Study on the effect of rehabilitation therapy based on deep learning on functional recovery of stroke patients with hemiplegia

 No clue what deep learning is.

Study on the effect of rehabilitation therapy based on deep learning on functional recovery of stroke patients with hemiplegia

Xuefei HAN1 , Yongmei Yan2* 1. Shaanxi University of Chinese Medicine, Xianyang, Shaanxi 712046, China 2 Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, Xianyang, Shaanxi 712000, China *corresponding author 

Abstract: 

Objective: 

Based on deep learning, to explore the clinical effect of early rehabilitation intervention management model on the recovery of neurological function in patients with acute stroke. 

Methods: 

A total of 86 inpatients in our department from June 2019 to August 2020 were selected. According to the ward distribution, the hospital was randomly divided into routine drug treatment group (control group, 44 cases) and another ward was divided into early comprehensive rehabilitation treatment group (treatment group, 42 cases). The treatment group received regular rehabilitation training in addition to clinical medication, while the control group received clinical medication and self-exercise without guidance. They were evaluated 24 hours before treatment and 7-10 weeks after treatment. The motor function was evaluated by Furl—Meyer motor function integral method (FMA), and the daily living ability was scored by Barthel index. 

Results: 

There was no significant difference in Barthel index and FMA score between the treatment group and the control group before treatment. After treatment, the two indexes in the control group improved to a certain extent, but compared with the treatment group, the improvement degree was far less than that in the treatment group, and the difference was statistically significant (P < 0.01). The effective rate and total effective rate in the treatment group were significantly higher than those in the control group, with statistical difference between the two groups (P<0.05). 

Conclusion: 

Early rehabilitation intervention management model can effectively improve the neurological function of patients with acute stroke and improve the clinical efficacy, which is worthy of further promotion and use in clinical practice.

Qi Zhi Tong Luo(QZTL) Capsule in Stroke rehab

You can see if your doctor knows of this and can find it. Qi Zhi Tong Luo (QZTL) capsule, a traditional Chinese herbal medicine.

Efficacy and Safety of Qi Zhi Tong Luo Capsule in Vascular Cognitive Impairment

Effect of Qizhitongluo Capsule on Lower Limb Rehabilitation After Stroke：A Randomized Clinical Trial

 

Longitudinal study of quality of life in acquired brain injury: A self- and proxy-report evaluation

It is your DOCTOR'S RESPONSIBILITY to get your quality of life back to 100%.

Longitudinal study of quality of life in acquired brain injury: A self- and proxy-report evaluation

Acquired brain injury (ABI) isui a leading cause of death and disability in the world (Nichol et al., 2011). In Spain, there is a prevalence of 420,064 people with ABI and approximately 104,701 new cases per year (Quezada et al., 2015). Although it is increasingly possible to save more lives because of advances in medicine, the percentage of people left with impairments after the ABI is very high, even with mild injuries (Chiang et al., 2015, Haagsma et al., 2015). Individuals who have sustained an ABI often experience physical and emotional problems (Haagsma et al., 2015, Lin et al., 2010, Yeoh et al., 2019), cognitive deficits (Grauwmeijer et al., 2018, Yeoh et al., 2019) and behavioural and social alterations (Azouvi et al., 2016, Lin et al., 2010). Some of these impairments may have a prolonged progression time that lead to chronic health problems (Azouvi et al., 2016, Grauwmeijer et al., 2018), which negatively impact the quality of life (QoL) (Andelic et al., 2009, Forslund et al., 2013, Pagnini et al., 2019, Yeoh et al., 2019).

Traditionally, QoL has been studied through generic instruments conceptualized from a health-related QoL approach (HRQoL), such as the SF-36 (Ware & Sherbourne, 1992). HRQoL focused on very specific domains of the person’s QoL, mainly related to health and physical well-being. In recent years, a specific instrument for ABI has been developed: the QOLIBRI scale (von Steinbüchel et al., 2010), which allows a more specific and comprehensive QoL evaluation. However, it continued to be sheltered by the HRQoL model, excluding important QoL areas such as self-determination, material well-being or personal development. In addition, this instrument has been used only in populations with traumatic brain injury (TBI), while its use in other ABI aetiologies (stroke, brain anoxia, brain tumour or cerebral infection) has been ignored.

In 2018, a specific-ABI QoL instrument was developed and validated, based on a comprehensive model that considers a psychosocial approach that goes beyond aspects merely related to health, and that can be used in the entire ABI population: the CAVIDACE scale (Fernández et al., 2019). This instrument is based on Schalock and Verdugo’s QoL model, which has been widely used in other populations, such as intellectual and developmental disabilities (Schalock & Verdugo, 2002) and the elderly (Vanleerberghe et al., 2017). According to the model (Schalock et al., 2018), QoL is a multidimensional phenomenon that reflects the well-being desired by the person in relation to eight basic needs: emotional well-being (EW), interpersonal relations (IR), material well-being (MW), personal development (PD), physical well-being (PW), self-determination (SD), social inclusion (SI) and rights (RI). Moreover, this core domain shows intergroup stability and sensitivity to personal perceptions, including subjective and objective aspects, and are influenced by environmental and personal factors and their interaction (Schalock et al., 2016, Schalock et al., 2018).

QoL has been considered a subjective construct that should be evaluated through self-report. However, in many cases of people with ABI, this is not possible due to the severity of the impairments (e.g., consciousness alterations) or the inability to communicate (e.g., global aphasia). Furthermore, the validity of the self-reports has been questioned because of the frequent presence of memory alterations and anosognosia in this population (Formisano et al., 2017, Grauwmeijer et al., 2018). Therefore, in some cases, it is necessary to use QoL instruments that can be answered by a relative or professional who knows the person (Kozlowski et al., 2015). However, there are very few studies that have analysed the discrepancies depending on the assessment approach (Verdugo et al., 2005) and how they have evolved over time. The existing studies show discordant results, with some showing an overestimation of the QoL by the ABI person when compared to their relatives’ evaluation (Formisano et al., 2017, Hwang et al., 2017, Kozlowski et al., 2015) and others showing high correlations between the results found (Câmara-Costa et al., 2020).

QoL after ABI is not stable over time. Most of the studies refer to a period of time around one (Chiang et al., 2015, Haller et al., 2017, Pucciarelli et al., 2019, Yeoh et al., 2019) or two years after ABI (Hu et al., 2012, Zhang et al., 2013), in which the QoL can improve and then achieve stability (Andelic et al., 2018, Forslund et al., 2013, Grauwmeijer et al., 2018), but generally staying lower than in the normative population (Forslund et al., 2013, Hu et al., 2012, Yeoh et al., 2019, Zhang et al., 2013). On the other hand, there are studies which show late recovery patterns three and four years after ABI (Gould & Ponsford, 2015), while others have shown evidence that the QoL worsens from the beginning (Schindel et al., 2019). The use of different instruments, aetiologies and research designs could explain this lack of agreement. However, they distinguish different evaluation patterns in QoL levels, and these patterns depend on multiple factors such as age, gender or severity of the injury (Scholten et al., 2015). Furthermore, the QoL evolution is not uniform between the different domains, with higher rates of improvement in the physical aspects than in the emotional (Haller et al., 2017, Scholten et al., 2015) and social areas (Chuluunbaatar et al., 2016, Lin et al., 2010, Pucciarelli et al., 2019).

In summary, longitudinal QoL studies in ABI have typically reported an initial period of improvement followed by later stabilization. However, we do not have comparative data on this evolution depending on whether self- or proxy-report instrument are used, or taking into account QoL’s domains that go beyond a HRQoL model. This manuscript aimed to contribute to the current literature by: (1) describing the patterns of evolution of the eight-QoL domains over a one-year follow-up in a sample of Spanish adults with ABI; (2) determining whether there are differences when the QoL assessment is carried out by a relative, professional or by the person with ABI; and (3) examining whether these evolution patterns depend on the time elapsed since the injury, considering recent (i.e., three years or less) or chronic ABI.

 

Exercise-based cardiac rehab added to stroke recovery, reveals study

 Of course this means YOUR DOCTOR IS RESPONSIBLE  for getting you recovered enough to do this exercise.

YOUR DOCTOR'S RESPONSIBILITY! Don't you dare let your doctor blame you in any form for not recovering, it is her responsibility.

Exercise-based cardiac rehab added to stroke recovery, reveals study

 

A new study suggested that stroke survivors who completed a cardiac rehabilitation program focused on aerobic exercise significantly improved their ability to transition from sitting to standing

Topics
Cardiac arrest

ANI  |  Health  Last Updated at January 31, 2021 16:21 IST

Image: Shutterstock

• 
  

While exercising regularly has many health benefits, a new study suggested that stroke survivors who completed a cardiac rehabilitation program focused on aerobic exercise significantly improved their ability to transition from sitting to standing, and how far they could walk during a six-minute walking test.

The research was published today in the 'Journal of the American Heart Association', an open-access journal of the American Heart Association.

Cardiac rehabilitation is a structured exercise program prevalent in the U.S. for people with cardiovascular disease that has been shown to increase cardiovascular endurance and improve quality of life. Despite many similar cardiovascular risk factors, stroke is not among the covered diagnoses for cardiac rehab.

Physical inactivity is common among stroke survivors, with more than 75 per cent of all U.S. patients who survive a stroke not receiving the guideline-recommended amount of exercise (150 minutes of moderate-intensity or 75 minutes of vigorous-intensity physical activity per week). Currently, exercise-based cardiac rehab programs are not the standard of care provided to stroke survivors in the U.S.

"Through this study, we hoped to improve controllable risk factors for stroke survivors, and potentially prevent future stroke and cardiac events," said lead study author Elizabeth W. Regan, D.P.T., Ph.D., clinical assistant professor of exercise science in the physical therapy program at the University of South Carolina in Columbia, South Carolina.

"Increasing physical activity is an important way to prevent stroke, and we wanted to see whether the rehab that patients receive after surviving a heart attack could have similar positive outcomes for patients who survive a stroke," Regan added.

Researchers launched a pilot study at a North Carolina medical center to investigate the benefits of a cardiac rehab program for stroke survivors. In total, 24 participants, ages 33 to 81, who had a stroke from three months to 10 years earlier, were enrolled in a cardiac rehab program including 30-to-51-minute aerobic exercise sessions three times a week, for three months.

At the beginning of the program, participants were evaluated for physical function (cardiovascular endurance, functional strength, and walking speed) and other health measures such as a mental health questionnaire and a balance test. In a post-program assessment, participants repeated these evaluations. At a six-month follow-up appointment, they completed the same tests a final time and answered life and exercise habit questionnaires. At the initial post-program assessment, researchers found that compared to the beginning of the study:

Participants saw an improvement in the distance they could walk during a six-minute walking test. On average, each participant improved their distance by 203 feet.

Participants improved their ability to quickly move from sitting to standing in the five-times-sit-stand test. Improvements on this test correspond to increased leg strength and can correspond to lower fall risk for people after stroke.

Study participants improved their metabolic equivalent of task (MET) level, or the maximum level of the amount of energy generated by the average person to perform a specific task, by about 3.6. For example, one metabolic equivalent of the task is defined as the energy it takes to watch TV, and seven are required for jogging.At the six-month follow-up visit, participants had maintained these gains, and 83.3% of participants reported that they were still exercising at least once a week.

"Our most important goal as health care professionals is to help stroke survivors reduce as many risk factors as possible to prevent future stroke or cardiovascular disease. Based on these preliminary findings, we hope prescribing cardiac rehab will be considered for all patients following a stroke, as it is for patients after a heart attack," Regan said.

"We need to place value on exercise as medicine. Exercise is health, and it is important for every individual, regardless of physical limitations or age. Hopefully, increasing physical activity can be one of the first steps to improving overall health following a stroke," Regan added.

This study included a small patient sample and was a pilot study at a single center in a multi-center health system; therefore, larger studies are needed to confirm these preliminary results.

(Only the headline and picture of this report may have been reworked by the Business Standard staff; the rest of the content is auto-generated from a syndicated feed.)

How Well Do Neurochecks Perform After Stroke?

This doesn't help one bit. We need EXACT PROTOCOLS  to recover the neurological deterioration that is found. 

How Well Do Neurochecks Perform After Stroke?

 

Andres M. De Leon Benedetti

,

Ritwik Bhatia

,

Selena R. Ancheta

,

Jose G. Romano

,

Sebastian Koch

Originally published28 Jan 2021https://doi.org/10.1161/STROKEAHA.120.032303Stroke. ;0

Abstract

Background:

In the certification of stroke centers, the performance of serial nursing neurological assessments and reassessments, commonly known as neurochecks, is often cited as one of the most problematic standards. The role of neurochecks is to readily detect neurological change, but it is surprising that this practice has undergone relatively little scientific study. Their effectiveness in detecting worsening in acute ischemic stroke patients has not been well studied. Our objective was to investigate the sensitivity of neurochecks to detect neurological deterioration after acute ischemic stroke. We performed a retrospective chart review of patients with acute ischemic stroke who were admitted to a comprehensive stroke center over a 2-year period and who received intravenous thrombolysis. The incidence, reasons, and detection rates for neurological deterioration by neurochecks were collected during the first 72 hours of admission.

Results:

A total of 231 patient records were reviewed. Over the first 72 hours of admission, each patient had a mean of 63±15 neurochecks. Neurological worsening as determined by a stroke neurologist was found in 62 (27%) patients. This deterioration was first detected by a scheduled neurocheck in 28 (45%) patients and was discovered by the nurse outside of a scheduled neurocheck in 16 (26%) patients. In 18 out of 62 (29%) patients, the worsening was not detected.

Conclusions:

Although neurochecks detected neurological deterioration in almost half of patients with acute stroke, a significant proportion of deteriorations were found outside scheduled assessments or remained undetected. This suggests that novel monitoring strategies are needed to readily identify worsening neurological status in acute stroke.(WHAT THE FUCK ARE YOU GOING TO DO AFTER YOU IDENTIFY THIS CRAP?  NOTHING!)

The Supplement Linked To Surviving COVID-19 - omega-3

This doesn't help much because nothing is mentioned about the amounts needed to get to the O3I  greater than 5.7 percent.  How many cans of sardines do I need to eat daily?

The Supplement Linked To Surviving COVID-19 - omega-3

COVID-19 patients who have higher levels of this nutrient in their blood are more likely to recover from the disease.

Scientists have published the first direct evidence that suggests higher omega-3 fatty acid levels can lower the risk of dying from the coronavirus infection.

Previous studies have found that omega-3 fatty acids have anti-inflammatory properties that could lower the severity and mortality in COVID-19 patients but up to now there wasn’t enough supporting evidence.

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• This Personality Change Is A Sign Of Dementia (M)

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The present study examined 100 hospitalized patients with Covid-19 at Cedars-Sinai Medical Center in Los Angeles.

They analysed those patients blood samples for their omega-3 index (O3I), which is a measure of EPA and DHA levels in red blood cells.

They found that the chance of surviving was nearly four times greater for those with the highest omega-3 index compared with those with the lowest.

The patients were divided into four quartiles based on their omega-3 index, ensuring each quartile contained 25 percent of participants.

The top quartile group consisted of patients with an O3I  greater than 5.7 percent and these subjects had a 75 percent reduced risk of death from coronavirus disease compared with those in the 3 lower quartiles.

Dr Arash Asher, the study’s first author, said:

“While not meeting standard statistical significance thresholds, this pilot study—along with multiple lines of evidence regarding the anti-inflammatory effects of EPA and DHA—strongly suggests that these nutritionally available marine fatty acids may help reduce risk for adverse outcomes in COVID-19 patients.

Larger studies are clearly needed to confirm these preliminary findings.”

Professor Clemens von Schacky, co-developer of the Omega-3 Index, said:

“Asher et al have demonstrated that a low Omega-3 Index might be a powerful predictor for death from COVID-19.

Although encouraging, their findings clearly need to be replicated.”

Clinical studies show that 3 grams a day of EPA and DHA supplementation for 10 weeks can lower levels of circulating inflammatory cytokines.

Cytokines are messengers in the immune system that regulate the activity of white blood cells.

Dr James H O’Keefe, commenting on the study, said:

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“An excessive inflammatory response, referred to as a ‘cytokine storm,’ is a fundamental mediator of severe COVID-19 illness.

Omega-3 fatty acids (DHA and EPA) have potent anti-inflammatory activities, and this pilot study provides suggestive evidence that these fatty acids may dampen COVID-19’s cytokine storm.”

A diet high in oily fish containing EPA and DHA such as mackerel, salmon, herring, trout, albacore tuna, and sardines can be the best way to obtain omega-3.

About the author

Mina Dean is a Nutritionist and Food Scientist. She holds a BSc in Human Nutrition and an MSc in Food Science.

The study was published in the journal Prostaglandins, Leukotrienes and Essential Fatty Acids (Asher et al., 2020).

Science Says Taking an Afternoon Nap Could Lead to a Sharper Mind

Not sure how you are going to manage this if still working. Managers won't acknowledge your science backed reason. 

Science Says Taking an Afternoon Nap Could Lead to a Sharper Mind

Scientists have long known that getting a solid amount of sleep is essential for our overall wellness, but according to new research, when you are getting more rest can make all the difference. A study published in General Psychiatry revealed that catching some z's regularly during an afternoon nap could actually help your mental agility. Their findings? People are able to have strong awareness of where they are, verbal skills, and memory overall.

Credit: Westend61 / Getty Images

To get to their conclusion, the researchers studied 2,214 healthy people over the age of 60 in China cities, namely Beijing, Shanghai, and Xian. They found that 1,534 of the subjects took afternoon naps on a routine basis, while the other 680 stayed awake. While both groups average six-and-a-half hours of sleep at night, those who napped in the afternoon got between five minutes to two hours of extra sleep after eating lunch. Some nap participants mentioned that they got their afternoon rest each day and others just once a week.

Related: Sleep, Diet, and Exercise All Impact Your Mental Health, but One Plays a Bigger Role Than the Others

Each participant also went through health checks, like the Mini Mental State Exam (MMSE), to see if they experienced dementia. These tests included 30 different measurements of cognitive strength and functioning, such as visuo-spatial skills, memory, attention span, problem-solving skills, locational awareness, and verbal ability. The findings noted that those who napped had higher MMSE scores, specifically with the locational awareness, verbal ability, memory skills.

The team noted that more research on this topic will be helpful, as the specific amount of napping time varied among the participants. They do believe that the ease of inflammation takes place when people nap during the middle of the day. "Sleep regulates the body's immune response and napping is thought to be an evolved response to inflammation; people with higher levels of inflammation also nap more often," the researchers explained.

 

 

 

Semaphorins in stroke

 Your doctor should know of all of these and have a protocol to utilize them. No knowledge they need to be fired.  We have to clean out a lot of dead wood in stroke. You can see from the dates here that this has been around for a while. There is ABSOLUTELY NO EXCUSE  that our fucking failures of stroke associations haven't put together a protocol on this and distributed it to all stroke doctors and survivors.

Semaphorins and their Signaling Mechanisms January 2018

From there: 

Early studies revealed that semaphorins function as axon guidance molecules,(We need this to have our white matter do the connections needed.) but it is now understood that semaphorins are key regulators of morphology and motility in many different cell types including those that make up the nervous, cardiovascular, immune, endocrine, hepatic, renal, reproductive, respiratory and musculoskeletal systems, as well as in cancer cells.

 

Astrocyte-Derived Exosomes Treated With a Semaphorin 3A Inhibitor Enhance Stroke Recovery via Prostaglandin D₂ Synthase September 2018

 

Following experimental stroke, the recovering brain is vulnerable to lipoxygenase‐dependent semaphorin signaling  October 2012

Serum semaphorin 7A is associated with the risk of acute atherothrombotic stroke  February 2019

Use of semaphorin-4D binding molecules to promote neurogenesis following stroke  May 2012

Ischemic neurons prevent vascular regeneration of neural tissue by secreting semaphorin 3A  June 2011

Sustained up-regulation of semaphorin 3A, Neuropilin1, and doublecortin expression in ischemic mouse brain during long-term recovery  February 2008

 

Cellular and molecular mechanisms of neural repair after stroke: making waves April 2006

 

 

 

 

 

 

 

Pilot study to characterize middle cerebral artery dynamic response to an acute bout of moderate intensity exercise at 3‐ and 6‐months poststroke

What the hell was this research for? It is your doctor's responsibility to get you able to do this moderate exercise.

Pilot study to characterize middle cerebral artery dynamic response to an acute bout of moderate intensity exercise at 3‐ and 6‐months poststroke

Billinger SA, Whitaker AA, Morton A, et al.

Journal of the American Heart Association|January 27, 2021

At 3‐ and 6‐months after stroke, researchers assessed the middle cerebral artery blood velocity (MCAv) dynamic response to an acute bout of exercise in humans. Individuals were categorized according to the MCAv dynamic response to the exercise bout as responder or nonresponder(???) and they investigated if physical activity, aerobic fitness, and exercise mean arterial blood pressure differed between groups. In this analysis, MCAv was evaluated by transcranial Doppler ultrasound during a 90‐second baseline followed by a 6‐minute moderate-intensity exercise bout. A faster time delay, higher amplitude, and reported higher levels of physical activity and aerobic fitness was seen in responders vs nonresponders. An immediate rise in MCAv following exercise onset followed by an immediate decline to near baseline values was seen in the nonresponders, while the responders showed an exponential rise until steady state was reached. It was shown that patients with a greater MCAv response to the exercise stimulus reported statin use and regular participation in exercise.

Read the full article on Journal of the American Heart Association.

 

Restoration of early deficiency of axonal guidance signaling by guanxinning injection as a novel therapeutic option for acute ischemic stroke

You'll have to see if your doctors and stroke hospital DO ANYTHING AT ALL to get this tested in humans. 

Restoration of early deficiency of axonal guidance signaling by guanxinning injection as a novel therapeutic option for acute ischemic stroke

 Available online 26 January 2021, 105460       

Author links open overlay panelGuangxuXiao^ab1MingLyu^abc1ZhixiongLi^abLinghuaCao^abXinyanLiu^abYuleWang^abShuangHe^abZihaoChen^abHongxiaDu^abYuxinFeng^abJigangWang^cYanZhu^ab

https://doi.org/10.1016/j.phrs.2021.105460Get rights and content

Highlights

•

First reported that GXNI, a Chinese herbal medicine previously prescribed for coronary artery diseases, had neuroprotective effects on ischemic stroke, which had been verified in vivo and in vitro experiments.

•

Our findings showed that deficiencies in axonal guidance signaling and promoting neurogenesis already occurred in the acute model of stroke.

•

GXNI protected brain tissue from I/R injury via up-regulating SHH-PTCH1-GLI1-mediated axonal guidance signaling to promote axon growth and synaptogenesis.

Abstract

Despite of its high morbidity and mortality, there is still a lack of effective treatment for ischemic stroke in part due to our incomplete understanding of molecular mechanisms of its pathogenesis. In this study, we demonstrate that SHH-PTCH1-GLI1-mediated axonal guidance signaling and its related neurogenesis, a central pathway for neuronal development, also plays a critical role in early stage of an acute stroke model. Specifically, in vivo, we evaluated the effect of GXNI on ischemic stroke mice via using the middle cerebral artery embolization model, and found that GXNI significantly alleviated cerebral ischemic reperfusion (I/R) injury by reducing the volume of cerebral infarction, neurological deficit score and cerebral edema, reversing the BBB permeability and histopathological changes. A combined approach of RNA-seq and network pharmacology analysis was used to reveal the underlying mechanisms of GXNI followed by RT-PCR, immunohistochemistry and western blotting validation. It was pointed out that axon guidance signaling pathway played the most prominent role in GXNI action with Shh, Ptch1, and Gli1 genes as the critical contributors in brain protection. In addition, GXNI markedly prevented primary cortical neuron cells from oxygen-glucose deprivation/reoxygenation damage in vitro, and promoted axon growth and synaptogenesis of damaged neurons, which further confirmed the results of in vivo experiments. Moreover, due to the inhibition of the SHH-PTCH1-GLI1 signaling pathway by cyclopropylamine, the effect of GXNI was significantly weakened. Hence, our study provides a novel option for the clinical treatment of acute ischemic stroke by GXNI via SHH-PTCH1-GLI1-mediated axonal guidance signaling, a neuronal development pathway previously considered for after-stroke recovery.

Graphical abstract

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Keywords

Guanxinning injection

Acute ischemic stroke

Oxygen-glucose deprivation/reoxygenation

Cerebral ischemia-reperfusion injury

Axonal guidance signaling

Neuroprotection

                                                                                                                       

Evaluating the effect of immersive virtual reality technology on gait rehabilitation in stroke patients: a study protocol for a randomized controlled trial

You'll have to ask your doctor what the results of this trial are, and if successful when EXACTLY it will be available in their hospital.

Evaluating the effect of immersive virtual reality technology on gait rehabilitation in stroke patients: a study protocol for a randomized controlled trial

• Huihui Cai,
• Tao Lin,
• Lina Chen,
• Huidan Weng,
• Ruihan Zhu,
• Ying Chen &
• Guoen Cai 

Trials volume 22, Article number: 91 (2021) Cite this article

• 71 Accesses

• 6 Altmetric

• Metrics details

Abstract

Background

The high incidence of cerebral apoplexy makes it one of the most important causes of adult disability. Gait disorder is one of the hallmark symptoms in the sequelae of cerebral apoplexy. The recovery of walking ability is critical for improving patients’ quality of life. Innovative virtual reality technology has been widely used in post-stroke rehabilitation, whose effectiveness and safety have been widely verified. To date, however, there are few studies evaluating the effect of immersive virtual reality on stroke-related gait rehabilitation. This study outlines the application of immersive VR-assisted rehabilitation for gait rehabilitation of stroke patients for comparative evaluation with traditional rehabilitation.

Methods

The study describes a prospective, randomized controlled clinical trial. Thirty-six stroke patients will be screened and enrolled as subjects within 1 month of initial stroke and randomized into two groups. The VRT group (n = 18) will receive VR-assisted training (30 min) 5 days/week for 3 weeks. The non-VRT group (n = 18) will receive functional gait rehabilitation training (30 min) 5 days/week for 3 weeks. The primary outcomes and secondary outcomes will be conducted before intervention, 3 weeks after intervention, and 6 months after intervention. The primary outcomes will include time “up & go” test (TUGT). The secondary outcomes will include MMT muscle strength grading standard (MMT), Fugal-Meyer scale (FMA), motor function assessment scale (MAS), improved Barthel index scale (ADL), step with maximum knee angle, total support time, step frequency, step length, pace, and stride length.

Discussion

Virtual reality is an innovative technology with broad applications, current and prospective. Immersive VR-assisted rehabilitation in patients with vivid treatment scenarios in the form of virtual games will stimulate patients’ interest through active participation. The feedback of VR games can also provide patients with performance awareness and effect feedback, which could be incentivizing. This study may reveal an improved method of stroke rehabilitation which can be helpful for clinical decision-making and future practice.

Trial registration

Chinese Clinical Trial Registry ChiCTR1900025375. Registered on 25 August 2019

Peer Review reports

Background

Stroke is a serious disease with a high disability rate. Often occurring in elderly populations, stroke-related disability contributes one of the main causes of adult disability [1]. Studies show that stroke survivors experience residual physical dysfunction which has a great impact on their ability to live. Studies have reported that 55–80% of stroke survivors demonstrate continuous motor dysfunction, decreased quality of life, and limited activities in daily life [1,2,3,4]. Other studies have reported that 80% of stroke patients experience movement disorders, including loss of balance and gait ability [1, 3]. The disease-related movement disorders and the subsequent decrease in daily living activity can be a great burden to patients, their families, and society. Gait disorder is one of the most common symptoms in stroke sequelae; thus, the recovery of walking ability is the key to improving patients’ self-care ability and quality of life. Compared with that of the healthy people, the gait of patients with cerebral apoplexy often manifests as slowed, shortened standing time on the paralyzed side, too early toes falling when standing, etc. [5]. As such, gait rehabilitation is often the primary goal of stroke rehabilitation [6,7,8]. As the population continues to age, an increasing number of stroke patients are posed to experience great challenges to disease-related effects. In turn, improving the efficiency of rehabilitation strategies remains of paramount importance.

Virtual reality (VR) is an innovative tool to realize connection, operation, and interaction between human vision and computer-simulated scenarios [9]. Non-immersive VR (for example Xbox Kinect) has been applied in clinical trials of stroke rehabilitation [10, 11]. VR training experience is interesting and enjoyable for the patient, which reduces fatigue, keeps patients in a happy mood, and reduces the boredom of repetitive, conventional rehabilitation. Non-immersive VR-assisted rehabilitation is proposed to provide a more personalized intervention therapy [12]. VR training for stroke patients can therefore improve the participation and autonomy of patients in the rehabilitation process, qualities that have been shown to be more cost and resource effective [13]. Overall, non-immersive VR has been shown to increase limb function learning and improves the quality of life [14].

Recently, immersive VR is a novel VR type. Immersive VR involves a head-mounted display with visual and auditory cues and controllers using haptic (sense of touch) feedback in a 3-dimensional environment [15]. Immersive VR is a technology that provides more realistic environment scene design and object tracking than previous ordinary VR [16], which provides virtual interaction and real-time feedback in vision, touch, hearing, and even motion in realistic scenarios. Patients can experience controllable movement or operation in a simulated virtual environment, so as to achieve the rebuilding or restoring of physical functions.

Immersive VR researches have been reported in the field of pain medicine [17]. In the field of post-stroke rehabilitation, immersive VR has also been reported in upper limb motor function and cognitive ability [16, 18]. However, a few studies have previously explored the application of immersive VR-assisted training in gait rehabilitation after stroke. For example, Biffi et al. found that immersive virtual reality platform enhances the walking ability of children with acquired brain injuries [19] and research by Irene Cortes-Perez has shown that immersive virtual reality improves balance in stroke patients and reduces the risk of falls [20]. Thus, research on immersive VR-assisted training in gait rehabilitation requires its own dedicated investigation. As a VR device of reasonable cost, it has become a powerful research tool for scientific researchers [21, 22]. This study will apply the immersive device to execute VR scenes of rehabilitation training according to clinical practice, so as to systematically evaluate the application of immersive VR technology in the rehabilitation of stroke gait disorders.

 

Prediction of Balance After Inpatient Rehabilitation in Stroke Subjects with Severe Balance Alterations at the Admission

Useless because it is using the current failures to recover as the status quo. CHANGE THAT TO 100% RECOVERY and survivors will gladly accept those predictions.

Prediction of Balance After Inpatient Rehabilitation in Stroke Subjects with Severe Balance Alterations at the Admission

Author links open overlay panelChristian FedericoGathPT^⁎

Matias GabrielGianellaPT^⁎LucasBonamicoMD^†LisandroOlmosMD^†Maria JulietaRussoMD^†

https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.105627Get rights and content

Abstract

Background

Patients with severe motor alterations would be those on who the prediction of the expected motor response after inpatient rehabilitation programs is most required.

Objectives

To analyze if the balance progress measured by the Berg Balance Scale and the time of hospitalization could be independent predictors of the Berg Balance at the end of a post stroke rehabilitation program in patients with severe balance alteration at the admission. Secondly, to compare a Berg Balance prediction model at the time of discharge based on the Berg Balance at the time of admission (model 1) to a Berg Balance prediction model at the time of discharge based on Berg Balance progress and the time of hospitalization (model 2).

Methods

Subjects suffering a first subacute supratentorial stroke admitted for inpatient rehabilitation between 2010 through 2018 were included to develop two linear regression models of predicted Berg Balance at discharge (n=149).

Results

According to model 1 (p < 0.0001, R²= 0.166), the Berg Balance at the admission would be a predictor of the Berg Balance at discharge from hospitalization. According to model 2 (p < 0.0001, R²= 0.993) the Berg Balance progress (β= 1.026; p < 0.0001) and the hospitalization time (β=-0.006; p < 0.0001) would be independent predictors of the Berg Balance at discharge.

Conclusions

The motor response to the rehabilitation programs in subacute patients with severe motor alterations could be explained on the basis of balance condition at the admission, but this explanation may be improved considering the progress on the balance the patients achieve during inpatient rehabilitation irrespective the time of hospitalization.