Topics in Stroke Rehabilitation最新文献

Background: The ability to step over an obstacle is often evaluated as part of fall-risk and balance assessments. Although different obstacle-crossing tests exist, their comparative predictive validity in stroke is unknown.

Objectives: To examine the predictive validity of different obstacle depths and different obstacle-crossing tests, including a novel, custom-height test and an existing "one-size-fits-all" obstacle test, for predicting post-stroke fallers.

Methods: 46 independently ambulatory adults with stroke completed a custom-height obstacle-crossing test with 3 depths (0.5-inch, 1.5-inch, 3.0-inch) and the Functional Gait Assessment (FGA) 1-3 days before hospital discharge. Falls were tracked prospectively for 3 months using fall calendars and fortnightly phone calls.

Results: 35% of participants fell at least once in 3 months. Test accuracy was not significantly different between obstacle depth conditions. However, the 0.5-inch obstacle depth condition demonstrated the highest sensitivity and specificity, and participants who failed were 9 times more likely to fall in the first 3 months after discharge than those who passed (95% CI 1.9, 42.1; p = 0.005). Performance on the obstacle item of the FGA at hospital discharge was not significantly associated with fall status at 3 months post-discharge and had a 50% floor effect.

Conclusions: The ability to step over a custom-height obstacle may be a good indicator of post-stroke fall status 3 months after hospital discharge. Subtle increases in obstacle depth did not significantly alter accuracy. The "one-size-fits-all" obstacle test from the FGA had poor predictive validity at discharge from inpatient rehabilitation for stroke.

Background: The successful transition of stroke patients from hospital to home relies on the preparedness of caregivers. Assessing this preparedness is crucial, but existing tools need adaptation and validation for Iranian caregivers.

Objectives: This study aimed to translate, culturally adapt, and validate the Persian version of the "Preparedness Assessment for the Transition Home After Stroke" (PATH-s) for use among Iranian caregivers of stroke survivors. It also assessed the association of patient and caregivers' characteristic association with the final PATH score.

Methods: The PATH-s was translated and culturally adapted using the Backward-Forward translation method and expert consultations. Face and content validity were ensured through input from both caregivers and experts. Participants were recruited from two referral hospitals in Tehran, Iran. The sample consisted of 386 caregivers, 74.4% female with a mean age of 47.18 years (SD = 12.2). Construct validity was assessed using Exploratory and Confirmatory Factor Analyses (EFA and CFA). Convergent validity was evaluated through the correlation with Zarit Burden Interview scores. Reliability was tested through internal consistency (Cronbach's alpha) and test-retest reliability (Intraclass Correlation Coefficient, ICC).

Results: The factor analysis revealed a seven-factor structure with robust fit indices (CFI = 0.92, TLI = 0.90, RMSEA = 0.068, SRMR = 0.074). Convergent validity was supported by a significant negative correlation with the Zarit Burden Interview (r = -0.27, p < 0.001). Reliability analysis showed good internal consistency (Cronbach's alpha = 0.84) and excellent test-retest reliability (ICC = 0.96).

Conclusions: The Persian version of PATH-s is a valid and reliable tool for assessing caregiver preparedness in Iran. Its use can improve patient outcomes and caregiver support during hospital-to-home transitions.

Background: Self-management interventions empower individuals to manage their chronic conditions and daily life after stroke. However, traditional in-person self-management interventions often face transportation and geographical barriers. Digital interventions may offer a solution to address this gap.

Objectives: This pilot randomized controlled trial (RCT) aimed to examine treatment satisfaction, user experiences, and the initial effect of the interactive Self-Management Augmented by Rehabilitation Technologies (iSMART) intervention in stroke survivors to improve post-stroke functioning.

Methods: Participants (N = 24) with mild-to-moderate chronic stroke completed a parallel, 2-arm, nonblinded, remote RCT. They were randomly assigned to either a 12-week iSMART or a control intervention (post-stroke information). iSMART was a technology-based self-management intervention involving skill-building education, human coaching, and text messaging. Participants completed a battery measuring treatment satisfaction, use experiences, and function and participation outcomes at baseline and post-intervention.

Results: iSMART participants expressed greater satisfaction with their treatment (r = 0.387), healthcare environment (r = 0.454), relationships with providers (r = 0.374), and higher expectations for positive treatment outcomes (r = 0.328) than control participants, with medium effect sizes. The iSMART group rated the overall program and its coaching, skill-building, and text messaging components as helpful. iSMART participants showed a medium effect in improving overall post-stroke functioning, but control participants showed a small effect. Moreover, iSMART participants showed moderate-to-large effects in improving hand function (r = 0.699), mobility (r = 0.499), memory and thinking (r = 0.436), communication (r = 0.416), social participation (r = 0.307), community reintegration (r = 0.652), and perceived recovery (r = 0.545).

Conclusions: Our results provide initial evidence that iSMART supports stroke survivors in managing chronic conditions and enhancing post-stroke functioning.

Background: People with stroke (PwST) often have significant balance limitations, making it crucial to focus rehabilitation on improving mobility and reducing the risk of falls. The Modified Dynamic Gait Index (MDGI) is recommended for measuring balance in various neurological conditions, but a minimal clinically important difference (MCID) score specific to PwST is missing.

Objectives: To calculate the MCID of the MDGI in PwST during the subacute phase.

Methods: This study is a secondary analysis utilizing data from an observational longitudinal study. Forty-four PwST met the inclusion criteria such as age > 18 years, diagnosis of cerebral infarction or hemorrhage within 180 days, and Mini-Mental State Examination ≥ 21. Participants received at least 10 sessions of tailored physiotherapy to improve balance and gait. Balance was assessed using the MDGI and the Activities-specific Balance Confidence Scale (ABC) before and after intervention. The MCID was determined using an anchor-based approach, with the ABC serving as the anchor.

Results: Statistically significant improvements were observed in mean MDGI change scores of 19.5(14.6) points, (p < 0.01) and ABC change scores of 27.1(25.3) points, (p < 0.01). The MCID for the MDGI total score was identified as 17.5 points. The Spearman correlation between MDGI and ABC change scores was 0.51 (p < 0.01).

Conclusions: An MCID of 17.5 points for the MDGI total score indicates clinically meaningful improvements in balance and gait performance in subacute PwST undergoing rehabilitation. This value provides a robust metric for evaluating the efficacy of balance-related interventions in this population.

Objectives: The plantar fascia stretching intervention can correct balance ability and induces a change spatiotemporal parameter doing gait ability. Our objective is to compare the effects of a 4-week program of plantar fascia stretching with those of calf stretching exercise on ankle dorsiflexion passive range of motion (DF-PROM), open and closed eyes static balance ability, gait parameters, and foot and ankle disability index in chronic post-stroke condition.

Methods: Participants were randomized to either the plantar fascia stretching (n = 10) or calf stretching (n = 10) group. Each group performed 5 times per week for 4 weeks and 3 sets of Calf stretch, and Plantar fascia stretch. Each set comprised 10 repetitions. Ankle DF-PROM, open and closed eyes static balance ability, gait parameters, and foot and ankle disability index were measured after 4 weeks of training.

Results: After 4 weeks of training, the plantar fascia stretching group showed significant improvement in all outcome measures compared with baseline (p < 0.05). Furthermore, ankle DF-PROM, open and closed eyes static balance ability, cadence, and foot and ankle disability index showed greater improvement in the plantar fascia stretching group compared to the calf stretching group (p < 0.05).

Conclusions: This study demonstrated that plantar fascia stretching exercise improved ankle DF-PROM, open and closed eyes static balance ability, cadence, and foot and ankle disability index in chronic post-stroke condition.

Background: The core is important in providing local strength and balance and is central to almost all kinetic chains of daily activities.

Objective: This study aimed to assess the effectiveness of additional Core Stability Exercises (CSE) to conventional physiotherapy (CP) versus CP alone to improve dynamic sitting balance, coordination, trunk function, and stepping (gait) as a primary outcome and functional sitting balance, postural control, standing balance and fall risk, lower limb spasticity, activities of daily living, degree of disability, and quality of life for early subacute stroke recovery.

Methods: A multicentre parallel, randomized, controlled, assessor-blinded trial was conducted. Eighty-seven early stroke survivors initiated (≤30 days) were divided into two groups. Experimental group (EG) performed CSE in addition to CP and the control group (CG) performed CP alone for 5-day/week for 5-week. Outcomes were assessed at the beginning and end of the intervention (5-week) and follow-up (12-week). Quality of life was assessed at 5-week and 12- week. Variables were analyzed using a repeated-measures analysis of variance (ANOVA), with Bonferroni's post-hoc test. All statistical tests were performed for 0.05 significance level and 95% confidence interval.

Results: Eighty-three individuals were analyzed 40 in the EG and 43 in the CG. Differences between groups were shown favoring EG regarding dynamic sitting balance, trunk coordination/function (Spanish-Trunk Impairment Scale), lower limb spasticity (modified-Ashworth Scale) and balance (Spanish-Postural Assessment Scale). No differences were observed for the other outcomes.

Conclusions: CSE in addition to CP improves dynamic sitting balance, trunk coordination/function, lower-limb spasticity, and balance in early recovery post-stroke.

Background: Individuals having experienced a stroke need the help of an individual to perform their activities of daily living. Therefore, the disease affects not only patients but also their caregivers.

Objectives: This study aimed to investigate how aphasia affects caregivers' burden of care, quality of life, and occupational performance.

Methods: This cross-sectional study involved Group 1, (n=51) the caregivers of individuals having experienced a stroke with aphasia, and Group 2 (n = 51), the caregivers of individuals having experienced a stroke without aphasia. The caregivers were evaluated using the sociodemographic information form, the Zarit Caregiver Burden Scale, the SF-36 Short Form, and Canadian Occupational Performance Measure tests.

Results: Our study found that the caregiver burden in Group 1 was higher than in Group 2 (t = 3.8, p = 0.01). Caregivers in Group 1 also had higher pain levels (t = -2.21, p = 0.029) and lower social functions than those in Group 2 (t = -2.54, p = 0.013). There was no statistically significant difference between the other sub-parameters of quality of life (p > 0.05). It was observed that the occupational performance (t = -3.31, p = 0.001) and satisfaction levels (t = -3.57, p = 0.001) of the caregivers in Group 1 were lower than those of the caregivers in Group 2.

Conclusions: Occupational therapy evaluation and intervention programs for caregivers should consider the occupational performance of caregivers of individuals with aphasia and include approaches to problem areas.

Background: This study aimed to evaluate the clinical efficacy and safety of inspiratory and expiratory muscle training (IEMT) for patients who underwent tracheostomy after stroke.

Methods: The study was an investigator-initiated, single-center, two-arm, evaluator-blinded, randomized clinical trial conducted at West China Hospital of Sichuan University, China, from January 2022 to June 2022. The patients were randomly divided into the intervention group and control group. Patients in both groups received conventional clinical, rehabilitation treatment and usual care. The intervention group also received IEMT for three weeks. There were three primary outcomes including maximal inspiratory pressure (MIP, cmH₂O), maximal expiratory pressure (MEP, cmH2O) and decannulation outcome after intervention (n, %). The secondary outcomes were other respiratory function outcomes, motor function, activities of daily living (ADL), quality of life (QoL) and the new pulmonary infection rate after the intervention at three weeks.

Results: A total of 50 participants were enrolled [25 in each group; 39 (78%) were men; mean (SD) age, 55.94 (11.97) years]. At three weeks, significant differences were found in the MIP [control vs IEMT: 39.04 (6.21) vs 56.28 (10.41), p < 0.001]; MEP [43.48 (5.36) vs 62.16 (10.18), p < 0.001], and tracheal tube extraction success rate [2 (8%) vs 9 (36%), p = 0.019] between the two groups. In addition, the new pulmonary infection rate in the intervention groups were significantly different (all p < 0.05) from those in the control group.

Conclusions: IEMT can improve respiratory function, decannulation outcome, among patients with tracheostomy after stroke.

Background: Research has demonstrated that adults post-stroke may experience sensory impairments across different sensory systems. There is a gap in research describing how sensory changes after stroke affect participation in health promoting activities.

Objectives: The purpose of this study is to understand how changes in sensory health after stroke affect participation in meaningful activities.

Methods: We adopted a qualitative phenomenological design to conduct four focus groups with ten participants: two focus groups with a cohort of adults post-stroke (n=5) and two focus groups with a cohort of stroke rehabilitation therapists and stroke caregivers (n=5). Focus group transcripts were coded using open and focused coding with NVivo software to develop themes.

Results: Participants reported changes in their visual, vestibular, proprioceptive, olfactory, gustatory, tactile, and auditory systems that affected their participation in meaningful activities. Participants also reported that they experienced insufficient resources and therapies addressing their sensory health after their stroke. Analyses yielded the following themes:(1) it's hidden and invisible;(2) sensory changes affect participation and can be overwhelming; and (3) it's easy to stay inside: sensory changes negatively affect social participation.

Conclusions: Adults post-stroke experience sensory changes that restrict their participation in meaningful activities including social activities; however, these changes were often missed. More research is needed to further explore the impact of changes in sensory health and understand needs regarding the development of assessment tools and intervention protocols to address the sensory health of adults post-stroke in the clinic, home, and community.

Background: Post-Stroke Dysphagia (PSD) is a common complication that significantly affects the quality of life and health outcomes of stroke survivors. Traditional treatments often have limitations, necessitating the exploration of new therapeutic approaches. This systematic review and meta-analysis aimed to evaluate the efficacy of intermittent Theta Burst Stimulation (iTBS) as an innovative treatment for PSD.

Methods: Following the PRISMA guidelines, a comprehensive literature search was conducted in PubMed, Embase, and Cochrane Library up to July 2024. Studies included were randomized controlled trials (RCTs) involving stroke patients with confirmed dysphagia, comparing iTBS to control treatments. Data extraction and quality assessment were performed independently by two reviewers using the Cochrane RoB 2 tool. Primary outcomes were changes in the Penetration-Aspiration Scale (PAS) and Swallowing Severity Scale (SSA). Meta-analyses were conducted using Review Manager (RevMan) 5.4.

Results: Four RCTs with a total of 199 participants were included. iTBS significantly improved SSA (MD = -3.26, 95% CI [-4.66, -1.86], p < 0.001) and PAS (MD = -1.67, 95% CI [-2.49, -0.86], p < 0.001) immediately after treatment compared to sham stimulation. No significant adverse events were reported.

Conclusion: iTBS appears to have a positive immediate effect on improving swallowing function and reducing aspiration risk in PSD patients compared to sham stimulation. However, these effects may not persist in the long term, and further large-scale RCTs are needed to confirm these findings and establish standardized treatment protocols.