Topics in Stroke Rehabilitation最新文献

Background and purpose: Enhancing afferent information from the paretic limb can improve post-stroke motor recovery. However, uncertainties exist regarding varied sensory peripheral neuromodulation protocols and their specific impacts. This study outlines the use of repetitive peripheral sensory stimulation (RPSS) and repetitive magnetic stimulation (rPMS) in individuals with stroke.

Methods: This scoping review was conducted according to the JBI Evidence Synthesis guidelines. We searched studies published until June 2023 on several databases using a three-step analysis and categorization of the studies: pre-analysis, exploration of the material, and data processing.

Results: We identified 916 studies, 52 of which were included (N = 1,125 participants). Approximately 53.84% of the participants were in the chronic phase, displaying moderate-to-severe functional impairment. Thirty-two studies used RPSS often combining it with task-oriented training, while 20 used rPMS as a standalone intervention. The RPSS primarily targeted the median and ulnar nerves, stimulating for an average of 92.78 min at an intensity that induced paresthesia. RPMS targeted the upper and lower limb paretic muscles, employing a 20 Hz frequency in most studies. The mean stimulation time was 12.74 min, with an intensity of 70% of the maximal stimulator output. Among the 114 variables analyzed in the 52 studies, 88 (77.20%) were in the "s,b" domain, with 26 (22.8%) falling under the "d" domain of the ICF.

Discussion and conclusion: Sensory peripheral neuromodulation protocols hold the potential for enhancing post-stroke motor recovery, yet optimal outcomes were obtained when integrated with intensive or task-oriented motor training.

Aims: The aim of this study was to evaluate the accuracy of screening tools for sarcopenia and to determine whether the same or different cutoff points should be applied in patients with chronic stroke.

Materials and methods: Sixty-eight participants with residual hemiparetic deficit for over 6 months were enrolled. We evaluated the accuracy of calf circumference, SARC-F questionnaire, SARC-CalF, and Ishii's score chart using the Asia Working Group for Sarcopenia (AWGS) 2019 revised criteria as the gold standard.

Results: Sarcopenia was identified in 22 participants (32.4%) based on the AWGS criteria. Overall, SARC-F showed the lowest diagnostic accuracy. The Area Under the receiver operating characteristic Curves (AUC) of calf circumference, SARC-F, SARC-CalF, and Ishii's score chart were 0.77 (95% confidence interval [CI], 0.66-0.88), 0.58 (95% CI, 0.42-0.74), 0.75 (95% CI, 0.62-0.87), and 0.78 (95% CI, 0.65-0.90), respectively. The mean AUC of SARC-F was inferior to SARC-CalF (0.58 vs. 0.75, p = 0.035).

Conclusions: The accuracy and diagnostic properties of calf circumference, SARC-CalF, and Ishii's score chart were comparable (mean AUC of 0.77, 0.75, and 0.78, respectively). SARC-F showed the lowest accuracy (mean AUC = 0.58). The recommended screening tools are calf circumference, SARC-CalF, and Ishii's score chart. It is not recommended to rely solely on SARC-F for screening sarcopenia after stroke. We proposed potential new cutoff points for each screening instrument, including SARC-F, SARC-CalF, calf circumference in women, and Ishii's score chart for both men and women.

Objectives: To identify factors associated with the resumption of social outings 6 months after stroke onset and develop a simple clinically practical prediction model.

Materials and methods: Participants were recruited from first-ever stroke survivors admitted to three rehabilitation wards, and resumption of social outings 6 months after stroke onset was assessed using the Japanese version of the Frenchay Activities Index. The association of physical and cognitive functions with activities of daily living at admission to the rehabilitation ward and resumption of social outings 6 months after stroke onset was examined using logistic regression and decision trees.

Results: Notably, 63.2% of the 57 stroke survivors who participated in this study had lower Frenchay Activities Index scores for social outings 6 months after stroke onset than before. Logistic regression analysis revealed that attention deficit and grooming on the Functional Independence Measure (FIM^TM) were significantly associated with decreased social outing scores 6 months after stroke onset. A decision tree model was created to predict the resumption of social outings using the presence or absence of attention disorders and FIM^TM grooming score (>2 or ≤ 2).

Conclusions: The results of this study suggest that attention deficit and beyond a certain level of independence in grooming (FIM^TM >2) at admission to the rehabilitation ward are associated with recovery to the pre-stroke level of social outings 6 months after stroke onset. The decision tree created in this study holds promise as a simple model to predict the resumption of social outings among stroke survivors.

Background: A Lycra arm sleeve has the potential to reduce glenohumeral subluxation (GHS) in people with stroke (PwS). Aims were (1) to provide feasibility data to inform a future fully powered randomized controlled trial, (2) to understand whether patients would be willing to be randomized, (3) to measure changes in GHS at 3 months after wearing the sleeve when compared to not wearing the sleeve.

Method: PwS ≥18 years with ≤3/5 shoulder abduction strength and able to give informed consent were recruited. The feasibility data on recruitment, screening, and retention rate at 12 weeks were collected. Participants were asked if they would be happy to be randomized into one of the two groups. The immediate group received the Lycra sleeve on recruitment and wore for up to 10 hours/day for 3 months. The delayed group received the sleeve after follow-up assessment at 3 months. GHS was assessed using diagnostic ultrasound method.

Results: Over one year, 257 patients were screened, 34 patients were eligible, and 31 (91%) were recruited. Retention at 3 months was 27 (87%). Of those eligible, all found randomization to be acceptable. In the immediate group, GHS showed reduction from 2.6 ± 0.7 cm (95% CI 2.0-3.1 cm) at baseline to 2.2 ± 0.4 cm (CI 2.0-2.5 cm) at 12 weeks. In the delayed group, mean GHS remained unchanged over 3 months period (2.3 ± 0.5 cm, CI 1.9-2.7 cm).

Conclusion: Recruitment was harder than anticipated, but there was high retention demonstrating feasible methodology. There is some indication of a clinical effect of Lycra sleeve on GHS early after stroke.

Background: The validity, reliability, and accuracy of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) for face-to-face assessment in the stroke population are well established. However, the validity and reliability of WHODAS 2.0 through tele-assessment remain uncertain. OBJECTIVE: To assess the reliability, agreement, internal consistency, criterion and discriminant validity of WHODAS 2.0 when administered through video calls.

Methods: A longitudinal methodological study included fifty individuals with chronic stroke. Both in-person and video call assessments were conducted, and their sequence was randomized. The reliability was determined using the Intraclass Correlation Coefficient (ICC2,1). Measurement errors were assessed using the standard error of measurement (SEM) and smallest detectable change (SDC). Internal consistency was assessed using Cronbach's α. Criterion validity was determined by conducting Pearson's correlation coefficient analysis between in-person and video call assessments. Discriminant validity was examined using the Receiver Operating Characteristic (ROC) curve to distinguish disability levels, with the Modified Rankin Scale as the reference standard.

Results: The participants had a mean age of 56.10 ± 10.8 years, with an equal distribution of genders. Adequate reliability was observed between the two methods (ICC2,1 = 0.88; 95% CI = 0.79-0.93; p < 0.001), and internal consistency was also adequate (Cronbach's α = 0.88). The criterion validity revealed a strong correlation (r = 0.78; p < 0.001). Discriminant validity demonstrated satisfactory accuracy in distinguishing disability levels via video call (AUC = 0.67; p = 0.04).

Discussion: This study offers evidence supporting the validity and reliability of the WHODAS 2.0 assessment through video call. Teleassessment using WHODAS 2.0 proves suitable for individuals who have had a stroke, enabling remote evaluation and care.