Topics in Stroke Rehabilitation最新文献

Background: Although assessment of the capacity to get up from the floor after a fall is considered beneficial in maintaining physical safety for stroke survivors, measurement properties of the Independently Get Off the Floor Scoring System (IGO) for this population is not well established.

Objective: To translate the IGO into Japanese, and to investigate reliability, construct validity, and feasibility of it for stroke survivors.

Design: Sixty-five Japanese stroke survivors participated in this study. This study was designed based on COSMIN standards. The IGO was translated into Japanese using forward and backward translation. For the inter- and intra-rater reliability, weighted Cohen's kappa values and Fleiss's kappa values were used. For the construct validity, hypotheses testing method was used. Correlations between the IGO and standard measurements, the Stroke Impairment Assessment Set, knee extensor muscle strength, range of motion in the shoulder and ankle joint, the 5-repetition Sit-To-Stand test, and the Timed Up and Go test were examined using the Spearman's rank correlation coefficient.

Results: The IGO demonstrates moderate inter-rater reliability between three raters (κ = 0.620) and strong to almost perfect reliability between two raters (κ = 0.824 to 0.862) and strong to almost perfect intra-rater reliability for each rater (κ = 0.884 to 0.959). Seven of 8 hypotheses to test construct validity were confirmed. The significant correlation coefficients obtained ranged from 0.345 to 0.633.

Conclusions: The IGO is a reliable, valid, and feasible measurement to assess the capacity of stroke survivors to get up from the floor.

Background: The Fugl-Meyer Assessment of Lower Extremity (FMA-LE) is a widely recognized and recommended tool for evaluating motor impairments post-stroke; however, an official Persian version is currently unavailable.

Objective: This study translated, culturally adapted the lower extremity FMA (FMA-LE) method into Persian and evaluated its clinimetric properties in Persian post-stroke patients.

Methods: In this cross-sectional study, Persian speaking post stroke patients (n = 80, age 66.66 ± 11.70 years, male = 60%) were enrolled. Translation and cultural adaptations were performed according to the standard guidelines and published papers. Clinimetric properties evaluation included face validity, content validity, and construct validity through correlation with motor subscale of Functional independence measurement (FIM) method; additionally, inter-rater and test-retest reliability were conducted.

Results: A Persian FAM-LE version was developed through consensus agreement on the challenging items with minor modifications. The Content Validity Index values for motor function score (0.91) and its total score (0.94) were acceptable. The intra-rater and inter-rater reliability were ICC = 0.94 (95% CI: 0.90-0.96) and ICC = 0.98 (95% CI: 0.80-0.99), respectively. Concurrent validity showed a moderate correlation between the FMA-LE total score, FMA-LE motor function section, and FIM motor subscale score (r = 0.55 and 0.49). No floor/ceiling effects were found.

Conclusions: The Persian FMA-LE method demonstrated excellent reliability and moderated validity, rendering it suitable for measuring motor function and related disability levels in Iranian post-stroke patients.

Background: Aerobic exercise training leads to cardiovascular changes and improves cardiovascular performance and functional capacity after a stroke. However, the effect of aerobic exercise on cardiac remodeling in patients with stroke has been poorly explored. This study aimed to investigate the effects of a physical exercise program on morphofunctional echocardiographic variables and the functional capacity of post-stroke patients.

Methods: This randomized, controlled clinical trial included patients with stroke, categorized into the control group (CG), conventional physiotherapeutic care, and intervention group (IG). The IG underwent a cardiovascular rehabilitation program consisting of warm-up, aerobic exercise, and muscle cooling. Both conventional and test interventions lasted 45 min, three times a week for 16 weeks. The patients underwent transthoracic echocardiography, a 6-minute walk test, neurological and nutritional evaluation, laboratory tests, and QoL assessment initially and at 16 weeks after the intervention.

Results: The IG showed significant reduction in the following morphological echocardiographic variables compared to the CG after intervention: diastolic thicknesses of the posterior wall (p = 0.0001) and interventricular septum (p = 0.004), relative wall thickness (p = 0.001), left ventricular mass (LVM, p < 0.001), LVM index (p < 0.0001), and left atrial diameter (p = 0.003). Regarding systolic and diastolic functions, the IG showed a significant increase in LV ejection fraction (p = 0.001) and tricuspid ring systolic excursion (p = 0.0002), and a reduction in the left atrial volume index (p = 0.001) and E/E' ratio (p = 0.01) compared to the CG. In addition, the IG showed an increase in the distance covered compared to the CG after the intervention (p = 0.04).

Conclusions: The cardiovascular rehabilitation program improved the cardiac morphological and functional parameters and had a positive impact on the functional capacity of patients with chronic ischemic stroke.

Trial registration: REBEC, RBR-4wk4b3. Registered on 19 September 2016.

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: Anxiety after stroke is common and has a negative impact on quality of life but might be underdiagnosed or undertreated.

Objectives: To describe the course of anxiety symptoms post-stroke, and the relation with psychological care and unmet needs.

Methods: In an observational prospective cohort study, patients with stroke completed the Hospital Anxiety and Depression Scale (HADS) at 3, 6, 12 and 24 months after the start of rehabilitation; 1 item about psychological care; and the Longer-Term Unmet Needs after Stroke. Chi-square and Kruskal-Wallis tests were used to compare patients within three different trajectories of anxiety symptoms based on the HADS anxiety subscale: no (all times <8), non-consistent (one to three times ≥8) or persistent anxiety symptoms (all times ≥8).

Results: Six hundred and ninety patients were included (37.7% females, median age 62 years). At 3, 6, 12 and 24 months after baseline, 136/612 (22.2%), 129/586 (22.0%), 125/548 (22.8%), and 96/487 (19.7%) patients reported anxiety symptoms, respectively. There were 248/384 (64.6%) patients with no, 97/384 (25.3%) with non-consistent, and 39/348 (10.2%) with persistent anxiety symptoms. A minority of patients with non-consistent or persistent anxiety symptoms received psychological care. They had more unmet needs and more often an unmet need related to mood.

Conclusion: The prevalence of post-stroke anxiety remains around 20%, and in 10.2% of patients persistent anxiety symptoms were found. Optimization of screening and treatment seems of value.

Background: Clinicians report that numerous personal and environmental factors affect their ability to address sexuality in their practice. However, no validated tool in any language exists to assess these factors.

Objectives: To translate and cross-culturally validate the Determinants for Implementation Behavior Questionnaire (DIBQ) to sexual health (SH) services for Canadian French speaking stroke rehabilitation clinicians and assess its measurement properties.

Methods: The DIBQ was adapted for sexual health services and translated into Canadian French using a back-translation process. The resulting DIBQ-SH was pretested, improved, and was then sent to clinicians of seven rehabilitation centers in Quebec, Canada, for testing. Exploratory factor analysis, Cronbach's alpha, intraclass correlation coefficients (ICC), standard error of measurement (SEM), minimal detectable change (MDC), and floor and ceiling effects analysis were computed.

Results: A sample of 184 clinicians completed the DIBQ-SH. Factor analysis revealed a six-factor solution explaining 55.2% of the variance. Internal consistency for the total score (α = 0.94) and subscales "Capabilities" (α = 0.91), "Support and resources" (α = 0.87), "Emotions" (α = 0.83), "Planning and delivery" (α = 0.85), "Beliefs" (α = 0.83), and "Motivation" (α = 0.78) was considered "good" to "very good." Test-retest reliability was "good" for the total score and 5/6 subscales (ICC = 0.79-0.88), excluding the "Beliefs" subscale, which was "critical" (ICC = 0.59). SEM and MDC were also presented.

Conclusion: The DIBQ-SH showed good measurement properties for assessing factors that influence provision of sexual health services among French Canadian speaking clinicians who provide services to persons with stroke.

Background: Stroke is a major cause of disability globally, with particularly severe effects in low-resource countries like Ghana. Survivors often experience upper limb motor impairments that limit independence, while access to advanced rehabilitation technologies remains limited. This highlights the need for affordable and effective solutions to support recovery.

Objectives: This study develops a low-cost mechanical hand exoskeleton to assist rehabilitation using pneumatic and biomechanical design principles suitable for resource-limited environments.

Methods: Pneumatic soft actuators made from 3D-printed TPU 95A bellows and PLA scaffolds were designed to generate finger flexion through controlled pressurization. A pneumatic box equipped with dual vacuum pumps, solenoid valves, silicone tubing, and an Arduino-based controller regulated airflow. Integrated flex sensors enabled real-time motion replication for bilateral training. Iterative prototyping and testing were performed to optimize performance and usability, and the final prototype was evaluated for functionality in hand rehabilitation tasks.

Results: The exoskeleton successfully assisted digit flexion and extension by mimicking movements of the healthy hand. It achieved a bend angle of 66.0° at 30 kPa in approximately 5 seconds, producing a flexion force of 3.82 N and a hyperextension force of 1.342 N at a 16.0° hyperextension angle. The glove weighed 207 g, and the pneumatic control box weighed 794 g.

Conclusions: This low-cost pneumatic exoskeleton offers a practical and accessible rehabilitation tool with strong potential to improve hand recovery outcomes for stroke patients in Ghana and similar settings.

Background: Post-stroke cognitive impairment (PSCI) significantly affects patients' quality of life. Although standard repetitive transcranial magnetic stimulation (rTMS) has shown promising efficacy, the effectiveness of the newer, more time-efficient intermittent theta-burst stimulation (iTBS) remains to be validated.

Methods: Two groups of randomly assigned patients with PSCI received either four weeks of two 600-pulse iTBS treatment sessions with a 50-minute interval between sessions or sham stimulation. Cognitive function and activities of daily living were assessed before and after treatment using the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and the Modified Barthel Index (MBI).

Results: Sixty patients were enrolled, and 57 completed the study. Patients in the iTBS group demonstrated significantly higher MMSE scores, MoCA scores, and MBI scores compared to the sham stimulation group (p < 0.05for all). Only one patient experienced a headache during treatment, and no serious adverse events occurred.

Conclusion: Two blocks of iTBS therapy with 600 pulses each at 50-minute intervals demonstrated favorable therapeutic effects in patients with PSCI.

Background: Imaging biomarkers of corticospinal tract (CST) involvement show significant correlations with the upper extremity Fugl-Meyer Assessment (FMA) - a measure of body structure and function within the International Classification of Functioning, Disability, and Health framework (ICF) - particularly in the acute and subacute phases after stroke. However, the relationships between CST biomarkers and the FMA, as well as with ICF activity-level outcomes, remain insufficiently characterized.

Objective: This cross-sectional study investigated, in 36 individuals in the chronic phase after stroke, the correlation between three markers of CST integrity, (1) asymmetry in fractional anisotropy measured in the posterior limb of the internal capsule (FA-PLIC), (2) asymmetry in cerebral peduncle (CP) area, and (3) the CST lesion load, and outcomes of body function/structure and activity.

Methods: The participants were assessed with the FMA and the Wolf Motor Function Test (WMFT) consisting of a timed component (WMFT-Time) and the Functional Ability Scale (WMFT-FAS). Associations between imaging and clinical measures were analyzed with Pearson correlation coefficients.

Results: FA-PLIC asymmetry was significantly correlated with FMA (r = 0.33; p = 0.047) and WMFT-FAS (r = 0.35; p = 0.035), but not with WMFT-Time (r = 0.26; p = 0.120). No significant correlations were observed between CP area asymmetry or CST lesion load and any of the outcome measures.

Conclusions: Our findings support FA-PLIC asymmetry as a biomarker of CST involvement, associated with the FMA and with the quality of movement during execution of functional tasks, in the chronic phase after stroke.

Background: Upper limb paresis and spasticity are predictors of limitations on activities of daily living and decrease in quality of life in post-stroke patients. The French National Authority for Health doesn't recommend the orthosis use; nevertheless, they are commonly used in clinical practice despite the lack of consensus.

Objectives: To develop algorithms guiding specialists in choosing an orthosis as an adjunct therapy for motor function recovery in post-stroke patients, depending on their recovery stage, paresis impairment and level of spasticity.

Methods: This is a scoping review, by searching four electronic databases up to August 2023 for reports of controlled trials comparing two different orthoses or an orthosis versus usual rehabilitation.

Results: Twenty-eight studies were included evaluating static, dynamic, electromyography-drive, and/or robotic orthoses. None can be recommended, due to the low power of studies, but some showed positive results. The orthoses evaluated included, in the early subacute stage, the HANDS Therapy or the Gloreha Professional; in the late subacute stage, the NESS handmaster (new noninvasive hybrid neuroprosthesis which has been developed for therapy and restoration of hand function) or a 3D-printed orthosis; in the chronic stage, the TIGER device, a static splint in extension, a robotic hand exoskeleton, a static splint in neutral position post-botulinum toxin type A or a 3D-printed dynamic hand device.

Conclusions: These are the first algorithms, to our knowledge, to classify wrist-hand orthoses studied for motor function recovery, in adults with an upper limb hemiparesis post stroke. No orthosis can be recommended, but some present promising results.