Rehabilitation of Upper Limb Motor Impairment in Stroke: A Narrative Review on the Prevalence, Risk Factors, and Economic Statistics of Stroke and State of the Art Therapies

This type of research would not be necessary if our fucking failures of stroke associations kept an up-to-date database of all effective stroke interventions.

 Rehabilitation of Upper Limb Motor Impairment in Stroke: A Narrative Review on the Prevalence, Risk Factors, and Economic Statistics of Stroke and State of the Art Therapies

Saba Anwer 1 , Asim Waris 1 , Syed Omer Gilani 1 , Javaid Iqbal 1 , Nusratnaaz Shaikh 2 , Amit N. Pujari 3,4 and Imran Khan Niazi 2,5,6, * 1 School of Mechanical & Manufacturing Engineering, National University of Sciences and Technology (NUST), Islamabad 45200, Pakistan; sanwer.bmes19smme@student.nust.edu.pk (S.A.); asim.waris@smme.nust.edu.pk (A.W.); omer@smme.nust.edu.pk (S.O.G.); j.iqbal@ceme.nust.edu.pk (J.I.) 2 Faculty of Health & Environmental Sciences, Health & Rehabilitation Research Institute, AUT University, Auckland 0627, New Zealand; nusrat.shaikh@aut.ac.nz 3 School of Physics, Engineering and Computer Science, University of Hertfordshire, Hatfield AL10 9AB, UK; amit.pujari@ieee.org 4 School of Engineering, University of Aberdeen, Aberdeen AB24 3FX, UK 5 Center of Chiropractic Research, New Zealand College of Chiropractic, Auckland 1060, New Zealand 6 Center for Sensory-Motor Interaction, Department of Health Science & Technology, Aalborg University, 9000 Alborg, Denmark * Correspondence: imran.niazi@nzchiro.co.nz 

Abstract: 

Stroke has been one of the leading causes of disability worldwide and is still a social health issue. Keeping in view the importance of physical rehabilitation of stroke patients, an analytical review has been compiled in which different therapies have been reviewed for their effectiveness, such as functional electric stimulation (FES), noninvasive brain stimulation (NIBS) including transcranial direct current stimulation (t-DCS) and transcranial magnetic stimulation (t-MS), invasive epidural cortical stimulation, virtual reality (VR) rehabilitation, task-oriented therapy, robot-assisted training, tele rehabilitation, and cerebral plasticity for the rehabilitation of upper extremity motor impairment. New therapeutic rehabilitation techniques are also being investigated, such as VR. This literature review mainly focuses on the randomized controlled studies, reviews, and statistical meta-analyses associated with motor rehabilitation after stroke. Moreover, with the increasing prevalence rate and the adverse socio-economic consequences of stroke, a statistical analysis covering its economic factors such as treatment, medication and post-stroke care services, and risk factors (modifiable and non-modifiable) have also been discussed. This review suggests that if the prevalence rate of the disease remains persistent, a considerable increase in the stroke population is expected by 2025, causing a substantial economic burden on society, as the survival rate of stroke is high compared to other diseases. Compared to all the other therapies, VR has now emerged as the modern approach towards rehabilitation motor activity of impaired limbs. A range of randomized controlled studies and experimental trials were reviewed to analyse the effectiveness of VR as a rehabilitative treatment with considerable satisfactory results. However, more clinical controlled trials are required to establish a strong evidence base for VR to be widely accepted as a preferred rehabilitation therapy for stroke.

Modulation of brain plasticity in stroke: a novel model for neurorehabilitation

 Useless. A lot of words to say nothing specific.

Modulation of brain plasticity in stroke: a novel model for neurorehabilitation

 Giovanni Di Pino, Giovanni Pellegrino, Giovanni Assenza, Fioravante Capone, Florinda Ferreri, Domenico Formica, Federico Ranieri, Mario Tombini, Ulf Ziemann, John C. Rothwell and Vincenzo Di Lazzaro

Abstract

 | Noninvasive brain stimulation (NIBS) techniques can be used to monitor and modulate the excitability of intracortical neuronal circuits. Long periods of cortical stimulation can produce lasting effects on brain function, paving the way for therapeutic applications of NIBS in chronic neurological disease. The potential of NIBS in stroke rehabilitation has been of particular interest, because stroke is the main cause of permanent disability in industrial nations, and treatment outcomes often fail to meet the expectations of patients. Despite promising reports from many clinical trials on NIBS for stroke recovery, the number of studies reporting a null effect remains a concern. One possible explanation is that the interhemispheric competition model—which posits that suppressing the excitability of the hemisphere not affected by stroke will enhance recovery by reducing interhemispheric inhibition of the stroke hemisphere, and forms the rationale for many studies—is oversimplified or even incorrect. Here, we critically review the proposed mechanisms of synaptic and functional reorganization after stroke, and suggest a bimodal balance–recovery model that links interhemispheric balancing and functional recovery to the structural reserve spared by the lesion. The proposed model could enable NIBS to be tailored to the needs of individual patients.

 
Nat. Rev. Neurol.
 advance online publication 9 September 2014; doi:10.1038/nrneurol.2014.162

Introduction

Stroke is among the principal causes of death worldwide, and although most stroke survivors achieve at least some spontaneous recovery after the ictus, it remains the main cause of permanent disability in Europe and the USA. ^1–3

The only existing treatment for stroke is tissue plasminogen activator, which can salvage tissue at risk in the penumbra of a brain infarct and reduce future disability if administered within a few hours after stroke onset.⁴No treatments specifically designed to restore function through repair of damaged tissue have been developed to date. Current best practice in stroke management is to reduce initial impact, take precautions to avoid the further burden of complications, and maximize functional ability through extensive physiotherapy.Although early rehabilitative interventions can improve arm function above what would be achieved by natural recovery alone,
5
 the majority of patients are still unable to use the affected hand and/or arm for simple activities of daily living 6 months after the stroke.⁶Robot-assisted therapy has been proposed as an excellent low-cost way to increase the amount of therapy that an individual patient receives, because a robot can deliver a higher amount of exercise in the same time than can a human physiotherapist,⁷but in controlled trials robot-assisted therapy has shown disappointingly little additional benefit over conventional regimes of intensive physiotherapy.^8,9The lack of effective neurorepair after stroke and the limitations of functional recovery attained by physio-therapy have led researchers to consider alternative approaches that improve the scope for recovery by enhancing the natural plasticity of the sensorimotor system. If recovery depends on ‘relearning’ new patterns of activity to maximize the use of remaining undamaged brain, interventions that increase plasticity, and thereby the ability to learn, should improve recovery. Two approaches are of great current interest: pharmaco logical interventions and noninvasive brain stimulation (NIBS). In this Review, we focus on NIBS. Although NIBS has been used to improve gait, neglect symptoms and lan-guage after stroke, we will concentrate here on its appli-cation to recovery of arm and hand function, because most studies have assessed the efficacy of NIBS on upper limb function.More than 350 articles have been published on trans-cranial stimulation in stroke since 2012. These include more than 50 small clinical trials that evaluated the potential for NIBS to enhance recovery of hand and arm function. Recent meta-analyses disagree on the effective-ness of these techniques: two Cochrane reviews do not support the use of repetitive transcranial magnetic stimu-lation (rTMS)¹⁰or transcranial direct current stimu lation (tDCS)¹¹in stroke rehabilitation, whereas two other systematic reviews conclude that NIBS can have a moder-ate benefit in terms of stroke recovery, with few major adverse effects.^12,13Here, we discuss the factors that have contributed to the slow progress of accepting NIBS as a part of routine clinical practice, and suggest ways to develop the use of NIBS in stroke rehabilitation.

The Effect of Noninvasive Brain Stimulation on Poststroke Cognitive Function: A Systematic Review

Fuck, stop with the reviews and just write a protocol on the use of it. If preliminary, then just write a preliminary protocol. Survivors can't wait forever for solutions.

The Effect of Noninvasive Brain Stimulation on Poststroke Cognitive Function: A Systematic Review 

Review

Show all authors

Eline C. C. van Lieshout, MSc, Roel F. van Hooijdonk, MSc, Rick M. Dijkhuizen, PhD, MD, ...

First Published April 25, 2019 Review Article

https://doi.org/10.1177/1545968319834900

Article information

Abstract

Introduction. Cognitive impairment after stroke has been associated with lower quality of life and independence in the long run, stressing the need for methods that target impairment for cognitive rehabilitation. The use of noninvasive brain stimulation (NIBS) on recovery of language functions is well documented, yet the effects of  on other cognitive domains remain largely unknown. Therefore, we conducted a systematic review that evaluates the effects of different stimulation techniques on domain-specific (long-term) cognitive recovery after stroke.  
Methods. Three databases (PubMed, EMBASE, and PsycINFO) were searched for articles (in English) on the effects of NIBS on cognitive domains, published up to January 2018. Results. A total of 40 articles were included: randomized controlled trials (n = 21), studies with a crossover design (n = 9), case studies (n = 6), and studies with a mixed design (n = 4). Most studies tested effects on neglect (n = 25). The majority of the studies revealed treatment effects on at least 1 time point poststroke, in at least 1 cognitive domain. Studies varied highly on the factors time poststroke, number of treatment sessions, and stimulation protocols. Outcome measures were generally limited to a few cognitive tests.
Conclusion. Our review suggests that NIBS is able to alleviate neglect after stroke. However, the results are still inconclusive and preliminary for the effect of NIBS on other cognitive domains. A standardized core set of outcome measures of cognition, also at the level of daily life activities and participation, and international agreement on treatment protocols, could lead to better evaluation of the efficacy of NIBS and comparisons between studies.

Keywords cognition, noninvasive brain stimulation, systematic review, stroke, cognitive rehabilitation, cognitive deficits

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Vol 33, Issue 5, 2019

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Restoring Motor Functions After Stroke: Multiple Approaches and Opportunities

Notice that nothing here has your doctor doing one damn thing.  They are ignoring stopping the 5 causes of the neuronal cascade of death in the first week tat would result in vastly less dead and damaged neurons! And they are specifically leaving survivors behind. I expect 100% recovery for all, NOT this cherry picking of less damaged survivors.

Restoring Motor Functions After Stroke: Multiple Approaches and Opportunities

Estelle Raffin, Friedhelm C. Hummel, Estelle Raffin, ...

First Published November 7, 2017 Review Article

Article information

Abstract

More than 1.5 million people suffer a stroke in Europe per year and more than 70% of stroke survivors experience limited functional recovery of their upper limb, resulting in diminished quality of life. Therefore, interventions to address upper-limb impairment are a priority for stroke survivors and clinicians. While a significant body of evidence supports the use of conventional treatments, such as intensive motor training or constraint-induced movement therapy, the limited and heterogeneous improvements they allow are, for most patients, usually not sufficient to return to full autonomy. Various innovative neurorehabilitation strategies are emerging in order to enhance beneficial plasticity and improve motor recovery. Among them, robotic technologies, brain-computer interfaces, or noninvasive brain stimulation (NIBS) are showing encouraging results. These innovative interventions, such as NIBS, will only provide maximized effects, if the field moves away from the “one-fits all” approach toward a “patient-tailored” approach. After summarizing the most commonly used rehabilitation approaches, we will focus on NIBS and highlight the factors that limit its widespread use in clinical settings. Subsequently, we will propose potential biomarkers that might help to stratify stroke patients in order to identify the individualized optimal therapy. We will discuss future methodological developments, which could open new avenues for poststroke rehabilitation, toward more patient-tailored precision medicine approaches and pathophysiologically motivated strategies.

Noninvasive Neuromodulation in Poststroke Gait Disorders Rationale, Feasibility, and State of the Art

My post stroke walking disturbance is strictly from spasticity. I can't tell from this if spasticity was accounted for or tested. 

Noninvasive Neuromodulation in Poststroke Gait Disorders Rationale, Feasibility, and State of the Art

1. Raffaella Chieffo, MD, PhD1⇑
2. Giancarlo Comi, MD1
3. Letizia Leocani, MD, PhD1

1. ¹Scientific Institute Vita-Salute University San Raffaele, Milan, Italy

1. Raffaella Chieffo, MD, PhD, Neurological Department and Institute of Experimental Neurology—INSPE, Scientific Institute Hospital San Raffaele, Via Olgettina 48, 20133 Milan, Italy. Email: raffaella.chieffo@hsr.it

Abstract

Walking rehabilitation is one of the primary goals in stroke survivors because of its great potential for recovery and its functional relevance in daily living activities. Although 70% to 80% of people in the chronic poststroke phases are able to walk, impairment of gait often persists, involving speed, endurance, and stability. Walking involves several brain regions, such as the sensorimotor cortex, supplementary motor area, cerebellum, and brainstem, which are approachable by the application of noninvasive brain stimulation (NIBS). NIBS techniques, such as repetitive transcranial magnetic stimulation and transcranial direct current stimulation, have been reported to modulate neural activity beyond the period of stimulation, facilitating neuroplasticity. NIBS methods have been largely applied for improving paretic hand motor function and stroke-associated cognitive deficits. Recent studies suggest a possible effectiveness of these techniques also in the recovery of poststroke gait disturbance. This article is a selective review about functional investigations addressing the mechanisms of lower-limb motor system reorganization after stroke and the application of NIBS for neurorehabilitation.

Noninvasive Neuromodulation in Poststroke Gait Disorders Rationale, Feasibility, and State of the Art

What is your therapist using from this to help you walk better? I can't tell from this if they have addressed spasticity at all. Spasticity is the reason I can't correct my gait to normal. But why are we allowing such a dangerous modality as walking to be the primary goal? Falling is a common result of walking and falls kill lots of older people each year.
http://nnr.sagepub.com/content/early/2015/05/06/1545968315586464.abstract?

1. Raffaella Chieffo, MD, PhD1
2. Giancarlo Comi, MD1
3. Letizia Leocani, MD, PhD1

1. ¹Scientific Institute Vita-Salute University San Raffaele, Milan, Italy

1. Raffaella Chieffo, MD, PhD, Neurological Department and Institute of Experimental Neurology—INSPE, Scientific Institute Hospital San Raffaele, Via Olgettina 48, 20133 Milan, Italy. Email: raffaella.chieffo@hsr.it

Abstract

Walking rehabilitation is one of the primary goals in stroke survivors because of its great potential for recovery and its functional relevance in daily living activities. Although 70% to 80% of people in the chronic poststroke phases are able to walk, impairment of gait often persists, involving speed, endurance, and stability. Walking involves several brain regions, such as the sensorimotor cortex, supplementary motor area, cerebellum, and brainstem, which are approachable by the application of noninvasive brain stimulation (NIBS). NIBS techniques, such as repetitive transcranial magnetic stimulation and transcranial direct current stimulation, have been reported to modulate neural activity beyond the period of stimulation, facilitating neuroplasticity. NIBS methods have been largely applied for improving paretic hand motor function and stroke-associated cognitive deficits. Recent studies suggest a possible effectiveness of these techniques also in the recovery of poststroke gait disturbance. This article is a selective review about functional investigations addressing the mechanisms of lower-limb motor system reorganization after stroke and the application of NIBS for neurorehabilitation.