Brain & NeuroRehabilitation最新文献

This study analyzed the impact of post-stroke fatigue (PSF) on functional recovery in acute and subacute stroke patients during inpatient rehabilitation. Medical records of 177 patients were retrospectively reviewed. PSF was assessed using the Fatigue Severity Scale (FSS)-9. Patients were classified into two groups: a PSF group (mean FSS ≥ 4) and a non-PSF group (mean FSS < 4). Stroke severity was measured with the National Institutes of Health Stroke Scale, and functional outcomes were evaluated using Functional Ambulation Category (FAC), Berg Balance Test, Korean version of the Modified Barthel Index (K-MBI), and Mini-Mental State Examination-Korean version (MMSE-K). Statistical significance was set at p < 0.05. The prevalence of PSF was 52.5%. The repeated measures of analysis of variance showed significant "time" effects on FAC (F = 29.726, p < 0.001) and K-MBI (F = 15.348, p < 0.001). A significant "group" effect was observed on MMSE-K (F = 4.571, p = 0.035), and a "time × group" interaction on only K-MBI (F = 4.284, p = 0.041). Multivariable logistic regression analysis showed that improvements in K-MBI scores were independent of initial severity, depression, and age (p = 0.043). PSF affects the recovery of activities of daily living (ADL) in stroke patients, suggesting that regulating early fatigue after stroke positively affects functional recovery.

Post-stroke cognitive impairment (PSCI) is a common and significant disorder affecting a considerable proportion of stroke patients. PSCI is a known factor that increases the risk of mortality, dependency, and institutionalization in stroke patients. The early prediction of PSCI and the implementation of cognitive rehabilitation could enhance the quality of life of stroke patients and reduce the burden on their families. It is therefore imperative to identify risk factors for PSCIs in the early stages of stroke and to implement early cognitive rehabilitation with an appropriate prognosis. A number of risk factors for PSCI can be identified in patient characteristics, clinical findings, and imaging findings. It is unfortunate that the majority of factors associated with PSCI are non-modifiable. However, the only modifiable factor that can be controlled is the management of stroke risk factors for secondary prevention. Further research is needed to elucidate the potential benefits of various cognitive rehabilitation programs for the prevention and improvement of PSCI.

This meta-analysis aimed to evaluate the effect of constraint-induced movement therapy (CIMT) on arm function and daily living compared with conventional rehabilitation in stroke patients with hemiplegia. We searched three international electronic databases-MEDLINE, Embase, and the Cochrane Library-for relevant studies. The risk of bias was evaluated using Cochrane's Risk of Bias version 1.0, and the certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations method. A total of 34 randomized controlled trials (RCTs) were included herein. Specifically, 21 RCTs regarding arm motor function, 13 on upper limb motor impairment, and 12 on activities of daily living (ADL) performance were analyzed. The results of the meta-analysis demonstrated that CIMT was significantly more effective than conventional therapy in improving arm motor function, reducing upper limb motor impairment, and enhancing ADL performance. CIMT should be implemented and tailored to the strength of the affected upper limb to improve upper limb function and ADL performance in post-stroke patients with hemiplegia.

From the perspective of a Parkinson's patient, this paper aims to elucidate some of the unreasonable and difficult-to-understand realities in Korea, from diagnosis to treatment, with a view to improving the system and policies. Adequate procedures for furnishing information to patients following a diagnosis are lacking. To date, no websites have been established by doctors, public institutions, or the government to provide adequate information. This dearth of information creates a problematic situation that gives rise to patients receiving erroneous or misleading information, thereby wasting their time, financial resources, and ultimately, impacts their health. It is recommended that the government establish an authoritative organization to provide information about Parkinson's disease in order to prevent harm and promote non-motor and motor symptom treatments, such as psychotherapy, as demonstrated in the United States and the United Kingdom. In Korea, the Korea Parkinson Association, a nonprofit private organization, has initiated a campaign for understanding and consideration. With the support of the government and society, an environment can be created where people with Parkinson's disease can live with dignity as members of society.

Transcranial direct current stimulation (tDCS) has emerged as a valuable neuromodulation technique. Many clinical conditions are associated with brain damage, and in severe cases, structural changes such as skull defects are common. These clinical characteristics result in distinct electrical flow patterns during tDCS application compared to cases without brain damage. Recently, notable advancements have been made in both the medical and engineering fields pertaining to the use of in silico modelling and simulation with the aid of magnetic resonance imaging (MRI). As a result, it is now possible to conduct simulations tailored to the unique structural anatomy of an individual's brain, using their own MRI data, to provide targeted tDCS. We have developed software that performs both segmentation and simulation, and have conducted randomized controlled trials using optimized tDCS for stroke and disorders of consciousness. Additionally, we have carried out simulation-related research on stroke and burr hole surgery. This review examines various articles related to simulation and optimized tDCS, evaluating their clinical implications. We believe that these insights will provide valuable guidance for both current and future applications of tDCS.

Stroke frequently results in mobility impairments, contributing to an increased cardiovascular risk. Despite efforts to promote physical activity, stroke survivors fail to meet recommended levels. This secondary analysis of the 'Physical Fitness in Patients with Subacute Stroke' (Phys-Stroke) trial analyzes physical activity at 6 months post-stroke, and examines the effect of gains in walking capacity during the subacute phase on physical activity in the chronic stage. Phys-Stroke compared aerobic exercise vs relaxation in 200 stroke patients. Data from the 6-minute walk test (6MWT) pre and post intervention as well as accelerometry and questionnaire data at 6 months were used. Data was analyzed using mixed linear models and function-on-scalar regression. At 6 months after stroke, participants exhibited low daily step counts (5,623 ± 2,998 steps/day), with most activity occurring in the morning and midday. Per meter gained in the 6MWT during the intervention period, participants increased daily steps by 8.2 (95% confidence interval, 1.6 to 14.8, p = 0.017) at 6 months. Questionnaire data showed that engagement in sports activities was minimal, basic activities being the primary activity. Stroke survivors demonstrated suboptimal activity levels at 6 months but increases in walking capacity during the subacute stage did result in meaningful increases chronically.

Trial registration: ClinicalTrials.gov Identifier: NCT01953549.

To investigate the safety and efficacy of balance training for stroke patients with reduced balance ability by performing a meta-analysis of randomized controlled trials. The PubMed, Embase, and Cochrane Central Register of Controlled Trials databases were searched up to February 2022. Quality assessment was performed using the using the Cochrane risk of bias tool. Studies were included if: 1) patient allocation was randomized; 2) the participant was composed of stroke patients with reduced balance ability (Berg Balance Scale [BBS] ≤ 40, Timed-Up and Go ≥ 14 seconds, or Mini-Balance Evaluation Systems Test ≤ 17.5); and 3) intervention was additional balance training for the experimental group. Six studies including 466 patients were included in the final analysis. The meta-analysis showed a significant improvement in the BBS (mean difference [MD], 8.14; 95% confidence interval [CI], 4.65, 11.64) and Trunk Impairment Scale (MD, 4.71; 95% CI, 3.45, 5.96) after balance training relative to the comparison group. Ambulation function was significantly improved (standardized MD, 0.98; 95% CI, 0.46, 1.49) after balance training. There was one report of a femur fracture among 230 participants in the balance training group. Balance training in addition to conventional rehabilitation program in stroke patients with reduced balance ability appears to be effective and safe.

Although the benefits of exercise therapy in stroke rehabilitation are well-documented, the optimal amount remains a matter of debate. This study investigated the impact of the total amount of exercise therapy on clinical outcomes in adult patients with stroke. We conducted a comprehensive search of three major international databases (Medline, Embase, and the Cochrane Library) and included 18 randomized controlled trials that compared the effects of different amounts of exercise therapy on activities of daily living, upper limb function, lower limb function, and adverse events in stroke patients. We performed a risk of bias assessment, conducted a meta-analysis using a random-effects model, and evaluated the certainty of the evidence. The results indicated that more time spent in exercise therapy significantly improved activities of daily living compared to less time (standardized mean difference [SMD], 0.18; 95% confidence interval [CI], 0.06, 0.30; p = 0.002), with moderate evidence. Additionally, higher intensity of exercise therapy enhanced lower limb function compared to lower intensity (SMD, 0.66; 95% CI, 0.18, 1.13; p = 0.007), with a low level of evidence. No significant differences were found in the incidence of adverse events. Based on these findings, physicians may consider increasing the total amount of exercise therapy for stroke patients in order to improve their activities of daily living and motor function, while carefully considering each patient's neurological and medical condition.

This study aims to develop maximal voluntary isometric contraction (MVIC) and submaximal voluntary isometric contraction (subMVIC) methods and to assess the reliability of the developed methods for in-bed healthy individuals and patients with subacute stroke. The electromyography (EMG) activities from the lower-limb muscles including the tensor fascia lata (TFL), rectus femoris (RF), tibialis anterior (TA), and gastrocnemius (GC) on both sides were recorded during MVIC and subMVIC using surface EMG sensors in 20 healthy individuals and 20 subacute stroke patients. In inter-trial reliability, both MVIC and subMVIC methods demonstrated excellent reliability for all the measured muscles at baseline and follow-up evaluations in both healthy individuals and stroke patients. In inter-day reliability, MVIC showed good reliability for the TFL and moderate reliability for the RF, TA, and GC, while subMVIC showed good reliability for the TFL, RF, and GC and poor reliability for the TA in healthy individuals. In conclusion, the MVIC and subMVIC methods of EMG activities were feasible in in-bed healthy individuals and patients with subacute stroke. The results can serve as a basis for the clinical evaluation of muscular activities using quantitative EMG signals on the lower-limb muscles in stroke patients with impaired mobility.

Patients with brain injury often experience accompanying disabilities that can make it challenging for them to use tools or perform complex tests. Therefore, Korean Mini-Mental State Examination (K-MMSE) is widely used in clinical practice as an alternative to the computerized neurocognitive test (CNT) or Wechsler Adult Intelligence Scale tests to assess cognitive function in these individuals. This study aimed to investigate the correlation between the K-MMSE and CNT in brain injury patients to evaluate the and clinical usefulness of K-MMSE. A total of 120 patients were assessed using both tests, and a significant correlation was observed between the total scores of K-MMSE and CNT. The orientation component of K-MMSE was significantly correlated with CNT components, indicating that individuals who perform well on orientation tasks are likely to have better cognitive abilities overall. While K-MMSE has limitations in evaluating specific cognitive domains, it is a useful tool in clinical practice for evaluating cognitive impairment, especially in patients who have difficulty using more complex cognitive tests.