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BMJ Open Jan 2022A growing evidence base demonstrates the effectiveness of supported self-management in stroke for stroke survivors and their families. However, there is significant...
INTRODUCTION
A growing evidence base demonstrates the effectiveness of supported self-management in stroke for stroke survivors and their families. However, there is significant variation in its implementation in community stroke care and little understanding about how supported self-management works and is delivered across different settings, models used and contexts of community stroke rehabilitation.
METHODS AND ANALYSIS
Using a mixed method, realist approach across two phases, this protocol describes a study on community-based supported self-management. The aim is to identify the mechanisms and outcomes of supported self-management in stroke and to understand how supported self-management is implemented in different contexts of community stroke rehabilitation. Phase 1 involves (1) a realist synthesis, (2) a scoping and mapping of current community rehabilitation settings and (3) a Q-methodology study to develop initial programme theories about how community-based supported self-management works, for whom and in what contexts. Phase 2 involves realist informed interviews/focus groups with stroke survivors, community rehabilitation practitioners and team managers from across Scotland to test and refine programme theories and an explanatory model for how supported self-management works across different contexts of community-based stroke rehabilitation.
ETHICS AND DISSEMINATION
Ethical approval and R&D approvals have been granted from East of Scotland Research Ethics Committee (REC reference number: 19/ES/0055) and participating NHS boards. An understanding of and community-based supported self-management works will help to strengthen its delivery in practice. Such an understanding will enable the design of context-specific recommendations for policy and practice that genuinely reflect the challenges in implementing supported self-management in community stroke care. Results will be disseminated to clinical partners working in community stroke rehabilitation, stroke survivors and families and to policymakers and third sector partners involved in the provision of long-term support for people affected by stroke.
PROSPERO REGISTRATION NUMBER
CRD42020166208.
Topics: Community Health Services; Focus Groups; Humans; Medicine; Research Design; Self-Management; Stroke Rehabilitation
PubMed: 35058265
DOI: 10.1136/bmjopen-2021-055491 -
Brain and Behavior Aug 2023Numerous studies have described the positive effects of action observation therapy (AOT) on motor recovery among patients with stroke. However, there is no standardized... (Review)
Review
BACKGROUND
Numerous studies have described the positive effects of action observation therapy (AOT) on motor recovery among patients with stroke. However, there is no standardized procedure for when and how to intervene with AOT.
OBJECTIVES
Thus, we reviewed and analyzed previous studies to provide a guideline for the application of AOT in stroke rehabilitation.
METHOD
We searched PubMed, Cochrane Library, and EMBASE from inception to October 31 2022, using title and abstract search terms of "action observation" and "stroke" or "hemiplegia." Of 4108 potential articles, 29 articles (sample size = 429 in AOT groups; sample size = 423 in control groups) that met inclusion criteria were included in final analyses.
RESULTS
The results suggested starting adjuvant AOT > 23 days after stroke onset and conducting 30-40 min/session, 3-5 times/week for at least 4 weeks.
CONCLUSION
Based on our results, many factors will impact the effect of AOT on stroke rehabilitation, when to apply (timing) and how to apply (frequency, single, and total duration) should be fully considered when applying AOT as adjuvant therapy in stroke rehabilitation.
Topics: Humans; Stroke Rehabilitation; Activities of Daily Living; Behavior Observation Techniques; Photic Stimulation; Movement; Gait
PubMed: 37480161
DOI: 10.1002/brb3.3157 -
The Kaohsiung Journal of Medical... May 2023Several studies have reported the effects of robotic arms on improving upper limb function in patients with stroke. However, previous studies have reported inconsistent... (Meta-Analysis)
Meta-Analysis Review
Several studies have reported the effects of robotic arms on improving upper limb function in patients with stroke. However, previous studies have reported inconsistent findings that may lead to incorrect applications of robotic arm use. Six databases were searched for relevant randomized controlled trials. Meta-analyses were performed for upper limb performance measures, including subgroup analysis of pooled upper limb rehabilitation data such as stroke stage and intervention delivery dose. Furthermore, the Cochrane risk-of-bias tool for randomized trials version 2 (RoB 2) and sensitivity analysis were used to assess methodology and determine publication bias. The final analysis included 18 studies. Robotic arms improved upper limb and hand function in patients with stroke. Subgroup analysis revealed that robotic arm interventions lasting 30-60 min per session significantly improved upper limb function. However, no significant improvement was observed in shoulder and elbow or wrist and hand movements. This review may help develop applicable rehabilitation robots and collaboration between clinicians.
Topics: Humans; Stroke Rehabilitation; Robotic Surgical Procedures; Recovery of Function; Stroke; Upper Extremity
PubMed: 36999894
DOI: 10.1002/kjm2.12679 -
Current Opinion in Neurology Feb 2021Homonymous visual field defects are a common sequela of stroke, and are assumed to be permanent within a few weeks of the event. Because consensus about the efficacy of... (Review)
Review
PURPOSE OF REVIEW
Homonymous visual field defects are a common sequela of stroke, and are assumed to be permanent within a few weeks of the event. Because consensus about the efficacy of rehabilitation is lacking, visual therapy is rarely prescribed. Here, we review current rehabilitation options and strategies in the translational pipeline that could change these perspectives.
RECENT FINDINGS
The mainstays of available therapy for homonymous visual defects are compensation training and substitution, which allow patients to better use their spared vision. However, early clinical studies suggest that vision can partially recover following intensive training inside the blind field. Research into the relative efficacy of different restorative approaches continues, providing insights into neurophysiologic substrates of recovery and its limitations. This, in turn, has led to new work examining the possible benefits of earlier intervention, advanced training procedures, noninvasive brain stimulation, and pharmacological adjuvants, all of which remain to be vetted through properly powered, randomized, clinical trials.
SUMMARY
Research has uncovered substantial visual plasticity after occipital strokes, suggesting that rehabilitative strategies for this condition should be more aggressive. For maximal benefit, poststroke vision-restorative interventions should begin early, and in parallel with strategies that optimize everyday use of an expanding field of view.
Topics: Cerebral Cortex; Humans; Stroke; Stroke Rehabilitation; Vision Disorders; Vision, Ocular; Visual Fields
PubMed: 33230035
DOI: 10.1097/WCO.0000000000000884 -
Journal of Rehabilitation Medicine Jun 2021To estimate societal costs and changes in health-related quality of life in stroke patients, up to one year after start of medical specialist rehabilitation.
OBJECTIVE
To estimate societal costs and changes in health-related quality of life in stroke patients, up to one year after start of medical specialist rehabilitation.
DESIGN
Observational.
PATIENTS
Consecutive patients who received medical specialist rehabilitation in the Stroke Cohort Outcomes of REhabilitation (SCORE) study.
METHODS
Participants completed questionnaires on health-related quality of life (EuroQol EQ-5D-3L), absenteeism, out-of-pocket costs and healthcare use at start and end of rehabilitation and 6 and 12 months after start. Clinical characteristics and rehabilitation costs were extracted from the medical and financial records, respectively.
RESULTS
From 2014 to 2016 a total of 313 stroke patients completed the study. Mean age was 59 (standard deviation (SD) 12) years, 185 (59%) were male, and 244 (78%) inpatients. Mean costs for inpatient and outpatient rehabilitation were US$70,601 and US$27,473, respectively. For inpatients, utility (an expression of quality of life) increased significantly between baseline and 6 months (EQ-5D-3L 0.66-0.73, p = 0.01; visual analogue scale 0.77-0.82, p < 0.001) and between baseline and 12 months (visual analogue scale 0.77-0.81, p < 0.001).
CONCLUSION
One-year societal costs from after the start of rehabilitation in stroke patients were considerable. Future research should also include costs prior to rehabilitation. For inpatients, health-related quality of life, expressed in terms of utility, improved significantly over time.
Topics: Female; Hospitalization; Humans; Male; Middle Aged; Quality of Life; Societies, Medical; Stroke Rehabilitation; Treatment Outcome
PubMed: 33856036
DOI: 10.2340/16501977-2829 -
BioMed Research International 2022This study was conducted according to Arksey and O'Malley's framework. To investigate the evidence on the effects of Kinect-based rehabilitation, a search was executed... (Review)
Review
METHOD
This study was conducted according to Arksey and O'Malley's framework. To investigate the evidence on the effects of Kinect-based rehabilitation, a search was executed in five databases (Web of Science, PubMed, Cochrane Library, Scopus, and IEEE) from 2010 to 2020.
RESULTS
Thirty-three articles were finally selected by the inclusion criteria. Most of the studies had been conducted in the US (22%). In terms of the application of Kinect-based rehabilitation for stroke patients, most studies had focused on the rehabilitation of upper extremities (55%), followed by balance (27%). The majority of the studies had developed customized rehabilitation programs (36%) for the rehabilitation of stroke patients. Most of these studies had noted that the simultaneous use of Kinect-based rehabilitation and other physiotherapy methods has a more noticeable effect on performance improvement in patients.
CONCLUSION
The simultaneous application of Kinect-based rehabilitation and other physiotherapy methods has a stronger effect on the performance improvement of stroke patients. Better effects can be achieved by designing Kinect-based rehabilitation programs tailored to the characteristics and abilities of stroke patients.
Topics: Humans; Stroke; Stroke Rehabilitation; Upper Extremity
PubMed: 35386303
DOI: 10.1155/2022/4339054 -
Journal of Neuroengineering and... Dec 2022Restoring movement after hemiparesis caused by stroke is an ongoing challenge in the field of rehabilitation. With several therapies in use, there is no definitive...
BACKGROUND
Restoring movement after hemiparesis caused by stroke is an ongoing challenge in the field of rehabilitation. With several therapies in use, there is no definitive prescription that optimally maps parameters of rehabilitation with patient condition. Recovery gets further complicated once patients enter chronic phase. In this paper, we propose a rehabilitation framework based on computational modeling, capable of mapping patient characteristics to parameters of rehabilitation therapy.
METHOD
To build such a system, we used a simple convolutional neural network capable of performing bilateral reaching movements in 3D space using stereovision. The network was designed to have bilateral symmetry to reflect the bilaterality of the cerebral hemispheres with the two halves joined by cross-connections. This network was then modified according to 3 chosen patient characteristics-lesion size, stage of recovery (acute or chronic) and structural integrity of cross-connections (analogous to Corpus Callosum). Similarly, 3 parameters were used to define rehabilitation paradigms-movement complexity (Exploratory vs Stereotypic), hand selection mode (move only affected arm, CIMT vs move both arms, BMT), and extent of plasticity (local vs global). For each stroke condition, performance under each setting of the rehabilitation parameters was measured and results were analyzed to find the corresponding optimal rehabilitation protocol.
RESULTS
Upon analysis, we found that regardless of patient characteristics network showed better recovery when high complexity movements were used and no significant difference was found between the two hand selection modes. Contrary to these two parameters, optimal extent of plasticity was influenced by patient characteristics. For acute stroke, global plasticity is preferred only for larger lesions. However, for chronic, plasticity varies with structural integrity of cross-connections. Under high integrity, chronic prefers global plasticity regardless of lesion size, but with low integrity local plasticity is preferred.
CONCLUSION
Clinically translating the results obtained, optimal recovery may be observed when paretic arm explores the available workspace irrespective of the hand selection mode adopted. However, the extent of plasticity to be used depends on characteristics of the patient mainly stage of stroke and structural integrity. By using systems as developed in this study and modifying rehabilitation paradigms accordingly it is expected post-stroke recovery can be maximized.
Topics: Humans; Stroke Rehabilitation; Recovery of Function; Stroke; Arm; Neural Networks, Computer; Paresis
PubMed: 36536385
DOI: 10.1186/s12984-022-01106-3 -
Health Technology Assessment... Oct 2020Loss of arm function is common after stroke. Robot-assisted training may improve arm outcomes. (Randomized Controlled Trial)
Randomized Controlled Trial
Robot-assisted training compared with an enhanced upper limb therapy programme and with usual care for upper limb functional limitation after stroke: the RATULS three-group RCT.
BACKGROUND
Loss of arm function is common after stroke. Robot-assisted training may improve arm outcomes.
OBJECTIVE
The objectives were to determine the clinical effectiveness and cost-effectiveness of robot-assisted training, compared with an enhanced upper limb therapy programme and with usual care.
DESIGN
This was a pragmatic, observer-blind, multicentre randomised controlled trial with embedded health economic and process evaluations.
SETTING
The trial was set in four NHS trial centres.
PARTICIPANTS
Patients with moderate or severe upper limb functional limitation, between 1 week and 5 years following first stroke, were recruited.
INTERVENTIONS
Robot-assisted training using the Massachusetts Institute of Technology-Manus robotic gym system (InMotion commercial version, Interactive Motion Technologies, Inc., Watertown, MA, USA), an enhanced upper limb therapy programme comprising repetitive functional task practice, and usual care.
MAIN OUTCOME MEASURES
The primary outcome was upper limb functional recovery 'success' (assessed using the Action Research Arm Test) at 3 months. Secondary outcomes at 3 and 6 months were the Action Research Arm Test results, upper limb impairment (measured using the Fugl-Meyer Assessment), activities of daily living (measured using the Barthel Activities of Daily Living Index), quality of life (measured using the Stroke Impact Scale), resource use costs and quality-adjusted life-years.
RESULTS
A total of 770 participants were randomised (robot-assisted training, = 257; enhanced upper limb therapy, = 259; usual care, = 254). Upper limb functional recovery 'success' was achieved in the robot-assisted training [103/232 (44%)], enhanced upper limb therapy [118/234 (50%)] and usual care groups [85/203 (42%)]. These differences were not statistically significant; the adjusted odds ratios were as follows: robot-assisted training versus usual care, 1.2 (98.33% confidence interval 0.7 to 2.0); enhanced upper limb therapy versus usual care, 1.5 (98.33% confidence interval 0.9 to 2.5); and robot-assisted training versus enhanced upper limb therapy, 0.8 (98.33% confidence interval 0.5 to 1.3). The robot-assisted training group had less upper limb impairment (as measured by the Fugl-Meyer Assessment motor subscale) than the usual care group at 3 and 6 months. The enhanced upper limb therapy group had less upper limb impairment (as measured by the Fugl-Meyer Assessment motor subscale), better mobility (as measured by the Stroke Impact Scale mobility domain) and better performance in activities of daily living (as measured by the Stroke Impact Scale activities of daily living domain) than the usual care group, at 3 months. The robot-assisted training group performed less well in activities of daily living (as measured by the Stroke Impact Scale activities of daily living domain) than the enhanced upper limb therapy group at 3 months. No other differences were clinically important and statistically significant. Participants found the robot-assisted training and the enhanced upper limb therapy group programmes acceptable. Neither intervention, as provided in this trial, was cost-effective at current National Institute for Health and Care Excellence willingness-to-pay thresholds for a quality-adjusted life-year.
CONCLUSIONS
Robot-assisted training did not improve upper limb function compared with usual care. Although robot-assisted training improved upper limb impairment, this did not translate into improvements in other outcomes. Enhanced upper limb therapy resulted in potentially important improvements on upper limb impairment, in performance of activities of daily living, and in mobility. Neither intervention was cost-effective.
FUTURE WORK
Further research is needed to find ways to translate the improvements in upper limb impairment seen with robot-assisted training into improvements in upper limb function and activities of daily living. Innovations to make rehabilitation programmes more cost-effective are required.
LIMITATIONS
Pragmatic inclusion criteria led to the recruitment of some participants with little prospect of recovery. The attrition rate was higher in the usual care group than in the robot-assisted training or enhanced upper limb therapy groups, and differential attrition is a potential source of bias. Obtaining accurate information about the usual care that participants were receiving was a challenge.
TRIAL REGISTRATION
Current Controlled Trials ISRCTN69371850.
FUNDING
This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in ; Vol. 24, No. 54. See the NIHR Journals Library website for further project information.
Topics: Activities of Daily Living; Adult; Aged; Cost-Benefit Analysis; Female; Humans; Male; Middle Aged; Models, Economic; Quality of Life; Quality-Adjusted Life Years; Recovery of Function; Robotics; Severity of Illness Index; Single-Blind Method; State Medicine; Stroke Rehabilitation; Technology Assessment, Biomedical; United Kingdom; Upper Extremity
PubMed: 33140719
DOI: 10.3310/hta24540 -
BMC Neurology Mar 2024At present, stroke has become the first cause of death and disability among Chinese adults. With the coming of the aging population in China, the disease burden brought... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
At present, stroke has become the first cause of death and disability among Chinese adults. With the coming of the aging population in China, the disease burden brought by stroke will be increasingly aggravated. And stroke is a leading cause of disability. There is a golden plastic period after stroke, during which timely and safe intervention and rehabilitation therapy can effectively improve the disability status. However, there is still controversy about the duration of interventional rehabilitation after stroke. This study conducted a meta-analysis on the influence of intervention in early and late ischemic stroke rehabilitation.
METHOD
Chinese language databases such as CNKI, Wanfang, and VIP, and English language databases such as Embase, PubMed, Web of Science, and The Cochrane Library were searched, and RCT related to early and late rehabilitation of ischemic stroke from the establishment of the database to October 2023 was collected. Review Manager 5.4.1 was used for relevant analysis. The main outcomes were Barthel Index or Modified Barthel Index, Fugl-Meyer Assessment scale, NIHSS, China Stroke Scale. Standardized Mean Difference (SMD) was used as an effective indicator of continuity variables, and the estimated interval was expressed by 95% confidence interval (CI).
RESULTS
A total of 1908 patients were included in 16 studies. The results showed that, compared with late rehabilitation, early rehabilitation improved clinical efficacy. Barthel Index or Modified Barthel Index score was [SMD = 1.40, 95%CI(1.16,1.63), p < 0.001]; the score of Fugl-Meyer Assessment Scale was [SMD = 1.18, 95%Cl (0.85, 1.52), P < 0.001]; the score of NIHSS was [SMD= -0.44, 95% CI(-0.65, -0.24), P < 0.001]; the result of China Stroke Scale score was [SMD= -0.37, 95%CI(-0.56, -0.18), P < 0.001].
CONCLUSION
In comparison with late rehabilitation, early rehabilitation can significantly improve self-care abilities, daily activities, and neurological functions of ischemic stroke patients.
TRIAL REGISTRATION
This meta-analysis has been registered with Prospero, and the registration number is CRD42022309911. The registration period is March 22, 2022.
Topics: Humans; Activities of Daily Living; Ischemic Stroke; Stroke; Stroke Rehabilitation; Treatment Outcome
PubMed: 38459477
DOI: 10.1186/s12883-024-03565-8 -
Computational and Mathematical Methods... 2022Stroke is a common cerebrovascular disease among the middle-aged and elderly, which can lead to a series of neurological disorders. Acupuncture is an important part of...
BACKGROUND
Stroke is a common cerebrovascular disease among the middle-aged and elderly, which can lead to a series of neurological disorders. Acupuncture is an important part of traditional Chinese medicine, with great value in improving the neurological deficits of stroke patients. In addition, rehabilitation therapy is also of great significance for alleviating the neurological deficits of patients and improving their activities of daily living.
OBJECTIVE
To explore the effect of acupuncture and moxibustion combined with rehabilitation therapy on the recovery of neurological function and prognosis of stroke patients.
METHODS
The case data of 100 stroke patients treated in the Wuhan Hospital of Traditional Chinese Medicine from January 2019 to July 2021 were analyzed retrospectively. According to the treatment plan patients received, they were divided into the following two groups: an observation group ( = 52) treated with acupuncture combined with rehabilitation therapy and a control group ( = 48) treated with rehabilitation therapy alone. The two groups were compared in terms of the following items: therapeutic efficacy, plasma levels of cortisol (Cor) and neuropeptide Y (NPY), nerve function, motor function, balance ability, self-care ability, swallowing function, negative emotions, and quality of life.
RESULTS
The therapeutic effect of the observation group was significantly higher than that of the control group ( < 0.05). The levels of Cor and NPY, as well as the neurological function, motor function, balance ability, self-care ability, swallowing function, and negative emotions, were not significantly different between the two groups before treatment ( > 0.05). While after intervention, all the above indexes improved in both groups, with better improvements in the observation group compared with the control group ( < 0.05). And the various dimensions concerning the quality of life of patients were also significantly better in the observation group when compared with the control group.
CONCLUSION
Acupuncture of traditional Chinese medicine combined with rehabilitation therapy has outstanding effects in stroke treatment and can effectively improve the neurological function, prognosis, and quality of life of patients, which is worthy of clinical promotion.
Topics: Activities of Daily Living; Acupuncture Therapy; Aged; Combined Modality Therapy; Computational Biology; Female; Humans; Male; Medicine, Chinese Traditional; Middle Aged; Prognosis; Quality of Life; Recovery of Function; Retrospective Studies; Stroke; Stroke Rehabilitation; Treatment Outcome
PubMed: 35242206
DOI: 10.1155/2022/4581248