Topics in Stroke Rehabilitation最新文献

Background: Rehabilitation is the primary method of promoting functional recovery post-stroke. Identification of patients for rehabilitation services during the acute stroke hospitalization is essential to delivery of rehabilitation services. Social determinants of health (SDOH) impact health care and health outcomes in a myriad of ways, but it is unknown whether SDOH affects rehabilitation services utilization.

Objectives: This study elucidates the relationship of, and additional explanatory value of, county-level metrics of SDOH on rehabilitation services utilization during acute inpatient hospitalization for stroke.

Methods: Using the American Heart Association Get with the Guidelines®-Stroke registry and the Institute for Health Metrics and Evaluation data, we investigated the impact of SDOH on rehabilitation services utilization over the years ranging from 2010 to 2019 in hospitalized ischemic stroke or intracerebral hemorrhage stroke patients. Analyses focused on determining which county-level SDOH metrics influenced rehabilitation services utilization using generalized linear mixed models. Akaike Information Criterion was used for model selection.

Results: County-level SDOH improved the predictive ability of the models to determine who would be transferred to a rehabilitation facility and who would be referred for rehabilitation after discharge. We found indicators that county-level metrics of high school education (p = 0.0003), being foreign-born (p < 0.001), and rurality of the hospital (p = 0.004) influenced rehabilitation services utilization.

Conclusions: SDOH impact rehabilitation utilization after acute stroke hospitalization. Future studies should focus on both individual- and county-level metrics of SDOH and their impact on access to rehabilitation. This information should be used to develop interventions to improve the equity of rehabilitation utilization after stroke.

Background: The Frailty and Injuries: Cooperative Studies of Intervention Techniques - 4 (FICSIT-4) is a measure that assesses standing balance ability. However, the psychometric properties of the FICSIT-4 have not been examined in people with stroke.

Objectives: To investigate the psychometric properties of the FICSIT-4, including its internal consistency, test - retest reliability, concurrent validity, and known-group validity, and identify the cutoff score on the FICSIT-4 that discriminates people with stroke from healthy older people.

Methods: Sixty-two participants with stroke and 49 age-matched healthy controls were recruited. The FICSIT-4 was administered twice, on days 1 and 2, with a 1-week interval, to the participants with stroke to examine test - retest reliability. Various health-related measures were also administered to the stroke participants on day 1. The FICISIT-4 was only administered once, on day 1, to the healthy participants.

Results: The FICIST-4 was found to exhibit fair internal consistency, good test - retest reliability and significant correlations with various health-related outcome measures. It also demonstrated known-group validity, and a score of 25 was found to distinguish people with stroke from healthy older people.

Conclusion: The FICISIT-4 is a reliable and valid measure for assessing the standing balance ability of people with stroke.

Aims: To investigate the association between pre-stroke frailty and discharge destination in hospitalized older adults in China.

Methods: We conducted this prospective cohort study in a tertiary care hospital in China. We enrolled patients aged 60 years and older admitted to the hospital for acute stroke from January 2022 to May 2022. We used telephone tracking to record the destination of participants after discharge. Generalized estimating equations were used to determine the association between pre-stroke frailty and post-discharge destination.

Results: Among the 230 participants enrolled, the prevalence of pre-stroke frailty was 75.2% and about 75.7% of participants chose to go home at discharge. 70.5% of pre-stroke frail patients chose to go home, compared with 91.2% for non-pre-stroke frail patients. The generalized estimating equation showed a statistical difference between the frailty and non-frailty groups in the post-discharge destination of acute stroke patients between different time points (Waldχ² 36.428 and 13.893, P < 0.001 and 0.008, respectively). After adjustment for the group, the model showed an interaction effect of time and pre-stroke frail status on the post-discharge destination (P < 0.001). The results confirm the importance of pre-stroke frail status in predicting patients' post-discharge outcomes.

Conclusions: Pre-stroke frailty is related to the post-discharge destination and stroke prognosis in elderly Chinese. For Chinese families, most acute stroke patients choose to go home when they are discharged from the hospital, even those who are frail before acute stroke occurs. Further research is needed to confirm this finding and to actively intervene in the pre-stroke frail population.

Background: Proprioceptive deficits are common after stroke. However, limited research has investigated their relationship with functional outcomes (balance and walking ability), particularly in weight-bearing conditions.

Objectives: This study aimed to investigate ankle proprioception on both sides (affected and unaffected), measured in biaxial movement directions (plantar flexion and inversion) and relationships with balance and walking ability in stroke survivors.

Methods: This cross-sectional study involved 70 mild to moderate, first-time, unilateral stroke survivors. Ankle proprioception was measured in a weight-bearing standing position, using the active movement extent discrimination apparatus (AMEDA). Balance and walking ability were measured using the Berg Balance Scale (BBS), the 10-Meter Walking Test (10MWT) and the Timed Up and Go Test (TUG).

Results: Ankle proprioception showed moderate correlations with balance and walking ability (0.4<|r|<0.6, all p < 0.001), regardless of side or movement direction. The only exception was proprioceptive acuity scores for plantar flexion movements made on the unaffected side, which were weakly correlated with BBS (r = 0.3, p = 0.006) and TUG (r = 0.3, p = 0.0015). Regression analysis indicated that ankle proprioception for inversion movement on the affected side was the only factor to independently predict balance (BBS, p = 0.001) and walking ability (10MWT: p < 0.001; TUG: p = 0.01). Ankle proprioception predicts 36% of the variation in BBS, 38% of the variation in 10MWT and 28% of the variation in TUG.

Conclusion: Ankle proprioception showed moderate associations with balance and walking ability in people with mild to moderate stroke. These findings suggest that ankle proprioception could potentially be an indicator of post-stroke functional outcomes, warranting further investigation.

Background: Self-management interventions empower individuals to manage their chronic conditions and daily life after stroke. However, traditional in-person self-management interventions often face transportation and geographical barriers. Digital interventions may offer a solution to address this gap.

Objectives: This pilot randomized controlled trial (RCT) aimed to examine treatment satisfaction, user experiences, and the initial effect of the interactive Self-Management Augmented by Rehabilitation Technologies (iSMART) intervention in stroke survivors to improve post-stroke functioning.

Methods: Participants (N = 24) with mild-to-moderate chronic stroke completed a parallel, 2-arm, nonblinded, remote RCT. They were randomly assigned to either a 12-week iSMART or a control intervention (post-stroke information). iSMART was a technology-based self-management intervention involving skill-building education, human coaching, and text messaging. Participants completed a battery measuring treatment satisfaction, use experiences, and function and participation outcomes at baseline and post-intervention.

Results: iSMART participants expressed greater satisfaction with their treatment (r = 0.387), healthcare environment (r = 0.454), relationships with providers (r = 0.374), and higher expectations for positive treatment outcomes (r = 0.328) than control participants, with medium effect sizes. The iSMART group rated the overall program and its coaching, skill-building, and text messaging components as helpful. iSMART participants showed a medium effect in improving overall post-stroke functioning, but control participants showed a small effect. Moreover, iSMART participants showed moderate-to-large effects in improving hand function (r = 0.699), mobility (r = 0.499), memory and thinking (r = 0.436), communication (r = 0.416), social participation (r = 0.307), community reintegration (r = 0.652), and perceived recovery (r = 0.545).

Conclusions: Our results provide initial evidence that iSMART supports stroke survivors in managing chronic conditions and enhancing post-stroke functioning.

Background: Pelvic floor dysfunction (PFD) are common following stroke. Physiotherapy interventions such as pelvic floor muscle training (PFMT) seems to be effective in the general population with PFD, but its usefulness in stroke patients has rarely been addressed.

Objectives: We aimed to explore existing physiotherapy interventions and their influence in managing PFD in men and women stroke survivors.

Methods: Eight major databases were searched from inception to date using appropriate keywords and search strings. We included experimental studies comparing physiotherapy to control interventions/alternate treatments. PFD were grouped under urinary incontinence (UI), bowel dysfunction (BD), and sexual dysfunctions (SD) based on the studies. Two reviewers independently screened the title and abstract, to determine the included studies and the third author resolved disputes.

Results: Fourteen studies were identified of which ten focused on the management of UI, one on BD, and three on the management of SD. PFMT was predominantly used to manage UI independently or combined with other forms of treatment such as timed voiding, intermittent catheterization, acupuncture, and drug therapy. BD was managed using anal sphincter strengthening exercises, PFMT, and bowel training. Management of SD for both men and women included comfortable and safe sexual position training, stretching, and PFMT. Studies found significant improvement in terms of symptoms of bladder and bowel incontinence, number of incontinence episodes and muscle strength on digital palpation of the pelvic floor muscles.

Conclusion: Physiotherapy interventions including PFMT may help in managing the symptoms and improving the quality of life of stroke survivors with PFD.

Trial design: Pilot study embedded within an assessor-blinded parallel randomized controlled trial.

Objective: To determine the feasibility and utility of using unexpected and untrained balance perturbations in future studies assessing the efficacy of reactive balance training (RBT) post-stroke.

Methods: Participants were community-dwelling adults with chronic stroke who could walk independently without a gait aid for > 10 m. Participants were assigned using blocked stratified randomization to six weeks of RBT or "traditional" balance training (control group). Outcomes were proportion of unexpected slips triggered as intended; state anxiety, perceptions of situations, and participants' subjective responses to the unexpected slip perturbation; and spatiotemporal and kinematic features of unperturbed and perturbed walking pre- and post-training. Assessors were blinded to group allocation.

Results: 28 participants were randomized (15 RBT, 13 control). Nine RBT participants and seven control participants were eligible and consented to additional data collection for the pilot study. 12 participants (six per group) completed the post-training unexpected slip data collection and were included in analysis of pilot objectives. All unexpected slips triggered as intended. Participants did not report increased state anxiety or concerns about the unexpected slip. Spatiotemporal and kinematic data suggested better stability following the unexpected slip for RBT than control participants; however, there were also between-group differences in spatiotemporal and kinematic features of walking pre- and post-training.

Conclusions: Unexpected slips are feasible in research. However, their value as outcomes in clinical trials may depend on balancing the groups on prognostic factors.

Trial registration: ISRCTN05434601.

Background: Spasticity is a common consequence of upper motor neuron syndrome, affecting approximately 42.6% of stroke patients and impairing quality of life. Although stretching is widely used, the optimal type and parameters remain unclear.

Objective: This study investigates the immediate effects of dynamic and static stretching on spasticity reduction and motor function improvement in stroke patients using a robotic hand-wrist stretching device (RHWSD).

Methods: This study was a randomized crossover trial with double-blind design. Thirty-one stroke patients with wrist flexor spasticity were randomly assigned to three RHWSD stretching protocols: 30° dynamic stretching (30° DS), 60° static stretching (60° SS), and 60° dynamic stretching (60° DS). Each protocol involved a 3-minute session with 20-minute rest intervals. Wrist flexor spasticity was assessed with the Modified Ashworth Scale (MAS). Active range of motion (AROM) and passive range of motion (PROM) of wrist extension and finger metacarpophalangeal (MP) extension, were measured at baseline and after each session.

Results: Significant reductions in MAS scores were observed with both dynamic stretching protocols (30° DS: 2.45 ± 0.72; 60° DS: 2.48 ± 0.63) compared to static stretching (60° SS: 2.94 ± 0.51; p < .000). Both dynamic protocols yielded significantly greater gains in AROM and PROM for wrist and finger MP extension than static stretching (all p < .001).

Conclusions: Dynamic stretching is more effective at reducing spasticity in stroke patients. A stretching angle of 80% of the normal range (60°) is sufficient to achieve significant improvements in ROM. The RHWSD was effective in providing consistent stretching.

Background: Repetitive transcranial magnetic stimulation (rTMS) is a promising noninvasive treatment for upper extremity motor impairment in people with stroke. However, response variability underscores the need for tools to support more personalized and effective rTMS planning.

Objectives: Implement a biomarker-based PREScription for personalized rTMS (PRESp-rTMS) in stroke patients with upper extremity motor impairment and verify its effectiveness.

Methods: In this randomized, triple-blind, single-center trial, 20 people with stroke, aged 18-80 years and presenting upper extremity motor impairment, were enrolled and assigned to either a control group receiving standard low-frequency rTMS (s-rTMS) on the non-lesioned hemisphere or a personalized rTMS (p-rTMS) group guided by the PRESp-rTMS algorithm, based on neurophysiological and clinical biomarkers. The p-rTMS group received one of four protocols, each targeting specific frequencies on a single or both hemispheres. The primary outcome was the mean difference in the Fugl-Meyer Assessment for the Upper Extremity (ΔFMA-UE). Secondary outcomes included the Functional Independence Measure, Box and Block Test, Trunk Control Test, and Modified Ashworth Scale.

Results: Compared to the s-rTMS group (ΔFMA-UE = 4.9 ± 1.4; mean ± SD), the p-rTMS group demonstrated a larger improvement in upper extremity motor impairment (ΔFMA-UE = 11.8 ± 2.9; p < 0.01; Cohen's D = 3.2, 95% CI = 2.15-3.90). No significant differences were found for secondary outcomes, although very large effect sizes favored the p-rTMS group.

Conclusions: Using the PRESp-rTMS algorithm results in greater improvements in upper extremity motor impairment in people with stroke compared to the standard rTMS protocol.