Stage Of Stroke Recovery Research Articles

Clinical observation of tuina plus rehabilitation therapy for lower limb extensor spasticity in recovery stage of stroke

To observe the clinical efficacy of traditional tuina plus modern rehabilitation in the treatment of lower limb extensor spasticity during stroke recovery. A total of 93 stroke patients who met the inclusion criteria were randomly divided into an observation group and a control group. Forty-four patients in the observation group were treated with traditional tuina plus modern rehabilitation, and 49 patients in the control group were treated with modern rehabilitation. The modified Ashworth scale (MAS), the Fugl-Meyer assessment scale (FMA) and the modified Barthel index (MBI) were used to evaluate the knee extensors state, lower limb motor function and activities of daily living (ADL) of the two groups. After treatment, the overall efficacy of the observation group was better than that of the control group, and the difference was statistically significant (P<0.05). After treatment, the MAS scores of both groups were significantly lower, FMA and MBI scores were significantly higher, and the differences were statistically significant in each group (P<0.01). After treatment, the MAS score of the observation group was lower than that of the control group, and the difference between the groups was statistically significant (P<0.01). The MBI score of the observation group was higher than that of the control group, and the difference between the two groups was statistically significant (P<0.05). There were significant differences in the post-treatment changes in MAS, FMA and MBI scores between the two groups (all P<0.05). Traditional tuina plus modern rehabilitation therapy can effectively alleviate or prevent lower limb extensor spasticity after stroke, and improve limb mobility and ADL. Hence, it is worthy of clinical promotion.

Systemic inflammation and sarcopenia in recovery stage of stroke: The negative impact on functional rehabilitation outcomes

To determine how systemic inflammation relates to sarcopenia and its impact on functional outcomes in the recovery stages of stroke. A retrospective cohort study was performed in consecutive patients admitted to convalescent rehabilitation wards. Patients with acute or chronic high-grade inflammatory diseases were excluded. Systemic inflammation was evaluated using the modified Glasgow Prognostic Score (mGPS). Sarcopenia was defined as a loss of skeletal muscle mass and decreased muscle strength with the cut-off values set by Asian Working Group for Sarcopenia. The primary outcome was the motor domain of the Functional Independence Measure (FIM-motor). Univariate and multivariate analyses were used to determine whether mGPS was associated with sarcopenia and FIM-motor at discharge. The present study included 204 patients (mean age of 74.1 years, 109 men, and 95 women) for analysis. An mGPS score of 0, 1 and 2 was assigned to 149 (73.0%), 40 (19.6%) and 13 (6.4%) patients, respectively. Sarcopenia was diagnosed in 81 (39.7%) patients and independently associated with stroke history (odds ratio [OR] 1.890, P = 0.027), premorbid modified Rankin scale (OR 1.520,P = 0.040), body mass index (OR 0.858, P = 0.022), and mGPS score (OR 1.380, P = 0.021). Furthermore, the mGPS score was independently associated with FIM-motor at discharge (Beta = −0.134, P = 0.038). Systemic inflammation is closely associated with sarcopenia and poor functional outcomes in the recovery stage of stroke. Early detection of systemic inflammation and sarcopenia can help promote both adequate exercise and nutritional support to restore muscle mass and improve functional recovery in the post-stroke patients.

Systemic Inflammation in the Recovery Stage of Stroke: Its Association with Sarcopenia and Poor Functional Rehabilitation Outcomes.

The aim of our study was to investigate how systemic inflammation relates to sarcopenia and its impact on functional outcomes in the recovery stages of stroke. A retrospective cohort study was performed in consecutive patients admitted to convalescent rehabilitation wards following stroke. Patients with acute or chronic high-grade inflammatory diseases were excluded. Systemic inflammation was evaluated using the modified Glasgow Prognostic Score (mGPS). Sarcopenia was defined as a loss of skeletal muscle mass and decreased muscle strength, with the cut-off values set by the Asian Working Group for Sarcopenia. The primary outcome was the motor domain of the Functional Independence Measure (FIM-motor). Univariate and multivariate analyses were used to determine whether mGPS was associated with sarcopenia and FIM-motor at discharge. The study included 204 patients (mean age 74.1 years, 109 men). mGPS scores of 0, 1, and 2 were assigned to 149 (73.0%), 40 (19.6%), and 13 (6.4%) patients, respectively. Sarcopenia was diagnosed in 81 (39.7%) patients and was independently associated with stroke history (odds ratio [OR] 1.890, P=0.027), premorbid modified Rankin scale (OR 1.520, P=0.040), body mass index (OR 0.858, P=0.022), and mGPS score (OR 1.380, P=0.021). Furthermore, the mGPS score was independently associated with sarcopenia (OR 1.380, P=0.021) and FIM-motor at discharge (β=-0.131, P=0.031). Systemic inflammation is closely associated with sarcopenia and poor functional outcomes in the recovery stage of stroke. Early detection of systemic inflammation and sarcopenia can help promote both adequate exercise and nutritional support to restore muscle mass and improve post-stroke functional recovery.

Design, characterisation and evaluation of a soft robotic sock device on healthy subjects for assisted ankle rehabilitation

Motor impairment is one of the common neurological conditions suffered by stroke patients, where this chronic immobility together with the absence of early limb mobilisation can lead to conditions such as joint contracture with spastic limbs. In this study, a soft robotic sock device was developed, which can provide compliant actuation to the ankle joint in the early stage of stroke recovery. The device is fitted with soft extension actuators and when the actuators are inflated, they extend and guide the foot into plantarflexion; upon deflation, the actuators will resume their initial conformations. Each actuator is linked to a pneumatic pump-valve control system that injects pressurised air into or release air from the system. In this study, the design and characterisation of the soft actuators will be presented, where the theoretical and experimental forces generated by the actuators were compared. The performance of the device was also evaluated on healthy subjects and the results had shown that the device was able to move the subjects’ ankles into cycles of dorsiflexion-plantarflexion, in the absence of voluntary muscle effort. The findings suggested that the soft wearable robotic device was capable of assisting the subjects in performing repeated cycles of ankle flexion.

How Physically Active Are People Following Stroke? Systematic Review and Quantitative Synthesis.

Mobility limitations are common following stroke and frequently lead to poor participation in physical activity (PA). The purpose of this study was to describe PA across the various stages following stroke (acute, subacute, and chronic). Searches were conducted in 5 databases. Eligible studies included participants with stroke whose PA was quantitatively measured for at least 4 hours in a single session. Two reviewers independently reviewed titles and abstracts. One reviewer extracted data and assessed quality using the Downs and Black checklist. Weighted means were calculated for PA outcomes. Searches yielded 103 eligible papers including 5306 participants aged 21 to 96 years. Devices (eg, activity monitors) were used in 73 papers, and behavioral mapping (observational monitoring) in 30. Devices show that people with stroke took on average 5535 steps per day (n = 406, 10 studies) in the subacute phase and 4078 steps (n = 1280, 32 studies) in the chronic phase. Average daily walking duration (% measured time) was higher in the chronic phase (9.0%, n = 100) than subacute (1.8%, n = 172), and sedentary time was >78% regardless of time post stroke. Acute data were lacking for these variables. Matched healthy individuals took an average of 8338 steps per day (n = 129). Behavioral mapping showed time in bed was higher in the acute than subacute phase (mean 45.1% versus 23.8%), with similar time spent sitting (mean 37.6% versus 32.6%). Limitations of this review include not pooling data reported as medians. Physical activity levels do not meet guidelines following stroke. Time spent inactive and sedentary is high at all times. Increasing PA and developing standardized activity targets may be important across all stages of stroke recovery.

Neurorestorative effect of erythropoietin and environmental enrichment in the early stage of stroke recovery

ABSTRACTThe purpose of this study was to investigate whether erythropoietin (EPO) and environmental enrichment (EE) after hypoxic ischemic insult can prevent brain damage, improve neuronal plasticity, and reduce sensorimotor deficits and whether the combination of EPO and EE has a synergistic effect. Sixty Sprague-Dawley rats were used for this study. The rats were divided into three groups: middle cerebral artery occlusion (MCAO) without treatment, MACO + EPO, and MCAO + EPO + EE. For the behavior test, the foot-fault test and measurement of the crossing time in the parallel bars were used. Infarct volume measurement, Neuronal nuclei (NeuN) immunohistochemistry, western blot of the synaptophysin (SYP), and Growth-Associated protein 43 (GAP-43) were used. On postoperative days (POD) at 1 week and 4 weeks, group of EPO and EE increased the recovery as seen in the behavior test. The infarct volume of the EPO group was 32.4%, the EPO + EE group was 28.5%, and the control group was 44.0% on POD 4 weeks. The SYP and GAP-43 expression showed an increase in the EPO and EPO + EE group compared with the MCAO group. EPO and EPO + EE treatment creates a neurorestorative effect, improved neural plasticity, and reduced sensorimotor deficits. But the synergistic effect of the combination of EPO and EE was significantly not proved. In the results of this study, we suggest that EPO and EE treatment may offer a neruorestoration, which can improve the functional brain disturbance of stroke patients.

The assessment of the efficacy of citicoline in the early and recovery stages of stroke

The review presents data on the evaluation of the efficacy of citicoline in ischemic stroke. It presents research findings about the effect of citicoline to reduce infarct volume in animal models of cerebral ischemia. Long-term treatment of CDP-choline initiated 24 hours after stroke contributes to the increased plasticity of neurons in intact brain areas (functionally associated with the damaged areas) and accelerated functional recovery. The oral administration of citicoline within the first 24 hours after the onset of symptoms in moderate and severe stroke increases the probability of complete recovery in 3 months. A neuroprotective effect of citicoline in acute and early restorative stages of stroke accompanied by cognitive impairment was shown. According to the results of clinical trials of the dosage regimen, citicoline administered in the dose of 1000 mg/day for 8 weeks accelerates the regression of hemiplegia; the intravenous injection in the dose of 750 mg/day for 10 days, starting with the first 48 hours of stroke onset symptoms, promotes the recovery of motor and cognitive functions; the intravenous injection in the dose of 1 g within 14 days improves the recovery of consciousness, general condition and functional status.

Selecting Measures for Balance and Mobility to Improve Assessment and Treatment of Individuals After Stroke

Assessment of individuals with stroke using reliable and valid outcome measures is a key component of the treatment planning process. Health care professionals may have difficulty selecting balance and mobility measures given the large number of measures to choose from. This article utilizes a case-based approach to describe the benefits of using a common set of outcome measures and a process for selecting optimal measures across body structure/function, activity, and participation domains of the International Classification of Functioning, Disability and Health (ICF) model and stages of stroke recovery. Specific measures for use in acute care, rehabilitation, outpatient, and home health care settings are discussed based on StrokEDGE task force recommendations by the Neurology Section of the American Physical Therapy Association.

Validity of Rating of Perceived Exertion Ranges in Individuals in the Subacute Stage of Stroke Recovery

Background: Rating of perceived exertion (RPE) is used to monitor or prescribe workload of exercise, but its utility among individuals with a stroke remains in question. Objective: To examine the validity of RPE at multiple percentages of peak aerobic capacity (Vo2peak) in individuals in the subacute stage of stroke recovery. Methods: Thirty-seven patients with stroke in the subacute stage of recovery from an inpatient rehabilitation institute completed a graded maximal exercise test on a semi-recumbent cycle ergometer. Respiratory gas exchange was monitored for analysis of Vo2, while heart rate and RPE (Borg CR10 Scale) were measured at the end of each minute. RPE was compared with expected ranges when at 60%, 70%, and 80% of Vo2peak. Post hoc analyses were performed to determine whether patient characteristics differed between participants who fell within and outside the expected RPE range at 80% of Vo2peak. Results: Median (interquartile range) RPE at 60%, 70%, and 80% Vo2peak were 3.0 (3.0-3.5), 3.0 (3.0-5.0), and 4.75 (3.0-5.75), respectively; 76.2%, 69.0%, and 38.9% of participants fell into the expected RPE range at each intensity. Patient characteristics were similar between participants who fell within and outside the expected RPE range at 80% Vo2peak. Conclusion: RPE appears to be a reasonable indicator of exercise intensity after stroke at moderate (60%-70% Vo2peak) but not high-intensity exercise (80% Vo2peak). This conclusion is based on the high degree of between-subject variability in RPE at 80% Vo2peak. Future research should identify whether RPE can be adapted to accurately capture exertion during high-intensity exercise after stroke.

Using computers to enable self‐management of aphasia therapy exercises for word finding: the patient and carer perspective

Speech and language therapy (SLT) for aphasia can be difficult to access in the later stages of stroke recovery, despite evidence of continued improvement with sufficient therapeutic intensity. Computerized aphasia therapy has been reported to be useful for independent language practice, providing new opportunities for continued rehabilitation. The success of this option depends on its acceptability to patients and carers. To investigate factors that affect the acceptability of independent home computerized aphasia therapy practice. An acceptability study of computerized therapy was carried out alongside a pilot randomized controlled trial of computer aphasia therapy versus usual care for people more than 6 months post-stroke. Following language assessment and computer exercise prescription by a speech and language therapist, participants practised three times a week for 5 months at home with monthly volunteer support. Semi-structured interviews were conducted with 14 participants who received the intervention and ten carers (n = 24). Questions from a topic guide were presented and answered using picture, gesture and written support. Interviews were audio recorded, transcribed verbatim and analysed thematically. Three research SLTs identified and cross-checked themes and subthemes emerging from the data. The key themes that emerged were benefits and disadvantages of computerized aphasia therapy, need for help and support, and comparisons with face-to-face therapy. The independence, flexibility and repetition afforded by the computer was viewed as beneficial and the personalized exercises motivated participants to practise. Participants and carers perceived improvements in word-finding and confidence-talking. Computer practice could cause fatigue and interference with other commitments. Support from carers or volunteers for motivation and technical assistance was seen as important. Although some participants preferred face-to-face therapy, using a computer for independent language practice was perceived to be an acceptable alternative. Independent computerized aphasia therapy is acceptable to stroke survivors. Acceptability can be maximized by tailoring exercises to personal interests of the individual, ensuring access to support and giving consideration to fatigue and life style when recommending practice schedules.

Abstract NS14: Independent Speech and Language Practice with Aphasia Computer Software is an Acceptable Alternative to Face to Face Therapy in the Long Term Post Stroke

Background: Speech and language therapy (SLT) for aphasia can be difficult to access in the later stages of stroke recovery, despite evidence of continued improvement with sufficient therapeutic intensity. Computerized aphasia therapy has been reported to be useful for independent language practice, providing new opportunities for continued rehabilitation. The success of this option depends on its acceptability to patients and carers. The purpose of this study was to investigate factors that affect the acceptability of computerized aphasia therapy. Methods: A qualitative study was carried out alongside a pilot randomized controlled trial of computer aphasia therapy versus usual care for people more than 6 months post stroke. A SLT tailored computer exercises to individual needs. Participants practised 3 times a week for 5 months at home with monthly volunteer support. Semi structured interviews were conducted with 14 participants who received the intervention and 10 carers. Questions from a topic guide were presented and answered using picture, gesture, and written support. Interviews were audio recorded, transcribed verbatim and analysed thematically. Three research SLTs identified and cross checked themes and subthemes emerging from the data. Results: Benefits and disadvantages, need for help/support and comparisons with face to face therapy were key themes. The independence, flexibility, and repetition afforded by the computer was viewed as beneficial and the personalised exercises motivated participants to practise. Participants and carers perceived improvements in word finding and confidence talking. Computer practice could cause fatigue and interference with other commitments. Four participants with severe aphasia did not perceive any improvement. Support from carers/volunteers for motivation and technical assistance was seen as important. Participants generally preferred face to face therapy, however, using a computer for independent language practice was viewed as an acceptable alternative. Conclusions: Independent computerized aphasia therapy is acceptable to stroke survivors. Acceptability can be maximised by personalised exercises, access to support and consideration of aphasia severity, fatigue and life style.

Abstract TP314: Moderate-High Intensity Exercise Training Improves Submaximal and Peak Cardiorespiratory Response in Sub-acute Stroke

Purpose: Limited research is available for exercise prescription during the subacute stage of stroke recovery. Peak and submaximal cardiorespiratory response during exercise testing in sub-acute stroke has also not been extensively studied. We assessed the hypothesis that an eight-week aerobic exercise intervention at moderate-high intensity would improve cardiorespiratory response during submaximal and peak effort in sub-acute stroke. Methods: Ten individuals (68.6+40.1 days post-stroke) enrolled in the study and 9 participants completed the exercise intervention. The nine participants were 61.2+4.7 years of age with a total Fugl-Meyer score, 102.2+30.4. Peak exercise testing was done at baseline and post-intervention to assess oxygen consumption (VO2), HR and minute ventilation (VE). A seated stepper was the mode of exercise with exercise intensity at 50-59% of HR reserve (first 4 weeks) and then increased to 60-69% of HR reserve for the last 4 weeks. Paired t-tests were used to assess differences at peak effort. Submaximal performance on the exercise test was assessed using an analysis of variance, with Test Minute (minutes 1-6) and Study Visit (baseline, post-exercise) as within subject factors. P-values &lt; 0.05 were considered statistically significant. Results: At peak effort, VO2, HR and VE were higher post-intervention but only VO2 peak was statistically significant. During submaximal effort, we found VO2 and HR to be lower after the exercise intervention. For VO2 there was no interaction (F5,40=0.95, p=0.40) between Study Visit and Test Minute but we report a main effect of Study Visit (F1,8=8.5, p=0.02). There was not a significant interaction for HR between Study Visit and Test Minute (F5,40=0.28, p=0.92). Nor was there a main effect of Study Visit (F1,8=2.7, p=0.14). VE increased similarly across Test Minute and Study Visits. No interaction of Study Visit and Test Minute were evident nor was there a main effect of Study Visit. Conclusion: This preliminary data demonstrates that an 8-week aerobic exercise intervention shows promise for improving peak and submaximal cardiorespiratory response in sub-acute stroke.

Abstract WP316: Submaximal Exercise Test to Predict VO2 Peak in Subacute Stroke

Purpose: Submaximal exercise testing can be an attractive alternative to peak testing especially in clinical environments where a metabolic cart and adequately trained medical staff may not be readily available. We examined the relationship between peak oxygen consumption (VO2 peak) and a predicted VO2 peak value obtained from a submaximal exercise test that we developed for a total body recumbent stepper (TBRS). We hypothesized that in people with subacute stroke, the actual VO2 peak and predicted VO2 peak would have a moderate (r &gt; 0.75) relationship. Methods: Ten individuals in the subacute stage of stroke recovery (68.6+40.1 days post-stroke) and 61.2+ 5.0 years of age participated in the study. Exercise testing using a metabolic cart and the TBRS for the exercise modality was performed on the first day to obtain VO2 peak. We used the Young Men’s Christian Association (YMCA) protocol for the TBRS. The step rate was maintained between 95-100 steps per minute (spm). Participants started the test at 30 watts and resistance was increased every 3 minutes according to the protocol until volitional fatigue, or 85% of age-predicted HR max was achieved. HR was recorded ten seconds prior to the end of the second and third minute of each stage. If the two HR measures were within 5 bpm of each other, participants progressed to the next stage. However, if the difference was greater than 5 bpm, an additional minute was performed to ensure a steady-state. The participants completed the submaximal exercise test within one to two days after the peak exercise test. The workload in watts and HR at the end of the submaximal exercise test along with age, sex and weight (kg) were used in the equation to predict VO2 peak. Results: We found that predicted VO2 peak generated from the submaximal exercise test equation had a strong correlation to the actual VO2 peak (r = 0.80, p = 0.006). Mean peakVO2 (ml*kg-1*min-1) from the exercise test was 22.9 + 7.3 ml*kg-1*min-1 and the predicted mean value was 17.6 + 6.1 ml*kg-1*min-1. Paired t-test revealed a statistically significant difference between these two values (p = 0.005). Conclusion: This preliminary data demonstrates the TBRS submaximal exercise test shows promise for assessing VO2 peak in sub-acute stroke.

Brain activation pattern according to exercise complexity: A functional MRI study

The aim of this study was to compare the areas of brain activation between complex and simple exercises in a unimanual hand and to assess the possibility of an exercise task for paretic hands following stroke. The subjects included 11 healthy right-handed volunteers. The complex exercise was a wooden ball rotation task with the unimanual hand and the simple exercise was a hand grasp task performed during a functional MRI scan. Stronger activation of the left primary sensorimotor cortex, the left premotor area, and the ipsilateral cerebellum emerged when the complex movement was performed. Ipsilateral activity was located in the primary sensory cortex and premotor area, and contralateral activity was shown in the left cerebellum. These results suggest that a unimanual ball rotation task may be appropriate for rehabilitation of a movable paretic hand in an early stage of stroke recovery, which should provide motor and sensory input using external stimuli, while the simple motor task may appropriate in a compensatory stage, and should inhibit the ipsilateral activity due to maladaptive plasticity.

LONG-TERM EFFECTS OF STROKE

LONG‐TERM EFFECTS OF STROKE Edited by Julien Bogousslavsky 2002. Monticello, NY: Marcel Dekker, Inc. Price $175. pp. 344. ISBN 0–8247–0624–2 A serious shortcoming in current neurological practice is the post‐acute care we are able to provide to patients with stroke. Whereas tremendous research has recently changed the ways in which neurologists view acute ischaemic stroke, with a number of thrombolytic and neuroprotective approaches now available and others under investigation, little attention is paid to patients following maximal acute care. Progress in the intensive care of such patients in specialised critical care neurology units has also improved outcomes, as has good aetiological diagnosis (e.g. cardiogenic embolism, carotid stenosis) and secondary prevention. However, after discharge from the intensive care unit and the inpatient neurology ward, with maximal acute treatment and perhaps secondary prevention tailored to a specific aetiological diagnosis, patients are sent off to the care of physiatrists and therapists for various re‐educational programs that are not motivated by the goals of brain recovery or purposeful neural remodelling. Furthermore, practising neurologists pay little attention to patients at this stage of stroke recovery, despite the fact that these patients have a serious neurological illness (they have the same illness as before, just as do patients with amyotrophic lateral sclerosis or Alzheimer’s disease or Parkinson’s disease), and the fact that they have marked neurological signs and symptoms. A particular irony of improved acute stroke care is the increased survival of patients with such problems. In advanced countries, stroke is the primary cause of disability in adults. A recent book, targeted at clinical neurologists, aims to reduce this knowledge gap regarding the long‐term effects of stroke. This book, edited by the well‐known stroke neurologist Julien Bogousslavsky of Lausanne, contains twelve chapters focusing on various aspects of assessment and prognosis of stroke sequelae, including several chapters …