Neuroprotective Effect of Tephrosia purpurea Against Mitochondrial Dysfunction by Regulation of the Caspase3/9 and Pink1/Parkin Complexes

Lots of work for your doctor and stroke hospital to initiate. You don't want to get Parkinsons and this will eventually need to get to human testing. So if your hospital starts RIGHT NOW, in 15 years we might have results. So probably not in time for you but maybe in time for your children and grandchildren. 

Parkinson’s Disease May Have Link to Stroke March 2017 

HAS YOUR HOSPITAL DONE ONE DAMN THING IN THE PAST FOUR YEARS TO CREATE PROTOCOLS THAT PREVENT PARKINSONS? 

Or are you giving them a pass to be incompetent with no consequences except to you?

The latest here: 

 Neuroprotective Effect of Tephrosia purpurea Against Mitochondrial Dysfunction by Regulation of the Caspase3/9 and Pink1/Parkin Complexes

Swathi Kesh, Rajaretinam Rajesh Kannan Neuroscience Laboratory, Centre for Molecular and Nanomedical Sciences, School of Bio and Chemical Engineering, Sathyabama Institute of Science and Technology, Chennai, Tamil Nadu, India Date of Submission 07-Jan-2021 Date of Decision 01-Feb-2021 Date of Acceptance 16-Feb-2021 Date of Web Publication 22-Apr-2021 Correspondence Address: Rajaretinam Rajesh Kannan Centre for Molecular and Nanomedical Sciences, Sathyabama Institute of Science and Technology, Chennai 600119, Tamil Nadu India Login to access the Email id Source of Support: None, Conflict of Interest: None Crossref citations Check DOI: 10.4103/ijnpnd.ijnpnd_1_21 Rights and Permissions 

Abstract 

Background: 

Tephrosia pupurea is a perennial shrub that has been widely incorporated in Indian traditional medicine for its anti-inflammatory and hepatoprotective effects. Recent studies have identified T. purpurea as a source of acetylcholine esterase inhibitors. 

Aim: 

In this study, we have established the potential of T. purpurea as a potential source of drugs against Parkinsonism using an oxidopamine (6-OHDA) model. Methods: Metabolomics profiling of T. purpurea extract (TPE) was obtained using the HR-LCMS method. Enzymatic activities of Catalase, Glutathione, Superoxide Dismutase and Malondialdehyde were measured in vitro. Reactive Oxygen Species generation capacity and the mitochondrial membrane potential were also determined. The zebrafish embryos were treated with oxidopamine along with varying concentrations of T. purpurea extract and the swimming pattern and total distance travelled was evaluated. The mRNA expression of mitophagy related genes were measured using RT-PCR studies.  

Results: 

The metabolite profile of T. purpurea identified the presence of various polyphenols such as Genistein, Esculetin, and Chrysin that have neuroprotective effects. 6-OHDA-induced PD causes an increase in oxidative stress, reactive oxygen species generation, and affects mitochondrial stability. There was a significant increase in the catalase, glutathione, and superoxide dismutase levels and a decrease in Malondialdehyde and Reactive Oxygen Species levels in cells treated with TPE when compared to 6-OHDA treated cells. We then treated zebrafish embryos with 6-OHDA along with varying concentrations of T. purpurea extract, and the mRNA expression and swimming pattern were evaluated. The embryos cotreated with TPE showed improved swim pattern similar to untreated embryos, whereas those treated with the positive control failed to do so. T. purpurea extract also significantly decreased the expressions of casp3, casp9, lrrk2, and increased pink1 and parkin expression. 

Conclusion: 

Our study identifies Tephrosia purpurea extract as a viable candidate against 6-OHDA induced-neurotoxicity, and further studies of its effect in models of neurodegenerative diseases are required. Keywords: Caspases, oxidopamine, Pink1/Parkin, Tephrosia purpurea, zebrafish How to cite this article: Kesh S, Kannan RR. Neuroprotective Effect of Tephrosia purpurea Against Mitochondrial Dysfunction by Regulation of the Caspase3/9 and Pink1/Parkin Complexes. Int J Nutr Pharmacol Neurol Dis 2021;11:137-47 How to cite this URL: Kesh S, Kannan RR. Neuroprotective Effect of Tephrosia purpurea Against Mitochondrial Dysfunction by Regulation of the Caspase3/9 and Pink1/Parkin Complexes. Int J Nutr Pharmacol Neurol Dis [serial online] 2021 [cited 2021 Apr 26];11:137-47. Available from: https://www.ijnpnd.com/text.asp?2021/11/2/137/314375 

Paucity of Entorhinal Cortex Pathology of the Alzheimer’s Type in SuperAgers with Superior Memory Performance

Now your doctors and stroke hospital need to initiate research that will create protocols that prevent these neurofibrillary tangles (NFTs). Or are you going to give your doctors and hospital a pass on their incompetence?

Paucity of Entorhinal Cortex Pathology of the Alzheimer’s Type in SuperAgers with Superior Memory Performance

 

Tamar Gefen, Allegra Kawles, Beth Makowski-Woidan, Janessa Engelmeyer, Ivan Ayala, Payam Abbassian, Hui Zhang, Sandra Weintraub, Margaret E Flanagan, Qinwen Mao ... Show more

Cerebral Cortex, bhaa409, https://doi.org/10.1093/cercor/bhaa409

Published:

17 February 2021

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Abstract

Advancing age is typically associated with declining memory capacity and increased risk of Alzheimer’s disease (AD). Markers of AD such as amyloid plaques (AP) and neurofibrillary tangles (NFTs) are commonly found in the brains of cognitively average elderly but in more limited distribution than in those at the mild cognitive impairment and dementia stages of AD. Cognitive SuperAgers are individuals over age 80 who show superior memory capacity, at a level consistent with individuals 20–30 years their junior. Using a stereological approach, the current study quantitated the presence of AD markers in the memory-associated entorhinal cortex (ERC) of seven SuperAgers compared with six age-matched cognitively average normal control individuals. Amyloid plaques and NFTs were visualized using Thioflavin-S histofluorescence, 6E10, and PHF-1 immunohistochemistry. Unbiased stereological analysis revealed significantly more NFTs in ERC in cognitively average normal controls compared with SuperAgers (P < 0.05) by a difference of ~3-fold. There were no significant differences in plaque density. To highlight relative magnitude, cases with typical amnestic dementia of AD showed nearly 100 times more entorhinal NFTs than SuperAgers. The results suggest that resistance to age-related neurofibrillary degeneration in the ERC may be one factor contributing to preserved memory in SuperAgers.

Alzheimer’s disease, entorhinal cortex, memory, stereology, SuperAgers

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Ischemic stroke: A paradoxical manifestation of cancer

Something else to add to your doctor's stroke protocols; checking for cancer.

YOUR DOCTOR'S RESPONSIBILITY. Or I suppose you can take on that and give your doctor a pass.

Ischemic stroke: A paradoxical manifestation of cancer

 

Author links open overlay panelRuth A.Salazar-Camelo^ab

Eder A.Moreno-Vargas^abAndrés F.Cardona^cdeHernán F.Bayona-Ortiz^abf

https://doi.org/10.1016/j.critrevonc.2020.103181Get rights and content

Under a Creative Commons license

open access

Abstract

Introduction

Approximately 5–10 % of the patients with cryptogenic stroke have an underlying malignancy. Stroke as a complication of cancer increases the morbidity and mortality among cancer patients, leading to increased disability and healthcare costs.

Objective

To provide elements to guide physicians for when to suspect and evaluate for cancer in stroke patients.

Development

We performed a narrative review, portrayed in a question-answer format, to report relevant aspects of cancer stroke patients in the clinical practice and provide a guide based on the state-of-the-art literature. Conventional stroke mechanisms are only found in a fraction of patients with cancer. Although cardiovascular risk factors play an important role in both cancer and stroke pathogenesis, the recognition of more specific cancer-associated risk factors raises clinical suspicion for occult malignancy. We also expose the main type location and histology of tumors that are most commonly associated with stroke as well as potential blood biomarkers and current treatment considerations in the scenario of cancer associated stroke.

Conclusion

Subjects with active cancer are a patient population at increased risk for developing an ischemic stroke. Cryptogenic stroke patients have a higher risk of cancer diagnosis in the following 6–12 months. We recommend a multidisciplinary approach considering the high probability of a hidden malignancy and running a comprehensive evaluation including neurologic imaging, serological biomarkers and tight follow up.

• 
  

Keywords

Stroke

Cancer

Prognosis

Risk factors

Mortality

Hypercoagulability (MeSH)

1. Introduction

Stroke is a heterogeneous pathologic process that results in acute neurologic injury. Cancer is one of the many risk factors associated to it. Globally, both stroke and cancer, represent a significant public health burden. In the specific case of Colombia, both are leading causes of death, stroke in the second place and cancer occupying the third place (Stefan et al., 2009; Gobierno de colombia, 2018; Rodríguez-García et al., 2017). Concurrently, the incidence and prevalence of both entities appears to be increased among the aging population. Likewise, among patients with cancer, cerebrovascular disease is the second most common neurological manifestation following metastases (Zhang et al., 2006). Yet, this association is often disregarded in clinical practice. Stroke can occur at any point during malignancy and it can even be the first manifestation of an occult malignancy in up to 3% of patients (Uemura et al., 2010). Furthermore, autopsy findings of cancer patients reveal stroke in 15 % of cases; half of which are asymptomatic (Kim et al., 2010). Given that stroke can be a potential first sign of neoplasia (Uemura et al., 2010), it demands an accurate etiological diagnosis in order to gear therapy accordingly and improve clinical outcomes (Uemura et al., 2010; Kim et al., 2010). Prognosis, disability and health expenses are greater in patients with cancer and stroke compared with subjects without cancer (Dearborn et al., 2014). Therefore, it is important to search for occult malignancy in acute stroke patients (Uemura et al., 2010). The aim of the present review is to describe the clinical characteristics, risk factors, biomarkers and treatment approaches in patients with cryptogenic stroke associated with neoplasia. Additionally, we will provide physicians with some additional clues for suspecting occult malignancy as the potential silent cause of cerebrovascular disease.

2. What are the possible scenarios in which cancer can be associated with ischemic stroke?

Currently, there is no consensus on how to identify cancer risk in acute stroke patients.

In the clinical practice, there are four situations in which cerebral ischemic disease could be associated with neoplasia: i. Subjects with recent cancer diagnosis who present with a stroke of unknown mechanism (cryptogenic stroke with active cancer), ii. A known cancer patient with a typical stroke etiology; iii. A stroke in a patient who had cancer but has now recovered (cryptogenic stroke with inactive cancer) and iv. A patient with an occult malignancy that manifests with a stroke; (cryptogenic stroke with unknown neoplasia) (Kneihsl et al., 2016). The first and second groups have been cataloged as the active cancer group. This represents a common clinical scenario. Usually these patients have been recently diagnosed (within the last 6–12 months) and underwent any type of cancer treatment and may or may not have local or distant recurrences (Kim et al., 2012; Lee et al., 2014). The patients in the inactive cancer group (group three); represent disease survivors. Commonly, their time since diagnosis is above 12 months (Kassubek et al., 2017; Guo et al., 2014). Finally, and probably the most frightening and challenging group corresponds to the cryptogenic stroke patients whose cancer is yet to be uncovered (Selvik et al., 2015). As the case depicted on Fig. 1 In this situation, the clinician’s high level of suspicion and expertise drives the subsequent clinical conduct. Therefore, this latter group represents a real challenge, as it is not necessary to screen for cancer in every case of cryptogenic stroke since it isn’t cost effective (Selvik et al., 2015). Consequently, it is primordial to limit the scenarios in which cancer should be considered as part of the differential diagnosis in patients with stroke of unknown etiology.

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Fig. 1. Typical brain MRI of cancer-associated acute ischemic stroke.

A 60-year-old man who initially presented with left hemiparesis. Subsequently acute ischemic stroke was diagnosed. The brain DWI-MRI showed multiple infarct lesions in multiple vascular territories on bilateral hemispheres (A, B, C) and small-scattered lesions in the right and predominant in left hemisphere (D). At the same time, a chest-CT showed a pulmonary nodule and pulmonary embolism (E), after work-up a pulmonary adenocarcinoma was diagnosed 1 month later. The PET-CT (F) documented the right apical active nodule and mediastinum multiple ganglia.

3. What is the relationship between cryptogenic stroke patients and cancer

A stroke of cryptogenic etiology is an ischemic stroke with no identified cause despite an exhaustive investigation (Dearborn et al., 2014; Saver, 2016). The underlying mechanisms are varied and categorized as embolic and non-embolic. Common causes of embolic stroke are cancer, occult paroxysmal atrial fibrillation, among others (Fig. 2) (Fonseca and Ferro, 2015). In the general population, the frequency of cryptogenic stroke is 20–40 % (Fonseca and Ferro, 2015; Bayona-Ortiz et al., 2017). However, an etiology is not found in up to 40–51 % of patients with cancer (Quintas et al., 2018; Gon et al., 2016; Navi et al., 2014). Strikingly, approximately 20 % of patients with stroke of undetermined cause could have an occult malignancy at the time of presentation (Selvik et al., 2018). Simultaneously, stroke has been described as the first manifestation of an unknown neoplasia in up to 3% of patients (Cocho et al., 2015). Therefore, patients who present with a cryptogenic stroke are at increased risk of having an occult malignancy. The pathogenesis of stroke seems to be different in subjects without neoplasia compared with cancer patients, but the evidence is controversial (Cocho et al., 2015; Grisold et al., 2009). Even though classic etiologies of stroke such as large artery disease and cardioembolic source are frequent among patients with malignancy, cryptogenic stroke is more frequent and has a stronger association with cancer (Dearborn et al., 2014; Cocho et al., 2015).

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Fig. 2. Pathophysiology of cancer-associated thrombosis remains partially unknown. This figure illustrates the diagnostic sequence of a patient with stroke considering cancer as a possible etiology after ruling out other nosological entities. Finally, the pathogenesis and risk factors of cancer-associated thrombosis are presented into three categories: patient characteristics, treatment-related issues, and cancer-specific factors.

4. What kind of cancer associated risk factors play a role in stroke development?

Both cancer and cerebrovascular disease share a significant amount of risk factors. These are more common in the aging population and are burdened with vascular risk factors. Indeed, reports have showed that the prevalence of such vascular risk factors (hypertension & smoking, hyperlipidemia, diabetes mellitus, alcoholism, obesity, atrial fibrillation) is similar between cancer stroke patients and non-cancer stroke patients (Dearborn et al., 2014; Quintas et al., 2018; Selvik et al., 2014). Given the high prevalence and pathogenic effect of vascular risk factors, it is not surprising that these are still the most frequent cause of stroke, even among cancer population (Dearborn et al., 2014). On the same note, reports have demonstrated that the proportion of conventional stroke mechanisms (atherosclerotic, cardioembolic, lacunar) are approximately equal between patients with and without cancer (Dearborn et al., 2014). Additionally, some studies have demonstrated that atherosclerosis is the most common cause of ischemic stroke in patients with neoplasia (Kim and Lee, 2014). However, data is conflicting as other studies have established that on the contrary, conventional vascular risk factors were less relevant in ischemic stroke cancer patients (Shin et al., 2016).

The mechanisms of stroke in the context of cancer is not entirely elucidated. Since vascular risk factors are highly prevalent on stroke patients regardless of their cancer status, whether both diseases processes arise independently and simultaneously or if cancer has a direct influence on the pathophysiology of stroke is still unclear. (Fig. 3).

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Fig. 3. Interaction of multiple factors involved in the pathogenesis of arterial thrombosis in cancer patients. IMIDs: immunomodulatory drugs; TKI: tyrosine kinase inhibitors; VEGF: vascular endothelial growth factor; TNF: tumor necrosis factor; u-PA: urokinase-type plasminogen activator; t-PA: tissue plasminogen activator; PAI-1 and 2: plasminogen activator inhibitor-1 and 2; TF: tissue factor; CVCs: central venous catheter; BCR/ABL: Philadelphia chromosome.

4.1. Coagulopathy

Hypercoagulability is regarded as the most significant mechanism of cryptogenic stroke in patients with cancer (Grazioli et al., 2018). It was first described by Trousseau in 1865 in the setting of gastric carcinoma and migratory thrombophlebitis. Tumor cells release pro-coagulant molecules, tissue factor and cancer procoagulant (a cysteine protease), that heightens the coagulation cascade. In addition, other cytokines are released such as TNF-alpha, IL-1 and IL-6 (Grisold et al., 2009). These molecules act as pro coagulants by: i). Inducing cells to express tissue factor, ii). Inhibiting Protein C activation and iii). Shedding vascular endothelial cells and therefore further thickening blood (Dearborn et al., 2014). It constitutes a paraneoplastic and yet poorly understood phenomenon that decreases survival in affected individuals (Schwarzbach et al., 2012; Lee et al., 2017).

Other coagulopathies, including disseminated intravascular coagulation (DIC) present more frequently in stroke patients with cancer (Dearborn et al., 2014). Several studies have tried to use laboratory markers to quantify coagulopathy. d-dimer is a marker of an activated coagulation system. Cancer stroke patients have higher d-dimer levels compared to patients with stroke and no cancer (Kim et al., 2010; Dearborn et al., 2014; Quintas et al., 2018; Schwarzbach et al., 2012; Lee et al., 2017). It is also an independent predictor for stroke of non-conventional mechanisms and is significantly associated to cancer in multiple studies (Kim et al., 2010; Álvarez-Pérez et al., 2012). Seok et al. found a higher prevalence of micro embolisms in transcranial doppler recordings of cancer stroke patients, predominantly in those with unconventional stroke mechanisms which correlated significantly with d-dimer levels (Seok et al., 2010). However, d-dimer is a non-specific marker, it can become elevated in numerous circumstances including cancer patients without stroke (Schwarzbach et al., 2012).

4.2. Cancer site and histologic subtype

Adenocarcinoma of the lung and adenocarcinomas of the gastrointestinal tract are the most common type of malignancies among cancer stroke patients across multiple cohorts (Kim et al., 2010; Dearborn et al., 2014; Navi et al., 2014). Adenocarcinomas are the most common histologic subtypes in stroke and cancer series (Dearborn et al., 2014; Quintas et al., 2018; Lee et al., 2017; Álvarez-Pérez et al., 2012). This is probably because they are frequently associated with clotting disorders via its production and secretion of mucin, a high molecular weight particle that interacts with cell adhesion molecules (P and l-selectins) and induces micro thrombi formation (Schwarzbach et al., 2012). Other common cancers in stroke cohorts are prostate, breast, bladder, gynecological cancer, pancreatic and melanoma (Dearborn et al., 2014; Quintas et al., 2018; Zhang et al., 2007; Navi et al., 2015). Hematological malignancies like non-Hodgkin lymphoma have also been reported (Quintas et al., 2018). Outstandingly, patients with smoking-related cancers have higher risk of stroke (lung, colon, bladder, rectum, pancreas, kidney, stomach, and head and neck) (Andersen and Olsen, 2018).

Additional but infrequent direct cancer mechanisms for stroke also include the occurrence of an embolism to the brain from heart tumors, hematologic malignancies like polycythemia vera’s hyperviscosity syndrome and direct infiltration of vascular structures such as the case of intravascular lymphoma (Dearborn et al., 2014; Grisold et al., 2009).

4.3. Non-bacterial thrombotic endocarditis (NBTE)

In NBTE, sterile vegetations in the cardiac valves that are thought to develop due to valve attachment of disrupted fibrin that forms a matrix for platelets to bind. One of the most common targets for emboli due to NBTE is the cerebral circulation. NBTE is found as one of the most prevalent risk factors in cancer and stroke in studies (Navi et al., 2014; Sun et al., 2016). It is related with mucinous carcinomas mainly of pancreatic origin (Grisold et al., 2009).

4.4. Tumor mass effect

The tumor mass itself or its surrounding edema can cause direct compression of blood vessels in the brain, causing ischemia of the affected territory. This must be differenced from a hemorrhagic conversion of a brain metastasis leading instead to a hemorrhagic stroke. This phenomenon has also been described in primary brain neoplasia such as high-grade glioma and benign tumors like meningioma. Surgery of this type of tumors is related with perioperative stroke but the mechanism is not defined yet (Grisold et al., 2009).

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Exoskeleton use in post-stroke gait rehabilitation: a qualitative study of the perspectives of persons post-stroke and physiotherapists

How does this one compare to these other ones? 92 posts on exoskeletons.

 You do think your stroke hospital should have already evaluated all these earlier ones? Or are you giving them a pass on their incompetency?

Exoskeleton use in post-stroke gait rehabilitation: a qualitative study of the perspectives of persons post-stroke and physiotherapists

• Julie Vaughan-Graham,
• Dina Brooks,
• Lowell Rose,
• Goldie Nejat,
• Jose Pons &
• Kara Patterson 

Journal of NeuroEngineering and Rehabilitation volume 17, Article number: 123 (2020) Cite this article

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Abstract

Background

Wearable powered exoskeletons are a new and emerging technology developed to provide sensory-guided motorized lower limb assistance enabling intensive task specific locomotor training utilizing typical lower limb movement patterns for persons with gait impairments. To ensure that devices meet end-user needs it is important to understand and incorporate end-users perspectives, however research in this area is extremely limited in the post-stroke population. The purpose of this study was to explore in-depth, end-users perspectives, persons with stroke and physiotherapists, following a single-use session with a H2 exoskeleton.

Methods

We used a qualitative interpretive description approach utilizing semi-structured face to face interviews, with persons post-stroke and physiotherapists, following a 1.5 h session with a H2 exoskeleton.

Results

Five persons post-stroke and 6 physiotherapists volunteered to participate in the study. Both participant groups provided insightful comments on their experience with the exoskeleton. Four themes were developed from the persons with stroke participant data: (1) Adopting technology; (2) Device concerns; (3) Developing walking ability; and, (4) Integrating exoskeleton use. Five themes were developed from the physiotherapist participant data: (1) Developer-user collaboration; (2) Device specific concerns; (3) Device programming; (4) Patient characteristics requiring consideration; and, (5) Indications for use.

Conclusions

This study provides an interpretive understanding of end-users perspectives, persons with stroke and neurological physiotherapists, following a single-use experience with a H2 exoskeleton. The findings from both stakeholder groups overlap such that four over-arching concepts were identified including: (i) Stakeholder participation; (ii) Augmentation vs. autonomous robot; (iii) Exoskeleton usability; and (iv) Device specific concerns. The end users provided valuable perspectives on the use and design of the H2 exoskeleton, identifying needs specific to post-stroke gait rehabilitation, the need for a robust evidence base, whilst also highlighting that there is significant interest in this technology throughout the continuum of stroke rehabilitation.

Introduction

Over the period 1990–2017 there has been a 3% increase in age-standardized rates of global stroke prevalence [1] and a 33% decrease in mortality due to improved risk factor control and treatments [2]. Therefore, stroke survivors are living longer with mild to severe lifelong disabilities requiring long term assistance [1]. As a result, stroke presents a significant socioeconomic burden accounting for the largest proportion of total disability adjusted life years (47.3%) of neurological disorders [3]. Walking impairments, one aspect of stroke disabilities, negatively impact independence and quality of life [4], and recovery of walking is a primary goal post-stroke [5].

Wearable powered exoskeletons are a new and emerging technology originally developed as robots to enable persons who were completely paralyzed due to spinal cord injury to stand and walk [6, 7], but more recently developed to provide sensory-guided motorized lower limb assistance to persons with gait impairments [8]. They require the active participation of the user from the perspective of integrating postural control/balance and the locomotion pattern in real life environments whilst simultaneously providing assistance to achieve typical lower limb movement patterns in a task specific manner [8]. The Exo-H2 is a novel powered exoskeleton in that it has six actuated joints, the hip, knee and ankle bilaterally, and uses an assistive gait control algorithm to provide lower limb assistance when the gait pattern deviates from a prescribed pattern [9]. As stroke impairments typically influence hip, knee and ankle movements the H2 was considered an appropriate exoskeleton for our study [8, 10].

Significant limitations persist in current exoskeleton designs such as weight, cost, size, speed and efficiency [11]. Although end-users’ perspectives are essential in the design and development of assistive technology [12, 13], there is a paucity of literature from both persons with disabilities and physiotherapists (PTs) perspectives [14, 15]. Over the last decade end-user perspectives have primarily been studied in spinal cord injury (SCI) in which four studies used semi-structured interviews [16,17,18,19], and 3 studies used survey methods [20,21,22] with sample size ranging from 3 to 20 persons. However, these studies included both complete and incomplete SCI with most participants being non-ambulatory representing a very different end-user population compared to persons post-stroke. A further two studies reported end-user perspectives using survey methods with persons with multiple sclerosis (MS) [23], and persons with MS, SCI or acquired brain injury (ABI) [24]. Wolff et al.,(2014) utilized an online survey to evaluate perspectives on potential use of exoskeletons with wheelchair users, primarily persons with SCI, and healthcare professionals, but no PTs were included [25]. To date only one study by Read et al.,(2020) specifically investigated perspectives of 3 PTs on exoskeleton use using semi-structured interviews with persons with SCI or stroke. Currently, a mixed-methods study is underway to investigate perspectives of PTs and persons with stroke [26]. Thus, further research is needed to explore in-depth, utilizing a qualitative research approach, end-users’ perspectives on lower limb exoskeleton use in post-stroke gait rehabilitation.

It is important to understand and incorporate end-user perspectives [27], persons post-stroke and physiotherapists, with respect to the design of exoskeletons and their implementation to effectively facilitate uptake both in clinical practice and community settings. Therefore, the purpose of our study is to explore the perspectives of persons post-stroke and physiotherapists following a 1.5 h single-use session with a H2 exoskeleton.

 

 

Effects of Robot-assisted therapy on upper limb recovery after stroke: A Systematic Review

Interesting that significant improvement in upper limb function but not ADLs.  Ask your hospital EXACTLY what updates to this have occurred in the last 14 years.  You do expect your hospital to be competently following appropriate stroke research? Or are you giving them a pass on their incompetency?

Effects of Robot-assisted therapy on upper limb recovery after stroke: A Systematic Review

Gert Kwakkel, PhD1,2, Boudewijn J. Kollen, PhD3, and Hermano I. Krebs, PhD4,5,6
1 Department Rehabilitation and Research Institute MOVE, VU University Medical Center Amsterdam, The Netherlands 2 Department Rehabilitation, Rudolf Magnus Institute of NeuroScience, University Medical Center Utrecht, The Netherlands 3 Research Bureau, Isala Klinieken Zwolle, The Netherlands 4 Mechanical Engineering Department, Massachusetts Institute of Technology, Cambridge, MA, USA 5 Department of Neurology and Neuroscience, Burke Institute of Medical Research, Weill Medical College, Cornell University, White Plains, NY, USA 6 Department of Neurology, University of Maryland, School of Medicine, Baltimore, MD, USA

Abstract Background and Purpose— 

To present a systematic review of studies that investigates the effects of robot-assisted therapy on motor and functional recovery in patients with stroke. Summary of Review—A database of articles published up to October 2006 was compiled using the following MEDLINE key words: cerebral vascular accident, cerebral vascular disorders, stroke, paresis, hemiplegia, upper extremity, arm and robot. References listed in relevant publications were also screened. Studies that satisfied the following selection criteria were included: (1) patients were diagnosed with cerebral vascular accident; (2) effects of robot-assisted therapy for the upper limb were investigated; (3) the outcome was measured in terms of motor and/or functional recovery of the upper paretic limb; (4) The study was a randomised clinical trial (RCT). For each outcome measure, the estimated effect size (ES) and the summary effect size (SES) expressed in standard deviation units (SDU) were calculated for motor recovery and functional ability (ADL) using fixed and random effect models. Ten studies, involving 218 patients, were included in the synthesis. Their methodological quality ranged from 4 to 8 on a (maximum) 10 point scale. Meta-analysis showed a non-significant heterogeneous SES in terms of upper limb motor recovery. Sensitivity analysis of studies involving only shoulder-elbow robotics subsequently demonstrated a significant homogeneous SES for motor recovery of the upper paretic limb. No significant SES was observed for functional ability (ADL). 

Conclusion—

As a result of marked heterogeneity in studies between distal and proximal arm robotics, no overall significant effect in favour of robot-assisted therapy was found in the present meta-analysis. However, subsequent sensitivity analysis showed a significant improvement in upper limb motor function after stroke for upper arm robotics. No significant improvement was found in ADL function. However, the administered ADL scales in the reviewed studies fail to adequately reflect recovery of the paretic upper limb and valid instruments that measure outcome of dexterity of the paretic arm and hand are mostly absent in selected studies. Future research on the effects of robot-assisted therapy should therefore distinguish between upper and lower robotics arm training and concentrate on kinematical analysis to differentiate between genuine upper limb motor recovery and functional recovery due to compensation strategies by proximal control of the trunk and upper limb.

Correspondence: G. Kwakkel (PhD), Senior Researcher, Dept. Rehabilitation Medicine, VU University Medical Center, de Boelelaan 1117, 1081 HV Amsterdam, PO Box 7057, 1007 MB Amsterdam, The Netherlands, E-mail: g.kwakkel@vumc.nl.