Topics in Stroke Rehabilitation最新文献

Background: Understanding the hemodynamic mechanisms underlying orthostatic hypotension is essential for selecting the appropriate treatment based on individual hemodynamic patterns. However, the relative contribution of changes in cardiac output and total peripheral resistance to orthostatic hypotension in stroke survivors remains unclear.

Objective: This study aimed to determine whether orthostatic hypotension is more strongly associated with a marked cardiac output decrease or an impaired total peripheral resistance increase among individuals with stroke.

Methods: In this cross-sectional study, 23 participants with stroke (13 males, mean [SD] age 63.7 [12.1] years, mean time since stroke 85.1 [34.1] days) underwent a head-up tilt test to assess orthostatic changes in blood pressure and hemodynamic variables. The head-up tilt test protocol consisted of a 5-min period in the supine position followed by a 5-min period with a 70° head-up tilt. Orthostatic hypotension was defined as a reduction in systolic blood pressure of at least 20 mmHg or diastolic blood pressure of at least 10 mmHg during the test. Heart rate, stroke index, cardiac index, and total peripheral resistance index were measured as hemodynamic variables.

Results: Orthostatic hypotension was identified in five participants (22%). These individuals demonstrated significantly greater orthostatic cardiac index increases (F_(5,105) = 2.75, p = 0.023, partial η² = 0.126) and more pronounced orthostatic total peripheral resistance index decreases (F_(5,105) = 4.19, p = 0.002, partial η² = 0.166) than those without orthostatic hypotension.

Conclusions: Our results suggest that impaired orthostatic total peripheral resistance increase mainly contributes to orthostatic hypotension in stroke survivors.

Background: A single session of perturbation-based training (PBT) reduces fall-risk and enhances reactive balance control in people with stroke (PwS). However, its long-term effect on clinical outcomes remains unclear. This study examined the retention effects of a single session of overground walk-PBT on clinical measures of body structure and function, activity limitation, and participation restriction in PwS.

Methods: Forty-eight PwS were randomized to training (n = 25) or control (n = 23) groups. Participants completed baseline, 6- and 12-month sessions, including reactive balance and clinical assessments. The training group underwent overground walk-PBT, while the control group completed unperturbed walking alone. Outcomes were assessed using the International Classification of Functioning, Disability, and Health (ICF) framework: body structure and function (Modified Rankin Scale, Activities-specific Balance Confidence - ABC), activity limitation (Berg Balance Scale, Timed Up and Go - TUG, 10-Meter Walk Test - 10MWT, 6-Minute Walk Test), and participation restriction (Community Integration Questionnaire - CIQ). A Two-way ANOVA examined group × time interactions on all outcomes followed by post-hoc comparisons.

Results: Significant group × time interactions were observed for ABC, TUG, 10MWT, and CIQ (p < 0.05). The training group demonstrated improvements from baseline to 6 months (p < 0.02), with no differences between the 6- and 12-month sessions (except improvements in CIQ) (p > 0.02). The control group showed no improvements (p > 0.02) and demonstrated a reduction in balance confidence from baseline to 6-months (p < 0.02).

Conclusion: A single session of overground walk-PBT showed long-term improvements in outcomes across all ICF domains, highlighting its clinical utility as an effective rehabilitation strategy for PwS.

Background: Community mobility requires adaptability, or the ability to adapt walking to meet task goals and environmental needs; with backward walking (BW) being a critical aspect. The 3-Meter Backward Walk Test (3MBWT) is a reliable and valid measure of BW speed and may be an important indicator of walking function. However, little research has examined its association to other recommended outcomes of stepping, balance, and adaptability in individuals post-stroke.

Objectives: To evaluate the concurrent and convergent validity of the 3MBWT and measures of stepping, balance, and adaptability in individuals post-stroke, across stages of chronicity.

Methods: Fifty-nine participants (40 male; 34 right hemiparesis; 58.0 ± 13.3 years; 2.9 ± 1.1 months post-stroke) with first time stroke participated in a battery of outcomes assessed at 2-4 months (subacute) and 12 months (chronic) post-stroke. For both time points, correlations between the 3MBWT and each outcome of stepping, balance, and adaptability were determined using Spearman's rank correlation analysis.

Results: At both time points, moderate to strong correlations were evident between the 3MBWT and all performance-based outcomes. Specifically, the highest associations were noted for stepping during subacute and chronic time points (10-Meter Walk Test, 0.87 and 0.81; 6-Minute Walk Test, 0.88 and 0.89), respectively.

Conclusions: This study demonstrated moderate to strong correlations between the 3MBWT and other standard mobility assessments across the subacute and chronic stages post-stroke. The strong correlations between the 3MBWT and other outcome measures recommended by current clinical practice guidelines support the use of the 3MBWT as an important mobility assessment of individuals post-stroke.

Background: Family and social support can have a large impact on the recovery of stroke patients. The purpose of this scoping review is to explore patient-centered strategies that can be implemented to ensure long-term and sustained family support for US adult stroke patients.

Methods: The development of the study sections was guided by the PRISMA-ScR checklist (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). The methodology used in the review followed the York framework by Arksey and O'Malley (2005). Additionally, recommendations from the Joanna Briggs Institute (JBI) were incorporated for the extraction, analysis, and presentation of results in scoping reviews.

Results: A total of 6 articles were retained for analysis. Hands-on caregiver training was associated with improved physical function and enhanced quality of life for both caregivers and stroke survivors. Improvements were also seen in caregiver mental health outcomes such as experiencing fewer depressive symptoms. Caregiver burden often stemmed from the intense nature of caregiving responsibilities and the complex needs of stroke survivors. Major themes in lessons learned for future evidence-based caregiver-oriented stroke were also highlighted.

Conclusion: Findings can provide informed patient- and family-centered recommendations for sustaining positive rehabilitation outcomes for adults who have experienced stroke.

Background and purpose: This study aimed to compare the efficacy of Botulinum Toxin Type A (BoNT-A) injection and BoNT-A injection in combination with ESWT for post-stroke lower extremity ankle plantar flexor spasticity in this prospective, randomized cohort study.

Methods: Patients with post-stroke ankle plantar flexor spasticity of 1+ or more on the Modified Ashworth Scale (MAS) were randomized into two groups. Group 1 (n:20): BoNT-A was injected into the gastrocnemius muscle, and conventional physical therapy exercises were performed. Group 2 (n:20): ESWT was applied to the gastrocnemius muscle in addition to the treatments in group 1. MAS, Brunnstrom Motor Recovery Stage (BMRS), ankle range of motion (ROM) measurement, clonus score (CS), Barthel Index (BI), Heckmatt measurements with ultrasonography, and visual analog scale (VAS) evaluations were performed on the patients.

Results: No statistically significant differences were observed between the groups in any of the measured parameters at baseline or at any other time (p > 0.05). In both groups, there was a statistically significant improvement in all scores, except for the Heckmatt scores, after treatment compared to before treatment (p < 0.05).

Conclusion: ESWT treatment added to BoNT-A was not statistically significantly superior to BoNT-A in terms of MAS, BME, ROM, BI, Heckmatt grade, VAS, and CS. Our study did not observe the additional antispastic contribution of ESWT on spasticity.

Background: Robot-assisted gait training is becoming an effective alternative to therapist-assisted gait training in stroke rehabilitation. This method has the potential to reduce therapist burden and treatment costs, and is receiving considerable attention for the functional recovery of stroke patients.

Objectives: The purpose of this study was to compare the effects of robot-assisted gait training using Functional electrical stimulation (FES) and Virtual Reality(VR) on balance and gait abilities in stroke patients and to suggest an effective treatment strategies.

Methods: All subjects were randomly divided into three groups: Robot-assisted gait training using FES Group (RFG) (n = 22), Robot-assisted gait training using VR Group (RVG) (n = 23) and control group (n = 20). Subjects in RFG or RVG underwent robot-assisted gait training for 30 minutes, three times a week for six weeks. All Subjects were assessed for lower extremity muscle strength, balance, gait, motor function, and ADL pre- and post-intervention.

Results: All subjects showed that all outcome measures significantly improved post-intervention (p < 0.05). In addition, it has been confirmed that RFG had significantly improved in MRC and BBS scores compared with RVG (p < 0.05). And, both groups showed significant differences compared to the control group in all areas except MBI (p < 0.05).

Conclusions: These results suggest that showed improved lower extremity muscle strength and balance abilities after RFG compared with RVG and may be effective strategy to enhance the functional recovery of persons with stroke.

Objective: To evaluate the efficacy of integrating Solution-Focused Brief Therapy (SFBT) and Mindfulness-Based Cognitive Therapy (MBCT) in alleviating psychological distress and improving functional outcomes in patients with post-stroke depression (PSD).

Methods: A controlled study enrolled 60 PSD patients from a tertiary hospital in Jiangxi. Participants were allocated to a control group (n = 29) or an intervention group (n = 27). Primary and secondary outcomes were assessed using the Hamilton Depression Rating Scale-17 (HAMD-17), Hamilton Anxiety Scale (HAMA), Five Facet Mindfulness Questionnaire (FFMQ), Stroke-Specific Quality of Life Scale (SS-QOL), and Barthel Index (BI). Data were analyzed using mixed linear models to examine group-by-time interactions.

Results: Mixed linear model analysis revealed significant group-by-time interaction effects favoring the intervention group across all outcomes: depression severity (HAMD-17: F = 5.24, p < 0.001), anxiety (HAMA: F = 8.90, p < 0.05), mindfulness (FFMQ: F = 5.24, p < 0.05), quality of life (SS-QOL: F = 4.88, p < 0.005), and functional independence (BI: F = 6.12, p < 0.001).

Conclusions: The combined SFBT-MBCT intervention significantly reduces depressive and anxiety symptoms while enhancing mindfulness, quality of life, and functional independence in PSD patients, demonstrating clinical value as an adjunct to routine post-stroke care.

Background: Stroke patients often experience impaired balance and gait due to hip abductor weakness. Although Reformer exercises are recognized to enhance muscular strength and functional outcomes, their effects on specific muscle groups in stroke rehabilitation remain insufficiently investigated.

Objectives: This study examined the effects of Reformer-based hip abductor strengthening exercises on muscle strength, balance, spatiotemporal gait parameters, and fall efficacy in patients with chronic stroke.

Methods: This study utilized a single-blinded randomized controlled trial design. The participants were randomly assigned to an experimental group (Reformer-based hip abductor exercises, n = 12) or a control group (mat-based hip abductor exercises, n = 12). The intervention consisted of 15-minute sessions conducted five times per week for four weeks. Muscle strength, balance, spatiotemporal gait parameters, and fall efficacy were assessed before and after the intervention using mixed-design ANOVA.

Results: Significant group × time interactions were observed for muscle strength, total center of pressure sway distance, timed up and go test, gait speed, step length (unaffected side), and fall efficacy scale (p < 0.05). Within-group comparisons showed significant improvements in all variables (p < 0.05), except for step length on the affected side.

Conclusions: Reformer-based hip abductor strengthening exercises effectively improved muscle strength, balance, gait speed, step length on unaffected side, and fall efficacy in patients with chronic stroke, highlighting their potential benefits in stroke rehabilitation.

Background: Sleep problems are significant and common complications among patients who have experienced a stroke. Acupuncture is considered a potentially effective, low-risk, and cost-efficient therapeutic option for post-stroke insomnia.

Objectives: The aim of this study is to evaluate the effect of acupuncture therapy on sleep quality in patients experiencing insomnia in the early post-stroke period.

Methods: In this randomized, controlled, single-blind study, 70 ischemic stroke patients undergoing inpatient rehabilitation were included. Participants were randomly assigned to either the acupuncture group, which received acupuncture alongside standard rehabilitation, or the control group, which received standard rehabilitation alone. PSQI scores were evaluated at three time points: before treatment (baseline), at the end of treatment (week 4), and 4 weeks after the end of treatment (week 8).

Results: The acupuncture group showed significantly greater improvement in sleep quality compared to the control group. Significant differences were observed between the baseline PSQI scores and the PSQI scores at the 4th week in both the acupuncture and control groups (p < 0.001 and p = 0.008, respectively). The change between baseline and 8th-week PSQI scores was also significant (p < 0.001 for both groups). However, the decrease in PSQI scores was significantly greater in the acupuncture group compared to the control group. The addition of acupuncture therapy to standard rehabilitation resulted in a significant improvement in sleep quality. Additionally, baseline PSQI scores were found to correlate with the severity of depression.

Conclusions: This study suggests that acupuncture therapy can be an effective intervention for improving sleep quality in patients with early post-stroke insomnia.

Background: Spasticity-induced muscle changes affect structure and metabolism. Little is known about the effect of stroke-related muscle changes on peripheral muscle oxygenation.

Objective: To investigate the effect of spasticity severity on peripheral muscle oxygenation in patients with hemiparetic stroke.

Methods: This cross-sectional study was conducted with 20 hemiparetic stroke patients and 10 healthy individuals. The hemiparetic stroke patients were divided into the high-level spasticity group (HLS, MAS ≥ 2) and the low-level spasticity group (LLS, MAS < 2). Healthy individuals were included in the control group (CG). Gastrocnemius muscle oxygenation was measured with near-infrared spectroscopy at rest, during activity (6-minute walk test and stair climbing test) and after activity. Ankle plantar flexor spasticity was evaluated with the Modified Ashworth Scale (MAS). Secondary outcome measures were motor recovery, disability level, and calf adipose tissue thickness.

Results: Resting average muscle oxygenation was lower in HLS than in CG (p = .021). Muscle oxygenation changes from baseline to final values were lower in HLS than in LLS after 6-minute walk test (p = .037) and lower than in CG after stair climbing test (p = .011). Baseline and final muscle oxygen saturation were lower in HLS, differences were not significant. In HLS, muscle oxygen saturation during 6-minute walk test increased unexpectedly, while it decreased during recovery.

Conclusions: Spasticity severity affected peripheral muscle oxygenation. In patients with high-level spasticity, resting average muscle oxygenation and changes in muscle oxygenation during recovery were lower, and different patterns were observed during 6MWT, suggesting impaired oxygen utilization and delivery, possibly related to spasticity severity.

Trial registration: Clinical trial registry: NCT06362954.