Deans' stroke musings

Changing stroke rehab and research worldwide now.Time is Brain!Just think of all the trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 493 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It's quite disgusting that this information is not available from every stroke association and doctors group.
My back ground story is here:http://oc1dean.blogspot.com/2010/11/my-background-story_8.html

Thursday, February 22, 2018

Virtual reality for upper limb rehabilitation in sub-acute and chronic stroke: a randomized controlled trial

This is useless until it is written up in stroke protocol format and published in a publicly available database.  Your doctor will never find this and the only option is for survivors to find it and bring it to their therapists attention for recovery use.




Highlights

Combined RFVE with CR treatment provided clinically meaningful improvements
Effectiveness of RFVE is comparable for ischemic and hemorrhagic post-stroke patients
Effectiveness of virtual therapy remains sensitive to time since stroke onset
Effectiveness of virtual therapy do not dependent on age and sex

Abstract

Objective

To evaluate the effectiveness of reinforced feedback in virtual environment (RFVE) treatment combined with conventional rehabilitation (CR) in comparison with CR alone, and to study whether changes are related to stroke aetiology (i.e. ischemic or hemorrhagic).

Design

Randomized controlled trial.

Setting

Inpatients in a hospital facility for intensive rehabilitation.

Participants

136 patients within one year from onset of a single stroke.

Interventions

The experimental treatment was based on the combination of RFVE with CR, while control treatment was based on the same amount of CR. Both treatments lasted 2 hours daily, 5 days a week, for 4 weeks.

Main Outcome Measures

Fugl-Meyer upper extremity (F-M UE) scale (primary outcome), Functional Independence Measure (FIM), National Institutes of Health Stroke Scale (NIHSS), and Edmonton Symptom Assessment Scale (ESAS) (secondary outcomes). Kinematic parameters of requested movements: duration (Time), mean linear velocity (Speed), number of submovements (Peak) (secondary outcomes).

Results

136 patients (ischemic=78, hemorrhagic=58) were randomized in two groups (RFVE=68, CR=68) and stratified by stroke aetiology (ischemic, hemorrhagic). Both groups improved after treatment, but the experimental group had better results than the control group (Mann-Whitney U test) at: F-M UE (p<0.001), FIM (p<0.001), NIHSS (p≤0.014), ESAS (p≤0.022), Time (p<0.001), Speed (p<0.001), Peak (p<0.001). Stroke aetiology did not have significant effects on patient outcomes.

Conclusion

The RFVE therapy combined with CR treatment promotes better outcomes for upper limb than the same amount of CR, regardless of stroke aetiology (Clinical Trial Registration – NCT01955291).

Keywords

  • Stroke;
  • Virtual Reality;
  • Rehabilitation;
  • Treatment Effectiveness

List of abbreviations

  • RFVE, Reinforced Feedback in Virtual Environment;
  • CR, Conventional Rehabilitation;
  • QoL, Quality of Life;
  • VR, Virtual Reality;
  • KR, Knowledge of Results;
  • KP, Knowledge of Performance;
  • CNS, Central Nervous System;
  • VRRS, Virtual Reality Rehabilitation System;
  • F-M UE, Fugl-Meyer upper extremity scale;
  • FIM, Functional Independence Measure scale;
  • NIHSS, National Institutes of Health Stroke scale;
  • ESAS, Edmonton Symptom Assessment scale;
  • MMSE, Mini-Mental State Examination;
  • SD, Standard Deviation;
  • ADL, Activities of Daily Living
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We would like to acknowledge Aneta Kiper, MSc, PT for her support and assistance throughout the study.
Conflict of Interest
The Authors declare that there is no conflict of interest

Corresponding author Pawel Kiper Fondazione Ospedale San Camillo IRCCS via Alberoni 70, 30126 Venezia, Italy Tel. 00390412207214, Fax. 00390412207129

This is useless until it is written up in stroke protocol format and published in a publicly available database.  Your doctor will never find this and the only option is for survivors to find it and bring it to their therapists attention for recovery use.
https://www.sciencedirect.com/science/article/pii/S0003999318300996

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