Topics in Stroke Rehabilitation最新文献

Background: Affective instability is a form of emotion dysregulation and a known precursor to affective disorders. Sleep plays a critical role in emotional regulation. Survivors of stroke frequently experience disrupted sleep that contributes to affective disturbances, but the specific dimensions of sleep health associated with affective instability remain unclear.

Objective: To examine the associations between dimensions of sleep health and affective instability in survivors of stroke.

Methods: A secondary analysis of a 7-day prospective study involving 40 community-dwelling survivors of stroke who completed daily sleep diaries and eight daily ecological momentary assessments (EMA). Affective instability was assessed with EMA and quantified using mean squared successive difference (MSSD) and probability of acute change (PAC). Six dimensions of sleep health were assessed via EMA, sleep diaries, and the Pittsburgh Sleep Quality Index. Multivariable linear regression analyses were conducted to examine associations of sleep health with affective instability.

Results: Higher mental fatigue (MSSD: β = .55, p = .001; PAC: β = .76, p < .001), lower sleep efficiency (PAC: β = -.35, p = .036), and longer sleep latency (PAC: β = .38, p = .030) were associated with greater depressed affect instability. More irregular mid-sleep timing (MSSD: β = .57, p < .001; PAC: β = .48, p = .004), more irregular sleep duration (MSSD: β = .43, p = .012), later sleep timing (MSSD: β = .51, p = .002), and longer sleep latency (MSSD: β = .39, p = .020; PAC: β = .39, p = .021) were associated with greater cheerful affect instability.

Conclusions: Poorer sleep efficiency, higher mental fatigue, later sleep timing, and more irregular sleep patterns were associated with greater affective instability. Designing behavioral therapies targeting these sleep health dimensions may reduce affective instability and prevent post-stroke affective disorders.

Background: Obtaining stair-climbing ability at discharge is crucial, and identifying the predictors of independent stair-climbing ability is important for making rehabilitation more effective.

Objectives: This study aimed to clarify the factors associated with stair climbing at discharge in patients with stroke classified according to the severity of lower limb paralysis.

Method: This study is a multi-institutional retrospective observational study included patients with acute ischemic stroke and intracerebral hemorrhage. Patients were classified into the severe group and the mild groups based on the severity of their lower limb function. Multiple logistic regression analysis was performed for all included patients and each severity group to investigate factors associated with stair-climbing ability at discharge.

Results: We included 2,097 patients (41.5 % female) with a median age (interquartile range) of 75 (66-83) years in the present analysis. Overall, 105 (19.6 %) patients in the severe group were able to stair climbing independently and 1,069 (68.5 %) in the mild group were able to climb stairs independently. Predictors independently associated with stair-climbing ability in the severe group included age, paralyzed side, sitting ability, acute length of stay (acute LOS), and functional independence measure (FIM) motor items. Predictors in mild group were age, stroke type, upper limb function, sitting ability, acute LOS, FIM motor, FIM cognitive.

Conclusions: The predictors of stair-climbing ability differed according to the severity of lower limb paralysis. The results of this study can be used to predict the prognosis of stair-climbing ability to support goal setting and decision-making in rehabilitation treatment.

Background: People with chronic stroke have significant impairments in their walking capacity. Minimal clinically important differences (MCIDs) can be used to interpret changes in patient outcomes following interventions. There is significant variability in the response to moderate-to-high walking interventions in people with chronic stroke. One reason for this response variability could be the lack of understanding of the threshold exercise dose needed to achieve an MCID.

Objectives: The purpose of this analysis was to determine the threshold of exercise training speed most predictive of a small (≥20 m) or moderate (≥50 m) clinically important difference in 6MWT in people with chronic stroke.

Methods: Participants with chronic stroke with a walking speed of 0.3-1.0 m/s were randomized into a 12-week (1) fast-walking training or (2) fast-walking training and step-activity monitoring intervention. This analysis included participants (n = 129; age: 63.1 ± 12.5, 46% female) with complete pre- and post-intervention data. Exercise intensity was quantified as average training speed.

Results: Receiver operating characteristic curves analyzed whether training speed is predictive of attaining a clinically important difference in the 6MWT. Training speed had poor, non-significant accuracy of predicting a small (AUC [95% CI] = 0.584 [0.475-0.693], p = 0.131) or moderate (AUC [95% CI] = 0.597 [0.498-0.696], p = 0.056) change in 6MWT.

Conclusions: The average walking training speed during this high-intensity walking intervention did not accurately predict which people with chronic stroke would attain a small or moderate clinically meaningful change in 6MWT distance.

Background: Stroke causes a variety of dysfunctions, and thus the rehabilitation of such patients is important. The respiratory rehabilitation is necessary for stroke patients undergoing tracheotomy. The aim of this study was to provide evidences for a new rehabilitation program of the combination of active cycle of breathing technique (ACBT) with external diaphragm pacing (EDP) for the improvement of respiratory rehabilitation in severe stroke patients with tracheotomy.

Methods: Data were collected from 50 patients, who received conventional therapy and ACBT. Among these patients, 25 cases additionally received EDP therapy. The therapeutic effects of the treatment were evaluated by assessing diaphragmatic ultrasound, arterial blood gas analysis, chest CT examinations and rehabilitation scale scores at 3 time points of prior treatment, 3 weeks and 6 weeks after treatment.

Results: The data analyzed in this study showed that after the treatment, the diaphragmatic excursion and thickening rate, PaO₂ showed increased, PaCO₂, Borg and VAS scores were decreased compared to the data before the treatment, in both ACBT and ACBT+EDP groups. What is noteworthy is that the data above showed more improved in ACBT combined with EDP group than that in ACBT alone group.

Conclusion: The combination method of ACBT plus EDP improves the respiratory function more significantly compared to the application of ACBT alone. Severe stroke patients can try to use this method, so as to improve the respiratory function and promote functional recovery.

Background: Differences in gait parameters between even- and uneven-surface walking in people with stroke (PwS) with different functional abilities remain unclear.

Objectives: We aimed to assess whether there are differences in the adjustments of gait parameters on uneven surfaces between PwS based on their even-surface gait speed (≥0.8 and < 0.8 m/s).

Methods: We calculated the root mean square (RMS) of trunk acceleration and maximum joint angles and co-contraction indexes of the lower limbs during even- and uneven-surface walking between the high-functioning group (HG) (n = 38; ≥0.8 m/s) and low-functioning group (LG) (n = 24; <0.8 m/s).

Results: Compared to the HG, the LG showed a greater reduction in gait speed (p = .015). Meanwhile, the RMS of trunk acceleration increased in the HG but remained unchanged in the LG on uneven surfaces. The increase in knee flexion angle during the swing phase was smaller in the LG than in the HG on uneven surfaces (p < .001). A reduction in the thigh co-contraction index during the stance phase was observed only in the HG on uneven surfaces (p = .005).

Conclusions: The LG responded with a conservative strategy, reducing gait speed more than the HG to maintain stability, whereas the HG exhibited decreased stability but a more flexible adaptation. The smaller increase in knee flexion during the swing phase in the LG suggests impaired motor control, while the reduction in thigh co-contraction during stance observed only in the HG indicates an adaptive response. These findings highlight that adaptation to uneven surfaces differs depending on gait ability on even surface.

Background: Blood flow restriction creates a state with increased motor function that permits treatment modalities to induce muscle hypertrophy. Blood flow-restricted exercise training (BFRET) may induce motor learning and boost the facilitatory effect of exercise training (ET).

Objective: This study investigated the effects of BFRET on post-stroke hemi paretic lower extremity function and walking capacity recovery.

Methodology: This randomized clinical trial was conducted from September 2021 to October 2022 at the Department of Rehabilitation Medicine of the Second Affiliated Hospital of Chongqing Medical University in China. Participants were randomized 1:1 to BFRET or ET, each involving 30 minutes of training twice per day for 4 weeks.

Main outcomes measures: The main outcomes were manual muscle testing (MMT) and Fugl-Meyer assessment scale-lower extremity (FMA-LE), the timed up and go test (TUGT), Outcomes were assessed by blinded raters after 4 weeks of training.

Results: 40 participants mean [SD] age 48.79[12.58] years, 30 males [75%], 20 were randomized to BFRET and 20 to ET. The mean (SD) time since stroke was 2.5 (1.3) years. The MMT scores showed greater strength by within-group comparisons and superior changes in hip flexion and plantar flexion in the BFRET group.

Conclusions: BFRET is superior to ET alone in enhancing muscle mass and strength in the lower extremities. BFRET may improve the function of the lower extremities through physiological adaptations for muscle hypertrophy.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: ChiCTR2100050206.

Introduction: Education deficiency increases caregiver burden, worsening patient's Quality of Life (QoL). The Seven-Step (7E) model enhances critical thinking and problem-solving skills using previous experiences. This study aimed at evaluating the influence of education using 7E model on the stroke patients' QoL and the caregivers' burden.

Methods: Following a single-blind parallel-group randomized controlled trial, 110 patient-caregiver dyads were included in the present study from 10 July 2024 to 15 November 2024. The study was conducted in two hospitals and one clinic affiliated with the Shahid Beheshti University of Medical Sciences. They were randomly divided into two groups: 7E model (n = 55) and routine education (n = 55). Data was collected with the Stroke-Specific Quality of Life Scale and Caregiver Burden Inventory (CBI). In the experimental group, training was conducted based on the 7E model. The questionnaires were completed at the pre-test stage and eight weeks later as post-tests.

Results: Before the intervention, the two groups did not have a statistically significant difference in demographic information and the total score of QoL and CBI (p > 0.05). After intervention, the analysis showed that the mean scores were significantly higher in all dimensions except mobility and self-care in the experimental group compared to the control group (p < 0.05). Also, regarding caregiver burden, after removing the effect of age, results showed that the CBI in all dimensions' scores in the experimental group were significantly lower compared to the control group (p = 0.004).

Conclusion: Compared to conventional educational approaches, 7E model demonstrated greater efficacy in improving patients' quality of life and reducing caregiver burden.

Objective: This study aims to investigate the effects of Mirror Therapy (MT) on spasticity and related parameters in stroke patients.

Methods: A systematic review was performed in databases PubMed, Web of Science, Science Direct, Cochrane, and Scopus databases for published RCTs (Randomized Controlled Trials) from the date of each database's inception to May 2021. Modified Ashworth Scale (MAS) in adult patients with stroke compared to conventional therapy, sham, and additional therapy control were included. Physiotherapy Evidence Database Scale was used to assess the methodological quality of each study.

Results: The overall effect of MT on MAS was statistically significant and beneficial when studies were analyzed in terms of both upper and lower extremities (p < 0.001). MT demonstrated a large and beneficial overall effect on the Brunnstrom Assessment compared to conventional therapy (p < 0.001). The overall impact of MT on Fugl-Meyer Assessment (FMA) was large and statistically significant (p < 0.001). However, a meta-analysis of three studies using the 10-meter walk test showed that the overall effect of MT was not statistically significant (p = 0.258).

Conclusion: This systematic review and meta-analysis demonstrates reductions in upper and lower extremity spasticity and improved motor recovery with MT, both isolated and combined with other treatments, in adults with stroke.

Prospero registration number: CRD42021255154.

Background: The Oxford Cognitive Screen (OCS) was specifically designed for acute stroke survivors and to be inclusive of aphasia, neglect, motor impairments. However, reduced visual acuity (VA), including lack of access to required reading glasses, can impact completion rates and performance. The aim of the study was to evaluate contrast enhanced OCS-tasks for completion rates and equivalence to the original version.

Methods: Adult stroke survivors were asked to complete two versions (standard and adapted) of two tasks (broken hearts cancellation and trails) in a randomized order, to determine relative completion rates and equivalency. A bedside vision assessment, completed by an orthoptist was collected, including near and distance VA with required refractive correction if available. Two groups were created based on near VA; normal near VA (≥0.2LogMAR) and reduced near VA (<0.2LogMAR).

Results: Five hundred participants were recruited, 56.8% male, mean age 70.62 years. Mean near VA was 0.278 (SD0.277) LogMAR. The broken hearts and trails tasks were completed by 2.2% (p=0.041) and 0.4% (p=0.791) more participants respectively with the adapted version. Participants completing both versions with good near VA were used to analyze equivalence. All the lower and upper bounds of the two one-sided test of equivalence fell within the range of 0.5SD for all scores, indicating that the means are equivalent. Analysis of impairment detection revealed fair to good agreement.

Conclusion: The adapted version is suitable for stroke survivors with reduced near VA to complete the assessment. In the presence of good VA, the tasks were deemed to be equivalent.