuable tool but reveals a lack of understanding and need for clear meaning from the data; (2) "Tracking incremental progress over days or years is important" highlights the persistence of hope and potential benefit of sEMG in detecting small changes that may inform neurorehabilitation practice and policy; and (3) "Neurorehabilitation technology is cumbersome" highlights the tension between optimizing therapy time and trying new technologies, managing cost, logistics and set-up, and desired technology features. Conclusion: Further translation of sEMG technology for neurorehabilitation holds promise for stroke survivors, but sEMG system design and user interface needs refinement. The process of using sEMG technology and products must be simple and provide meaningful insight to recovery. Including stroke survivors directly in translational efforts is essential to improve uptake in clinical environments.
Collapse
Affiliation(s)
- Heather A. Feldner
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Christina Papazian
- Department of Mechanical Engineering, University of Washington, Seattle, WA, United States
| | - Keshia Peters
- Department of Mechanical Engineering, University of Washington, Seattle, WA, United States
| | - Katherine M. Steele
- Department of Mechanical Engineering, University of Washington, Seattle, WA, United States
| |
Collapse
|
30
|
Zhang X, Yuan M, Yang S, Chen X, Wu J, Wen M, Yan K, Bi X. Enriched environment improves post-stroke cognitive impairment and inhibits neuroinflammation and oxidative stress by activating Nrf2-ARE pathway. Int J Neurosci 2020; 131:641-649. [PMID: 32677581 DOI: 10.1080/00207454.2020.1797722] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Neuroinflammation and oxidative stress are major mechanisms of post-stroke cognitive impairment (PSCI) neural injury and decreased spatial and memory capacity. Enriched environment (EE) is an effective method to improve cognitive dysfunction. However, the regulation by EE of neuroinflammation, oxidative stress and associated mechanisms in animal models remains unclear. MATERIALS AND METHODS In this study, a rat PSCI model was established by middle cerebral artery occlusion (MCAO). Rats were randomly divided into the control group, standard environment (SE) group and EE group for 28 days. A Morris water-maze test was used to measure cognitive function at 7, 14 and 28 days after MCAO. Rats were sacrificed on the 28th day. Quantitative PCR, immunohistochemistry and ELISA were respectively used to detect mRNA expression of NF-E2-related factor 2 (Nrf2) and Nrf2 response genes, the expression of IL-1β and levels of proinflammatory cytokines in the hippocampus. RESULTS EE improved mNSS scores and cognitive ability in PSCI rats. EE increased mRNA expression of the Nrf2 and Nrf2 response genes, including heme oxygenase-1 (HO-1) and NAD(P)H:quinone oxidoreductase 1 (NQO1). EE significantly decreased the level of malondialdehyde (MDA) and increased the levels of superoxide dismutase (SOD) and glutathione (GSH), in the hippocampus of PSCI rats. EE reduced the number of IL-1β positive cells in the hippocampus, and IL-1β levels in the hippocampus and serum. EE increased GFAP-positive astrocytes in the hippocampus, and BDNF levels in the hippocampus and serum. CONCLUSIONS EE can improve cognitive function in PSCI rats by inhibiting neuroinflammation and oxidative stress.
Collapse
Affiliation(s)
- Xinxin Zhang
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Mei Yuan
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Songbin Yang
- Department of Rehabilitation Medicine, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Xiaoya Chen
- Department of Rehabilitation Medicine, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Jichun Wu
- Department of Rehabilitation Medicine, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Mingyue Wen
- Department of Rehabilitation Medicine, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Kai Yan
- Department of Rehabilitation Medicine, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Xia Bi
- Department of Rehabilitation Medicine, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| |
Collapse
|
31
|
Vive S, Bunketorp-Käll L, Carlsson G. Experience of enriched rehabilitation in the chronic phase of stroke. Disabil Rehabil 2020; 44:412-419. [PMID: 32478573 DOI: 10.1080/09638288.2020.1768598] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: In this study, we explored the experiences of patients who participated in an enriched task-specific therapy (ETT) program in the chronic phase after stroke.Method: Focus group interviews were conducted with twenty participants with a mean time since stroke of 30 months and mean age 61 years, who completed the ETT program including task-specific training and environmental enrichment. ETT was delivered 3.5-6 h per day, 5½ days per week for 3 weeks in a climate suitable for both indoor and outdoor activities. The training consisted of repetitive mass practice of gradually increasing difficulty. Directly after the intervention, qualitative interviews were conducted in six focus groups. The interviews were analysed with qualitative content analysis.Results: Three main categories describing the informants' experiences of the ETT program were identified. These categories were; 1. The program-different and hard - highlighting the participants view of the ETT as strenuous and different in nature; 2. My body and mind learn to know better - describing positive changes in participants' body function and functional ability as well as behavioural changes experienced throughout the ETT; and 3. The need and trust from others - emphasizing the perceived importance of trust in rehabilitation clinicians and the support of family and other participants. From these categories, a main theme emerged: It's hard but possible-but not alone!Conclusion: A therapy program including task-specific training and environmental enrichment may provide late-phase stroke survivors with perceived improvements in functional ability, knowledge insights, perceptions of rehabilitation needs and enriching emotional impacts.Implications for rehabilitationETT is feasible and may lead to perceived improvements in function and a change of mindset, even in the chronic phase after stroke.Trust in the competence of the rehabilitation staff is an important factor in compliance with the high-intensity training in the ETT program.Given the lack of stimulation and socialization among many individuals with chronic stroke, the social and physical environment are important components of the ETT program.
Collapse
Affiliation(s)
- Sara Vive
- Section for Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Neurocampus, Sophiahemmet Hospital, Stockholm, Sweden
| | - Lina Bunketorp-Käll
- Section for Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Centre for Advanced Reconstruction of Extremities (C.A.R.E.), Sahlgrenska University Hospital, Mölndal, Sweden
| | - Gunnel Carlsson
- Section for Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
32
|
Grau-Sánchez J, Münte TF, Altenmüller E, Duarte E, Rodríguez-Fornells A. Potential benefits of music playing in stroke upper limb motor rehabilitation. Neurosci Biobehav Rev 2020; 112:585-599. [PMID: 32092314 DOI: 10.1016/j.neubiorev.2020.02.027] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 12/18/2022]
Abstract
Music-based interventions have emerged as a promising tool in stroke motor rehabilitation as they integrate most of the principles of motor training and multimodal stimulation. This paper aims to review the use of music in the rehabilitation of upper extremity motor function after stroke. First, we review the evidence supporting current music-based interventions including Music-supported Therapy, Music glove, group music therapy, Rhythm- and music-based intervention, and Musical sonification. Next, we describe the mechanisms that may be responsible for the effectiveness of these interventions, focusing on motor learning aspects, how multimodal stimulation may boost motor performance, and emotional and motivational aspects related to music. Then, we discuss methodological concerns in music therapy research related to modifications of therapy protocols, evaluation of patients and study designs. Finally, we highlight clinical considerations for the implementation of music-based interventions in clinical settings.
Collapse
Affiliation(s)
- Jennifer Grau-Sánchez
- Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, 08097, Spain; Escola Universitària d'Infermeria i Teràpia Ocupacional de Terrassa (EUIT), Universitat Autònoma de Barcelona, Terrassa, Catalonia, Spain.
| | - Thomas F Münte
- Department of Neurology, University of Lübeck, Lübeck, Germany
| | - Eckart Altenmüller
- Institute of Music Physiology and Musicians' Medicine, Hannover University of Music, Drama and Media, Hannover, Germany
| | - Esther Duarte
- Department of Physical Medicine and Rehabilitation, Hospitals del Mar i l'Esperança, Parc de Salut Mar, Barcelona, Spain
| | - Antoni Rodríguez-Fornells
- Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, 08097, Spain; Department of Cognition, Development and Educational Science, Campus Bellvitge, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, 08097, Spain; Catalan Institution for Research and Advanced Studies, ICREA, Barcelona, Spain.
| |
Collapse
|
33
|
Anåker A, von Koch L, Heylighen A, Elf M. "It's Lonely": Patients' Experiences of the Physical Environment at a Newly Built Stroke Unit. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2019; 12:141-152. [PMID: 30336696 PMCID: PMC6637812 DOI: 10.1177/1937586718806696] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this study was to explore patients' experiences of the physical environment at a newly built stroke unit. BACKGROUND For a person who survives a stroke, life can change dramatically. The physical environment is essential for patients' health and well-being. To reduce infections, a majority of new healthcare facilities mainly have a single-room design. However, in the context of stroke care, knowledge of how patients experience the physical environment, particularly their experience of a single-room design, is scarce. METHOD This study used a qualitative design. Patients (n = 16) participated in semistructured individual interviews. Data were collected in December 2015 and February 2017 in Sweden; interviews were transcribed verbatim and analyzed using content analysis. RESULTS Two main themes were identified: (i) incongruence exists between community and privacy and (ii) connectedness with the outside world provides distraction and a sense of normality. In single rooms, social support was absent and a sense of loneliness was expressed. Patients were positively distracted when they looked at nature or activities that went on outside their windows. CONCLUSIONS The physical environment is significant for patients with stroke. This study highlights potential areas for architectural improvements in stroke units, primarily around designing communal areas with meeting places and providing opportunities to participate in the world outside the unit. A future challenge is to design stroke units that support both community and privacy. Exploring patients' experiences could be a starting point when designing new healthcare environments and inform evidence-based design.
Collapse
Affiliation(s)
- Anna Anåker
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Lena von Koch
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Ann Heylighen
- Department of Architecture, Research[x]Design, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Marie Elf
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
- Department of Architecture and Civil Engineering, The School of Architecture, Chalmers University of Technology, Gothenburg, Sweden
| |
Collapse
|
34
|
Strzelewicz AR, Ordoñes Sanchez E, Rondón-Ortiz AN, Raneri A, Famularo ST, Bangasser DA, Kentner AC. Access to a high resource environment protects against accelerated maturation following early life stress: A translational animal model of high, medium and low security settings. Horm Behav 2019; 111:46-59. [PMID: 30708031 PMCID: PMC6527488 DOI: 10.1016/j.yhbeh.2019.01.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 12/18/2018] [Accepted: 01/10/2019] [Indexed: 12/21/2022]
Abstract
Early life exposure to a low security setting, characterized by a scarcity of resources and limited food access, increases the risk for psychiatric illness and metabolic dysfunction. We utilized a translational rat model to mimic a low security environment and determined how this manipulation affected offspring behavior, metabolism, and puberty. Because food insecurity in humans is associated with reduced access to healthy food options the "low security" rat manipulation combined a Western diet with exposure to a limited bedding and nesting manipulation (WD-LB). In this setting, dams were provided with limited nesting materials during the pups' early life (P2-P10). This manipulation was contrasted with standard rodent caging (SD) and environmental enrichment (EE), to model "medium security" and "high security" environments, respectively. To determine if transitioning from a low to high security environment improved outcomes, some juvenile WD-LB offspring were exposed to EE. Maternal care was impacted by these environments such that EE dams engaged in high quality care when on the nest, but spent less time on the nest than SD dams. Although WD-LB dams excessively chased their tails, they were very attentive to their pups, perhaps to compensate for limited resources. Offspring exposed to WD-LB only displayed subtle changes in behavior. However, WD-LB exposure resulted in significant metabolic dysfunction characterized by increased body weight, precocious puberty and alterations in the hypothalamic kisspeptin system. These negative effects of WD-LB on puberty and weight regulation were mitigated by EE exposure. Collectively, these studies suggest that both compensatory maternal care and juvenile enrichment can reduce the impact of a low security environment. Moreover, they highlight how utilizing diverse models of resource (in)stability can reveal mechanisms that confer vulnerability and resilience to early life stress.
Collapse
Affiliation(s)
- Arielle R Strzelewicz
- School of Pharmacy, Massachusetts College of Pharmacy and Health Sciences, Boston,MA 02115, United States
| | | | - Alejandro N Rondón-Ortiz
- School of Pharmacy, Massachusetts College of Pharmacy and Health Sciences, Boston,MA 02115, United States
| | - Anthony Raneri
- School of Arts & Sciences, Health Psychology Program, Massachusetts College of Pharmacy and Health Sciences, Boston, MA 02115, United States
| | - Sydney T Famularo
- Department of Psychology, Temple University, Philadelphia, PA 19122, United States
| | - Debra A Bangasser
- Department of Psychology, Temple University, Philadelphia, PA 19122, United States
| | - Amanda C Kentner
- School of Arts & Sciences, Health Psychology Program, Massachusetts College of Pharmacy and Health Sciences, Boston, MA 02115, United States.
| |
Collapse
|
35
|
Kentner AC, Cryan JF, Brummelte S. Resilience priming: Translational models for understanding resiliency and adaptation to early life adversity. Dev Psychobiol 2019; 61:350-375. [PMID: 30311210 PMCID: PMC6447439 DOI: 10.1002/dev.21775] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 06/22/2018] [Accepted: 07/10/2018] [Indexed: 12/20/2022]
Abstract
Despite the increasing attention to early life adversity and its long-term consequences on health, behavior, and the etiology of neurodevelopmental disorders, our understanding of the adaptations and interventions that promote resiliency and rescue against such insults are underexplored. Specifically, investigations of the perinatal period often focus on negative events/outcomes. In contrast, positive experiences (i.e. enrichment/parental care//healthy nutrition) favorably influence development of the nervous and endocrine systems. Moreover, some stressors result in adaptations and demonstrations of later-life resiliency. This review explores the underlying mechanisms of neuroplasticity that follow some of these early life experiences and translates them into ideas for interventions in pediatric settings. The emerging role of the gut microbiome in mediating stress susceptibility is also discussed. Since many negative outcomes of early experiences are known, it is time to identify mechanisms and mediators that promote resiliency against them. These range from enrichment, quality parental care, dietary interventions and those that target the gut microbiota.
Collapse
Affiliation(s)
- Amanda C. Kentner
- School of Arts & Sciences, Massachusetts College of Pharmacy and Health Sciences, 179 Longwood Ave, Boston, MA 02115,
| | - John F. Cryan
- Dept. Anatomy & Neuroscience & APC Microbiome Institute, University College Cork, College Rd., Cork, Ireland,
| | - Susanne Brummelte
- Department of Psychology, Wayne State University, 5057 Woodward Ave, Detroit, MI 48202,
| |
Collapse
|
36
|
Purcell S, Scott P, Gustafsson L, Molineux M. Stroke survivors' experiences of occupation in hospital-based stroke rehabilitation: a qualitative exploration. Disabil Rehabil 2019; 42:1880-1885. [PMID: 30672347 DOI: 10.1080/09638288.2018.1542460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: Studies highlighting the time spent in self-isolating and inactive activities during stroke rehabilitation have led to the introduction of group programs and environmental enrichment to improve activity levels. A less explored perspective is to understand how the introduced changes align with the occupational needs of the stroke survivors. Therefore, the aim of this study was to explore stroke survivors experiences of engagement in occupations during stroke rehabilitation.Methods: A descriptive phenomenological approach with semi-structured interviews explored stroke survivors experiences.Results: Eight participants (five male and three female, mean age 72 years) described their experiences with two themes emerging: (1) "I'm here for that reason:" which highlighted therapy as an occupation which participants wanted to perform and (2) "Celebration of quiet moments:" exploring the value of rest and recreation.Conclusion: This study provides a preliminary understanding of how stroke survivors experience occupational engagement during rehabilitation. There was an apparent shift in priorities with therapy considered the most important occupation and a strong need expressed for rest and relaxation to be factored into people's days. It appears the increasing activity levels may not always align with people's occupations and that due consideration of this malalignment may further enhance engagement and outcomes.Implications for rehabilitationDuring hospital-based stroke rehabilitation, stroke survivors prioritized the occupations of therapy, rest, and recreation.People with stroke are motivated to participate when the activities within and outside of, therapy align with their pre-stroke life and occupations.A daily stroke rehabilitation program should be balanced with opportunities for rest to support recovery time from therapy and possible consolidation of learning.
Collapse
Affiliation(s)
- Sarah Purcell
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Peter Scott
- Discipline of Occupational Therapy, School of Allied Health Sciences, Griffith University, Australia
| | - Louise Gustafsson
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.,Discipline of Occupational Therapy, School of Allied Health Sciences, Griffith University, Australia
| | - Matthew Molineux
- Discipline of Occupational Therapy, School of Allied Health Sciences, Griffith University, Australia
| |
Collapse
|
37
|
Wang H, Gaur U, Xiao J, Xu B, Xu J, Zheng W. Targeting phosphodiesterase 4 as a potential therapeutic strategy for enhancing neuroplasticity following ischemic stroke. Int J Biol Sci 2018; 14:1745-1754. [PMID: 30416389 PMCID: PMC6216030 DOI: 10.7150/ijbs.26230] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 06/03/2018] [Indexed: 12/11/2022] Open
Abstract
Sensorimotor recovery following ischemic stroke is highly related with structural modification and functional reorganization of residual brain tissues. Manipulations, such as treatment with small molecules, have been shown to enhance the synaptic plasticity and contribute to the recovery. Activation of the cAMP/CREB pathway is one of the pivotal approaches stimulating neuroplasticity. Phosphodiesterase 4 (PDE4) is a major enzyme controlling the hydrolysis of cAMP in the brain. Accumulating evidences have shown that inhibition of PDE4 is beneficial for the functional recovery after cerebral ischemia; i. subtype D of PDE4 (PDE4D) is viewed as a risk factor for ischemic stroke; ii. inhibition of PDE4 enhances neurological behaviors, such as learning and memory, after stroke in rodents; iii.PDE4 inhibition increases dendritic density, synaptic plasticity and neurogenesis; iv. activation of cAMP/CREB signaling by PDE4 inhibition causes an endogenous increase of BDNF, which is a potent modulator of neuroplasticity; v. PDE4 inhibition is believed to restrict neuroinflammation during ischemic stroke. Cumulatively, these findings provide a link between PDE4 inhibition and neuroplasticity after cerebral ischemia. Here, we summarized the possible roles of PDE4 inhibition in the recovery of cerebral stroke with an emphasis on neuroplasticity. We also made some recommendations for future research.
Collapse
Affiliation(s)
- Haitao Wang
- Department of Neuropharmacology and Drug Discovery, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou 510515, China
| | - Uma Gaur
- Faculty of Health Sciences, University of Macau, Taipa, Macau, China
| | - Jiao Xiao
- Department of Neuropharmacology and Drug Discovery, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou 510515, China
| | - Bingtian Xu
- Department of Neuropharmacology and Drug Discovery, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou 510515, China
| | - Jiangping Xu
- Department of Neuropharmacology and Drug Discovery, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou 510515, China
| | - Wenhua Zheng
- Faculty of Health Sciences, University of Macau, Taipa, Macau, China
| |
Collapse
|
38
|
Yuan ZY, Yang J, Ma XW, Wang YY, Wang MW. Enriched environment elevates expression of growth associated protein-43 in the substantia nigra of SAMP8 mice. Neural Regen Res 2018; 13:1988-1994. [PMID: 30233074 PMCID: PMC6183044 DOI: 10.4103/1673-5374.239447] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
An enriched environment protects dopaminergic neurons from 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced neuronal injury, but the underlying mechanism for this is not clear. Growth associated protein-43 (GAP-43) is closely associated with neurite outgrowth and axon regeneration during neural development. We speculate that an enriched environment can reduce damage to dopaminergic neurons by affecting the expression of GAP-43. This study is designed to test this hypothesis. Three-month-old female senescence-accelerated mouse prone 8 (SAMP8) mice were housed for 3 months in an enriched environment or a standard environment. These mice were then subcutaneously injected in the abdomen with 14 mg/kg MPTP four times at 2-hour intervals. Morris water maze testing demonstrated that learning and memory abilities were better in the enriched environment group than in the standard environment group. Reverse-transcription polymerase chain reaction, immunohistochemistry and western blot assays showed that mRNA and protein levels of GAP-43 in the substantia nigra were higher after MPTP application in the enriched environment group compared with the standard environment group. These findings indicate that an enriched environment can increase GAP-43 expression in SAMP8 mice. The upregulation of GAP-43 may be a mechanism by which an enriched environment protects against MPTP-induced neuronal damage.
Collapse
Affiliation(s)
- Zhen-Yun Yuan
- The First Hospital of Hebei Medical University; Brain Aging and Cognitive Neuroscience Laboratory of Hebei Province, Shijiazhuang, Hebei Province, China
| | - Jie Yang
- The First Hospital of Hebei Medical University; Brain Aging and Cognitive Neuroscience Laboratory of Hebei Province, Shijiazhuang, Hebei Province, China
| | - Xiao-Wei Ma
- The First Hospital of Hebei Medical University; Brain Aging and Cognitive Neuroscience Laboratory of Hebei Province, Shijiazhuang, Hebei Province, China
| | - Yan-Yong Wang
- The First Hospital of Hebei Medical University; Brain Aging and Cognitive Neuroscience Laboratory of Hebei Province, Shijiazhuang, Hebei Province, China
| | - Ming-Wei Wang
- The First Hospital of Hebei Medical University; Brain Aging and Cognitive Neuroscience Laboratory of Hebei Province, Shijiazhuang, Hebei Province, China
| |
Collapse
|
39
|
Experiences from a multimodal rhythm and music-based rehabilitation program in late phase of stroke recovery - A qualitative study. PLoS One 2018; 13:e0204215. [PMID: 30226862 PMCID: PMC6143265 DOI: 10.1371/journal.pone.0204215] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 09/05/2018] [Indexed: 01/26/2023] Open
Abstract
Background Rehabilitative stroke interventions based on principles of multimodal stimulation have the potential to profoundly affect neuroplastic processes beyond the sub-acute phase. In order to identify important core mechanisms, there is a need to explore how interventions that combine physical, social, sensory, and cognitively challenging activities are perceived and experienced by the participants. This qualitative study, based on an interpretive interactionist perspective, explored the experiences of stroke survivors who participated in a group-based multimodal rehabilitation program based on rhythm and music. Methods and findings Within four weeks after completion of the multimodal rehabilitation program, face-to-face semi-structured interviews were conducted on a single occasion with 15 purposively selected individuals (mean age 65, 8 men, 7 women). The interview duration was between 13 and 44 minutes. Qualitative content analysis with an inductive approach was used to analyze data. Three categories were identified, each containing several sub-categories: To be intellectually challenged (energy-consuming activity and coordinating multiple input and output), Perceived therapeutic benefits (motor skills, cognitive skills, emotional and psychological responses), and Pros and cons with social integration (fellowship, competing with others, and instructor characteristics). From these categories, an overall theme was derived: The multifaceted layers of multimodal stimulation. Enjoying music, being part of a group with peers, a skilled instructor, and being able to manage the challenging movements, were related to positive experiences. In contrast, negative experiences were associated with not being able to perform the exercises, and with group members who dominated the conversational space. Conclusion This study shows that access to a multimodal rehabilitation program with rhythm and music as operating ingredients may contribute to positive experiences for many individuals in a late phase after stroke in terms of motor, cognitive, as well as emotional enhancements. Important components were the music, the social interaction, the challenging exercises, and the skilled instructor.
Collapse
|
40
|
Marcheschi E, Von Koch L, Pessah-Rasmussen H, Elf M. Home setting after stroke, facilitators and barriers: A systematic literature review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:e451-e459. [PMID: 29210130 DOI: 10.1111/hsc.12518] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/06/2017] [Indexed: 06/07/2023]
Abstract
This paper seeks to improve the understanding of the interaction between patients with stroke and the physical environment in their home settings. Stroke care is increasingly performed in the patient's home. Therefore, a systematic review was conducted to identify the existing knowledge about facilitators and barriers in the physical environment of home settings for the stroke rehabilitation process. Based upon Arksey and O'Malley's framework, a Boolean search strategy was performed in the databases; CINAHL, Medline, Web of Science and Scopus. Fifteen articles were retained from the literature search conducted between August and November 2016, and two researchers independently assessed their quality based on the Swedish Council on Health Technology Assessment guidelines. The results suggest that despite the healthcare system's ongoing shift towards home-based rehabilitation, the role played by the physical environment of home settings is still considered a side finding. Moreover, the research appears to focus mainly on how this environment supports mobility and activities of daily living, whereas information regarding the psychosocial and emotional processes that mediate the interaction between stroke survivors and their home setting are missing. A lack of information was also found with regard to the influence of different geographic locations on the stroke rehabilitation process. Future investigations are therefore needed to advance the understanding of the role played by the physical environment of home settings in supporting stroke recovery.
Collapse
Affiliation(s)
- Elizabeth Marcheschi
- Department of Architecture and Building Design, Chalmers University, Gothenburg, Sweden
| | - Lena Von Koch
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | | | - Marie Elf
- Department of Architecture and Building Design, Chalmers University, Gothenburg, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| |
Collapse
|
41
|
Tai LW, Yeung SC, Cheung CW. Enriched Environment and Effects on Neuropathic Pain: Experimental Findings and Mechanisms. Pain Pract 2018; 18:1068-1082. [PMID: 29722923 DOI: 10.1111/papr.12706] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 04/04/2018] [Accepted: 04/22/2018] [Indexed: 12/16/2022]
Abstract
Neuropathic pain inflicts tremendous biopsychosocial suffering for patients worldwide. However, safe and effective treatment of neuropathic pain is a prominent unmet clinical need. Environmental enrichment (EE) is an emerging cost-effective nonpharmacological approach to alleviate neuropathic pain and complement rehabilitation care. We present here a review of preclinical studies in ascertaining the efficacy of EE for neuropathic pain. Their proposed mechanisms, including the suppression of ascending nociceptive signaling to the brain, enhancement of the descending inhibitory system, and neuroprotection of the peripheral and central nervous systems, may collectively reduce pain perception and improve somatic and emotional functioning in neuropathic pain. The current evidence offers critical insights for future preclinical research and the translational application of EE in clinical pain management.
Collapse
Affiliation(s)
- Lydia Wai Tai
- Laboratory and Clinical Research Institute for Pain, Department of Anaesthesiology, The University of Hong Kong, Hong Kong, Special Administrative Region, China.,Department of Anaesthesiology, The University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - Sung Ching Yeung
- Laboratory and Clinical Research Institute for Pain, Department of Anaesthesiology, The University of Hong Kong, Hong Kong, Special Administrative Region, China.,Department of Anaesthesiology, The University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - Chi Wai Cheung
- Laboratory and Clinical Research Institute for Pain, Department of Anaesthesiology, The University of Hong Kong, Hong Kong, Special Administrative Region, China.,Department of Anaesthesiology, The University of Hong Kong, Hong Kong, Special Administrative Region, China.,Research Centre of Heart, Brain, Hormone & Healthy Aging, The University of Hong Kong, Hong Kong, Special Administrative Region, China
| |
Collapse
|
42
|
Anåker A, von Koch L, Sjöstrand C, Heylighen A, Elf M. The physical environment and patients' activities and care: A comparative case study at three newly built stroke units. J Adv Nurs 2018; 74:1919-1931. [PMID: 29676493 DOI: 10.1111/jan.13690] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2018] [Indexed: 11/29/2022]
Abstract
AIM To explore and compare the impact of the physical environment on patients' activities and care at three newly built stroke units. BACKGROUND Receiving care in a stroke unit instead of in a general ward reduces the odds of death, dependency and institutionalized care. In stroke units, the design of the physical environment should support evidence-based care. Studies on patients' activities in relation to the design of the physical environment of stroke units are scarce. DESIGN This work is a comparative descriptive case study. METHOD Patients (N = 55) who had a confirmed diagnosis of stroke were recruited from three newly built stroke units in Sweden. The units were examined by non-participant observation using two types of data collection: behavioural mapping analysed with descriptive statistics and field note taking analysed with deductive content analysis. Data were collected from April 2013 - December 2015. RESULTS The units differed in the patients' levels of physical activity, the proportion of the day that patients spent with health professionals and family presence. Patients were more physically active in a unit with a combination of single and multi-bed room designs than in a unit with an entirely single-room design. Stroke units that were easy to navigate and offered variations in the physical environment had an impact on patients' activities and care. CONCLUSIONS Patients' activity levels and interactions appeared to vary with the design of the physical environments of stroke units. Stroke guidelines focused on health status assessments, avoidance of bed-rest and early rehabilitation require a supportive physical environment.
Collapse
Affiliation(s)
- Anna Anåker
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Lena von Koch
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Neurovascular Diseases, Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Christina Sjöstrand
- Department of Neurovascular Diseases, Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Ann Heylighen
- Department of Architecture, Research[x]Design, KU Leuven, Leuven, Belgium
| | - Marie Elf
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
- Department of Architecture and Civil Engineering, The School of Architecture, Chalmers University of Technology, Gothenburg, Sweden
| |
Collapse
|
43
|
The Effects of Early Exercise on Motor, Sense, and Memory Recovery in Rats With Stroke. Am J Phys Med Rehabil 2017; 96:e36-e43. [PMID: 27977432 DOI: 10.1097/phm.0000000000000670] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Exercise is an effective, inexpensive, home-based, and accessible intervention strategy for stroke treatment, and early exercise after stroke has attracted a great deal of attention in recent years. However, the effects of early exercise on comprehensive functional recovery remain poorly understood. The present study investigated the effect of early exercise on motor, sense, balance, and spatial memory recovery. DESIGN Adult Sprague-Dawley rats were subjected to unilateral middle cerebral artery occlusion (MCAO) and were randomly divided into early exercise group (EE), non-exercise group (NE), and sham group. EE group received 2 weeks of exercise training initiated at 24 hours after operation. The recovery of motor, sense, and balance function was evaluated every 3 days after MCAO. Spatial memory recovery was detected from 21 to 25 days after MCAO. RESULTS The results showed that early exercise significantly promoted the motor and spatial memory recovery with statistical differences. The rats in EE group have a better recovery in sense and balance function, but there is no statistically significant difference about these results. CONCLUSION Our results showed that early moderate exercise can significantly promote motor and spatial memory recovery, but not the sense and balance functions.
Collapse
|
44
|
Kenah K, Bernhardt J, Cumming T, Spratt N, Luker J, Janssen H. Boredom in patients with acquired brain injuries during inpatient rehabilitation: a scoping review. Disabil Rehabil 2017; 40:2713-2722. [DOI: 10.1080/09638288.2017.1354232] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Katrina Kenah
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
| | - Julie Bernhardt
- Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, The Florey Institute of Neuroscience & Mental Health, Heidelberg, VIC, Australia
| | - Toby Cumming
- Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, The Florey Institute of Neuroscience & Mental Health, Heidelberg, VIC, Australia
| | - Neil Spratt
- Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Hunter Medical Research Institute, Newcastle, NSW, Australia
- School of Biomedical Science and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
| | - Julie Luker
- Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, The Florey Institute of Neuroscience & Mental Health, Heidelberg, VIC, Australia
- International Centre for Allied Health Evidence, Sansom Institute, University of South Australia, Adelaide, SA, Australia
| | - Heidi Janssen
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
- Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Hunter Medical Research Institute, Newcastle, NSW, Australia
| |
Collapse
|
45
|
Chen X, Zhang X, Xue L, Hao C, Liao W, Wan Q. Treatment with Enriched Environment Reduces Neuronal Apoptosis in the Periinfarct Cortex after Cerebral Ischemia/Reperfusion Injury. Cell Physiol Biochem 2017; 41:1445-1456. [DOI: 10.1159/000468368] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 01/17/2017] [Indexed: 01/07/2023] Open
Abstract
Background/Aims: Enriched environment (EE) has been reported to exert neuroprotective effect in animal models of ischemic stroke. However, the underlying mechanism remains unclear. The purpose of this study was to investigate the effect of EE treatment on neuronal apoptosis in the periinfarct cortex after cerebral ischemia/reperfusion (I/R) injury. Methods: The cerebral I/R injury was established by middle cerebral artery occlusion (MCAO). A set of behavioral tests including the modified neurological severity score (mNSS), limb-placing test and foot-fault test were conducted. The infarct volume and the neuronal survival rate were evaluated by Nissl staining. The morphology and ultrastructure of ischemic neurons was examined by transmission electron microscopy. Neuronal apoptosis was assessed by double labeling of TdT-mediated dUTP-biotin nick end labeling (TUNEL) with NeuN. The expressions of apoptosis-related proteins were tested by western blotting and immunohistochemical labeling. Results: EE treatment improved neurological function, reduced infarct volume, increased neuronal survival rate and alleviated the morphological and ultrastructural damage of neurons (especially mitochondria) after I/R injury. EE treatment reduced the neuronal apoptosis, increased B cell lymphoma/leukemia-2 (Bcl-2) protein levels while decreased Bcl-2-associated X protein (Bax), cytochrome c, caspase-3 expressions and Bax/Bcl-2 ratio in the periinfarct cortex after cerebral I/R injury. Conclusion: Our findings suggest that EE treatment inhibits neuronal apoptosis in the periinfarct cortex after focal cerebral I/R injury, which may be one of the possible mechanisms underlying the neuroprotective effects of EE.
Collapse
|
46
|
Quattromani MJ, Pruvost M, Guerreiro C, Backlund F, Englund E, Aspberg A, Jaworski T, Hakon J, Ruscher K, Kaczmarek L, Vivien D, Wieloch T. Extracellular Matrix Modulation Is Driven by Experience-Dependent Plasticity During Stroke Recovery. Mol Neurobiol 2017; 55:2196-2213. [PMID: 28290150 PMCID: PMC5840227 DOI: 10.1007/s12035-017-0461-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Accepted: 02/16/2017] [Indexed: 11/24/2022]
Abstract
Following stroke, complete cellular death in the ischemic brain area may ensue, with remaining brain areas undergoing tissue remodelling to various degrees. Experience-dependent brain plasticity exerted through an enriched environment (EE) promotes remodelling after central nervous system injury, such as stroke. Post-stroke tissue reorganization is modulated by growth inhibitory molecules differentially expressed within the ischemic hemisphere, like chondroitin sulfate proteoglycans found in perineuronal nets (PNNs). PNNs in the neocortex predominantly enwrap parvalbumin-containing GABAergic (PV/GABA) neurons, important in sensori-information processing. Here, we investigate how extracellular matrix (ECM) proteases and their inhibitors may participate in the regulation of PNN integrity during stroke recovery. Rats were subjected to photothrombotic stroke in the motor cortex, and functional deficits were assessed at 7 days of recovery. Sham and stroked rats were housed in either standard or EE conditions for 5 days, and infarct volumes were calculated. PNNs were visualized by immunohistochemistry and counted in the somatosensory cortex of both hemispheres. mRNA expression levels of ECM proteases and protease inhibitors were assessed by RT-qPCR and their activity analyzed by gel zymography. PNNs and protease activity were also studied in brains from stroke patients where similar results were observed. EE starting 2 days after stroke and continuing for 5 days stimulated behavioral recovery of limb-placement ability without affecting infarct size. EE promoted a decrease of PNNs around PV/GABA neurons and a concomitant modulation of the proteolytic activity and mRNA expression of ECM proteases and protease inhibitors in the somatosensory cortex. This study provides molecular targets for novel therapies that could support rehabilitation of stroke patients.
Collapse
Affiliation(s)
- Miriana Jlenia Quattromani
- Laboratory for Experimental Brain Research, Division of Neurosurgery, Department of Clinical Sciences, Lund University, BMC A13, 22184, Lund, Sweden.
| | - Mathilde Pruvost
- INSERM UMR-S U919, Serine Proteases and Pathophysiology of the Neurovascular Unit, Université Caen Basse Normandie, GIP Cyceron, F-14074, Caen, France
| | - Carla Guerreiro
- Laboratory for Experimental Brain Research, Division of Neurosurgery, Department of Clinical Sciences, Lund University, BMC A13, 22184, Lund, Sweden
| | - Fredrik Backlund
- Laboratory for Experimental Brain Research, Division of Neurosurgery, Department of Clinical Sciences, Lund University, BMC A13, 22184, Lund, Sweden
| | - Elisabet Englund
- Division of Oncology and Pathology, Lund University Hospital, 22185, Lund, Sweden
| | - Anders Aspberg
- Rheumatology and Molecular Skeletal Biology, Department of Clinical Sciences, Lund University, BMC C12, 22184, Lund, Sweden
| | - Tomasz Jaworski
- Laboratory of Neurobiology, Nencki Institute of Experimental Biology, 02-093, Warsaw, Poland
| | - Jakob Hakon
- Laboratory for Experimental Brain Research, Division of Neurosurgery, Department of Clinical Sciences, Lund University, BMC A13, 22184, Lund, Sweden
| | - Karsten Ruscher
- Laboratory for Experimental Brain Research, Division of Neurosurgery, Department of Clinical Sciences, Lund University, BMC A13, 22184, Lund, Sweden
| | - Leszek Kaczmarek
- Laboratory of Neurobiology, Nencki Institute of Experimental Biology, 02-093, Warsaw, Poland
| | - Denis Vivien
- INSERM UMR-S U919, Serine Proteases and Pathophysiology of the Neurovascular Unit, Université Caen Basse Normandie, GIP Cyceron, F-14074, Caen, France.,Department of Clinical Research, Caen University Hospital, CHU Caen, 14000, Caen, France
| | - Tadeusz Wieloch
- Laboratory for Experimental Brain Research, Division of Neurosurgery, Department of Clinical Sciences, Lund University, BMC A13, 22184, Lund, Sweden
| |
Collapse
|
47
|
Bhagya VR, Srikumar BN, Veena J, Shankaranarayana Rao BS. Short-term exposure to enriched environment rescues chronic stress-induced impaired hippocampal synaptic plasticity, anxiety, and memory deficits. J Neurosci Res 2016; 95:1602-1610. [DOI: 10.1002/jnr.23992] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 10/27/2016] [Accepted: 10/28/2016] [Indexed: 01/04/2023]
Affiliation(s)
- Venkanna Rao Bhagya
- Department of Neurophysiology; National Institute of Mental Health and Neuro Sciences (NIMHANS); Bengaluru India
| | - Bettadapura N. Srikumar
- Department of Neurophysiology; National Institute of Mental Health and Neuro Sciences (NIMHANS); Bengaluru India
| | - Jayagopalan Veena
- Department of Neurophysiology; National Institute of Mental Health and Neuro Sciences (NIMHANS); Bengaluru India
| | | |
Collapse
|
48
|
Miltner WHR. Plasticity and Reorganization in the Rehabilitation of Stroke. ZEITSCHRIFT FUR PSYCHOLOGIE-JOURNAL OF PSYCHOLOGY 2016. [DOI: 10.1027/2151-2604/a000243] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Abstract. This paper outlines some actual developments in the behavioral treatment and rehabilitation of stroke and other brain injuries in post-acute and chronic conditions of brain lesion. It points to a number of processes that demonstrate the enormous plasticity and reorganization capacity of the human brain following brain lesion. It also highlights a series of behavioral and neuroscientific studies that indicate that successful behavioral rehabilitation is paralleled by plastic changes of brain structures and by cortical reorganization and that the amount of such plastic changes is obviously significantly determining the overall outcome of rehabilitation.
Collapse
Affiliation(s)
- Wolfgang H. R. Miltner
- Department of Biological and Clinical Psychology, Friedrich Schiller University, Jena, Germany
| |
Collapse
|
49
|
Luker J, Lynch E, Bernhardsson S, Bennett L, Bernhardt J. Stroke Survivors' Experiences of Physical Rehabilitation: A Systematic Review of Qualitative Studies. Arch Phys Med Rehabil 2015; 96:1698-708.e10. [PMID: 25847387 DOI: 10.1016/j.apmr.2015.03.017] [Citation(s) in RCA: 179] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 03/17/2015] [Accepted: 03/28/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To report and synthesize the perspectives, experiences, and preferences of stroke survivors undertaking inpatient physical rehabilitation through a systematic review of qualitative studies. DATA SOURCES MEDLINE, CINAHL, Embase, and PsycINFO were searched from database inception to February 2014. Reference lists of relevant publications were searched. All languages were included. STUDY SELECTION Qualitative studies reporting stroke survivors' experiences of inpatient stroke rehabilitation were selected independently by 2 reviewers. The search yielded 3039 records; 95 full-text publications were assessed for eligibility, and 32 documents (31 studies) were finally included. Comprehensiveness and explicit reporting were assessed independently by 2 reviewers using the consolidated criteria for reporting qualitative research framework. Discrepancies were resolved by consensus. DATA EXTRACTION Data regarding characteristics of the included studies were extracted by 1 reviewer, tabled, and checked for accuracy by another reviewer. All text reported in studies' results sections were entered into qualitative data management software for analysis. DATA SYNTHESIS Extracted texts were inductively coded and analyzed in 3 phases using thematic synthesis. Nine interrelated analytical themes, with descriptive subthemes, were identified that related to issues of importance to stroke survivors: (1) physical activity is valued; (2) bored and alone; (3) patient-centered therapy; (4) recreation is also rehabilitation; (5) dependency and lack of control; (6) fostering autonomy; (7) power of communication and information; (8) motivation needs nurturing; and (9) fatigue can overwhelm. CONCLUSIONS The thematic synthesis provides new insights into stroke survivors' experiences of inpatient rehabilitation. Negative experiences were reported in all studies and include disempowerment, boredom, and frustration. Rehabilitation could be improved by increasing activity within formal therapy and in free time, fostering patients' autonomy through genuinely patient-centered care, and more effective communication and information. Future stroke rehabilitation research should take into account the experiences and preferences of stroke survivors.
Collapse
Affiliation(s)
- Julie Luker
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia; International Centre for Allied Health Evidence, University of South Australia, Adelaide, Australia.
| | - Elizabeth Lynch
- International Centre for Allied Health Evidence, University of South Australia, Adelaide, Australia
| | - Susanne Bernhardsson
- International Centre for Allied Health Evidence, University of South Australia, Adelaide, Australia; Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, Linköping, Sweden; Närhälsan Hönö/Öckerö Rehabilitation, Region Västra Götaland, Sweden
| | - Leanne Bennett
- International Centre for Allied Health Evidence, University of South Australia, Adelaide, Australia
| | - Julie Bernhardt
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| |
Collapse
|