Modern approaches to the management of early rehabilitation period after ischemic stroke

 Early mobilization has been discussed forever; WHERE IS THE PROTOCOL LOCATED? And you incompetently DIDN'T CREATE A PROTOCOL?

Early Mobilization (20 posts to May 2014)

Modern approaches to the management of early rehabilitation period after ischemic stroke

Authors: Galimov A.R.¹, Stenkina N.V.¹, Gaikina E.A.², Shafikova E.S.¹, Bashirova A.R.¹, Yapparov A.R.¹, Amirkhanyan A.V.³, Rozhkov M.I.³, Morozov N.P.¹, Davletbaeva N.R.¹, Gimranova N.M.¹, Yamgurova R.R.¹, Shagiakhmetova D.R.¹, Sultanmuratov I.R.¹, Reshetnikova A.A.¹

Affiliations:

1.Bashkir State Medical University, Ufa, Russia 

2. Ulyanovsk State University, Ulyanovsk, Russia

3. Voronezh State Medical University named after N.N. Burdenko, Voronezh, Russia

• Section: Reviews
• URL: https://rjmseer.com/1560-9537/article/view/680937
• DOI: https://doi.org/10.17816/MSER680937
• ID: 680937

Abstract

Ischemic stroke (IS) is a form of acute cerebral circulatory failure (ACBF), the pathogenesis of which is based on occlusion of the head or neck arteries supplying blood to the brain, which leads to ischemia and, as a consequence, to the death of cortical areas of the brain and the development of focal neurological disorders. This disease remains one of the leading causes of death and disability in the world. According to the latest statistical data, about 16.9 million cases of IS are registered annually and this figure is steadily increasing, especially in connection with the increase in life expectancy of the population. The present review is devoted to the analysis of modern approaches to the management of early rehabilitation period after IS, which remains one of the leading causes of disability and mortality in the world. The authors analyze the pathophysiological basis of the early rehabilitation period, including the role of neuroplasticity, neuroinflammation, and interhemispheric cortical reorganization. Special attention is paid to innovative rehabilitation methods such as robotic technology, transcranial magnetic stimulation, virtual reality and cell therapy. The efficacy of these techniques is reviewed based on data from randomized controlled trials and meta-analyses. The results demonstrate significant improvement in functional outcomes with early initiation of rehabilitation programs and combined use of traditional and innovative techniques.

Electromyography (EMG)-triggered transcutaneous spinal cord and hip stimulation for gait rehabilitation in persons with chronic stroke: a randomized, controlled trial

 Where is the protocol located so survivors can find it and deliver it to their therapists?

Electromyography (EMG)-triggered transcutaneous spinal cord and hip stimulation for gait rehabilitation in persons with chronic stroke: a randomized, controlled trial

• Mami Tani, 
• Tomofumi Yamaguchi, 
• Kaoru Honaga, 
• Yoko Takahashi, 
• Hidemi Kono, 
• Yuhei Murakami, 
• Reina Isayama, 
• Koshiro Haruyama, 
• Yuji Fujino, 
• Tadamitsu Matsuda, 
• Issei Fukunaga, 
• Masaaki Hori, 
• Akira Tanuma, 
• Futoshi Wada, 
• Kozo Hatori & 
• Toshiyuki Fujiwara 

Journal of NeuroEngineering and Rehabilitation volume 22, Article number: 154 (2025) Cite this article

Abstract

Background

Transcutaneous spinal stimulation has been applied to gait rehabilitation for persons with neurological diseases. The authors developed electromyography-triggered transcutaneous spinal cord and hip stimulation for gait rehabilitation and called this system FAST walk. This study aimed to assess the effect of FAST walk in a randomized, controlled trial.

Methods

All participants were randomly allocated to three groups: FAST walk combined with treadmill gait training (FAST walk); spinal stimulation combined with treadmill gait training (spinal stim); and treadmill gait training (treadmill). Participants performed two sets of 15-min treadmill gait training with 5-min intervals in the FAST walk, spinal stim, and treadmill groups. Gait training was performed twice weekly for a total of 10 sessions. The primary outcome was 10-m walking time. The secondary outcomes were the time symmetry index (TSI) with gait analysis and spinal reciprocal inhibition on the conditioned-test H reflex study.

Results

Twenty persons with chronic stroke participated in this study, and 17 persons completed this study. For the primary outcome, there was no significant interaction between time and intervention in 10-m walking time on two-way analysis of covariance (ANCOVA) (P = 0.382, η2 = 0.064). For the FAST walk group, 10-m walking time improved significantly at post and post-4w (P = 0.024 and 0.022, respectively). In the other groups, no significant improvements in 10-m walking time were seen at post and post-4w compared with before. There was also no significant between-group difference in the 10-m walking time.

Conclusions

The newly developed electromyography-triggered transcutaneous spinal cord and hip stimulation, FAST walk, is safe and may improve the gait speed of persons with chronic stroke. We did not, however, find a significant between-group difference among the FAST walk, spinal stim, and treadmill gait groups.

Trial registration: Japan Registry of Clinical Trial (JRCT registration ID: jRCTs032180289).

Introduction

Most persons with stroke suffer a gait disturbance. The goal of rehabilitation medicine is to help persons acquire independence of locomotion, and improvement of gait function is one of the primary goals of stroke rehabilitation. More than 80% of persons with stroke, however, show gait impairment [1]. A cohort study reported that 22% of persons with stroke did not regain any walking function [2]. Eighty percent of persons with stroke regained gait independence, but gait speed was limited. A previous study showed that gait speed determined the ambulation category of full community, limited community, and home ambulators [3], and gait impairment determined the participation of persons with stroke.

Conventional therapist-assisted gait training, muscle strengthening, partial weight-bearing treadmill gait training, robot-assisted gait training, and functional electrical stimulation have been applied in gait rehabilitation [4, 5].

Recently, spinal cord stimulation has been applied in gait rehabilitation for spinal cord injury, Parkinson’s disease, and stroke [6,7,8,9,10]. Supra-threshold lumbosacral spinal cord stimulation generated smooth, coordinated, flexion–extension movements at the hip, knee, and ankle [11]. This finding suggested that there existed a spinal locomotor circuit in the spinal cord. Minassian et al. [12] showed that subthreshold transcutaneous spinal electrical stimulation at Th11-12 evoked posterior root muscle reflexes in bilateral quadriceps, hamstrings, tibialis anterior, and triceps surae muscles. This finding suggested that subthreshold spinal electrical stimulation might activate a large diameter of the dorsal root afferent nerves. Spinal electrical stimulation of the lumbosacral spinal cord modulates the activity of motor neurons by activating a large diameter of the dorsal root afferent nerve [13]. Continuous spinal stimulation induced rhythmic lower extremity EMG activity, and sub-threshold spinal stimulation increased muscle activities of the lower extremities in rats with spinal cord injuries [14]. It was supposed that there existed spinal locomotor circuit and this spinal locomotor circuitry consists of spinal reflexes (e.g., crossed extensor reflex, flexor reflex) and contributes to the stereotyped locomotive movement [15, 16].

Hip extension at the late stance phase may produce an initial swing of the paralyzed lower extremity [17]. The crossed extensor reflex induces the reciprocating hip movement [18]. Hip extension is a strong trigger of the crossed extensor reflex. Hip sensory afferents induced by hip movements regulate locomotion [19]. In patients with stroke, late stance assisted-hip extension decreased the primary sensorimotor cortex activity and promoted the rhythmic coordinated gait pattern [20]. It was supposed that assisted-hip extension enhances the activity of the spinal locomotor circuit and the effect of spinal stimulation in patients with stroke.

It is hypothesized that subthreshold spinal stimulation combined with hip extensor stimulation activates spinal locomotor circuitry in the spinal cord, which contributes to locomotion. We, therefore, developed a new electromyography (EMG)-triggered transcutaneous spinal and hip stimulation system called FAST walk.

This study aimed to assess the effect of FAST walk combined with treadmill training in persons with chronic stroke in a randomized, controlled trial (RCT). We hypothesized that FAST walk combined with treadmill training improves gait function compared to the spinal stimulation combined with treadmill training, and treadmill training.

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Goal-Oriented Balance Rehabilitation System For Balance Disorder

 I don't see a written protocol from this; SO USELESS!

Goal-Oriented Balance Rehabilitation System For Balance Disorder

Author links open overlay panel, 

https://doi.org/10.1016/j.medengphy.2025.104386Get rights and content

Highlights

• •
  Developed a cost-effective balance rehab system using sensors and interactive games.
• •
  Conducted a clinical trial with 36 patients with orthopedic and neurological balance issues.
• •
  Used Intrinsic Motivation Inventory to find 91% enjoyed the system, 98% saw benefits.
• •
  Adjusted exercise difficulty for each patient, showing potential for personalized treatment.

Abstract

Balance is a critical component of daily activities and overall quality of life. This study aims to develop a cost-effective exercise system for the rehabilitation of balance disorders by combining a sensor module with target-oriented video games. The system, designed using a microcontroller-controlled sensor module and Unity game engine, features a game component that provides visual feedback and is synchronized with the platform movements. The system detects the patient's movements on the platform and translates them into simultaneous movements of the game character, enhancing both therapy participation and patient motivation. A clinical trial was conducted with 36 patients suffering from orthopedic and neurological balance disorders. The Intrinsic Motivation Inventory (IMI) was used to analyze the scores obtained during the clinical evaluation. The results indicate that 91.96% of participants found the system engaging, and 97.70% believed it would contribute positively to their treatment process. The results indicate that game-based balance exercises contribute to rehabilitation by increasing patient motivation. This study highlights the potential of target-oriented games in balance therapy and suggests that future improvements, such as incorporating patient monitoring features and advanced hardware, along with 3D game designs, could further enhance the system's effectiveness.

Introduction

Maintaining balance is essential for executing everyday tasks such as standing, climbing stairs, or walking on uneven surfaces. This is especially important for older adults, as impaired balance significantly elevates the risk of falls and related injuries. Studies have demonstrated that regular, balance-focused exercise can effectively enhance postural stability and reduce fall risk [1].

Balance refers to the body's ability to maintain its center of gravity over its base of support and is a key determinant of quality of life. It is generally classified into two types: static balance (maintaining a position) and dynamic balance (controlling the body during movement) [2]. Recent research has emphasized the advantages of interactive game-based rehabilitation approaches in improving balance. These methods, particularly those involving visual video games, not only increase patient engagement but also improve motivation and potentially accelerate recovery [3], [4].

Currently, alongside traditional physical therapy and rehabilitation techniques, visual feedback technologies are employed in the treatment of balance disorders. However, their application is constrained by the high cost of such systems. This study aims to develop a balance exercise system(WHERE THE FUCK IS THE PROTOCOL LOCATED?) that integrates a pre-existing platform featuring a visually interactive video game. This system is specifically designed for the lower extremities to support physical therapy and rehabilitation in patients experiencing orthopedic and neurological balance disorders due to factors such as accidents, injuries, or aging. The primary objective of this system is to improve the healing process by increasing patient engagement and motivation, thus improving participation in treatment and accelerating recovery for individuals with balance impairments.

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Role of human urinary kallikrein in reducing progressive ischemic stroke among acute ischemic stroke patients with concurrent hypertension and diabetes: a hospital-based retrospective cohort study

Where is the protocol located so all stroke hospitals will find and implement it? Oh, you INCOMPENTLY DIDN'T DO THAT? You're fired!

 Role of human urinary kallikrein in reducing progressive ischemic stroke among acute ischemic stroke patients with concurrent hypertension and diabetes: a hospital-based retrospective cohort study

Zeyang Zheng^†Yuelong Li^†Shanshan YangYuanqi XuLian YiYushuang LiuLi ZhangZhongling Zhang^*

• Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin, China

Background: Progressive ischemic stroke (PIS) poses significant challenges in the management of acute ischemic stroke (AIS), with higher morbidity and mortality rates, especially among patients with vascular risk factors such as hypertension and diabetes. This study evaluates the efficacy of human urinary kallidinogenase (HUK) in reducing the incidence of PIS in patients with AIS, with a particular focus on subgroups based on vascular pathology and thrombolytic treatment.

Methods: This retrospective cohort study included 916 patients with AIS treated at a single tertiary care center between January 2022 and September 2023. The patients were divided into two groups based on whether they received HUK treatment in addition to standard care or standard care alone. The primary outcome was the incidence of PIS. Independent sample t-tests or chi-squared tests were used for univariate analysis between groups to identify potential predictors associated with the occurrence of PIS, with factors achieving a p-value < 0.1 considered for multivariate binary logistic regression analysis. Multivariate analysis adjusted for potential confounders to determine independent predictors significantly associated with PIS. The significance threshold was set at p < 0.05. In addition, subgroup analyses were conducted based on stroke subtype (TOAST classification), thrombolysis treatment, and infarction location.

Results: HUK treatment significantly reduced the incidence of PIS (p < 0.001), with the most notable effects observed in patients with large-artery atherosclerosis and small-artery occlusion, those not undergoing intravenous thrombolysis, and those with anterior circulation infarctions. Conversely, no significant reduction was noted in patients with cardioembolic stroke, other etiologies of infarction, intravenous thrombolysis, posterior circulation infarctions, or both anterior and posterior circulation infarctions. Factors such as low body mass index (BMI) and high activated partial thromboplastin time are associated with an increased risk of PIS.

Conclusion: HUK treatment appears to be an effective strategy for reducing the risk of PIS in patients with AIS, particularly in those at higher risk owing to specific vascular pathologies. These findings support the use of HUK in clinical practice to improve the outcomes of patients with stroke. Future prospective, multicenter, randomized controlled trials are warranted to validate these findings and further elucidate the underlying mechanisms.

1 Introduction

Stroke remains the second leading cause of death worldwide and the third most common cause of disability and mortality. Ischemic strokes, representing 62.4% of all new stroke cases, disproportionately affect populations in low to upper-middle-income countries, accounting for over 80% of stroke-related disability-adjusted life years (DALYs) (1). Notably, approximately 25 to 33% of stroke survivors develop PIS within days following the initial event, presenting with worsening neurological deficits and generally poorer prognostic outcomes (2).

HUK, a serine protease derived from urine, has garnered attention for its therapeutic potential in AIS, primarily through enhancing collateral circulation, stimulating angiogenesis, and improving cerebral perfusion (3–5). A longitudinal study involving 300 patients demonstrated that those receiving HUK exhibited notably lower scores on the modified Rankin Scale (mRS) at a 12-month follow-up compared to their counterparts in the control group (6). Moreover, a meta-analysis incorporating data from 24 studies quantified the neurologic improvement attributable to HUK, indicating a 0.56-fold increase in recovery rates (7). Focusing on patients with large artery atherosclerosis, another retrospective analysis revealed that HUK treatment was associated with significantly reduced National Institutes of Health Stroke Scale (NIHSS) scores (8).

Hypertension and diabetes are prevalent risk factors in the AIS patient demographic, with the National Inpatient Sample highlighting that 79% of these patients suffer from hypertension, and 34% are diabetic (9–11). Endothelial dysfunction, insulin resistance, and impaired vascular reactivity caused by hypertension and diabetes may increase the adverse risks in AIS patients. Previous studies have demonstrated that blood pressure levels in AIS patients are significantly associated with their neurological outcomes. Maintaining appropriate blood pressure levels can significantly improve the prognosis of AIS patients (12, 13). Given the high prevalence of these comorbidities and their significant impact on stroke outcomes, investigating the therapeutic potential in this high-risk subgroup is of great clinical significance. Despite these statistics, research into HUK’s effectiveness specifically for patients with AIS concurrently diagnosed with these conditions remains sparse. One study reported that patients with AIS with stage 3 hypertension undergoing HUK treatment showed substantial improvements in mRS scores and recovery rates 3 months post-treatment (14). Another study contrasting patients with AIS with abnormal glucose metabolism observed a significant reduction in NIHSS scores following HUK treatment, although mRS scores did not differ significantly between the treated and control groups (15).

Thus, the present study aimed to investigate the effects of HUK on the incidence of PIS post-admission in patients with AIS with both hypertension and with diabetes, with a subgroup analysis by site of lesions, TOAST subtypes, and the use of intravenous thrombolysis.

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