Neurorehabilitation and neural repair最新文献

Objectives: This study aimed to examine whether centrality of pain behavior differs between individuals with post-stroke shoulder pain (PSSP) and those with non-hemiplegic chronic shoulder pain.

Methods: Participants with a history of cerebrovascular accident (CVA) were assigned to the PSSP group, whereas those without a history of CVA were classified as the non-hemiplegic shoulder pain group. Pain intensity was measured with the numeric pain scale. The Centrality of Pain Scale (COPS) assessed pain centralizing behavior. Shoulder pain and functional status were evaluated using the Shoulder Pain and Disability Index (SPADI).

Results: A total of 130 participants were included: 65 individuals with PSSP (mean age = 61.84 ± 11.47) and 65 with non-hemiplegic shoulder pain (mean age = 57.09 ± 11.80). The PSSP group demonstrated significantly higher COPS scores (MD = -3.21; 95% confidence interval [CI] = -5.78 to -0.65; P = .014) and higher SPADI disability (MD = -28.01; 95% CI = -54.77 to -1.24; P = .040) and total scores (MD = -10.09; 95% CI = -16.85 to -3.33; P = .004) compared with the non-hemiplegic shoulder pain group. Pain intensity and duration showed no clinically meaningful differences. COPS further explained 54% of the variance in SPADI pain scores and 51.1% of the variance in SPADI total scores.

Conclusion: Individuals with PSSP demonstrated significantly higher pain centralizing behavior despite similar pain intensity and shorter pain duration compared with non-hemiplegic shoulder pain. Moreover, COPS scores explained a meaningful portion of pain and disability, highlighting the role of central mechanisms in PSSP.

Background: The TWIST tool uses clinical measures at 1 week post-stroke to predict whether patients will achieve independent walking by 4, 6, 9, 16 or 26 weeks post-stroke. TWIST was developed with 93 participants from 2 hospitals and was at least 83% accurate at all timepoints. Validation of TWIST is necessary before implementation into clinical practice.

Objective: The study aimed to perform temporal external validation of the TWIST prediction tool in a single hospital site.

Methods: Adults with stroke were recruited if they had new lower limb weakness and were unable to walk independently. A TWIST score out of 4 was calculated for each participant using age, knee extension strength and Berg Balance Test score at 1 week post-stroke. Discrimination and calibration of TWIST were calculated for each timepoint and the model was refined as required.

Results: There were 89 participants in this validation cohort (43% women, median age 69 years, 56% moderate-severe stroke). Predictions were valid for most TWIST scores at most timepoints. The TWIST tool was too optimistic for participants with TWIST scores of 0 and 2 at 16 and 26 weeks, and a TWIST score of 3 at all timepoints. The TWIST tool and clinical interpretations were refined. Discrimination of the TWIST tool is good (C-statistic > 0.8) for all timepoints.

Conclusions: TWIST is a temporally externally validated prediction tool that combines routine tests at 1-week post-stroke to predict the probability of an individual patient achieving independent walking by 4, 6, 9, 16 or 26 weeks post-stroke.

Dr. Steven L. Wolf has been engaged in neurorehabilitation research for 6 decades. During this time, he has published numerous studies, of great breadth and depth, and of substantial impact. Along the way, he has taught many people a number of key lessons, pertaining to subjects such as leadership, tenacity, creativity, and generosity. This editorial explores 10 of the top lessons from the career of Dr. Wolf.

BackgroundStudies show that beat-based cues from music and metronomes benefit gait in persons with progressive multiple sclerosis (PwPMS) during short walking. While useful for controlled assessment, prolonged walking better reflects real-world function. Adaptive beat-alignment algorithms using biofeedback may enhance synchronization and benefit gait dynamics but their effects in PwPMS remain unknown.AimsTo investigate the effect of walking with and without an adaptive beat-alignment algorithm on synchronization consistency during 8 minutes of walking compared to walking in silence, and its effects on gait. We also examined how clinical factors like dynamic balance and cognition affect synchronization consistency during walking with music and metronomes, with and without adaptive beat alignment.MethodsHealthy controls (HCs) and PwPMS walked for 8 minutes under 5 conditions: silence, music, and metronomes, with or without adaptive beat alignment, at their preferred pace. The algorithm adjusted phase and tempo in real time to restore baseline cadence. We measured synchronization, gait parameters, dynamics, and clinical outcomes.ResultsTwenty-one PwPMS and 18 HCs participated. Adaptive beat-alignment improved synchronization consistency and gait dynamics compared to fixed-tempo walking. Cognitive flexibility and working memory explained 10% of variance in the non-adaptive and 6% in the adaptive conditions, while dynamic balance (40%) impaired synchronization across both algorithms. Auditory cues resulted in slower walking and shorter strides compared to silence.ConclusionThis study demonstrates the feasibility of adaptive beat-alignment strategies enhancing synchronization consistency and gait dynamics in PwPMS; however, cognitive flexibility, working memory, and dynamic balance influenced synchronization performance.

ObjectiveTo explore the latent trajectory classes of objective sleep quality in stroke patients and their impact on neurological functional recovery.MethodsA multicenter cluster sampling method was used to recruit 362 stroke patients from the neurology departments of 5 tertiary hospitals in China between November 2023 and July 2024. Baseline data were collected using a general information questionnaire and related scales. Objective sleep data were obtained using ActiGraph GT3X triaxial accelerometers during the acute (T0), recovery (T1), and chronic (T2) phases of stroke. Neurological recovery was assessed at 12 months post-onset (T3) using the modified Rankin Scale. Parallel-process latent class growth modeling was used to identify trajectory classes. Binary logistic regression examined the association between sleep trajectories and neurological recovery.ResultsA total of 306 patients were followed up. Four distinct trajectory classes were identified: Consistently good sleep quality group (34.31%), Short sleep-increased efficiency-improved fragmentation group (49.02%), Long sleep-reduced efficiency-deteriorated fragmentation group (7.84%), and Consistently poor sleep quality group (8.82%). Compared to the consistently good sleep quality group, patients in the Long sleep-reduced efficiency-deteriorated fragmentation group and Consistently poor sleep quality group had 5.728 (95% confidence interval [CI]: 2.124-15.444) and 6.769 (95% CI: 2.580-17.758) times higher risks of poor neurological recovery, respectively.ConclusionStroke patients exhibit heterogeneous sleep quality trajectories, with differential impacts on neurological recovery. Healthcare providers should implement personalized sleep management strategies to optimize both sleep quality and functional outcomes.

Introduction: Randomized Controlled Trials (RCTs) are essential to underpin the superiority of novel interventions affecting upper extremity capacity post-stroke. However, many RCTs are underpowered, due to heterogeneity in recovery. Prognostic targeting may help reduce sample sizes while maintaining sufficient power.

Objective: This study investigates the effects of prognostic targeting on the required sample size to achieve 70% to 90% power in early post-stroke RCTs with upper extremity capacity measured with the Action Research Arm Test (ARAT) as the outcome.

Patients and methods: Serial data from 4 prospective cohort studies (N = 372 stroke patients) were pooled, with assessments from week 1 to 6 months post-stroke. Using this dataset, we generated synthetic 6-month ARAT outcomes and analyzed data cross-sectionally and longitudinally, with and without prognostic targeting based on a pre-existing prognostic model predicting 6-month outcome. We then calculated power for different sample sizes and assessed trial efficiency, determined by the estimated sample size and inclusion rate.

Results: Prognostic targeting within 3 weeks post-stroke theoretically reduced the required sample size by up to 56% and improved trial efficiency by 40 to 45% for detecting a 6-point ARAT difference at 6 months. The targeted trials needed 220, 270, and 360 patients vs. 470, 560, and 820 in non-targeted trials for 70% to 90% power. Benefits persisted in longitudinal analyses.

Conclusion: This study demonstrates the benefits of prognostic targeting for improving power and efficiency in early post-stroke upper extremity trials using ARAT as outcome. We strongly recommend its use in future stroke rehabilitation and recovery studies.

IntroductionFunctional electrical stimulation (FES) may enhance the impact of locomotor training on walking impairments following spinal cord injury (SCI).ObjectiveThis systematic review (PROSPERO: CRD42023435210) evaluated the therapeutic effectiveness of FES-assisted locomotor training (FALT) on improving walking speed and endurance for individuals with motor incomplete SCI (iSCI).MethodsDatabases (MEDLINE, EMBASE, CINAHL) were searched for interventional studies of FALT in iSCI that assessed the therapeutic effects on walking speed and/or endurance when the FES was not active. Study characteristics and findings were extracted, summarized, and narratively synthesized. Risk of bias was assessed using the Cochrane tools for interventional studies. Random effects meta-analyses were conducted to generate standardized pooled effect sizes for both outcomes.ResultsThirteen studies were identified: 4 randomized controlled trials (RCTs) and 9 pre-post tests. RCTs scored low (n = 1 study), intermediate (n = 1), and high (n = 2) on the RoB2, and all pre-post tests studies (n = 9) scored high on the ROBINS-I. Meta-analyses of 3 RCTs found that treadmill-based FALT was associated with a small, non-significant effect on walking speed (n = 76 participants; Hedge's g: -0.01; 95% CI: -0.46, 0.43; P = .96) and a small, non-significant effect on walking endurance (n = 71; Hedge's g: 0.20; 95% CI: -0.25, 0.65; P = .39) when compared to control conditions.DiscussionThis review did not find evidence that FALT improves walking speed or endurance for people with iSCI relative to other types of locomotor training. Future trials of FALT for SCI should aim to better standardize and report training dose and stimulation parameters to improve comparability.

BackgroundSpoken language and environmental sounds hold rich and nuanced meaning for the listener, but depend on accurate hearing of the soundscape, including the timing, volume, and contrasts of its component pitches. Sensorineural hearing loss with aging degrades these properties, leading to progressive disability.ObjectivesThis case study and review describe my experience and behavioral accommodations to progressive bilateral hearing loss, limited compensation with hearing aids, and the stuttering evolution of gains after a unilateral cochlear implant (CI).ResultsDespite increasingly powerful hearing aids over 25 years, spoken phonemes and words became increasingly muffled, misheard, and often dissipated into ambient background noise. The cognitive effort to extract meaning and mask my disability grew exhausting. I gradually eliminated many of my usual family, medical career, and social roles. To try to recover some communication-dependent activities, I sought a bionic solution. A right-sided CI initially carried an ambiguous, fizzling code and unrecognizable synthetic voices. With 8 months of auditory rehabilitation, I better deciphered conversational speech and ambient sounds. By audiological testing, I improved from 10% hearing accuracy of single words to 65%, typical of post lingual adult users. Better hearing in ambient noise and for what had been excessively rapid speech evolved out to 18 months, allowing me to re-engage in many of my daily roles.ConclusionsHearing loss beyond the compensation of aids deeply challenges quality of life. Auditory rehabilitation after cochlear implantation engages neuroplasticity to re-establish functional communication.

Background: Action observation (AO) has emerged as a potentially powerful therapeutic tool to improve stroke rehabilitation. What remains unclear are the underlying visual attention mechanisms that inform gaze strategies during AO. Further, it is unclear whether visual attention is sustained during AO or influenced by the severity of residual functional impairments following stroke.

Objective: This study seeks to explore eye gaze patterns and vigilance during a single session of AO in stroke survivors with varying levels of impairment.

Methods: Twenty stroke survivors with upper limb impairment (Fugl-Meyer Scores ranging 23-54) engaged in AO by watching an actor performing a disc placement task (observation phase), followed by the participant performing the task (execution phase) with their more affected, then less affected limb. Gaze patterns during the observation phase were evaluated for areas of most prominent gaze and compared between varying levels of severity of residual limb impairment.

Results: Gaze during AO prior to movement on the more affected side is focused on hand and object while AO prior to movement on the less affected side is focused on the overall action in the video. These patterns are prevalent for all levels of severity.

Conclusions: This suggests that participants are developing gaze patterns in line with optimal approaches to encode action specifics, especially on the more affected side. This presents valuable understanding of perceptual patterns of AO that may be optimal for studies evaluating AO in stroke.