Effects of robot therapy on upper body kinematics and arm function in persons post stroke: a pilot randomized controlled trial

Where is the protocol located so survivors can bring it to their stroke medical 'professionals' attention? Top down dissemination of research is a complete fucking failure; bottom up is the way to go!

Effects of robot therapy on upper body kinematics and arm function in persons post stroke: a pilot randomized controlled trial

Ilaria Carpinella 1 , 

Tiziana Lencioni 1* , 

Thomas Bowman 1 , 

Rita Bertoni 1 , 

Andrea Turolla 2 , 

Maurizio Ferrarin 1 and 

Johanna Jonsdottir 1 

Abstract 

Background: 

Robot-based rehabilitation for persons post-stroke may improve arm function and daily-life activities as measured by clinical scales, but its effects on motor strategies during functional tasks are still poorly investigated. This study aimed at assessing the effects of robot-therapy versus arm-specific physiotherapy in persons post-stroke on motor strategies derived from upper body instrumented kinematic analysis, and on arm function measured by clinical scales. 

Methods: 

Forty persons in the sub-acute and chronic stage post-stroke were recruited. This sample included all those subjects, enrolled in a larger bi-center study, who underwent instrumented kinematic analysis and who were randomized in Center 2 into Robot (R_Group) and Control Group (C_Group). R_Group received robot-assisted training. C_ Group received arm-specific treatment delivered by a physiotherapist. Pre- and post-training assessment included clinical scales and instrumented kinematic analysis of arm and trunk during a virtual untrained task simulating the transport of an object onto a shelf. Instrumented outcomes included shoulder/elbow coordination, elbow extension and trunk sagittal compensation. Clinical outcomes included Fugl-Meyer Motor Assessment of Upper Extremity (FM-UE), modified Ashworth Scale (MAS) and Functional Independence Measure (FIM). 

Results: 

R_Group showed larger post-training improvements of shoulder/elbow coordination (Cohen’sd= - 0.81, p = 0.019), elbow extension (Cohen’sd= - 0.71, p = 0.038), and trunk movement (Cohen’sd= - 1.12, p = 0.002). Both groups showed comparable improvements in clinical scales, except proximal muscles MAS that decreased more in R_Group (Cohen’sd= - 0.83, p = 0.018). Ancillary analyses on chronic subjects confirmed these results and revealed larger improvements after robot-therapy in the proximal portion of FM-UE (Cohen’s d = 1.16, p = 0.019). 

Conclusions: 

Robot-assisted rehabilitation was as effective as arm-specific physiotherapy in reducing(NOT RECOVERY!) arm impairment (FM-UE) in persons post-stroke, but it was more effective(If not 100% recovery, IT IS NOT EFFECTIVE!) in improving motor control strategies adopted during an untrained task involving vertical movements not practiced during training. Specifically, robot therapy induced larger improvements of shoulder/elbow coordination and greater reduction of abnormal trunk sagittal movements. The beneficial effects of robot therapy seemed more pronounced in chronic subjects. Future studies on a larger sample should be performed to corroborate present findings. Trial registration: www.ClinicalTrials.gov NCT03530358. Registered 21 May 2018. Retrospectively registered. Keywords: Stroke, Robot therapy, Upper limb, Trunk, Kinematic analysis, Motor strategies 

Effectiveness of unilateral lower-limb exoskeleton robot on balance and gait recovery and neuroplasticity in patients with subacute stroke: a randomized controlled trial

 Where is the protocol located so survivors can bring it to their stroke medical 'professionals' attention? Top down dissemination of research is a complete fucking failure; bottom up is the way to go!

Effectiveness of unilateral lower-limb exoskeleton robot on balance and gait recovery and neuroplasticity in patients with subacute stroke: a randomized controlled trial

• Congcong Huo,
• Guangjian Shao,
• Tiandi Chen,
• Wenhao Li,
• Jue Wang,
• Hui Xie,
• Yan Wang,
• Zengyong Li,
• Pengyuan Zheng,
• Liguo Li &
• Luya Li 

Journal of NeuroEngineering and Rehabilitation volume 21, Article number: 213 (2024) Cite this article

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Abstract

Background

Impaired balance and gait in stroke survivors are associated with decreased functional independence. This study aimed to evaluate the effectiveness of unilateral lower-limb exoskeleton robot-assisted overground gait training compared with conventional treatment and to explore the relationship between neuroplastic changes and motor function recovery in subacute stroke patients.

Methods

In this randomized, single-blind clinical trial, 40 patients with subacute stroke were recruited and randomly assigned to either a robot-assisted training (RT) group or a conventional training (CT) group. All outcome measures were assessed at the enrollment baseline (T0), 2nd week (T1) and 4th week (T2) of the treatment. The primary outcome was the between-group difference in the change in the Berg balance scale (BBS) score from baseline to T2. The secondary measures included longitudinal changes in the Fugl-Meyer assessment of the lower limb (FMA-LE), modified Barthel index (mBI), functional ambulation category (FAC), and locomotion assessment with gait analysis. In addition, the cortical activation pattern related to robot-assisted training was measured before and after intervention via functional near-infrared spectroscopy.

Results

A total of 30 patients with complete data were included in this study. Clinical outcomes improved after 4 weeks of training in both groups, with significantly better BBS (F = 6.341, p = 0.018, partial η2 = 0.185), FMA-LE (F = 5.979, p = 0.021, partial η2 = 0.176), FAC (F = 7.692, p = 0.010, partial η2 = 0.216), and mBI scores (F = 7.255, p = 0.042, partial η2 = 0.140) in the RT group than in the CT group. Both groups showed significant improvement in gait speed and stride cadence on the locomotion assessment. Only the RT group presented a significantly increased stride length (F = 4.913, p = 0.015, partial η2 = 0.267), support phase (F = 5.335, p = 0.011, partial η2 = 0.283), and toe-off angle (F = 3.829, p = 0.035, partial η2 = 0.228) on the affected side after the intervention. The RT group also showed increased neural activity response over the ipsilesional motor area and bilateral prefrontal cortex during robot-assisted weight-shift and gait training following 4 weeks of treatment.

Conclusions

Overground gait training with a unilateral exoskeleton robot showed improvements in balance and gait functions, resulting in better gait patterns and increased gait stability for stroke patients. The increased cortical response related to the ipsilesional motor areas and their related functional network is crucial in the rehabilitation of lower limb gait in post-stroke patients.

Introduction

Stroke is commonly associated with motor dysfunction of the lower extremities, manifested as decreased muscle strength, impaired balance, and abnormal gait. Despite professional rehabilitation attempts, 20–30% of patients still experience difficulties or loss of the ability to walk [1]. Three months after stroke, 85% of patients still have great potential to improve their walking ability, which is strongly correlated with quality of life of stroke survivors [2]. Consequently, improving walking ability is the primary focus of lower-limb rehabilitation for stroke patients.

Specific, repetitive, and high-intensity motor training is a key element in inducing functional neuroplasticity related to stroke motor rehabilitation within the 6-month post-stroke window [3, 4]. Thus, implementing gait training for stroke patients at an early stage is critical for the restoration of lower-limb function. However, traditional physical therapies are limited in providing long-term, high-quality gait training due to decreased muscle strength in early stroke patients. Robotic exoskeleton training is a promising way to deliver repetitive walking training assisted by mechanical legs, promoting the walking, balance, and daily living abilities of stroke patients [5, 6]. Achieving positive effects in gait training necessitates repetitive natural walking on the ground along with accurate proprioception and external sensory feedback [7]. Wearable robots possess the advantage of portability, enabling treatments to be performed in real-world scenarios, which have been widely applied to improve walking efficiency and enhance mobility in stroke patients [8,9,10,11]. Currently, robots for overground gait training mainly target chronic stroke survivors, with limited application in the subacute patients due to early muscle weakness. Based on the early-stage gait rehabilitation needs, the unilateral lower-limb exoskeleton robot is designed to support overground walking in real environments with active engagement of stroke patients with hemiplegia. However, there is scant evidence to support the effectiveness of overground gait training with a unilateral lower-limb exoskeleton robot for stroke patients in the literature.

Furthermore, restoring motor ability poststroke relies on brain functional reorganization. Assessment of cortical activation related to a specific task is essential for a better understanding of neural motor control. Currently, limited information is available on the cerebral mechanisms underlying locomotor recovery after stroke due to technical limitations in assessing cerebral activation during movement, particularly walking tasks. Recently, functional near-infrared spectroscopy (fNIRS) has gained attraction as a novel neuroimaging technology in stroke rehabilitation. Its low cost, portability, noninvasiveness, and motion tolerance make it a suitable for studying gait disturbances induced by stroke [12, 13]. Research has shown a bilateral increase in oxygenated hemoglobin (

[oxy-Hb]) in the sensorimotor cortex (SMC) and supplementary motor area (SMA) in stroke patients during gait training [14]. Additionally, increased activation in the SMC, SMA, and premotor cortex (PMC) was detected in healthy participants during exoskeleton robot walking in contrast to treadmill walking or stepping [15]. However, the effects of long-term robot-assisted overground gait training on neuroplastic reorganization have not been adequately studied in subacute patients.

This study aimed to compare the effectiveness of robot-assisted overground gait training and conventional training for the lower-limb rehabilitation of stroke patients with hemiplegia. Wearable gait analyzers(Where and what are these so our stroke medical 'professionals' can get an objective damage diagnosis of our gait problems, so they can prescribe EXACT PROTOCOLS to fix those problems?) combined with clinical assessment scales, including the Berg balance scale (BBS), Fugl Meyer assessment for lower extremity (FMA-LE), functional ambulation category (FAC), and modified Barthel index (mBI), were used to evaluate the motor function of the patients before and after 4 weeks of training. It was hypothesized that compared with conventional training (CT), robot-assisted training (RT) would have superior effects on both clinical outcomes and gait balance. Additionally, fNIRS was employed to monitor the cortical activation response of the patients during robot-assisted training. It was expected that the activation of ipsilesional motor-related cortices would increase following motor recovery of the lower limb. The results of this study will be used to explore the relationship between neuroplasticity and lower-limb motor recovery, thereby providing a theoretical basis for the clinical application of robot-assisted lower-limb rehabilitation.

More at link.

Home-based guidance training system with interactive visual feedback using kinect on stroke survivors with moderate to severe motor impairment

 

I see nothing here that suggests that protocols were written and placed in a public database that survivors can find and access so this can be presented to their stroke medical 'professionals' to implement. Top down research dissemination does not work, bottom up will work because survivors will demand it be delivered to them.

Home-based guidance training system with interactive visual feedback using kinect on stroke survivors with moderate to severe motor impairment

• Hsuan-Yu Lu,
• Xiaoyi Wang,
• Chengpeng Hu,
• Cathy Choi-Yin Lau &
• Raymond Kai-Yu Tong 

Journal of NeuroEngineering and Rehabilitation volume 21, Article number: 189 (2024) Cite this article

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Abstract

The home-based training approach benefits stroke survivors by providing them with an increased amount of training time and greater feasibility in terms of their training schedule, particularly for those with severe motor impairment. Computer-guided training systems provide visual feedback with correct movement patterns during home-based training. This study aimed to investigate the improvement in motor performance among stroke survivors with moderate to severe motor impairment after 800 min of training using a home-based guidance training system with interactive visual feedback. Twelve patients with moderate to severe stroke underwent home-based training, totaling 800 min (20–40 min per session, with a frequency of 3 sessions per week). The home-based guidance training system uses Kinect to reconstruct the 3D human body skeletal model and provides real-time motor feedback during training. The training exercises consisted of six core exercises and eleven optional exercises, including joint exercises, balance control, and coordination. Pre-training and post-training assessments were conducted using the Fugl-Meyer Assessment-Upper Limb (FMA-UE), Fugl-Meyer Assessment-Lower Limb (FMA-LE), Functional Ambulation Categories (FAC), Berg Balance Scale (BBS), Barthel Index (BI), Modified Ashworth Scale (MAS), as well as kinematic data of joint angles and center of mass (COM). The results indicated that motor training led to the attainment of the upper limit of functional range of motion (FROM) in hip abduction, shoulder flexion, and shoulder abduction. However, there was no improvement in the active range of motion (AROM) in the upper extremity (U/E) and lower extremity (L/E) joints, reaching the level of the older healthy population. Significant improvements were observed in both left/right and superior/inferior displacements, as well as body sway in the mediolateral axis of the COM, after 800 min of training. In conclusion, the home-based guidance system using Kinect aids in improving joint kinematics performance at the level of FROM and balance control, accompanied by increased mediolateral body sway of the COM for stroke survivors with moderate to severe stroke. Additionally, spasticity was reduced in both the upper and lower extremities after 800 min of home-based training.

Introduction

Existing home-based training systems use games as the primary trend to enhance the level of motivation [1,2,3,4,5]. In addition, the training efficiency, in terms of repetitions, may be lower when utilizing the home-based training system without feedback [6]. If the fun environment is enriched and the correct movement is guided by visual feedback during training exercises, this approach would be a feasible training approach. Cloud computing technology has advanced recently, cloud-based networks can easily connect the training from home to the center, and therapists can adjust the training protocol remotely and access the training data. Two markerless systems for motion tracking 3D depth sensor technique and RGB camera system. 3D depth-sensing cameras, employing technologies such as stereo vision, time of flight, or structured light, are now capable of identifying 3D body segments. Notable examples include Kinect [7,8,9,10,11], ZED [12, 13], Intel RealSense [14]. Another type of system using markerless’s AI-driven motion capture technology with RGB cameras (e.g., Theia3D) [15] to construct the 3D skeletal models for tracking joint movements and balance control. In this work, we raise the following questions: Is it possible to have an interactive guidance system for home-based users during training, and what is the effectiveness of motor recovery after 800 min of home-based training using computer-guided visual feedback?

The home-based training approach [16,17,18] provides training for chronic stroke and benefits stroke survivors with an increased amount of training time and more feasibility in the training schedule, especially in patients with severe levels. The depth sensor-based training systems (i.e., UINCARE Home + (UINCARE Corp., South Korea) [19, 20], MindMotion^® GO (Switzerland) [21], EvolvRehab (Spain) [22], LongGood TeleRehabilitation System (Taiwan) [23]) provide the visual feedback with specific symbols or targets to guide the user in achieving the tasks. However, these training approaches display virtual objects in a video game or demonstration videos without providing feedback on the user’s real-time motions. In this study, we developed a home-based guidance training system for stroke survivors, enabling to provide the RGB-depth sensor to capture 25 artificial anatomical landmarks to reconstruct the body skeleton and real-time visual feedback on users' body segment movements and joint angles during training.

The purpose of this study was to investigate the improvement in motor performance for stroke survivors with moderate to severe motor impairment after 800 min of training using the home-based guidance training system with interactive visual feedback. With the technology of depth sensors, home-based training with computer-guided motion guidance in real-time may help users improve motor performance with minimal therapist assistance, which can greatly enhance the flexibility to facilitate their training time schedule.

Bottom-up versus Top-down designed rehabilitation sessions in chronic stroke survivors: a pilot randomized controlled trial

 Nothing here tells me what protocols are used in bottom-up vs. top-down. So totally useless in survivors telling their stroke medical 'professionals' how to treat them. USELESS!

Bottom-up versus Top-down designed rehabilitation sessions in chronic stroke survivors: a pilot randomized controlled trial

Mahnaz Hejazi-Shirmard

,

Ghorban Taghizadeh

,

Mehdi Rassafiani

,

Moslem Cheraghifard

,

Mahin Yousefi

,

Seyed Hossein Hosseini

, show all

Received 29 Aug 2023, Accepted 14 Jul 2024, Published online: 30 Jul 2024

• Cite this article
• https://doi.org/10.1080/09638288.2024.2384622
• CrossMark

 

Abstract

Purpose

The present study aimed to compare the effectiveness of Top-down and Bottom-up approaches on levels of the International Classification of Functioning, Disability and Health Framework (ICF), including impairments, activities, and participation.

Materials and methods

Thirty-nine chronic stroke survivors were recruited for this single-blinded randomized clinical trial. Participants were assigned to Top-down, Bottom-up interventions, or control group, and received a 6-week intervention. They were assessed before/after treatments and at follow-up (6 weeks later). Impairments were measured through kinematic analysis, Trail Making Tests (TMT), and Fugl-Meyer Assessment (FMA). Activity and participation were evaluated via Box and Block Test, Motor Activity Log (MAL), and Canadian Occupational Performance Measure (COPM), respectively.

Results

We found significant improvements in impairment (FMA) and participation (COPM) in all groups, however, COPM scores improved beyond the MCID only in the Top-down, and FMA scores exceeded the MCID in Top-down and Bottom-up groups. Use of the upper limb in daily activities (MAL) enhanced in the Top-down group, although was not clinically significant.

Conclusion

In most of the outcome measures, no significant difference was observed between groups. It seems that Top-down, Bottom-up, and traditional interventions have relatively comparable effectiveness in chronic stroke survivors.

Trial Registration

IRCT20150721023277N2

IMPLICATIONS FOR REHABILITATION

• Sensory-motor, cognitive, and psychological impairments are the most common consequences of stroke that lead to activity limitations and participation restrictions in stroke survivors.

• There are various rehabilitation approaches for stroke survivors.

• Some rehabilitation approaches address underlying impairments (Bottom-up), while others focus on enhancing individuals’ ability to participate in meaningful roles (Top-down).

• Top-down, Bottom-up, and traditional interventions seem to have relatively comparable effectiveness in chronic stroke survivors, and occupational therapists should use their clinical reasoning to select the most appropriate approach for each client.

Ipsilateral Motor Pathways and Transcallosal Inhibition During Lower Limb Movement After Stroke

I have absolutely no clue what this says so there is no way I can tell my doctor and therapists what is needed to be done to get me recovered. The top-down approach to stroke rehab is a complete failure, only 10% almost fully recover. Bottom up, where survivors specify the protocols they want used to recover would work much much better.  They would be invested in their recovery, right now with guidelines they are just a bystander.

Ipsilateral Motor Pathways and Transcallosal Inhibition During Lower Limb Movement After Stroke

Brice T. Cleland PhD, Sangeetha Madhavan, PT, PhD

First Published March 11, 2021 Research Article 

https://doi.org/10.1177/1545968321999049

Article information

 

Abstract

Background

Stroke rehabilitation may be improved with a better understanding of the contribution of ipsilateral motor pathways to the paretic limb and alterations in transcallosal inhibition. Few studies have evaluated these factors during dynamic, bilateral lower limb movements, and it is unclear whether they relate to functional outcomes.

Objective

Determine if lower limb ipsilateral excitability and transcallosal inhibition after stroke depend on target limb, task, or number of limbs involved, and whether these factors are related to clinical measures.

Methods

In 29 individuals with stroke, ipsilateral and contralateral responses to transcranial magnetic stimulation were measured in the paretic and nonparetic tibialis anterior during dynamic (unilateral or bilateral ankle dorsiflexion/plantarflexion) and isometric (unilateral dorsiflexion) conditions. Relative ipsilateral excitability and transcallosal inhibition were assessed. Fugl-Meyer, ankle movement accuracy, and walking characteristics were assessed.

Results

Relative ipsilateral excitability was greater during dynamic than isometric conditions in the paretic limb (P ≤ .02) and greater in the paretic than the nonparetic limb during dynamic conditions (P ≤ .004). Transcallosal inhibition was greater in the ipsilesional than contralesional hemisphere (P = .002) and during dynamic than isometric conditions (P = .03). Greater ipsilesional transcallosal inhibition was correlated with better ankle movement accuracy (R² = 0.18, P = .04). Greater contralateral excitability to the nonparetic limb was correlated with improved walking symmetry (R² = 0.19, P = .03).

Conclusions

Ipsilateral pathways have increased excitability to the paretic limb, particularly during dynamic tasks. Transcallosal inhibition is greater in the ipsilesional than contralesional hemisphere and during dynamic than isometric tasks. Ipsilateral pathways and transcallosal inhibition may influence walking asymmetry and ankle movement accuracy.

Keywords lower extremity, neural pathways, neuroplasticity, stroke

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Contralaterally Controlled Neuromuscular Electrical Stimulation for Recovery of Ankle Dorsiflexion

So where did you put this protocol where all 10 million yearly stroke survivors  can find it and use it to train their stroke team? I do not trust top down delivery of stroke research, it has never worked.

Contralaterally Controlled Neuromuscular Electrical Stimulation for Recovery of Ankle Dorsiflexion

Jayme S. Knutson, PhD
1,2,3
,
Kristine Hansen, PT
3
,
Jennifer Nagy, PT
3
,
Stephanie N. Bailey,BSE
4
,
Douglas D. Gunzler, PhD
5
,
Lynne R. Sheffler, MD
1,2,3
, and
John Chae, MD
1,2,3
1
Dept of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, OH
2
Cleveland Functional Electrical Stimulation Center, Cleveland, OH
3
Dept of Physical Medicine and Rehabilitation, MetroHealth Rehabilitation Institute of Ohio,MetroHealth Medical Center, Cleveland, OH
4
Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH
5
Center for Health Care Research and Policy, MetroHealth Medical Center, Cleveland, OH

 Abstract

Objective—
Compare the effects of contralaterally controlled neuromuscular electrical stimulation (CCNMES) versus cyclic neuromuscular electrical stimulation (NMES) on lower extremity impairment, functional ambulation, and gait characteristics.
Design—
Twenty-six stroke survivors with chronic (≥6mo) foot drop during ambulation were randomly assigned to six weeks of CCNMES or cyclic NMES. Both groups had ten sessions per week of self-administered home application of either CCNMES or cyclic NMES plus two sessions per week of gait training with a physical therapist. Primary outcomes included lower extremity Fugl-Meyer score, modified Emory Functional Ambulation Profile, and gait velocity. Assessments were made at pretreatment, post treatment, and at 1 and 3 months post treatment.
Results—
There were no significant differences between groups in the outcome trajectories for any of the measures. With data from both groups pooled, there were significant but modest and sustained improvements in the Fugl-Meyer score and the modified Emory Functional Ambulation Profile, but not in gait velocity.
Conclusions—
The results support the hypothesis that gait training combined with either CCNMES or cyclic NMES reduces lower extremity impairment and functional ambulation, but do not support the hypothesis that CCNMES is more effective than cyclic NMES in chronic patients.
Keywords
Stroke Rehabilitation; Hemiplegia; Neuromuscular Electrical Stimulation; Footdrop
Correspondence:
 Jayme S. Knutson, PhD Dept of Physical Medicine and Rehabilitation MetroHealth Rehabilitation Institute of Ohio4229 Pearl Road, Suite N527 Cleveland, Ohio 44109, USA.
Disclosures:
 Financial disclosure statements have been obtained, and no other conflicts of interest have been reported by the authorsor by any individuals in control of the content of this article.This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providingthis early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before itis published in its final citable form. Please note that during the production process errors may be discovered which could affect thecontent, and all legal disclaimers that apply to the journal pertain.
NIH Public Access
Author Manuscript
Am J Phys Med Rehabil
. Author manuscript; available in PMC 2014 August 01.
Published in final edited form as:
Am J Phys Med Rehabil
. 2013 August ; 92(8): 656–665. doi:10.1097/PHM.0b013e31829b4c16.
 

Repetitive transcranial magnetic stimulation in stroke rehabilitation: review of the current evidence and pitfalls

So still NO PROTOCOLS.  A great stroke association would ensure that protocols are created for all stroke research and would have a publicly available database of all protocols and research for survivor use. We need a bottom up approach where survivors direct their own therapy. The top down approach has been a failure forever, proven by current rehab that only gets you 100% recovered 10% of the time.  Our non-existent stroke leadership and strategy has totally failed survivors.  None of the following have been solved or is even being worked on. 

No one is even addressing all these problems;

Here is their list of problems to solve. 'WHY THE HELL WON'T THEY WORK ON THEM? 

1. 30% get spasticity NOTHING THAT WILL CURE IT.

2. At least half of all stroke survivors experience fatigue Or is it 70%?

Or is it 40%?

NOTHING THAT WILL CURE IT.

3. Over half of stroke patients have attention problems.

NOTHING THAT WILL CURE IT.

4.  The incidence of constipation was 48%.

NO PROTOCOLS THAT WILL CURE IT.

5. No EXACT stroke protocols that address any of your muscle limitations.

6. Poststroke depression(33% chance)

NO PROTOCOLS THAT WILL ADDRESS IT. 

7.  Poststroke anxiety(20% chance) NO PROTOCOLS THAT WILL ADDRESS IT. 

8. Posttraumatic stress disorder(23% chance)  NO PROTOCOLS THAT WILL ADDRESS IT.

  9.  12% tPA efficacy for full recovery NO ONE IS WORKING ON SOMETHING BETTER.

10.  10% seizures post stroke NO PROTOCOLS THAT WILL ADDRESS IT. 

11. 21% of patients had developed cachexia NO PROTOCOLS THAT WILL ADDRESS IT. 

 

12. You lost 5 cognitive years from your stroke  NO PROTOCOLS THAT WILL ADDRESS IT.

13.  33% dementia chance post-stroke from an Australian study?

       Or is it 17-66%?

       Or is it 20% chance in this research?

NO PROTOCOLS THAT WILL ADDRESS THIS

 

The latest useless shit here:

Repetitive transcranial magnetic stimulation in stroke rehabilitation: review of the current evidence and pitfalls

Show all authors

Francesco Fisicaro, Giuseppe Lanza, Alfio Antonio Grasso, ...

First Published September 25, 2019 Review Article

https://doi.org/10.1177/1756286419878317

Article information

Abstract

Acute brain ischemia causes changes in several neural networks and related cortico-subcortical excitability, both in the affected area and in the apparently spared contralateral hemisphere. The modulation of these processes through modern techniques of noninvasive brain stimulation, namely repetitive transcranial magnetic stimulation (rTMS), has been proposed as a viable intervention that could promote post-stroke clinical recovery and functional independence. This review provides a comprehensive summary of the current evidence from the literature on the efficacy of rTMS applied to different clinical and rehabilitative aspects of stroke patients. A total of 32 meta-analyses published until July 2019 were selected, focusing on the effects on motor function, manual dexterity, walking and balance, spasticity, dysphagia, aphasia, unilateral neglect, depression, and cognitive function after a stroke. Only conventional rTMS protocols were considered in this review, and meta-analyses focusing on theta burst stimulation only were excluded. Overall, both HF-rTMS and LF-rTMS have been shown to be safe and well-tolerated. In addition, the current literature converges on the positive effect of rTMS in the rehabilitation of all clinical manifestations of stroke, except for spasticity and cognitive impairment, where definitive evidence of efficacy cannot be drawn. However, routine use of a specific paradigm of stimulation cannot be recommended yet due to a significant level of heterogeneity of the studies in terms of protocols to be set and outcome measures that have to be used. Future studies need to preliminarily evaluate the most promising protocols before going on to multicenter studies with large cohorts of patients in order to achieve a definitive translation into daily clinical practice.