RESUMO
BACKGROUND: Although whole-body vibration (WBV) training is acknowledged for its benefits in enhancing motor functions across several neurological disorders, its precise influence on ankle joint proprioception and balance in stroke patients is still not well understood. This research seeks to assess the impact of WBV training on ankle joint proprioception and balance in stroke patients, thereby filling this important research void. METHODS: In this prospective cohort study, thirty-five stroke patients were randomly assigned to either the WBV group (n = 17) or a control group (n = 18) using a random number table method. The control group received daily general rehabilitation for four weeks, while the WBV group received an additional 30 min of WBV training each day with the Trunsan S110 Vibration Training System. Blinded outcome assessments were conducted at baseline and post-treatment, utilizing the Berg balance scale (BBS), Functional reach test (FRT), Romberg test length (RTL) and area (RTA), and completion rates of ankle joint dorsiflexion-plantar flexion (DP) and inversion-eversion (IE) tests. Follow-up assessments were performed after four weeks of intervention, focusing on RTL, RTA, DP, and IE as primary outcomes. RESULTS: Analysis of intra-group changes from baseline to post-treatment revealed significant improvements across the BBS, FRT, RTL, RTA, and DP and IE assessments (p < 0.001). Notably, the WBV group showed significant enhancements compared to the control group in DP and IE (p < 0.001 and p < 0.05, respectively), with mean values increasing from 13.556 to 16.765 (23.7%) and from 5.944 to 8.118 (36.6%), respectively. However, WBV did not provide additional benefits over the control treatment for balance recovery parameters such as BBS, FRT, RTL, and RTA (p > 0.05). CONCLUSIONS: This study demonstrates that WBV therapy is equally effective as conventional methods in enhancing proprioception and balance in stroke patients, but it does not provide additional benefits for balance recovery. WBV significantly improves proprioceptive functions, particularly in DP and IE parameters. However, it does not surpass traditional rehabilitation methods in terms of balance recovery. These findings indicate that WBV should be incorporated into stroke rehabilitation primarily to enhance proprioception rather than to optimize balance recovery. TRIAL REGISTRATION: This study was retrospectively registered in the ISRCTN Registry on 29/07/2024 ( https://www.isrctn.com/ , ISRCTN64602845).
Assuntos
Articulação do Tornozelo , Equilíbrio Postural , Propriocepção , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Vibração , Humanos , Propriocepção/fisiologia , Reabilitação do Acidente Vascular Cerebral/métodos , Vibração/uso terapêutico , Feminino , Estudos Prospectivos , Pessoa de Meia-Idade , Masculino , Equilíbrio Postural/fisiologia , Articulação do Tornozelo/fisiopatologia , Idoso , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , Resultado do Tratamento , AdultoRESUMO
Aims: This study aimed to assess the effects of Low-to-Moderate Intensity Continuous Training (LMICT), Moderate-Intensity Interval Training (MIIT), and Reduced-Exertion High-Intensity Training (REHIT) on blood glucose regulation, functional recovery, and lipid levels in individuals who have experienced a stroke and are diagnosed with Type 2 Diabetes Mellitus (T2DM). Methods: Forty-two T2DM stroke patients were randomly allocated to four groups: LMICT, MIIT, REHIT, and a control group (CON). Participants continuously monitored their blood glucose levels throughout the intervention using continuous glucose monitoring (CGM) devices. The study comprised two exercise intervention cycles: the first lasting from Day 3 to Day 14 and the second from Day 15 to Day 28, with the initial two days serving as contrasting periods. Primary outcomes encompassed CGM-derived blood glucose measurements, the Barthel Index (BI), Fugl-Meyer Assessment lower-extremity subscale (FMA-LE), and alterations in triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-c), and low-density lipoprotein cholesterol (LDL-c). Results: Compared with the CON, the MIIT group showed significant improvements in mean glucose (MG), glucose standard deviation (SD), time above range (TAR), and time in range (TIR). The REHIT group exhibited significantly reduced time below range (TBR), glucose SD, and coefficient of variation (CV). Regarding lipid levels, although the REHIT group achieved a significant reduction in TG levels compared with the CON, the overall effects of LMICT, MIIT, and REHIT on lipid profiles were relatively modest. Concerning functional recovery, the REHIT group significantly improved the BI and FMA-LE. Conclusion: Although the short-term quantitative impact of exercise on lipid levels may be limited, both REHIT and MIIT significantly improved glycemic management and reduced glucose variability in post-stroke patients with Type 2 Diabetes Mellitus. Additionally, REHIT notably enhanced functional recovery.
Assuntos
Glicemia , Diabetes Mellitus Tipo 2 , Terapia por Exercício , Exercício Físico , Controle Glicêmico , Lipídeos , Acidente Vascular Cerebral , Humanos , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/terapia , Diabetes Mellitus Tipo 2/complicações , Masculino , Feminino , Controle Glicêmico/métodos , Pessoa de Meia-Idade , Glicemia/metabolismo , Glicemia/análise , Idoso , Lipídeos/sangue , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/terapia , Exercício Físico/fisiologia , Terapia por Exercício/métodos , Reabilitação do Acidente Vascular Cerebral/métodosRESUMO
OBJECTIVE: To investigate whether high-intensity lower extremity constraint-induced movement therapy can improve balance, leg strength, and dual-task ability. DESIGN: A longitudinal cohort study in a real-world outpatient clinic. PATIENTS: 147 community-dwelling participants in the subacute and chronic poststroke phases. METHODS: Participants received lower extremity constraint-induced movement therapy for 6 hours/day during 2 consecutive weeks, including balance, strength, and functional training. The Berg Balance Scale (BBS), Single-Leg-Stance (SLS) bilaterally, one Repetition Maximum (1RM) in a leg press, symmetry of leg strength (Diff-1RM), Timed Up and Go (TUG), and the TUG Manual test were assessed before, after, and 3 months after lower extremity constraint-induced movement therapy. RESULTS: Compared with preintervention data, statistically significant improvements after lower extremity constraint-induced movement therapy (p < 0.001) were demonstrated for balance with an absolute value in BBS at 1.9 points (effect size 0.38) and SLS at 2.4 s (effect size 0.24), and for leg strength at 10.2 kg (effect size 0.54) for the affected leg. Diff 1RM decreased significantly at 5.8 kg (effect size 0.39) and improvements on dual-task ability at 2.7 s were significant (effect size 0.14). The effects persisted at the 3-month follow-up. CONCLUSIONS: High-intensity lower extremity constraint-induced movement therapy may be a feasible treatment option for middle-aged stroke patients to affect balance, leg strength, and dual-task ability positively in an out-patient clinical setting.
Assuntos
Extremidade Inferior , Força Muscular , Equilíbrio Postural , Reabilitação do Acidente Vascular Cerebral , Humanos , Equilíbrio Postural/fisiologia , Reabilitação do Acidente Vascular Cerebral/métodos , Masculino , Feminino , Estudos Longitudinais , Pessoa de Meia-Idade , Força Muscular/fisiologia , Extremidade Inferior/fisiopatologia , Idoso , Acidente Vascular Cerebral/fisiopatologia , Estudos de Coortes , Terapia por Exercício/métodos , Perna (Membro)/fisiopatologiaRESUMO
BACKGROUND: Stroke survivors can exhibit a mismatch between the actual motor ability of their affected upper limb and how much they use it in daily life. The resulting non-use of the affected upper limb has a negative impact on participation in neurorehabilitation and functional independence. The factors leading to non-use of the affected upper limb are poorly understood. One possibility is that non-use comes about through inappropriately low confidence in their own upper limb motor abilities. OBJECTIVE: We asked whether chronic stroke survivors underestimate the motor ability of their affected upper limb. METHODS: 20 chronic stroke survivors (Mean FM: 28.2 ± 10.5) completed a 2D reaching task using an exoskeleton robot. Target sizes were individually altered to ensure success rates were similar for both upper limbs. Prior to each reaching movement, participants rated their confidence about successfully hitting the target (estimated upper limb motor ability). RESULTS: Confidence ratings were significantly lower for the affected upper limb (estimated ability), even though it was equally successful in the reaching task in comparison to the less affected upper limb (actual ability). Furthermore, confidence ratings did not correlate with level of impairment. CONCLUSIONS: Our results demonstrate that chronic stroke survivors can underestimate the actual motor abilities of their affected upper limb, independent of impairment level. Low confidence in affected upper limb motor abilities should be considered as a therapeutic target to increase the incorporation of the affected upper limb into activities of daily living.
Assuntos
Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Extremidade Superior , Humanos , Masculino , Extremidade Superior/fisiopatologia , Feminino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/complicações , Adulto , Reabilitação do Acidente Vascular Cerebral/métodos , Sobreviventes , Idoso , Doença Crônica , Exoesqueleto Energizado , Desempenho Psicomotor/fisiologiaRESUMO
BACKGROUND: Extracorporeal shockwave therapy (ESWT) has been proven beneficial for post-stroke spasticity (PSS) of ankle plantar flexor muscles. This study aims to investigate the dose-response effectiveness of focused-ESWT and the duration of its effect on the treatment of ankle PSS in stroke patients. METHODS: In this double-blinded randomized controlled trial, stroke patients diagnosed with PSS in the ankle plantar flexor muscles were randomly assigned to two groups. The experimental group received double-dose ESWT (4000 pulses per session) targeting spastic calf muscles, while the control group received half the dose (2000 pulses per session). Both groups underwent four sessions over two weeks. The outcomes, including modified Ashworth Scale (MAS), modified Tardieu Scale (MTS), passive range of motion (PROM) of the ankle, Timed Up and Go (TUG) Test, Barthel index and strain elastography were evaluated at baseline, 1st, 4th, 12th, and 24th week after ESWT. RESULTS: Within-group analysis revealed significant improvements in MAS, PROM, TUG Test, and Barthel index for the double-dose ESWT group and improvements in Barthel index for the control group. Between-group analysis revealed greater improvements in TUG Test, Barthel Index and strain elastography for the double-dose ESWT group. Generalized estimating equations analysis indicated that the double-dose ESWT group achieved superior outcomes in the TUG Test, Barthel Index, and strain elastography across various time points and groups. CONCLUSIONS: Double-dose ESWT showed better functional improvement and elastography compared to the control group. ESWT demonstrated dose-response effectiveness for PSS of ankle-equinus. TRIAL REGISTRATION: NCT05878223.
Assuntos
Tratamento por Ondas de Choque Extracorpóreas , Espasticidade Muscular , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Humanos , Espasticidade Muscular/etiologia , Espasticidade Muscular/reabilitação , Espasticidade Muscular/terapia , Masculino , Tratamento por Ondas de Choque Extracorpóreas/métodos , Feminino , Pessoa de Meia-Idade , Método Duplo-Cego , Acidente Vascular Cerebral/complicações , Reabilitação do Acidente Vascular Cerebral/métodos , Tornozelo , Resultado do Tratamento , Adulto , Idoso , Amplitude de Movimento Articular , Articulação do TornozeloRESUMO
BACKGROUND: Post-stroke cognitive impairment (PSCI) not only increases patient mortality and disability, but also adversely affects motor function and the ability to perform routine daily activities. Current therapeutic approaches for, PSCI lack specificity, primarily relying on and medication and traditional cognitive therapy supplemented by a limited array of tools. Both transcranial direct current stimulation (tDCS) and virtual reality (VR) training have demonstrated efficacy in improving cognitive performance among PSCI patients. Previous findings across various conditions suggest that implementing a therapeutic protocol combining tDCS and VR (tDCS - VR) may yield superior in isolation. Despite this, to our knowledge, no clinical investigation combining tDCS and VR for PSCI rehabilitation has been conducted. Thus, the purpose of this study is to explore the effects of tDCS - VR on PSCI rehabilitation. METHODS: This 4-week, single-center randomized clinical trial protocol will recruit 200 patients who were randomly assigned to one of four groups: Group A (tDCS + VR), Group B (tDCS + sham VR), Group C (sham tDCS + VR), Group D (sham tDCS + sham VR). All four groups will receive conventional cognitive rehabilitation training. The primary outcome measurement utilizes the Mini-Mental State Examination (MMSE). Secondary outcome measures include the Montreal Cognitive Assessment, Frontal Assessment Battery, Clock Drawing Test, Digital Span Test, Logic Memory Test, and Modified Barthel Index. Additionally, S-YYZ-01 apparatus for diagnosis and treating language disorders assesses subjects' speech function. Pre- and post-four-week intervention assessments are conducted for all outcome measures. Functional near-infrared spectroscopy (fNIRS) is employed to observe changes in oxygenated hemoglobin (HbO), deoxy-hemoglobin (HbR), and total hemoglobin (HbT) in the cerebral cortex. DISCUSSION: Our hypothesis posits that the tDCS - VR therapy, in opposed to individual tDCS or VR interventions, could enhance cognitive function, speech ability and daily living skills in PSCI patients while concurrently augmenting frontal cortical activity. This randomized study aims to provide a robust theoretical foundation supported by scientific evidence for the practical implementation of the tDCS - VR combination as a secure and efficient PSCI rehabilitation approach. TRIAL REGISTRATION: Chictr.org.cn Identifier: ChiCTR2300070580. Registered on 17th April 2023.
Assuntos
Disfunção Cognitiva , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Estimulação Transcraniana por Corrente Contínua , Realidade Virtual , Humanos , Estimulação Transcraniana por Corrente Contínua/métodos , Disfunção Cognitiva/terapia , Disfunção Cognitiva/etiologia , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/complicações , Feminino , Masculino , Terapia de Exposição à Realidade Virtual/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Idoso , Pessoa de Meia-Idade , Adulto , Terapia CombinadaRESUMO
BACKGROUND: Enhancing long-term support for post-stroke cognitive impairment is a top research priority. Addressing current gaps in UK post-stroke cognitive care provision requires a pragmatic and scalable intervention that can be integrated within the existing stroke care pathway. This study aimed to develop consensus on an initial set of core features for a UK-based monitoring and psychoeducational intervention for cognitive changes after stroke. METHODS: An expert panel of UK healthcare professionals and researchers participated in an online modified Delphi survey. Candidate intervention features were identified from clinical guidelines, existing literature, research team/collaborator expertise, and PPI group lived experience. Survey participants indicated whether they agreed/disagreed/had no opinion about including each candidate feature in the intervention and free-text responses were invited. We analysed responses for consensus (≥ 75% agreement) using descriptive statistics, with items not reaching consensus carried into subsequent rounds. Template analysis was used to identify similarities/differences in viewpoints for items that did not reach consensus. RESULTS: Three survey rounds were completed by 36, 29 and 26 participants, respectively. Participants agreed reviews should include a stroke-specific cognitive screen (97% agree) and assessment of other psychological changes (low mood, anxiety, fatigue: 94%, 90%, 89% agree, respectively). They agreed stroke survivors should be offered at least one review, regardless of their cognitive profile in hospital. They agreed on the importance of various cognition-focused psychoeducation topics, and formal (100% agree) and informal (79% agree) training for those conducting reviews. Consensus was not reached on the review mode (in person/remote options: 67% agree), offering reviews one-year post-discharge to patients without acute cognitive impairments (68% disagree), or including a dementia screen (63% disagree) and/or neuropsychological assessment battery (58% disagree). However, there were similarities in participant viewpoints. For example, participants emphasised the importance of onwards referral where clinically indicated. CONCLUSIONS: The UK-based post-stroke monitoring and psychoeducation intervention was originally conceptualised as a cognitive care pathway, but expert participants agreed on the importance of simultaneously addressing related psychological changes (e.g. low mood, anxiety). There was clear consensus on a minimum set of intervention features. Recommendations outlined here may usefully inform local service improvements.
Assuntos
Consenso , Técnica Delphi , Acidente Vascular Cerebral , Humanos , Reino Unido , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/terapia , Acidente Vascular Cerebral/psicologia , Disfunção Cognitiva/terapia , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/psicologia , Feminino , Inquéritos e Questionários , Masculino , Procedimentos Clínicos/normas , Reabilitação do Acidente Vascular Cerebral/métodos , Reabilitação do Acidente Vascular Cerebral/normasRESUMO
BACKGROUND: The patient with pusher syndrome (PS) is characterized by showing postural control alterations due to a lack of perception of his own body in the space. It appears when the patient actively pushes with his unaffected limbs towards the injured side, reacting with resistance to passive straightening towards the midline. Between 10% and 50% of strokes present PS. Nowadays, there is no clearly defined treatment for PS. OBJECTIVE: To design and validate an exercise program using visual feedback and specific core stability exercises (FeViCoS) for the treatment of patients with PS. METHODS: Validation was conducted by expert consensus using the Delphi method. Thirteen neurorehabilitation experts participated in the process. An online questionnaire with 18 Likert-type questions was used to evaluate the designed program. Consensus was considered reached if there was convergence between the quartile 1 and 3 values (RIQ = Q1-Q3) or if the relative interquartile range (RIR) was less than 20%. The degree of agreement between experts was measured by calculating the Fleiss' kappa coefficient. RESULTS: A total of 2 rounds were required to achieve 97.44% consensus with 100% participation. The RIR was less than or equal to 20% for all questions. The Fleiss' kappa index (0.831) showed that the degree of agreement between experts was excellent. CONCLUSION: Neurorehabilitation experts considered FeViCoS valid for the therapeutic approach to patients with PS. Expert consensus suggests a novel strategy in physical therapy clinical practice to improve balance and postural orientation in patients with subacute stroke and PS.
Assuntos
Técnica Delphi , Terapia por Exercício , Retroalimentação Sensorial , Equilíbrio Postural , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Humanos , Reabilitação do Acidente Vascular Cerebral/métodos , Equilíbrio Postural/fisiologia , Masculino , Acidente Vascular Cerebral/complicações , Feminino , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Accurately predicting the walking independence of stroke patients is important. Our objective was to determine and compare the performance of logistic regression (LR) and three machine learning models (eXtreme Gradient Boosting (XGBoost), Support Vector Machines (SVM), and Random Forest (RF)) in predicting walking independence at discharge in stroke patients, as well as to explore the variables that predict prognosis. METHODS: 778 (80% for the training set and 20% for the test set) stroke patients admitted to China Rehabilitation Research Center between February 2020 and January 2023 were retrospectively included. The training set was used for training models. The test set was used to validate and compare the performance of the four models in terms of area under the curve (AUC), accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and F1 score. RESULTS: Among the three ML models, the AUC of the XGBoost model is significantly higher than that of the SVM and RF models (P < 0.001, P = 0.024, respectively). There was no significant difference in the AUCs between the XGBoost model and the LR model (0.891 vs. 0.880, P = 0.560). The XGBoost model demonstrated superior accuracy (87.82% vs. 86.54%), sensitivity (50.00% vs. 39.39%), PPV (73.68% vs. 73.33%), NPV (89.78% vs. 87.94%), and F1 score (59.57% vs. 51.16%), with only slightly lower specificity (96.09% vs. 96.88%). Together, the XGBoost model and the stepwise LR model identified age, FMA-LE at admission, FAC at admission, and lower limb spasticity as key factors influencing independent walking. CONCLUSION: Overall, the XGBoost model performed best in predicting independent walking after stroke. The XGBoost and LR models together confirm that age, admission FMA-LE, admission FAC, and lower extremity spasticity are the key factors influencing independent walking in stroke patients at hospital discharge. TRIAL REGISTRATION: Not applicable.
Assuntos
Aprendizado de Máquina , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Caminhada , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/diagnóstico , Idoso , Caminhada/fisiologia , Reabilitação do Acidente Vascular Cerebral/métodos , Máquina de Vetores de Suporte , Prognóstico , Valor Preditivo dos Testes , AdultoRESUMO
Assessment of the upper limb is critical to guiding the rehabilitation cycle. Drawbacks of observation-based assessment include subjectivity and coarse resolution of ordinal scales. Kinematic assessment gives rise to objective quantitative metrics, but uptake is encumbered by costly and impractical setups. Our objective was to investigate feasibility and accuracy of computer vision (CV) for acquiring kinematic metrics of the drinking task, which are recommended in stroke rehabilitation research. We implemented CV for upper limb kinematic assessment using modest cameras and an open-source machine learning solution. To explore feasibility, 10 neurotypical participants were recruited for repeated kinematic measures during the drinking task. To investigate accuracy, a simultaneous marker-based motion capture system was used, and error was quantified for the following kinematic metrics: Number of Movement Units (NMU), Trunk Displacement (TD), and Movement Time (MT). Across all participant trials, kinematic metrics of the drinking task were successfully acquired using CV. Compared to marker-based motion capture, no significant difference was observed for group mean values of kinematic metrics. Mean error for NMU, TD, and MT were - 0.12 units, 3.4 mm, and 0.15 s, respectively. Bland-Altman analysis revealed no bias. Kinematic metrics of the drinking task can be measured using CV, and preliminary findings support accuracy. Further study in neurodivergent populations is needed to determine validity of CV for kinematic assessment of the post-stroke upper limb.
Assuntos
Extremidade Superior , Humanos , Fenômenos Biomecânicos , Projetos Piloto , Masculino , Feminino , Adulto , Extremidade Superior/fisiologia , Movimento/fisiologia , Reabilitação do Acidente Vascular Cerebral/métodos , Adulto Jovem , Aprendizado de Máquina , Pessoa de Meia-IdadeRESUMO
Cerebrovascular accidents, commonly known as strokes, represent a prevalent neurological event leading to significant upper limb disabilities, thereby profoundly affecting individuals' activities of daily living and diminishing their quality of life. Traditional rehabilitation methods for upper limb recovery post-stroke are often hindered by limitations, including therapist and patient fatigue, reliance on singular training methodologies, and lack of sustained motivation. Addressing these challenges, this study introduces an upper limb rehabilitation robot, which uses intelligent feedback motion control to improve therapeutic outcomes. The system is distinguished by its capability to adjust the direction and magnitude of force feedback dynamically, based on the detection of spastic movements during exercises, thereby offering a tailored therapeutic experience. This system is equipped with four distinct training modes, intelligent assessment of joint range of motion, and the ability to personalize training programs. Moreover, it provides an immersive interactive gaming experience coupled with comprehensive safety measures. This multifaceted approach not only elevates the engagement and interest of participants beyond traditional rehabilitation protocols but also demonstrates significant improvements in upper limb functionality and the activities of daily living among hemiplegic patients. The system exemplifies an advanced tool in upper limb rehabilitation, offering a synergistic blend of precision, personalization, and interactive engagement, thereby broadening the therapeutic options available to stroke survivors.
Assuntos
Robótica , Reabilitação do Acidente Vascular Cerebral , Extremidade Superior , Humanos , Reabilitação do Acidente Vascular Cerebral/métodos , Robótica/métodos , Robótica/instrumentação , Extremidade Superior/fisiopatologia , Destreza Motora/fisiologia , Acidente Vascular Cerebral/fisiopatologia , Masculino , FemininoRESUMO
BACKGROUND: Delivering HD-tDCS on individual motor hotspot with optimal electric fields could overcome challenges of stroke heterogeneity, potentially facilitating neural activation and improving motor function for stroke survivors. However, the intervention effect of this personalized HD-tDCS has not been explored on post-stroke motor recovery. In this study, we aim to evaluate whether targeting individual motor hotspot with HD-tDCS followed by EMG-driven robotic hand training could further facilitate the upper extremity motor function for chronic stroke survivors. METHODS: In this pilot randomized controlled trial, eighteen chronic stroke survivors were randomly allocated into two groups. The HDtDCS-group (n = 8) received personalized HD-tDCS using task-based fMRI to guide the stimulation on individual motor hotspot. The Sham-group (n = 10) received only sham stimulation. Both groups underwent 20 sessions of training, each session began with 20 min of HD-tDCS and was then followed by 60 min of robotic hand training. Clinical scales (Fugl-meyer Upper Extremity scale, FMAUE; Modified Ashworth Scale, MAS), and neuroimaging modalities (fMRI and EEG-EMG) were conducted before, after intervention, and at 6-month follow-up. Two-way repeated measures analysis of variance was used to compare the training effect between HDtDCS- and Sham-group. RESULTS: HDtDCS-group demonstrated significantly better motor improvement than the Sham-group in terms of greater changes of FMAUE scores (F = 6.5, P = 0.004) and MASf (F = 3.6, P = 0.038) immediately and 6 months after the 20-session intervention. The task-based fMRI activation significantly shifted to the ipsilesional motor area in the HDtDCS-group, and this activation pattern increasingly concentrated on the motor hotspot being stimulated 6 months after training within the HDtDCS-group, whereas the increased activation is not sustainable in the Sham-group. The neuroimaging results indicate that neural plastic changes of the HDtDCS-group were guided specifically and sustained as an add-on effect of the stimulation. CONCLUSIONS: Stimulating the individual motor hotspot before robotic hand training could further enhance brain activation in motor-related regions that promote better motor recovery for chronic stroke. TRIAL REGISTRATION: This study was retrospectively registered in ClinicalTrials.gov (ID NCT05638464).
Assuntos
Eletromiografia , Mãos , Robótica , Reabilitação do Acidente Vascular Cerebral , Estimulação Transcraniana por Corrente Contínua , Extremidade Superior , Humanos , Masculino , Projetos Piloto , Feminino , Pessoa de Meia-Idade , Reabilitação do Acidente Vascular Cerebral/métodos , Robótica/métodos , Estimulação Transcraniana por Corrente Contínua/métodos , Imageamento por Ressonância Magnética , Idoso , Recuperação de Função Fisiológica/fisiologia , Córtex Motor/diagnóstico por imagem , Córtex Motor/fisiologia , Acidente Vascular Cerebral/fisiopatologia , AdultoRESUMO
BACKGROUND: Contractures (reduced range of motion and increased stiffness of a joint) are a frequent complication of stroke. Contractures can interfere with function and cause cosmetic and hygiene problems. Preventing and managing contractures might improve rehabilitation and recovery after stroke. OBJECTIVES: To assess the effects of assistive technologies for the management of contractures in adults after a stroke. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, five other databases, and three trials registers in May 2022. We also searched for reference lists of relevant studies, contacted experts in the field, and ran forward citation searches. SELECTION CRITERIA: Randomised controlled studies (RCTs) that used electrical, mechanical, or electromechanical devices to manage contractures in adults with stroke were eligible for inclusion in this review. We planned to include studies that compared assistive technologies against no treatment, routine therapy, or another assistive technology. DATA COLLECTION AND ANALYSIS: Three review authors (working in pairs) selected all studies, extracted data, and assessed risk of bias. The primary outcomes were passive joint range of motion (PROM) with and without standardised force, and indirect measures of PROM. The secondary outcomes included hygiene. We also wanted to evaluate the adverse effects of assistive technology. Effects were expressed as mean differences (MDs) or standardised mean differences (SMDs) with 95% confidence intervals (CIs). MAIN RESULTS: Seven studies fulfilled the inclusion criteria. Five of these were meta-analysed; they included 252 adults treated in acute and subacute rehabilitation settings. All studies compared assistive technology with routine therapy; one study also compared assistive technology with no treatment, but we were unable to obtain separate data for stroke participants. The assistive technologies used in the studies were electrical stimulation, splinting, positioning using a hinged board, and active repetitive motor training using a non-robotic device with electrical stimulation. Only one study applied stretching to end range. Treatment duration ranged from four to 12 weeks. The overall risk of bias was high for all studies. We are uncertain whether: ⢠electrical stimulation to wrist extensors improves passive range of wrist extension (MD -7.30°, 95% CI -18.26° to 3.66°; 1 study, 81 participants; very low-certainty evidence); ⢠a non-robotic device with electrical stimulation to shoulder flexors improves passive range of shoulder flexion (MD -9.00°, 95% CI -25.71° to 7.71°; 1 study; 50 participants; very low-certainty evidence); ⢠assistive technology improves passive range of wrist extension with standardised force (SMD -0.05, 95% CI -0.39 to 0.29; four studies, 145 participants; very low-certainty evidence): ⢠a non-robotic device with electrical stimulation to elbow extensors improves passive range of elbow extension (MD 0.41°, 95% CI -0.15° to 0.97°; 1 study, 50 participants; very low-certainty evidence). One study reported the adverse outcome of pain when using a hinged board to apply stretch to wrist and finger flexors, and another study reported skin breakdown when using a thumb splint. No studies reported hygiene or indirect measures of PROM. AUTHORS' CONCLUSIONS: Only seven small RCTs met the eligibility criteria of this review, and all provided very low-certainty evidence. Consequently, we cannot draw firm conclusions on the effects of assistive technology compared with routine therapy or no therapy. It was also difficult to confirm whether there is a risk of harm associated with treatment using assistive technology. Future studies should apply adequate treatment intensity (i.e. magnitude and the duration of stretch) and use valid and reliable outcome measures. Such studies might better identify the role of assistive technology in the management of contractures in adults after a stroke.
Assuntos
Contratura , Aparelhos Ortopédicos , Ensaios Clínicos Controlados Aleatórios como Assunto , Amplitude de Movimento Articular , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Humanos , Reabilitação do Acidente Vascular Cerebral/métodos , Reabilitação do Acidente Vascular Cerebral/instrumentação , Contratura/reabilitação , Contratura/etiologia , Acidente Vascular Cerebral/complicações , Adulto , Tecnologia Assistiva , Viés , Pessoa de Meia-IdadeRESUMO
INTRODUCTIN: Improper gait patterns, impaired balance and foot drop consistently plague stroke survivors, preventing them from walking independently and safely. Neuromuscular electrical stimulation (NMES) technology can help patients reactivate their muscles and regain motor coordination. This study aims to systematically review and summarize the evidence for the potential benefits of NMES on the improvement of gait patterns after stroke. EVIDENCE ACQUISITION: PubMed, Cochrane Library, Embase, Science Direct and Web of Science were systematically searched until April 2024, to identify randomized controlled trials with the following criteria: stroke survivors as participants; NMES as intervention; conventional rehabilitation as a comparator; and gait assessment, through scales or quantitative parameters, as outcome measures. EVIDENCE SYNTHESIS: 29 publications involving 1711 patients met the inclusion criteria. Meta-analysis showed no significant differences in Ten-meter walk test, Fugl-Meyer assessment lower extremity, Modified Ashworth Assessment and asymmetry between the NMES group and the control group. Besides, NMES was associated with changes in outcome indicators such as quantitative gait analysis speed [SMD = 0.53, 95% CI (0.20, 0.85), P = 0.001], cadence [SMD = 0.76, 95% CI (0.32, 1.20), P = 0.0008], affected side step length [SMD = 0.73, 95% CI (0.16, 1.31), P = 0.01], angle of ankle dorsiflexion [WMD = 1.57, 95% CI (0.80, 2.33), P < 0.0001], Six-Minute Walk Test [WMD = 14.83, 95% CI (13.55, 16.11), P<0.00001]. According to the PEDro scale, 21 (72.4%) studies were of high quality and 8 were of moderate quality (27.6%). CONCLUSIONS: Taken together, the review synthesis indicated that NMES might play a potential role in stroke-induced walking dysfunction. And NMES may be superior for survivors in the chronic phase than the acute and subacute phases, and the efficacy of short sessions received by patients was greater than that of those who participated in a longer session. Additionally, further comparisons of the effects of NMES with different types or stimulation frequencies may provide unexpected benefits.
Assuntos
Terapia por Estimulação Elétrica , Equilíbrio Postural , Reabilitação do Acidente Vascular Cerebral , Humanos , Terapia por Estimulação Elétrica/métodos , Reabilitação do Acidente Vascular Cerebral/métodos , Equilíbrio Postural/fisiologia , Fenômenos Biomecânicos , Transtornos Neurológicos da Marcha/reabilitação , Transtornos Neurológicos da Marcha/etiologia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/fisiopatologia , Marcha/fisiologiaRESUMO
BACKGROUND: Numerous studies have validated the clinical effectiveness of electromagnetic pairing-associated stimulation. Building upon this foundation, we have developed a novel approach involving high-frequency magnetic paired-associated stimulation, aiming to enhance clinical applicability and potentially improve efficacy. However, the clinical effectiveness of this approach remains unclear. Our objective is to demonstrate the therapeutic efficacy of this novel approach by employing high-frequency pairing to intervene in patients experiencing motor dysfunction following a stroke. METHODS: This is a single-center, single-blind, sham stimulation controlled clinical trial involving patients with upper limb motor dysfunction post-stroke. The intervention utilizes paired magnetic stimulation, combining peripheral and central magnetic stimulation, in patients with Brunnstrom stage III-V stroke lasting from 3 months to 1 year. Evaluation of patients' upper limb motor function occurred before the intervention and after 3 weeks of intervention. Follow-up visits will be conducted after 5 weeks and 3 months of intervention. The primary outcome measure is the Action Research Arm Test, with secondary measures including the Fugl-Meyer Assessment-upper, Modified Barthel Index, modified Tardieu scale, functional near-infrared spectroscopy, and neuroelectrophysiology. DISCUSSION: The high-frequency magnetic paired associative stimulation used in this study combined high-frequency magnetic stimulation with paired stimulation, potentially facilitating both cortical excitation through high-frequency stimulation and specific circuit enhancement through paired stimulation. As dual-coil magnetic stimulation equipment becomes increasingly popular, magnetic-magnetic paired associated stimulation may offer patients improved clinical outcomes at reduced costs. TRIAL REGISTRATION: Chinese Clinical Trial Registry,ChiCTR2400083363. Registered on 23 April 2024.
Assuntos
AVC Isquêmico , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica , Reabilitação do Acidente Vascular Cerebral , Extremidade Superior , Humanos , Método Simples-Cego , Reabilitação do Acidente Vascular Cerebral/métodos , AVC Isquêmico/fisiopatologia , AVC Isquêmico/terapia , AVC Isquêmico/diagnóstico , Resultado do Tratamento , Extremidade Superior/inervação , Atividade Motora , Pessoa de Meia-Idade , Magnetoterapia/métodos , Masculino , Feminino , Fatores de Tempo , Idoso , AdultoRESUMO
BACKGROUND: Robot-Assisted Gait Training (RAGT) is a novel technology widely employed in the field of neurological rehabilitation for patients with subacute stroke. However, the effectiveness of RAGT compared to conventional gait training (CGT) in improving lower extremity function remains a topic of debate. This study aimed to investigate and compare the effects of RAGT and CGT on lower extremity movement in patients with subacute stroke. METHODS: Comprehensive search was conducted across multiple databases, including PubMed, Web of Science, Cochrane Library, EBSCO, Embase, Scopus, China National Knowledge Infrastructure, Wan Fang, SinoMed and Vip Journal Integration Platform. The database retrieval was performed up until July 9, 2024. Meta-analysis was conducted using RevMan 5.4 software. RESULTS: A total of 24 RCTs were included in the analysis. The results indicate that, compared with CGT, RAGT led to significant improvements in the Fugl-Meyer Assessment for Lower Extremity [MD = 2.10, 95%CI (0.62, 3.59), P = 0.005], Functional Ambulation Category[MD = 0.44, 95%CI (0.23, 0.65), P < 0.001], Berg Balance Scale [MD = 4.55, 95%CI (3.00, 6.11), P < 0.001], Timed Up and Go test [MD = -4.05, 95%CI (-5.12, -2.98), P < 0.001], and 6-Minute Walk Test [MD = 30.66, 95%CI (22.36, 38.97), P < 0.001] for patients with subacute stroke. However, it did not show a significant effect on the 10-Meter Walk Test [MD = 0.06, 95%CI (-0.01, 0.14), P = 0.08]. CONCLUSIONS: This study provides evidence that RAGT can enhance lower extremity function, balance function, walking ability, and endurance levels compared to CGT. However, the quality of evidence for improvements in gait speed remains low.
Assuntos
Extremidade Inferior , Robótica , Reabilitação do Acidente Vascular Cerebral , Humanos , Reabilitação do Acidente Vascular Cerebral/métodos , Reabilitação do Acidente Vascular Cerebral/instrumentação , Robótica/métodos , Robótica/instrumentação , Marcha/fisiologia , Terapia por Exercício/métodos , Terapia por Exercício/instrumentação , Acidente Vascular Cerebral/fisiopatologia , Transtornos Neurológicos da Marcha/reabilitação , Transtornos Neurológicos da Marcha/fisiopatologia , Transtornos Neurológicos da Marcha/etiologiaRESUMO
INTRODUCTION: Many stroke survivors do not receive optimal levels of personalised therapy to support their recovery. Use of technology for stroke rehabilitation has increased in recent years to help minimise gaps in service provision. Markerless motion capture technology is currently being used for musculoskeletal and occupational health screening and could offer a means to provide personalised guidance to stroke survivors struggling to access rehabilitation. AIMS: This study considered context, stakeholders, and key uncertainties surrounding the use of markerless motion capture technology in community stroke rehabilitation from the perspectives of stroke survivors and physiotherapists with a view to adapting an existing intervention in a new context. METHODS: Three focus groups were conducted with eight stroke survivors and five therapists. Data were analysed using reflexive thematic analysis. RESULTS: Five themes were identified: limited access to community care; personal motivation; pandemic changed rehabilitation practice; perceptions of technology; and role of markerless technology for providing feedback. CONCLUSIONS: Participants identified problems associated with the access of community stroke rehabilitation, exacerbated by Covid-19 restrictions. Participants were positive about the potential for the use of markerless motion capture technology to support personalised, effective stroke rehabilitation in the future, providing it is developed to meet stroke survivor specific needs.
Assuntos
Grupos Focais , Fisioterapeutas , Reabilitação do Acidente Vascular Cerebral , Sobreviventes , Humanos , Reabilitação do Acidente Vascular Cerebral/métodos , Feminino , Masculino , Pessoa de Meia-Idade , Idoso , COVID-19/reabilitação , Adulto , Acidente Vascular Cerebral , Atitude do Pessoal de Saúde , Captura de MovimentoRESUMO
Post-stroke gait control is a complex, often fail to account for the heterogeneity and continuity of gait in existing gait models. Precisely evaluating gait speed adjustability and gait instability in free-living environments is important to understand how individuals with post-stroke gait dysfunction approach diverse environments and contexts. This study aimed to explore individual causal interactions in the free-living gait control of persons with stroke. To this end, fifty persons with stroke wore an accelerometer on the fifth lumbar vertebra (L5) for 24 h in a free-living environment. Individually directed acyclic graphs (DAGs) were generated based on the spatiotemporal gait parameters at contemporaneous and temporal points calculated from the acceleration data. Spectral clustering and Bayesian model comparison were used to characterize the DAGs. Finally, the DAG patterns were interpreted via Bayesian logistic analysis. Spectral clustering identified three optimal clusters from the DAGs. Cluster 1 included persons with moderate stroke who showed high gait asymmetry and gait instability and primarily adjusted gait speed based on cadence. Cluster 2 included individuals with mild stroke who primarily adjusted their gait speed based on step length. Cluster 3 comprised individuals with mild stroke who primarily adjusted their gait speed based on both step length and cadence. These three clusters could be accurately classified based on four variables: Ashman's D for step velocity, Fugl-Meyer Assessment, step time asymmetry, and step length. The diverse DAG patterns of gait control identified suggest the heterogeneity of gait patterns and the functional diversity of persons with stroke. Understanding the theoretical interactions between gait functions will provide a foundation for highly tailored rehabilitation.
Assuntos
Teorema de Bayes , Transtornos Neurológicos da Marcha , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Humanos , Masculino , Feminino , Transtornos Neurológicos da Marcha/fisiopatologia , Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/reabilitação , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/fisiopatologia , Idoso , Pessoa de Meia-Idade , Reabilitação do Acidente Vascular Cerebral/métodos , Análise por Conglomerados , Algoritmos , Acelerometria , Velocidade de Caminhada , Marcha/fisiologia , Adulto , Fenômenos Biomecânicos , Vértebras Lombares/fisiopatologiaRESUMO
INTRODUCTION: There is currently a lack of easy-to-use and effective robotic devices for upper-limb rehabilitation after stroke. Importantly, most current systems lack the provision of somatosensory information that is congruent with the virtual training task. This paper introduces a novel haptic robotic system designed for upper-limb rehabilitation, focusing on enhancing sensorimotor rehabilitation through comprehensive haptic rendering. METHODS: We developed a novel haptic rehabilitation device with a unique combination of degrees of freedom that allows the virtual training of functional reach and grasp tasks, where we use a physics engine-based haptic rendering method to render whole-hand interactions between the patients' hands and virtual tangible objects. To evaluate the feasibility of our system, we performed a clinical mixed-method usability study with seven patients and seven therapists working in neurorehabilitation. We employed standardized questionnaires to gather quantitative data and performed semi-structured interviews with all participants to gain qualitative insights into the perceived usability and usefulness of our technological solution. RESULTS: The device demonstrated ease of use and adaptability to various hand sizes without extensive setup. Therapists and patients reported high satisfaction levels, with the system facilitating engaging and meaningful rehabilitation exercises. Participants provided notably positive feedback, particularly emphasizing the system's available degrees of freedom and its haptic rendering capabilities. Therapists expressed confidence in the transferability of sensorimotor skills learned with our system to activities of daily living, although further investigation is needed to confirm this. CONCLUSION: The novel haptic robotic system effectively supports upper-limb rehabilitation post-stroke, offering high-fidelity haptic feedback and engaging training tasks. Its clinical usability, combined with positive feedback from both therapists and patients, underscores its potential to enhance robotic neurorehabilitation.
Assuntos
Mãos , Robótica , Reabilitação do Acidente Vascular Cerebral , Extremidade Superior , Humanos , Reabilitação do Acidente Vascular Cerebral/instrumentação , Reabilitação do Acidente Vascular Cerebral/métodos , Masculino , Feminino , Pessoa de Meia-Idade , Robótica/instrumentação , Idoso , Adulto , Desenho de Equipamento , Interface Usuário-ComputadorRESUMO
Functional electrical stimulation (FES) is often used in poststroke gait rehabilitation to address decreased walking speed, foot drop, and decreased forward propulsion. However, not all individuals experience clinically meaningful improvements in gait function with stimulation. Previous research has developed adaptive functional electrical stimulation (AFES) systems that adjust stimulation timing and amplitude at every stride to deliver optimal stimulation. The purpose of this work was to determine the effects of a novel AFES system on functional gait outcomes and compare them to the effects of the existing FES system. Twenty-four individuals with chronic poststroke hemiparesis completed 64-min walking trials on an adaptive and fixed-speed treadmill with no stimulation, stimulation from the existing FES system, and stimulation from the AFES system. There was no significant effect of stimulation condition on walking speed, peak dorsiflexion angle, or peak propulsive force. Walking speed was significantly faster and peak propulsive force was significantly larger on the adaptive treadmill (ATM) than the fixed-speed treadmill (both p < 0.0001). Dorsiflexor stimulation timing was similar between stimulation conditions, but plantarflexor stimulation timing was significantly improved with the AFES system compared to the FES system (p = 0.0059). Variability between and within subjects was substantial, and some subjects experienced clinically meaningful improvements in walking speed, peak dorsiflexion angle, and peak propulsive force. However, not all subjects experienced benefits, suggesting that further research to characterize which subjects exhibit the best instantaneous response to FES is needed to optimize poststroke gait rehabilitation using FES.