Use the labels in the right column to find what you want. Or you can go thru them one by one, there are only 34,483 posts. Searching is done in the search box in upper left corner. I blog on anything to do with stroke. DO NOT DO ANYTHING SUGGESTED HERE AS I AM NOT MEDICALLY TRAINED, YOUR DOCTOR IS, LISTEN TO THEM. BUT I BET THEY DON'T KNOW HOW TO GET YOU 100% RECOVERED. I DON'T EITHER BUT HAVE PLENTY OF QUESTIONS FOR YOUR DOCTOR TO ANSWER.
Changing stroke rehab and research worldwide now.Time is Brain!trillions and trillions of neuronsthatDIEeach day because there areNOeffective hyperacute therapies besides tPA(only 12% effective). I have 523 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. Did your doctor somehow miss the recovery protocol that Pedro Bach-y-Rita used to recover fully back in 1958 with only a partial brain?
What this blog is for:
My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. 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 lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.
A whole book that every stroke hospital with ANY COMPETENCE AT ALL should have their nutritionist apply to meals at the hospital and the diet protocol for home use. I want to know how to get the correct circulating level of resveratrol in the bloodstream and get it to my brain.
If your doctor doesn't get you recovered enough to exercise and get these benefits you don't have a competent doctor. 12.54 minutes for you to see what you can do without your doctors help. My definition of a competent stroke doctor is one who gets an EXACT damage diagnosis, then uses that diagnosis to select EXACT stroke protocols that DELIVER RECOVERY. If your doctor is like mine and just writes 3 E.T.(Evaluate and Treat) prescriptions to PT, OT and ST then your doctor knows absolutely nothing about stroke recovery. I'm sure I could train a rat to type E T for all stroke patients.
Oops, I'm not playing by the polite rules of Dale Carnegie, 'How to Win Friends and Influence People'.
Telling stroke medical persons they know nothing about stroke is a no-no even if it is true.
Politeness
will never solve anything in stroke. Yes, I'm a bomb thrower and proud
of it. Someday a stroke 'leader' will try to ream me out for making them look bad by being truthful , I
look forward to that day.
Your hospital can compare this exoskeleton to all the other ones out there and the ones they have in house. Don't laugh, I'm just making a crazy assed assumption what a competent stroke hospital would be doing. You can compare that to what your stroke hospital is doing.
Hemiplegia
is a medical condition in which half-side of the body gets paralyzed.
It is often observed in patients who have undergone a stroke. As many as
eighty eight percentage of stroke patients suffer from hemiplegia.
Rehabilitation, using physiotherapy, is the most effective treatment for
hemiplegia. This research aims to develop an exoskeleton that can be
used to generate motion in the limbs to assist physiotherapy, thereby
facilitating rehabilitation. The exoskeleton is designed such that it
can be used for both upper limbs and lower limbs, interchangeably. In
this paper, we discuss some existing designs for the purpose and the
proposed exoskeleton is discussed through mechanical design, dynamics
study and a brief into the possible control methods.
Conference Location: Tehran, Iran, Islamic Republic of
I. Introduction
The
recent progress in a powered exoskeleton has been focused on many
regions within the medical sectors, including the purpose of load
augmentation for assisting trauma patients, paraplegic patients,
hemiplegic patients, spinal cord injured patients and rehabilitation
purposes [1]. Based on the purpose, the exoskeleton can be designed for
the upper limb or the lower limb. The human body’s upper limb consists
of an intricate skeletal structure, including shoulder complex, elbow
complex, wrist joint, and fingers. The upper limb’s significant motions
are allowed by the glenohumeral joints in the shoulder, elbow joint,
radioulnar joint, wrist joint, and the movement of fingers [2]. The
glenohumeral joint allows three degrees of freedom (abduction/adduction,
flexion/extension and internal/external rotation) in the shoulder
complex. In the elbow joint, the primary movement is flexion/extension,
which provides one degree of freedom. Besides, the radioulnar joint
enables the pronation/supination motion, and the wrist joint allows
flexion/extension and abduction/adduction, hence overall providing three
degrees of freedom. Rehabilitation for each joint in the fingers would
require a complex setup as the fingers’ intricate movements are allowed
through numerous joints. In this paper, we will be only focusing on the
shoulder, elbow and wrist joints. For lower limbs, excluding the toes,
the significant motions are enabled by the hip joint with three degrees
of freedom (flexion/extension, abduction/adduction and internal/external
rotation), knee joint with three degrees of freedom (flexion/extension
and rotation) and ankle joint with three degrees of freedom
(plantarflexion/dorsiflexion, abduction/adduction and
eversion/inversion) [3]. Furthermore, due to the knee joint profile, the
instantaneous helical axis of rotation of the biological joint deviates
from a monocentric joint of the exoskeleton [4]. Based on the study [4]
results, the knee joint experiences a maximum misalignment of 27.212 mm
from the respective axis. As the obtained misalignment is significant
enough to cause discomfort during the flexion of the knee, the design
proposed in this paper has considered this issue. Another classification
of the exoskeleton is based on the type of actuation. Previous research
[5]–[7] indicates that there are two common modes of actuations:
motor-driven actuation and pneumatic air muscle actuation. For each
actuation, there are various modes of transmission to the system. Table I
illustrates the different actuations and transmission generally used
for the medical exoskeleton. In addition to these actuations, there were
other actuations such as the three-layered spring slider spring
mechanism [8] and Shape Memory Alloy actuation [9], but these actuations
lacked controllability and feasibility. Based on the research in Table I
and the availability of actuators in the market, the motor-driven
actuation directly attached to the joints was a more feasible option.
The primary issue of most of the previous exoskeletons is the
cost-effectiveness of the solution, hence preventing it from reaching
the market for the general public’s usage. Also, the previous works have
only provided solutions individually for the upper limbs and the lower
limbs. Hence, this paper’s primary goal is to provide a viable design
and analysis of the exoskeleton suit, which utilizes the minimal number
of actuators for the required exercises and provides a way to use the
suit interchangeably for both upper and lower limbs.
Survivors don't give a shit about length of stay, they want to know how the fuck you're going to get them 100% recovered! And your mentors and senior researchers approved this useless crapola?
Lateropulsion is pusher syndrome, yep this is more difficult to recover from but your doctor should have protocols for it if competent at all.
Lateropulsion
is a common impairment after stroke. Regardless of stroke severity,
functional recovery is slower in people with lateropulsion, resulting in
requirement for longer rehabilitation duration. In Australia, inpatient
rehabilitation funding is determined via the Australian National
Sub-Acute and Non-Acute Patient Classification (AN-SNAP). AN-SNAP class
is determined using age, diagnosis, weighted Functional Independence
Measure (FIM) motor score, and FIM cognitive score.
Objectives
To explore accuracy of the AN-SNAP to predict length of stay (LOS) for people with poststroke lateropulsion.
Methods
A
retrospective database audit was undertaken. AN-SNAP predicted LOS for
each participant was calculated based on 2019 calendar year national
benchmarks. A multivariable linear regression model estimated mean
differences in reported LOS and AN-SNAP predicted LOS after adjusting
for lateropulsion severity (Four Point Pusher Score). A separate
logistic regression model assessed whether FIM change during admission
was associated with reported LOS exceeding AN-SNAP predicted LOS.
Results
Data
were available from 1126 admissions. Reported LOS exceeding AN-SNAP
predicted LOS was associated with greater lateropulsion severity on
admission. Where AN-SNAP predicted LOS was longer, those with no
lateropulsion on admission showed shorter reported than predicted LOS.
Greater improvement in FIM during rehabilitation was associated with
increased odds of reported LOS exceeding AN-SNAP predicted LOS (OR 1.02,
95%CI 1.01–1.03, p < .001).
Conclusions
Inclusion
of a measure of poststroke lateropulsion in the AN-SNAP classification
model would result in more accurate LOS predictions to inform funding.
Costs of longer rehabilitation LOS may be countered by optimized
long-term physical function, reducing requirement for ongoing care.
Department of Neurology, University Hospital Carl Gustav Carus, Technische Universitaet Dresden, Dresden, Germany
Background: Neuroprotective and
neurorestorative effects have been postulated for selective
serotonin-reuptake inhibitors (SSRI). We hypothesized that sertraline,
which is characterized by less severe adverse effects and more stable
pharmacokinetics than classic SSRI, is associated with improved
functional recovery in acute ischemic stroke patients with motor
deficits.
Methods: Prospective observational
study of consecutive acute ischemic stroke patients who received
sertraline for clinically suspected post-stroke depression (PSD) or at
high risk for PSD. Eligibility comprised acute motor deficit caused by
ischemic stroke (≥2 points on NIHSS motor items) and functional
independence pre-stroke (mRS ≤1). Decision to initiate treatment with
SSRI during hospital stay was at the discretion of the treating stroke
physician. Patients not receiving sertraline served as control group.
Favorable functional recovery defined as mRS ≤2 was prospectively
assessed at 3 months. Multivariable logistic regression analysis was
used to explore the effects of sertraline on 3-months functional
recovery. Secondary outcomes were frequency of any and incident PSD
(defined by BDI ≥10) at 3 months.
Results: During the study period (03/2017–12/2018), 114 patients were assigned to sertraline (n = 72, 62.6%) or control group (n
= 42, 37.4%). At study entry, patients in sertraline group were more
severely neurologically affected than patients in the control group
(NIHSS: 8 [IQR, 5–11] vs. 5 [IQR, 4–7]; p = 0.002). Also, motor NIHSS scores were more pronounced in sertraline than in control group (4 [IQR 2–7] vs. 2 [IQR 2–4], p
= 0.001). After adjusting for age and baseline NIHSS, multivariable
regression analysis revealed a significant association between
sertraline intake and favorable functional outcome at 3 months (OR 3.10,
95% CI 1.02–9.41; p = 0.045). There was no difference between
both groups regarding the frequency of any depression at 3 months (26/53
[49.1%] vs. 14/28 [50.0%] patients, p = 0.643, BDI ≥10).
However, fewer incident depressions were observed in sertraline group
patients compared to patients in control group (0/53 [0%] vs. 5/28
[17.9%] patients, p = 0.004).
Conclusions: In this non-randomized
comparison, early treatment with sertraline tended to favor functional
recovery in patients with acute ischemic stroke. While exploratory in
nature, this hypothesis needs further investigation in a clinical trial.
No clue how this is going to help your recovery, so ask your doctor very very specifically how this will help. NO KNOWLEDGE OF THE RESEARCH, CALL THE PRESIDENT AND ASK WHEN COMPETENT PEOPLE WILL BE HIRED!
Preclinical
stroke studies endeavor to model the pathophysiology of clinical
stroke, assessing a range of parameters of injury and impairment.
However, poststroke pathology is complex and variable, and associations
between diverse parameters may be difficult to identify within the usual
small study designs that focus on infarct size.
Methods:
We
have performed a retrospective large-scale big data analysis of records
from 631 C57BL/6 mice of either sex in which the middle cerebral artery
was occluded by 1 of 5 surgeons either transiently for 1 hour followed
by 23-hour reperfusion (transient middle cerebral artery occlusion
[MCAO]; n=435) or permanently for 24 hours without reperfusion
(permanent MCAO; n=196). Analyses included a multivariate linear mixed
model with random intercept for different surgeons as a random effect to
reduce type I and type II errors and a generalized ordinal regression
model for ordinal data when random effects are low.
Results:
Analyses
indicated that brain edema volume was associated with infarct volume at
24 hours (β, 0.52 [95% CI, 0.45–0.59]) and was higher after permanent
MCAO than after transient MCAO (P<0.05). A more severe
clinical score was associated with a greater infarct volume but not with
the animal’s age or edema volume. Further, a more severe clinical score
was observed for a given brain infarct volume after transient MCAO
versus permanent MCAO. Remarkably the animal’s age, which corresponded
with the period of young adulthood (6–40 weeks; equivalent to ≈18–35
years in humans), was positively associated with severity of lung
infection (β, 0.65 [95% CI, 0.42–0.88]) and negatively with spleen
weight (β, −0.36 [95% CI, −0.63 to −0.09]).
Conclusions:
Large-scale
analysis of preclinical stroke data can provide researchers in our
field with insight into relationships between variables not possible if
individual studies are analyzed in isolation and has identified
hypotheses for future study.
You still don't know how fast mechanical thrombectomy needs to occur to get 100% recovery so your doctors are completely clueless. THAT should initiate immediate research to solve if your stroke hospital had any competency at all. But they don't, they are relying on the tyranny of low expectations to give off the false impression of success.
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Abstract
BACKGROUND AND PURPOSE:
Current stroke care recommendations for patient selection for
mechanical thrombectomy in the extended time window demand advanced
imaging to determine the stroke core volume and hypoperfusion mismatch(So you are cherry picking patients, which means you as a patient have to have the correct stroke your doctors can minimally treat!),
which may not be available at every center. We aimed to determine
outcomes in patients selected for mechanical thrombectomy solely on the
basis of noncontrast CT and CTA in the early (<6-hour) and extended
(≥6-hour) time windows.
MATERIALS AND METHODS:
Consecutive mechanical thrombectomies performed for acute large-vessel
occlusion ischemic (ICA, M1, M2) stroke between February 2016 and August
2020 were retrospectively reviewed. Eligibility was based solely on
demographics and noncontrast CT (ASPECTS) and CTA, due to the limited
availability of perfusion imaging during the study period. Propensity
score matching was performed to compare outcomes between time windows.
RESULTS:
Of 417 mechanical thrombectomies performed, 337 met the inclusion
criteria, resulting in 205 (60.8%) and 132 (39.2%) patients in the 0- to
6- and 6- to 24-hour time windows, respectively. The ASPECTS was higher
in the early time window (9; interquartile range = 8–10) than the
extended time window (9; interquartile range = 7–10; P = .005).
Propensity score matching yielded 112 well-matched pairs. Equal rates
of TICI 2b/3 revascularization and symptomatic intracranial hemorrhage
were observed. A favorable functional outcome (mRS 0–2) at 90 days was
numerically more frequent in the early window (45.5% versus 33.9%, P = .091). Mortality was numerically more frequent in the early window (25.9% versus 17.0%, P = .096).
CONCLUSIONS:
Patients selected for mechanical thrombectomy in the extended time
window solely on the basis of noncontrast CT and CTA still achieved
decent rates of favorable 90-day functional outcomes(Did they get 100% recovery? Then it wasn't favorable!), not statistically
different from patients in the early time window(So early and late are failures).
Intracerebral
hemorrhage (ICH) remains the deadliest form of stroke worldwide,
inducing neuronal death through a wide variety of pathways. Therapeutic
hypothermia (TH) is a robust and well studied neuroprotectant widely
used across a variety of specialties.
Aims
This review
summarizes results from preclinical and clinical studies to highlight
the overall effectiveness of TH to improve long-term ICH outcomes while
also elucidating optimal protocol regimens to maximize therapeutic
effect.
Summary of Review
A systematic review was conducted
across three databases to identify trials investigating the use of TH
to treat ICH. A random-effects meta-analysis was conducted on
preclinical studies, looking at neurobehavioral outcomes, blood brain
barrier breakdown (BBB), cerebral edema, hematoma volume, and tissue
loss. Several mixed-methods meta-regression models were also performed
to adjust for variance and variations in hypothermia induction
procedures. 21 preclinical studies and 5 human studies were identified.
The meta-analysis of preclinical studies demonstrated a significant
benefit in behavioral scores (ES=-0.43, p=0.02), cerebral edema
(ES=1.32, p=0.0001), and BBB (ES=2.73, p=<0.00001). TH was not found
to significantly affect hematoma expansion (ES=-0.24, p=0.12) or tissue
loss (ES=0.06, p=0.68). Clinical study outcome reporting was
heterogeneous, however there was recurring evidence of TH-induced edema
reduction.
Conclusions
The combined preclinical evidence
demonstrates that TH reduced multiple cell death mechanisms initiated by
ICH, yet there is no definitive evidence in clinical studies. The
cooling strategies employed in both preclinical and clinical studies
were highly diverse, and focused refinement of cooling protocols should
be developed in future preclinical studies. The current data for TH in
ICH remains questionable despite the highly promising indications in
preclinical studies. Definitive randomized controlled studies are still
required to answer this therapeutic question.
Or your doctor could have competently years ago created a protocol on all this that reduces stroke risk by 307%. Pills vs. more natural methods, which way is your doctor going?
Aspirin in one of the four drugs in the cocktail - Jonathan Brady/PA
A daily cocktail of aspirin, statins and blood pressure pills slashes a person’s risk of a stroke in half, a study has found.
Canadian researchers analysed data from three large studies, totalling more than 18,000 people who had an average age of 63.
People
were given either a regimen of placebo pills; statins alongside two
blood pressure drugs; or statins, two blood pressure drugs and also
aspirin.
Researchers looked at how likely a person was to suffer a cardiovascular health issue, which included heart attacks, strokes, or death from heart disease, over a five year period.
Overall,
people who took all four drugs were 47 per cent less likely to suffer
one of the aforementioned health issues. But in the non-aspirin cohort,
the figure was just 32 per cent.
Only dementia (70,047) and Covid-19 (73,766) claimed more lives than heart diseases in England last year (55,807).
Aspirin
and statins are prescribed to people who are at high risk of
cardiovascular health issues, or who have a history of the conditions.
Data
show that when aspirin was included in the preventative treatment,
either as standalone tablets or rolled into one capsule — a so-called
polypill — the risk of a person having a stroke is reduced by 51 per
cent compared to someone not on medication.
The study, published in The Lancet, also found the treatment lowers the likelihood of a heart attack by 53 per cent, and of death from cardiovascular disease by 49 per cent.
In
contrast, the risk reduction is just 41 per cent for stroke, 48 per
cent for heart attack, and 35 per cent for cardiovascular death for
people taking a polypill that does not include aspirin.
“This
combination, either given separately or combined as a polypill,
substantially reduces fatal and non-fatal cardiovascular disease
events,” said lead author Dr Philip Joseph, associate professor of
medicine at McMaster University.
“The largest effects are seen
with treatments that include blood pressure lowering agents, a statin
and aspirin together, which can reduce fatal and non-fatal
cardiovascular events by about half.
“The benefits are consistent
at different blood pressure levels, cholesterol levels and with or
without diabetes, but larger benefits may occur in older people.”
A commonly prescribed statin - Finnbarr Webster / Alamy
Polypills
are not a new concept, first being discussed around 20 years ago as a
way of tackling the growing scourge of cardiovascular disease. However,
there is some debate over the balance of risks and benefits.
Currently, no polypills are authorised in the UK, but they continue to win support from experts.
Professor Fausto Pinto, president of the World Heart Federation (WHF), said: “The demonstration of a low-cost approach using fixed dose combinations
to reduce cardiovascular disease by about 50 per cent is extraordinary
and represents a huge opportunity to tackle the condition globally, with
a major potential impact on people's lives.
“The WHF has
supported the use of a polypill for the last decade and these results
provide robust evidence to strengthen our global advocacy strategy.”
“Although
a polypill strategy might sit uncomfortably with precision medicine,
there is now a substantial evidence base that such an approach is
effective at reducing cardiovascular disease,” added Jonathan Mant and
Richard McManus, professors of primary care at the University of
Cambridge and Oxford, respectively, who were not involved in the study
but wrote an accompanying comment article, also published in The Lancet.
“Guideline writers and policy makers should consider how to incorporate this evidence base into guidelines and policies.”
A
separate study from The George Institute in Australia, published Sunday
in the New England Journal of Medicine, found that ditching normal salt
for a low-sodium alternative reduced a high-risk person’s risk of
stroke by 14 per cent.(Since this is a study in China and their use of salt is completely different than the rest of the first world this is likely not transferable to other countries.)
Salt and pepper mills on a wooden table - Alamy
“Almost
everyone in the world eats more salt than they should. Switching to a
salt substitute is something that everyone could do if salt substitutes
were on the supermarket shelves,’’ said study author Professor Bruce
Neal.
‘’Better still, while salt substitutes are a bit more
expensive than regular salt, they’re still very low-cost – just a few
dollars a year to make the switch.”
Objectives:
Therapist competencies when delivering an intervention can impact
clinical outcomes. However, the relationship between competence and
outcome in the context of memory rehabilitation has not previously been
investigated. We aimed to evaluate whether therapist competencies in
delivering a group-based memory rehabilitation intervention, as part of a
randomized-controlled trial, was associated with changes in clinical
outcome in the participants with traumatic brain injury.
Method:
Outcome data on the Everyday Memory Questionnaire (EMQ) and Goal
Attainment Scaling (GAS) were obtained for 24 participants of the memory
rehabilitation trial. Video recordings of intervention sessions
delivered by six therapists were coded using a checklist designed to
evaluate therapist competence in group facilitation.
Results:
Therapists demonstrated consistently high levels of competency in
facilitating the memory group. Correlational analyses showed that there
was a non-significant weak association between EMQ and therapist
competence (r = .28, p = .18), and between GAS and therapist competence for short- and long-term goals (r = −.33, p = .12 and r = −.24, p = .25, respectively).
Conclusions:
We found no significant association between competence and outcome in
this memory rehabilitation trial. This may reflect insufficient
variability in therapist competence and/or the nature of the clinical
outcome measures used. Further research is needed to understand
competence-outcome relationships in cognitive rehabilitation.
Since you lost 5 cognitive years from the stroke maybe you want your doctor to have this available for you. Up to you if you want to enforce competence in your stroke hospital. It might help your children and grandchildren when they have strokes.
1Neuropsychology Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
2IRCCS, Fondazione Don Carlo Gnocchi – ONLUS, Milan, Italy
3Service of Statistics, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
4Department of Rehabilitation and Functional
Recovery, IRCCS San Raffaele Hospital and Scientific Institute,
Vita-Salute San Raffaele University, Milan, Italy
5IRCCS Centro Neurolesi “Bonino Pulejo,” Messina, Italy
6MAC Memory Clinic and Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
7NEtS, Scuola Universitaria Superiore IUSS-Pavia, Pavia, Italy
8IRCCS Fondazione Mondino, Pavia, Italy
Background: In recent years, the potential
usefulness of cognitive training procedures in normal aging and mild
cognitive impairment (MCI) have received increased attention.
Objective: The main aim of this study was to
evaluate the efficacy of the face-to-face cognitive virtual reality
rehabilitation system (VRRS) and to compare it to that of face-to-face
cognitive treatment as usual for individuals with MCI. Moreover, we
assessed the possibility of prolonging the effects of treatment with a
telerehabilitation system.
Methods: A total of 49 subjects with MCI were
assigned to 1 of 3 study groups in a randomized controlled trial design:
(a) those who received face-to-face cognitive VRRS (12 sessions of
individualized cognitive rehabilitation over 4 weeks) followed by
telerehabilitation (36 sessions of home-based cognitive VRRS training,
three sessions for week); (b) those who received face-to-face cognitive
VRRS followed by at-home unstructured cognitive stimulation (36 sessions
of home-based unstructured cognitive stimulation, three sessions for
week); and (c) those who received face-to-face cognitive treatment as
usual (12 sessions of face-to-face cognitive treatment as usual).
Results: An improvement in memory, language and
visuo-constructional abilities was observed after the end of
face-to-face VRRS treatment compared to face-to-face treatment as usual.
The application of home-based cognitive VRRS telerehabilitation seems
to induce more maintenance of the obtained gains than home-based
unstructured stimulation.
Discussion: The present study provides preliminary
evidence in support of individualized VRRS treatment and
telerehabilitation delivery for cognitive rehabilitation and should pave
the way for future studies aiming at identifying optimal cognitive
treatment protocols in subjects with MCI.
Given the limited effectiveness of pharmacological
treatments, there is a critical need to develop novel interventions
aimed at preventing or delaying the onset of Alzheimer’s disease (AD),
and mild cognitive impairment (MCI) might represent a potential target
for intervention trials (Kidd, 2008; Hong et al., 2015; Janoutova et al., 2015).
Traditional cognitive training involves intensive
in-person sessions that may not prove to be feasible and cost-effective
in the case of large-scale implementation. The average lifespan in the
world almost doubled during the 20th century and has resulted in a large
number of people living to old ages, causing an increased risk of
developing age-related diseases, disability and dementia (Fratiglioni et al., 1999; Brown, 2015).
In the coming years, the growing demand and the need to contain the
costs of health care will dictate the need to reorganize the services
dedicated to people at risk of developing cognitive impairment by taking
advantage of technological developments (Bharucha et al., 2009; Astell, 2019; Moyle, 2019). Telerehabilitation via information and communication technologies (Brennan et al., 2011; Realdon et al., 2016; Pitt et al., 2019)
represents an innovative approach to overcome the obstacles associated
with face-to-face intervention. Telerehabilitation technologies allow to
provide services remotely in patients’ homes or other environments,
allowing access to health care to patients living in rural settings or
with mobility difficulties (Brennan et al., 2002, 2009, 2011; Forducey et al., 2003; Mashima and Doarn, 2008; Zampolini et al., 2008; Hailey et al., 2011; Peretti et al., 2017).
In addition, the telerehabilitation modality offers the advantage of
providing rehabilitation within the natural environment of the patient’s
home, making the treatment more realistic and possibly more
generalizable to the person’s daily life (McCue et al., 2010).
A recent systematic review showed the efficacy of
telerehabilitation on cognitive abilities in individuals with MCI and in
patients with neurodegenerative diseases associated with cognitive
impairment (Cotelli et al., 2019).
MCI is a condition associated with risk of progression to dementia, and
represents a well-suited target for prevention studies (Petersen et al., 1999, 2014; Petersen, 2004; Livingston et al., 2017).
However, these treatments are delivered in several ways and there is
not a clinical consensus about content-design of telerehabilitation. A
fixed schedule approach has proved to be effective in the treatment of
elderly people with high risk of conversion in dementia resulting in a
significant improvement in global cognitive functioning, memory and
processing speed (Lampit et al., 2014).
In other studies, participants were given the opportunity to choose
free among the activities available in each session of training (Medalia and Freilich, 2008; Gooding et al., 2016).
A third alternative consisted in the user-centered approach, which
customized the choice of rehabilitative contents based on the
performance obtained by the individual to the set up tests implemented
in the software at the beginning of the rehabilitation path (Solana et al., 2015; Vance et al., 2018).
So far, the majority of studies are feasibility or pilot studies with
small-medium sample size and are very heterogeneous in terms of
intensity and duration of treatment (Burdea et al., 2015; Espay et al., 2016; Dodakian et al., 2017).
For this reason, in the light of this ongoing deep transformation of
health care, it is of great relevance the effort to harmonize
intervention protocols and randomized controlled trials (RCTs) are
strongly needed to demonstrate the effectiveness of these home-based
technology-enhanced treatment protocols with respect to the
gold-standard, named the usual face-to-face care (Linden et al., 2016; Fetta et al., 2017; Topol, 2019).
The main aim of the current study was to evaluate the
efficacy of the cognitive face-to-face virtual reality rehabilitation
system (VRRS) and to compare it to that of face-to-face cognitive
treatment as usual for subjects with MCI. We hypothesized that the
face-to-face VRRS system would ameliorate memory and attentional
abilities more than treatment as usual in subjects with MCI.
Moreover, we tested the hypothesis that the
implementation of home-based treatment through the cognitive VRRS system
could induce long-term benefits, prolonging the beneficial effects of
face-to-face.
Isabella Stuckart
Timo Siepmann
Christian Hartmann, 
Lars-Peder Pallesen
Jessica Barlinn
Volker Puetz
Kristian Barlinn
Rosa Manenti
Elena Gobbi
Francesca Baglio
Clarissa Ferrari
Ilaria Pagnoni
Federica Rossetto
Sonia Di Tella
Federica Alemanno
Placido Bramanti
Stefano F. Cappa
Maria Cotelli