Post-stroke Individuals Research Articles

Brain and Muscle derived features to discriminate simple hand motor tasks for a rehabilitative BCI: comparative study on healthy and post-stroke individuals.

Brain-Computer Interfaces targeting post-stroke recovery of the upper limb employ mainly electroencephalography to decode movement-related brain activation. Recently hybrid systems including muscular activity were introduced. We compared the motor task discrimination abilities of three different features, namely event-related desynchronization/synchronization (ERD/ERS) and movement-related cortical potential (MRCP) as brain-derived features and cortico-muscular coherence (CMC) as a hybrid brain-muscle derived feature, elicited in 13 healthy subjects and 13 stroke patients during the execution/attempt of two simple hand motor tasks (finger extension and grasping) commonly employed in upper limb rehabilitation protocols. 
Approach. We employed a three-way statistical design to investigate whether their ability to discriminate the two movements follows a specific temporal evolution along the movement execution and is eventually different among the three features and between the two groups. We also investigated the differences in performance at the single-subject level.
Main results. The ERD/ERS and the CMC-based classification showed similar temporal evolutions of the performance with a significant increase in accuracy during the execution phase while MRCP-based accuracy peaked at movement onset. Such temporal dynamics were similar but slower in stroke patients when the movements were attempted with the affected hand. Moreover, CMC outperformed the two brain features in healthy subjects and stroke patients when performing the task with their unaffected hand, whereas a higher variability across subjects was observed in patients performing the tasks with their affected hand. Interestingly, brain features performed better in this latter condition with respect to healthy subjects. 
Significance. Our results provide hints to improve the design of Brain-Computer Interfaces for post-stroke rehabilitation, emphasizing the need for personalized approaches tailored to patients' characteristics and to the intended rehabilitative target.

Delayed Cortical Responses During Reactive Balance After Stroke Associated With Slower Kinetics and Clinical Balance Dysfunction.

Slowed balance and mobility after stroke have been well-characterized. Yet the effects of unilateral cortical lesions on whole-body neuromechanical control is poorly understood, despite increased reliance on cortical resources for balance and mobility with aging. Objective. We tested whether individuals post stroke show impaired cortical responses evoked during reactive balance, and the effect of asymmetrical interlimb contributions to balance recovery and the evoked cortical response. Using electroencephalography, we assessed cortical N1 responses evoked over fronto-midline regions (Cz) during backward support-surface perturbations loading both legs and posterior-lateral directions that preferentially load the paretic or nonparetic leg in individuals' post-stroke and age-matched controls. We tested relationships between cortical responses and clinical balance/mobility function, as well as to center of pressure (CoP) rate of rise (RoR) during balance recovery. Cortical N1 responses were smaller and delayed after stroke (P < .047), regardless of perturbation condition. In contrast to controls, slower cortical response latencies associated with lower clinical function in stroke (Mini Balance Evaluation Systems Test: r = -.61, P = .007; Timed-Up-and-Go: r = .53, P = .024; walking speed: r = -.46, P = .055). Paretic-loaded balance recovery revealed slower CoP RoR (P = .012) that was associated with delayed cortical response latencies (r = -.70, P = .003); these relationships were not present during bilateral and nonparetic-loaded conditions, nor in the older adults control group. Individuals after stroke may be limited in their balance ability by the slowed speed of their cortical responses to destabilization. In particular, paretic leg loading may reveal cortical response impairments that reflect reduced paretic motor capacity.

Between-limb difference in peak knee flexion angle can identify persons post-stroke with Stiff-Knee gait

BackgroundStiff-Knee gait affects 25–75 % of individuals with post-stroke gait impairment and is typically defined as reduced swing phase knee flexion. Different studies use various measures to identify Stiff-Knee gait, such as peak swing knee flexion angle, timing of peak knee flexion, knee range of motion, and ankle push-off acceleration, leading to inconsistent results. MethodsThis study used univariate cluster analysis to examine the independence, consistency, validity, and accuracy of different definitions in 50 post-stroke individuals (24 with and 26 without Stiff-Knee gait), as determined by a physiatrist. Spearman's rank correlation was used for correlation analysis, and five clustering techniques along with clinician evaluations were used for validity analysis. FindingsCorrelation analysis showed that peak knee flexion timing and knee hyperextension are poorly correlated with reduced swing-phase knee flexion angle (ρ = −0.09 and ρ = −0.26 respectively). Validity analysis indicated that the between-limb difference in peak swing knee flexion angle and peak swing knee flexion angle at self-selected gait speeds were the most valid differentiators. At the fastest comfortable gait speed, the between-limb difference of peak knee flexion angle had the highest sensitivity, lowest specificity, and highest F1 scores. InterpretationWe determined thresholds of less than 44.3° for peak swing knee flexion angle and greater than 17.0° for the between-limb difference of peak knee flexion angle identify Stiff-Knee gait during self-selected walking. We recommend using the difference in peak swing knee flexion angle between limbs to diagnose post-stroke Stiff-Knee gait due to its robustness to changes in gait speed.

Non-pharmacological interventions to treat mood disturbances post-stroke: a systematic review

ABSTRACT Background Stroke survivors face high rates of depression, anxiety, and pseudobulbar affect. Clinicians report lack of clarity on effective non-pharmacological interventions due to uncertainty about treatment options as barriers to evidence-based treatment. No systematic review has investigated the effectiveness of non-pharmacological interventions on the conditions of depression, anxiety, and pseudo-bulbar affect. Objectives The aim of this study was to evaluate the effectiveness of non-pharmacological interventions on the outcomes of depression, anxiety, and pseudobulbar affect in post-stroke individuals. Methods Following the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched databases Medline, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PsycINFO for randomized controlled trials in English, within 2012–2023, evaluating the effect of a non-pharmacological intervention on depression, anxiety, and/or pseudobulbar affect. Two researchers screened titles, abstracts, and full texts. One researcher extracted data and assessed risk of bias. Data were synthesized narratively. Results Forty-two studies were included. Intervention types included education (n = 9), psychological therapy (n = 8), and physical exercise (n = 8). Intervention types reporting positive outcomes for depression were psychological therapy (n = 6), physical exercise (n = 3) and robot-assisted therapy (n = 3). Intervention types effective in improving anxiety were physical exercise (n = 2), psychological therapy (n = 3) and multi-modal therapy approaches (n = 2). No studies explored the impact on pseudobulbar affect. Conclusion Non-pharmacological interventions may be effective in improving mood in stroke survivors. Robot-assisted therapy and physical exercise were seen to improve multiple outcome measures. Patient education should be delivered alongside rehabilitation and directed to both stroke-survivor and caregiver.

Evaluation of Psychometric Proprieties of Mann Assessment of Swallowing Ability (MASA) in Italian Language: A Cross-Sectional Study.

The aim of this cross-sectional study was to translate, culturally adapt, and evaluate the psychometric properties of the Italian version of the Mann Assessment of Swallowing Ability (MASA) in post-stroke individuals. The original MASA scale was translated and culturally adapted from English to Italian following the international guidelines. The internal consistency and test-retest reliability of the MASA-IT were assessed, and its concurrent validity was examined through Pearson correlation coefficients with the Italian versions of two established gold standard scales for dysphagia assessment: the Dysphagia Outcome Severity Scale (DOSS) and the De Pippo Test-Three Oz Water Swallow. The MASA-IT was administered to 78 participants. The items demonstrated excellent internal consistency, with Cronbach's alpha ranging between 0.86 and 0.89. The interclass correlation coefficient was 0.98 for inter-rater reliability and 0.99 for intra-rater reliability, indicating high reproducibility. Regarding concurrent validity, the MASA-IT showed a strong direct correlation with the DOSS scale (r = 0.949, p = 0.01) and an inverse correlation with the De Pippo Test (r = -0.783, p = 0.01), confirming its good concurrent validity. The Italian version of the Mann Assessment of Swallowing Ability (MASA-IT) is a reliable and valid tool for assessing swallowing ability in post-stroke patients. Its strong psychometric properties make it well suited for clinical use in Italy.

Comparative analysis of upper body kinematics in stroke, Parkinson's disease, and healthy subjects: An observational study using IMU-based targeted box and block test

BackgroundThe Box and Block Test (BBT) is an essential and widely used test in rehabilitation for the assessment of gross unilateral manual dexterity. Although it is a valid, simple, and ecological instrument, it does not provide a quantitative measure of the upper limb trajectories during the test. Research questionThe study introduces a new motion-capture-based method (using ecological Inertial Measurement Units - IMUs) to evaluate upper body kinematics while performing a targeted version of BBT (tBBT). MethodsThis observational study compares data from 35 healthy subjects, 35 subjects with Parkinson’s disease, and 35 post-stroke individuals to evaluate upper limb kinematics during tBBT quantitatively. Seven IMUs were placed on the trunk, head, and upper limb of each subject. The joint angles and kinematic scores were calculated and analyzed. Motor task execution time and kinematic scores were statistically correlated with clinical assessment measures. Kruskal-Wallis between groups test and Dunn-Bonferroni post-hoc were used. ResultsThe statistics revealed significant differences (p<0.05) among the three groups. The analyzed joint angles highlight various compensatory strategies in neurological subjects, such as using the trunk to complete a motor task instead of the shoulder and using the wrist instead of the elbow, along with differences in movement fluidity (DimensionLess-Jerk, p<0.05). A positive correlation was found between kinematics and the Fugl-Meyer Assessment-Upper Limb (r=0.7344; p<0.01), and a negative correlation between kinematics and the Unified Parkinson's Disease Rating Scale (r=-0.5286; p<0.01). SignificanceThe quantitative assessments of joint kinematics correlated to clinical assessments could guarantee a new method of assessment of the upper limb in subjects with motor deficits. This would allow to capture new insight into the characteristics of the subject’s disability, with implications for the choice of a personalized rehabilitation treatment focused on the motor recovery of the upper limb.

Exploring the Impact of Stroke on Health Management Among Individuals Experiencing Health Care Disparities

Abstract Date Presented 03/23/24 Highlights the need to engage in legislative efforts to inform health policies and tailor interventions that influence provision and access to health education and resources among poststroke individuals experiencing health care disparities. Primary Author and Speaker: Jennifer Decker Additional Authors and Speakers: Barbara Nadeau

Assessing actigraphy performance for daytime sleep detection following stroke: insights from inpatient monitoring in a rehabilitation hospital.

Stroke can result in or exacerbate various sleep disorders. The presence of behaviors such as daytime sleepiness poststroke can indicate underlying sleep disorders which can significantly impact functional recovery and thus require prompt detection and monitoring for improved care. Actigraphy, a quantitative measurement technology, has been primarily validated for nighttime sleep in healthy adults; however, its validity for daytime sleep monitoring is currently unknown. Therefore this study aims to identify the best-performing actigraphy sensor and algorithm for detecting daytime sleep in poststroke individuals. Participants wore Actiwatch Spectrum and ActiGraph wGT3X-BT on their less-affected wrist, while trained observers recorded daytime sleep occurrences and activity levels (active, sedentary, and asleep) during non-therapy times. Algorithms, Actiwatch (Autoscore AMRI) and ActiGraph (Cole-Kripke, Sadeh), were compared with on-site observations and assessed using F2 scores, emphasizing sensitivity to detect daytime sleep. Twenty-seven participants from an inpatient stroke rehabilitation unit contributed 173.5 hours of data. The ActiGraph Cole-Kripke algorithm (minute sleep time = 15 minutes, bedtime = 10 minutes, and wake time = 10 minutes) achieved the highest F2 score (0.59). Notably, when participants were in bed, the ActiGraph Cole-Kripke algorithm continued to outperform Sadeh and Actiwatch AMRI, with an F2 score of 0.69. The study demonstrates both Actiwatch and ActiGraph's ability to detect daytime sleep, particularly during bed rest. ActiGraph (Cole-Kripke) algorithm exhibited a more balanced sleep detection profile and higher F2 scores compared to Actiwatch, offering valuable insights for optimizing daytime sleep monitoring with actigraphy in stroke patients.

The impacts of a healthy lifestyle on the physical and mental health status of female stroke survivors in Australia

ABSTRACT Introduction This longitudinal study aimed to explore the impacts of adopting a healthy lifestyle on self-reported physical and mental health outcomes among Australian females who are living with stroke. Methods The study utilized data retrieved from the Australian Longitudinal Study on Women’s Health’s 1946–51 cohort (from survey 5 conducted in 2007 to survey 9 conducted in 2019), focusing on 531 female stroke survivors. The dependent variables for this study were self-reported physical and mental health status, whereas the independent variables were lifestyle behaviors, including physical activity, smoking, alcohol consumption, and supplement use. Generalized Estimating Equation models were employed to assess the longitudinal associations between a dependent variable and the independent and confounding variables. Results The average age of the participants was 58.1 (SD = 1.4) years in survey 5 and 70.5 years in survey 9. The longitudinal analyses revealed that stroke survivors who engaged in moderate/high levels of physical activity had significantly better physical and mental health status than their inactive or sedentary counterparts. Besides, current smokers had significantly poorer physical and mental health status than nonsmokers. In addition, risky/high-risk alcohol consumers had significantly poorer mental health status compared to no/low-risk alcohol consumers. Conclusions Our findings suggest that post-stroke individuals can improve their physical and mental health by maintaining a healthy lifestyle. Specifically, targeted and appropriate programs and strategies are needed to promote physical activity and reduce smoking and alcohol consumption in female stroke survivors in order to optimize their overall health and quality of life.

Measurement properties of activity monitoring for a rehabilitation (AMoR) platform in post-stroke individuals in a simulated home environment

ABSTRACT Aim The aim of this study was to evaluate the measurement properties of activity monitoring for a rehabilitation (AMoR) platform for step counting, time spent in sedentary behavior, and postural changes during activities of daily living (ADLs) in a simulated home environment. Methods Twenty-one individuals in the post-stroke chronic phase used the AMoR platform during an ADL protocol and were monitored by a video camera. Spearman’s correlation coefficient, mean absolute percent error (MAPE), intraclass correlation coefficient (ICC), and Bland–Altman plot analyses were used to estimate the validity and reliability between the AMoR platform and the video for step counting, time spent sitting/lying, and postural changes from sit-to-stand (SI-ST) and sit-to-stand (ST-SI). Results Validity of the platform was observed with very high correlation values for step counting (rs = 0.998) and time spent sitting/lying (rs = 0.992) and high correlation for postural change of SI-ST (rs = 0.850) and ST-SI (rs = 0.851) when compared to the video. An error percentage above 5% was observed only for the SI-ST postural change (7.13%). The ICC values show excellent agreement for step counting (ICC3, k = 0.999) and time spent sitting/lying (ICC3, k = 0.992), and good agreement for SI-ST (ICC3, k = 0.859) and ST-SI (ICC3, k = 0.936) postural change. Values of the differences for step counting, sitting/lying time, and postural change were within the limits of agreement according to the analysis of the Bland–Altman graph. Conclusion The AMoR platform presented validity and reliability for step counting, time spent sitting/lying, and identification of SI-ST and ST-SI postural changes during tests in a simulated environment in post-stroke individuals.

Feasibility of a neurorehabilitation pipeline and an automated algorithm to select appropriate treatments for upper extremity motor paralysis in individuals with chronic stroke.

This study aimed to investigate the feasibility of a neurorehabilitation pipeline and develop an algorithm to automatically select the appropriate treatment for individuals with upper extremity motor paralysis after stroke in the chronic phase. In Experiment 1, eight post-stroke participants in the chronic phase who underwent treatment sustaining two to three phases were assessed before and after treatment. In Experiment 2, a decision tree analysis was performed in which the dependent variable was set as the treatment option determined by a board-certified physiatrist for 95 post-stroke participants; the independent variables were only motor function scores or both motor function scores and electromyogram variables. In Experiment 1, the clinical assessment scores were improved significantly after treatment. Experiment 2 showed that the agreements of the model with only motor function scores as the dependent variable and with motor function scores and electromyogram variables as the dependent variables were 75.8% and 82.1%, respectively. This novel treatment package is feasible for improvement of motor function in post-stroke individuals with severe motor paralysis. The study also established an automated algorithm for selecting appropriate treatments for upper extremity motor paralysis after stroke, identifying standard values of key variables, including electromyography variables.

Presence of Self-Reported Sleep Alterations After Stroke and Their Relationship With Disability: A Longitudinal Study

Background Sleep disorders have a prevalence of 30% to 70% in post-stroke individuals. The presence of sleep disorders and poor sleep quality after stroke can affect important functions and lead to worse outcomes. However, most studies are restricted to the acute post-stroke stage only. Objective To investigate the frequency of self-reported sleep alterations in a sample of chronic stroke individuals and to identify which self-reported sleep alterations were associated with disability. Methods Prospective exploratory study. Self-reported sleep alterations were measured by the Pittsburgh Sleep Quality Index, Insomnia Severity Index, Epworth Sleepiness Scale, and STOP-Bang Questionnaire. The dependent variable was measured 3 years after the first contact by the Modified Rankin Scale (mRS). Step-wise multiple linear regression analysis was employed to identify which sleep alterations were associated with disability. Results Sixty-five individuals with stroke participated. About 67.7% of participants had poor sleep quality, 52.4% reported insomnia symptoms, 33.9% reported excessive daytime sleepiness, and 80.0% were classified as intermediate or high risk for obstructive sleep apnea. Only risk for obstructive sleep apnea was significantly associated with disability and explained 5% of the variance in the mRS scores. Conclusion Self-reported sleep alterations had a considerable frequency in a sample of chronic stroke individuals. The risk of obstructive sleep apnea was associated with disability in the chronic stage of stroke. Sleep alterations must be considered and evaluated in the rehabilitation process even after a long period since the stroke onset.

Poststroke Spasticity: Pathophysiology and Management An Accurate Evaluation of Spasticity

Stroke is a major contributor to long-term impairment and disability, affecting up to one-third of survivors and almost half of patients showing neurological deficit at six months. Spasticity affects approximately 25% of individuals within two weeks of a stroke and increases to 44% in patients who have had a second stroke. Severe or incapacitating spasticity affects 15% of post-stroke individuals. Poststroke spasticity is also linked to additional signs and symptoms of the upper motor neuron syndrome, such as simultaneous contraction of agonist and antagonist muscles, weakness of the muscles, and a lack of coordination. Spasticity arises due to aberrant neuroplasticity that develops after a stroke and there is currently no specific intervention method designed to address and correct this abnormal plasticity that takes place during the acute phase. Just before implementing any measures to deal with spasticity, it is crucial to evaluate the influence on the quality of life and level of severity. Several grading scales are used to measure spasticity such as the MAS and modified Tardieu scale.There are various therapeutic approaches that may be categorized into three main classes: physical, pharmaceutical, and surgical. Each class has a distinct purpose and is used at the appropriate moment to reduce the level of spasticity and improve the patient's health. Physiotherapy serves as a base of improving the patient's condition and facilitating the development of brain networks. The objective of post stroke spasticity management must include not only the reduction of muscle hypertonia, but also the evaluation of how post stroke influences functionality and overall mental health. Improper treatment or non-compliance may result in increased pain, joint contraction, and further disability. The goal is to assist the patient in achieving the best possible quality of life. Keywords: Pathophysiology of Post-Stroke Spasticity; Management of Post-Stroke Spasticity; Evaluation of Post-Stroke Spasticity

EMG-Constrained and Ultrasound-Informed Muscle-Tendon Parameter Estimation in Post-Stroke Hemiparesis.

Secondary morphological and mechanical property changes in the muscle-tendon unit at the ankle joint are often observed in post-stroke individuals. These changes may alter the force generation capacity and affect daily activities such as locomotion. This work aimed to estimate subject-specific muscle-tendon parameters in individuals after stroke by solving the muscle redundancy problem using direct collocation optimal control methods based on experimental electromyography (EMG) signals and measured muscle fiber length. Subject-specific muscle-tendon parameters of the gastrocnemius, soleus, and tibialis anterior were estimated in seven post-stroke individuals and seven healthy controls. We found that the maximum isometric force, tendon stiffness and optimal fiber length in the post-stroke group were considerably lower than in the control group. We also computed the root mean square error between estimated and experimental values of muscle excitation and fiber length. The musculoskeletal model with estimated subject-specific muscle tendon parameters (from the muscle redundancy solver), yielded better muscle excitation and fiber length estimations than did scaled generic parameters. Our findings also showed that the muscle redundancy solver can estimate muscle-tendon parameters that produce force behavior in better accordance with the experimentally-measured value. These muscle-tendon parameters in the post-stroke individuals were physiologically meaningful and may shed light on treatment and/or rehabilitation planning.

New technology to address affected vs nonaffected arm contributions to ergometer performance in people poststroke

ABSTRACT Background When pedaling a coupled-crank arm ergometer, individuals with hemiplegia may experience nonparetic arm overcompensation, and paretic arm resistance, due to neuromechanical deficits. Technologies that foster independent limb contributions may increase the effectiveness of exercise for people poststroke. Objective Examine the speed during uncoupled pedaling with the Advanced Virtual Exercise Environment Device among individuals poststroke and non-impaired comparisons. Methods We recruited 2 groups:Poststroke and Comparison. Participants attended one lab session and performed peak speed tests and a graded exercise repeated for bilateral pedaling, unilateral (left, right). Results Thirty-one participants completed the protocol (16 women, 15 men). Poststroke participants pedaled slower during the bilateral speed test (64 ± 39 RPM, p < .001), and graded exercise, (54 ± 28 RPM, p < .001) versus comparisons (141 ± 19, 104 ± 12 RPM). Poststroke individuals had lower peak RPM during the unilateral speed test with their paretic arm (70 ± 46 RPM, p < .001) and graded exercise (58 ± 33 RPM, p < .001) compared to their unilateral speed test (130 ± 37 RPM) and graded exercise (108 ± 25 RPM) with their nonparetic arm. Comparisons did not differ between arms during speed tests and graded exercise. Poststroke participants demonstrated lower peak speed with their affected arm during the bilateral speed test (52 ± 42 RPM, p < .001) and graded exercise (49 ± 28 RPM, p = .008) compared to the same arm during unilateral speed (70 ± 46 RPM) and graded exercise (58 ± 33 RPM). Conclusions Poststroke participants pedaled faster with their affected arm unilaterally versus bilateral pedaling, suggesting interhemispheric interference that reduces the ability to recruit the paretic arm during bilateral exercise.

Mitigating Trunk Compensatory Movements in Post-Stroke Survivors through Visual Feedback during Robotic-Assisted Arm Reaching Exercises.

Trunk compensatory movements frequently manifest during robotic-assisted arm reaching exercises for upper limb rehabilitation following a stroke, potentially impeding functional recovery. These aberrant movements are prevalent among stroke survivors and can hinder their progress in rehabilitation, making it crucial to address this issue. This study evaluated the efficacy of visual feedback, facilitated by an RGB-D camera, in reducing trunk compensation. In total, 17 able-bodied individuals and 18 stroke survivors performed reaching tasks under unrestricted trunk conditions and visual feedback conditions. In the visual feedback modalities, the target position was synchronized with trunk movement at ratios where the target moved at the same speed, double, and triple the trunk's motion speed, providing real-time feedback to the participants. Notably, trunk compensatory movements were significantly diminished when the target moved at the same speed and double the trunk's motion speed. Furthermore, these conditions exhibited an increase in the task completion time and perceived exertion among stroke survivors. This outcome suggests that visual feedback effectively heightened the task difficulty, thereby discouraging unnecessary trunk motion. The findings underscore the pivotal role of customized visual feedback in correcting aberrant upper limb movements among stroke survivors, potentially contributing to the advancement of robotic-assisted rehabilitation strategies. These insights advocate for the integration of visual feedback into rehabilitation exercises, highlighting its potential to foster more effective recovery pathways for post-stroke individuals by minimizing undesired compensatory motions.

Development of the Japanese version of the stroke stigma scale: a validity and reliability assessment

ABSTRACT Background The stigma perceived by many post-stroke persons hinders their social lives. A scale to measure stigma is needed to identify social problems related to stigma, and to evaluate effectiveness of interventions. Objectives This study aimed to develop a Japanese version of the Stroke Stigma Scale (SSS-J), and confirm its utility by examining reliability and validity. Methods Eighty community-dwelling post-stroke individuals were enrolled at six sites. After translating the scale into Japanese using back translation methods, psychometric properties of the rating scale, internal scale validity, and reliability were examined to fit the Rasch model. Criterion-related validity, construct validity, and test-retest reliability were examined using total scores transformed to logit. For test-retest reliability, 30 participants completed the SSS-J twice, one week apart. Results Rasch analysis showed that the SSS-J had the best fit with 15 items on a 3-category rating scale. Item difficulty logits were -2.01 to 2.21, person ability logits were -4.69 to 0.62 (mean, -1.41), person reliability coefficient was 0.71 (separation index, 1.58), and item reliability coefficient was 0.96 (separation index, 5.04). For criterion validity, Spearman’s rank correlation coefficient with the Center for Epidemiologic Studies Depression Scale was 0.51 (p < 0.001). For construct validity, Spearman’s rank correlation coefficients with each subscale of the Stroke Impact Scale ranged from -0.36 to -0.16 (p = 0.002–0.126). For test-retest reliability, the intra-class correlation coefficient was 0.64 (p < 0.001). Conclusions The SSS-J adapted to the Rasch model was reliable and valid. This scale can be used to quantitatively measure stigma among community-dwelling post-stroke persons in Japan.

Grade-4/5 motor activity log—Brazil for post-stroke individuals with a severely impaired upper limb: a validity, reliability and measurement error study

Purpose This study examined the clinimetrics of the Brazilian-Portuguese translation of the Grade-4/5 Motor Activity Log (MAL 4/5), which assesses everyday use of the more affected upper-limb (UL) in stroke survivors with moderate/severe or severe motor impairment. Materials and Methods The translated MAL 4/5 was administered to 47 stroke survivors with moderate/severe or severe UL motor impairment. Accelerometers were worn on participants’ wrists for five days on average prior to the first assessment. Test-retest and inter-rater reliabilities were assessed using the intraclass correlation coefficient (ICC), internal consistency using Cronbach’s α, and construct validity was tested with correlations with the accelerometry. The measurement error (SEM) and the minimal detectable change (MDC) were calculated. Results MAL4/5-Brazil’s test-retest reliability (AOU: ICC = 0.84; QOU: ICC = 0.90), inter-rater reliability (AOU: ICC = 0.83; QOU: ICC = 0.91), internal consistency (Cronbach’s α = 0.91 and 0.95 for AOU and QOU scales, respectively), the SEM and MDC were 0.3 and 0.8 points for the AOU subscale and 0.2 and 0.5 points for the QOU subscale, respectively. The construct validity (AOU scale: r = 0.67; QOU scale: r = 0.76) was high. Conclusion Grade-4/5 Motor Activity Log-Brazil is a reliable and valid instrument for assessing the more-affected UL use of stroke patients with moderate/severe or severe UL motor impairments.

Cycling using functional electrical stimulation therapy to improve motor function and activity in post-stroke individuals in early subacute phase: a systematic review with meta-analysis

BackgroundStroke necessitates interventions to rehabilitate individuals with disabilities, and the application of functional electrical stimulation therapy (FEST) has demonstrated potential in this regard. This study aimed to analyze the efficacy and effectiveness of cycling using FEST to improve motor function and lower limb activity in post-stroke individuals.MethodsWe performed a systematic review according to the recommendations of the PRISMA checklist, searching MEDLINE, Cochrane, EMBASE, LILACS, and PEDro databases by July 2022, without any date or language limitations. Studies were selected using the following terms: stroke, electrical stimulation therapy, cycling, and clinical trials. Randomized or quasi-randomized clinical trials that investigated the effectiveness of cycling using FEST combined with exercise programs and cycling using FEST alone for motor function and activity in subacute post-stroke individuals were included. The quality of included trials was assessed using the PEDro scores. Outcome data were extracted from eligible studies and combined in random-effects meta-analyses. The quality of evidence was determined according to the Grading of Recommendations Assessment, Development, and Evaluation system.ResultsFive randomized clinical trials involving 187 participants were included. Moderate-quality evidence indicates that cycling using FEST combined with exercise programs promotes relevant benefits in trunk control (MD 9 points, 95% CI 0.36–17.64) and walking distance (MD 94.84 m, 95% CI 39.63–150.05, I = 0%), the other outcomes had similar benefits. Cycling using FEST alone compared to exercise programs promotes similar benefits in strength, balance, walking speed, walking distance, and activities of daily living.ConclusionThis systematic review provides low- to moderate-quality evidence that cycling using FEST may be an effective strategy to consider in improving motor function and activity outcomes for post-stroke individuals in the early subacute phase.Review registration: PROSPERO (CRD42022345282).

Experimental Validation of an Upper Limb Benchmarking Framework in Healthy and Post-Stroke Individuals: A Pilot Study.

In the context of neurorehabilitation, there have been rapid and continuous improvements in sensors-based clinical tools to quantify limb performance. As a result of the increasing integration of technologies in the assessment procedure, the need to integrate evidence-based medicine with benchmarking has emerged in the scientific community. In this work, we present the experimental validation of our previously proposed benchmarking scheme for upper limb capabilities in terms of repeatability, reproducibility, and clinical meaningfulness. We performed a prospective multicenter study on neurologically intact young and elderly subjects and post-stroke patients while recording kinematics and electromyography. 60 subjects (30 young healthy, 15 elderly healthy, and 15 post-stroke) completed the benchmarking protocol. The framework was repeatable among different assessors and instrumentation. Age did not significantly impact the performance indicators of the scheme for healthy subjects. In post-stroke subjects, the movements presented decreased smoothness and speed, the movement amplitude was reduced, and the muscular activation showed lower power and lower intra-limb coordination. We revised the original framework reducing it to three motor skills, and we extracted 14 significant performance indicators with a good correlation with the ARAT clinical scale. The applicability of the scheme is wide, and it may be considered a valuable tool for upper limb functional evaluation in the clinical routine.