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Bindschedler A, Ziller C, Gerber EY, Behrendt F, Crüts B, Parmar K, Gerth HU, Gäumann S, Dierkes W, Schuster-Amft C, Bonati LH. Feasibility of an Application-Based Outpatient Rehabilitation Program for Stroke Survivors: Acceptability and Preliminary Results for Patient-Reported Outcomes. Bioengineering (Basel) 2024; 11:135. [PMID: 38391621 PMCID: PMC10886035 DOI: 10.3390/bioengineering11020135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/16/2024] [Accepted: 01/24/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND The majority of stroke survivors experience long-term impairments. Regular physical activity and other lifestyle modifications play an important role in rehabilitation. Outpatient rehabilitation using telemedicine might be suitable to improve functional ability and long-term secondary prevention. The Strokecoach Intervention Program (SIP, Strokecoach GmbH, Cologne, Germany) comprises training, coaching and monitoring with the aim of improving or at least maintaining functional independence and preventing further stroke through more targeted physical activity. The SIP is provided as blended care, which refers to the integrated and coordinated delivery of healthcare services that combines traditional in-person interactions with technology-mediated interventions, optimizing the use of both face-to-face and virtual modalities to enhance patient outcomes. OBJECTIVE The aim of this study was to evaluate the acceptance of the SIP by the participants and its practical application, as well as to obtain initial indications of effects of the SIP on the basis of patient-related outcome measures, blood pressure measurements and recording of physical activity in parallel with the intervention. METHODS Data from individuals with stroke participating in the SIP were analyzed retrospectively. Within the SIP, participants received an application-based training program, were instructed to measure their blood pressure daily and to wear an activity tracker (pedometer). During the intervention period of either 6 or 12 weeks, the participants were supported and motivated by a personal coach via a messenger application. The primary outcomes of the analysis were recruitment, acceptance of and satisfaction with the SIP. Secondary outcomes included functional measures, mobility and health-related quality of life. RESULTS A total of 122 individuals with stroke could be recruited for the SIP. A total of 96 out of 122 were able to start the program (54% female, mean age 54.8 (SD = 13.1), 6.1 (SD = 6.6) years after stroke onset) and 88 completed the SIP. Participants wore the activity tracker on 66% and tracked their blood pressure on 72% of their intervention days. A further analyzed subgroup of 38 participants showed small improvements in patient-reported outcomes such as health-related quality of life (SF-36) with an increase of 12 points in the subdomain mental health, vitality (12.6) and physical functioning (9.1). However, no statistically significant improvements were found in other performance-based measures (Timed Up and Go test, gait speed). CONCLUSIONS This study showed that a blended therapy approach for stroke survivors with mild to moderate impairments in the chronic phase is feasible and was highly accepted by participants, who benefitted from the additional coaching.
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Affiliation(s)
| | - Carina Ziller
- Research Department, Reha Rheinfelden, 4310 Rheinfelden, Switzerland
| | - Eve-Yaël Gerber
- Research Department, Reha Rheinfelden, 4310 Rheinfelden, Switzerland
- Faculty of Psychology, University of Basel, 4055 Basel, Switzerland
| | - Frank Behrendt
- Research Department, Reha Rheinfelden, 4310 Rheinfelden, Switzerland
- School of Engineering and Computer Science, Bern University of Applied Sciences, 2501 Biel, Switzerland
| | | | - Katrin Parmar
- Research Department, Reha Rheinfelden, 4310 Rheinfelden, Switzerland
- Department of Neurology, University Hospital Basel, 4031 Basel, Switzerland
| | - Hans Ulrich Gerth
- Research Department, Reha Rheinfelden, 4310 Rheinfelden, Switzerland
- Department of Medicine, University Hospital Münster, 48149 Münster, Germany
| | - Szabina Gäumann
- Research Department, Reha Rheinfelden, 4310 Rheinfelden, Switzerland
| | | | - Corina Schuster-Amft
- Research Department, Reha Rheinfelden, 4310 Rheinfelden, Switzerland
- School of Engineering and Computer Science, Bern University of Applied Sciences, 2501 Biel, Switzerland
- Department of Sport, Exercise and Health, University of Basel, 4052 Basel, Switzerland
| | - Leo H Bonati
- Research Department, Reha Rheinfelden, 4310 Rheinfelden, Switzerland
- Department of Neurology, University Hospital Basel, 4031 Basel, Switzerland
- Department of Clinical Research, University of Basel, 4031 Basel, Switzerland
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Gäumann S, Aksöz EA, Behrendt F, Wandel J, Cappelletti L, Krug A, Mörder D, Bill A, Parmar K, Gerth HU, Bonati LH, Schuster-Amft C. The challenge of measuring physiological parameters during motor imagery engagement in patients after a stroke. Front Neurosci 2023; 17:1225440. [PMID: 37583419 PMCID: PMC10423937 DOI: 10.3389/fnins.2023.1225440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 07/11/2023] [Indexed: 08/17/2023] Open
Abstract
Introduction It is suggested that eye movement recordings could be used as an objective evaluation method of motor imagery (MI) engagement. Our investigation aimed to evaluate MI engagement in patients after stroke (PaS) compared with physical execution (PE) of a clinically relevant unilateral upper limb movement task of the patients' affected body side. Methods In total, 21 PaS fulfilled the MI ability evaluation [Kinaesthetic and Visual Imagery Questionnaire (KVIQ-10), body rotation task (BRT), and mental chronometry task (MC)]. During the experiment, PaS moved a cup to distinct fields while wearing smart eyeglasses (SE) with electrooculography electrodes integrated into the nose pads and electrodes for conventional electrooculography (EOG). To verify MI engagement, heart rate (HR) and oxygen saturation (SpO2) were recorded, simultaneously with electroencephalography (EEG). Eye movements were recorded during MI, PE, and rest in two measurement sessions to compare the SE performance between conditions and SE's psychometric properties. Results MI and PE correlation of SE signals varied between r = 0.12 and r = 0.76. Validity (cross-correlation with EOG signals) was calculated for MI (r = 0.53) and PE (r = 0.57). The SE showed moderate test-retest reliability (intraclass correlation coefficient) with r = 0.51 (95% CI 0.26-0.80) for MI and with r = 0.53 (95% CI 0.29 - 0.76) for PE. Event-related desynchronization and event-related synchronization changes of EEG showed a large variability. HR and SpO2 recordings showed similar values during MI and PE. The linear mixed model to examine HR and SpO2 between conditions (MI, PE, rest) revealed a significant difference in HR between rest and MI, and between rest and PE but not for SpO2. A Pearson correlation between MI ability assessments (KVIQ, BRT, MC) and physiological parameters showed no association between MI ability and HR and SpO2. Conclusion The objective assessment of MI engagement in PaS remains challenging in clinical settings. However, HR was confirmed as a reliable parameter to assess MI engagement in PaS. Eye movements measured with the SE during MI did not resemble those during PE, which is presumably due to the demanding task. A re-evaluation with task adaptation is suggested.
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Affiliation(s)
- Szabina Gäumann
- Department of Research, Reha Rheinfelden, Rheinfelden, Switzerland
| | - Efe Anil Aksöz
- School of Engineering and Information Technology, Bern University of Applied Sciences, Biel, Switzerland
| | - Frank Behrendt
- Department of Research, Reha Rheinfelden, Rheinfelden, Switzerland
- School of Engineering and Information Technology, Bern University of Applied Sciences, Biel, Switzerland
| | - Jasmin Wandel
- Institute for Optimisation and Data Analysis, Bern University of Applied Sciences, Burgdorf, Switzerland
| | - Letizia Cappelletti
- Department of Health Professions, Bern University of Applied Science, Bern, Switzerland
| | - Annika Krug
- Institute for Physiotherapy, School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Daniel Mörder
- Department of Sport Science, Faculty of Humanities, University of Konstanz, Konstanz, Germany
| | - Annika Bill
- Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Katrin Parmar
- Department of Research, Reha Rheinfelden, Rheinfelden, Switzerland
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Hans Ulrich Gerth
- Department of Research, Reha Rheinfelden, Rheinfelden, Switzerland
- Department of Medicine, University Hospital Münster, Münster, Germany
| | - Leo H. Bonati
- Department of Research, Reha Rheinfelden, Rheinfelden, Switzerland
- Department of Neurology, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Corina Schuster-Amft
- Department of Research, Reha Rheinfelden, Rheinfelden, Switzerland
- School of Engineering and Information Technology, Bern University of Applied Sciences, Biel, Switzerland
- Department of Sport, Physical Activity, and Health, University of Basel, Basel, Switzerland
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Gäumann S, Gerber RS, Suica Z, Wandel J, Schuster-Amft C. A different point of view: the evaluation of motor imagery perspectives in patients with sensorimotor impairments in a longitudinal study. BMC Neurol 2021; 21:297. [PMID: 34315411 PMCID: PMC8314460 DOI: 10.1186/s12883-021-02266-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 06/03/2021] [Indexed: 11/10/2022] Open
Abstract
Background Motor imagery (MI) has been successfully applied in neurological rehabilitation. Little is known about the spontaneous selection of the MI perspectives in patients with sensorimotor impairments. What perspective is selected: internal (first-person view), or external (third-person view)? The aim was to evaluate the MI perspective preference in patients with sensorimotor impairments. Methods In a longitudinal study including four measurement sessions, 55 patients (25 stroke, 25 multiple sclerosis, 5 Parkinson’s disease; 25 females; mean age 58 ± 14 years) were included. MI ability and perspective preference in both visual and kinaesthetic imagery modalities were assessed using the Kinaesthetic and Visual Imagery Questionnaire-20 (KVIQ-20), the body rotation task (BRT), and mental chronometry (MC). Additionally, patients’ activity level was assessed. Descriptive analyses were performed regarding different age- (< 45, 45–64, > 64), activity levels (inactive, partially active, active), and KVIQ-20 movement classifications (axial, proximal, distal, upper and lower limb). A mixed-effects model was used to investiage the relationship between the primary outcome (MI perspective: internal, external) with the explanatory variables age, MI modality (visual, kinaesthetic), movement type (axial, proximal, distal), activity levels and the different assessments (KVIQ-20, BRT, MC). Results Imagery modality was not a significant predictor of perspective preference. Over the four measurement sessions, patients tended to become more consistent in their perspective selection, however, time point was not a significant predictor. Movement type was a significant predictor: imagination of distal vs. axial and proximal vs. axial movements were both associated with preference for external perspective. Patients with increased physical activity level tend to use internal imagery, however, this effect was borderline not statistically significant. Age was neither a significant precictor. Regarding the MI assessments, the KVIQ- 20 score was a significant predictor. The patients with higher test scores tend to use the external perspective. Conclusion It is recommended to evaluate the spontaneous MI perspective selection to design patient-specific MI training interventions. Distal movements (foot, finger) may be an indicator when evaluating the consistency of the MI perspective in patients with sensorimotor impairments. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02266-w.
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Affiliation(s)
- Szabina Gäumann
- Institute of Physiotherapy, School of Health Professions, Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8401, Winterthur, Switzerland.,Research Department, Reha Rheinfelden, Salinenstrasse 98, 4310, Rheinfelden, Switzerland
| | - Rahel Sarah Gerber
- Institute of Physiotherapy, School of Health Professions, Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8401, Winterthur, Switzerland
| | - Zorica Suica
- Research Department, Reha Rheinfelden, Salinenstrasse 98, 4310, Rheinfelden, Switzerland
| | - Jasmin Wandel
- Institute for Optimisation and Data Analysis, Bern University of Applied Sciences, Jlcoweg 1, 3400, Burgdorf, Switzerland
| | - Corina Schuster-Amft
- Research Department, Reha Rheinfelden, Salinenstrasse 98, 4310, Rheinfelden, Switzerland. .,Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, Pestalozzistrasse 20, 3400, Burgdorf, Switzerland. .,Division for Rehabilitative and Regenerative Sports Medicine, Department of Sport, Exercise and Health, University of Basel, Mittlere Allee 18, 4052, Basel, Switzerland.
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