Domain-specific responsiveness to mindfulness and cognitive rehabilitation in chronic ischemic stroke survivors

Secular Mindfulness-Based Interventions: Efficacy and Neurobiology.

Ischemic stroke survivors often experience persistent cognitive and psychosocial deficits not fully addressed by conventional rehabilitation. This study compared the effectiveness of Mindfulness-Based Stress Reduction (MBSR) and Cognitive Rehabilitation Therapy (CRT) on Stroke Impact Scale (SIS) outcomes. In a quasi-experimental design with a control group and follow-up, 45 eligible patients were purposively sampled and randomly assigned to MBSR, CRT, or control groups. Interventions followed standardized Kabat–Zinn (MBSR) and Powell (CRT) protocols. SIS data were analyzed using repeated measures ANOVA and Bonferroni tests. Participants were predominantly female (CRT:64%, MBSR:60%, control:57%). Both interventions significantly improved Communication (η 2 = 0.21, p < 0.001) and Participation/Role Function (η 2 = 0.18, p = 0.003). Notably, MBSR additionally yielded a significant improvement in Memory and Thinking (η 2=0.24, p = 0.001), an effect not observed with CRT (p > 0.05). Findings suggest MBSR offers unique benefits for cognitive domains. Integrating mindfulness-based interventions into cognitive rehabilitation frameworks may enhance both cognitive and functional outcomes, representing a promising direction for future research and clinical practice.

Mindfulness-based interventions for women victims of interpersonal violence: A systematic review

BackgroundExergames are increasingly being used among survivors of stroke with chronic upper extremity (UE) sequelae to continue exercising at home after discharge and maintain activity levels. The use of virtual reality exergames combined with a telerehabilitation app (VirTele) may be an interesting alternative to rehabilitate the UE sequelae in survivors of chronic stroke while allowing for ongoing monitoring with a clinician.ObjectiveThis study aimed to determine the feasibility of using VirTele in survivors of chronic stroke at home and explore the impact of VirTele on UE motor function, quantity and quality of use, quality of life, and motivation in survivors of chronic stroke compared with conventional therapy.MethodsThis study was a 2-arm feasibility clinical trial. Eligible participants were randomly allocated to an experimental group (receiving VirTele for 8 weeks) or a control group (receiving conventional therapy for 8 weeks). Feasibility was measured from the exergame and intervention logs completed by the clinician. Outcome measurements included the Fugl-Meyer Assessment-UE, Motor Activity Log-30, Stroke Impact Scale-16, and Treatment Self-Regulation Questionnaire-15, which were administered to both groups at four time points: time point 1 (T1; before starting the intervention), time point 2 (after the intervention), time point 3 (1 month after the intervention), and time point 4 (T4; 2 months after the intervention).ResultsA total of 11 survivors of stroke were randomized and allocated to an experimental or a control group. At the onset of the COVID-19 pandemic, participants pursued the allocated treatment for 3 months instead of 8 weeks. VirTele intervention dose was captured in terms of time spent on exergames, frequency of use of exergames, total number of successful repetitions, and frequency of videoconference sessions. Technical issues included the loss of passwords, internet issues, updates of the system, and problems with the avatar. Overall, most survivors of stroke found the technology easy to use and useful, except for 9% (1/11) of participants. For the Fugl-Meyer Assessment-UE and Motor Activity Log-30, both groups exhibited an improvement in >50% of the participants, which was maintained over time (from time point 3 to T4). Regarding Stroke Impact Scale-16 scores, the control group reported improvement in activities of daily life (3/5, 60%), hand function (5/5, 100%), and mobility (2/5, 40%), whereas the experimental group reported varied and inconclusive results (from T1 to T4). For the Treatment Self-Regulation Questionnaire-15, 75% (3/4) of the experimental group demonstrated an increase in the autonomous motivation score (from T1 to time point 2), whereas, in the control group, this improvement was observed in only 9% (1/11) of participants.ConclusionsThe VirTele intervention constitutes another therapeutic alternative, in addition to conventional therapy, to deliver an intense personalized rehabilitation program for survivors of chronic stroke with UE sequelae.International Registered Report Identifier (IRRID)RR2-10.2196/14629

Background Each year, 795,000 Americans experience a stroke. As stroke mortality declines, more individuals are in the chronic phase of recovery (>6 months post-stroke). Over 80% of stroke survivors have multiple, chronic health conditions (MCC). While the relationship between MCC and mortality and function during acute recovery has been explored, less is known about how MCC burden affects participation in chronic stroke survivors. Objective This study investigated whether MCC burden is related to participation in those with chronic stroke. Methods Two hundred and sixty-six participants with chronic (≥6 months) stroke were included in this cross-sectional and retrospective analysis. Participants had a mean age of 62.2 ± 12.8 years, and time since stroke (TSS) of 36.0 ± 44.6 months (114F/152 M). Participants completed the 6-minute Walk Test (6MWT), Activities-Specific Balance Confidence Scale (ABC), Modified Cumulative Illness Rating Scale (MCIR) to quantify the presence and severity of chronic illness across 14 body systems, and the Stroke Impact Scale – Participation subscale (SIS-P). Participation (SIS-P) was the dependent variable. Independent variables were entered into a sequential regression model in three blocks: demographic variables, physical capacity (6MWT distance) and balance self-efficacy (ABC), and MCC burden (MCIR). Results After adjusting for age, sex, and time since stroke, physical capacity and balance self-efficacy explained 31.4% (p < 0.001), and the MCC burden explained 2.0% (p = 0.004). Higher participation was related to lower MCC burden. Conclusions MCC burden is a significant contributor to variance in participation in chronic stroke survivors, above and beyond demographics, physical capacity, and self-efficacy, and therefore should be considered when creating rehabilitation programs to improve participation.

Purpose The profession of physical therapy has historically relied on manual facilitation to improve motor control strategies and performance in persons rehabilitating from a stroke, yet there is insufficient evidence to support its use during functional task training. The purpose of this study was to determine the effects of integrated cueing (verbal and manual) and verbal cueing approaches during sit-to-stand training on midline alignment & muscle activation in chronic stroke survivors. Methods Twenty-one chronic right-brained stroke survivors with hemiplegia were randomly assigned to the Integrated Cueing or Verbal Only group and outcome measures were recorded using an 18-Camera Motion Capture System, force plates, and surface electromyography (EMG). Results Both groups demonstrated a significant improvement in symmetry toward the midline after thirty training repetitions. Significant improvements in muscle activation were found in two muscle groups on the affected side of the body in the Integrated Cueing group, gastrocnemius and rectus femoris. Conclusion Both the Verbal Only and Integrated Cueing groups made significant progress toward more symmetrical movement, yet more significant changes in the activation of hemiparetic extensor muscles were seen in the Integrated Cueing group. These findings support the use of manual cueing in movement activation and performance during the training of functional tasks. IMPLICATIONS FOR REHAB Physical therapists commonly use manual tactile cues to facilitate movement performance but there is currently insufficient evidence to support this use with stroke survivors. In a relatively small sample size, both verbal cues and integrated cues (verbal plus manual) improved symmetry during sit to stand in chronic right brain stroke survivors. Integrated cueing enhanced motor activation and performance during sit to stand better than verbal cues alone. Manual tactile cueing should be considered during functional task retraining.

Cognitive impairment (CI) is one of the main features of multiple sclerosis (MS). Cognitive rehabilitation (CR) programs are crucial for improving cognition and computer-assisted cognitive rehabilitation is considered as an effective method for cognition rehabilitation. To assess the effects of computer-based cognitive rehabilitation program on cognition in patients with multiple sclerosis (MS). We performed a comprehensive search in PubMed, Scopus, Web of Science, EMBASE, and Google Scholar databases along with gray literature up to September 2021. Randomized clinical trials, articles had been published in the English language. We evaluated the risk of potential bias via the Cochrane Collaboration's tool for assessing the risk of bias. Standardized mean difference (SMD) was calculated. The preliminary search retrieved 2302 articles by literature search, after deleting duplicates 2248 remained. Eight articles remained for meta-analysis. Totally, 235 patients in intervention group and 192 in control group were evaluated. Mean age ranged from 43.5-52 years. The SMD of PASAT (Paced Auditory Serial Addition Test) (Case-control) test was 0.35 (95%CI:0.1-0.66) (I2:24.4%, P=0.2). The SMD of SDMT (Case-control) test was 0.07 (95%CI:-0.18-0.33). The SMD of PASAT before and after intervention in case group was 0.68 (95%CI:0.45-0.91) (I2:40%, P=0.15). The SMD of SDMT before and after intervention in case group was 0.44 (95%CI:0.21-0.66) (I2:40%, P=0.15). The results of this systematic and meta-analysis showed that computerized cognitive rehabilitation program is effective in improving PASAT score.

Objective: To determine whether stroke survivors could maintain workloads during functional task practice that can reach moderate levels of cardiometabolic stress (i.e., ≥40% oxygen uptake reserve (O2R) for ≥20 min) without the use of ergometer-based exercise.Design: Cross-sectional study using convenience sampling.Setting: Research laboratory in a tertiary rehabilitation hospital.Participants: Chronic hemiparetic stroke survivors (>6-months) who could provide consent and walk with or without assistance.Intervention: A single bout of intermittent functional training (IFT). The IFT protocol lasted 30 min and involved performing impairment specific multi-joint task-oriented movements structured into circuits lasting ~3 min and allowing 30–45 s recovery between circuits. The aim was to achieve an average heart rate (HR) 30-50 beats above resting without using traditional ergometer-based aerobic exercise.Outcome measures: Attainment of indicators for moderate intensity aerobic exercise. Oxygen uptake (O2), carbon dioxide production (CO2), and HR were recorded throughout the 30 min IFT protocol. Values were reported as percentage of O2R, HR reserve (HRR) and HRR calculated from predicted maximum HR (HRRpred), which were determined from a prior maximal graded exercise test.Results: Ten (3-female) chronic (38 ± 33 months) stroke survivors (70% ischemic) with significant residual impairments (NIHSS: 3 ± 2) and a high prevalence of comorbid conditions (80% ≥ 1) participated. IFT significantly increased all measures of exercise intensity compared to resting levels: O2 (Δ 820 ± 290 ml min−1, p < 0.001), HR (Δ 42 ± 14 bpm, p < 0.001), and energy expenditure (EE; Δ 4.0 ± 1.4 kcal min−1, p < 0.001). Also, mean values for percentage of O2R (62 ± 19), HRR (55 ± 14), and HRRpred (52 ± 18) were significantly higher than the minimum threshold (40%) indicating achievement of moderate intensity aerobic exercise (p = 0.004, 0.016, and 0.043, respectively).Conclusion: Sufficient workloads to achieve moderate levels of cardiometabolic stress can be maintained in chronic stroke survivors using impairment-focused functional movements that are not dependent on ergometers or other specialized equipment.

BackgroundNonpharmacological interventions such as exercise and cognitive rehabilitation programs have shown promise in reducing the impact of dementia on the individual and the caregiver. In this study, we examine the effect of a multimodal cognitive and physical rehabilitation program for persons with mild dementia and their caregivers using conventional measures of cognition, behavior, quality of life (QoL), and caregiver burden together with goal attainment scaling (GAS), an individualized outcome measure.MethodsGoals were set at baseline, and GAS score was calculated at the end of the program. Participants were also assessed with the Chinese Mini-Mental State Examination, functional and behavioral scales (Barthel Index), Instrumental Activities of Daily Living, Neuropsychiatric Inventory Questionnaire, QoL, and caregiver burden using EuroQol-five dimension questionnaire and Zarit Burden Interview (ZBI). Differences in median scores postintervention were obtained. Further analysis of caregiver burden was undertaken utilizing the multidimensional classification of burden on the ZBI.ResultsThirty-four (61.8%) patients were assessed to have met their goals (GAS score≥50). Mean (standard deviation) GAS score was 48.6 (6.5). Cognition goals were set in only 20.6%, followed by goals to improve engagement and socialization; reduce caregiver stress; and improve physical function, behavior, and mood. Median scores in the cognitive, functional, and QoL measures did not differ significantly pre- and postintervention. The intervention had a positive impact on role strain, a unique dimension of caregiver burden.ConclusionThis study provides evidence that a multimodal approach combining physical exercise and cognitive rehabilitation improves goal attainment and caregiver burden in individuals and caregivers of persons with mild dementia.

Despite evidence for a role of nutrition in the development of metabolic dysfunction, physical deconditioning, and psychological dysfunction common post-stroke, very little is known about the dietary habits and nutritional needs of chronic (>6 months) stroke survivors. This review summarizes the available evidence regarding dietary intake adequacy in chronic stroke survivors. It appears that a combination of screening methods, including food record, laboratory and malnutrition screening tools assessments may be beneficial to assess the dietary intake adequacy of stroke survivors. We also review the evidence suggesting the need for dietary modification by summarizing the strongest evidence (i.e., randomized controlled trial data) supporting and refuting the impact of nutritional interventions on clinical outcomes post-stroke. Data suggest that the B vitamins, omega 3s and vitamin D have promising effects on recovery post-stroke; however, to date, study limitations make drawing definitive conclusions regarding the impact of nutritional supplementation difficult. Further research is needed to provide insight on the ideal supplement dose and duration and about how different rehabilitation therapies (i.e., nutritional supplements, medications, exercise and caloric restriction) may interact to affect recovery. A better understanding of the role of nutrition during chronic stroke is needed as this information may one day help to individualize rehabilitation approaches to optimize patient outcomes.

Mindfulness-based interventions (MBIs) have been widely implemented to improve self-regulation behaviors, often by targeting emotion-related constructs to facilitate change. Yet the degree to which MBIs engage specific measures of emotion-related constructs has not been systematically examined. Using advanced meta-analytic techniques, this review examines construct and measurement engagement in trials of adults that used standardized applications of the two most established MBIs: Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT), or modified variations of these interventions that met defined criteria. Seventy-two studies (N=7,378) were included (MBSR k=47, MBCT k = 21, Modified k=4). MBIs led to significant improvement in emotion-related processing overall, compared to inactive controls (d=0.58; k =36), and in all constructs assessed: depression (d=0.66; k=26), anxiety (d =0.63; k=19), combined mental health (d =0.75; k=7 ) and stress (d =0.44; k=11). Reactions to pain, mood states, emotion regulation, and biological measures lacked sufficient data for analysis. MBIs did not outperform active controls in any analyses. Measurement tool and population-type did not moderate results, but MBI-type did, in that MBCT showed stronger effects than MBSR, although these effects were driven by a small number of studies. This review is the first to examine the full scope of emotion-related measures relevant to self-regulation, to determine which measures are most influenced by MBCT/MBSR. Compared to extant reviews, which typically focused on MBI outcomes, this work examined mechanistic processes based on measurement domains and tools. While effect sizes were similar among measurement tools, this review also includes a descriptive evaluation of measures and points of caution, providing guidance to MBI researchers and clinicians for selection of emotion-related measurement tools.

Objective: Cerebrovascular accidents are the second leading cause of death and the third leading cause of disability worldwide. We hypothesized that cerebellar transcranial direct current stimulation (ctDCS) of the dentate nuclei and the lower-limb representations in the cerebellum can improve functional reach during standing balance in chronic (>6 months’ post-stroke) stroke survivors. Materials and Methods: Magnetic resonance imaging (MRI) based subject-specific electric field was computed across a convenience sample of 10 male chronic (>6 months) stroke survivors and one healthy MRI template to find an optimal bipolar bilateral ctDCS montage to target dentate nuclei and lower-limb representations (lobules VII–IX). Then, in a repeated-measure crossover study on a subset of 5 stroke survivors, we compared 15 min of 2 mA ctDCS based on the effects on successful functional reach (%) during standing balance task. Three-way ANOVA investigated the factors of interest– brain regions, montages, stroke participants, and their interactions. Results: “One-size-fits-all” bipolar ctDCS montage for the clinical study was found to be PO9h–PO10h for dentate nuclei and Exx7–Exx8 for lobules VII–IX with the contralesional anode. PO9h–PO10h ctDCS performed significantly (alpha = 0.05) better in facilitating successful functional reach (%) when compared to Exx7–Exx8 ctDCS. Furthermore, a linear relationship between successful functional reach (%) and electric field strength was found where PO9h–PO10h montage resulted in a significantly (alpha = 0.05) higher electric field strength when compared to Exx7–Exx8 montage for the same 2 mA current. Conclusion: We presented a rational neuroimaging based approach to optimize deep ctDCS of the dentate nuclei and lower limb representations in the cerebellum for post-stroke balance rehabilitation. However, this promising pilot study was limited by “one-size-fits-all” bipolar ctDCS montage as well as a small sample size.

Introduction: Stroke is one of the most serious and debilitating diseases in our society. Stroke survivors can suffer several neurological impairments. They typically show pathological changes in neural functions of brain areas. Transcranial direct current stimulation (tDCS) can be applied to modify cerebral excitability and has been recently applied in the treatment of neuropsychological and neurological disorders. The aim of the study herein was to evaluate changes in movement and cognitive functions of chronic ischemic stroke patients using anodic and cathodic tDCS. Method: In this clinical trial, 100 patients with chronic ischemic stroke were divided in 4 groups (control, sham, anodic tDCS, and cathodic tDCS; n=25 per group). The patients underwent routine treatment and received the same tDCS protocol (3 times per week of 30-min sessions during one month). Movement and cognitive functions were evaluated using the NIHSS Scale &amp; Trail Making Test and the Beck Test, before and after 1 and 3 months of tDCS sessions. All data were analyzed by 2-way repeated measures ANOVA using SPSS program (version 18). Results: The results showed that there were significant increases (P&lt;0.001) in NIHSS score and Barthel index between anodic group versus control, sham, or cathodic group, at various timepoints (before vs. 1 month after tDCS, 1 month vs. 3 months after tDCS, and before vs. 3 months after tDCS). Furthermore, there were significant decreases (P&lt;0.001) between anodic group versus control, sham, or cathodic group, at the various timepoints (before vs. 1 month after tDCS, 1 month vs. 3 months after tDCS, and before vs. 3 months after tDCS). Conclusion: Anodic tDCS has advantageous effects on movement and cognitive rehabilitation in stroke patients, but future studies are needed to further discern the differences and develop precise treatment protocols.

BackgroundIn Canada, only 11% of stroke survivors have access to outpatient and community-based rehabilitation after discharge from inpatient rehabilitation. Hence, innovative community-based strategies are needed to provide adequate postrehabilitation services. The VirTele program, which combines virtual reality exergames and a telerehabilitation app, was developed to provide stroke survivors with residual upper extremity deficits, the opportunity to participate in a personalized home rehabilitation program.ObjectiveThis study aims to determine the feasibility of VirTele for remote upper extremity rehabilitation in a chronic stroke survivor; explore the preliminary efficacy of VirTele on upper extremity motor function, the amount and quality of upper extremity use, and impact on quality of life and motivation; and explore the determinants of behavioral intention and use behavior of VirTele along with indicators of empowerment.MethodsA 63-year-old male stroke survivor (3 years) with moderate upper extremity impairment participated in a 2-month VirTele intervention. He was instructed to use exergames (5 games for upper extremity) for 30 minutes, 5 times per week, and conduct videoconference sessions with a clinician at least once per week. Motivational interviewing was incorporated into VirTele to empower the participant to continue exercising and use his upper extremities in everyday activities. Upper extremity motor function (Fugl-Meyer Assessment–upper extremity), amount and quality of upper extremity use (Motor Activity Log-30), and impact on quality of life (Stroke Impact Scale-16) and motivation (Treatment Self-Regulation Questionnaire-15) were measured before (T1), after (T2) VirTele intervention, and during a 1- (T3) and 2-month (T4) follow-up period. Qualitative data were collected through logs and semistructured interviews. Feasibility data (eg, number and duration of videoconference sessions and adherence) were documented at the end of each week.ResultsThe participant completed 48 exergame sessions (33 hours) and 8 videoconference sessions. Results suggest that the VirTele intervention and the study protocol could be feasible for stroke survivors. The participant exhibited clinically meaningful improvements at T2 on the Fugl-Meyer and Stroke Impact Scale-16 and maintained these gains at T3 and T4. During the follow-up periods, the amount and quality of upper extremity use showed meaningful changes, suggesting more involvement of the affected upper extremity in daily activities. The participant demonstrated a high level of autonomous motivation, which may explain his adherence. Performance, effort, and social influence have meaningful weights in the behavioral intention of using VirTele. However, the lack of control of technical and organizational infrastructures may influence the long-term use of technology. At the end of the intervention, the participant demonstrated considerable empowerment at both the behavioral and capacity levels.ConclusionsVirTele was shown to be feasible for use in chronic stroke survivors for remote upper extremity rehabilitation. Meaningful determinants of behavioral intention and use behavior of VirTele were identified, and preliminary efficacy results are promising. International Registered Report Identifier (IRRID)RR2-10.2196/14629

Psychological distress, including depression, anxiety, and stress, is highly prevalent among adults with cancer. Mindfulness-based interventions (MBIs), such as Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT), are increasingly used to address these symptoms. However, no prior review has comprehensively stratified MBI effects across intervention types, symptom domains, cancer populations, and geographic regions. To evaluate the effectiveness of MBIs, including standard and adapted formats, on depression, anxiety, and stress in adults with cancer. A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted in accordance with PRISMA guidelines. Six databases were searched from January 2010 to July 2025. Eligible studies included RCTs comparing MBIs to control conditions in adults with cancer, reporting validated outcomes for depression, anxiety, or stress. Random-effects meta-analyses were performed using Hedges' g, with subgroup analyses by intervention type, duration, geographic region, and cancer type. Across 84 effect sizes from 45 RCTs (N=7395), mindfulness-based interventions were evaluated. MBIs significantly reduced depression (g=-0.92), anxiety (g=-1.06), and stress (g=-1.50). Modified MBIs MBIs demonstrated the largest effects (g=-1.57), followed by MBSR (g=-0.72) and MBCT (g=-0.68). The strongest effects were observed in breast cancer populations (g=-1.48) and in studies conducted in North America (g=-1.21) and Asia (g=-1.07). Mindfulness-based interventions (MBIs) were associated with reduced depression, anxiety, and stress in adults with cancer, though heterogeneity was high and evidence was largely from breast cancer trials. MBIs appear scalable, particularly for women with breast cancer, but broader conclusions remain limited. Findings support their inclusion in tailored psychosocial care, with a need for more diverse and rigorously controlled research.