Topics in Stroke Rehabilitation最新文献

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.

Background: Measurements of cardiorespiratory fitness are mandatory after a stroke. The 6-min step test emerges as an alternative method in absence of maximal tests.

Objective: To provide information regarding the measurement properties of the 6-min step test in individuals with chronic stroke.

Methods: A cross-sectional, methodological study was conducted. Participants were individuals with stroke, who performed the 6-min step test and the 6-min walk test for calculation of measurement properties and comparison purposes. Outcomes of interest were test-retest and inter-rater reliability, measurement error, minimal detectable change, construct validity, criterion validity by video, intra-rater and inter-rater reliability by video.

Results: Fifty individuals with chronic stroke were included. The 6-min step test had a very-high test-retest (ICC 0.98; CI 95% 0.97-0.99) and inter-rater reliability (ICC 0.95; CI 95% 0.92-0.97). The test's measurement error was 4(5%) and the minimal detectable change was 11 repetitions. The correlation between the 6-min step test and the 6-min walk test suggested high construct validity (r = 0.79; CI 0.66-0.89). In addition, the 6-min step test by video had comparable results with the in-person administration with very high criterion validity (r = 1.00; CI 95% 1.00-1.00),intra-rater (ICC = 1.00; CI 95% 1.00-1.00) and inter-rater reliability (ICC = 1.00; CI 95% 1.00-1.00).

Conclusion: The 6-min step test has appropriate measurement properties to estimate cardiorespiratory fitness in individuals with chronic stroke. Moreover, the video administration of the 6-min step test produced comparable results with the in-person administration.

Background: Although peak cough flow (PCF) is a critical indicator for tracheostomized stroke patients, it remains unclear whether diaphragmatic excursion during reflex cough, as the primary driver of inspiration, can predict PCF.

Objective: To explore whether the diaphragmatic excursion during reflex coughing can predict PCF in stroke patients with tracheostomy.

Methods: A total of 57 stroke patients were included in the study. The diaphragm excursion and PCF were measured and a simple linear regression was used to analyze the relationship between them. T-test, Chi-square test and Mann-Whitney U test were used to analyze the influencing factors of PCF, and multiple linear regression was used to construct a regression model.

Results: A simple regression model showed significant associations between diaphragmatic excursion and PCF in patients with unilateral and bilateral paralysis (p = 0.036, R = 0.372, R² = 0.139 for patients with unilateral paralysis; p = 0.002, R = 0.592, R² = 0.350 for patients with bilateral paralysis). Except for the diaphragmatic excursion, the type of paresis was also an influencing factor for PCF. A multiple regression model adjusted for type of paresis showed a significant association between PCF and diaphragmatic excursion (p < 0.001, adjusted regression coefficient = 7.883, adjusted R² = 0.257).

Conclusions: Diaphragmatic excursion during coughing was correlated with PCF. Furthermore, the type of paresis in stroke patients was identified as a significant factor affecting PCF. Our study established the preliminary diaphragmatic excursion-adjusted type of paresis equation as a predictor for estimating PCF in patients with stroke who underwent tracheostomy.

Trial registration numbers: ChiCTR2200063174.

Background: Complex regional pain syndrome (CRPS) is a frequent complication after stroke that negatively impacts pain, function, and rehabilitation outcomes.

Objective: This study aimed to assess the effectiveness of additional contrast compression therapy combined with conventional rehabilitation on edema, pain, function, motor recovery, and spasticity in post-stroke CRPS.

Methods: This prospective, assessor-blind randomized controlled trial was conducted at the inpatient stroke rehabilitation clinic. Seventy-two patients with upper extremity CRPS type-I in the subacute stage after a first-ever stroke were randomly assigned to an experimental or control group. Both groups underwent a standardized conventional rehabilitation program 5-day/week, 3-hours/day for 4 weeks, including positioning, range of motion, stretching, strengthening, and transcutaneous electrical nerve stimulation. The experimental group additionally received contrast compression therapy once daily 15-minutes/session for 10 days. Outcomes were edema (water displacement), rest and activity-related pain (Visual Analog Scale), neuropathic pain (painDETECT Questionnaire), functional status (Functional Independence Measure-Motor), motor recovery (Brunnstrom Stages), and spasticity (Modified Ashworth Scale) assessed at baseline and post-treatment 4 weeks.

Results: Both groups showed significant improvements in all outcomes (p < .05). The experimental group demonstrated significantly greater reductions in edema volume and activity-related pain than the control group (p < .001 and p = .001, respectively). No between-group differences were observed in neuropathic pain, functional status, motor recovery, and spasticity.

Conclusions: Contrast compression therapy provided superior short-term benefits for reducing upper extremity edema and activity-related pain when added to conventional rehabilitation in post-stroke CRPS. It may serve as an effective non-pharmacologic adjunct in stroke rehabilitation.Clinical Trial Registration: NCT07062913.

Methods: Between September 2023 and June 2024, 46 stroke patients admitted to the Department of Rehabilitation Medicine at Binzhou Medical University Affiliated Hospital were recruited and randomly assigned to either a control group (n = 23) or an experimental group (n = 23). The control group received conventional rehabilitation training (CRT) with ankle functional training (AFT), whereas the experimental group received APT on top of the control group, 30 minutes per day, 5 times per week, for 4 weeks. Both the control group and the experimental group comprised research subjects selected through screening. The Fugl-Meyer assessment of lower extremity (FMA-LE), Zebris plantar pressure assessment, Noraxon MyoMOTION 3D system, and surface electromyography were used to evaluate the results before and after treatment. The data collected included range of motion (ROM) for the hip and ankle joints, knee flexion angle, maximum pressure value (MPV) in the three-part division of the foot plantar (forefoot, midfoot, rearfoot), and the root mean square (RMS) value of the tibialis anterior (TA) muscle.

Results: Compared between groups, the experimental group's FMA, flexion angle of the affected knee, ROM of the affected ankle, MPV of the affected forefoot, and the affected TA muscle RMS values were all significantly better than the control group (p < 0.05).

Conclusion: Compared with AFT, APT can effectively improve some kinematic parameters of stroke patients, change the plantar pressure distribution, and optimize the gait pattern of patients when walking. This is of great significance for improving the walking ability of stroke patients.

Background: Digital Twins (DTs) have transitioned from theory to reality, with growing applications in healthcare. Data generated by technologies (e.g. rehabilitation robots), essential for DT implementation, though widely produced in clinical settings, remains untapped in DT stroke rehabilitation, highlighting a gap compared to broader healthcare use.

Objectives: We conducted a scoping review to i) define DT rehabilitation objectives, their input data, generation methods and user involvement; ii) analyze mechanisms underpinning DT models and outputs; iii) map key stakeholders driving innovation; iv) identify desirable properties for DT studies from broader healthcare literature and map them to stroke rehabilitation DT studies.

Methods: Following PRISMA-ScR guidelines, PubMed, Scopus, Web of Science and Google Scholar were searched for studies including only empirical data. Full-text reviews were conducted by three reviewers through repeated calibration.

Results: Sixteen studies were included, addressing five rehabilitation objectives: upper-limb (10), gait (3), and engagement, mental health, and general/planning (1 each). Patient sample sizes varied widely, with one retrospective study including 1,216 patients, while 15 studies involved 54 patients in total (median = 1).We identified 16 DTs mechanisms (e.g. variational autoencoders, Hill muscle models) and outcomes (e.g. exoskeleton control, upper-limb exercise delivery, gait torque estimation, impaired hand-mobility quantification). Academic institutions conducted 12 studies, Europe contributed 8 studies across 6 countries. Of 25 desirable properties identified, 8 (e.g. reproducible algorithms) showed high adoption, while 15 (e.g. cost-effectiveness, clinical integration) showed low/very low adoption by included studies.

Conclusions: DTs in stroke rehabilitation show promise, though challenges remain (e.g. patient involvement, scalability).

Background: Neurological damage resulting from stroke can impair the respiratory system, leaving stroke patients susceptible to pulmonary complications, such as stroke-associated pneumonia (SAP). Due to the substantial mortality risk associated with SAP and its complications, we conducted a systematic review and meta-analysis to estimate the global prevalence of SAP.

Method: A comprehensive search of MEDLINE via PubMed, EMBASE, Scopus, and Web of Science was conducted from 1 January 2014 to 7 August 2024. The cross-sectional studies were selected. The primary study outcome was the prevalence of SAP. Subgroup analysis was implemented. The random-effects method was used to implement meta-analysis. The Joanna Briggs Institute tool for prevalence was used to assess risk of bias in the included studies.

Result: A comprehensive search of MEDLINE via PubMed, EMBASE, Scopus, and Web of Science was conducted from 1 January 2014 to 7 August 2024. The cross-sectional studies were selected. The primary study outcome was the prevalence of SAP. Subgroup analysis was implemented. The random-effects method was used to implement meta-analysis. The Joanna Briggs Institute tool for prevalence was used to assess risk of bias in the included studies. Result The present systematic review and meta-analysis integrated data from 24 studies, encompassing 4,272,805 participants. The prevalence of SAP was 18.3% (95% CI: 13.7-23.0). Results showed significant heterogeneity among studies regarding prevalence estimates (I2= 99.74%, p<0.001). Subgroup analysis by country revealed a substantial reduction in heterogeneity within one specific subgroup (I2=0.00, P=0.67). Utilizing Begg's and Egger's tests showed no statistically significant evidence (P = 0.9013 and P = 0.8398, respectively) of publication bias. The trim-and-fill analysis did not impute additional studies, implying that publication bias is unlikely. A leave-one-out sensitivity analysis revealed that excluding the study by Asgedom et al. resulted in the most significant change in the overall prevalence of SAP.

Conclusion: Our results emphasized the need to effectively identify and manage risk factors to reduce the likelihood of SAP.

Background: Chronic pain is a common complication following stroke. However, most studies assessing its prevalence among stroke survivors include relatively small samples and lack include comparator groups from the general population.

Aims: This cross-sectional study compares prevalence and severity of chronic pain according to history of stroke survivorship by utilizing a large, nationally representative sample of United States adults.

Methods: We analyzed data from adult respondents to the 2019, 2020, 2021, and 2023 National Health Interview Surveys (NHIS). Stroke survivorship was identified based on respondent self-report, and chronic pain was identified as experiencing pain most or every day for the past 3 months. Secondary outcomes included pain severity and pain impact on life, work, and family.

Results: Among 105,179 survey responses, 3.6% reported a history of stroke. Nearly half of these respondents (48%, 95% confidence interval [CI]: 0.45, 0.50) reported chronic pain, in contrast to only 21% (95% CI: 0.21, 0.22) of respondents without a stroke history. Stroke respondents were more likely to suffer from chronic pain (odds ratio [OR]: 1.46, 95% CI: 1.32, 1.62), report higher pain severity (OR: 1.40, 95% CI: 1.28, 1.53), and higher impact pain (OR: 1.77, 95% CI: 1.59, 2.00) compared to those without a history of stroke.

Conclusions: Future research on stroke and chronic pain should explore the mechanisms of chronic pain development to establish more targeted therapeutic interventions. Additionally, the association of stroke and chronic pain indicates that treatment should involve collaboration with multidisciplinary teams to promote early rehabilitation to reduce pain and disability.