Topics in Stroke Rehabilitation最新文献

Background: Anxiety and depressive disorders as well as suicidal ideas are common post stroke and early identification via routine screening is imperative for stroke survivors to access formal assessment and treatment. Currently there is a dearth of training programs available and no online mood screening training programs have been evaluated to date.

Objectives: The current study aims to evaluate the Online Mood Assessment Post Stroke Training Program (OMAPS) developed in partnership with the Stroke Foundation in Australia via a phase II wait listed Randomized Control Trial.

Methods: Recruitment occurred online via webinars and social media pages for stroke clinicians and enrolled participants were randomized, using REDCAP randomization software, into the immediate intervention group or wait list control (where participants waited for one week to complete the training). Participants completed a Mood Screening Self-Efficacy Questionnaire (MSEQ) and a mood screening knowledge quiz, pre and post training. Participants were followed up one month following via e-mail to determine whether they implemented the training.

Results: The results indicated that participants screening knowledge quiz scores improved (M = 1.01, t (59) = 6.81, p=<0.0001, d = 1.05) and self-reported self-efficacy increased for both groups after completing the training (t = 8.294, p < 0.001). Many participants reported a change of practice following completing the training and others reported remaining barriers to implementation.

Conclusions: The results of this study are promising and indicate the preliminary efficacy of the OMAPS training program in boosting stroke clinicians' self-efficacy in mood screening. Further studies should evaluate and explore other changes in clinical practices as a result of the training.

Background: The ability to step over an obstacle is often evaluated as part of fall-risk and balance assessments. Although different obstacle-crossing tests exist, their comparative predictive validity in stroke is unknown.

Objectives: To examine the predictive validity of different obstacle depths and different obstacle-crossing tests, including a novel, custom-height test and an existing "one-size-fits-all" obstacle test, for predicting post-stroke fallers.

Methods: 46 independently ambulatory adults with stroke completed a custom-height obstacle-crossing test with 3 depths (0.5-inch, 1.5-inch, 3.0-inch) and the Functional Gait Assessment (FGA) 1-3 days before hospital discharge. Falls were tracked prospectively for 3 months using fall calendars and fortnightly phone calls.

Results: 35% of participants fell at least once in 3 months. Test accuracy was not significantly different between obstacle depth conditions. However, the 0.5-inch obstacle depth condition demonstrated the highest sensitivity and specificity, and participants who failed were 9 times more likely to fall in the first 3 months after discharge than those who passed (95% CI 1.9, 42.1; p = 0.005). Performance on the obstacle item of the FGA at hospital discharge was not significantly associated with fall status at 3 months post-discharge and had a 50% floor effect.

Conclusions: The ability to step over a custom-height obstacle may be a good indicator of post-stroke fall status 3 months after hospital discharge. Subtle increases in obstacle depth did not significantly alter accuracy. The "one-size-fits-all" obstacle test from the FGA had poor predictive validity at discharge from inpatient rehabilitation for stroke.

Objectives: Anton syndrome is arare stroke syndrome that develops after damage to both occipital lobes, leading to cortical blindness and visual anosognosia. This report describes the rehabilitation course and functional progress of a 42-year-old man diagnosed with Anton syndrome.Methods: The patient started visual stimulation therapy using a color looming disc 5 months after Anton syndrome onset, for 30 minutes a day, 5 times a week for 4 weeks, totaling 20 sessions.Results: After 4 weeks of visual stimulation therapy using color-looming discs, reading tests for consonants, numbers, words, and colors and the latency of the P100 of Visual Evoked Potential showed improvement. Additionally, improvements were noted in the Modified Barthel Index and Mini-Mental State Examination scores related to visual function.Conclusions: This case illustrates the effectiveness of visual stimulation therapy using color-looming discs and its potential to achieve positive outcomes.

Background: Orthosis satisfaction may be an important parameter that increases orthosis usage and reveals orthosis' positive effect on rehabilitation.

Objectives: To investigate the relationship between lower limb orthosis user satisfaction and quality of life (QOL) and functionality in stroke patients.

Methods: Forty-four stroke patients with a mean age of 56.91 ± 14.08 years were included. Orthosis user satisfaction was evaluated using the Orthotics and Prosthetics Users' Survey (OPUS). QOL was assessed using the Stroke-Specific Quality of Life Scale (SS-QOL). Lastly, functional status was evaluated using the Fugl - Meyer Assessment of Lower Extremity (FMA-LE) and Timed Up and Go Test (TUGT).

Results: The relationships were found between the OPUS total satisfaction and SS-QOL-selfcare (r = -0.412, p = 0.005), and upper extremity (r = -0.401, p = 0.007); OPUS device satisfaction and SS-QOL-selfcare (r = -0.484, p < 0.001) and upper extremity function (r = -0.379, p = 0.011); and OPUS service satisfaction and FMA-LE (r = 0.880, p = 0.001). There was no relationship between the OPUS total satisfaction, service satisfaction, and daily orthosis use time (p > 0.05). While participants' QOL and lower extremity functionality were generally at low, those with better functional status had lower orthosis satisfaction because it made ambulation at home difficult.

Conclusion: Taking patient opinions into account in the orthotic design process will help to eliminate the problems related to comfort and orthotic wear that might affect orthotic satisfaction. The production of more comfortable orthoses might positively affect individuals' use of orthoses and satisfaction. This outcome may be a good starting point for prospective studies.

Background: People with stroke (PwST) often have significant balance limitations, making it crucial to focus rehabilitation on improving mobility and reducing the risk of falls. The Modified Dynamic Gait Index (MDGI) is recommended for measuring balance in various neurological conditions, but a minimal clinically important difference (MCID) score specific to PwST is missing.

Objectives: To calculate the MCID of the MDGI in PwST during the subacute phase.

Methods: This study is a secondary analysis utilizing data from an observational longitudinal study. Forty-four PwST met the inclusion criteria such as age > 18 years, diagnosis of cerebral infarction or hemorrhage within 180 days, and Mini-Mental State Examination ≥ 21. Participants received at least 10 sessions of tailored physiotherapy to improve balance and gait. Balance was assessed using the MDGI and the Activities-specific Balance Confidence Scale (ABC) before and after intervention. The MCID was determined using an anchor-based approach, with the ABC serving as the anchor.

Results: Statistically significant improvements were observed in mean MDGI change scores of 19.5(14.6) points, (p < 0.01) and ABC change scores of 27.1(25.3) points, (p < 0.01). The MCID for the MDGI total score was identified as 17.5 points. The Spearman correlation between MDGI and ABC change scores was 0.51 (p < 0.01).

Conclusions: An MCID of 17.5 points for the MDGI total score indicates clinically meaningful improvements in balance and gait performance in subacute PwST undergoing rehabilitation. This value provides a robust metric for evaluating the efficacy of balance-related interventions in this population.

Background: The core is important in providing local strength and balance and is central to almost all kinetic chains of daily activities.

Objective: This study aimed to assess the effectiveness of additional Core Stability Exercises (CSE) to conventional physiotherapy (CP) versus CP alone to improve dynamic sitting balance, coordination, trunk function, and stepping (gait) as a primary outcome and functional sitting balance, postural control, standing balance and fall risk, lower limb spasticity, activities of daily living, degree of disability, and quality of life for early subacute stroke recovery.

Methods: A multicentre parallel, randomized, controlled, assessor-blinded trial was conducted. Eighty-seven early stroke survivors initiated (≤30 days) were divided into two groups. Experimental group (EG) performed CSE in addition to CP and the control group (CG) performed CP alone for 5-day/week for 5-week. Outcomes were assessed at the beginning and end of the intervention (5-week) and follow-up (12-week). Quality of life was assessed at 5-week and 12- week. Variables were analyzed using a repeated-measures analysis of variance (ANOVA), with Bonferroni's post-hoc test. All statistical tests were performed for 0.05 significance level and 95% confidence interval.

Results: Eighty-three individuals were analyzed 40 in the EG and 43 in the CG. Differences between groups were shown favoring EG regarding dynamic sitting balance, trunk coordination/function (Spanish-Trunk Impairment Scale), lower limb spasticity (modified-Ashworth Scale) and balance (Spanish-Postural Assessment Scale). No differences were observed for the other outcomes.

Conclusions: CSE in addition to CP improves dynamic sitting balance, trunk coordination/function, lower-limb spasticity, and balance in early recovery post-stroke.

Background: Post-Stroke Dysphagia (PSD) is a common complication that significantly affects the quality of life and health outcomes of stroke survivors. Traditional treatments often have limitations, necessitating the exploration of new therapeutic approaches. This systematic review and meta-analysis aimed to evaluate the efficacy of intermittent Theta Burst Stimulation (iTBS) as an innovative treatment for PSD.

Methods: Following the PRISMA guidelines, a comprehensive literature search was conducted in PubMed, Embase, and Cochrane Library up to July 2024. Studies included were randomized controlled trials (RCTs) involving stroke patients with confirmed dysphagia, comparing iTBS to control treatments. Data extraction and quality assessment were performed independently by two reviewers using the Cochrane RoB 2 tool. Primary outcomes were changes in the Penetration-Aspiration Scale (PAS) and Swallowing Severity Scale (SSA). Meta-analyses were conducted using Review Manager (RevMan) 5.4.

Results: Four RCTs with a total of 199 participants were included. iTBS significantly improved SSA (MD = -3.26, 95% CI [-4.66, -1.86], p < 0.001) and PAS (MD = -1.67, 95% CI [-2.49, -0.86], p < 0.001) immediately after treatment compared to sham stimulation. No significant adverse events were reported.

Conclusion: iTBS appears to have a positive immediate effect on improving swallowing function and reducing aspiration risk in PSD patients compared to sham stimulation. However, these effects may not persist in the long term, and further large-scale RCTs are needed to confirm these findings and establish standardized treatment protocols.

Background: Regular participation in stroke rehabilitation sessions and adherence to prescribed physical activities are crucial, however, emotional imbalances often act as barriers, resulting in low adherence among stroke survivors. The autogenic relaxation technique (ART) has shown positive effects in various conditions but remains underexplored in the stroke population.

Objective: This experimental study evaluated the outcomes of ART in addition to usual physiotherapy for stroke survivors in improving emotional wellbeing and enhancing patients' commitment to physical activity and functional independence.

Methodology: Sixty-six participants were randomly assigned to either an experimental group or a control group using stratified block randomization. Experimental group participants received 20 minutes of ART followed by 40 minutes of usual physiotherapy, and the control group received 60 minutes of usual physiotherapy. The 12-week program involved three 1-hour sessions per week (one supervised and two non-supervised). Intervention outcomes were assessed using the Hospital Anxiety and Depression Scale for Anxiety (HADS), the Recovery Locus of Control (RLOC) Scale for perceived control and beliefs about health, and Modified Barthel Index (MBI) for functional independence. Intervention effects were analyzed using mixed-model analysis of variance. Changes in the outcome measures were analyzed using paired and independent t-tests, with p < 0.05 considered statistically significant.

Results: After the 12-week intervention, there were significant time and group effects for all outcomes (p < 0.01), with significant reductions in participants' HADS - Anxiety (p = 0.001) and HADS-Depression (p = 0.001) scores, and improvement in RLOC (p = 0.016) and MBI (p = 0.007) scores.

Conclusion: These findings highlight the effectiveness of ART as a non-intimidating and readily accessible strategy with wide-ranging benefits for stroke survivors.

Background: Individuals having experienced a stroke need the help of an individual to perform their activities of daily living. Therefore, the disease affects not only patients but also their caregivers.

Objectives: This study aimed to investigate how aphasia affects caregivers' burden of care, quality of life, and occupational performance.

Methods: This cross-sectional study involved Group 1, (n=51) the caregivers of individuals having experienced a stroke with aphasia, and Group 2 (n = 51), the caregivers of individuals having experienced a stroke without aphasia. The caregivers were evaluated using the sociodemographic information form, the Zarit Caregiver Burden Scale, the SF-36 Short Form, and Canadian Occupational Performance Measure tests.

Results: Our study found that the caregiver burden in Group 1 was higher than in Group 2 (t = 3.8, p = 0.01). Caregivers in Group 1 also had higher pain levels (t = -2.21, p = 0.029) and lower social functions than those in Group 2 (t = -2.54, p = 0.013). There was no statistically significant difference between the other sub-parameters of quality of life (p > 0.05). It was observed that the occupational performance (t = -3.31, p = 0.001) and satisfaction levels (t = -3.57, p = 0.001) of the caregivers in Group 1 were lower than those of the caregivers in Group 2.

Conclusions: Occupational therapy evaluation and intervention programs for caregivers should consider the occupational performance of caregivers of individuals with aphasia and include approaches to problem areas.

Background: Little is known about the use of ultrasonography to evaluate lower-limb function during early stroke-induced hemiparesis rehabilitation.

Objective: To investigate the changes in structural and mechanical parameters using high-frequency ultrasonography to identify parameters correlating with functional improvement.

Methods: Forty-five patients with first-ever stroke within the past 6 months and unilateral lower-limb motor dysfunction were prospectively included. The patients were divided into groups based on the change in their Fugl-Meyer Assessment-Lower Extremities score after a 4-week comprehensive physical rehabilitation therapy: markedly effective (≥4 point increase), effective (1-3 point increase), and ineffective (no change/decrease). High-frequency ultrasonography was used to measure the ankle pennation angle (PA), muscle thickness (MT), fascicle length (FL), and shear wave velocity at the medial head of the gastrocnemius with patients in the neutral position. Pre-treatment and post-treatment comparisons were also performed.

Results: The markedly effective, effective, and ineffective groups included 21, 18, and six patients, respectively. Before treatment, the PA, MT, and FL of the medial head of the gastrocnemius on the affected side were significantly lower than those on the unaffected side (p < 0.05). After treatment, PA and FL increased significantly in the markedly effective and effective groups (p < 0.05), but not in the ineffective group. No changes in these parameters were observed in the ineffective group.

Conclusions: High-frequency ultrasonography provides a quantitative method to distinguish between paretic and non-paretic limbs and identify patients who benefit from treatment. PA and FL of the medial head of the gastrocnemius may be effective indicators of functional improvement.