Brunnstrom Stage Research Articles

Machine learning-based prediction model of lower extremity deep vein thrombosis after stroke.

This study aimed to apply machine learning (ML) techniques to develop and validate a risk prediction model for post-stroke lower extremity deep vein thrombosis (DVT) based on patients' limb function, activities of daily living (ADL), clinical laboratory indicators, and DVT preventive measures. We retrospectively analyzed 620 stroke patients. Eight ML models-logistic regression (LR), support vector machine (SVM), random forest (RF), decision tree (DT), neural network (NN), extreme gradient boosting (XGBoost), Bayesian (NB), and K-nearest neighbor (KNN)-were used to build the model. These models were extensively evaluated using ROC curves, AUC, PR curves, PRAUC, accuracy, sensitivity, specificity, and clinical decision curves (DCA). Shapley's additive explanation (SHAP) was used to determine feature importance. Finally, based on the optimal ML algorithm, different functional feature set models were compared with the Padua scale to select the best feature set model. Our results indicated that the RF algorithm demonstrated superior performance in various evaluation metrics, including AUC (0.74/0.73), PRAUC (0.58/0.58), accuracy (0.75/0.77), and sensitivity (0.78/0.80) in both the training set and test set. DCA analysis revealed that the RF model had the highest clinical net benefit. SHAP analysis showed that D-dimer had the most significant influence on DVT, followed by age, Brunnstrom stage (lower limb), prothrombin time (PT), and mobility ability. The RF algorithm can predict post-stroke DVT to guide clinical practice.

High-frequency magnetic paired associated stimulation promotes motor function recovery in ischemic stroke patients: a study protocol for single-center, sham stimulation randomized controlled trials (H2MPAS)

BackgroundNumerous 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.MethodsThis 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.DiscussionThe 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 registrationChinese Clinical Trial Registry,ChiCTR2400083363. Registered on 23 April 2024.

Electromyography-Triggered Constraint-Induced Movement Cycling Therapy for Enhancing Motor Function in Chronic Stroke Patients: A Randomized Controlled Trial.

This single-blind randomized controlled trial investigated the effectiveness of surface electromyography (sEMG)-triggered constraint-induced movement cycling therapy (CIMCT) in improving balance, lower extremity strength, and activities of daily living in patients with chronic stroke. The participants included patients with chronic stroke-induced hemiplegia who had been diagnosed for more than 6 months, with a minimum score of 24 points on the Mini-Mental State Examination and above level 3 on the Brunnstrom stages. The trial lasted 4 weeks and participants were divided into a CIMCT group and a general cycling training (GCT) group. The CIMCT group (n = 20) used an sEMG-triggered constrained-induced movement therapy device, whereas the GCT group (n = 19) used a standard stationary bicycle. The primary outcome measures showed a significant increase in muscle strength on the affected side in the CIMCT group, as assessed by a manual muscle tester (p < 0.05), with a large effect size (d = 1.86), while no meaningful improvement was observed in the GCT group. Both groups demonstrated significant improvements in dynamic balance, as measured by the Timed Up and Go (TUG) test (p < 0.05), with the CIMCT group showing superior results compared to the GCT group, reflected by a large effect size (d = 0.96). Additionally, both groups showed significant improvements in balance as assessed by the Berg Balance Scale (BBS) and the Functional Reach Test (FRT). The CIMCT group exhibited more pronounced improvements than the GCT group, with large effect sizes of 0.83 for the BBS and 1.25 for the FRT. The secondary outcome measures revealed significant improvements in activities of daily living in both groups, as assessed by the modified Barthel index (MBI), with the CIMCT group achieving a substantial improvement (p < 0.05), accompanied by a large effect size (d = 0.87). This study concludes that sEMG-triggered CIMCT effectively improved muscle strength, postural balance, and activities of daily living in patients with chronic stroke.

Predictive value of early serum ACSL4 and ASITN/SIR grade for motor function recovery in patients with post-ischemic stroke lower limb neurological sequelae after modified constraint-induced movement therapy

BackgroundIschemic stroke accounts for over 85 % of all stroke types. Acyl-CoA synthetase long chain family member 4 (ACSL4) is considered to promote myocardial and cerebral ischaemia/ reperfusion. However, up to now, no study focused on the role of ACSL4 in patients with post-stroke lower limb neurological sequelae. ObjectiveThe present study aimed to investigate the predictive value of ACSL4 and collateral circulation for lower limb neurological sequelae of ischemic stroke patients after modified constraint-induced movement therapy (mCIMT). MethodsThis is a prospective cohort study which included 99 ischemic stroke patients with lower limb neurological sequelae who were admitted to our hospital during January 2021 to December 2022. All patients received mCIMT after the admission. Collateral circulation was evaluated by digital subtraction angiography (DSA) and graded by the American Society of Interventional and Therapeutic Neuroradiology/ Society of Interventional Radiology (ASITN/SIR) grading system. Enzyme linked immunosorbent assay (ELISA) was used to detect serum ACSL4. Basic characteristics were collected and lower limb motor function was measured by Fugl-Meyer score (FMS), modified Ashworth score (MAS) and Brunnstrom stage, as well as timed up and go (TUG) test, ten-Meter walk test (10MWT), and six-minute walk test (6MWT) before and after treatment. ResultsSerum ACSL4 and percentage of patients with ASITN/SIR 0–1 decreased significantly after treatment compared with the values before treatment. Patients with higher baseline serum ACSL4 values at admission showed significantly lower FMS scores, higher TUG and 10MWT, as well as lower 6MWT. Patients with ASITN/SIR grade 0–1 at admission only showed significantly higher TUG and 10MWT, as well as lower 6MWT. Receiver operating characteristic (ROC) curves showed ACSL4 and ASITN/SIR grade could be used to predict the prognosis. Logistic regression found only national institutes of health stroke scores (NIHSS) was the independent risk factor for post-treatment motor impairment after mCIMT. ConclusionHigher levels of ACSL4 and ASITN/SIR 0–1 are associated with poor recovery of motor functions of patients with post-stroke sequelae after mCIMT.

Effects of Thermal Stimulation and Transcutaneous Electrical Nerve Stimulation on Sensory and Motor Function of Upper Extremity in Acute Stroke Survivors: A Randomized Controlled Pilot Study.

Objective Upper-limb coordination is crucial for daily activities, especially among stroke survivors who may encounter obstacles during upper-limb rehabilitation. This study aimed to investigate the effects of thermal stimulation (TS) and transcutaneous electrical nerve stimulation (TENS) on sensory and motor function during recovery in acute stroke patients. Design This is a parallel study with a randomized controlled design. The experiment was conducted in the E-Da Hospital Rehabilitation Department, Kaohsiung, Taiwan. Intervention Thirty participants were in-patients with acute stroke at the E-Da Hospital. Participants were randomly assigned tothree groups for a one-week intervention: exercise combined with TS, exercise combined with TENS, or conventional physical therapy with exercise alone. The Fugl-Meyer upper extremity scale, Brunnstrom stage, minimal current perception (MCP), and modified Ashworth scale were collected for the assessment. Results The outcomes demonstrated considerable improvement in MCP in all the groups after treatment. Specifically, the groups receiving TS and TENS showed significant improvements in the Brunnstrom stage, suggesting that both treatments improved distal motor recovery. Conclusion The results, following a one-week intervention period, suggested that both TS and TENS contributed to the improvement of motor and sensory function, with a significant impact on the Brunnstrom stage in the upper extremity, particularly in the distal region. The inclusion of TS or TENS in rehabilitation protocols improved distal motor function compared to baseline measures, suggesting these treatments as effective components in acute stroke rehabilitation.

Effects of Maitland mobilization technique on upper extremity function in stroke survivors with spasticity: An experimental study.

The recovery of upper limb function is of great significance for stroke patients to regain their self-care ability, yet it is still a difficult point in clinical practice of neurological rehabilitation. This study aimed to investigate the effect of Maitland joint mobilization technique on the recovery of upper extremity function in patients with spasticity after stroke. From August to December 2023, 71 patients with upper extremity flexor spasm after stroke were recruited and randomly divided into experimental group (n = 35) and control group (n = 36). The control group was given conventional rehabilitation treatment, while the experimental group was treated with Maitland mobilization technique treatment of upper extremity joints on the basis of the control group. The experiment lasted for 8 weeks. Participants of the 2 groups were observed for Fugl-Meyer motor assessment-upper extremity (FMA-UE), box and block test (BBT) and Brunnstrom stage, modified Ashworth scale (MAS), and functional independence measure (FIM) at pre- and post-8 weeks study. There was no significant difference in gender distribution, hemiplegic side, diagnosis, past history, age, duration, body mass index, and mini-mental state examination between the 2 groups (P > .05). After 8 weeks of intervention, both groups showed significant improvement in FMA-UE, Brunnstrom stage, BBT, FIM, and MAS of the shoulder (P < .05); however, there was no significant change in MAS of the elbow, wrist, and finger joints (P > .05). The posttreatment values showed a significant improvement in FMA-UE, BBT, and FIM in the experimental group compared to the control group. Comparing the changes in pretreatment and posttreatment, FMA-UE, BBT, and FIM in the experimental group were significantly improved compared with those in the control group (P < .05). Maitland joint mobilization can improve the motor function of upper extremity and the spasticity of shoulder joint complex in patients with stroke.

Effects of ankle–foot orthoses on gait parameters in post-stroke patients with different Brunnstrom stages of the lower limb: a single-center crossover trial

BackgroundAnkle-foot orthoses (AFO) can improve gait posture and walking ability in post-stroke patients. However, the effect of AFO on gait parameters in post-stroke patients according to the Brunnstrom stage of stroke recovery of the lower limbs remains unclear. The study aimed to investigate whether stroke patients with different Brunnstrom stages benefit from wearing AFO.MethodsTwenty-five post-stroke participants included 18 men (50 ± 13 years) and 7 women (60 ± 15 years). The patients were divided based on Brunnstrom stage III or IV of the lower limbs. All patients underwent the gait and timed up and go (TUG) test using a gait analysis system while walking barefoot or with an AFO. The spatiotemporal and asymmetric parameters were analyzed.ResultsAll 25 patients completed the study. Significant differences were observed between barefoot and AFO use in TUG time (P < 0.001) but not walking velocity (P > 0.05). The main effect of the swing time ratio was significant in both groups (P < 0.05); however, the main effects of stride length, stance time, and gait asymmetry ratio were nonsignificant (P > 0.05). For barefoot versus AFO, the main effects of stride length (P < 0.05) and swing time (P < 0.01) ratios were significant, whereas those of stance time and gait asymmetry ratio were nonsignificant (P > 0.05).ConclusionsPost-stroke patients with lower Brunnstrom stages benefitted more from AFO, particularly in gait asymmetry.

Research on multi-dimensional intelligent quantitative assessment of upper limb function based on kinematic parameters.

Rehabilitation assessment is a critical component of rehabilitation treatment. This study focuses on a comprehensive analysis of patients' movement performance using the upper limb rehabilitation robot. It quantitatively assessed patients' motor control ability and constructed an intelligent grading model of functional impairments. These findings contribute to a deeper understanding of patients' motor ability and provide valuable insights for personalized rehabilitation interventions. Patients at different Brunnstrom stages underwent rehabilitation training using the upper limb rehabilitation robot, and data on the distal movement positions of the patients' upper limbs were collected. A total of 22 assessment metrics related to movement efficiency, smoothness, and accuracy were extracted. The performance of these assessment metrics was measured using the Mann-Whitney U test and Pearson correlation analysis. Due to the issue of imbalanced sample categories, data augmentation was performed using the Synthetic Minority Over-sampling Technique (SMOTE) algorithm based on weighted sampling, and an intelligent grading model of functional impairment based on the Extreme Gradient Boosting Tree (XGBoost) algorithm was constructed. Sixteen assessment metrics were screened. These metrics were effectively normalized to their maximum values, enabling the derivation of quantitative assessment scores for motor control ability across the three dimensions through a weighted fusion approach. Notably, when applied to the data-enhanced dataset, the intelligent grading model exhibited remarkable improvement, achieving an accuracy rate exceeding 0.98. Moreover, significant enhancements were observed in terms of precision, recall, and f1-score. The research findings demonstrate that this study enables the quantitative assessment of patients' motor control ability and intelligent grading of functional impairments, thereby contributing to the efficiency enhancement of clinical rehabilitation assessment. Moreover, this method resolves the issues associated with the subjectivity and prolonged periods of traditional rehabilitation assessment methods.

Clinical characteristics of 11 patients with Vibrio vulnificus infection and the establishment of a rapid diagnosis procedure for this disease

Clinical characteristics of 11 patients with Vibrio vulnificus infection and the establishment of a rapid diagnosis procedure for this disease

Angong niuhuang pill improves the neurological function of younger patients with basal ganglia and cerebral lobe intracerebral hemorrhage: A randomized controlled trial

Background &amp; Objective: Spontaneous intracerebral hemorrhage (SICH) is one of the stroke forms with the highest disability and mortality rates and significant differences in prognosis among patients with different locations of SICH. Angong Niuhuang Pill (ANP) 安宫牛黄丸 is one of the most well-known traditional Chinese patent medicines used in the clinical emergency treatment of cardio-cerebrovascular diseases. This prospective study was performed to determine the therapeutic effect of ANP in different locations of SICH. Methods: Patients with basal ganglia(n=81) and cerebral lobe (n=67) hemorrhage were randomly assigned into two groups: the standard medical management (SMM) group and the combined ANP as well as medical management group (ANP group). Fisher exact test and Mann- Whitney U test were used for comparing the differences between two groups. Primary and secondary outcomes were the 6-month modified Rankin Scale (mRS) scores and the 2-week Brunnstrom stage ratings. Results: For patients with basal ganglia hemorrhage and cerebral lobe hemorrhage, there were no significant differences observed between the ANP group and the SMM group in terms of patient age (53.1±5.3 vs 52.7±6.4; 54.7±4.8 vs 52.7±5.9), sex (male:64.3% vs 53.8%; 63.6% vs 58.8%), body mass index (25.1±2.1 vs 24.2±2.6; 25.6±2.0 vs 25.0±2.4), mean hematoma volume (17.1±6.6 vs 18.6±5.7; 18.4±7.4 vs 18.9±6.0), as well as the proportions of hypertension (88.1%vs71.8%; 90.9% vs 76.5%), alcoholism (40.5% vs 51.3%; 54.6% vs 41.2%), smoking (40.5% vs 38.5%; 36.4% vs 38.2%), and diabetes mellitus (21.4% vs 18%; 12.1% vs 17.7%). The proportion of basal ganglia hemorrhage patients with a 6-month mRS score of 0-2 in the ANP group was significantly higher than that in the SMM group (26.2% vs. 2.6%, P=0.004), but it was not significantly improved in patients with cerebral lobe hemorrhage (57.6% vs 38.2%, P=0.145). The 2-week Brunnstrom stage ratings of patients with basal ganglia hemorrhage were significant difference (P=0.048). But for patients with cerebral lobe hemorrhage, there was no significant difference (P=0.164). The incidence of liver dysfunction, renal dysfunction, gastrointestinal dysfunction, hypothermia and allergy in the two groups of patients was not significantly different. Conclusions: ANP has different therapeutic effects on different locations of SICH, and has the most obvious effect on improving the long-term neurological function of patients with basal ganglia hemorrhage.

Evaluation of the health literacy in patients with stroke and relationship between health literacy and functional status on quality of life in patients with stroke

Aims: This study was aimed to evaluate the health literacy in patients with stroke and relationship between health literacy and functional status on quality of life. Methods: This cross-sectional study was studied on 50 participants with stroke (mean age: 59.4±10.6 years) and 50 healthy controls (mean age: 61.7±10.1 years). Clinical and demographic and characteristics were recorded. Health literacy levels of the participants were assessed with the Turkish version of European Health Literacy Scale (EHLS-TR), Motor development for hand, upper and lover extremity with Brunnstrom staging, evaluation of health-related quality of life with Notthingham Health Profile (NHP), pain with assessed with numeric rating scale (NRS). Results: Age, gender, marital status, education, job and residential area were similar between the groups. The EHLS-TR scores were significantly lower, in patients with stroke compared to the control group (p=0.041δ). There was a statistically significant negative correlation between EHLS-TR scores, age and positive correlation with educational status. EHLS-TR scores were found to be higher in patients younger than 60 years old and university graduates. Health releated quality of life levels are similar between the groups. EHLS-TR scores were found to be statistically effective on Nottingham Health Profile (NHP) total scores (rho:-0,357 and p=0,011) and also physical activity sub domain and energy level sub domains. There was moderate negative correlation between the EHLS-TR scores and NHP energy sub domain (p=0.002, r:-0.436) and weak negative correlation between the EHLS-TR scores and NHP emotional, sleep, physical activity sub domains (r:-0.279 p=0.049, r:-0.344 p=0.015, r:-0.288 p=0.043). There was no correlation between the EHLS-TR scores and Brunnstrom staging, Functional ambulation and pain levels in patients with stroke. Conclusion: Our study results suggest that healthy literacy level is lower in patients with stroke compared to healthy controls. In addition, healthy literacy is associated with age and education. Health literacy has been found to have an impact on quality of life and energy, emotional, sleep and physical activity subdomains of NHP. There was no association found between functional status on health literacy in this patient population.

Analysis of immune cells and risk factors related to lower limb deep vein thrombosis in patients with cerebral infarction.

This study retrospectively analyzed data from 174 patients with cerebral infarction admitted to The Rehabilitation Department of Shanghai Fifth Rehabilitation Hospital and Shanghai First People's Hospital from June 2022 to June 2023. Based on the results of lower limb venous color Doppler ultrasound examinations, patients were divided into two groups: the LDVT group (35 cases) and the non-LDVT group (139 cases). We compared the clinical data and hematologic indicators (D-dimer value, fibrinogen, white blood cells, platelets, uric acid, creatinine, etc.) of the two groups to identify the risk factors of cerebral infarction complicated with LDVT. Statistical analysis revealed that the D-dimer values of the LDVT group were significantly (P<0.05) higher than those of the non-LDVT group. The uric acid value of the LDVT group was significantly lower than that of the non-LDVT group, with statistical significance (P<0.05). The Brunnstrom staging in the LDVT group was significantly different from that in the non-LDVT group (P<0.05). Meanwhile, binary logistic regression analysis showed that LDVT complicated with cerebral infarction was associated with D-dimer level [OR=1.302, 95% CI (1.077, 1.575)], uric acid level [OR=0.995, 95% CI (0.990, 1.000)], and Brunnstrom staging [OR=3.005, 95% CI (1.312, 6.880)]. D-dimer value, uric acid value, and Brunnstrom stage I to II are closely related to the occurrence of LDVT in patients with cerebral infarction. High D-dimer value, low uric acid value, and Brunnstrom stage I to II are independent risk factors for LDVT in cerebral infarction. Early assessment of D-dimer value, uric acid value, and Brunnstrom stage of cerebral infarction should be considered in clinical practice.

Risk factors for dysphagia in patients with acute and chronic ischemic stroke: A retrospective cohort study

BackgroundDysphagia is a common and clinically significant complication of ischemic stroke. The prevalence and risk factors for dysphagia may vary at different stages following an ischemic stroke. MethodsThis study included patients with acute and chronic ischemic stroke who were treated at the Department of Rehabilitation, First Affiliated Hospital, Zhejiang University School of Medicine from 2019 to 2022. Various demographic, clinical, and laboratory parameters were collected, and statistical analyses were performed to investigate their association with dysphagia. ResultsAmong the 399 ischemic stroke patients included in the study, 165 (41.4 %) experienced dysphagia, with 72 (38.7 %) in the acute phase and 93 (43.7 %) in the chronic phase. Univariate analysis revealed significant associations (p < 0.05) between dysphagia and factors such as pulmonary infection, aphasia, NIHSS score, ADL score, NLR score, lower extremity Brunnstrom's stages, and sit-to-stand balance. Multiple logistic regression analysis, after adjusting for confounding factors, identified the ADL score as an independent predictor of dysphagia. These findings were consistent across three time-windows: the acute phase, the chronic phase, and 180 days after stroke onset. Additionally, the lymphocyte count and pulmonary infection were identified as potential independent indicators. ConclusionsThis study investigated the prevalence and risk factors for dysphagia in ischemic stroke patients at different time-windows. A low ADL score (<40) may serve as a valuable and reliable predictor for poststroke dysphagia in clinical settings.

Robot-assisted therapy in stratified intervention: a randomized controlled trial on poststroke motor recovery.

To compare the effects of robot-assisted therapy with conventional therapy for accelerating stratified intervention in poststroke patients with upper limb dysfunction. For stroke survivors, recovery of upper extremity function remains a major challenge in rehabilitation. Literature has suggested that the rate of recovery may improve if treatments can be individualized to their clinical profiles. However, there still lack clinical evidence on how to create treatment tailored to individual patients. Robot-assisted Therapy (RT) provides a straightforward approach to adjustment of the assistance-resistance continuum for individual patients. In early Brunnstrom stages of recovery, patients benefit from assistance training, whereas in later stages the training is favored with resistance. Therefore, RT may enhance Conventional Therapy (CT) but the use of RT in stratified intervention has not been investigated. This study evaluated the possible benefit of adopting RT following a protocol of upper-limb training, which was stratified with the Brunnstrom stage of each individual. This study was a single-blinded randomized controlled trial. A total of 53 patients with stroke were recruited and randomized into 2 groups (CT, n = 27, 3 dropped out and RT, n = 26, 2 dropped out). Both groups were trained once per day, 5 days per week for 4 weeks. The CT group received 30 min of conventional therapy; the RT group received 30 min of upper limb robot-assisted training. Patients were assessed at the beginning, week-2, and week-4 of the treatment. The outcome measures included the Fugl-Meyer Assessment Upper-Extremity (FMA-UE) and the Modified Barthel Index (MBI). Across the 4-week intervention, participants in the RT group recovered 1.979 points of FMA-UE per week, compared to 1.198 points per week in the CT group (t94 = 3.333, p < 0.01); the recovery rate was 0.781 points/week higher in the RT group than in the CT group. Moreover, the recovery of FMA-UE was faster in proximal joints (t94 = 3.199, p < 0.01), and for patients in Brunnstrom Stage III (t34 = 2.526, p < 0.05). The improvements in MBI were not significantly different between RT and CT. Robot-assisted therapy showed initial evidence for the acceleration of post-stroke recovery of motor function in the upper limb. Initial observations suggested that patients in Brunnstrom recovery stage III might benefit the most from the stratified intervention assisted by robotics. https://www.chictr.org.cn/showproj.html?proj=61834, Identifier [ChiCTR2000039010]. Registered 13 March 2020.

Validity and reliability of selective control of upper extremity scale (SCUES) in patients with chronic stroke

Purpose The aim of this study is to investigate the validity and reliability of the Selective Control of Upper Extremity Scale (SCUES) in patients with stroke. Materials and Methods Forty-two patients with stroke aged 18–75 years, were included in the study. Patients were video-recorded while SCUES was administered. The videos were scored to determine the intrarater and inter-rater reliability. Fugl Meyer Assessment of Upper Extremity (FMA-UE), Box and Block test (BBT) and Brunnstrom Stages of Motor Recovery were measured to evaluate validity of SCUES. Spearman correlation analysis was used to assess the validity of SCUES. Intraclass correlation coefficient (ICC), Kappa (κ) and weighted Kappa (κw) were calculated to determine intrarater and inter-rater reliability. Results There were significant positive high correlations between SCUES and FMA-UE and BBT and Brunnstrom upper extremity proximal and distal values (rho = 0.944, p = 0.01; rho = 0,875, p = 0.01; rho = 0.84, p = 0.01, rho = 0.82, p = 0.01; respectively) showing validity of SCUES. The ICC value of inter-rater reliability of SCUES was 0,99 (%95 CI: 0,989-0,997, p = 0,001) showing excellent reliability. κ and κ w values for inter-rater and intrarater reliability of individual SCUES items were above 0.7 indicating excellent reliability. ICC of SCUES and FMA-UE indicated excellent intrarater reliability (ICC = 0,99; %95 CI: 0,989–0,997, p = 0,001; ICC = 0.943; %95 CI: 0.9–0.97, p = 0,0001, consecutively). Conclusions SCUES showed similar validity and reliability with FMA-UE and SCUES can be used in the evaluation of upper extremity selective motor control in patients with stroke.

Effect of Russian Current in Motor Performance among Chronic Stroke Survivors: A Pilot Study

Background and Aim: Stroke is a leading cause of permanent disability in developing nations. Motor impairment in stroke contributes to limitations in activities of daily life, participation in community, and overall quality of life. Recovery following stroke is challenged by poor lower-limb muscle performance interfering with balance, gait, and functional tasks. Objective: The objective of this study was to investigate the effect of Russian current over the quadriceps muscle in 10-m walk performance and Brunnstrom stages of lower-extremity recovery in chronic stroke survivors. Materials and Methods: The Institutional Review Board approval was obtained for this pilot study, and a total of 36 chronic stroke survivors were recruited from the outpatient department of Alva’s College of Physiotherapy and Research Center, Moodubidire, Karnataka. Consent was obtained from the voluntary participants, and they were randomly assigned to one of the two groups; intervention and the control groups. Participants in the intervention group received Russian current over the quadriceps muscle in addition to the conventional rehabilitation, whereas the control group participants received only conventional rehabilitation. The study duration was 6 weeks. The outcomes measured were 10-m walk test and Brunnstrom stages of lower-extremity recovery. Results: Statistical analysis was performed with SPSS statistical software. The Kolmogorov–Smirnov test was performed for normality. The paired t-test, within-group analysis, demonstrated a significant increase in the 10-m walk test (P &lt; 002) and Brunnstrom stage of lower extremity (P &lt; 0.043) for the intervention group. The independent t-test demonstrated a highly significant (P = 0.001) value for the intervention group than the control group. Conclusion: Statistical results conclude that Russian current is effective in improving 10-m walk performance and Brunnstrom stages of motor recovery of lower limb in chronic stroke survivors.

Protocol for a single-blind randomized clinical trial to test the efficacy of bilateral transcranial magnetic stimulation on upper extremity motor function in patients recovering from stroke

BackgroundNo consensus currently exists regarding the optimal protocol for repetitive transcranial magnetic stimulation (rTMS) treatment of upper-extremity motor dysfunction after stroke. Studies have shown that combined low- and high-frequency stimulation (LF-HF-rTMS) of the bilateral cerebral hemispheres is more effective than sham stimulation or stimulation of one cerebral hemisphere alone in treating motor dysfunction in the subacute stage of stroke. The efficacy of this protocol in the convalescence phase of stroke has rarely been reported, and its mechanism of action has not been clarified. In this study, we designed a prospective, single-blind, randomized controlled trial to investigate the efficacy and safety of different stimulation regimens for the treatment of upper extremity motor disorders in patients with convalescent stage stroke and aimed to explore the underlying mechanisms based on biomarkers such as brain-derived neurotrophic factor (BDNF).MethodsSeventy-six subjects will be randomly divided into combined, low-frequency, high-frequency, and control groups based on the proportion of 1:1:1:1, with 19 cases in each group. All groups will have conventional rehabilitation, on top of which the combined group will receive 1 Hz rTMS in the unaffected hemisphere and 10 Hz rTMS in the affected hemisphere. The low-frequency group will be administered 1 Hz rTMS in the unaffected hemisphere and sham stimulation in the contralateral hemisphere. The high-frequency group will be administered 10 Hz rTMS in the affected hemisphere and contralateral sham stimulation. The control group will receive bilateral sham stimulation. Assessments will be performed at baseline, after 2 weeks of treatment, and at post-treatment follow-up at week 6. The primary outcomes are FMA-UE (Fugl-Meyer assessment-upper extremity), latency, and serum BDNF levels. The secondary outcomes are the National Institute of Health Stroke Scale (NIHSS), Brunnstrom staging (BS), modified Ashworth scale (MAS), Modified Barthel Index (MBI), central motor conduction time (CMCT), precursor proteins of mature BDNF (proBDNF), and matrix metalloproteinase-9 (MMP-9) levels. Adverse events, such as headaches and seizures, will be recorded throughout the study.DiscussionThe findings of this study will help develop optimal stimulation protocols for motor recovery in stroke patients and identify biomarkers that respond to post-stroke motor rehabilitation, for better guidance of clinical treatment.Trial registrationThe study protocol was passed by the Medical Research Ethics Committee of the General Hospital of Ningxia Medical University on January 1, 2022 (no. KYLL-2021–1082). It was registered into the Chinese Clinical Trials Registry on May 22, 2022 (no. ChiCTR2200060201). This study is currently in progress.Graphical

Factors influencing the willingness to participate in rehabilitation in patients with subacute stroke

ObjectiveThe aim of this study was to examine the parameters that may influence the willingness of patients to participate in post-stroke rehabilitation. MethodsPatients in the subacute phase of stroke who underwent inpatient rehabilitation for one month were included in this study. The primary outcome measure was the level of rehabilitation participation as measured on the Pittsburgh Rehabilitation Participation Scale (PRPS). Other outcome measures evaluated were Mini-Mental State Examination (MMSE) for cognitive functions, Brunnstrom stage for motor recovery, modified Rankin Scale (mRS) for disability, Functional Independence Measure for functionality, Pittsburgh Sleep Quality Index for sleep quality, and Beck Depression Inventory for emotional state. ResultsA total of 38 patients with first-time stroke were studied. A negative correlation was found between the participation in rehabilitation and body mass index (BMI) (r: −0.398p = 0.012), myocardial infarction (MI) history (r: −0.387p = 0.015) and mRS (r: −0.351p = 0.031), while a positive correlation was determined with MMSE (r: 0.432P = 0.007). A 1-unit increase in BMI, MI history, and mRS resulted in a 0.176, 0.673, and 0.294-unit decrease in participation in rehabilitation, respectively. In addition, a 1-unit increase in MMSE provided an increase of 0.606-unit in participation. ConclusionBMI within normal limits, prevention/treatment of cardiovascular diseases, and well-being of physical and cognitive functions might be the factors that positively influence participation in rehabilitation process. We consider that it would be appropriate to evaluate these parameters with particular emphasis in stroke patients in the subacute period to be rehabilitated.

Investigation of the efficacy of low-frequency repetitive transcranial magnetic stimulation on upper-limb motor recovery in subacute ischemic stroke without cortical involvement: a protocol paper for a multi-center, double-blind randomized controlled trial.

The incidence of stroke is increasing steadily due to factors such as population aging. Approximately 80% of stroke survivors have motor disorders affecting their daily lives. Repetitive transcranial magnetic stimulation (rTMS) has been reported to maximize functional recovery after stroke along with exercise intervention in upper limb rehabilitation treatment. However, whether rTMS affects the recovery of upper limb function in patients with stroke remains unclear. Therefore, in this trial, we will investigate the efficacy of low-frequency rTMS in patients with subcortical and brainstem ischemic stroke. This study has been designed as a multi-center, double-blind, randomized controlled trial to compare the efficacy of low-frequency rTMS over the contralesional M1 with sham stimulation. Overall, 88 participants will be allocated to the intervention or control group in a 1:1 ratio, with stratification according to their initial upper extremity Fugl-Meyer assessment (UE-FMA) score. The participants will receive either 30 min of real rTMS (intervention group) or sham rTMS (control group), followed by 30 min of occupational therapy for 10 consecutive workdays. All the participants will receive the same amount of rehabilitation therapy throughout the intervention period. Evaluations will be performed at baseline (T0), at the end of treatment (T1), and 4 weeks after the end of treatment (T2), including the box and block test (BBT), UE-FMA, Korean version of the Modified Barthel Index, and NIH Stroke Scale scores, Finger tapping test, Brunnstrom stage, modified Ashworth scale, and grip strength. The primary outcome will be the change in the BBT score between T0 and T2. This study will provide evidence on the efficacy of low-frequency rTMS in motor function recovery of the upper limb in patients with subacute, subcortical, and brainstem ischemic stroke. ClinicalTrials.gov, identifier [NCT05535504].

The effect of pre-rehabilitation and rehabilitation period on functional status in hospitalized stroke patients

Objective: In this study, we aimed to investigate the effect of pre-rehabilitation and rehabilitation hospitalization periods on the functional status of the patient. Methods: In this retrospective study, stroke patients hospitalized in our rehabilitation clinic were screened. Patients' age, gender, type of stroke, affected hemisphere, spasticity, functional ambulation category (FAC), mini-mental status, length of pre-rehabilitation and rehabilitation period, Brunsstrom staging, and Barthel index were investigated. Results: One hundred eight patients were included in the study. The mean age was 64.9±14.8. The mean length of pre-rehabilitation was 16.2±12.8 and rehabilitation was 20.7±9.1 days. A significant negative correlation was observed between the length of the rehabilitation period and all Brunnstrom sub-assessments after rehabilitation. A significant positive correlation was observed between the length of the rehabilitation period and the change in Brunnstrom stage for upper and lower extremity values, the stroke effect scale after rehabilitation, and the change in stroke impact scale value. A significant negative correlation was observed between pre-rehabilitation time and the Barthel index before and after rehabilitation. Conclusion: The prolongation of the pre-rehabilitation period is not a negative factor for functional gain in rehabilitation. The rehabilitation period of the patient should be decided by considering the functional status of the patient.