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Noé E, Gómez A, Bernabeu M, Quemada I, Rodríguez R, Pérez T, López C, Laxe S, Colomer C, Ríos M, Juárez-Belaúnde A, González C, Pelayo R, Ferri J. Guidelines: basic principles of neurorehabilitation for patients with acquired brain injury. Recommendations of the Spanish Society of Neurorehabilitation. Neurologia 2024; 39:261-281. [PMID: 37116696 DOI: 10.1016/j.nrleng.2023.04.002] [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: 05/24/2021] [Accepted: 06/27/2021] [Indexed: 04/30/2023] Open
Abstract
INTRODUCTION We present the Spanish Society of Neurorehabilitation's guidelines for adult acquired brain injury (ABI) rehabilitation. These recommendations are based on a review of international clinical practice guidelines published between 2013 and 2020. DEVELOPMENT We establish recommendations based on the levels of evidence of the studies reviewed and expert consensus on population characteristics and the specific aspects of the intervention or procedure under research. CONCLUSIONS All patients with ABI should receive neurorehabilitation therapy once they present a minimal level of clinical stability. Neurorehabilitation should offer as much treatment as possible in terms of frequency, duration, and intensity (at least 45-60minutes of each specific form of therapy that is needed). Neurorehabilitation requires a coordinated, multidisciplinary team with the knowledge, experience, and skills needed to work in collaboration both with patients and with their families. Inpatient rehabilitation interventions are recommended for patients with more severe deficits and those in the acute phase, with outpatient treatment to be offered as soon as the patient's clinical situation allows it, as long as intensity criteria can be maintained. The duration of treatment should be based on treatment response and the possibilities for further improvement, according to the best available evidence. At discharge, patients should be offered health promotion, physical activity, support, and follow-up services to ensure that the benefits achieved are maintained, to detect possible complications, and to assess possible changes in functional status that may lead the patient to need other treatment programmes.
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Affiliation(s)
- E Noé
- NEURORHB Servicio de Neurorrehabilitación de Hospitales Vithas, Fundación Hospitales Vithas, Valencia, Spain.
| | - A Gómez
- Centro Estatal de Atención al Daño Cerebral-CEADAC, Madrid, Spain
| | | | - I Quemada
- Red Menni de Daño Cerebral, Bilbao, Spain
| | | | - T Pérez
- Clínica San Vicente, Madrid, Spain
| | - C López
- Centro Lescer, Madrid, Spain
| | - S Laxe
- Hospital Clínic, Barcelona, Spain
| | - C Colomer
- NEURORHB Servicio de Neurorrehabilitación de Hospitales Vithas, Fundación Hospitales Vithas, Valencia, Spain
| | - M Ríos
- Unidad de Daño Cerebral, Hospital Beata María Ana, Madrid, Spain
| | | | - C González
- Centro Estatal de Atención al Daño Cerebral-CEADAC, Madrid, Spain
| | - R Pelayo
- Institut Guttmann, Barcelona, Spain
| | - J Ferri
- NEURORHB Servicio de Neurorrehabilitación de Hospitales Vithas, Fundación Hospitales Vithas, Valencia, Spain
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Nakajima M, Oki K, Omori T, Koyama T, Oyama N, Koga M, Hayase M, Ohta T, Matsumoto K, Iguchi Y, Fujimoto S, Kakuda W, Ogasawara K. A nationwide survey for the provision of acute stroke rehabilitation in Japan: initial dose and weekend/holiday rehabilitation. J Stroke Cerebrovasc Dis 2024; 33:107550. [PMID: 38142566 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107550] [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: 10/18/2023] [Revised: 12/14/2023] [Accepted: 12/20/2023] [Indexed: 12/26/2023] Open
Abstract
OBJECTIVES The early initiation of acute stroke rehabilitation with a sufficient dose, including at weekends/holidays, is important to improve functional outcome. We investigated the status of acute stroke rehabilitation in Japan by using a nationwide survey. MATERIALS AND METHODS Facility features, rehabilitation dose provided in the first week in each stroke subtype, and weekend/holiday rehabilitation were investigated by using the results of a web-based survey among primary stroke centers. The relationships between facility features and weekend/holiday rehabilitation were also analyzed. RESULTS A total of 639 stroke centers (66.6%) completed the questionnaire. The overall median dose was 2.0 (interquartile range, 1.7-3.0) U/day (1U = 20 min). After 7 days, the overall median dose increased to 4.0 (2.0-5.4) U/day. Almost 50% of facilities replied that they could not provide a sufficient dose of rehabilitation; the main reason was a lack of therapists (31%). For rehabilitation on long weekends, no rehabilitation was provided on 3-day weekends in 19% of facilities, and in 5% of facilities on ≥4-day weekends. The mean number of therapists was almost 50% less in the facilities that provided no rehabilitation on 3-day weekends compared to those that provided daily rehabilitation (19.4 vs. 36.2 therapists, respectively, p < 0.001). CONCLUSIONS In this survey, the provision of acute stroke rehabilitation, including non-working days, was clarified. According to the results, prospective interventional or observational studies are needed to design more effective rehabilitation programs to improve outcome. In particular, it is important to determine the optimal dose and intensity of acute stroke rehabilitation.
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Affiliation(s)
- Makoto Nakajima
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
| | - Koichi Oki
- Department of Neurology, Tokyo Saiseikai Central Hospital, Tokyo, Japan.
| | - Tomohiro Omori
- Division of Rehabilitation Medicine, International University of Health and Welfare Narita Hospital, Japan.
| | - Tetsuo Koyama
- Department of Rehabilitation Medicine, Nishinomiya Kyoritsu Neurosurgical Hospital, Hyogo, Japan.
| | - Naoki Oyama
- Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan.
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.
| | - Makoto Hayase
- Department of Neurosurgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
| | - Tsuyoshi Ohta
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Hyogo, Japan.
| | - Koichi Matsumoto
- Division of Rehabilitation Medicine, General Tokyo Hospital, Japan.
| | - Yasuyuki Iguchi
- Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan.
| | - Shigeru Fujimoto
- Division of Neurology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan.
| | - Wataru Kakuda
- Rehabilitation Medicine, International University of Health and Welfare Narita Hospital, Chiba, Japan.
| | - Kuniaki Ogasawara
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan.
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Tong Y, Ding Y, Han Z, Duan H, Geng X. Optimal rehabilitation strategies for early postacute stroke recovery: An ongoing inquiry. Brain Circ 2023; 9:201-204. [PMID: 38284113 PMCID: PMC10821682 DOI: 10.4103/bc.bc_33_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/26/2023] [Accepted: 08/29/2023] [Indexed: 01/30/2024] Open
Abstract
Early rehabilitation is crucial in reducing stroke-related disability, but the optimal training model remains unclear. We conducted a trial comparing different initiation timings and intensities of mobilization strategies after stroke. Results showed that early intensive mobilization had favorable outcomes at 3 months post-stroke, while very early intensive mobilization had poorer chances of favorable outcomes. Our investigation into brain injury mechanisms induced by very early exercise within 24 hours of stroke onset aligned with guidelines advising against high-dose very early mobilization. Additionally, we are studying the effects of various exercise intensities and frequencies on early stroke rehabilitation. Integrated rehabilitation models, such as combining remote ischemic conditioning (RIC) with exercise (RICE), hold promise. Our study found RICE to be safe and feasible for early rehabilitation of acute ischemic stroke patients, and further research is underway to determine its efficacy in a larger sample size. Despite extensive research, identifying the most effective early recovery strategies remains a complex challenge, necessitating ongoing work in the field of early rehabilitation after stroke.
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Affiliation(s)
- Yanna Tong
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Luhe Institute of Neuroscience, Capital Medical University, Beijing, China
| | - Yuchuan Ding
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Zhenzhen Han
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Luhe Institute of Neuroscience, Capital Medical University, Beijing, China
| | - Honglian Duan
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Luhe Institute of Neuroscience, Capital Medical University, Beijing, China
| | - Xiaokun Geng
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Luhe Institute of Neuroscience, Capital Medical University, Beijing, China
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Polito G, Russo M, Santilli M, Cantarella C, D'Aurizio C, Sensi SL. Role of neurorehabilitation in the recovery of bilateral thalamic stroke related to the artery of Percheron anatomical variant. BMJ Case Rep 2023; 16:e254872. [PMID: 37714557 PMCID: PMC10510918 DOI: 10.1136/bcr-2023-254872] [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: 09/17/2023] Open
Abstract
Bilateral thalamic stroke is a rare condition, mostly related to the presence of the artery of Percheron (AoP) variant. The clinical presentation of AoP-related strokes is remarkably heterogeneous and often includes cognitive and behavioural alterations. Our report describes the clinical course of an AoP-related bilateral thalamic stroke and highlights the pivotal role of a tailored rehabilitation programme plays in enhancing recovery. A man in his 40s was admitted to the neurology ward due to the abrupt onset of mental status alterations and weakness in his left limbs. The first brain CT scan and subsequent MRI exam revealed a bilateral thalamic stroke and the presence of an AoP anatomical variant. After the first critical phase, the patient's condition became stable, but he still suffered from severe attention, memory and speech deficits. The patient was then transferred to the rehabilitation unit and was subjected to a tailored neurorehabilitation programme that allowed a complete recovery of the symptoms. Neurorehabilitation plays a pivotal role in the patient's recovery and should always be pursued to minimise the residual deficits and, most importantly, to prevent permanent cognitive deficits.
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Affiliation(s)
- Gaetano Polito
- Department of Neuroscience, Imaging and Clinical Science, Università degli Studi Gabriele d'Annunzio Chieti Pescara, Chieti, Italy
| | - Mirella Russo
- Department of Neurosciences, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Matteo Santilli
- Department of Neuroscience, Imaging and Clinical Science, Università degli Studi Gabriele d'Annunzio Chieti Pescara, Chieti, Italy
| | | | | | - Stefano L Sensi
- CeSI-MeT, Center for Excellence on Aging and Translational Medicine, University "G. d'Annunzio" Chieti-Pescara, Chieti, Italy
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Lip GYH, Lenarczyk R, Pastori D, Ntaios G, Doehner W, Schnabel R. Post-stroke cardiovascular management: Current concepts, integrated care and future developments. Curr Probl Cardiol 2023; 48:101738. [PMID: 37040854 DOI: 10.1016/j.cpcardiol.2023.101738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/06/2023] [Indexed: 04/13/2023]
Abstract
After an ischaemic stroke patients often have cardiovascular complications known as stroke-heart syndrome. The cardiovascular management after stroke has a significant impact on life expectancy as well as the quality of life. The development and implementation of management pathways to improve outcomes for patients with stroke-heart syndrome requires a multidisciplinary involvement from health care professionals from primary, secondary and tertiary prevention levels. A holistic, integrated care approach could follow the ABC pathway: A) Appropriate antithrombotic therapy in all stroke/TIA patients in the acute phase as well as recommendations for the longer term treatment regimen are required to avoid recurrent stroke. B) For better functional and psychological status the assessment of post-stroke cognitive and physical impairment, depression, and anxiety as part of routine post-stroke work-up in every patient is necessary. C) Cardiovascular risk factors and comorbidities management further includes cardiovascular work-up, adapted drug therapy, but often also lifestyle changes that are central to the success of integrated care for stroke-heart syndrome. Greater patient and family/caregiver involvement in planning actions and the input and feedback on optimizing stroke care pathways is needed. Achieving integrated care is challenging and highly context dependent on different healthcare levels. A tailored approach will utilize a variety of enabling factors. In this narrative review, we summarize the current evidence and outline potential factors that will contribute to the successful implementation of integrated cardiovascular care for stroke-heart syndrome management.
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Affiliation(s)
- Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | - Radosław Lenarczyk
- The Medical University of Silesia, Division of Medical Sciences in Zabrze, Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center of Heart Diseases, Curie-Sklodowska Str 9, 41-800 Zabrze, Poland
| | - Daniele Pastori
- Emergency Medicine Unit - Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Italy
| | - George Ntaios
- Department of Internal Medicine, School of Health Sciences, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Wolfram Doehner
- BIH Center for Regenerative Therapies (BCRT) and Department of Internal Medicine and Cardiology (Virchow Klinikum), German Centre for Cardiovascular Research (DZHK) partner site Berlin and Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Renate Schnabel
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
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6
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Wang Q, Wehbe A, Wills M, Li F, Geng X, Ding Y. The Key Role of Initiation Timing on Stroke Rehabilitation by Remote Ischemic Conditioning with Exercise (RICE). Neurol Res 2023; 45:334-345. [PMID: 36399507 DOI: 10.1080/01616412.2022.2146259] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Physical therapy is an integral part of post-stroke rehabilitation. Remote ischemic conditioning (RIC) induces neuroprotection within 24 hours after stroke, during which exercise is unsafe and ineffective. We combined RIC with exercise to establish a novel rehabilitation strategy, RICE (RIC+Exercise). The aim of this study was to optimize the RICE protocol in neurorehabilitation. METHODS Thirty-two adult male Sprague-Dawley rats were placed in one of four groups: stroke with no rehabilitation or stroke with various RICE protocols. To further understand the mechanisms underlying neurorehabilitation, sixteen adult male Sprague-Dawley were added, each placed in one of two groups: stroke with exerciseor RIC . Long-term functional outcomes were determined by beam balance, rota-rod, grid walk, forelimb placing, and Morris water maze tests up to 28 days after stroke (p < 0.05). Changes in neuroplasticity including synaptogenesis (assessed by measuring synaptophysin, post-synaptic density protein-95, and brain-derived neutrophic factor), angiogenesis (via vascular endothelial growth factor, Angiopoietin-1, and Angiopoietin-2), and regulatory molecules (including hypoxia inducible factor-1α, phospholipase D2 and the mechanistic target of rapamycin pathway), were all measured at both mRNA and protein levels (p < 0.05). RESULTS All rehabilitation groups showed significant improvement in functional outcomes and levels of synaptogenesis and angiogenesis. 5 day RICE groups, in which RIC was started five days prior to exercise, demonstrated the greatest improvement among these parameters. The results also suggested that the HIF-1α/PLD2/mTOR signaling pathway may be implicated in post-stroke neuroplasticity. CONCLUSIONS RICE, particularly RIC initiation at hour 6 post-reperfusion followed by exercise on day 5, enhanced post-stroke rehabilitation in rats.
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Affiliation(s)
- Qingzhu Wang
- China-America Institute of Neuroscience, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Alexandra Wehbe
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA.,Department of Social and Behavioral Sciences Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Melissa Wills
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Fengwu Li
- China-America Institute of Neuroscience, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Xiaokun Geng
- China-America Institute of Neuroscience, Beijing Luhe Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA.,Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Yuchuan Ding
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
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Tollár J, Vetrovsky T, SZéPHELYI K, Csutorás B, Prontvai N, Ács P, Hortobágyi T. Effects of 2-Year-Long Maintenance Training and Detraining on 558 Subacute Ischemic Stroke Patients' Clinical-Motor Symptoms. Med Sci Sports Exerc 2023; 55:607-613. [PMID: 36730024 DOI: 10.1249/mss.0000000000003092] [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: 02/03/2023]
Abstract
PURPOSE This study aimed to determine the effects of a 2-yr-long maintenance training (MT) exergaming and detraining (DT) on clinical-motor symptoms in subacute ischemic patients with stroke (PwST). The hypothesis was that MT motor rehabilitation program would further increase the effects of the initial rehabilitation. METHODS After high-intensity and high-frequency exergaming twice or once a day, 5 times per week for 5 wk (EX2: 50 sessions; EX1: 25 sessions, results reported previously), 558 PwST were randomized to EX2-MT, EX2-DT, EX1-MT, and EX1-DT. MT exergaming consisted of once a day, 3 times per week for 2 yr, and DT did not train. Outcomes were measured at 6, 12, 18, and 24 months. The data were analyzed using longitudinal linear mixed-effects models and general linear hypotheses testing. RESULTS Modified Rankin Score (primary outcome), body mass, Mini-Mental State Examination score, Beck Depression Inventory, measures of quality of life, Berg Balance Scale, 6-min walk test, and four measures of center of pressure path tended to retain the initial rehabilitation-induced gains in the MT patients in selected outcomes (especially walking capacity). The scores tended to mildly worsen after DT, partially supporting the hypothesis. CONCLUSIONS MT successfully maintained, but only in selected variables did it further increase the initial exergaming rehabilitation-induced robust improvements. DT modestly reduced the initial exergaming rehabilitation-induced improvements. MT programs might be needed after initial stroke rehabilitation to reduce subsequent losses of quality of life and further improve clinical-motor symptoms.
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Affiliation(s)
| | - Tomas Vetrovsky
- Faculty of Physical Education and Sport, Charles University, Prague, CZECH REPUBLIC
| | - Klaudia SZéPHELYI
- Faculty of Health Sciences, Department of Medical Imaging, University of Pécs, Pécs, HUNGARY
| | - Bence Csutorás
- Somogy County Kaposi Mór Teaching Hospital, Kaposvár, HUNGARY
| | - Nándor Prontvai
- Somogy County Kaposi Mór Teaching Hospital, Kaposvár, HUNGARY
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8
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Johnson L, Burridge J, Ewings S, Westcott E, Gayton M, Demain S. Principles into Practice: An Observational Study of Physiotherapists use of Motor Learning Principles in Stroke Rehabilitation. Physiotherapy 2023; 118:20-30. [PMID: 36306569 PMCID: PMC9907222 DOI: 10.1016/j.physio.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 03/21/2022] [Accepted: 06/14/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE(S) To describe a) how motor learning principles are applied during post stroke physiotherapy, with a focus on lower limb rehabilitation; and b) the context in which these principles are used, in relation to patient and/or task characteristics. DESIGN Direct non-participation observation of routine physiotherapy sessions, with data collected via video recording. A structured analysis matrix and pre-agreed definitions were used to identify, count and record: type of activity; repetitions; instructional and feedback statements (frequency and type); strategies such as observational learning and augmented feedback. Data was visualised using scatter plots, and analysed descriptively. SETTING 6 UK Stroke Units PARTICIPANTS: 89 therapy sessions were observed, involving 55 clinicians and 57 patients. RESULTS Proportion of time spent active within each session ranged from 26% to 98% (mean 85, SD 19). The frequency of task repetition varied widely, with a median of 3.7 repetitions per minute (IQR 2.1-8.6). Coaching statements were common (mean 6.46 per minute), with 52% categorised as instructions, 14% as feedback, and 34% as verbal cues/motivational statements. 13% of instructions and 6% of feedback statements were externally focussed. Examining the use of different coaching behaviours in relation to patient characteristics found no associations. Overall, practice varied widely across the dataset. CONCLUSIONS To optimise the potential for motor skill learning, therapists must manipulate features of their coaching language (what they say, how much and when) and practice design (type, number, difficulty and variability of task). There is an opportunity to implement motor learning principles more consistently, to benefit motor skill recovery following stroke. TRIAL REGISTRATION NUMBER Clinicaltrials.gov (NCT03792126). CONTRIBUTION OF THE PAPER.
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Affiliation(s)
- Louise Johnson
- University Hospitals Dorset NHS Foundation Trust, Castle Lane East, Bournemouth, Dorset, UK; School of Health Sciences, Faculty of Environmental and Life Sciences, Building 45, University of Southampton, Southampton SO17 1BJ.
| | - Jane Burridge
- School of Health Sciences, Faculty of Environmental and Life Sciences, Building 45, University of Southampton, Southampton SO17 1BJ
| | - Sean Ewings
- Southampton Clinical Trials Unit, University of Southampton, University Road, Southampton, SO17 1BJ
| | - Ellie Westcott
- University Hospitals Dorset NHS Foundation Trust, Castle Lane East, Bournemouth, Dorset, UK
| | - Marianne Gayton
- University Hospitals Dorset NHS Foundation Trust, Castle Lane East, Bournemouth, Dorset, UK
| | - Sara Demain
- School of Health Sciences, Faculty of Environmental and Life Sciences, Building 45, University of Southampton, Southampton SO17 1BJ
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Lee HY, Song SY, Hwang J, Baek A, Baek D, Kim SH, Park JH, Choi S, Pyo S, Cho SR. Very early environmental enrichment protects against apoptosis and improves functional recovery from hypoxic-ischemic brain injury. Front Mol Neurosci 2023; 15:1019173. [PMID: 36824441 PMCID: PMC9942523 DOI: 10.3389/fnmol.2022.1019173] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 12/29/2022] [Indexed: 02/10/2023] Open
Abstract
Appropriate rehabilitation of stroke patients at a very early phase results in favorable outcomes. However, the optimal strategy for very early rehabilitation is at present unclear due to the limited knowledge on the effects of very early initiation of rehabilitation based on voluntary exercise (VE). Environmental enrichment (EE) is a therapeutic paradigm for laboratory animals that involves complex combinations of physical, cognitive, and social stimuli, as well as VE. Few studies delineated the effect of EE on apoptosis in very early stroke in an experimental model. Although a minimal benefit of early rehabilitation in stroke models has been claimed in previous studies, these were based on a forced exercise paradigm. The aim of this study is to determine whether very early exposure to EE can effectively regulate Fas/FasL-mediated apoptosis following hypoxic-ischemic (HI) brain injury and improve neurobehavioral function. C57Bl/6 mice were housed for 2 weeks in either cages with EE or standard cages (SC) 3 h or 72 h after HI brain injury. Very early exposure to EE was associated with greater improvement in motor function and cognitive ability, reduced volume of the infarcted area, decreased mitochondria-mediated apoptosis, and decreased oxidative stress. Very early exposure to EE significantly downregulated Fas/FasL-mediated apoptosis, decreased expression of Fas, Fas-associated death domain, cleaved caspase-8/caspase-8, cleaved caspase-3/caspase-3, as well as Bax and Bcl-2, in the cerebral cortex and the hippocampus. Delayed exposure to EE, on the other hand, failed to inhibit the extrinsic pathway of apoptosis. This study demonstrates that very early exposure to EE is a potentially useful therapeutic translation for stroke rehabilitation through effective inhibition of the extrinsic and intrinsic apoptotic pathways.
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Affiliation(s)
- Hoo Young Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea,National Traffic Injury Rehabilitation Hospital, Gyeonggi-do, Republic of Korea,Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Suk-Young Song
- Graduate Program of Biomedical Engineering, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jihye Hwang
- Graduate Program of Biomedical Engineering, Yonsei University College of Medicine, Seoul, Republic of Korea,Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ahreum Baek
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea,Department of Rehabilitation Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Dawoon Baek
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea,Department of Rehabilitation Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Sung Hoon Kim
- Department of Rehabilitation Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Jung Hyun Park
- Yonsei University College of Medicine, Seoul, Republic of Korea,Department of Rehabilitation Medicine, Rehabilitation Institute of Neuromuscular Disease, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sungchul Choi
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Soonil Pyo
- Neuracle Science Co. Ltd., Seoul, Republic of Korea,Brain Korea 21 PLUS Project for Medical Science, Yonsei University, Seoul, Republic of Korea
| | - Sung-Rae Cho
- Graduate Program of Biomedical Engineering, Yonsei University College of Medicine, Seoul, Republic of Korea,Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea,Brain Korea 21 PLUS Project for Medical Science, Yonsei University, Seoul, Republic of Korea,Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Republic of Korea,*Correspondence: Sung-Rae Cho, ✉
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10
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Yamakawa S, Nagayama H, Tomori K, Ikeda K, Niimi A. Effectiveness of active occupational therapy in patients with acute stroke: A propensity score-weighted retrospective study. FRONTIERS IN REHABILITATION SCIENCES 2023; 3:1045231. [PMID: 36684684 PMCID: PMC9849931 DOI: 10.3389/fresc.2022.1045231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/09/2022] [Indexed: 01/07/2023]
Abstract
Background and purpose The effects of therapy and patient characteristics on rehabilitation outcomes in patients with acute stroke are unclear. We investigated the effects of intensive occupational therapy (OT) on patients with acute stroke. Methods We performed a retrospective cohort study using the 2005-2016 Japan Rehabilitation Database, from which we identified patients with stroke (n = 10,270) who were admitted to acute care hospitals (n = 37). We defined active OT (AOT) and non-AOT as OT intervention times (total intervention time/length of hospital stay) longer or shorter than the daily physical therapy intervention time, respectively. The outcomes assessed were the Functional Independence Measure (FIM) and National Institutes of Health Stroke Scale (NIHSS) scores, duration of hospitalization, and rate of discharge. Propensity scores and inverse probability of treatment weighting analyses adjusted for patient characteristics were performed to investigate the effects of AOT on patient outcomes. Results We enrolled 3,501 patients (1,938 and 1,563 patients in the AOT and non-AOT groups, respectively) in the study. After inverse probability of treatment weighting, the AOT group had a shorter length of hospitalization (95% confidence interval: -3.7, -1.3, p < 0.001), and the FIM (95% confidence interval: 2.0, 5.7, p < 0.001) and NIHSS (95% confidence interval; 0.3, 1.1, p < 0.001) scores improved significantly. Subgroup analysis showed that lower NHISS scores for aphasia, gaze, and neglect and lower overall NIHSS and FIM scores on admission led to a greater increase in FIM scores in the AOT group. Conclusions AOT improved the limitations in performing activities of daily living (ADL) and physical function in patients with acute stroke and reduced the length of hospitalization. Additionally, subgroup analysis suggested that the increase in FIM score was greater in patients with severe limitations in performing ADLs and worse cognitive impairment, such as neglect, on admission.
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Affiliation(s)
- Shiori Yamakawa
- Department of Occupational Therapy, Kinugasa Hospital, Yokosuka, Japan
| | - Hirofumi Nagayama
- Department of Occupational Therapy, Kanagawa University of Human Services, Yokosuka, Japan,Correspondence: Hirofumi Nagayama
| | - Kounosuke Tomori
- Department of Occupational Therapy, Tokyo University of Technology, Tokyo, Japan
| | - Kohei Ikeda
- Department of Occupational Therapy, Kinugasa Hospital, Yokosuka, Japan
| | - Ayaka Niimi
- Department of Occupational Therapy, Yokohama Brain and Spine Center, Yokohama, Japan
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11
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Tong Y, Lee H, Kohls W, Han Z, Duan H, Cheng Z, Li F, Gao J, Liu J, Geng X, Ding Y. Remote ischemic conditioning (RIC) with exercise (RICE) is safe and feasible for acute ischemic stroke (AIS) patients. Front Neurol 2022; 13:981498. [PMID: 36457864 PMCID: PMC9706098 DOI: 10.3389/fneur.2022.981498] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/31/2022] [Indexed: 05/31/2024] Open
Abstract
OBJECTIVE Rehabilitation is essential in reducing stroke disability and should be performed as early as possible. Exercise is an established and effective rehabilitation method; however, its implementation has been limited as its very early use exacerbates cerebral injury and is restricted by patients' unstable conditions and disabilities. Remote ischemic conditioning (RIC) is a passive and accessible therapy in acute phases of stroke and appears to have similar neuroprotective effects as exercise. This study assessed the safety and feasibility of the novel rehabilitation strategy-early RIC followed by exercise (RICE) in acute ischemic stroke (AIS). METHODS We conducted a single-center, double-blinded, randomized controlled trial with AIS patients within 24 h of stroke onset or symptom exacerbation. All enrolled patients were randomly assigned, at a ratio of 1:1, to either the RICE group or the sham-RICE group (sham RIC with exercise). Each group received either RIC or sham RIC within 24 h after stroke onset or symptom exacerbation, once a day, for 14 days. Both groups started the exercise routine on day 4, twice daily, for 11 total days. The safety endpoints included clinical deterioration, recurrence of stroke, hemorrhagic transformation, complications, and adverse events resulting from RICE during hospitalization. The efficacy endpoints [Modified Rankin Scale (mRS) score, National Institutes of Health Stroke Scale (NIHSS) score, Barthel Index, and walking ability] were evaluated at admission and 90 days after stroke onset. RESULTS Forty AIS patients were recruited and completed the study. No significant differences in baseline characteristics were found between the two groups, which included risk factors, stroke severity at admission, pre-morbid disability, and other special treatments. No significant differences were found in the safety endpoints between two groups. Excellent recovery (mRS 0-2) at 3 months was obtained in 55% of the patients with RICE as compared 40% in sham group, but it did not reach a significant level. CONCLUSIONS RICE was safe and feasible for AIS patients, and seems to be a promising early stroke rehabilitation. The results of this study suggest a need for a future randomized and controlled multicenter trial with a larger sample size to determine the efficacy of RICE.
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Affiliation(s)
- Yanna Tong
- Institute of Neuroscience, Beijing Luhe Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Hangil Lee
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, United States
| | - Wesley Kohls
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, United States
| | - Zhenzhen Han
- Institute of Neuroscience, Beijing Luhe Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Honglian Duan
- Institute of Neuroscience, Beijing Luhe Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Zhe Cheng
- Institute of Neuroscience, Beijing Luhe Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Fenghai Li
- Institute of Neuroscience, Beijing Luhe Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Jie Gao
- Institute of Neuroscience, Beijing Luhe Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Jing Liu
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Xiaokun Geng
- Institute of Neuroscience, Beijing Luhe Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, United States
| | - Yuchuan Ding
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, United States
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12
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Wang W, Wei M, Cheng Y, Zhao H, Du H, Hou W, Yu Y, Zhu Z, Qiu L, Zhang T, Wu J. Safety and Efficacy of Early Rehabilitation After Stroke Using Mechanical Thrombectomy: A Pilot Randomized Controlled Trial. Front Neurol 2022; 13:698439. [PMID: 35463135 PMCID: PMC9028453 DOI: 10.3389/fneur.2022.698439] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 02/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background Early rehabilitation (ER) has been reported to be both safe and feasible for patients' post-stroke. To date, however, ER-related outcomes concerning patients who have undergone mechanical thrombectomy (MT) have not been investigated. This study aimed to determine the feasibility of ER and whether it improves prognosis in such patients. Methods In this single-center, double-blinded, randomized controlled study involving 103 patients who met the study criteria (i.e., has undergone MT), we randomly divided patients (1:1) into ER and conventional rehabilitation groups. The primary outcome was mortality, while secondary outcomes included favorable outcomes (modified Rankin scale of 0–2), the incidence of non-fatal complications, and Barthel Index (BI) scores. We assessed outcomes at 3 months and 1-year post-stroke. Results No significant between-group differences were found in terms of mortality and favorable outcomes at 3 months and 1-year post-stroke. At 3 months, 15 (28.8%) patients in the ER group and 29 (56.9%) in the conventional rehabilitation group (p = 0.002) had non-fatal complications. The BI in the ER and conventional rehabilitation groups was 100 (85–100) and 87.5 (60–100), respectively, (p = 0.007). At 1 year, the incidence of non-fatal complications was similar between both groups [BI in the ER group, 100 (90–100), p = 0.235; BI in the conventional rehabilitation group, 90 (63.8–100); p = 0.003]. Conclusion Early rehabilitation (ER) reduces the incidence of early immobility-related complications and effectively improves patients' activities of daily living on a short- and long-term basis. Our results indicate that MT contributes to ER in patients with stroke. Clinical Trial Registration www.chictr.org.cn, identifier: ChiCTR1900022665.
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Affiliation(s)
- Wei Wang
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Department of Neurorehabilitation and Neurology, Tianjin Neurosurgical Institute, Tianjin Huanhu Hospital, Tianjin, China
| | - Ming Wei
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China
| | - Yuanyuan Cheng
- Department of Rehabilitation, Tianjin Huanhu Hospital, Tianjin, China
| | - Hua Zhao
- Department of Rehabilitation, Tianjin Huanhu Hospital, Tianjin, China
| | - Hutao Du
- Department of Rehabilitation, Tianjin Huanhu Hospital, Tianjin, China
| | - Weijia Hou
- Department of Rehabilitation, Tianjin Huanhu Hospital, Tianjin, China
| | - Yang Yu
- Department of Rehabilitation, Tianjin Huanhu Hospital, Tianjin, China
| | - Zhizhong Zhu
- Department of Rehabilitation, Tianjin Huanhu Hospital, Tianjin, China
| | - Lina Qiu
- Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Department of Neurorehabilitation and Neurology, Tianjin Neurosurgical Institute, Tianjin Huanhu Hospital, Tianjin, China
| | - Tao Zhang
- Department of Intensive Care Unit, Tianjin Huanhu Hospital, Tianjin, China
| | - Jialing Wu
- Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Department of Neurorehabilitation and Neurology, Tianjin Neurosurgical Institute, Tianjin Huanhu Hospital, Tianjin, China
- *Correspondence: Jialing Wu
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13
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Distinctive Gut Microbiota Alteration Is Associated with Poststroke Functional Recovery: Results from a Prospective Cohort Study. Neural Plast 2021; 2021:1469339. [PMID: 34917142 PMCID: PMC8670901 DOI: 10.1155/2021/1469339] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/10/2021] [Indexed: 12/14/2022] Open
Abstract
Objectives Functional prognosis is potentially correlated with gut microbiota alterations following the dysregulation of the gut-microbiota-brain axis after stroke. This study was designed to explore the poststroke alterations of gut microbiota and potential correlations between gut microbiota and global functions. Methods A total of thirty-eight patients with stroke and thirty-five healthy demographics-matched controls were recruited. Their fecal DNAs were extracted, and the V3-V4 regions of the conserved bacterial 16S RNA were amplified and sequenced on the Illumina MiSeq platform. Microbial composition, diversity indices, and species cooccurrence were compared between groups. Random forest and receiver operating characteristic analysis were used to identify potential diagnostic biomarkers. Relationships between discriminant bacteria and poststroke functional outcomes were estimated. Results Higher alpha diversity of gut microbiota was observed in poststroke patients as compared to the healthy controls (p < 0.05). Beta diversity showed that microbiota composition in the poststroke group was significantly different from that in the control group. Relative abundance of nine genera increased significantly in poststroke patients, while 82 genera significantly decreased (p < 0.05). The accuracy, specificity, and susceptibility of the optimal model consisted of the top 10 discriminant species were 93%, 100%, and 86%, respectively. Subgroup analysis showed that bacterial taxa abundant between subacute and chronic stroke patients were overall different (p < 0.05). The modified Rankin scale (mRS) (r = −0.370, p < 0.05), Fugl-Meyer assessment (FMA) score (r = 0.364, p < 0.05), water swallow test (WST) (r = 0.340, p < 0.05), and Barthel index (BI) (r = 0.349, p < 0.05) were significantly associated with alterations of distinctive gut microbiota. Conclusions The gut microbiota in patients with stroke was significantly changed in terms of richness and composition. Significant associations were detected between alterations of distinctive gut microbiota and global functional prognosis. It would facilitate novel treatment target selection in the context of stroke while the causal relationships between distinctive gut microbiota alterations and functional variations need to be further verified with well-designed studies.
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14
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Clark B, Whitall J, Kwakkel G, Mehrholz J, Ewings S, Burridge J. The effect of time spent in rehabilitation on activity limitation and impairment after stroke. Cochrane Database Syst Rev 2021; 10:CD012612. [PMID: 34695300 PMCID: PMC8545241 DOI: 10.1002/14651858.cd012612.pub2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Stroke affects millions of people every year and is a leading cause of disability, resulting in significant financial cost and reduction in quality of life. Rehabilitation after stroke aims to reduce disability by facilitating recovery of impairment, activity, or participation. One aspect of stroke rehabilitation that may affect outcomes is the amount of time spent in rehabilitation, including minutes provided, frequency (i.e. days per week of rehabilitation), and duration (i.e. time period over which rehabilitation is provided). Effect of time spent in rehabilitation after stroke has been explored extensively in the literature, but findings are inconsistent. Previous systematic reviews with meta-analyses have included studies that differ not only in the amount provided, but also type of rehabilitation. OBJECTIVES To assess the effect of 1. more time spent in the same type of rehabilitation on activity measures in people with stroke; 2. difference in total rehabilitation time (in minutes) on recovery of activity in people with stroke; and 3. rehabilitation schedule on activity in terms of: a. average time (minutes) per week undergoing rehabilitation, b. frequency (number of sessions per week) of rehabilitation, and c. total duration of rehabilitation. SEARCH METHODS We searched the Cochrane Stroke Group trials register, CENTRAL, MEDLINE, Embase, eight other databases, and five trials registers to June 2021. We searched reference lists of identified studies, contacted key authors, and undertook reference searching using Web of Science Cited Reference Search. SELECTION CRITERIA We included randomised controlled trials (RCTs) of adults with stroke that compared different amounts of time spent, greater than zero, in rehabilitation (any non-pharmacological, non-surgical intervention aimed to improve activity after stroke). Studies varied only in the amount of time in rehabilitation between experimental and control conditions. Primary outcome was activities of daily living (ADLs); secondary outcomes were activity measures of upper and lower limbs, motor impairment measures of upper and lower limbs, and serious adverse events (SAE)/death. DATA COLLECTION AND ANALYSIS Two review authors independently screened studies, extracted data, assessed methodological quality using the Cochrane RoB 2 tool, and assessed certainty of the evidence using GRADE. For continuous outcomes using different scales, we calculated pooled standardised mean difference (SMDs) and 95% confidence intervals (CIs). We expressed dichotomous outcomes as risk ratios (RR) with 95% CIs. MAIN RESULTS The quantitative synthesis of this review comprised 21 parallel RCTs, involving analysed data from 1412 participants. Time in rehabilitation varied between studies. Minutes provided per week were 90 to 1288. Days per week of rehabilitation were three to seven. Duration of rehabilitation was two weeks to six months. Thirteen studies provided upper limb rehabilitation, five general rehabilitation, two mobilisation training, and one lower limb training. Sixteen studies examined participants in the first six months following stroke; the remaining five included participants more than six months poststroke. Comparison of stroke severity or level of impairment was limited due to variations in measurement. The risk of bias assessment suggests there were issues with the methodological quality of the included studies. There were 76 outcome-level risk of bias assessments: 15 low risk, 37 some concerns, and 24 high risk. When comparing groups that spent more time versus less time in rehabilitation immediately after intervention, we found no difference in rehabilitation for ADL outcomes (SMD 0.13, 95% CI -0.02 to 0.28; P = 0.09; I2 = 7%; 14 studies, 864 participants; very low-certainty evidence), activity measures of the upper limb (SMD 0.09, 95% CI -0.11 to 0.29; P = 0.36; I2 = 0%; 12 studies, 426 participants; very low-certainty evidence), and activity measures of the lower limb (SMD 0.25, 95% CI -0.03 to 0.53; P = 0.08; I2 = 48%; 5 studies, 425 participants; very low-certainty evidence). We found an effect in favour of more time in rehabilitation for motor impairment measures of the upper limb (SMD 0.32, 95% CI 0.06 to 0.58; P = 0.01; I2 = 10%; 9 studies, 287 participants; low-certainty evidence) and of the lower limb (SMD 0.71, 95% CI 0.15 to 1.28; P = 0.01; 1 study, 51 participants; very low-certainty evidence). There were no intervention-related SAEs. More time in rehabilitation did not affect the risk of SAEs/death (RR 1.20, 95% CI 0.51 to 2.85; P = 0.68; I2 = 0%; 2 studies, 379 participants; low-certainty evidence), but few studies measured these outcomes. Predefined subgroup analyses comparing studies with a larger difference of total time spent in rehabilitation between intervention groups to studies with a smaller difference found greater improvements for studies with a larger difference. This was statistically significant for ADL outcomes (P = 0.02) and activity measures of the upper limb (P = 0.04), but not for activity measures of the lower limb (P = 0.41) or motor impairment measures of the upper limb (P = 0.06). AUTHORS' CONCLUSIONS An increase in time spent in the same type of rehabilitation after stroke results in little to no difference in meaningful activities such as activities of daily living and activities of the upper and lower limb but a small benefit in measures of motor impairment (low- to very low-certainty evidence for all findings). If the increase in time spent in rehabilitation exceeds a threshold, this may lead to improved outcomes. There is currently insufficient evidence to recommend a minimum beneficial daily amount in clinical practice. The findings of this study are limited by a lack of studies with a significant contrast in amount of additional rehabilitation provided between control and intervention groups. Large, well-designed, high-quality RCTs that measure time spent in all rehabilitation activities (not just interventional) and provide a large contrast (minimum of 1000 minutes) in amount of rehabilitation between groups would provide further evidence for effect of time spent in rehabilitation.
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Affiliation(s)
- Beth Clark
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Jill Whitall
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, Baltimore, Maryland, USA
| | - Gert Kwakkel
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences and Amsterdam, Amsterdam Neurosciences, VU University Medical Center, Amsterdam, Netherlands
| | - Jan Mehrholz
- Department of Public Health, Dresden Medical School, Technical University Dresden, Dresden, Germany
| | - Sean Ewings
- Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, UK
| | - Jane Burridge
- Research Group, Faculty of Health Sciences, University of Southampton, Southampton, UK
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15
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Hernández-Méndez B, Martín-Silva I, Tapias-Vilanova M, Moreno-Gallo Y, Sanjuan-Menendez E, Lorenzo-Tamayo E, Ramos-González M, Montufo-Rosal M, Zuriguel-Pérez E. Very early mobilization in the stroke unit: Functionality, quality of life and disability at 90 days and 1 year post-stroke. NeuroRehabilitation 2021; 49:403-414. [PMID: 34308915 DOI: 10.3233/nre-210118] [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: 11/15/2022]
Abstract
BACKGROUND The evidence of early mobilization after stroke is conflicting, and the recovery period is an important concern. OBJECTIVE To analyse the functionality, quality of life and disability at 90 days and 1 year post-stroke of patients who received a Very Early Mobilization Protocol (VEMP). METHODS Prospective cohort study in a tertiary stroke unit. Consecutive patients aged≥18 years and without prior significant disability, who presented motor deficit after acute stroke, were included. A symmetry test was performed to compare the changes in the main variables: Barthel Index (BI), Functional Ambulation Category (FAC), modified Rankin Scale (mRS) and EuroQol five-dimensions three-level (EQ-5D-3L) between 90 days and 1 year post-stroke. RESULTS A total of 123 patients were recruited. The BI reflected an improvement at 1 year in transfer to chair/bed in 25.8%(p < 0.01) of patients and in toilet use in 25.8%(p = 0.02). The FAC showed an improvement at 1 year in 44.4%(p < 0.01) of patients and the mRS in 19.1%(p = 0.01). The usual activities dimension of the EQ-5D-3L showed a clinically relevant improvement after 1 year in 15.9%(p = 0.23) of patients. CONCLUSIONS A significant percentage of patients show improvements in some functional areas and in disability between 90 days and 1 year post-stroke.
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Affiliation(s)
- Beatriz Hernández-Méndez
- Rehabilitation Service/Physiotherapy and Occupational Therapy Unit, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, Barcelona, Spain.,Multidisciplinary Nursing Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, Barcelona, Spain
| | - Isabel Martín-Silva
- Rehabilitation Service/Physiotherapy and Occupational Therapy Unit, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, Barcelona, Spain
| | - Martíi Tapias-Vilanova
- Rehabilitation Service/Physiotherapy and Occupational Therapy Unit, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, Barcelona, Spain
| | - Yolanda Moreno-Gallo
- Rehabilitation Service/Physiotherapy and Occupational Therapy Unit, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, Barcelona, Spain
| | - Estela Sanjuan-Menendez
- Neurology Service/Stroke Unit, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, Barcelona, Spain.,Stroke Research, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, Barcelona, Spain
| | - Eva Lorenzo-Tamayo
- Neurology Service/Stroke Unit, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, Barcelona, Spain
| | - Montserrat Ramos-González
- Neurology Service/Stroke Unit, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, Barcelona, Spain
| | - Marina Montufo-Rosal
- Neurology Service/Stroke Unit, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, Barcelona, Spain
| | - Esperanza Zuriguel-Pérez
- Multidisciplinary Nursing Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, Barcelona, Spain
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16
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Zheng Y, Yan C, Shi H, Niu Q, Liu Q, Lu S, Zhang X, Cheng Y, Teng M, Wang L, Zhang X, Hu X, Li J, Lu X, Reinhardt JD. Time Window for Ischemic Stroke First Mobilization Effectiveness: Protocol for an Investigator-Initiated Prospective Multicenter Randomized 3-Arm Clinical Trial. Phys Ther 2021; 101:6123582. [PMID: 33513232 DOI: 10.1093/ptj/pzab038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 10/01/2020] [Accepted: 01/02/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of this study is to investigate the optimal time window for initiating mobilizing after acute ischemic stroke. METHODS The TIME Trial is a pragmatic, investigator-initiated, multi-center, randomized, 3-arm parallel group, clinical trial. This trial will be conducted in 57 general hospitals in mainland China affiliated with the China Stroke Databank Center and will enroll 6033 eligible patients with acute ischemic stroke. Participants will be randomly allocated to either (1) the very early mobilization group in which mobilization is initiated within 24 hours from stroke onset, (2) the early mobilization group in which mobilization begins between 24 and 72 hours poststroke, or (3) the late mobilization group in which mobilization is started after 72 hours poststroke. The mobilization protocol is otherwise standardized and identical for each comparison group. Mobilization is titrated by baseline mobility level and progress of patients throughout the intervention period. The primary outcome is death or disability assessed with the modified Rankin scale at 3 months poststroke. Secondary outcomes include impairment score of the National Institutes of Health Stroke Scale, dependence in activities of daily living as measured using the modified Barthel Index, cognitive ability assessed with the Mini-Mental State Examination, incidence of adverse events, hospital length of stay, and total medical costs. IMPACT The TIME Trial is designed to answer the question "when is the best time to start mobilization after stroke?" The effect of timing is isolated from the effect of type and dose of mobilization by otherwise applying a standard mobilization protocol across groups. The TIME Trial may, therefore, contribute to increasing the knowledge base regarding the optimal time window for initiating mobilization after acute ischemic stroke.
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Affiliation(s)
- Yu Zheng
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chengjie Yan
- Department of Neurorehabilitation, Kunshan Rehabilitation Hospital, Kunshan, China
| | - Haibin Shi
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qi Niu
- Department of Geriatric Neurology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qianghui Liu
- Department of Emergency, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shanshan Lu
- Department of Nuclear Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xintong Zhang
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yihui Cheng
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Meiling Teng
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lu Wang
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiu Zhang
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaorong Hu
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jian Li
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiao Lu
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jan D Reinhardt
- Institute for Disaster Management and Reconstruction of Sichuan University, Chengdu, China.,Hong Kong Polytechnic University, Chengdu, China.,Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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17
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Han Z, Zhao W, Lee H, Wills M, Tong Y, Cheng Z, Dai Q, Li X, Wang Q, Geng X, Ji X, Ding Y. Remote Ischemic Conditioning With Exercise (RICE)-Rehabilitative Strategy in Patients With Acute Ischemic Stroke: Rationale, Design, and Protocol for a Randomized Controlled Study. Front Neurol 2021; 12:654669. [PMID: 34012417 PMCID: PMC8126608 DOI: 10.3389/fneur.2021.654669] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 03/15/2021] [Indexed: 01/01/2023] Open
Abstract
Objective: Exercise rehabilitation is an effective therapy in reducing the disability rate after stroke and should be carried out as early as possible. However, very early rehabilitation exercise exacerbates brain injury and is difficult to conduct in stroke patients due to their weakened and potentially disabled state. It is valuable to explore additional early rehabilitation strategies. Remote Ischemic Conditioning (RIC) is a novel therapy designed to protect vital organs from severe lethal ischemic injury by transient sublethal blood flow to non-vital organs, including the distal limbs, in order to induce endogenous protection. RIC has previously been conducted post-stroke for neuroprotection. However, whether combined early RIC and exercise (RICE) therapy enhances stroke rehabilitation remains to be determined. Methods: This is a single-center, double-blinded, randomized controlled trial that will enroll acute ischemic stroke patients within 24 h of symptom onset or symptom exacerbation. All enrolled patients will be randomly assigned to either the RICE group (exercise with RIC) or the control group (exercise with sham RIC) at a ratio of 1:1, with 20 patients in each group. Both groups will receive RIC or sham RIC within 24 h after stroke onset or symptom exacerbation, once a day, for 14 days. All patients will begin exercise training on the fourth day, twice a day, for 11 days. Their neurological function [Modified Rankin Scale (mRS) score, National Institutes of Health Stroke Scale (NIHSS) score, Barthel Index, and walking ability], infarct volume (nuclear magnetic resonance, MRI), and adverse events will be evaluated at different time points in their post-stroke care. Results: The primary outcome is safety, measured by the incidence of any serious RICE-related adverse events and decreased adverse events during hospitalization. The secondary outcome is a favorable prognosis within 90 days (mRS score < 2), determined by improvements in the mRS score, NIHSS score, Barthel Index, walking ability after 90 days, and infarct volume after 12 ± 2 days. Conclusion: This study is a prospective randomized controlled trial to determine the rehabilitative effect of early RIC followed by exercise on patients with acute ischemic stroke. Trial Registration:www.chictr.org.cn, identifier: ChiCTR2000041042
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Affiliation(s)
- Zhenzhen Han
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Wenbo Zhao
- Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Hangil Lee
- School of Medicine, Wayne State University, Detroit, MI, United States
| | - Melissa Wills
- School of Medicine, Wayne State University, Detroit, MI, United States
| | - Yanna Tong
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Zhe Cheng
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Qingqing Dai
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Xiaohua Li
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Qingzhu Wang
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Xiaokun Geng
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Xunming Ji
- Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yuchuan Ding
- School of Medicine, Wayne State University, Detroit, MI, United States
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18
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Zhang M, Wang Q, Jiang Y, Shi H, Peng T, Wang M. Optimization of Early Mobilization Program for Patients With Acute Ischemic Stroke: An Orthogonal Design. Front Neurol 2021; 12:645811. [PMID: 33912126 PMCID: PMC8072335 DOI: 10.3389/fneur.2021.645811] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 03/15/2021] [Indexed: 01/01/2023] Open
Abstract
Background and purpose: Early mobilization is considered to have favorable outcomes for stroke patients, but there is currently a lack of specific data to guide this early mobilization, including the initiation time, intensity, frequency, and duration of each activity. Therefore, the optimal strategy for early mobilization is unclear. In this study, we investigated the best combination of different factors to achieve early mobilization, to develop the optimal program. Methods: We conducted an L9 (33) orthogonal experiment with a blinded follow-up assessment. Patients with ischemic stroke, admitted to a stroke unit within 24–72 h of its onset, were recruited. Eligible subjects were randomly assigned to one of nine different programs of early mobilization. The outcomes were assessed at baseline, discharge, and 1 and 3 months after discharge to observe the changes in various efficacy indicators and determine the main factors affecting outcome. Results: We analyzed 57 of 63 patients, after six were excluded for poor compliance, failure to cooperate with the study, or worsening of the disease. The initiation time, intensity, and frequency of mobilization were the main factors affecting outcome (all P < 0.05), and the duration of each activity was a secondary factor (P > 0.05). A comprehensive analysis of the various parameters showed that the optimal level of the early mobilization program was an initiation time: 24–48 h after stroke; intensity: bed and chair transfer, sitting out of bed, standing and walking or climbing stairs when mobility permitted; frequency: 2–3 times/day; duration of each mobilization: determined according to the actual situation of the patient. Conclusions: Early rehabilitation with high-intensity physical exercise at 24–48 h after the onset of stroke, 2–3 times/day, may benefit stroke patients. Applying the optimized program of early mobilization to stroke patients effectively alleviated their symptoms of neurological deficit, improved their capacity for self-care, restored their self-efficacy, improved their quality of life and social participation, and reduced post-stroke fatigue at 3 months.
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Affiliation(s)
- Min Zhang
- Department of Neurology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Qing Wang
- Department of Nursing, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Yuanyuan Jiang
- Department of Neurology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Huiling Shi
- Department of Neurology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Tiantian Peng
- Department of Neurology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Mengyue Wang
- Department of Neurology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
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19
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Tamakoshi K, Maeda M, Nakamura S, Murohashi N. Very Early Exercise Rehabilitation After Intracerebral Hemorrhage Promotes Inflammation in the Brain. Neurorehabil Neural Repair 2021; 35:501-512. [PMID: 33825570 DOI: 10.1177/15459683211006337] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Very early exercise has been reported to exacerbate motor dysfunction; however, its mechanism is largely unknown. OBJECTIVE This study examined the effect of very early exercise on motor recovery and associated brain damage following intracerebral hemorrhage (ICH) in rats. METHODS Collagenase solution was injected into the left striatum to induce ICH. Rats were randomly assigned to receive placebo surgery without exercise (SHAM) or ICH without (ICH) or with very early exercise within 24 hours of surgery (ICH+VET). We observed sensorimotor behaviors before surgery, and after surgery preexercise and postexercise. Postexercise brain tissue was collected 27 hours after surgery to investigate the hematoma area, brain edema, and Il1b, Tgfb1, and Igf1 mRNA levels in the striatum and sensorimotor cortex using real-time reverse transcription polymerase chain reaction. NeuN, PSD95, and GFAP protein expression was analyzed by Western blotting. RESULTS We observed significantly increased skillful sensorimotor impairment in the horizontal ladder test and significantly higher Il1b mRNA levels in the striatum of the ICH+VET group compared with the ICH group. NeuN protein expression was significantly reduced in both brain regions of the ICH+VET group compared with the SHAM group. CONCLUSION Our results suggest that very early exercise may be associated with an exacerbation of motor dysfunction because of increased neuronal death and region-specific changes in inflammatory factors. These results indicate that implementing exercise within 24 hours after ICH should be performed with caution.
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20
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Dalton EJ, Churilov L, Lannin NA, Corbett D, Campbell BCV, Hayward KS. Early-phase dose articulation trials are underutilized for post-stroke motor recovery: A systematic scoping review. Ann Phys Rehabil Med 2021; 65:101487. [PMID: 33429089 DOI: 10.1016/j.rehab.2021.101487] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 11/27/2020] [Accepted: 11/30/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND To enable development of effective interventions, there is a need to complete systematic early-phase dose articulation research. This scoping review aimed to synthesize dose articulation research of behavioral motor interventions for stroke recovery. METHODS MEDLINE and EMBASE were systematically searched for dose articulation studies. Preclinical experiments and adult clinical trials were classified based on the discovery pipeline and analyzed to determine which dose dimensions were articulated (time, scheduling or intensity) and how they were investigated (unidimensional vs multidimensional approach). Reporting of dose, safety and efficacy outcomes were summarized. The intervention description, risk of bias, and quality was appraised. RESULTS We included 41 studies: 3 of preclinical dose preparation (93 rodents), 2 Phase I dose ranging (21 participants), 9 Phase IIA dose screening (198 participants), and 27 Phase IIB dose finding (1879 participants). All studies adopted a unidimensional approach. Time was the most frequent dimension investigated (53%), followed by intensity (29%), and scheduling (18%). Overall, 95% studies reported an efficacy outcome; however, only 65% reported dose and 45% reported safety. Across studies, 61% were at high risk of bias, and the average percentage reporting of intervention description and quality was 61% and 67%, respectively. CONCLUSION This review highlights a need to undertake more high-quality, early-phase studies that systematically articulate intervention doses from a multidimensional perspective in the field of behavioral motor stroke recovery. To address this gap, we need to invest in adapting early phase trial designs, especially Phase I, to support multidimensional dose articulation.
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Affiliation(s)
- Emily J Dalton
- Melbourne School of Health Sciences, University of Melbourne, Heidelberg, Australia
| | - Leonid Churilov
- Melbourne Medical School, University of Melbourne, Parkville, Australia
| | - Natasha A Lannin
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Australia; Alfred Health, Melbourne, Australia
| | - Dale Corbett
- Cellular & Molecular Medicine and Canadian Partnership for Stroke Recovery, University of Ottawa, Canada
| | - Bruce C V Campbell
- Department of Medicine and Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Kathryn S Hayward
- Melbourne School of Health Sciences and Florey Institute of Neuroscience and Mental Health, University of Melbourne, 245 Burgundy Street, 3084 Heidelberg, Australia.
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21
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Karamchandani RR, Strong D, Rhoten JB, Prasad T, Selig J, Defilipp G, Asimos AW. Age and discharge modified Rankin score are associated with 90-Day functional outcome after basilar artery occlusion treated with endovascular therapy. Interv Neuroradiol 2021; 27:531-538. [PMID: 33412967 DOI: 10.1177/1591019920987040] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Prognostic factors for functional outcome after basilar artery occlusion (BAO) treated with modern endovascular therapy (EVT) are sparse. We investigated the association between clinical characteristics, readily available imaging variables, and outcome in BAO patients treated with EVT. METHODS Retrospective analysis from a large healthcare system's prospectively collected code stroke registry of acute BAO patients treated with EVT between January 2017-January 2020. The primary outcome measure was a favorable 90-day modified Rankin score (mRS) of 0-2. RESULTS 65 patients (median age 67 years, 57% male, median NIHSS 16) met the study inclusion criteria. Thrombolysis in Cerebral Infarction (TICI) 2 b-3 revascularization was achieved in 57/65 patients (88%) with a median time to revascularization of 445 minutes [IQR 302-840]. Ninety-day good outcome was seen in 35% (23/65) of patients. In a univariate analysis, age, history of ischemic stroke, baseline NIHSS, BAO site, and discharge mRS were associated with significant differences between the good and poor outcome groups. A multivariable logistic regression analysis demonstrated an independent association with 90-day good outcome and younger age (per 1-year, OR 0.79, 95% CI 0.64, 0.98) and good discharge mRS (0-2) (OR > 999.99, 95% CI 13.26, > 999.99). CONCLUSIONS Patients presenting with an acute BAO treated with modern EVT have a good 90-day outcome in over one-third of cases. Age and discharge mRS are independently associated with good 90-day outcome. Additional studies may focus on factors that can enhance discharge function after BAO, a novel prognostic indicator for favorable 90-day outcome in our study.
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Affiliation(s)
| | - Dale Strong
- Information and Analytics Services, Atrium Health, Charlotte, USA
| | - Jeremy B Rhoten
- Neurology, Neurosciences Institute, Atrium Health, Charlotte, USA
| | - Tanushree Prasad
- Information and Analytics Services, Atrium Health, Charlotte, USA
| | - Jacob Selig
- Neurology, Neurosciences Institute, Atrium Health, Charlotte, USA
| | - Gary Defilipp
- Charlotte Radiology, Neurosciences Institute, Atrium Health, Charlotte, USA
| | - Andrew W Asimos
- Emergency Medicine, Neurosciences Institute, Atrium Health, Charlotte, USA
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22
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Wang CY, Chen YC, Wang CH. Early Rehabilitation in Acute Care Inpatient Wards May Be Crucial to Functional Recovery 3 Months After Ischemic Stroke. Phys Ther 2021; 101:5943766. [PMID: 33125475 DOI: 10.1093/ptj/pzaa197] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/10/2020] [Accepted: 09/15/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Early rehabilitation in acute care inpatient wards may maximize functional outcome at 3 months after stroke in survivors of stroke. It is unknown whether functional change during acute care hospitalization is significantly associated with functional recovery at 3 months in survivors of acute stroke. The purposes of this study were to examine the association of the Barthel Index (BI) at 3 months with functional change as measured with the Barthel Index (ΔBI) in an acute care inpatient ward and to identify the factors associated with ΔBI and who could benefit from an early rehabilitation program. METHODS In this prospective longitudinal study, 76 patients with ischemic stroke in an acute care inpatient ward received early rehabilitation of up to 2 sessions per day for 5 d/wk during their stay. Therapy density was calculated as the proportion of total therapy sessions completed. At admission and discharge, they were assessed with the BI and the Postural Assessment Scale for Stroke Patients (PASS). Demographic and health-related information was also collected. The Barthel Index (BI) was reassessed at 3 months. RESULTS ΔBI in the acute care inpatient ward significantly predicted the BI at 3 months, over and above the other significant variables; in addition, therapy density and change in PASS were significantly associated with ΔBI. Patients with moderate initial functional dependence had the largest ΔBI, followed by the group with a more severe condition. CONCLUSIONS ΔBI in acute care inpatient wards may be an important predictor of the BI at 3 months. Therapy density and change in PASS were significantly associated with ΔBI. IMPACT Survivors of acute stroke who receive up to 2 rehabilitation sessions per day for 5 d/wk early in their hospitalization have better functional recovery at 3 months after stroke.
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Affiliation(s)
- Ching-Yi Wang
- Department of Physical Therapy, Chung Shan Medical University, Taichung, Taiwan; Physical Therapy Room, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Yueh-Chi Chen
- Department of Physical Therapy, Chung Shan Medical University, Taichung, Taiwan; Physical Therapy Room, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chun-Hou Wang
- Department of Physical Therapy, Chung Shan Medical University, Taichung, Taiwan; Physical Therapy Room, Chung Shan Medical University Hospital, Taichung, Taiwan
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23
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Wills M, Ding Y. Beyond reperfusion: Enhancing endogenous restorative functions after an ischemic stroke. Brain Circ 2020; 6:223-224. [PMID: 33506144 PMCID: PMC7821811 DOI: 10.4103/bc.bc_72_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 12/14/2020] [Indexed: 01/14/2023] Open
Affiliation(s)
- Melissa Wills
- Department of Neurosurgery, School of Medicine, Wayne State University, Detroit, MI, USA
| | - Yuchuan Ding
- Department of Neurosurgery, School of Medicine, Wayne State University, Detroit, MI, USA
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24
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Tollár J, Nagy F, Csutorás B, Prontvai N, Nagy Z, Török K, Blényesi E, Vajda Z, Farkas D, Tóth BE, Repa I, Moizs M, Sipos D, Kedves A, Kovács Á, Hortobágyi T. High Frequency and Intensity Rehabilitation in 641 Subacute Ischemic Stroke Patients. Arch Phys Med Rehabil 2020; 102:9-18. [PMID: 32861668 DOI: 10.1016/j.apmr.2020.07.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 07/06/2020] [Accepted: 07/15/2020] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To determine the effects of exergaming on quality of life (QoL), motor, and clinical symptoms in subacute stroke patients. DESIGN A pseudorandomized controlled trial, using a before-after test design. SETTING University hospital. PARTICIPANTS Subacute, ischemic stroke outpatients (N=3857), 680 of whom were randomized and 641 completed the study. INTERVENTIONS We determined the effects of 5 times a week twice daily (EX2; 50 sessions; n=286) and once daily (EX1; 25 sessions; n=272) exergaming and low-intensity standard care (control [CON]; 25 sessions; n=83) on clinical, mobility, blood pressure (BP), and QoL outcomes. MAIN OUTCOME MEASURES The primary outcome was Modified Rankin Scale. Secondary outcomes were activities of daily living, 5 aspects of health-related QoL, Beck Depression Inventory, 6-minute walk test (6MWT), Berg Balance Scale (BBS), and static balance (center of pressure). RESULTS During exercise, the peak heart rate was 134, 134, and 126 beats per minute in the EX2, EX1, and CON groups, respectively. mRS improved similarly in the EX2 (-1.8; effect size, d=-4.0) and EX1 (-1.4; d=-2.6) groups, but more than in the CON group (-0.7; d=-0.6). QoL, Barthel Index, BBS, 6MWT, and standing posturography improved more in the EX2 group and the same in the EX1 and CON groups. Systolic and diastolic resting BP decreased more in the EX2 and EX1 groups than in the CON group. The intervention effects did not differ between men (n=349) and women (n=292). CONCLUSIONS Twice daily compared with once daily high-intensity exergaming or once daily lower intensity standard care produced superior effects on clinical and motor symptoms, BP, and QoL in male and female subacute ischemic stroke participants.
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Affiliation(s)
- József Tollár
- Somogy County Móricz Kaposi Teaching Hospital, Kaposvár, Hungary; University of Pécs, Faculty of Health Sciences, Doctoral School of Health Sciences, Pécs, Hungary.
| | - Ferenc Nagy
- Somogy County Móricz Kaposi Teaching Hospital, Kaposvár, Hungary; University of Pécs, Faculty of Health Sciences, Doctoral School of Health Sciences, Pécs, Hungary
| | - Bence Csutorás
- Somogy County Móricz Kaposi Teaching Hospital, Kaposvár, Hungary
| | - Nándor Prontvai
- Somogy County Móricz Kaposi Teaching Hospital, Kaposvár, Hungary
| | - Zsófia Nagy
- Somogy County Móricz Kaposi Teaching Hospital, Kaposvár, Hungary
| | - Katalin Török
- Somogy County Móricz Kaposi Teaching Hospital, Kaposvár, Hungary
| | - Eszter Blényesi
- Somogy County Móricz Kaposi Teaching Hospital, Kaposvár, Hungary
| | - Zsolt Vajda
- Somogy County Móricz Kaposi Teaching Hospital, Kaposvár, Hungary; University of Pécs, Faculty of Health Sciences, Doctoral School of Health Sciences, Pécs, Hungary; Dr József Baka Diagnostical, Oncoradiological, Research and Educational Center, Kaposvár, Hungary
| | - Dóra Farkas
- Somogy County Móricz Kaposi Teaching Hospital, Kaposvár, Hungary
| | - Béla E Tóth
- Department of Pharmaceutical Surveillance and Economics, Faculty of Pharmacy, University of Debrecen, Debrecen, Hungary
| | - Imre Repa
- Somogy County Móricz Kaposi Teaching Hospital, Kaposvár, Hungary; University of Pécs, Faculty of Health Sciences, Doctoral School of Health Sciences, Pécs, Hungary; Dr József Baka Diagnostical, Oncoradiological, Research and Educational Center, Kaposvár, Hungary
| | - Mariann Moizs
- Somogy County Móricz Kaposi Teaching Hospital, Kaposvár, Hungary
| | - Dávid Sipos
- University of Pécs, Faculty of Health Sciences, Doctoral School of Health Sciences, Pécs, Hungary; Dr József Baka Diagnostical, Oncoradiological, Research and Educational Center, Kaposvár, Hungary
| | - András Kedves
- Dr József Baka Diagnostical, Oncoradiological, Research and Educational Center, Kaposvár, Hungary
| | - Árpád Kovács
- University of Pécs, Faculty of Health Sciences, Doctoral School of Health Sciences, Pécs, Hungary; Dr József Baka Diagnostical, Oncoradiological, Research and Educational Center, Kaposvár, Hungary; Department of Oncoradiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Tibor Hortobágyi
- University of Groningen, University Medical Center, Groningen, The Netherlands
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25
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Riberholt CG, Wagner V, Lindschou J, Gluud C, Mehlsen J, Møller K. Early head-up mobilisation versus standard care for patients with severe acquired brain injury: A systematic review with meta-analysis and Trial Sequential Analysis. PLoS One 2020; 15:e0237136. [PMID: 32790771 PMCID: PMC7425882 DOI: 10.1371/journal.pone.0237136] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/20/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND There is increasing focus on earlier rehabilitation in patients with traumatic or hypoxic brain injury or stroke. This systematic review evaluates the benefits and harms of early head-up mobilisation versus standard care in patients with severe acquired brain injury. METHODS We searched Medline, CENTRAL, EMBASE, four other databases and 13 selected clinical trial registries until April 2020. Eligible randomised clinical trials compared early head-up mobilisation versus standard care in patients with severe acquired brain injury and were analysed conducting random- and fixed-effects meta-analyses and Trial Sequential Analysis (TSA). Certainty of evidence was assessed by GRADE. MAIN RESULTS We identified four randomised clinical trials (total n = 385 patients) with severe acquired brain injury (stroke 86% and traumatic brain injury 13%). Two trials were at low risk and two at high risk of bias. We found no evidence of a difference between early mobilisation vs. standard care on mortality or poor functional outcome at end of the intervention (relative risk (RR) 1.19, 95% CI 0.93 to 1.53; I2 0%; very low certainty) or at maximal follow-up (RR 1.03, 95% CI 0.89 to 1.21; I2 0%; very low certainty). We found evidence against an effect on quality of life at maximal follow-up. The proportion of patients with at least one serious adverse event did not differ at end of intervention or at maximal follow-up. For most comparisons, TSA suggested that further trials are needed. CONCLUSIONS We found no evidence of a difference between early mobilisation versus standard care for patients with severe acquired brain injury. Early mobilisation appeared not to exert a major impact on quality of life. This systematic review highlights the insufficient evidence in patients with severe brain injury, and no firm conclusions can be drawn from these data. TRIAL REGISTRATION Protocol uploaded to PROSPERO: April 2018 (revised October 2018, CRD42018088790).
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Affiliation(s)
- Christian Gunge Riberholt
- Department of Neurorehabilitation, Traumatic Brain Injury, Rigshospitalet, Copenhagen University Hospital, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Healthcare Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Vibeke Wagner
- Department of Neurorehabilitation, Traumatic Brain Injury, Rigshospitalet, Copenhagen University Hospital, Hvidovre, Denmark
| | - Jane Lindschou
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jesper Mehlsen
- Surgical Pathophysiology Unit, Juliane Marie Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kirsten Møller
- Department of Clinical Medicine, Faculty of Healthcare Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Neuroanaesthesiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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26
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Rethnam V, Langhorne P, Churilov L, Hayward KS, Herisson F, Poletto SR, Tong Y, Bernhardt J. Early mobilisation post-stroke: a systematic review and meta-analysis of individual participant data. Disabil Rehabil 2020; 44:1156-1163. [PMID: 32673130 DOI: 10.1080/09638288.2020.1789229] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE To investigate the safety and efficacy of early mobilisation (EM) compared to usual care by meta-analysing individual participant data (IPD). MATERIALS AND METHODS IPD were sought from randomised controlled trials comparing out-of-bed mobilisation starting within 48 h from stroke onset to usual care for acute stroke patients. Six trials were sourced from a recent Cochrane review. Favourable outcome (modified Rankin Scale 0-2) and death at 3 months post-stroke were compared between both groups using mixed-effect logistic regression modelling. Adjusted odds ratios (aORs) with respective 95% confidence intervals (95%CI) were reported. RESULTS Out of 2630 participants, 1437 (54.6%) were assigned to EM and 1193 (45.4%) to usual care. Intervention protocols varied considerably between trials. The median (interquartile range) delay to starting mobilisation post-stroke onset was 20 h (14.5-23.8) for EM and 23 h (16.7-34.3) for usual care group. Fewer EM participants had a favourable outcome at 3 months post-stroke compared to the usual care group (678 [48%] vs. 611 [52%]; aOR = 0.75, 95%CI: 0.62-0.92, p = 0.005). No difference in death at 3 months post-stroke between EM and usual care was observed (102 [7%] vs. 84 [7%]; aOR = 1.46, 95%CI: 0.92-2.31, p = 0.108). CONCLUSION The commencement of mobilisation should only be considered after 24 h post-stroke. Further research is required to identify safe, optimal dose, and timing of EM post-stroke.IMPLICATIONS FOR REHABILITATIONPatients who commenced mobilisation early after stroke had worse outcome than usual care.Insufficient detail about mobilisation interventions or usual care in many studies limits any further interpretation.The commencement of mobilisation should only be considered after 24-h post-stroke.
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Affiliation(s)
- Venesha Rethnam
- Florey Institute of Neuroscience and Mental Health - Austin Campus, Heidelberg, Australia.,NHMRC Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Melbourne, Australia
| | - Peter Langhorne
- Institute of Cardiovascular and Medical Sciences, Royal Infirmary, Glasgow, UK
| | - Leonid Churilov
- NHMRC Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Melbourne, Australia.,Melbourne Medical School, University of Melbourne, Parkville, Australia
| | - Kathryn S Hayward
- Florey Institute of Neuroscience and Mental Health - Austin Campus, Heidelberg, Australia.,NHMRC Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Melbourne, Australia.,Melbourne School of Health Sciences, University of Melbourne, Parkville, Australia
| | - Fanny Herisson
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Simone R Poletto
- Clinical School of Physiotherapy, Lutheran University of Brazil, Canoas, Brazil
| | - Yanna Tong
- China-America Institute of Neuroscience, Beijing Luhe Hospital, Beijing, China
| | - Julie Bernhardt
- Florey Institute of Neuroscience and Mental Health - Austin Campus, Heidelberg, Australia.,NHMRC Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Melbourne, Australia
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27
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Askew RL, Capo-Lugo CE, Naidech A, Prabhakaran S. Differential Effects of Time to Initiation of Therapy on Disability and Quality of Life in Patients With Mild and Moderate to Severe Ischemic Stroke. Arch Phys Med Rehabil 2020; 101:1515-1522.e1. [PMID: 32450061 DOI: 10.1016/j.apmr.2020.05.005] [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] [Received: 08/16/2019] [Revised: 04/02/2020] [Accepted: 05/06/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To assess the effect of time to acute therapy on health-related quality of life (HRQoL) and disability after ischemic stroke. DESIGN Prospective cohort study. SETTING Comprehensive stroke care center in a large metropolitan city. PARTICIPANTS Patients (N=553; mean age, 67 y; 51.9% male; 64.4% white; 88.8% ischemic stroke) with ischemic stroke or transient ischemic attack (TIA) enrolled in a longitudinal observational study between August 2012 to January 2014 who received rehabilitation services. INTERVENTION Not applicable. MAIN OUTCOME MEASURES Disability status was assessed with the modified Rankin Scale (mRS) and Barthel Index (BI). HRQoL was assessed using the Quality of Life in Neurological Disorders measures of executive function, general cognitive concerns, upper extremity dexterity, and lower extremity mobility. Time to therapy consult and treatment were defined as the number of days from hospital admission to initial consult by a therapist and number of days from hospital admission to initial treatment, respectively. RESULTS Among the participants, the median number of days from hospital admission to acute therapy consult was 2 days (interquartile range, 1-3d). Multivariable linear and logistic regression models indicated that for those with the National Institutes of Health Stroke Scale (NIHSS) score<5, longer time to therapy consult was associated with worse BI scores (BI=100; odds ratio [OR], 0.818; P=.008), executive function T scores (b=-0.865; P=.001), and general cognitive concerns T scores (b=-0.609; P=.009) at 1-month in adjusted analyses. In those with NIHSS score≥5, longer time to therapy treatment led to increased disability (ie, mRS≥ 2; OR, 1.15; P=.039) and lower extremity mobility T scores (b=-0.591; P=.046) at 1 month in adjusted analyses. CONCLUSIONS Longer time to initiation of acute therapy has differential effects on poststroke disability and HRQoL up to 1-month after ischemic stroke and TIA. The effect of acute therapy consult is more notable for those with mild deficits, while the effect of acute therapy treatment is more notable for those with moderate to severe deficits. Minimizing time to therapy consults and treatments in the acute hospital period might improve outcomes after ischemic stroke and TIA.
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Affiliation(s)
- Robert L Askew
- Department of Psychology, Stetson University, DeLand, Florida.
| | - Carmen E Capo-Lugo
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, Alabama
| | - Andrew Naidech
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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28
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Nakao M, Banno M, Kataoka Y, Taito S. Commentary: High Intensity Physical Rehabilitation Later Than 24 h Post Stroke Is Beneficial in Patients: A Pilot Randomized Controlled Trial (RCT) Study in Mild to Moderate Ischemic Stroke. Front Neurol 2020; 11:182. [PMID: 32210910 PMCID: PMC7076229 DOI: 10.3389/fneur.2020.00182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 02/25/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mari Nakao
- Rehabilitation Department, Niigata Rehabilitation Hospital, Niigata, Japan.,Rehabilitation Department, Tohoku University Graduate School of Medicine, Sendai, Japan.,Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan
| | - Masahiro Banno
- Department of Psychiatry, Seichiryo Hospital, Nagoya, Japan.,Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Systematic Review Workshop Peer Support Group (SRWS-PSG), Japan
| | - Yuki Kataoka
- Systematic Review Workshop Peer Support Group (SRWS-PSG), Japan.,Hospital Care Research Unit, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan.,Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.,Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Shunsuke Taito
- Systematic Review Workshop Peer Support Group (SRWS-PSG), Japan.,Division of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University Hospital, Hiroshima, Japan
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29
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Siebler M. Rehabilitation des Schlaganfalls. PRAXISHANDBUCH SCHLAGANFALL 2020:327-336. [DOI: 10.1016/b978-3-437-23431-6.00028-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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30
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Kulesh AA. Rehabilitation in acute stroke from the point of view of evidence-based medicine: possibilities of drug treatment. NEUROLOGY, NEUROPSYCHIATRY, PSYCHOSOMATICS 2019. [DOI: 10.14412/2074-2711-2019-3-99-103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The review highlights the fundamental principles of early rehabilitation in ischemic stroke, the benefits and risks of early and very early patient mobilization. It presents data on the efficiency of CIMT-kinesiotherapy and mirror therapy in restoring upper extremity function, as well as procedures for nonpharmacological correction of spatial neglect syndrome. The effect on the rehabilitation of concomitant Alzheimer's disease is analyzed. The areas of pharmacological potentiation of poststroke rehabilitation, the efficiency of cerebrolysin in particular, are considered.
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Affiliation(s)
- A. A. Kulesh
- Acad. E.A. Vagner Perm State Medical University, Ministry of Health of Russia;
City Clinical Hospital Four
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31
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Taguchi S, Choudhury ME, Miyanishi K, Nakanishi Y, Kameda K, Abe N, Yano H, Yorozuya T, Tanaka J. Aggravating effects of treadmill exercises during the early-onset period in a rat traumatic brain injury model: When should rehabilitation exercises be initiated? IBRO Rep 2019; 7:82-89. [PMID: 31720487 PMCID: PMC6838542 DOI: 10.1016/j.ibror.2019.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 10/08/2019] [Indexed: 12/14/2022] Open
Abstract
A traumatic brain injury model was prepared in rats by stab wounding. Rats were forced to walk slowly on a treadmill once for 10 min at 24 h or 48 h after wounding. Exercise, particularly at 24 h, aggravated motor impairment while increasing the expression of proinflammatory factors. Exercise for rehabilitation should be initiated after 48 h of severe brain injury onset.
Physical exercise is one of the best interventions for improving traumatic brain injury (TBI) outcomes. However, an argument has been raised regarding the timing at which physical exercise should be initiated. In this study, male Wistar rats were subjected to stab wounding of the right hemisphere to develop a TBI model and were forced to walk once on a treadmill at a 5-m/min pace at 24 h or 48 h after TBI for 10 min. Injured brain tissue was dissected after TBI to evaluate the effects of exercise. Behavioral abnormalities and motor impairment were assessed by various behavioral tests between 2 and 3 weeks after TBI. Exercise did not affect the circulating corticosterone levels and the weight of the adrenal glands. Exercise particularly that at 24 h, worsened the motor impairment of the left forelimbs. Quantitative reverse-transcription polymerase chain reaction showed that exercise at 24 h increased proinflammatory cytokines and chemokines on the third day while suppressing the proinflammatory reactions on the fourth day. Exercise at both time points decreased expression of transforming growth factor (TGF) β1 and its receptor TGFβR1. Exercise at 24 h increased phosphorylation of IκB kinase on the fourth day, which may be correlated with the decreased effects of TGFβ1. Even a low-intensity exercise activity could cause deleterious effects when it is initiated within 48 h after the onset of severe TBI, probably because of the resulting proinflammatory effects. Therefore, rehabilitation exercise programs should be initiated after 48 h of TBI onset.
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Affiliation(s)
- Satoru Taguchi
- Department of Molecular and Cellular Physiology, Graduate School of Medicine, Ehime University, Toon, Ehime, Japan
| | - Mohammed E Choudhury
- Department of Molecular and Cellular Physiology, Graduate School of Medicine, Ehime University, Toon, Ehime, Japan
| | - Kazuya Miyanishi
- Department of Molecular and Cellular Physiology, Graduate School of Medicine, Ehime University, Toon, Ehime, Japan
| | - Yuiko Nakanishi
- Department of Molecular and Cellular Physiology, Graduate School of Medicine, Ehime University, Toon, Ehime, Japan
| | - Kenji Kameda
- Advanced Research Support Center, Division of Analytical Bio-Medicine, Ehime University, Toon, Ehime, Japan
| | - Naoki Abe
- Department of Anesthesia and Perioperative Medicine, Graduate School of Medicine, Ehime University, Toon, Ehime, Japan
| | - Hajime Yano
- Department of Molecular and Cellular Physiology, Graduate School of Medicine, Ehime University, Toon, Ehime, Japan
| | - Toshihiro Yorozuya
- Department of Anesthesia and Perioperative Medicine, Graduate School of Medicine, Ehime University, Toon, Ehime, Japan
| | - Junya Tanaka
- Department of Molecular and Cellular Physiology, Graduate School of Medicine, Ehime University, Toon, Ehime, Japan
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32
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Shear A, Nishihiro S, Hishikawa T, Hiramatsu M, Sugiu K, Yasuhara T, Date I. Cerebral circulation improves with indirect bypass surgery combined with gene therapy. Brain Circ 2019; 5:119-123. [PMID: 31620658 PMCID: PMC6785951 DOI: 10.4103/bc.bc_33_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/28/2019] [Accepted: 09/02/2019] [Indexed: 02/06/2023] Open
Abstract
Angiogenesis involves new blood vessels sprouting from preexisting blood vessels. This process may serve to improve brain circulation. Moyamoya disease (MMD) is a cerebrovascular disorder causing intracranial stenosis which significantly reduces the blood supply to the brain. Mainly stroke is the first symptom of the disorder, so treatments that reduce the risk of stroke are used for patients with MMD. To prevent stroke for those with chronic cerebral hypoperfusion, more blood needs to flow to the brain, which was thought to be achieved by enhancing angiogenesis. Indirect bypass surgery, such as encephalo-myo-synangiosis (EMS), is used for revascularization. However, EMS alone sometimes cannot provide enough circulation to avoid ischemic strokes. The current study examined if EMS combined with high-mobility group box-1 (HMGB1) and vascular endothelial growth factor (VEGF) enhanced angiogenesis and increased cerebral circulation. The results indicated that HMGB1 administered with EMS increased angiogenesis through a VEGF-dependent mechanism. In addition, exercising and stem cell transplantation possess possible means to increase angiogenesis. Overall, EMS with gene therapy, maintaining fitness, and stem cell utilization may prevent or help one recover from stroke by enhancing brain angiogenesis. Thus, these treatments may be applicable for patients with MMD. This paper is a review article. Referred literature in this paper has been listed in the references section. The datasets supporting the conclusions of this article are available online by searching various databases, including PubMed.
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Affiliation(s)
- Alex Shear
- Department of Neurosurgery and Brain Repair, College of Medicine, University of South Florida Morsani, Tampa, FL, USA
| | - Shingo Nishihiro
- Department of Neurological Surgery, Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Tomohito Hishikawa
- Department of Neurological Surgery, Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Masafumi Hiramatsu
- Department of Neurological Surgery, Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Kenji Sugiu
- Department of Neurological Surgery, Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Takao Yasuhara
- Department of Neurological Surgery, Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Isao Date
- Department of Neurological Surgery, Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
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Barzegar M, Kaur G, Gavins FNE, Wang Y, Boyer CJ, Alexander JS. Potential therapeutic roles of stem cells in ischemia-reperfusion injury. Stem Cell Res 2019; 37:101421. [PMID: 30933723 DOI: 10.1016/j.scr.2019.101421] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/12/2019] [Accepted: 03/14/2019] [Indexed: 12/11/2022] Open
Abstract
Ischemia-reperfusion injury (I/RI), produced by an initial interruption of organ blood flow and its subsequent restoration, contributes significantly to the pathophysiologies of stroke, myocardial infarction, renal I/RI, intestinal I/RI and liver I/RI, which are major causes of disability (including transplant failure) and even mortality. While the restoration of blood flow is required to restore oxygen and nutrient requirements, reperfusion often triggers local and systemic inflammatory responses and subsequently elevate the ischemic insult where the duration of ischemia determines the magnitude of I/RI damage. I/RI increases vascular leakage, changes transcriptional and cell death programs, drives leukocyte entrapment and inflammation and oxidative stress in tissues. Therapeutic approaches which reduce complications associated with I/RI are desperately needed to address the clinical and economic burden created by I/RI. Stem cells (SC) represent ubiquitous and uncommitted cell populations with the ability to self-renew and differentiate into one or more developmental 'fates'. Like immune cells, stem cells can home to and penetrate I/R-injured tissues, where they can differentiate into target tissues and induce trophic paracrine signaling which suppress injury and maintain tissue functions perturbed by ischemia-reperfusion. This review article summarizes the present use and possible protective mechanisms underlying stem cell protection in diverse forms of ischemia-reperfusion.
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Affiliation(s)
- M Barzegar
- Department of Molecular and Cellular Physiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA
| | - G Kaur
- Department of Molecular and Cellular Physiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA
| | - F N E Gavins
- Department of Molecular and Cellular Physiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA
| | - Y Wang
- Department of Molecular and Cellular Physiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA; Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA
| | - C J Boyer
- Department of Molecular and Cellular Physiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA
| | - J S Alexander
- Department of Molecular and Cellular Physiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA.
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