Effects of virtual reality in post-stroke aphasia: a systematic review and meta-analysis

OBJECTIVE

To investigate whether virtual reality (VR) interventions have beneficial effects on the functional communication and language function of patients with post-stroke aphasia (PSA).

METHODS

We searched nine electronic literature databases and two clinical registry platforms to identify randomized controlled trials (RCTs) and quasi-RCTs performed up to September 2020. Screening, quality assessment, and data collection were performed by two authors independently, using standard protocols. Data aggregation and risk of bias evaluation were conducted using Review Manager Version 5.4. The quality of evidence was evaluated with GRADEpro.

RESULTS

A total of five studies involving 121 participants met the inclusion criteria and were appraised. Four studies were included in the quantitative synthesis. VR reduced the severity of language impairment with borderline significance [SMD (95%CI) = 0.70[0.01, 1.39], P=0.05]. The meta-analysis showed no statistical difference in functional communication [SMD (95%CI) =0.41[-0.29, 1.12], P=0.25], word finding [SMD (95%CI) =0.42[-0.24, 1.08], P=0.21], and repetition [SMD (95%CI) =0.16[-0.62, 0.94], P=0.68] between VR group and the control group.

CONCLUSION

This review demonstrated a borderline positive clinical effect of VR for the severity of language impairment when compared with conventional rehabilitation therapy. Conversely, VR had no effect on functional communication, word finding, and repetition. Further research is warranted to reach more definite conclusions.

Overcoming practical challenges to conducting clinical research in the inpatient stroke rehabilitation setting

BACKGROUND

There is a shortage of published empirical studies conducted in acute inpatient stroke rehabilitation, though such studies are greatly needed in order to shed light on the most efficacious inpatient stroke rehabilitation interventions. The inherent challenges of inpatient research may dissuade researchers from undertaking this important work.

OBJECTIVE

This paper describes our institution's experience devising practical solutions to research barriers in this setting.

METHOD

Through concentrated efforts to overcome research barriers, such as by cultivating collaborative relationships and capitalizing on unanticipated benefits, we successfully facilitated conduct of five simultaneous inpatient stroke studies.

RESULTS

Tangible benefits realized include increased effectiveness of research participant identification and enrollment, novel collaborative projects, innovative clinical care initiatives, and enhanced emotional and practical support for patients and their families. We provide recommendations based on lessons learned during our experience, and discuss benefits of this collaboration for our research participants, clinical staff, and the research team.

Qualitative analysis of a nurse's responses to stroke caregivers on a web-based supportive intervention

BACKGROUND

Approximately 800 000 people experience a stroke every year; most are cared for by unpaid family members in home settings. Web-based interventions provide 24/7 access to education/support services and have been explored in the literature with family caregivers dealing with chronic conditions. Current research into nurses' web-based interactions with caregivers in these interventions is lacking.

OBJECTIVE

The aim of this qualitative secondary data analysis was to examine a nurse specialist's responses and advice that she gave in a web-based supportive intervention for stroke family caregivers used in a randomized controlled trial for 1 year.

METHODS

Using a qualitative research design, caregivers were recruited from rehabilitation facilities in Ohio and Michigan (n = 36). They accessed the intervention's email forum and discussion group facilitated by the nurse. These email message data were examined using rigorous content analysis.

RESULTS

The caregivers were primarily white women caring for a spouse, with an average age of 54 years. From the 2148 email messages between the nurse and caregivers, five themes emerged and were drawn to Friedemann's Framework. These themes included: getting to know the situation (Friedemann's coherence and individuation), validating emotions (individuation), promoting self-care (individuation), assisting in role adaptation (system maintenance and individuation), and providing healthcare information (system maintenance and individuation).

CONCLUSIONS

These caregivers of stroke survivors were asking for advice, seeking support, and looking for information from an advanced practice nurse. Nurses, and others, in supportive roles can use these findings to promote informed care and directed interventions for caregivers dealing with stroke and its outcomes.

Cognitive impairments and mood disruptions negatively impact instrumental activities of daily living performance in the first three months after a first stroke

BACKGROUND

Cognition and mood play crucial roles in post-stroke recovery; however, the stroke literature is unclear as to how impairments in both domains influence performance of instrumental activities of daily living (IADL).

OBJECTIVE

(1) Evaluate the extent to which mood and cognition at two weeks post-stroke predict performance three months post-stroke. (2) Assess performance differences in patients with impairments in both cognition and mood to patients with impairments in either cognition or mood.

METHODS

Inpatients with a first-ever ischemic or hemorrhagic stroke were assessed at 2 weeks (n = 52) and at 3 months (n = 41) post-stroke. Patients completed a battery of neuropsychological tests, self-report measures and performance-based tests. Cognitive impairments and mood disruptions were assessed at 2 weeks and three months and IADL performance, as assessed by the Executive Function Performance Test, was evaluated at three months.

RESULTS

Complete data from the 41 patients assessed at both time points were analyzed. Regression analysis showed that composite cognition and composite mood variables at two weeks post-stroke predicted 48% of the variance in IADL performance at three months (F3,37 = 12.04; adjusted R(2) = 0.48, P < 0.001). Statistically significant differences were found in performance scores for patients with a single impairment (M = 7.86, SD = 7.81) and for those with impairments in both mood and cognition (M = 19.2, SD = 13.2) (t(39) = - 3.41, P = 0.008).

CONCLUSION

The results of this study suggest that cognitive and mood impairments at two weeks post-stroke are important predictors of performance in complex activities required for full independence at home and should be routinely assessed in stroke rehabilitation.

Efficacy of adhesive taping as an adjunt to physical rehabilitation to influence outcomes post-stroke: a systematic review

BACKGROUND

Adhesive taping as a therapeutic modality post-stroke has been investigated for two decades. No systematic review of the evidence to inform clinical practice exists.

OBJECTIVE

To systematically review the efficacy of adhesive taping as an adjunct to physical rehabilitation on outcomes related to body function and structure, activity, and participation post-stroke.

METHODS

The databases of PubMed, CINAHL, EMBASE, and Web of Science from 1966 through December 2013 were searched. Full-text articles in English from peer-reviewed journals reporting original research on the use of adhesive taping post-stroke were included. Two reviewers independently searched and then rated the quality of evidence using the PEDro evidence rating system. Randomized controlled trials were further assessed using the Consolidated Standards of Reporting Trials (CONSORT) guidelines.

RESULTS

Fifteen studies met the inclusion criteria. Two used elastic tape and 13 used rigid tape. The evidence quality ranged from poor to good, and included seven shoulder, one wrist, two hip, one knee, and four ankle studies. There were four good-quality studies.

CONCLUSIONS

Preliminary evidence in the domain of body function and structure suggests that use of rigid adhesive tape as an adjunct may increase the number of pain-free days at the shoulder. Evidence for the improvement of pain intensity, range of motion, muscle tone, strength, or function with taping is inconclusive. The evidence related to activity and participation is insufficient. The use of adhesive taping post-stroke needs further and more rigorous research to compare the types, methods and dosage of taping.

Real-world affected upper limb activity in chronic stroke: an examination of potential modifying factors

BACKGROUND

Despite improvement in motor function after intervention, adults with chronic stroke experience disability in everyday activity. Factors other than motor function may influence affected upper limb (UL) activity.

OBJECTIVE

To characterize affected UL activity and examine potential modifying factors of affected UL activity in community-dwelling adults with chronic stroke.

METHODS

Forty-six adults with chronic stroke wore accelerometers on both ULs for 25 hours and provided information about potential modifying factors [time spent in sedentary activity, cognitive impairment, depressive symptomatology, number of comorbidities, motor dysfunction of the affected UL, age, activities of daily living (ADL) status, and living arrangement]. Accelerometry was used to quantify duration of affected and unaffected UL activity. The ratio of affected-to-unaffected UL activity was also calculated. Associations within and between accelerometry-derived variables and potential modifying factors were examined.

RESULTS

Mean hours of affected and unaffected UL activity were 5.0 ± 2.2 and 7.6 ± 2.1 hours respectively. The ratio of affected-to-unaffected UL activity was 0.64 ± 0.19, and hours of affected and unaffected UL activity were strongly correlated (r = 0.78). Increased severity of motor dysfunction and dependence in ADLs were associated with decreased affected UL activity. No other factors were associated with affected UL activity.

CONCLUSIONS

Severity of motor dysfunction and ADL status should be taken into consideration when setting goals for UL activity in people with chronic stroke. Given the strong, positive correlation between affected and unaffected UL activity, encouragement to increase activity of the unaffected UL may increase affected UL activity.