Stroke Rehabilitation Therapy Research Articles

Comparison Of Bobath Technique And Constraint Induced Movement Therapy In Stroke Rehabilitation: A Systematic Review

Comparison Of Bobath Technique And Constraint Induced Movement Therapy In Stroke Rehabilitation: A Systematic Review

Focused magnetic stimulation for motor recovery after stroke

Background and objectivesThe effects of noninvasive focused magnetothermal brain stimulation using magnetic nanoparticles (MNPs) on post-stroke motor deficits and metabolic dormancy in subacute ischemic injury are not well-established. This study examined if magnetothermal brain stimulation using magnetic nanoparticles (Nano-MS) enhances motor recovery after stroke. MethodsWe randomly distributed rats into Sham, Control, MNP injection only, and Nano-MS groups. We administered focused magnetic stimulation for 30 min daily following an MNP injection (15 mg/mL) into the targeted motor cortex via the carotid artery three weeks after the transient (90 min) middle cerebral artery occlusion. We assessed motor functionality via behavioral tests and conducted positron emission tomography (PET) imaging to verify cerebral metabolic activity. We assessed neuronal excitability, neuroinflammation, blood-brain barrier (BBB) integrity, and neurogenesis four weeks post-stroke. ResultsThe Nano-MS group exhibited significantly improved motor deficits and cerebral metabolic activity compared to the Control and MNP groups (p < 0.05). Focused Nano-MS modulated neuronal excitability, evident by a depolarized action potential threshold for spike initiation and reduced firing frequency post-stroke. The Nano-MS group demonstrated markedly decreased inflammatory markers, such as IL-1β, IL-6, TNF-α, MCP-1, and ICAM-1, compared to the Control and MNP groups. BBB integrity and immunofluorescence for neurogenesis markers were substantially improved in the Nano-MS group. ConclusionsFocused Nano-MS facilitates the recovery of motor deficits and metabolic inactivity in the brain by effectively modulating excitability, reducing neuroinflammation, enhancing BBB stability, and promoting neurogenesis. Nano-MS is a potential novel, noninvasive therapy for stroke rehabilitation. Further investigation is warranted.

A single-center, assessor-blinded, randomized controlled clinical trial to test the safety and efficacy of a novel brain-computer interface controlled functional electrical stimulation (BCI-FES) intervention for gait rehabilitation in the chronic stroke population

BackgroundIn the United States, there are over seven million stroke survivors, with many facing gait impairments due to foot drop. This restricts their community ambulation and hinders functional independence, leading to several long-term health complications. Despite the best available physical therapy, gait function is incompletely recovered, and this occurs mainly during the acute phase post-stroke. Therapeutic options are limited currently. Novel therapies based on neurobiological principles have the potential to lead to long-term functional improvements. The Brain-Computer Interface (BCI) controlled Functional Electrical Stimulation (FES) system is one such strategy. It is based on Hebbian principles and has shown promise in early feasibility studies. The current study describes the BCI-FES clinical trial, which examines the safety and efficacy of this system, compared to conventional physical therapy (PT), to improve gait velocity for those with chronic gait impairment post-stroke. The trial also aims to find other secondary factors that may impact or accompany these improvements and establish the potential of Hebbian-based rehabilitation therapies.MethodsThis Phase II clinical trial is a two-arm, randomized, controlled, longitudinal study with 66 stroke participants in the chronic (> 6 months) stage of gait impairment. The participants undergo either BCI-FES paired with PT or dose-matched PT sessions (three times weekly for four weeks). The primary outcome is gait velocity (10-meter walk test), and secondary outcomes include gait endurance, range of motion, strength, sensation, quality of life, and neurophysiological biomarkers. These measures are acquired longitudinally.DiscussionBCI-FES holds promise for gait velocity improvements in stroke patients. This clinical trial will evaluate the safety and efficacy of BCI-FES therapy when compared to dose-matched conventional therapy. The success of this trial will inform the potential utility of a Phase III efficacy trial.Trial registrationThe trial was registered as ”BCI-FES Therapy for Stroke Rehabilitation” on February 19, 2020, at clinicaltrials.gov with the identifier NCT04279067.

The Impact of Virtual Reality Training Combined with Traditional Chinese Medicine Health Preservation Therapy on Cognitive Function, Neurological Function, and Physical Function of Stroke Patients.

The aim of this study was to investigate the effects of virtual reality training combined with traditional Chinese medicine health preservation therapy on cognitive function, neurological function, and physical function of stroke patients. The patients were randomly divided into an experimental group (receiving virtual reality training combined with traditional Chinese medicine health preservation therapy) and a control group (receiving conventional rehabilitation treatment combined with traditional Chinese medicine health preservation therapy). A series of cognitive, neurological, and physical function assessments were conducted to collect and analyze data from both groups before treatment, after treatment, and during follow-up. The application of traditional Chinese medicine health preservation concepts was also explored. After treatment, the experimental group had significantly higher scores in the Mini-Mental State Examination (MMSE) compared to the control group. The overall effective rate of neurological function in the experimental group was higher than that in the control group. The Fugl-Meyer Assessment (FMA) scores for upper limb function in the experimental group were significantly higher than those in the control group. The degree of improvement in the Modified Barthel Index scores after treatment was significantly better in the experimental group compared to the control group (all P < 0.05). The results of this study demonstrate that virtual reality training combined with traditional Chinese medicine health preservation therapy significantly improves cognitive function, neurological function, and physical function in stroke patients. This approach provides new insights and methods for stroke rehabilitation therapy and is worthy of promotion.

Yoga as an Integrated Therapy for Stroke Rehabilitation – A Case Study

Background and Purpose: A stroke (cerebrovascular accident) is damage to the brain cells from an interruption of their blood supply due to blockage or rupture of an artery to the brain. It is the second-leading cause of death and long-term disability worldwide. The present study is a case report investigating the effect of yoga therapy in addition to acupressure and physiotherapy on activities of daily living and the quality of life of patients after stroke. Subject and method: It is a single case study of 38-year-old women diagnosed with acute ischemic stroke who have chief complaints of loss of function of the left upper and lower limbs, and hypertension. For better management of stroke and recovery, she was undergoing yoga, physiotherapy, and acupuncture treatment in the CAM department at DSVV. The primary outcome measures were activities of daily living by the Barthel index and quality of life by the stroke-specific quality of life scale. The subject received integrated treatment for 12 weeks consisting of 45-minute, 1-hour yoga sessions 6 days a week, regular physiotherapy in the subject’s home, and acupuncture every 2 weeks. The primary outcome data were collected before and after the treatment intervention phase. Result: The subject had improved Barthel’s activity and quality of life score. Discussion and Conclusion: The results suggest that yoga integrated with other complementary therapies may be beneficial to stroke survivors in rehabilitation.

Emerging Trends in Physical Therapy for Stroke Rehabilitation: A Comprehensive Review

Emerging Trends in Physical Therapy for Stroke Rehabilitation: A Comprehensive Review

Enhancing upper-limb rehabilitation robot: autonomous self-adaptive resistance generation using EMG-based Fuzzy-PI control

ABSTRACT Upper-limb rehabilitation is a technique for improving muscle development and nervous function in stroke patients through repetitive rhythmic hand movements. However, conventional robot-assisted therapy cannot generate the natural resistant responses seen in therapy administered by therapists, leading to critical limitations in its effectiveness compared to conventional therapy. To overcome this limitation, we propose a novel strategy enabling a rehabilitation robot to generate self-adaptive resistance using electromyography (EMG) autonomously signals from the patient. A position-based force control system based on Fuzzy-PI (proportional and integral) control was successfully implemented in robot-assisted upper-limb rehabilitation. Performance evaluation comprised two primary aspects: examining rehabilitation durations and assessing movement smoothness through jerk values. Experimental outcomes revealed that the self-adaptive control (SAC) strategy, which automatically adjusts resistance, outperforms the non-adaptive control (NAC) approach. SAC demonstrated notable superiority in movement smoothness and extended the duration of upper-limb rehabilitation tasks nearly twofold compared to NAC. Furthermore, applying the jerk concept, and assessing motion smoothness, indicated that SAC exhibited more controlled and seamless movements than NAC. The alignment between participant surveys and the outcomes of parallel tests confirms the validity of the study's conclusions. Thus, this research makes a significant contribution towards improving the effectiveness of robot-assisted therapy in stroke rehabilitation.

Art and Craft of Music Therapy for Stroke Rehabilitation in a Remote North Indian Community

This case study describes how a music therapist (Stephen) and a music therapy intern (Sahitya) worked conjointly with a client and her granddaughter in a remote part of North India. The description provides a unique insight into conditions, culture, and lifestyle in this location, and how these two clinicians were able to merge broader arts-based and holistic approaches, on a journey towards client-centered and functional neurologic music therapy exercises to help the client regain more independence. The background to initial work undertaken by the music therapist, which lasted for one year and eleven months, is followed by a summary of five weekly conjoint sessions with the intern, including the evolution of exercises, rationale, and client responses, illustrated with embedded video excerpts. The communication, relationship, and trust-building with the client and her granddaughter, together with the intern joining the dynamic, paved the way for assimilating music therapy theoretical models that were new to them, and adapting neurologic music therapy approaches using an electronic keyboard that incorporated preferred facilitating music. This resulted in greater client engagement with higher levels of motivation and adherence and increased hand use in daily activities.

Robotic mirror therapy for stroke rehabilitation through virtual activities of daily living

Mirror therapy is a standard technique of rehabilitation for recovering motor and vision abilities of stroke patients, especially in the case of asymmetric limb function. To enhance traditional mirror therapy, robotic mirror therapy (RMT) has been proposed over the past decade, allowing for assisted bimanual coordination of paretic (affected) and contralateral (healthy) limbs. However, state-of-the-art RMT platforms predominantly target mirrored motions of trajectories, largely limited to 2-D motions. In this paper, an RMT platform is proposed, which can facilitate the patient to practice virtual activities of daily living (ADL) and thus enhance their independence. Two similar (but mirrored) 3D virtual environments are created in which the patients operate robots with both their limbs to complete ADL (such as writing and eating) with the assistance of the therapist. The recovery level of the patient is continuously assessed by monitoring their ability to track assigned trajectories. The patient’s robots are programmed to assist the patient in following these trajectories based on this recovery level. In this paper, the framework to dynamically monitor recovery level and accordingly provide assistance is developed along with the nonlinear controller design to ensure position tracking, force control, and stability. Proof-of-concept studies are conducted with both 3D trajectory tracking and ADL. The results demonstrate the potential use of the proposed system to enhance the recovery of the patients.

Preparing for a clinical study on implant-enhance stroke rehabilitation

Preparing for a clinical study on implant-enhance stroke rehabilitation Martin Schuettler, Chief Technology Officer at CorTec GmbH, addresses key questions around the development of the company’s innovative Brain Interchange System to support stroke rehabilitation therapy. CorTec has developed the Brain Interchange (BIC) implant system to improve stroke rehabilitation outcomes by enhancing the effect of conventional physio and/or occupational therapy. (1, 2) The effectiveness of the new implant-supported therapy will be investigated in an early feasibility study planned for 2024 to be carried out in Washington, US. While working on the approval of the feasibility study, uncertainties and unknowns of the study are investigated. These involve questions around usability and technical performance.

What is Task-Oriented Training? A Scoping Review

Task-Oriented Training (TOT) is an proven stroke rehabilitation intervention with significant evidence-based research that supports its effectiveness. The absence of a clear definition has led to variability in research reporting and subsequent confusion with practical implementation. A consistent definition seeks to remedy this ambiguity to facilitate knowledge translation. The objective of this study was to determine a comprehensive definition of TOT that encapsulates previous definitions and descriptions in the literature. In order to derive this definition, a two stage scoping review process was conducted across four databases searching for articles on the use of TOT in adult stroke rehabilitation therapy. The analysis of this scoping review included 174 articles. Commonly found words used to define TOT included: repetitive, functional, task practice, task specific, task oriented, intensity, and client-centered. Other salient words that aligned with the principles of neuroplasticity and key components of TOT were meaningful, progressive, graded, variable, and feedback. Based on these findings, a comprehensive proposed definition is as follows: Task-oriented training is an effective stroke rehabilitation intervention that focuses on the use of client-centered, repetitive practice of activities that are of high intensity and meaningful to the client. In conclusion, although similar principles were described in the TOT literature, there was no consistent and comprehensive definition of TOT. This scoping review identified key concepts from TOT methodology, and discussion sections in rehabilitation literature to generate a proposed comprehensive definition of TOT to guide research and practice.

Navigating the AI frontiers in cardiovascular research: a bibliometric exploration and topic modeling.

Artificial intelligence (AI) has emerged as a promising field in cardiovascular disease (CVD) research, offering innovative approaches to enhance diagnosis, treatment, and patient outcomes. In this study, we conducted bibliometric analysis combined with topic modeling to provide a comprehensive overview of the AI research landscape in CVD. Our analysis included 23,846 studies from Web of Science and PubMed, capturing the latest advancements and trends in this rapidly evolving field. By employing LDA (Latent Dirichlet Allocation) we identified key research themes, trends, and collaborations within the AI-CVD domain. The findings revealed the exponential growth of AI-related research in CVD, underscoring its immense potential to revolutionize cardiovascular healthcare. The annual scientific publication of machine learning papers in CVD increases continuously and significantly since 2016, with an overall annual growth rate of 22.8%. Almost half (46.2%) of the growth happened in the last 5 years. USA, China, India, UK and Korea were the top five productive countries in number of publications. UK, Germany and Australia were the most collaborative countries with a multiple country publication (MCP) value of 42.8%, 40.3% and 40.0% respectively. We observed the emergence of twenty-two distinct research topics, including "stroke and robotic rehabilitation therapy," "robotic-assisted cardiac surgery," and "cardiac image analysis," which persisted as major topics throughout the years. Other topics, such as "retinal image analysis and CVD" and "biomarker and wearable signal analyses," have recently emerged as dominant areas of research in cardiovascular medicine. Convolutional neural network appears to be the most mentioned algorithm followed by LSTM (Long Short-Term Memory) and KNN (K-Nearest Neighbours). This indicates that the future direction of AI cardiovascular research is predominantly directing toward neural networks and image analysis. As AI continues to shape the landscape of CVD research, our study serves as a comprehensive guide for researchers, practitioners, and policymakers, providing valuable insights into the current state of AI in CVD research. This study offers a deep understanding of research trends and paves the way for future directions to maximiz the potential of AI to effectively combat cardiovascular diseases.

Neuropsychiatric outcomes of intensive music therapy in stroke rehabilitation

Neuropsychiatric outcomes of intensive music therapy in stroke rehabilitation

Delivering constraint-induced movement therapy in stroke rehabilitation requires informed stakeholders, sufficient resources and organisational buy-in: amixed-methods systematic review.

To summarise and synthesise the qualitative literature relating to constraint-induced movement therapy (CIMT) among stroke survivors, carers, therapists and rehabilitation service managers. Systematic review of qualitative studies. Quantitative studies using survey data were also included if they investigated perceptions and/or experiences related to CIMT. Cochrane Library, Medline, JBI, Emcare, Embase, PsycInfo, CINAHL, PEDro, OT Seeker and NICE from inception to January2022. Two reviewers independently extracted data from the included studies and assessed comprehensiveness of reporting using established tools. Thematic synthesis was undertaken to synthesise findings for studies using focus groups and interviews. A summary of themes from quantitative studies using survey data was compiled to complement the qualitative synthesis. Searches yielded 1,450 titles after removal of duplicates; 60 full-text articles were assessed for eligibility and 14 studies were included (1,570 total participants). Thematic synthesis identified nine descriptive themes from which four analytical themes were developed: CIMT is challenging but support at all levels helps; therapists need the know-how, resources and staffing; CIMT is different to other interventions, and there are positives and negatives to this; and functional outcomes do not always meet high expectations. Quantitative survey themes included: knowledge, skills and confidence in delivering CIMT programs; patient factors; and institutional factors. This review identified several determinants of implementation related to CIMT. Rehabilitation therapists need to develop their knowledge and skills to deliver CIMT, engage with organisational leaders, and develop CIMT protocols to fit the local clinical context in order to sustainably deliver CIMT in stroke rehabilitation services. Stroke survivors and carers require improved education to increase their engagement and participation. After addressing these determinants, future research should evaluate population-level outcomes and policy-level implementation in establishing CIMT as global standard rehabilitation practice. CRD42021237757.

Optimized EEG-based Action Observation Therapy for stroke rehabilitation

Optimized EEG-based Action Observation Therapy for stroke rehabilitation

Effects of Electrode Position Targeting in Noninvasive Electromyography Technologies for Finger and Hand Movement Prediction

PurposeStroke patients may need to undergo rehabilitation therapy to improve their mobility. Electromyography (EMG) can be used to improve the effectiveness of at-home therapy programs, as it can assess recovery progress in the absence of a health professional. In particular, EMG armbands have the advantage of being easy to use compared to other EMG technologies, which could allow patients to complete therapy programs without external assistance. However, it is unclear whether there are drawbacks associated with the fixed electrode placement imposed by current armband designs. This study compared the hand gesture prediction capabilities of an off-the-shelf EMG armband with fixed electrode placement and an EMG setup with flexible electrode positioning.MethodsTen able-bodied participants performed a series of hand and finger gestures with their dominant hand, once with an EMG armband (Untargeted condition) and once with electrodes deliberately placed on specific muscles (Targeted condition). EMG features were extracted from overlapping sliding windows and were used to (1) classify the gestures and (2) predict finger joint positions as measured by a robotic hand exoskeleton.ResultsFor the classification task, a logistic regression model performed significantly better (p < 0.001) for the Targeted condition (55.8% pm 10.1%) compared to the Untargeted condition (47.9% pm 11.6%). For the regression task, a k-nearest neighbours model obtained significantly lower (p = 0.007) mean RMSE values for the Targeted condition (0.260 pm 0.037) compared to the Untargeted condition (0.270 pm 0.043).ConclusionWe observed a trade-off between predictive accuracy and ease-of-use of the EMG devices used in this study. It is important to consider such a trade-off when developing clinical applications such as at-home stroke rehabilitation therapy programs.

ALTERNATIVE METHODS FOR IMPROVING BALANCE IN STROKE RECOVERY: VISUAL AND VERBAL CUES AS COST-EFFECTIVE MODALITIES

Objective: Stroke is a significant global health concern, leading to high mortality and disability rates. Prompt assessment, management, and rehabilitation are crucial for improving clinical outcomes. Balance impairment is a common consequence of stroke, affecting the majority of survivors and increasing the risk of falls and disability.&#x0D; Methods: The study included 30 post-stroke hemiplegic individuals, randomly assigned to a control group and an experimental group. The control group received conventional physical therapy, while the experimental group received additional visual and verbal feedback. The Berg Balance Scale was used to assess balance on days 1, 15, and 30.&#x0D; Results: Both groups showed improvements in balance scores over time. However, the experimental group consistently had higher scores, indicating a greater effect of incorporating visual and verbal cues with conventional therapy.&#x0D; Conclusion: Our study demonstrates that the combination of visual and verbal cues with conventional therapy leads to improved balance outcomes in stroke recovery. These findings support the benefits of visual feedback, verbal feedback, and mirror therapy in stroke rehabilitation. Incorporating these alternative methods can be cost-effective and accessible interventions to enhance balance, reduce fall risk, and improve the overall recovery and quality of life in stroke survivors.

Unlocking the restraint-Development of a behaviour change intervention to increase the provision of modified constraint-induced movement therapy in stroke rehabilitation.

Strong evidence supports the provision of modified constraint-induced movement therapy (mCIMT) to improve upper limb function after stroke. A service audit identified that very few patients received mCIMT in a large subacute, early-supported discharge rehabilitation service. A behaviour change intervention was developed to increase the provision of mCIMT following an unsuccessful 'education only' attempt. This paper aims to systematically document the steps undertaken and to provide practical guidance to clinicians and rehabilitation services to implement this complex, yet effective, rehabilitation intervention. This clinician behaviour change intervention was developed over five stages and led by a working group of neurological experts (n = 3). Data collection methods included informal discussions with clinicians and an online survey (n = 35). The staged process included reflection on why the first attempt did not improve the provision of mCIMT (stage 1), mapping barriers and enablers to the Theoretical Domains Framework (TDF) and behaviour change wheel (BCW) to guide the behaviour change techniques (stages 2 and 3), developing a suitable mCIMT protocol (stage 4), and delivering the behaviour change intervention (stage 5). Reflection among the working group identified the need for upskilling in mCIMT delivery and the use of a behaviour change framework to guide the implementation program. Key determinants of behaviour change operated within the TDF domains of knowledge, skills, environmental context and resources, social role and identity, and social influences. Following the development of a context-specific mCIMT protocol, the BCW guided the behaviour change intervention, which included education, training, persuasion, environmental restructuring, and modelling. This paper provides an example of using the TDF and BCW to support the implementation of mCIMT in a large early-supported discharge service. It outlines the suite of behaviour change techniques used to influence clinician behaviour. The success of this behaviour change intervention will be explored in future research.

The Impact of Occupational Therapy on Motor Function and Activities of Daily Living in Stroke Survivors

The current study aims to examine the impact of occupational therapy on motor function and activities of daily living in stroke survivors. It presents a quasi-experimental study assessing the effect of occupational therapy on enhancing motor function and ADLs in stroke survivors. The study involved 30 participants divided into control and experimental groups. The measures include Fugl-Meyer Assessment (FMA) and Katz Index of Independence in Activities of Daily Living (ADL). Significant improvements were observed in the experimental group in both motor function and ADLs, as shown by ANOVA and post-hoc tests. The findings highlight the efficacy of occupational therapy in facilitating recovery and improving quality of life post-stroke, integrating traditional approaches with innovative technologies. The study also shows the necessity of occupational therapy in stroke rehabilitation and its holistic impact on physical recovery and patient well-being. For healthcare systems, these findings show the importance of allocating resources towards occupational therapy services for stroke survivors. This includes investing in advanced rehabilitation equipment and ensuring adequate staffing. Additionally, healthcare systems should consider developing collaborative models of care that involve multidisciplinary teams, including occupational therapists, to provide comprehensive and holistic treatment for stroke survivors.

Research Progress of Vagus Nerve Stimulation in Stroke Rehabilitation Treatment

<i>Background: </i>Stroke is the leading cause of adult death in China and the leading cause of death worldwide, characterized by high morbidity, disability, mortality, recurrence and economic burden, often leading to various functional impairments, such as motor impairment, sensory impairment, swallowing impairment, consciousness impairment and cognitive impairment. Therefore, finding effective intervention methods is currently a hot and difficult issue in stroke rehabilitation treatment. Vagus nerve stimulation, as a classical neuromodulation technique, has been widely certified for its safety and effectiveness. In recent years, several studies at home and abroad have reported that VNS can be used as a potential rehabilitation treatment to improve functional impairment after stroke. <i>Objective:</i> In this paper, the clinical application of vagus nerve stimulation in different dysfunctions after stroke is discussed in the context of relevant studies at home and abroad, and the effectiveness, safety and possible mechanisms of action of VNS in stroke treatment are reviewed, aiming to provide new therapeutic ideas for stroke rehabilitation. <i>Conclusion: </i>Vagus nerve stimulation, a classical neuromodulation technique, can help improve various dysfunctions after stroke and improve patients' survivability and quality of life. Vagus nerve stimulation is expected to be a potential new therapy for stroke rehabilitation and play an important role in the rehabilitation of post-stroke dysfunction.