ABSTRACT Background Individuals having experienced a stroke need the help of an individual to perform their activities of daily living. Therefore, the disease affects not only patients but also their caregivers. Objectives This study aimed to investigate how aphasia affects caregivers’ burden of care, quality of life, and occupational performance. Methods This cross-sectional study involved Group 1, (n=51) the caregivers of individuals having experienced a stroke with aphasia, and Group 2 (n = 51), the caregivers of individuals having experienced a stroke without aphasia. The caregivers were evaluated using the sociodemographic information form, the Zarit Caregiver Burden Scale, the SF-36 Short Form, and Canadian Occupational Performance Measure tests. Results Our study found that the caregiver burden in Group 1 was higher than in Group 2 (t = 3.8, p = 0.01). Caregivers in Group 1 also had higher pain levels (t = –2.21, p = 0.029) and lower social functions than those in Group 2 (t = –2.54, p = 0.013). There was no statistically significant difference between the other sub-parameters of quality of life (p > 0.05). It was observed that the occupational performance (t = –3.31, p = 0.001) and satisfaction levels (t = –3.57, p = 0.001) of the caregivers in Group 1 were lower than those of the caregivers in Group 2. Conclusions Occupational therapy evaluation and intervention programs for caregivers should consider the occupational performance of caregivers of individuals with aphasia and include approaches to problem areas.

ABSTRACT Background This study aimed to evaluate the clinical efficacy and safety of inspiratory and expiratory muscle training (IEMT) for patients who underwent tracheostomy after stroke. Methods The study was an investigator-initiated, single-center, two-arm, evaluator-blinded, randomized clinical trial conducted at West China Hospital of Sichuan University, China, from January 2022 to June 2022. The patients were randomly divided into the intervention group and control group. Patients in both groups received conventional clinical, rehabilitation treatment and usual care. The intervention group also received IEMT for three weeks. There were three primary outcomes including maximal inspiratory pressure (MIP, cmH2O), maximal expiratory pressure (MEP, cmH2O) and decannulation outcome after intervention (n, %). The secondary outcomes were other respiratory function outcomes, motor function, activities of daily living (ADL), quality of life (QoL) and the new pulmonary infection rate after the intervention at three weeks. Results A total of 50 participants were enrolled [25 in each group; 39 (78%) were men; mean (SD) age, 55.94 (11.97) years]. At three weeks, significant differences were found in the MIP [control vs IEMT: 39.04 (6.21) vs 56.28 (10.41), p < 0.001]; MEP [43.48 (5.36) vs 62.16 (10.18), p < 0.001], and tracheal tube extraction success rate [2 (8%) vs 9 (36%), p = 0.019] between the two groups. In addition, the new pulmonary infection rate in the intervention groups were significantly different (all p < 0.05) from those in the control group. Conclusions IEMT can improve respiratory function, decannulation outcome, among patients with tracheostomy after stroke.

ABSTRACT Background Post-Stroke Dysphagia (PSD) is a common complication that significantly affects the quality of life and health outcomes of stroke survivors. Traditional treatments often have limitations, necessitating the exploration of new therapeutic approaches. This systematic review and meta-analysis aimed to evaluate the efficacy of intermittent Theta Burst Stimulation (iTBS) as an innovative treatment for PSD. Methods Following the PRISMA guidelines, a comprehensive literature search was conducted in PubMed, Embase, and Cochrane Library up to July 2024. Studies included were randomized controlled trials (RCTs) involving stroke patients with confirmed dysphagia, comparing iTBS to control treatments. Data extraction and quality assessment were performed independently by two reviewers using the Cochrane RoB 2 tool. Primary outcomes were changes in the Penetration-Aspiration Scale (PAS) and Swallowing Severity Scale (SSA). Meta-analyses were conducted using Review Manager (RevMan) 5.4. Results Four RCTs with a total of 199 participants were included. iTBS significantly improved SSA (MD = −3.26, 95% CI [−4.66, −1.86], p < 0.001) and PAS (MD = −1.67, 95% CI [−2.49, −0.86], p < 0.001) immediately after treatment compared to sham stimulation. No significant adverse events were reported. Conclusion iTBS appears to have a positive immediate effect on improving swallowing function and reducing aspiration risk in PSD patients compared to sham stimulation. However, these effects may not persist in the long term, and further large-scale RCTs are needed to confirm these findings and establish standardized treatment protocols.

ABSTRACT Background Research has demonstrated that adults post-stroke may experience sensory impairments across different sensory systems. There is a gap in research describing how sensory changes after stroke affect participation in health promoting activities. Objectives The purpose of this study is to understand how changes in sensory health after stroke affect participation in meaningful activities. Methods We adopted a qualitative phenomenological design to conduct four focus groups with ten participants: two focus groups with a cohort of adults post-stroke (n=5) and two focus groups with a cohort of stroke rehabilitation therapists and stroke caregivers (n=5). Focus group transcripts were coded using open and focused coding with NVivo software to develop themes. Results Participants reported changes in their visual, vestibular, proprioceptive, olfactory, gustatory, tactile, and auditory systems that affected their participation in meaningful activities. Participants also reported that they experienced insufficient resources and therapies addressing their sensory health after their stroke. Analyses yielded the following themes:(1) it’s hidden and invisible;(2) sensory changes affect participation and can be overwhelming; and (3) it’s easy to stay inside: sensory changes negatively affect social participation. Conclusions Adults post-stroke experience sensory changes that restrict their participation in meaningful activities including social activities; however, these changes were often missed. More research is needed to further explore the impact of changes in sensory health and understand needs regarding the development of assessment tools and intervention protocols to address the sensory health of adults post-stroke in the clinic, home, and community.

ABSTRACT Background Orthosis satisfaction may be an important parameter that increases orthosis usage and reveals orthosis’ positive effect on rehabilitation. Objectives To investigate the relationship between lower limb orthosis user satisfaction and quality of life (QOL) and functionality in stroke patients. Methods Forty-four stroke patients with a mean age of 56.91 ± 14.08 years were included. Orthosis user satisfaction was evaluated using the Orthotics and Prosthetics Users’ Survey (OPUS). QOL was assessed using the Stroke-Specific Quality of Life Scale (SS-QOL). Lastly, functional status was evaluated using the Fugl – Meyer Assessment of Lower Extremity (FMA-LE) and Timed Up and Go Test (TUGT). Results The relationships were found between the OPUS total satisfaction and SS-QOL-selfcare (r = –0.412, p = 0.005), and upper extremity (r = –0.401, p = 0.007); OPUS device satisfaction and SS-QOL-selfcare (r = –0.484, p < 0.001) and upper extremity function (r = –0.379, p = 0.011); and OPUS service satisfaction and FMA-LE (r = 0.880, p = 0.001). There was no relationship between the OPUS total satisfaction, service satisfaction, and daily orthosis use time (p > 0.05). While participants’ QOL and lower extremity functionality were generally at low, those with better functional status had lower orthosis satisfaction because it made ambulation at home difficult. Conclusion Taking patient opinions into account in the orthotic design process will help to eliminate the problems related to comfort and orthotic wear that might affect orthotic satisfaction. The production of more comfortable orthoses might positively affect individuals’ use of orthoses and satisfaction. This outcome may be a good starting point for prospective studies.

ABSTRACT Background Combinations of rehabilitation therapies are widely used in patients with post-stroke hemiplegia. A combination of acupuncture and MOTOmed had been shown to promote the recovery of post-stroke hemiplegia patients. We conducted a systematic review of evidence from studies that investigated the use of acupuncture combined with MOTOmed for rehabilitation of patients with post-stroke hemiplegia. Objective To estimate the rehabilitation effect of acupuncture combined with MOTOmed movement therapy in patients with post-stroke hemiplegia. Methods Randomized controlled trials (RCTs) of acupuncture combined with MOTOmed movement therapy in patients with post-stroke hemiplegia were retrieved from nine databases. Risk-of-bias assessments were conducted using the Cochrane Risk-of-bias Tool. Meta-analysis of outcome measures was performed using RevMan 5.4 software. And we followed the PRISMA 2020 guidelines. Results Eighteen studies involving 1637 participants were included. Compared with conventional rehabilitation, acupuncture, or MOTOmed movement therapy alone, acupuncture combined with MOTOmed movement therapy increased the scores of Fugl-Meyer Assessment Scale-lower extremity (FMA-LE), Berg Balance Scale (BBS), Functional Ambulation Categories scale (FAC), Maximal Walking Speed test (MWS), gait parameters of 3D gait analysis, Barthel Index (BI), Modified Barthel Index (MBI), total effective rate, and the levels of neurotrophic factors (NGF, BDNF and NT-3) in serum, while reduced the scores of Clinic Spasticity Index (CSI) and National Institutes of Health Stroke Scale-Lower Extremity (NIHSS-LE) (p < 0.05 for all). Conclusion Acupuncture combined with MOTOmed movement therapy has better efficacy than conventional rehabilitation, acupuncture, or MOTOmed alone in patients with post-stroke hemiplegia. This combination therapy can promote the rehabilitation of these patients.

ABSTRACT Background The 2-Minute Walk Test (2MWT) is a simple and reliable test used by clinicians to assess gait function in people with stroke (pwST). No studies established the minimal clinically important difference (MCID) of the 2MWT. Objective To determine the MCID of the 2MWT in subacute pwST using data from a longitudinal cohort study. Methods PwST within 180 days of stroke onset were recruited from the Italian National Health System (NHS) rehabilitation services across the country. Participants underwent physical therapy to improve balance and gait according to their specific needs. The 2MWT was used to assess gait performance at the beginning (T0) and after a minimum of 10 rehabilitation sessions (T1). The Global Perceived Effect (GPE), Activities-specific Balance Confidence Scale (ABC) and the ABC_gait were used to assess balance confidence and the perceived effect of the intervention at T1. Results 51 pwST (69 ± 12 years; 66.7% males) were included in the analysis. Statistically significant improvements were observed in 2MWT, ABC, and ABC_gait scores after rehabilitation using the Wilcoxon signed-rank test. Using an anchor-based approach the receiver operating characteristic (ROC) curves were calculated to establish the MCID. The MCID of the 2MWT was 31 meters with an Area under the curve (AUC) = 0.74 [0.60–0.89], a specificity of 71% and a sensitivity of 63%. Conclusions An improvement of 31 meters on the 2MWT can be considered clinically significant in subacute pwST undergoing rehabilitation. This study provides valuable insights for clinicians to assess walking performance in pwST and determine clinically meaningful changes post-rehabilitation.

ABSTRACT Background The efficacy of various physiotherapy interventions for improving lung function has not been compared. Objectives To evaluate cardiorespiratory physiotherapy interventions on lung function in patients with stroke, prioritize intervention types, and establish hierarchy. Methods Twelve randomized controlled trials published during 2000–2022 in PubMed, EMBASE, Cochrane Library, and Web of Science were selected. Interventions included aerobic training (AT), combined inspiratory and expiratory training (CIET), inspiratory training (IT), combined aerobic and breadth training (CABT), and conventional training (CT). Outcome variables were forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and FEV1/FVC. Results CIET and IT were more effective than CT for FEV1 and FVC. CIET and IT showed larger effect sizes compared to AT for FEV1. The intervention rankings were as follows: IT (86.62%), CIET (63.31%), CABT (50.79%), AT (28.72%), and CT (20.55%) for FEV1; IT (93.89%), CIET (75.06%), CT (42.38%), CABT (37.73%), and AT (0.94%) for FVC; and IT (78.30%), CT (54.14%), CABT (42.62%), CIET (41.65%), and AT (33.29%) for FEV1/FVC. CIET and IT were more effective than CT for FVC in patients with stroke aged ≥60 years. Conclusions Besides FEV1/FVC, IT and CIET inhalation exercises improved lung function more effectively than other therapies, with IT or CIET being more effective than AT or CT. CIET and IT were more effective than CT for FVC in patients with stroke aged ≥60 years than in those <60 years. These findings highlight the significance of breathing training for patients with stroke and support clinical decision-making.

ABSTRACT Objective In people who have had stroke, are the effects of backward walking comparable with forward walking for improving walking (i.e. speed, cadence, and stride length)? Does the addition of backward walking to forward walking help improve the benefits of forward walking? Are any benefits maintained beyond intervention? Methods A systematic review of randomized trials, with adults following stroke, was developed. The intervention of interest was backward walking training, delivered either as a solo intervention or in combination with forward walking training. The outcome measures of interest were walking speed, cadence, and stride length. Results The effect of backward walking training is similar as or better than that of forward walking training for improving walking speed (MD 0.16 m/s, 95% CI 0.06 to 0.27), but results for cadence and stride length were very imprecise. The addition of backward walking training to forward walking training provided negligible effects on walking speed (MD 0.03 m/s, 95% CI 0.01 to 0.04), cadence (MD 5 steps/min, 95% CI 1 to 10), and stride length (MD 0.04 m, 95% CI −0.01 to 0.09). Maintenance of effects beyond the intervention period remains uncertain. Conclusions This review provided moderate-quality evidence that backward walking training is slightly better than forward walking training for improving walking speed after stroke, but not when it is additional to forward walking training. Large and well-designed trials are warranted to strengthen the evidence regarding backward walking training, especially in the subacute phase after stroke.

ABSTRACT Background Little is known about the ideal duration of inspiratory muscle training in stroke patients. Objective The aim of this study was to assess the effects of short-term and long-term inspiratory muscle strengthening exercises in stroke patients. Methods This study was a prospective, double-blind, randomized controlled trial involving 50 stroke patients. Based on baseline maximum inspiratory pressure (MIP) values, participants were divided into two strata: those with severely weak inspiratory muscle (stratum A) and those with moderately weak inspiratory muscle (stratum B). Within each stratum, individuals were randomly assigned to either the 4-week exercise group, the 8-week exercise group, or the sham group. The exercise groups underwent inspiratory muscle strengthening exercises. The MIP, 6-minute walk test (6MWT), and the Nottingham Extended Activities of Daily Living (NEADL) Index were assessed at baseline, 8, 12, and 24 weeks. Results Subjects in Stratum A exhibited notably greater improvement after 8 weeks of training compared to those in Stratum B. Furthermore, both Stratums displayed significantly greater improvement following 8 weeks of training compared to sham training. In Stratum B cases, a significantly higher level of improvement was noted with the 4-week training in comparison to the sham training. A significant increase in NEADL index and 6MWT score was observed during the 24-week follow-up period. Conclusion For individuals with moderately weak inspiratory muscle strength, a 4-week exercise program proves sufficient in enhancing inspiratory muscle strength, walking capacity, and daily life activities. However, individuals with severely weak inspiratory muscle strength benefit more from an 8-week treatment.