Topics in Stroke Rehabilitation最新文献

Background: Respiratory function and functional status are often impaired after stroke, yet respiratory assessment before rehabilitation is frequently overlooked. Few studies explore these parameters in the acute and subacute phases, which are critical for recovery. Understandingtheir relationship may guide more effective rehabilitation.

Objectives: To characterize respiratory function and functional status in stroke inpatients at rehabilitation admission. Secondary objectives were to examine correlations between them, and to assess the influence of sex, age, comorbidities, body mass index, stroke type, and time since stroke on these correlations.

Methods: A cross-sectional study included stroke inpatients admitted to rehabilitation between 2023 and 2024. Demographics, Maximal Inspiratory Pressure (MIP), Maximal Expiratory Pressure (MEP), Peak Cough Flow (PCF), Trunk Impairment Scale (TIS), and Functional Independence Measure (FIM) were collected.

Results: Eighty-four participants (67% male; 49% aged 60-69; 48% > 25 kg/m²; 70% ischemic stroke; 38 median days post-stroke) were included. Respiratory function was: MIP (median: 48.5 cmH₂O; interquartile range [IQR]: 28.5;66), MEP (mean: 65.1 cmH₂O; standard deviation [SD]: 26.1) and PCF (mean: 218.5 L/min; SD: 142.1), which were majorly below reference values, except for PCF. Functional status was as follows: FIM (median: 84; IQR: 70.75;93) and TIS (median: 14; IQR: 10.75;18). Correlation analysis showed weak correlation between PCF and FIM (R = 0.35) and TIS (R = 0.30), and moderate correlations between FIM and MIP (R = 0.47) and MEP (R = 0.42). Demographics and stroke subtypes did not significantly impact these correlations.

Conclusions: Respiratory and functional impairments are common early after stroke. Their significant correlation supports routine respiratory assessment at rehabilitation admission to guide individualized interventions, regardless of demographics or stroke subtypes.

Background: The relationships between cardiopulmonary exercise testing(CPET) variables at submaximal and peak efforts across severities of mobility and hemiparesis in patients with stroke are crucial for interpretation but unexplored.

Objectives: We hypothesized that patients with more severe neurological deficits are likely to exhibit a lower peak respiratory exchange ratio(pRER). Moreover, individuals with lower pRER experience greater limitations at peak performance compared to those with higher pRER, while their submaximal performance remains relatively unaffected.

Methods: This retrospective study involved 153 patients with hemiparetic stroke who underwent CPET between 2012 and 2023. Participants with pRER ≤1.05(n = 26), between 1.05-1.15(n = 48), and ≥1.15(n = 79) were selected for further analysis. Five established norms were used to evaluate peak $\dot{V}$O₂, ventilatory anaerobic threshold(VAT), and the lowest value of ventilatory equivalents for carbon dioxide($\dot{V}$_E/$\dot{V}$CO₂ nadir).

Results: Consistent with our hypothesis, patients with lower pRER showed decreased manual muscle strength on the paretic side and lower scores for transfers, mobility on level surfaces, and stair climbing. However, the ratio of VAT to peak $\dot{V}$O₂ remained consistent across different pRER values. Significant linear correlations were observed between the ratio of measured-to-predicted values of peak $\dot{V}$O₂ versus VAT, and peak $\dot{V}$O₂ versus $\dot{V}$_E/$\dot{V}$CO₂ nadir in all pRER groups(≥ 1.15, 1.05-1.15, and ≤1.05) utilizing different norms.

Conclusions: More severe hemiparesis and mobility impairments are associated with a lower pRER during CPET using cycle ergometry. Nevertheless, the measured peak $\dot{V}$O₂ still seems to represent a valid peak $\dot{V}$O₂. These findings aid in interpreting CPET results in patients with hemiparetic stroke.

Background: The contribution of personal and environmental factors to loss of mobility after stroke is unknown.

Objectives: To characterize the level of mobility after stroke and the amount of stroke-induced mobility limitations, and to estimate the magnitude of the contribution of activity limitations and contextual factors to mobility loss.

Methods: Cross-sectional, exploratory study. The outcomes of interest were mobility limitations and stroke-induced mobility limitations. The independent variables were: age, self-efficacy, social support, pre-stroke activity/participation, functional independence, pre-stroke environmental factors, post-stroke depression and cognition.

Results: A total of 209 participants (114 women) recently diagnosed with stroke ( < 7 days), with a mean age of 65 years (SD 12) were included. Mobility was 70 points out of 120 (SD 28) pre-stroke, and 32 points (SD 26) after stroke (stroke-induced mobility = 38 points; 95% CI 34 to 43). Age, self-efficacy and pre-stroke activity/participation combined with functional independence explained 57% of the variance in mobility limitations. In addition, self-efficacy and pre-stroke activity/participation combined with functional independence explained 36% of the variance in mobility limitations due to stroke.

Conclusions: Mobility was reduced prior to stroke, and stroke-induced mobility contributed to 30% additional loss immediately after stroke. Self-efficacy and pre-stroke activity/participation combined with functional independence best explained mobility limitations after stroke.

Background: Individuals frequently report adopting a sedentary lifestyle following a stroke. The Sedentary Behavior Questionnaire (SBQ) was developed to quantify daily time spent in specific sedentary behaviors (SB), and its translation will facilitate the identification of SB in Brazilian stroke survivors.

Objective: Translate and cross-culturally adapt the SBQ questionnaire into Brazilian-Portuguese for use in stroke survivors.

Methods: This is a methodological study for the translation and cross-cultural adaptation of the questionnaire. The nine SBQ items were translated in six steps, according Beaton et al: initial translation of the questionnaire, synthesis of translations, back-translation, synthesis of back-translations, committee of experts and testing of the pre-final (with 33 stroke survivors).

Results: No discrepancies were observed between the original and back-translated versions, demonstrating adequate semantic and conceptual equivalence. The expert committee (10 physiotherapists) adapted the item descriptions to the grammatical rules of the Portuguese language and added examples to the item descriptions to increase comprehension. Participants included for final testing presented an average of 7.4 hours of SB per day, corresponding to 30.8% of the day. While on weekends this average was 6.9 hours per day, being approximately 28.75% of the day. There was an average of 37.04 total hours of SB during the week and 13.81 total hours of SB on weekends.  .

Conclusion: The SBQ-Brazil was adequately translated and cross-culturally adapted into Brazilian-Portuguese, allowing its use in stroke survivors. Further research is required to validate the psychometric properties, such as reliability, and to support its broader application across diverse clinical populations in Brazil.

Background: Post-stroke shoulder pain (PSSP) is a common complication of stroke survivors, substantially impeding upper-limb functional recovery and diminishing quality of life. Conventional treatments usually target peripheral symptoms and only yield limited or transient benefits. Repetitive transcranial magnetic stimulation (rTMS) has shown analgesic potential in various neuropathic pain conditions, yet its efficacy in PSSP lacks systematic evaluation.

Methods: Eight databases were systematically searched to identify randomized controlled trials evaluating rTMS interventions for PSSP. The primary outcome was pain intensity measured by the visual analog scale or numeric rating scale. Secondary outcomes included Fugl-Meyer Assessment, Modified Barthel Index, and shoulder range of motion. Risk assessment and data analysis were performed using Review Manager 5.4.1, with heterogeneity quantified by the I² statistic and subgroup analyses conducted to explore its potential sources.

Results: 12 RCTs involving over 500 participants met the inclusion criteria. Results revealed that rTMS significantly reduced pain intensity compared to control (WMD: -1.62; 95% CI: -2.00, -1.24; p < 0.00001). Additionally, rTMS significantly improved the FMA, MBI scores and shoulder ROM.

Conclusion: rTMS appears to be a promising intervention for reducing PSSP and enhancing upper-limb motor function. These findings support incorporating rTMS into stroke rehabilitation protocols. In the future, high-quality, multi-center RCTs with extended follow-up are warranted to optimize stimulation parameters and validate long-term benefits.

Objective: To assess the efficacy of non-invasive brain stimulation (NIBS) in improving visual perception in stroke patients.

Methods: A systematic review and meta-analysis were conducted in accordance with the PRISMA guidelines. PubMed, Scopus, Web of Science (WoS), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Cochrane Controlled Register of Trials (CENTRAL) were searched for randomized controlled trials (RCTs) evaluating the efficacy of NIBS in improving visual perception in stroke patients up to 5 September 2025. Meta-analyses, forest and funnel plots and risk of bias assessment were performed using RevMan Web, and the certainty of evidence was assessed using GRADEpro GDT.

Results: A total of 7 RCTs met the eligibility criteria, of which 6 had data available for meta-analysis. Random effects meta-analyses showed that NIBS versus sham stimulation had a large effect size on visual perception in stroke patients as determined by the Motor-free Visual Perception Test (MVPT) (4 RCTs, n = 124, 82 men, 42 women; SMD [95% CI]: 0.83 [0.48 - 1.19]; I²: 0%); and that NIBS combined with other therapies versus other therapies alone had a large effect size on visual perception in stroke patients as determined by the MVPT (2 RCTs, n = 32, 14 men, 18 women; SMD [95% CI]: 1.20 [-0.42 - 2.82]; I²: 70%). There was no publication bias.

Conclusions: There is low-certainty evidence in favor of NIBS versus sham stimulation and very low-certainty evidence in favor of NIBS combined with other therapies versus other therapies alone for improving visual perception in stroke patients.

Prospero registration number: CRD42024594263.

Background: Driving restriction has far reaching negative impacts for people who have experienced a stroke. However, current understandings of driving restriction and community mobility after stroke are informed by experiences and perspectives of older men. Younger women (aged 55 years and younger) are facing increased risks for stroke and have unique needs related to life stage and socio-cultural gender roles. Despite these unique risks and needs, women are underrepresented in stroke and driving research, and health organizations are calling for more representation of women in cardiovascular research.

Objectives: To understand the experiences and perspectives of younger women related to driving restriction and their subsequent participation in valued activities and roles after a stroke.

Methods: We conducted a qualitative descriptive interview study with eight younger women (aged 55 years and younger) who had experienced a stroke. We used reflexive thematic analysis to identify themes in the data.

Results: Driving restriction after stroke among younger women is a significant disruption as driving is instrumental in enabling participation in valued activities, social interaction, and supportive roles. Women experienced significant psychological pain from driving restriction, compounded by the sudden and unexpected onset at their age. The women sought out social support, advocated for driver policy changes, and enacted agency to navigate driving restriction through the pursuit of self-determination and adaptation.

Conclusions: Women have unique needs related to driving after stroke. More research is needed to develop richer understandings of this underrepresented group in stroke and driving research.

Background: Ischemic stroke is linked to endothelial dysfunction, inflammation, and disrupted hemostasis, particularly involving Von Willebrand factor (vWF), ADAMTS13, and pro-inflammatory cytokines. While functional electrical stimulation (FES) and exercise are used in stroke rehabilitation, the combined effects on inflammation and hemostatic markers remain unclear.

Objectives: This study aimed to evaluate and compare the effects of aerobic-FES (A-ES), resistance-FES (R-ES), and FES alone on vWF, ADAMTS13 activity, interleukin-6 (IL-6), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) in men with ischemic stroke.

Methods: Thirty-two male stroke patients (55-85 years) were randomly assigned to four groups: A-ES, R-ES, ES, and control (CON). Over 8 weeks, participants in intervention groups completed three weekly sessions: aerobic or resistance training with FES, or FES alone. Blood samples were collected at baseline and 48 h post-intervention. vWF and IL-6 were measured by ELISA, ADAMTS13 by fluorimetry, and lipid profiles using the Selective Detergent method. Data were analyzed using mixed-model ANOVA.

Results: Significant reductions in LDL-C, LDL-C/HDL-C ratio, IL-6, and vWF, along with increased ADAMTS13 activity, were observed in A-ES and R-ES groups (p < 0.05), with no significant change in HDL-C. No significant changes were found in ES or CON groups. Between-group comparisons showed significant effects only for vWF and LDL-C/HDL-C ratio, while interaction effects were significant for LDL-C, IL-6, vWF, and ADAMTS13.

Conclusions: A-ES and R-ES improved inflammatory and hemostatic markers in men with ischemic stroke, showing similar efficacy. These benefits appear attributable to the aerobic and resistance components rather than FES, without evidence of synergistic effects.

Background: Alone or combined with other advanced rehabilitative treatments , non-invasive transcranial direct current stimulation (tDCS) is a promising tool to augment neuroplasticity as well as improve cognitive function post stroke.

Objective: To investigate the psychological and neurophysiological effects of tDCS application combined with cognitive virtual reality training (VRT) in patients with chronic ischemic stroke.

Material and methods: Twenty subjects were enrolled in this quasi-randomized pilot study and assigned to the experimental (EG) or control groups (CG). The EG received VRT combined with tDCS, while the CG received the VRT with sham-tDCS, five times a week for 4 weeks. Each patient was evaluated using a psychometric battery, including Mini Mental State Examination (MMSE), Hamilton Rating Scale (HRS-D), and Frontal Assessment Battery (FAB), at the beginning (T0) and the end (T1) of the study. Additionally, a neurophysiology technician measured the brain electrical activity through event-related potential P300.

Results: A significant improvement in MMSE scores from T0 to T1 was observed in the EG. A significant improvement in FAB scores was observed over time (i.e. at the intragroup analysis), with greater gains in the group receiving active tDCS. On the contrary, both groups showed a significant reduction in depressive symptoms scores over time. A key finding of the study was the enhancement of cognitive processing speed, as indicated by reduced P300 latency, in the EG.

Conclusions: This study suggests that tDCS may potentiate the effects of VR by promoting neuroplasticity and improving the efficiency of cognitive networks, ultimately contributing to better recovery outcomes in patients with stroke.

Background: The Testing Emotionalism After Recent Stroke-Questionnaire (TEARS-Q) evaluates post-stroke emotionalism by focusing on uncontrolled episodes of crying with a cutoff score compared to other available instruments. There is no Turkish scale to assess emotionalism in acute stroke patients.

Objectives: To translate and culturally adapt the TEARS-Q into Turkish and evaluate its validity and reliability.

Methods: The researchers used an Exploratory Factor Analysis (EFA) to determine construct validity. They calculated Cronbach's alpha to assess internal consistency, intraclass correlation coefficient (ICC), and standard error of measurement (SEM) to test-retest reliability. They used the Neurological Sciences Centre-Lability Scale (CNS-LS) and the Hospital Anxiety and Depression Scale (HAD) subscales (anxiety and depression) to determine convergent and discriminant validity, respectively. A five-year-experienced physiotherapist conducted assessments at baseline and after 15 days.

Results: The study comprised eighty-five acute stroke patients, with a mean age of 65.99 ± 13.59 years. EFA indicated a unidimensional structure for the TEARS-Q-TR accounting for 56.46% of the total variance. Cronbach's alpha was 0.883 which indicates good consistency. The analysis obtained an ICC of 0.725, indicating moderate reliability. SEM value of the scale was 3.162. There was a moderate positive relationship between TEARS-Q-TR and CNS-LS (r = 0.517) and a weak positive relationship between TEARS-Q-TR and HAD anxiety (r = 0.351) (p < 0.01). TEARS-Q-TR and HAD depression were not correlated (p > 0.01).

Conclusions: The researchers recommend TEARS-Q-TR, a valid and reliable scale for clinical use in acute stroke patients to assess emotionalism practically (with 8 items) and mitigate potential issues that may arise from the misdiagnosis of emotionalism.