Remote ischemic conditioning for stroke: A critical systematic review

 This is totally useless! You didn't create a protocol on this that survivors can bring to their therapists! You've known about this for years and have DONE NOTHING USEFUL TO HELP SURVIVORS!

• Remote ischemic conditioning (19 posts to July 2018)

Remote ischemic conditioning for stroke: A critical systematic review

Harry Keevil, Bethan E Phillips, and Timothy J England https://orcid.org/0000-0001-5330-8584 timothy.england@nottingham.ac.ukView all authors and affiliations

Volume 19, Issue 3

https://doi.org/10.1177/17474930231191082

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• • Abstract
  • Introduction
  • Mechanisms
  • Animal studies
  • Human studies
  • Future directions
  • Conclusion
  • Declaration of conflicting interests
  • Funding
  • ORCID iD
  • References
  • Supplementary Material
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Abstract

Remote ischemic conditioning (RIC) is the application of brief periods of ischemia to an organ or tissue with the aim of inducing protection from ischemia in a distant organ. It was first developed as a cardioprotective strategy but has been increasingly investigated as a neuroprotective intervention. The mechanisms by which RIC achieves neuroprotection are incompletely understood. Preclinical studies focus on the hypothesis that RIC can protect the brain from ischemia reperfusion (IR) injury following the restoration of blood flow after occlusion of a large cerebral artery. However, increasingly, a role of chronic RIC (CRIC) is being investigated as a means of promoting recovery following an ischemic insult to the brain. The recent publication of two large, randomized control trials has provided promise that RIC could improve functional outcomes after acute ischemic stroke, and that there may be a role for CRIC in the prevention of recurrent stroke. Although less developed, there is also proof-of-concept to suggest that RIC may be used to reduce vasospasm after subarachnoid hemorrhage or improve cognitive outcomes in vascular dementia. As a cheap, well-tolerated and almost universally applicable intervention, the motivation for investigating possible benefit(You knew of the need, YET DID NOTHING TO HELP SURVIVORS!) of RIC in patients with cerebrovascular disease is great. In this review, we shall review the current evidence for RIC as applied to cerebrovascular disease.

Introduction

Remote ischemic conditioning (RIC) describes the technique of using non-lethal ischemic stimuli in one organ or tissue to protect against lethal ischemic events in a distant organ. Ischemic conditioning (IC) was first demonstrated using isolated dog hearts whereby brief periods of occlusion to the left circumflex artery were found to reduce infarct size when the same artery was subsequently occluded for 40 min, in comparison to non-conditioned hearts.¹ Subsequently, it was shown that brief periods of ischemia applied to the circumflex artery protected against ischemia from a 1 h occlusion of the left anterior descending artery,² suggesting that protection via IC is conveyed to a different part of an organ than that supplied by the conditioned artery. This concept was developed when brief periods of occlusion to the mesenteric artery reduced the size of myocardial infarction following prolonged occlusion of a coronary artery.³ While clearly an interesting phenomenon, it was difficult to imagine this technique translating into clinical practice, given the perceived danger of occluding blood supply to a major organ. However, cardioprotection was subsequently demonstrated using brief periods of ischemia to skeletal muscle.⁴ Thus, we arrive at the paradigm for RIC used today. Brief periods of non-lethal ischemia are applied to a limb, with the aim of inducing ischemic tolerance in a distant organ.

Several protocols exist for RIC. The stimulus can be given before, during, or after an ischemic event, referred to respectively as remote ischemic preconditioning (RIPreC), remote ischemic perconditioning (RIPerC), and remote ischemic postconditioning (RIPostC; see Figure 1). Ischemia is achieved by the inflation of a blood pressure cuff to supra-systolic pressures in one or multiple limbs. Most administration protocols involve four to five cycles of cuff inflation for 5 min. While early clinical studies predominantly used a single episode of RIC, given around the time of an ischemic event, increasingly, chronic RIC (CRIC) is used. This requires participants to carry out daily RIC as described above for several days, weeks, or even months.

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

 So it didn't improve upper limb ADLs, so immediate excuses were applied about wrong measurements. I expect better than that! You're fired! 

This is why I hate systematic reviews and meta-analysis. They do absolutely nothing towards getting survivors recovered.  Sure you get published, but the goal of all stroke research is survivor recovery. This did nothing towards that.

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

 Effects of Robot-assisted therapy on upper limb recovery after stroke: A Systematic Review
Gert Kwakkel, PhD 1,2,
Boudewijn J. Kollen, PhD 3, 

Hermano I. Krebs, PhD 4,5,6
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, IsalaKlinieken Zwolle, The Netherlands
4  Mechanical Engineering Department, Massachusetts Instituteof Technology, Cambridge, MA, USA
5  Department of Neurology and Neuroscience, Burke Instituteof 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 anon-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 Boelelaan1117, 1081 HV Amsterdam, PO Box 7057, 1007 MB Amsterdam, The Netherlands, E-mail: g.kwakkel@vumc.nl.
 
Keywords
robotics; cerebrovascular accident; Activities of daily living; Upper limb; Rebiew; systematic
Introduction
Stroke is the leading cause of disability in the United States. 750.000 individuals are affected each year and the prevalence rate is among 200–300 patients per 100.000 inhabitants.¹Although prospective epidemiological studies are lacking, findings of a number of longitudinalstudies indicate that in 30% to 66% of hemiplegic stroke patients, the paretic arm remainswithout function when measured 6 months after stroke, whereas only 5% to 20% demonstratecomplete functional recovery.²The results of a systematic review involving 123 randomized clinical trials (RCTs) by vanPeppen and colleagues demonstrated that there is strong evidence that intensity as well as task specificity are the main drivers in an effective treatment program after stroke. In addition, thistraining should be repetitive, functional, meaningful and challenging for a patient.³,⁴However, the question as to how the effects of exercise therapy can be further enhanced in aclinical environment presents a challenge to answer. Therefore, there is a need to develop better ways to augment exercise training in a functional way. Using therapeutic adjuncts to facilitate clinical practice, such as robotics⁵– ¹¹, is a new promising development. Robotics allows patients to train independently of a therapist and to improve upon their own functional level(i.e., robot-assisted therapy). In particular, there is strong evidence for robot-assisted therapy to increase treatment compliance by way of introducing incentives to the patient, such as games.In addition, by using computer assisted devices for regaining upper limb function, the robotcan easily apply new constraints, in order to optimize the required movement pattern.Therefore, the complexity of a motor task to be learned can be controlled for more preciselywith robotics than in conventional treatment approaches.Although many devices have been designed to deliver arm therapy in individuals with stroke,five of these devices, the MIT-MANUS⁵,⁶;(designed and built at the Massachusetts Instituteof Technology), the ARM-GUIDE
7 (Assisted Rehabilitation and Measurement guide), the MIME⁸,⁹;(Mirror-Image Motion Enabler), the InMotion²;Shoulder-Elbow Robot¹⁰;and the Bi-Manu-Track ¹¹, were tested in at least one Randomized Clinical Trial (RCT). The MIT-MANUS is a robot that allows subjects to execute reaching movements in the horizontal plane.This two degrees of freedom (DoF) robot enables unrestricted movements of the shoulder and elbow joints⁵. The ARM-GUIDE is a trombone-like device and has four controlled DoF. ADC servo motor can assist in the movement of a subject’s arm in the reaching direction alonga linear track. Optical encoders record the position in the reach, elevation and yaw axes⁷. TheMIME robot consists of a six DoF robot arm. The robot enables the bilateral practice of a threeDoF shoulder-elbow movement, whereby the non-paretic arm guides the paretic arm¹². The InMotion²;Shoulder-Elbow Robot, which is the commercial version of MIT-MANUS(Interactive Motion Technologies, Inc, Cambridge, MA, USA), has two DoF and providesshoulder/elbow training in the horizontal plane with a supported forearm¹⁰. The Bi-Manu-Track is designed to specifically train distal arm movements by practicing bilateral elbow pro-and supination as well as wrist flexion and extension in a mirror or parallel fashion¹¹.In the past, several studies were unable to prove superiority of one type of conventional strokeregimen over another ¹³;– ¹⁶, but there is strong evidence that highly repetitive movementtraining can result in improved recovery⁴,¹⁶. Applying robot-assisted therapy enables patientsto practice intensively with their upper paretic limb. The objective of the present systematic

Effects of rhythmic auditory stimulation on motor function and balance ability in stroke: A systematic review and meta-analysis of clinical randomized controlled studies

 This repeat systematic reviews and meta-analysis should never have to occur if we had a decent database of all stroke research and protocols, updated as new research comes in. But our fucking failures of stroke associations can't see the need and create one. 

• rhythmic auditory cueing (8 posts to April 2016)
  

• bilateral leg training with rhythmic auditory cueing (1 post to June 2020)

The latest here:

Effects of rhythmic auditory stimulation on motor function and balance ability in stroke: A systematic review and meta-analysis of clinical randomized controlled studies

Lei Wang^1*, Jin-lin Peng², Wu Xiang³, Yi-jie Huang⁴ and Ai-lian Chen^1*

• ¹Department of Rehabilitation Medicine, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
• ²Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
• ³Department of Rehabilitation, Beibei Traditional Chinese Medical Hospital, Chongqing, China
• ⁴Department of Rehabilitation Medicine, The Seventh Affiliated Hospital, Sun Yat-sen University, Guangzhou, China

Objective: Rhythmic auditory stimulation (RAS) belongs to neurologic music therapy, which has attracted clinical attention because of its efficacy in motor function after stroke. This study aimed to summarize the effectiveness of rhythmic auditory stimulation (RAS) for the treatment of motor function and balance ability in stroke through a systematic review and meta-analysis.

Methods: All studies were retrieved from six databases. The effects of RAS on stroke were determined using the following indicators: motor function including step length, step cadence, velocity, Fugl–Meyer assessment (FMA); and balance ability including overall balance index (OBI) and Berg Balance Scale (BBS). The risk map of bias of the quality of the studies and the meta-analysis results of the indicators was prepared using RevMan 5.2 software.

Results: A total of 1,363 abstracts were retrieved. Among them, 325 duplicate studies were eliminated, and 971 studies were excluded after reading the titles and abstracts. In addition, by downloading the full text for further reading and screening, 47 studies were excluded. A total of 22 studies were included in the systematic review, and 18 studies were included in the meta-analysis. Assessment of quality, based on the PEDro scale, two studies had low quality, three studies had excellent quality, and the other studies had good quality; based on the Cochrane Collaborative Network Bias Risk Assessment Scale. A total of 15 studies specifically explained the random methods used. Meanwhile, seven studies did not report random sequence generation. A total of 10 studies reported that the evaluation of experimental results was blinded. In the meta-analysis, the results of motor function [namely, velocity (SMD = 0.99, 95% CI (0.43, 1.55)), step length (SMD = 0.97, 95% CI (0.74, 1.20)), and step cadence (MD = 5.16, 95% CI (4.17, 6.14)), FMA (MD = 2.93, 95% CI (2.04, 3.83))], were statistically significant (P < 0.01). The results of balance ability [OBI (MD = −0.51, 95% CI (−0.86, −0.16)) and BBS (MD = 2.93, 95% CI (1.67, 4.20))], were also statistically significant (P < 0.01). Among all the outcome indicators, three indicators were included in more than 10 studies: these are step length, step cadence, and velocity. The results showed that the two sides of the funnel chart were asymmetrical, thus these results all showed heterogeneity. The GRADEpro GDT online tool was used to evaluate the quality of evidence for the outcome indicators in the included studies. Five outcome indicators were included, of which three were low-quality indicators and two were moderate-quality indicators.

Conclusions: RAS could improve gait parameters, walking function, and balance ability of individuals with stroke. However, studies or samples of outcome indicators for balance ability of stroke patients is relatively insufficient, which also requires further research in the future.

Systematic review registration: PROSPERO, identifier: CRD42021225102.

Introduction

Stroke is the second leading cause of death and the third leading cause of disability worldwide (Feigin et al., 2022), with more than 13 million new stroke cases annually (GBD 2016 Neurology Collaborators, 2019). In the 2022 World Stroke Organization (WSO) report, from 1990 to 2019, stroke events and stroke-related deaths increased by 70.0 and 43.0%, respectively (Feigin et al., 2022). Recently, stroke mortality has declined with improved medical care and preventive measures, however, the absolute number of new stroke cases annually has increased, thereby leading to a growing burden of stroke-related disability (Feigin et al., 2014; Platz, 2019). One-third of patients with stroke are permanently disabled, and more than half of stroke survivors aged 65 years and older have mobility impairment (Virani et al., 2020). Thus, these trends will continue with the development of the population on average as people are growing older (Platz, 2019).

Motor dysfunction is one of the most common consequences of stroke and includes impairment of coordination and postural control (Langhorne et al., 2009). About 60% of stroke patients have difficulty walking (Mehrholz et al., 2014) because of motor and sensory disturbances on the hemiplegic side, in addition to symptoms, such as spasticity and cognitive impairment that may further hinder walking. Therefore, gait recovery is often the focus of rehabilitation efforts to enhance not only physical activity but also autonomy and participation in daily life (Mainka et al., 2018). Therefore, gait recovery is the most important goal of rehabilitation programs for patients with stroke (Lee et al., 2018). In clinical practice, some therapeutic methods are used to treat motor dysfunction after stroke and show good efficacy, such as Neurologic music therapy, repetitive transcranial magnetic stimulation(rTMS) (Fan et al., 2021) and Virtual reality (Turolla et al., 2013).

Neurologic music therapy, a crucial complementary therapy, is currently used in the rehabilitation of movement, speech, and cognition and is accepted in the medical field (Thaut et al., 2014). Rhythmic auditory stimulation (RAS) is a technology in neurologic music therapy and is based on rhythmic and repetitive auditory stimuli (Yoo and Kim, 2016). RAS uses an external rhythm (music) to facilitate internally generated rhythmic movements, such as walking (Thaut, 2015). In addition, RAS can be used as auditory cues for walking and may facilitate internal neural timing among post-stroke patients from a neurophysiological perspective (Ghai and Ghai, 2019). One of the earliest and relevant studies about the use of RAS in stroke rehabilitation was conducted by Thaut et al. (1993): they observed that RAS can effectively reduce stride time variability and more balanced muscle activation patterns between hemiplegic and unaffected limbs. Moreover, RAS may lead to improved lower extremity and gait function after stroke and can easily be used as adjunctive therapy (Thaut, 2015). Suh et al. also confirmed that RAS with significant effects on improving balance as well as gait coordination and symmetry (Suh et al., 2014), Yang et al. also confirmed this conclusion (Yang et al., 2016). Furthermore, several studies support the use of gait training with RAS in the chronic phase of stroke because it improves walking speed and flexibility (Ko et al., 2016; Wright et al., 2017). In the last 20 years, the of RAS for stroke treatment has been widely investigated. Nascimento et al. (2015), which provided evidence that rhythm cue training can improve walking speed and stride length more than walking training alone. It can also benefit from the rhythm and symmetry of walking. This review includes only seven trials with a total of 211 participants, including randomized controlled trials (RCT) and clinical controlled trials (CCT). Yoo and Kim (2016) in a review obtained the beneficial effects of RAS through meta-analysis, which confirmed that RAS can improve the gait parameters and other motor functions of patients, thus supporting its application in widening the rehabilitation field of stroke patients. The study was published in 2016, and only 10 studies (RCT or CCT) were included in the meta-analysis, with a total of 356 subjects. However, the above two studies have some limitations in the number of articles, the number of participants, and the quality of studies (Nascimento et al., 2015; Yoo and Kim, 2016). In addition, those studies' systematic reviews did not involve research on the balance ability of stroke patients. Therefore, the scientific basis of the influence of RAS on gait should be based on high-quality evidence-based medicine by incorporating more high-quality literature.

Thus, this study aimed to determine the effect of rhythmic auditory stimulation on the rehabilitation of patients with stroke and movement disorders through a systematic review and meta-analysis of the literature. This study will include more RCT studies to further improve the quantity and quality of articles to improve the evidence of evidence-based medicine. This work also provides strong evidence for the use of RAS to treat stroke and analyze the deficiencies of previous studies.

Methods

Herein, a systematic review was planned and conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement (Cumpston et al., 2019) and was registered with PROSPERO (registration number CRD42021225102). A PRISMA checklist is provided in Supplementary material 1.

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Boswellic acids as promising agents for the management of brain diseases

 Earlier research from 2019 had this line: patients who were allocated to BA group had a significant recovery in neurological function during the 1-month follow-up.

So why the hell aren't you writing a protocol on this instead of this waste of time on a systematic review?  Your mentors and senior researchers incompetently did not know about it?

Boswellic acids as promising agents for the management of brain diseases

Author links open overlay panelArezooRajabian^a

MohammadrezaFarzanehfar^aHosseinHosseini^bFahimeh LaviArab^cdAliNikkhah^e

https://doi.org/10.1016/j.lfs.2022.121196Get rights and content

Abstract

Boswellic acid (BA)s are pentacyclic triterpenic acids present in gum resin of Boswellia species (such as B. serrata and B. carterii). They possess a variety of pharmacological effects such as anti-inflammatory, anti-oxidant, and anti-excitotoxic effects. These properties may have potential therapeutic implication in neurological disorders. Notably, the BAs-induced neuroprotection is proposed to be associated with the ability to reduce neurotoxic aggregates, decrease oxidative stress, and improve cognitive dysfunction. Recently, BAs have been suggested as potential agents for the treatment of brain tumors due to their potential to attenuate cell proliferation, migration, metastasis, angiogenesis, and promote apoptosis during both in vitro and in vivo studies. The present review aims to address these studies and highlights the possible underlying mechanisms of the observed effects. Besides, novel formulations and improving pharmacokinetic properties may enhance the therapeutic efficacy of BAs.

Graphical abstract

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Keywords

Boswellic acid

Neurodegenerative diseases

Brain tumor

Bioavailability

Data availability

Data will be made available on request.

Rehabilitation interventions for cognitive deficits in stroke survivors: A systematic review of randomized controlled trials

Well shit, if we had a database of all stroke research that was updated as research came in this type of systematic review would never need to be done. And you didn't even write up your findings as a protocol and distribute it to all 10 million yearly stroke survivors. I blame your mentors and senior researchers for such a failure in your objective.  The point of all stroke research is to get survivors recovered!

 Rehabilitation interventions for cognitive deficits in stroke survivors: A systematic review of randomized controlled trials

>

Abstract

Cognitive deficits are one of the most common impairments after stroke. It negatively affects physical and social functioning. Rehabilitation interventions for cognitive deficits post-stroke have taken less consideration. The present study aimed to provide an overview of the effects of various rehabilitation interventions on cognitive functions in patients with stroke. PUBMED, SCOPUS, PEDro, EMBASE, MEDLINE, and REHABDATA were searched for randomized controlled trials (RCTs) investigating the effects of rehabilitation interventions on cognitive domains poststroke until August 2021. The methodological quality of the selected studies was evaluated using the Cochrane Collaboration tool, and the effect sizes were calculated. Forty-four studies met the inclusion criteria. A total of 3561 individuals with stroke, 57.60% of whom were males. The mean age for all participants was 65.48 years. Eighteen RCTs were high, moderate  = 17), and low methodological quality (n = 9). The results showed evidence for the beneficial effects of many rehabilitation interventions on cognition in individuals with stroke.(And you did nothing with that evidence. Useless.) Rehabilitation plays a crucial role in improving cognitive functions in stroke patients with mild cognitive deficits. Virtual reality (VR), computer-based cognitive rehabilitation (CBCR), and non-aerobic exercises may promote cognitive functions in patients with stroke.

Predictors of post-stroke cognitive impairment using acute structural MRI neuroimaging: A systematic review and meta-analysis

Are your mentors and senior researchers that clueless that they don't know that predicting cognitive impairment is totally fucking useless for survivors?  If we had ANY KIND OF STROKE STRATEGY AT ALL, every piece of stroke research would lead directly to creation of stroke protocols that fix stroke problems.  I'd fire you all for being a complete waste.

Predictors of post-stroke cognitive impairment using acute structural MRI neuroimaging: A systematic review and meta-analysis

Emily L Ball https://orcid.org/0000-0002-7445-9581, Mahnoor Shah, […], Eilidh Ross, Rachel Sutherland, Charlotte Squires, Gillian E Mead https://orcid.org/0000-0001-7494-2023, Joanna M Wardlaw https://orcid.org/0000-0002-9812-6642, Terence J Quinn https://orcid.org/0000-0003-1401-0181, Dorota Religa, Erik Lundström https://orcid.org/0000-0002-5313-9052, Joshua Cheyne, and Susan D Shenkin https://orcid.org/0000-0001-7375-4776 Susan.Shenkin@ed.ac.uk, +9 -9View all authors and affiliations

OnlineFirst

https://doi.org/10.1177/17474930221120349

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Abstract

Background:

Stroke survivors are at an increased risk of developing post-stroke cognitive impairment and post-stroke dementia; those at risk could be identified by brain imaging routinely performed at stroke onset.

Aim:

This systematic review aimed to identify features which are associated with post-stroke cognitive impairment (including dementia) on magnetic resonance imaging (MRI) performed at stroke diagnosis.

Summary of review:

We searched the literature from inception to January 2022 and identified 10,284 records. We included studies that performed MRI at the time of stroke (0–30 days after a stroke) and assessed cognitive outcome at least 3 months after stroke. We synthesized findings from 26 papers, comprising 27 stroke-populations (N = 13,114, average age range = 40–80 years, 19–62% female). When data were available, we pooled unadjusted (OR_u) and adjusted (OR_a) odds ratios.

We found associations between cognitive outcomes and presence of cerebral atrophy (three studies, N = 453, OR_u = 2.48, 95% CI = 1.15–4.62), presence of microbleeds (two studies, N = 9151, OR_a = 1.36, 95% CI = 1.08–1.70), and increasing severity of white matter hyperintensities (three studies, N = 704, OR_a = 1.26, 95% CI = 1.06–1.49). Increasing cerebral small vessel disease score was associated with cognitive outcome following unadjusted analysis only (two studies, N = 499, OR_u = 1.34, 95%CI = 1.12–1.61; three studies, N = 950, OR_a = 1.23, 95% CI = 0.96–1.57). Associations remained after controlling for pre-stroke cognitive impairment. We did not find associations between other stroke features and cognitive outcome, or there were insufficient data.

Conclusion:

Acute stroke MRI features may enable healthcare professionals to identify patients at risk of post-stroke cognitive problems. However, there is still substantial uncertainty about the prognostic utility of acute MRI for this.

Introduction

Cognitive problems after stroke are of major concern to stroke survivors and their families.¹(Yep, AND YOU'RE DOING NOTHING TO SOLVE THEM!) Identifying who is at risk at the time of stroke may enable healthcare professionals to arrange appropriate follow-up, inform patients and their carers, and plan for possible future health outcomes. Individuals at risk of post-stroke cognitive problems could also be targeted for clinical trials with cognitive endpoints.

The cognitive consequences of stroke are conventionally described as post-stroke cognitive impairment (PSCI—impaired performance on a structured cognitive assessment) and the subcategory of post-stroke dementia (PSD—a clinical diagnosis of a cognitive change sufficient to interfere with daily life).

International guidelines for PSCI highlight that there are currently no prediction tools suitable for clinical practice.² A survey of 60 UK healthcare professionals reported that respondents were aware that imaging features could predict PSCI, but they did not use these features in clinical practice.³ Acute stroke neuroimaging could help healthcare professionals to identify who is at risk of PSCI.

Acute stroke computed tomography (CT) brain imaging is routinely performed in clinical practice to determine the cause of stroke. CT brain imaging is inexpensive and quick to perform but has lower resolution than magnetic resonance imaging (MRI). Recently, MRI has become more available for stroke diagnosis in clinical practice. MRI also allows the identification of neuroimaging features such as cerebral microbleeds (CMB) that are rarely visible on CT brain scans. MRI may help identify neuroimaging features associated with post-stroke cognitive problems.

Cerebral small vessel disease (cSVD) is commonly associated with stroke and dementia.⁴ Neuroimaging features include white matter hyperintensities (WMH), CMB, lacunes, perivascular spaces (PVS), recent small subcortical infarcts, and cerebral atrophy.⁵ Three systematic reviews have described the associations between neuroimaging features and PSD/PSCI.^6–8 One review found that stroke survivors with moderate to severe WMH had a two-to-three-fold increased risk in PSD/PSCI.⁷ Another review reported that medial temporal lobe atrophy (MTLA) and global atrophy were associated with increased risk of PSCI,⁶ and the third review highlighted an association between MTLA, WMH, and PSCI.⁸ These reviews included studies that performed brain imaging up to several months after a stroke, which does not reflect what happens in clinical practice. Only one review performed a sensitivity analysis comparing the association between severity of WMH and PSD when identified on CT versus MRI.⁷ The reviews did not report the association between acute stroke lesions and post-stroke cognitive outcome. However, a multicohort study of 2950 stroke survivors reported that infarcts in the left thalamus, left frontotemporal lobes, and right parietal lobe were associated with PSCI.⁹ Our previous systematic review focused on the prognostic utility of acute stroke CT finding that presence of atrophy, WMH, and pre-existing stroke lesions were associated with a two-to-three-fold increase in risk of PSD, and WMH was associated with a three-fold increased risk in PSCI.¹⁰ MRI is increasingly being used in clinical practice and is recommended for suspected TIA.¹¹ A similar review focusing on MRI was needed.

 

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Treatment of posterior circulation stroke: Acute management and secondary prevention

 If we had a decent database of all stroke research that was updated every time there was new research we wouldn't have to waste time on these systematic reviews. Then we could have researchers doing the important work of solving for 100% recovery protocols. But alas, we have NO STROKE LEADERSHIP directing anything.

Treatment of posterior circulation stroke: Acute management and secondary prevention

Hugh S Markus, Patrik Michel

First Published June 28, 2022 Review Article Find in PubMed 

https://doi.org/10.1177/17474930221107500

Article information

Abstract

One-fifth of strokes occur in the territory of the posterior circulation, but their management, particularly acute reperfusion therapy and neurointervention procedures for secondary prevention, has received much less attention than similar interventions for the anterior circulation. In this review, we overview the treatment of posterior circulation stroke, including both interventions in the acute setting and secondary prevention. We focus on areas in which the management of posterior circulation stroke differs from that of stroke in general and highlight recent advances.

Effectiveness of acute revascularization of posterior circulation strokes remains in large parts unproven. Thrombolysis seems to have similar benefits and lower hemorrhage risks than in the anterior circulation. The recent ATTENTION and BAOCHE trials have demonstrated that thrombectomy benefits strokes with basilar artery occlusion, but its effect on other posterior occlusion sites remains uncertain. Ischemic and hemorrhagic space-occupying cerebellar strokes can benefit from decompressive craniectomy.

Secondary prevention of posterior circulation strokes includes aggressive treatment of cerebrovascular risk factors with both drugs and lifestyle interventions and short-term dual anti-platelet therapy. Randomized controlled trial (RCT) data suggest basilar artery stenosis is better treated with medical therapy than stenting, which has a high peri-procedural risk. Limited data from RCTs in stenting for vertebral stenosis suggest that intracranial stenosis is currently best treated with medical therapy alone; the situation for extracranial stenosis is less clear where stenting for symptomatic stenosis is an option, particularly for recurrent symptoms; larger RCTs are required in this area.

Keywords

Vertebral, basilar, posterior circulation, vertebrobasilar, stenting, acute stroke therapy, treatment, prevention

Introduction

Stroke is globally the second leading cause of death and the third cause of death and disability.¹ One-fifth of strokes occur in the vertebrobasilar territory (also known as posterior) circulation.² Diagnosis of posterior circulation stroke and transient ischemic attack (TIA) can be more challenging than anterior circulation syndromes, and widely used screening protocols such as the face-arm-speech test (FAST) are less sensitive.³ Optimal management of posterior circulation stroke, particularly acute reperfusion therapy and neurointervention procedures for secondary prevention, has received much less attention than similar interventions for the anterior circulation.³ However, recent research and ongoing studies are improving our understanding. In this review, we cover the treatment of posterior circulation stroke, covering both interventions in the acute setting and secondary prevention. We focus on areas in which management of posterior circulation stroke differs from that of stroke in general and highlight recent advances.

The prognostic utility of electroencephalography in stroke recovery: A systematic review and meta-analysis

PROGNOSTICATION  DOES ABSOLUTELY NOTHING TO GET PATIENTS RECOVERED. Will you please do some useful research? I'd have you all fired.

The prognostic utility of electroencephalography in stroke recovery: A systematic review and meta-analysis

Neurorehabilitation and Neural Repair (NNR) , Volume 36(4-5) , Pgs. 255-268.

NARIC Accession Number: J88715.  What's this?
ISSN: 1545-9683.
Author(s): Vatinno, Amanda A.; Simpson, Annie; Ramakrishnan, Viswanathan; Bonilha, Heather S.; Bonilha, Leonardo; Seo, Na Jin.
Publication Year: 2022.
Number of Pages: 14.

Abstract: 

Study examined the evidence for the prognostic utility of electroencephalography (EEG) in stroke recovery. EEG provides a direct measure of the functional neuroelectricactivity in the brain that forms the basis for neuroplasticity and recovery, and thus may increase prognostic ability. PubMed (Medline), Scopus, and CINAHL electronic databases were searched for peer-reviewed journal articles that examined the relationship between EEG and subsequent clinical outcome(s) in stroke. Seventy-five articles met the inclusion criteria and were synthesized for the systematic review. Two independent researchers extracted data for synthesis. Linear meta-regressions were performed across subsets of papers with common outcome measures to quantify the association between EEG and outcome. Association between EEG and clinical outcomes was seen not only early post-stroke, but more than 6 months post-stroke. The most studied prognostic potential of EEG was in predicting independence and stroke severity in the standard acute stroke care setting. The meta-analysis showed that EEG was associated with subsequent clinical outcomes measured by the Modified Rankin Scale, National Institutes of Health Stroke Scale, and Fugl-Meyer Upper Extremity Assessment. EEG improved prognostic abilities beyond prediction afforded by standard clinical assessments. However, the EEG variables examined were highly variable across studies and did not converge. Findings indicate that EEG shows potential to predict post-stroke recovery outcomes. However, evidence is largely explorative, primarily due to the lack of a definitive set of EEG measures to be used for prognosis.
Descriptor Terms: BRAIN, ELECTROPHYSIOLOGY, LITERATURE REVIEWS, MOBILITY, MOTOR SKILLS, OUTCOMES, PREDICTION, REHABILITATION, STROKE.


Can this document be ordered through NARIC's document delivery service*?: Y.

Citation: Vatinno, Amanda A., Simpson, Annie, Ramakrishnan, Viswanathan, Bonilha, Heather S., Bonilha, Leonardo, Seo, Na Jin. (2022). The prognostic utility of electroencephalography in stroke recovery: A systematic review and meta-analysis.  Neurorehabilitation and Neural Repair (NNR) , 36(4-5), Pgs. 255-268. Retrieved 6/23/2022, from REHABDATA database.

The effect of split-belt treadmill interventions on step length asymmetry in individuals poststroke: A systematic review with meta-analysis

Well shit, hasn't split belt treadmills been proven for years already? 

• split-belt treadmill (9 posts to May 2013)

 The effect of split-belt treadmill interventions on step length asymmetry in individuals poststroke: A systematic review with meta-analysis

  Neurorehabilitation and Neural Repair (NNR) , Volume 35(7) , Pgs. 563-575.

NARIC Accession Number: J86907.  What's this?
ISSN: 1545-9683.
Author(s): Dzewaltowski, Alex C. ; Hedrick, Erica A. ; Leutzinger, Todd J. ; Remski, Lindsey E. ; Rosen, Adam B..
Publication Year: 2021.
Number of Pages: 13.
Abstract: 

Study evaluated the methods and results of existing studies that investigated the effects of split-belt treadmill training on step-length asymmetry in individuals poststroke both during and following training. A comprehensive search of PubMed/MEDLINE, CINAHL, Web of Science, and Scopus was conducted to find peer-reviewed journal articles that included stroke survivors who participated in a split-belt treadmill walking intervention. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) was used to assess risk of bias. Pooled Hedge’s g with random effects models were used to estimate the effect of split-belt training on step-length symmetry. Twenty-one studies were included in the systematic review with 11 of them included in the meta-analysis. Included studies had an average STROBE score of 16.2. The pooled effects for step-length asymmetry from baseline to late adaptation were not significant (g = 0.060). Large, significant effects were found at post training after a single session (g = 1.04), post training after multiple sessions (g = −0.70), and follow-up (g = −0.718). Results indicate split-belt treadmill training with the shorter step length on the fast belt has the potential to improve step-length symmetry post stroke when long-term training is implemented, but randomized controlled trials are needed to confirm the efficacy of split-belt treadmill training.
Descriptor Terms: AMBULATION, LITERATURE REVIEWS, MOBILITY TRAINING, REHABILITATION TECHNOLOGY, STROKE.


Can this document be ordered through NARIC's document delivery service*?: Y.

Citation: Dzewaltowski, Alex C. , Hedrick, Erica A. , Leutzinger, Todd J. , Remski, Lindsey E. , Rosen, Adam B.. (2021). The effect of split-belt treadmill interventions on step length asymmetry in individuals poststroke: A systematic review with meta-analysis.  Neurorehabilitation and Neural Repair (NNR) , 35(7), Pgs. 563-575. Retrieved 9/26/2021, from REHABDATA database.

Effectiveness of caregiver-mediated exercise interventions on activities of daily living (ADLs), anxiety and depression of post-stroke rehabilitation individuals: A systematic review and meta-analysis

This thesis should have never been necessary. That database of all stroke research and stroke protocols run by that great stroke association   would obviate the need to ever do systematic reviews. The database would be continually updated as all new research comes in. Doctors would not need to be reading thousands of research articles every year and trying to place them into their practices. 

 Effectiveness of caregiver-mediated exercise interventions on activities of daily living (ADLs), anxiety and depression of post-stroke rehabilitation individuals: A systematic review and meta-analysis

Authors:	CHOO WEN TING
Keywords:	Stroke rehabilitation exercise caregivers ADLs anxiety depression meta-analysis
Issue Date:	31-May-2021
Citation:	CHOO WEN TING (2021-05-31). Effectiveness of caregiver-mediated exercise interventions on activities of daily living (ADLs), anxiety and depression of post-stroke rehabilitation individuals: A systematic review and meta-analysis. ScholarBank@NUS Repository.
Abstract:	Background: Decreased mobility is one of the major concerns for stroke survivors, with demand for post stroke rehabilitation to restore optimal functional levels. Engaging caregivers in rehabilitation exercises show promise to support higher intensity training to improve functional and possibly psychological outcomes post-stroke. However, the effectiveness of caregiver mediated exercise (CME) interventions to improve such outcomes remains inconclusive. Objectives: To examine updated evidence to evaluate the effectiveness of CME interventions on basic Activities of Daily Living (ADLs), extended ADLs, anxiety and depression of post-stroke rehabilitation individuals. Methods: Six databases were systematically searched: CINAHL, CENTRAL, Embase, PubMed, PsycINFO and Scopus. Grey literature and trial registry were also searched. Only randomised controlled trials (RCTs) written in English including participants clinically diagnosed with stroke and CME interventions were included. Data extraction and risk of bias assessment were performed by two reviewers independently. Meta-analyses were conducted for basic ADLs, extended ADLs, anxiety and depression outcomes using the RevMan software. Overall quality of evidence was assessed using GRADE. Results: A total of 11 RCTs comprising 2120 participants were identified for inclusion, with ten trials meta-analysed. Meta-analyses indicated statistically significant effects favouring CME interventions for basic ADLs (d=0.18). Subgroup analyses revealed significant effects for exercise-only interventions mediated by caregivers for basic ADLs (d=0.63). No significant effects were found for extended ADLs, anxiety and depression for stroke survivors. However, possible publication bias was detected. Overall quality of evidence appraised was low. Conclusions and Implications: CME interventions appear to have beneficial impacts on basic ADLs for stroke survivors, suggesting CME interventions as a potentially feasible way to improve functional independence. Caregivers can be engaged in rehabilitation exercises in hospitals or home setting. Future research may include high-quality studies with focus on specific intervention components or to explore caregiver outcomes.
URI:	https://scholarbank.nus.edu.sg/handle/10635/193949
Appears in Collections:	Bachelor's Theses

 

The Effect of Split-Belt Treadmill Interventions on Step Length Asymmetry in Individuals Poststroke: A Systematic Review With Meta-Analysis

Why are we doing a review on this when it has been out for years? We need protocols, WILL YOU JUST STARTING WRITING PROTOCOLS, instead of this lazy crapola of reviews. Reviews do nothing for survivors.  

• split-belt treadmill (8 posts to May 2013)

The Effect of Split-Belt Treadmill Interventions on Step Length Asymmetry in Individuals Poststroke: A Systematic Review With Meta-Analysis

Show all authors

Alex C. Dzewaltowski, Erica A. Hedrick, MS, Todd J. Leutzinger, MS, ...

First Published May 12, 2021 Review Article Find in PubMed 

https://doi.org/10.1177/15459683211011226

Article information

Abstract

Background

Individuals poststroke experience gait asymmetries that result in decreased community ambulation and a lower quality of life. A variety of studies have utilized split-belt treadmill training to investigate its effect on gait asymmetry, but many employ various methodologies that report differing results.

Objective

The purpose of this meta-analysis was to determine the effects of split-belt treadmill walking on step length symmetry in individuals poststroke both during and following training.

Methods

A comprehensive search of PubMed/MEDLINE, CINAHL, Web of Science, and Scopus was conducted to find peer-reviewed journal articles that included individuals poststroke that participated in a split-belt treadmill walking intervention. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) was used to assess risk of bias. Pooled Hedge’s g with random effects models were used to estimate the effect of split-belt training on step length symmetry.

Results

Twenty-one studies were assessed and included in the systematic review with 11 of them included in the meta-analysis. Included studies had an average STROBE score of 16.2 ± 2.5. The pooled effects for step length asymmetry from baseline to late adaptation were not significant (g = 0.060, P = .701). Large, significant effects were found at posttraining after a single session (g = 1.04, P < .01), posttraining after multiple sessions (g = −0.70, P = .01), and follow-up (g = −0.718, P = .023).

Conclusion

Results indicate split-belt treadmill training with the shorter step length on the fast belt has the potential to improve step length symmetry in individuals poststroke when long-term training is implemented, but randomized controlled trials are needed to confirm the efficacy of split-belt treadmill training.

Keywords

gait rehabilitation, training, stroke, locomotion, adaptation

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