Topics in Stroke Rehabilitation最新文献

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.

Background: A better understanding of the overall picture of post-stroke motor trials in relation to country resources can be an important step to further understand potential disparities.

Objective: To characterize randomized controlled trials (RCTs) of interventions for the rehabilitation of post-stroke lower extremity (LE) motor disorders, conducted in high-income countries (HICs) and in low-to-middle-income countries (LMICs).

Methods: Systematic searches of RCTs in English were conducted in MEDLINE, Embase, CINAHL and PsycINFO, up to December 2024, according to the Preferred Reporting Items for Systematic reviews and Meta Analyses (PRISMA).

Results: A total of 1,577 RCTs met inclusion criteria. RCTs from LMICs have accelerated after 2014 and surpassed HICs on an annual basis after 2022. Most RCTs in HICs were conducted in the chronic phase post-stroke compared to LMICs (p < 0.001). Robotic training (p = 0.002), gait training (p = 0.000), treadmill training (p < 0.001), feedback training (p = 0.01), and rhythmic-auditory training (p = 0.03) were more likely to be examined in HICs, while acupuncture (p < 0.001), task-specific training (p = 0.03), neurodevelopmental techniques (p = 0.03), and mirror therapy (p = 0.04) were more likely to be examined in LMICs. A higher percentage of RCTs in HICs (28%) were published in journals with an impact factor of >3, compared to LMICs (18.4%), despite similar quality indicators and larger sample sizes in LMICs.

Conclusion: The number of RCTs from LMICs has surpassed HICs on an annual basis after 2022. RCTs from LMICs are more often published in journals with lower JIF, despite similar quality. Interventions studied were similar, challenging broad assumptions about LMICs evaluating less costly interventions.

Background: Following stroke, chronic cognitive impairments across multiple domains have been associated with depression. Currently, it is unknown if specific subtypes of cognitive impairments are differentially related to post-stroke depression severity.

Objectives: To explore the differential associations between within-domain cognitive impairment to depression severity six-months after stroke.

Methods: Participants (n = 385, Age M = 73.86 years [SD = 12.51], National Institutes of Health Stroke Severity M = 6.83 [SD = 6.01]) were recruited from an acute stroke ward. Participants completed a self-report mood measure (Hospital Anxiety and Depression Scale; HADS) and a stroke-specific cognitive assessment (Oxford Cognitive Screen; OCS). Separate multiple regressions predicting depression were conducted across 1) OCS domain-specific cognitive impairments of language, memory, attention, praxis, numeracy, and executive function, and 2) the novel subtask-specific impairments within each OCS domain. Anxiety severity and years of education attained were included as covariates.

Results: Within-domain impairments that were uniquely associated with depression severity were calculation (b_(.57) = 1.44, 95% CI [0.31, 2.56], p = .012), episodic memory (b_(.52) = 1.36, 95% CI [0.34, 2.37], p = .009), picture naming (b_(.45) = 1.18, 95% CI [0.31, 2.06], p = .008), number writing (b_(.46) = 2.54, 95% CI [0.26, 2.07], p = .012), and visuospatial attention (b_(.35) = 1.24, 95% CI [0.54, 1.93], p = .001). Analysis in pooled multiply imputed data (N = 430) corroborated complete case analysis findings.

Conclusions: Specific within-domain cognitive impairments have differential relationships with post-stroke depressive symptomology. Accommodating for these impairments in post-stroke depression interventions may potentially enhance therapeutic outcomes.

Background: Upper extremity (UE) paralysis and weakness due to stroke or traumatic brain injury (TBI) can limit independent functioning. Myoelectrically controlled orthoses can be used for compensatory support for activities of daily living (ADL), and for restorative rehabilitation to reduce disability.

Objective: We investigate the use of UE myoelectric orthoses (UE-MEO) for compensatory and/or restorative use after stroke or TBI.

Methods: We conducted a systematic review (PROSPERO CRD42024577225) from 15 databases including MEDLINE®, Embase®, and APA PsycInfo®. Peer-reviewed reports from 2014 onwards with patient use of UE-MEO after stroke or TBI were included.

Results: Ten studies (11 reports) met the criteria; all included individuals post-stroke and one included a post-TBI subset. The majority were Oxford level of evidence 3b and rated as low risk of bias. All compensatory use studies showed participants could complete more activities or more parts of activities while wearing the UE-MEO. Studies in which the UE-MEO was studied as a restorative therapy took place in outpatient clinics and in the home setting, with mixed results across studies.

Conclusion: The results suggest that use of a UE-MEO is a viable option as a compensatory tool to improve UE function in individuals with partial paralysis or weakness due to stroke or TBI. Additional evidence is needed to test the utility of a UE-MEO for restorative use and to identify the patient population most likely to derive benefits.

Objective: To investigate the effects of 10 Hz repetitive transcranial magnetic stimulation (rTMS) targeting the supplementary motor area (SMA) on balance and postural control in patients with stroke.

Methods: In this randomized controlled trial, 40 patients withbalance disorders were randomly assigned to either the transcranial magneticstimulation (TMS) group (n = 20) or the sham group (n = 20). Both groups underwent a two-week standardized physical therapy. Before each session, the TMS groupreceived 10 Hz, 1000pulses of TMS over the SMA, while the sham group receivedsham stimulation. The primary outcome was the Berg Balance Scale (BBS).Secondary outcomes included the Trunk Impairment Scale (TIS), PosturalAssessment Scale for Stroke Patients (PASS), active motor threshold (AMT) andmotor evoked potential (MEP) amplitude. Measurements were taken before andafter 10 sessions of interventions. The analysis used a 2 × 2 mixed repeatedmeasures ANOVA to assess the effects of the interventionswithin groups and between subjects.

Results: There were statistically meaningful group-by-timeinteractions on the BBS (p = 0.001, F = 31.25), TIS (p = 0.002, F = 24.62) and PASS (p = 0.001, F = 13.02). No significant group effect orgroup-by-time interaction was detected for AMT and MEP amplitude.

Conclusion: The study suggests that the applying 10 Hz rTMS over theSMA can significantly enhance balance and postural control in patients withstroke.

Background: Research has demonstrated that adults post-stroke may experience sensory impairments across different sensory systems. There is a gap in research describing how sensory changes after stroke affect participation in health promoting activities.

Objectives: The purpose of this study is to understand how changes in sensory health after stroke affect participation in meaningful activities.

Methods: We adopted a qualitative phenomenological design to conduct four focus groups with ten participants: two focus groups with a cohort of adults post-stroke (n=5) and two focus groups with a cohort of stroke rehabilitation therapists and stroke caregivers (n=5). Focus group transcripts were coded using open and focused coding with NVivo software to develop themes.

Results: Participants reported changes in their visual, vestibular, proprioceptive, olfactory, gustatory, tactile, and auditory systems that affected their participation in meaningful activities. Participants also reported that they experienced insufficient resources and therapies addressing their sensory health after their stroke. Analyses yielded the following themes:(1) it's hidden and invisible;(2) sensory changes affect participation and can be overwhelming; and (3) it's easy to stay inside: sensory changes negatively affect social participation.

Conclusions: Adults post-stroke experience sensory changes that restrict their participation in meaningful activities including social activities; however, these changes were often missed. More research is needed to further explore the impact of changes in sensory health and understand needs regarding the development of assessment tools and intervention protocols to address the sensory health of adults post-stroke in the clinic, home, and community.