Post-stroke Fatigue Research Articles

The impact of reminiscent music therapy and robot-assisted rehabilitation on older stroke patients: a protocol for a randomized controlled trial.

Stroke is the main disease that causes the burden of neurological disease, leading to upper limb dysfunction and affecting their self-care abilities. Robot-assisted rehabilitation therapy has been gradually used in the rehabilitation of upper limb function after stroke. However, it would be beneficial to explore auxiliary interventions such as reminiscent music therapy, a combination of music and reminiscent, to relieve negative emotions and post-stroke fatigue and improve rehabilitation outcomes. This protocol aims to evaluate the effectiveness of reminiscent music therapy combined with robot-assisted rehabilitation in older stroke patients. This trial is a single-blind, three-arm randomized controlled trial. Older stroke patients with upper limb dysfunction will be recruited. Participants will be randomly assigned to receive usual rehabilitation treatment and care, usual rehabilitation treatment and care plus robot-assisted rehabilitation and reminiscent music therapy, or usual rehabilitation treatment and care plus robot-assisted rehabilitation. Robot-assisted rehabilitation will be conducted by rehabilitation doctors five times per week for 3 weeks. In experimental group 1, a reminiscent song list will be played for patients. The primary outcome is activities of daily living. All outcomes will be evaluated at baseline and in the week immediately post-intervention. We are conducting the first randomized controlled trial on the effects of reminiscent music therapy combined with robot-assisted rehabilitation in older stroke patients. It is expected that this study, if proven effective in improving the activities of daily living in older stroke patients with upper limb dysfunction, will provide evidence-based rehabilitation strategies for medical staff.Clinical Trial Registration: ChiCTR2200063738.

Association between sleep-disordered breathing and post-stroke fatigue in patients with ischemic stroke

ObjectivesPost-stroke fatigue (PSF) is common and often disabling. Sleep-disordered breathing (SDB) is highly prevalent among stroke survivors and can cause fatigue. We explored the relationship between SDB and PSF over time. Materials and MethodsIschemic stroke (IS) patients within the BASIC project were offered SDB screening with a well-validated cardiopulmonary sleep apnea test at 0, 3-, 6-, and 12-months post-stroke. The primary exposure was the respiratory event index (REI; sum of apneas plus hypopneas per hour). The primary outcome was PSF, measured by the SF-36 vitality scale. Associations between REI and PSF were evaluated using linear regression including time-by-REI interactions, allowing the effect of REI to vary over time. ResultsOf the 411 IS patients who completed at least one outcome interview, 44 % were female, 61 % Mexican American (MA), 26 % non-Hispanic white, with a mean age of 64 (SD 10). Averaged across timepoints, REI was not associated with PSF. In a time-varying model, higher REI was associated with greater PSF at 3-months (β = 1.75, CI = 0.08, 3.43), but not at 6- or 12-months. Across timepoints, female sex, depressive symptoms, and comorbidity burden were associated with greater PSF, whereas MA ethnicity was associated with less PSF. ConclusionsHigher REI was associated with modestly greater PSF in the early post-stroke period, but no association was observed at 6 months and beyond. SDB may be a modest modifiable risk factor for early PSF, but its treatment is unlikely to have a substantial impact on long-term PSF. MA ethnicity seems to be protective against PSF.

Factors associated with fatigue among people who have returned to work after stroke: an exploratory study.

To explore the associations between fatigue impact and (a) personal and stroke-related characteristics, (b) functional impairments and (c) work-related factors among individuals who have returned to work after stroke. A cross-sectional exploratory study. 87 working stroke survivors. This study comprises data from a postal survey targeting work ability and perceived stroke-related consequences 1 year after stroke. Fatigue was evaluated using the Fatigue Severity Scale (FSS). Factors associated with having fatigue (FSS total score ≥ 4) were identified using univariable and multivariable logistic regression analyses. Three domain-specific multivariable models and 1 final combined model were created. Fatigue was reported by 43% of the participants. Several factors representing all the investigated domains were associated with fatigue. In the final combined regression model, self-perceived low cognitive functioning, low decision control at work and high quantitative job demands had the strongest independent effects on the odds of having fatigue. Among people who were working 1 year after stroke, fatigue was associated with both personal and stroke-related characteristics as well as functional impairments and work-related factors. This highlights the complex nature of post-stroke fatigue. Fatigue management interventions should have a comprehensive approach and also consider the work environment.

Validating the Fatigue Scale for Motor and Cognitive Function (FSMC) in chronic stroke.

Post-stroke fatigue can manifest as both physical and mental fatigue. The Fatigue Scale for Motor and Cognitive Functions (FSMC) evaluates fatigue on the motor and cognitive domains separately, however, the psychometric properties of this measure in stroke have not been reported. To determine the internal consistency, test-retest reliability, and concurrent validity of the FSMC in chronic stroke. Thirty-four participants with chronic stroke (55.26±12.27 years of age; 59.53±89.21 months post-stroke) completed the FSMC on two separate visits. Internal consistency and reliability of the FSMC were examined using Cronbach's alpha and two-way mixed effects intraclass correlation coefficients (ICC), respectively. Correlation between the FSMC and the Fatigue Severity Scale and Visual Analog Scale-Fatigue was used to assess concurrent validity. Internal consistency was excellent (Cronbach's alpha > 0.9) and reliability was moderate to good (ICC = 0.72-0.81) for all FSMC scores. The FSMC demonstrated moderate to good concurrent validity with the Fatigue Severity Scale (ρ= 0.66-0.72) but only fair concurrent validity with the Visual Analog Scale-Fatigue (ρ= 0.37-0.44). The FSMC is a valid and reliable measure of post-stroke fatigue and may be a useful tool to examine physical fatigue and cognitive fatigue in chronic stroke.

Relationship between glycated hemoglobin levels at admission and chronic post-stroke fatigue in patients with acute ischemic stroke

BackgroundChronic Post-Stroke Fatigue (PSF) is a common and persistent complications among ischemic stroke survivors. The serum glycated hemoglobin (HbA1c) level, as it is known has emerged as a critical risk factor for Acute Ischemic Stroke (AIS) and post-stroke cognitive and emotional impairment. However, no studies have been conducted on the link between HbA1c and PSF. Therefore, this study aims to estimate the relationship between HbA1c and PSF in the chronic phase. MethodsA longitudinal study was conducted on 559 patients diagnosed with their first AIS episode and admitted to Suining Central Hospital within three days after onset. All patients were examined for serum HbA1c, blood glucose levels and routine blood biochemical indicators at admission. The Fatigue Severity Scale (FSS) was employed to assess fatigue symptoms at six months post-stroke. Multivariate logistic regression and smooth curve fitting were used to analyze the relationship between admission HbA1c, blood glucose levels, discharge blood glucose and PSF, and the predictive value of HbA1c on PSF was assessed using a segmented linear regression model. Results189(33.8 %)of the 559 patients included in the study, reported PSF at six-month follow-up. Compared with the non-PSF group, the PSF group displayed significantly higher levels of HbA1c (7.8 ± 3.0 vs 6.5 ± 2.0 %, P < 0.001), admission blood glucose (7.8 ± 3.8 vs 7.1 ± 3.5 mmol/L, P = 0.041), and discharge blood glucose (6.3 ± 1.6 vs 5.8 ± 1.2 mmol/L, P < 0.001). The dose-response relationship among admission HbA1c, blood glucose, discharge blood glucose and PSF showed that HbA1c level is positively and non-linearly related to the risk of PSF. A linear positive correlation is noted between PSF and discharge blood glucose levels, while no significant correlation was observed for the blood glucose levels upon admission. ConclusionsHigher HbA1c levels at admission were independently associated with the risk of chronic PSF, the correlation between blood glucose and PSF showed significant variability, HbA1c may serve as a more stable risk factor in predicting the occurrence of chronic PSF and long-term active glycemic management may have a favorable impact on chronic PSF after AIS.

Validation of the Turkish version of the Neurological Fatigue Index for Stroke

ABSTRACT Introduction Post-stroke fatigue is an often overlooked problem that hinders recovery. Therefore, stroke patients should be evaluated for fatigue during the recovery period. This study aimed to adapt the Neurological Fatigue Index for Stroke (NFI-Stroke) into the Turkish language. Methods This methodological study was carried out on 110 stroke patients admitted to a university hospital in Istanbul. In addition to the NFI-Stroke, Functional Independence Measure, National Institutes of Health Stroke Scale, modified-Rankin Scale, Fatigue Severity-Scale, and Stroke Self Efficacy Questionnaire were used to collect data. Results Since the linguistic validity study of the scale has already been carried out, only psychometric properties were evaluated. The items in the scale were grouped under two factors. The Cronbach`s alpha coefficient was found to be 0.96 for the physical sub-dimension and 0.84 for the cognitive sub-dimension. Item-total correlation coefficients were found between 0.74-0.91 for the physical sub-dimension, and 0.82-0.91 for the cognitive sub-dimension. The test-retest evaluation confirmed the consistency of the responses to the scale against time. The scale was correlated with other scales used in the study as expected. Conclusions The NFI-Stroke will be useful in clinical practice in assessment of fatigue, which may affect the adaptation of patients to rehabilitation.

Survey of the clinical practices of physiotherapists for the management of post-stroke fatigue.

Post-stroke fatigue (PSF) is a common condition among stroke survivors. However, evidence supporting the effective clinical management of PSF is insufficient. Our objectives were to examine the clinical practices of physiotherapists for the management of PSF and evaluate their clinical knowledge and confidence in managing PSF. We conducted a cross-sectional study using an online survey of the sociodemographic profiles of participating physiotherapists, their current clinical practices, clinical knowledge, confidence in their clinical management of PSF, and the types and intensity of the exercises used in the management of PSF. A total of 160 physiotherapists completed the survey: 86 (53.8%) were women, 148 (92.5%) were Saudi nationals, 126 (78.7%) were employed by the Ministry of Health, and 34 (21.3%) worked in the private sector. The majority (60%) of physiotherapists did not routinely assess their patients for the presence of fatigue. Likewise, 93 (58.1%) did not provide any PSF-related educational material to their patients; however, 67 (41.9%) did provide these materials. The preferred exercises of the physiotherapists for their patients were bed and chair exercises (59.5%), followed by functional training (51.4%), and resistance training (23.1%). Our results suggest that while physiotherapists practicing in Saudi Arabia have a sound theoretical understanding of PSF management, their knowledge does not necessarily translate into practice. Interventions used to treat PSF include bed and chair exercises, functional training, and resistance training.

Exploring the Mediating Role of Sleep Deficit-Related Functional Status in Subacute Stroke Survivors.

Background: Understanding post-stroke fatigue (PSF) and its associated factors is crucial for effective therapy and rehabilitation. This study aimed to assess the mediating role of the excessive daytime sleepiness-related functional status (SFS) on the relationship between sleep and the severity of fatigue in subacute stroke survivors. Methods: Subacute stroke survivors (n = 50; male = 38; female = 12), completed a cross-sectional study involving the Pittsburgh sleep quality index (PSQI), the Epworth sleepiness scale (ESS), the insomnia severity index (ISI), the functional outcome of the sleep questionnaire (FOSQ), and the fatigue severity scale (FSS). Results: The SFS mediated the association between the severity of fatigue and sleep problems. The PSQI and FOSQ (b = -0.37, p < 0.001), and the FOSQ and FSS were correlated (b = -0.18, p < 0.05), with a significant indirect effect of the PSQI on the FSS. The ISI correlated with the FOSQ (b = -0.20, p < 0.001), with significant direct (b = 0.15, p < 0.001), as well as indirect, effects of the ISI on the FSS. The ESS correlated with the FOSQ (b = -0.23, p < 0.001), with a significant indirect effect of the ESS on the FSS. Conclusions: In subacute stroke survivors, fatigue and sleep are linked. Increased understanding of sleep-PSF may help in exploring new targets for supplement therapy.

Effect of high-definition transcranial direct current stimulation among late-subacute and chronic stroke survivors with fatigue: A randomized-controlled crossover trial protocol

Post-stroke fatigue (PSF) is a commonly overlooked symptom that impacts daily functioning and quality of life. It is caused by altered functional connectivity within the brain networks, which can potentially be influenced by neuromodulation. Multiple cortical regions have been targeted to reduce PSF, but the most efficient ones remain uncertain. Therefore, we aim to identify the most appropriate cortical stimulation site to reduce PSF. Twenty participants with PSF will be included in this cross-over trial. Each participant will receive one session of active anodal high definition- transcranial direct current stimulation (HD-tDCS) over three different cortical areas and one session of sham tDCS in a cross-over manner, with a two-week of washout period in between. Pre- and post- fatigue will be assessed using Fatigue Severity Scale and fatigability using electromyography by determining the time to task failure. Resting-state electroencephalography will be performed before and after each stimulation session to determine the functional connectivity of the cortical areas stimulated.

Post-stroke fatigue, hope and discharge readiness: A cross-sectional survey.

To explore the relationships among post-stroke fatigue, hope and discharge readiness in stroke patients, and to determine whether hope mediates the relationship between post-stroke fatigue and discharge readiness. In stroke patients, inadequate discharge readiness has been found to correlate with higher readmission and mortality rates. Although previous qualitative studies have confirmed the impact of fatigue on discharge readiness, few studies explore the impact of post-stroke fatigue and hope on discharge readiness of stroke patients. Consequently, the current research on this relationship and its underlying mechanisms is still quite limited. Cross-sectional study. Data were collected from 340 stroke patients. The research tools included demographic and disease characteristics, Discharge Readiness Assessment Scale for Stroke, Neurological Fatigue Index for Stroke and Herth Hope Index. The STROBE checklist was used to guide the presentation of this study. Discharge readiness was negatively correlated with post-stroke fatigue and positively correlated with hope. Additionally, post-stroke fatigue was negatively correlated with hope. Post-stroke fatigue had a direct negative effect on discharge readiness, and it can also generate indirect effects through hope. Hope was the partial mediator between post-stroke fatigue and discharge readiness, explaining 55.8% of the total effect. Discharge readiness of this population can be improved by reducing post-stroke fatigue and increasing hope. Therefore, effective management of post-stroke fatigue and hope will help improve discharge readiness. It is recommended that nursing staff should monitor the occurrence and development of post-stroke fatigue in stroke patients, dynamically evaluate the patient's level of hope, and pay attention to the important role of positive psychological qualities in the outcome of discharge. If medical staff can formulate corresponding intervention measures based on the influence path of discharge readiness, then the discharge readiness of stroke patients can be improved.

Influence of Perceptual Load on Attentional Orienting in Post-Stroke Fatigue: A Study of Auditory Evoked Potentials

Objective Increasing perceptual load alters behavioral outcomes in post-stroke fatigue (PSF). While the effect of perceptual load on top-down attentional processing is known, here we investigate if increasing perceptual load modulates bottom-up attentional processing in a fatigue dependent manner. Methods In this cross-sectional observational study, in 29 first-time stroke survivors with no clinical depression, an auditory oddball task consisting of target, standard, and novel tones was performed in conditions of low and high perceptual load. Electroencephalography was used to measure auditory evoked potentials. Perceived effort was rated using the visual analog scale at regular intervals during the experiment. Fatigue was measured using the fatigue severity scale. The effect of fatigue and perceptual load on behavior (response time, accuracy, and effort rating) and auditory evoked potentials (amplitude and latency) was examined using mixed model ananlysis of variances (ANOVA). Results Response time was prolonged with greater perceptual load and fatigue. There was no effect of load or fatigue on accuracy. Greater effort was reported with higher perceptual load both in high and low fatigue. p300a amplitude of auditory evoked potentials (AEP) for novel stimuli was attenuated in high fatigue with increasing load when compared to low fatigue. Latency of p300a was longer in low fatigue with increasing load when compared to high fatigue. There were no effects on p300b components, with smaller N100 in high load conditions. Interpretation High fatigue specific modulation of p300a component of AEP with increasing load is indicative of distractor driven alteration in orienting response, suggestive of compromise in bottom-up selective attention in PSF.

Abstract 140: Sleep-Disordered Breathing Shortly After Stroke Does Not Predict Post-Stroke Fatigue at 3-months

Background: Post-stroke fatigue (PSF) is a common and often disabling symptom, the causes of which are poorly understood. Sleep-disordered breathing (SDB) is highly prevalent among stroke survivors, and can cause fatigue. We examined whether SDB measured shortly after stroke predicted PSF at 3-months, and thus whether SDB might represent an intervention target for the treatment/prevention of PSF. Methods: Ischemic stroke (IS) patients within the Brain Attack Surveillance in Corpus Christi (BASIC) project were identified through active and passive surveillance, and were offered SDB screening with a well-validated cardiopulmonary sleep apnea testing device. The primary exposure was the respiratory event index (REI; sum of apneas plus hypopneas per hour of recording), measured shortly after stroke. The primary outcome was PSF, measured 3-months post-stroke, using the SF-36 vitality scale. Linear regression was used to evaluate the association between baseline REI and 3-month PSF, adjusting for clinical and sociodemographic factors listed in the Table, which were obtained from chart review and interviews. Results: A total of 355 IS participants completed baseline SDB screening and 3-month PSF assessments from May 2016 to December 2019. Participants were 44% female, 60% Mexican American (MA), and had a median NIHSS of 2 (IQR: 1-5). Multivariable regression model results are presented in the Table. No association between baseline REI and 3-month PSF was observed in unadjusted (β=0.95, 95% CI=-1.16, 3.05) or fully adjusted models (β=0.66, 95% CI=-1.40, 2.73). In the fully adjusted model, female sex and depression were associated with greater fatigue, while older age and MA ethnicity were associated with less fatigue. Conclusions: SDB in the immediate post-stroke period, at least in this predominantly MA sample, does not predict PSF at 3-months. Though identification and treatment of post-stroke SDB may be important, these efforts are unlikely to impact PSF.

Abstract TMP29: Plasma Proteomics Demonstrates Immune Dysregulation in Chronic Post-Stroke Fatigue

Introduction: Post-stroke fatigue is a common and impactful complaint of stroke survivors. As with fatigue from other causes, our understanding of the biological underpinnings of post-stroke fatigue is poor. Here we used plasma proteomics to better understand post-stroke fatigue. Methods: We report here on 97 participants 5 months to 10 years after ischemic stroke. Functional Assessment of Chronic Illness-Fatigue (FACIT) scale was used to assess fatigue. Disability and self-reported mood was measured using the modified Rankin Scale (mRS) and the Stroke Impact Scale’s mood subset (SIS3), respectively. We dichotomized participants into non-fatigued (FACIT &gt;41) and fatigued (FACIT ≤41) groups and employed a binary logistic regression to examine associations with clinical variables. Aptamer-based proteomics (Somalogic) was used to quantify 7288 plasma proteins, after which we performed pathway analyses. Results: Fatigue was present in 49.4% of our cohort. 39.2% was female and the mean age was 64.2±12.8. When adjusted for age and sex, a prior diagnosis of hypertension (OR=2.7, 95% CI 1.09-6.75, p=0.032) or any psychiatric disorder (OR=8.8, 95% CI 2.54-31, p&lt;0.001) was associated with fatigue. Adjustment for time since stroke did not affect these associations. Higher mRS (rho=-0.49) and worse SIS3 (rho=0.59) were associated with more fatigue. 215 proteins had an absolute correlation coefficient greater than 0.3 and differed between fatigued and non-fatigued patients (p&lt;0.001). Pathway analysis revealed dysregulation of both innate and adaptive immune responses and cytoskeletal regulation. The JAK/STAT pathway was highly dysregulated. In fatigued patients, plasma levels of several components were significantly elevated (log2Fc); CCL5 (0.81), JAK2 (0.73), and STAT3(0.53). The largest downregulation was in fetuin (AHSG, log2Fc -5.5), which contributes to the most down regulated pathway, regulation of ossification, and is an immunosuppressant. Conclusion: Immune dysregulation after stroke may be associated with fatigue, particularly upregulation of the JAK/STAT pathway and downregulation of fetuin. More studies are needed to replicate these findings and to probe mechanisms.

Abstract TP75: Age at Time of Stroke Does Not Predict Post-Stroke Fatigue

Introduction: Post-stroke fatigue (PSF) is a long-term sequelae of stroke that negatively impacts patients and their rehabilitation. Approximately 38% of people hospitalized for a stroke are less than 65 years old. Studies regarding PSF and age are sparse and vary in their results. We examined whether age at time of ischemic stroke correlates with the severity of PSF of ischemic stroke patients in a predominantly Afro-Caribbean population. Methods: An IRB-approved prospective, observational study. Patients above 18 years of age with a diagnosis of ischemic stroke in the past 3 years were enrolled after informed consent. Patients with treated depression, significant cognitive impairment, or active cancer were excluded. The Fatigue Assessment Scale (FAS) was used to measure the level of PSF. Linear regression analysis was used to examine the relationship between age at time of stroke and severity of FAS score, adjusted for sex, NIH Stroke Scale (NIHSS), Modified Rankin Scale (mRS), and Beck Depression Inventory (BDI) scores. A general linear model was used to predict log-log-transformed total FAS score from age at stroke, BDI score, mRS score, NIHSS score, and sex. First-order interactions among predictors were investigated; model residuals were examined for skew and for outliers. Results: Of the 121 patients included, 55.4% are female, the mean age is 65.3 +/- 12.1 years old, 93.4% have hypertension, and 60.3% have diabetes mellitus. The median FAS score is 19 (IQR 15-25), median NIHSS score is 3 (IQR 2-5), and median mRS score is 1 (IQR 0-2). Crude Spearman Correlation between age at stroke and total FAS score was -0.07. Age at stroke was not an independent predictor of FAS score (p=0.545). R 2 for the model was 0.38. Both BDI score (p&lt;0.001) &amp; mRS score (p=0.024) were positively associated with transformed FAS score. Conclusion: Our data suggests that age at time of stroke is not independently correlated with severity of PSF in a predominantly Afro-Caribbean population.

Abstract TP264: Does Cerebral White Matter Disease Predict Post-Stroke Fatigue or Depression in an Afro-Caribbean Cohort?

Background and Purpose: Fatigue and depression frequently occur after ischemic stroke and are associated with worse Health-Related Quality of Life. While there has been research on the correlation between the burden of white matter disease (WMD) and the onset of depressive symptoms, this relationship has yet to be validated in patients with stroke from minority groups. Methods: An IRB-approved retrospective, cross-sectional study. The study sampled a cohort of patients aged ≥18 years old who had stroke within the last 3 years and were assessed with standardized questionnaires for fatigue (Fatigue Assessment Scale [FAS], score range 10-50) and depression (Beck’s Depression Inventory, score range 0-63). Exclusion criteria included patients with prior depression or severely disabling pre-existing conditions that would confound assessment. Patients with available MRI were evaluated using the Fazekas scale (score range 0-3), a validated visual scale (correlates significantly with automated software), to grade WMD. Grading was conducted blinded to patient's fatigue and depression scores. The collected ordinal data presented a non-parametric distribution thus was analyzed using the Spearman correlation coefficient. Results: Of 72 patients with available MRI, 96% identified as African or Caribbean; mean age = 66, median FAS score = 19 (IQR 14-26), and median BDI score = 6 (IQR 2-11). The prevalence of stroke-related disability (modified ranking scale ≥ 2) was 38%. Within the Fazekas grading, the score was 0 in 12.4%, 1 in 41.4%, 2 in 31.7%, and 3 in 13.8%. Spearman correlation coefficients showed non significant associations between WMD severity and either depression ( R s =0.058, p=0.62, 95%CI -0.17,0.29) or fatigue ( R s =0.059, p=0.62, 95% CI -0.18,0.30). Conclusion: Our results suggest no association between WMD severity and the development of post-stroke fatigue or depression in an Afro-Caribbean population. However, the lack of statistical significance might be due to limited sample size and patient heterogeneity, since few patients exhibited high scores for fatigue and depression. Additional studies are needed to validate the absence of correlation.

Reminiscent music therapy combined with robot-assisted rehabilitation for elderly stroke patients: a pilot study

BackgroundAlthough some studies suggest that robot-assisted technology can significantly improve upper limb function in stroke patients compared to traditional rehabilitation training, it is still necessary to incorporate an auxiliary intervention to alleviate negative emotions, thereby alleviating the post-stroke fatigue and encouraging patients to actively respond to rehabilitation. However, the effect of the auxiliary intervention is unknown.ObjectiveTo evaluate the effect of reminiscent music therapy combined with robot-assisted rehabilitation in elderly patients with upper limb dysfunction.MethodsFrom November 2022 to March 2023, elderly patients with upper limb dysfunction after stroke were assigned to one of three groups, with group A receiving usual rehabilitation treatment and care plus robot-assisted rehabilitation and reminiscent music therapy, group B receiving usual rehabilitation treatment and care plus robot-assisted rehabilitation, and group C receiving only usual rehabilitation treatment and care. Thirty patients completed this study, with 10 participants in each group. Activities of daily living, self-esteem, rehabilitation self-efficacy, positive emotion and upper limb function were measured before and after the intervention. One-way analysis of variance, paired-sample t-test, Kruskal-Wallis H test, Wilcoxon signed rank sum test and Chi-square test were used to analyze the data.ResultsAccording to the intragroup comparisons, in the three groups, all outcome measurements were significantly higher than those at baseline (all P < 0.05). After the intervention, the differences in the self-management effectiveness, rehabilitation self-efficacy, and positive emotion score were statistically significant among the three groups (all P < 0.05). In accordance with the results of Bonferroni analysis, the self-management effectiveness score of group A was significantly higher than that of Group B and Group C (all P < 0.05). The rehabilitation self-efficacy score of group A was significantly higher than that of Group B and Group C (P < 0.05). The positive emotion score of group A was significantly higher than that of Group B and Group C (P < 0.05).ConclusionReminiscent music therapy combined with robot-assisted rehabilitation is a promising approach to improve rehabilitation self-efficacy and positive emotion, which is evidence that reminiscent music therapy may be an effective auxiliary intervention to improve rehabilitation outcomes.

Risk factors for early-onset and late-onset fatigue after a stroke

BACKGROUND. Post-stroke fatigue is a predictor of adverse outcomes such as high mortality, worse functional outcome and daily living dependence. It is a heterogeneous syndrome that changes over time, as demonstrated by studies.&#x0D; AIM. The aim of the study was to assess dynamic changes of risk factors related to post-stroke fatigue during a year after first-ever stroke.&#x0D; MATERIALS AND METHODS. This study formed a section of a prospective observational study involving of a cohort of 348 patients experiencing their first-ever stroke (53.2% male, 46.8% of female, with a mean age of 66±12 years). During the acute stroke period, 75 patients completed the Fatigue Severity Scale (FSS). Additionally, 19 patients completed the FSS at both 3 and 6 months after their stroke, while 33 patients did so at 12 months post-stroke. The neurological (NIHSS, Rankin) and psychiatric (HDRS, HARS) evaluation scores, pain scores measured with visual analogue scales, cognitive test results (MMSE, TMT-B) taken at the same time point, and locus control testing were compared with these findings. Spearman coefficient was utilized. The relationship between fatigue and depression (DSM-IV), stroke location, and patients’ demographic characteristics were tested with a χ2-test to avoid partiality.&#x0D; RESULTS. Fatigue following a stroke during the acute stage showed an association with pain, depression, anxiety scores and complaints about cognitive dysfunction prior to the stroke. In contrast, late-onset fatigue (12 months post-stroke) demonstrated a link with medical locus of control and more severe neurological deficit.&#x0D; CONCLUSION. Post-stroke fatigue manifests as a heterogeneous syndrome, characterized by changes in risk factors over time. Due to its complexity, accurate assessment necessitates the use of modern technologies, such as EMA and digital phenotyping.

Altered functional connectivity in patients with post-stroke fatigue: A resting-state fMRI study

BackgroundPost-stroke fatigue (PSF) was a common complication after stroke. This study aimed to explore the neuroimaging mechanism of PSF, which was rarely studied. MethodsPatients with the first episode of ischemic stroke were recruited from the First Affiliated Hospital of Wenzhou Medical University between March 2021 and December 2022. The fatigue severity scale (FSS) was used to assess fatigue symptoms. PSF was diagnosed by a neurologist based on the FSS score and PSF diagnostic criteria. All the patients were scanned by resting-state functional MRI (rs-fMRI). Precuneus, the posterior node of default-mode network (pDMN), was related to fatigue. Therefore, imaging data were further analyzed by the seed-based resting-state functional connectivity (FC) approach, with the left (PCUN.L) and right precuneus (PCUN.R) being the seeds. ResultsA total of 70 patients with acute ischemic stroke were finally recruited, comprising 40 patients with PSF and 30 patients without PSF. Both the PCUN.L and PCUN.R seeds (pDMN) exhibited decreased FC with the prefrontal lobes located at the anterior part of DMN (aDMN), and the FC values were negatively correlated with FSS scores (both p < 0.001). These two seeds also exhibited increased FC with the right insula, and the FC values were positively correlated with FSS scores (both p < 0.05). ConclusionThe abnormal FC between the aDMN and pDMN was associated with PSF. Besides, the insula, related to interoception, might also play an important role in PSF.

Functional connectome hierarchy of thalamus impacts fatigue in acute stroke patients.

This study aimed to explore the topographic features of thalamic subregions, functional connectomes and hierarchical organizations between thalamus and cortex in poststroke fatigue patients. We consecutively recruited 121 acute ischemic stroke patients (mean age: 59years) and 46 healthy controls matched for age, sex, and educational level. The mean age was 59years (range 19-80) and 38% of acute stroke patients were females. Resting-state functional and structural magnetic resonance imaging were conducted on all participants. The fatigue symptoms were measured using the Fatigue Severity Scale. The thalamic functional subdivisions corresponding to the canonical functional network were defined using the winner-take-all parcellation method. Thalamic functional gradients were derived using the diffusion embedding analysis. The results suggested abnormal functional connectivity of thalamic subregions primarily located in the temporal lobe, posterior cingulate gyrus, parietal lobe, and precuneus. The thalamus showed a gradual increase from the medial to the lateral in all groups, but the right thalamus shifted more laterally in poststroke fatigue patients than in non- poststroke fatigue patients. Poststroke fatigue patients also had higher gradient scores in the somatomotor network and the right medial prefrontal and premotor thalamic regions, but lower values in the right lateral prefrontal thalamus. The findings suggested that poststroke fatigue patients had altered functional connectivity and thalamocortical hierarchical organizations, providing new insights into the neural mechanisms of the thalamus.

Fatigue Models and Poststroke Fatigue: A Literature Review

Poststroke fatigue (PSF) is a common complication affecting a wide range of stroke patients, yet it remains under-reported and underestimated. PSF's exact underlying cause has not yet been identified and it seems to be multifactorial, with several models developed to answer that question. Identifying the true nature of PSF and its risk factors would help improve the quality of life of stroke patients.