From Immunity to Repair: BDNF-Engineered Tregs in the Fight Against Neurodegeneration

With your need for BDNF for better stroke recovery, your competent? doctor already has EXACT REHAB PROTOCOLS FOR THAT! NO? So, you DON'T have a functioning stroke doctor, do you? Only 14 years to completely prove incompetence!

And board of director incompetence also!

• BDNF (185 posts to April 2011)

 From Immunity to Repair: BDNF-Engineered Tregs in the Fight Against Neurodegeneration

Thesis submitted for the degree of doctor of Medical Sciences at the University of Antwerp to be defended by Jasper Van den Bos

 

Structural Brain Changes in Post-Stroke Depression: Emphasis on Putamen Atrophy via Voxel-Based Morphometry

 With nothing that will prevent post stroke depression the advisors here were incompetent in assigning a thesis.

Structural Brain Changes in Post-Stroke Depression: Emphasis on Putamen Atrophy via Voxel-Based Morphometry

Authors

• Ybraim Madina Yerbolatkyzy Master's student, Faculty of Biology and Biotechnology, Al-Farabi Kazakh National University, Kazakhstan, Almaty

Abstract

Post-stroke depression (PSD) and cognitive impairment significantly impact recovery and quality of life in ischemic stroke survivors. Using voxel-based morphometry (VBM), we examined brain MRI scans from 24 subacute ischemic stroke patients to identify structural correlates of depressive symptoms (CES-D) and cognitive function (MoCA). Analysis identified a significant negative relationship between depression severity and right putamen volume, with more severe depression linked to greater putaminal atrophy. Cognitive measures revealed no significant regional volume correlations at corrected thresholds, aligning with prior findings associating cognitive impairment with global rather than regional atrophy. Our findings emphasize the critical role of the putamen and basal ganglia integrity in PSD, highlighting disruptions in limbic–cortico–striatal networks post-stroke.

Does the Implementation of Safety Huddles Reduce Falls With Injury on an Inpatient Stroke Rehabilitation Unit?

 The correct way to prevent falls is 100% recovery! AND YOUR PROFESSORS DON'T KNOW THAT! More dead wood that needs to be fired!

Does the Implementation of Safety Huddles Reduce Falls With Injury on an Inpatient Stroke Rehabilitation Unit?

1

Does the implementation of safety huddles reduce falls with injury on an inpatient stroke

rehabilitation unit?

Martha Rafferty, DNP, MSN, RN

Dr. Debra Blyth-Wilk, DNP, JD, RN

Dr. Emily Sheff, PhD, RN, FNP-BC

April 6, 2025

Abstract

Problem Statement: In post-stroke patients admitted to the stroke rehabilitation unit, do daily

shift safety huddles reduce the number of patient falls when compared to no intervention?

Aim: To enhance the quality of care provided for post-stroke patients and to minimize their risk

of harm through implementing daily shift safety huddles, improving team communication and

alerting care providers to those patients at risk for falls using the Morse Fall Risk Assessment as

the guide.

Background: The implementation of daily safety huddles was borne out of the 1999 Institute of

Medicine’s (IOM) report, To err is human, where it is identified that nearly 98,000 patients die

per year from medical errors which could likely be prevented (Donaldson, et al, 2000). “Huddles

increase individual and collective accountability for patient safety, designate a fixed time during

the workday or shift to focus on care coordination, facilitate immediate face-to-face clarification

of issues, result in fewer interruptions during the rest of the workday, and foster a culture of

empowerment and collaboration in healthcare teams” (Shaikh, 2020).

Design: Exploratory descriptive interventional pilot study.

Data Sources: Patient identified inclusion criteria (admitting diagnosis of post-stroke, and

Morse fall risk assessment score of 55 or greater); safety huddle attendance sheets, falls with

injury data reported to National Database of Nursing Quality Indicators (NDNQI).

Method: Falls with injury data was assessed pre-implementation of safety huddles and during

implementation of safety huddles. Both occurrence and attendance at safety huddle was

analyzed using a Pearson Chi-Square Test, a Pearson Correlation Coefficient Chi-Square Test,

and a multiple regression three-way ANOVA test. These tests were conducted using IBM SPSS

Version 23.

6

Results: There was no statistically significant association between huddles and falls. There was

a significantly significant difference demonstrated in RN attendance at huddles and PCA

attendance at huddles with a correlation showing that PCA attendance at huddles was higher than

RN attendance at huddle.

Development of a Computerized Assessment Tool for Hand-arm Function After Stroke: Test-retest Reliability and Convergent Validity

 Assessments are completely worthless unless they point directly to the 100% recovery protocols. I see nothing here that suggests you go from the assessment to the chosen 100% recovery protocol. When the hell will the stroke medical world do ANYTHING TO GET STROKE SOLVED? I'd have you all fired! A lot of dead wood needs to removed in stroke and until that occurs stroke will never be solved! The only use of the word protocol in here is for testing; NOT RECOVERY! I'd have the faculty supervising this fired!

Development of a Computerized Assessment Tool for Hand-arm Function After Stroke: Test-retest Reliability and Convergent Validity

The Patient-Specific Functional Scale (PSFS) for measuring rehabilitation goals for patients with stroke

 The only goal in stroke is 100% recovery, your advisor failed you in allowing the tyranny of low expectations to infect your thesis.

The Patient-Specific Functional Scale (PSFS) for measuring rehabilitation goals for patients with stroke

Evensen, Janne

Doctoral thesis

Published version

View/Open

A-25-18-Evensen-HV-Publisert.pdf (5.732Mb)

URI

https://hdl.handle.net/11250/3182051

Date

2025

Metadata

Show full item record

Collections

• HV - PhD in Health Sciences [45]

Abstract

Background: Approximately 10,000 people are hospitalized due to a stroke annually in Norway, often requiring multidisciplinary rehabilitation. Goal-setting is an essential component of the rehabilitation, with literature emphasizing the need for a measurement to identify, document and monitor rehabilitation goals for patients with stroke. The measurement Patient-Specific Functional Scale (PSFS) appears suitable for this purpose, enabling patients to identify and rate their challenges. However, its use in the stroke population has not been explored.

Aim: To investigate the PSFS as a measurement to identify, document and monitor patient-identified rehabilitation goals for patients in specialized stroke rehabilitation by exploring the applicability, validity, reliability, responsiveness, and interpretability of the PSFS, and by exploring patients’ PSFS goals.

Methods: This thesis encompasses two prospective cohort studies and one cross-sectional study, involving two separate samples. Paper I included 59 patients with acquired brain injury (ABI) (92% with stroke). Papers II and III included 71 patients with stroke. The 130 participants were admitted to a specialized rehabilitation unit for more than 10 days. The PSFS was utilized in the development of rehabilitation goals with a shared decision-making (SDM) approach. The data collected included cognitive function, aphasia, vision, functional independence, activities of daily living (ADL), ambulation, gait speed, and perceived change in function. We calculated the proportion of participants who could complete the PSFS, and the time spent on identifying the rehabilitation goals and completion of the PSFS. The COSMIN checklist guided the methods of analysis of the measurement properties. The PSFS goals were linked to the International Classification of Functioning, Disability and Health (ICF) categories, and we calculated the number of times each ICF category was linked. We also calculated the frequency of patients who set PSFS goals in the functional areas of walking and mobility, ADL, language, cognition, and vision.

Results: Fifty-four of 59 participants completed the PSFS, while the five who were unable to complete it had severe aphasia or another cognitive impairment. Nine participants admitted to the rehabilitation unit in the acute phase were able to complete the PSFS. The average time spent on developing rehabilitation goals and completing the PSFS was 28 minutes. Cognitive function was the main explanatory factor for changes in the PSFS score, with patients of higher cognitive function showing greater improvement. The mean PSFS score improved by 2.6 points from admission to discharge, and by 1.2 points from discharge to the three-month follow-up. Eighty percent of the PSFS goals were ICF activities, indicating satisfactory content validity. Reliability was satisfactory with an ICC95 of 0.81. The SEM was calculated to be 0.70 points, the SDC 1.94 points, and the MIC 1.58 points. The construct validity was moderate and the responsiveness assessed with a construct approach was high. Responsiveness assessed using a criterion approach showed satisfactory responsiveness from admission to discharge but low responsiveness from discharge to three months post-discharge. A ceiling effect was observed in 25% of participants three months after discharge. “Walking and moving” and “Self-care” were the most frequent PSFS goals. Most participants with walking limitations set goals related to walking, but few participants with cognitive or visual impairments set goals in those areas of functioning. Only half of the ICF categories linked from the PSFS goals corresponded to areas assessed by the standardized measurement.

Conclusion: The findings indicate that the PSFS is an appropriate tool for identifying, documenting, and monitoring rehabilitation goals for patients in specialized stroke rehabilitation, when used in a SDM approach. 

Impact of Self-Controlled Practice on Motor Learning for Individuals With Post-Stroke Upper Limb Hemiparesis

 I consider this Self-controlled practice pretty much useless since there is nothing specific about what needs to be done to get recovered. You give survivors EXACT PROTOCOLS for recovery and they'll gladly do the millions of reps needed because they are looking forward to 100% recovery. Yeah, this is just a thesis, but the advisors incompetently didn't inform her of the flaws in her analysis.

Impact of Self-Controlled Practice on Motor Learning for Individuals With Post-Stroke Upper Limb Hemiparesis

Lauren Beth Winterbottom

Submitted in partial fulfillment of the

requirements for the degree of Doctor of Education in

Teachers College, Columbia University

2024

© 2024

Lauren Beth Winterbottom

All Rights Reserved

Abstract

Lauren Beth Winterbottom

Upper limb (UL) impairments are common after stroke and can lead to loss of

independence and long-term disability. Motor learning interventions for individuals with stroke

can improve UL function and engagement in daily activities. Self-controlled practice (SCP)

involves allowing choice during motor skill practice and has been shown to improve motor

learning in healthy adults as well as individuals with Parkinson's disease. Additionally, SCP may

impact psychological outcomes, including intrinsic motivation, self-efficacy, and positive affect.

Although SCP has been incorporated into complex stroke rehabilitation interventions, little is

known about its specific impact on motor learning for individuals with stroke. The purpose of

this study is to investigate the effect of SCP on motor learning and psychological outcomes for

adults with chronic UL impairment after stroke.

Sixteen participants with chronic UL impairment due to stroke were paired and

randomized into two groups. All participants practiced a standardized motor task with both their

more affected and less affected hands for two consecutive days. During each day of practice,

participants completed 50 30-second trials (10 blocks of 5 trials each) with their more affected

hand and 20 30-second trials (10 blocks of 2 trials each) with their less affected hand. The

experimental group was given control over their practice schedule and chose the order they

practiced blocks of trials. Participants in the control group followed a pre-determined practice

schedule based on the choices made by the participant they were paired with in the experimental group. Outcome measures were assessed on Day 1 before practice (Pre-Test), Day 2 after

practice (Post-Test), and Day 3 (Follow-up). Motor learning outcomes included 24-hour

retention of the trained motor task and immediate (10-minute) and delayed (24-hour) transfer of

learning to an untrained motor task. Psychological outcomes including intrinsic motivation, self-

efficacy, and positive affect were also assessed.

Both groups demonstrated significant improvements from baseline on both the trained

task and the untrained task at the Day 3 follow-up assessment. There were no significant

between-group differences on any motor learning or psychological outcome measures. However,

there was a significant association between perceived choice that was assessed on Day 2

following practice and amount of change on the untrained transfer task at Day 3. This suggests

that perception of choice may be a relevant factor for motor learning after stroke. However, more

research with larger sample sizes is needed to further investigate this finding

Longitudinal study of stroke-induced neuroplasticity using imaging and high-density neural recording

 

But your competent? doctor would already have started listening to brain signals using one of these already to make neuroplasticity repeatable on demand. Add sarcasm tag here.

1. Use nanowires to listen in on single neurons

2. Or lay a grid across the cortex to listen in.

But we have NO stroke leaders, nothing will get done until we get survivors in charge.

Leaders solve problems, they don't run away from them. We have NO leaders in stroke!

Longitudinal study of stroke-induced neuroplasticity using imaging and high-density neural recording

Abstract

The brain has a remarkable ability to undergo spontaneous self-repair in response to an injury or a cortical lesion. This dynamic and lasting restorative process involves a diverse array of neuroplastic mechanisms that are time and location dependent. Lesion-induced neuroplasticity is believed to involve neighboring intact neurons assuming the functional roles of the damaged ones, altering the brain’s activation map. Despite extensive research, there is still a lack of definitive evidence regarding neurons changing their functional response, leading to debates about the exact cellular mechanism of neuroplasticity. Conclusive evidence supporting or refuting functional remapping after stroke requires direct measurements and longitudinal tracking of neural activity at a single-neuron resolution and over chronic periods.

In this work, we employed multi-electrode arrays (NanoElectronic Threads) to record and longitudinally track both the sensory-evoked single-neuron spiking dynamics and population activity with high spatial specificity after a small-scale optically targeted stroke. Our multimodal measurement combined simultaneous laser speckle contrast imaging and hyperspectral reflectance spectroscopy, together with spatially distributed intracortical neural recordings. We found that while hemodynamic activation shifted following the cortical lesion, it no longer correlated with electrical neural activity. Direct neural recording showed a sustained suppression of evoked spiking activity near the lesioned infarct while an enhancement in the more distant cortical regions. Longitudinal tracking of individual neurons uncovered heterogeneous responses underlying the enhanced activity. We observed a distinct subset of neurons that demonstrated a significant upregulation in their sensory-evoked spiking activity which exhibited a stronger correlation with the overall population activity within the local cortical network, suggesting a potential restorative mechanism in response to the lesion. Contrary to the prevailing hypothesis of population-level changes in the peri-infarct region, our findings provide compelling evidence against this notion. Instead, our data reveal that lesion-induced plasticity at the single neuron level is manifested as a selective potentiation of pre-existing functional neurons.

Advisor

Luan, Lan

Degree

Doctor of Philosophy

Type

Thesis

Keywords

Electrophysiology, Flexible Electronics, Optical Imaging, Spectroscopy, Neural Recording, Neuroplasticity, Ischemic Stroke,

Citable link to this page

https://hdl.handle.net/1911/117800

Collections

Rice University Electronic Theses and Dissertations

Wearable sensor-based rehabilitation exercise assessment for post-stroke rehabilitation

 Your dissertation advisor should have told you assessments are almost completely worthless unless they point directly to the 100% recovery protocols. I see nothing here that suggests you go from the assessment to the chosen recovery protocol.

Wearable sensor-based rehabilitation exercise assessment for post-stroke rehabilitation 

Boukhennoufa, Issam (2024) Wearable sensor-based rehabilitation exercise assessment for post-stroke rehabilitation. Doctoral thesis, University of Essex.

Abstract

This thesis focuses on the use of wearable sensors (WS) and machine learning (ML) algorithms in post-stroke rehabilitation assessment. The conventional approach to rehabilitation involves subjective clinical assessments and frequent therapy sessions, which are time-consuming, costly, and often limited in availability. To address these limitations, WS have emerged as a portable and cost-effective solution, enabling patients to perform rehabilitation exercises at home. These sensors provide quantitative data on patients' movements, allowing for continuous monitoring and assessment. Additionally, ML algorithms offer the potential to enhance the accuracy and efficiency of rehabilitation assessment by processing the data collected from WS. The research presented in this thesis first aims to analyse recent developments in WS-based post-stroke rehabilitation assessment, identify limitations in the field, and propose state-of-the-art ML algorithms to improve assessment performance. The primary motivation is to provide a more comprehensive, personalised, and objective evaluation of motor function and mobility, leading to improved rehabilitation outcomes and quality of life for stroke survivors. Chapter 2 provides a comprehensive literature review that examines the current state-of-the-art in post-stroke rehabilitation assessment, specifically focusing on the utilisation of wearable sensors and machine learning techniques. The review encompasses a thorough examination of commonly employed sensors, targeted body limbs, outcome measures, study designs, and machine learning approaches. Furthermore, the review highlights the limitations encountered by researchers in the field, particularly pertaining to the accuracy of assessment algorithms and the availability of data. Subsequent chapters in this thesis address these identified limitations by proposing innovative solutions. Chapter 3 presents an approach aimed at enhancing the accuracy of assessment algorithms by adapting widely used computer vision algorithms to the time-series domain. This adaptation enables more precise and reliable analysis of the collected time-series data, thereby improving the assessment process. In Chapter 4, a novel methodology is introduced, which involves the transformation of time-series data into images and the subsequent utilisation of computer vision algorithms for assessment purposes. Furthermore, a linear interpolation methodology is implemented to adjust the size of the encoded images, allowing for an increase or decrease in dimensions. A comprehensive comparative analysis is then conducted to evaluate the impact of image size on the performance of the assessment algorithm. Finally, Chapter 5 introduces a novel algorithm that generates heterogeneous and realistic data, which serves to enhance the rehabilitation assessment process. By generating synthetic data that closely resembles real-world scenarios, this algorithm addresses the limitation of limited data availability, ultimately leading to more robust and accurate assessments. The contributions of each chapter provide insights into the current state-of-the-art in WS-based rehabilitation assessment, algorithm optimisation, data encoding techniques, and data augmentation strategies. The findings of this research aim to advance post-stroke rehabilitation outcomes and contribute to a more accurate and personalised assessment for stroke survivors.

Post-stroke lateropulsion – pushing for a greater understanding of rehabilitation and recovery

So it seems the faculty advisors didn't ask for the protocols used and the location of those protocols. That should be grounds for dismissal.

Post-stroke lateropulsion – pushing for a greater understanding of rehabilitation and recovery

Jessica Nolan, Edith Cowan UniversityFollow

Author Identifier

Jessica Nolan

https://orcid.org/0000-0001-5802-2120

Date of Award

2023

Document Type

Thesis - ECU Access Only

Publisher

Edith Cowan University

Degree Name

Doctor of Philosophy

School

School of Medical and Health Sciences

First Supervisor

Barbara Singer

Second Supervisor

Erin Godecke

Third Supervisor

Angela Jacques

Abstract

Background:

Post-stroke lateropulsion is prevalent. A person with lateropulsion actively pushes their body across the midline toward their more affected side and/or actively resists weight shift toward the less affected side.

Aims:

The objectives of this thesis were to; investigate outcomes associated with post-stroke lateropulsion; understand short- and long-term rehabilitation needs of affected people; and provide recommendations for rehabilitation best-practice.

This thesis aimed to:

• Determine the association of lateropulsion severity (Four Point Pusher Score: 4PPS), with functional change (Functional Independence Measure: FIM) and length of stay (LOS) in inpatient rehabilitation;
• Investigate accuracy of the Australian National Sub-Acute and Non-Acute Patient Classification (AN-SNAP) funding model to predict LOS for people with post-stroke lateropulsion;
• Explore associations between 4PPS, mobility status, adverse event occurrence, and FIM at three, six, nine and twelve months post-stroke;
• Explore associations between lateropulsion presence and aspects of stroke pathology, derived from neuroimaging data; and
• Develop international consensus on lateropulsion terminology, best-practice rehabilitation, and future research priorities.

Methods:

This research comprised three sections:

Section 1. Retrospective outcome data (4PPS, FIM, and LOS) for 1,087 participants admitted to a stroke rehabilitation unit (SRU) were analysed. Individual comparisons were made between AN-SNAP-predicted and actual LOS.

Section 2. The prospective longitudinal cohort study included 144 consecutive SRU admissions. Acute stroke imaging results were coded based on consensus from two neuroradiologists. Lateropulsion severity, FIM, mobility status, and adverse event occurrence were recorded at SRU admission, discharge and three, six, nine and twelve months post-stroke and tested for association with lateropulsion resolution.

Section 3. A Delphi Panel Process addressed lateropulsion terminology, best-practice rehabilitation, and research priorities. The process included four survey rounds. Round One consisted of 13 open questions. Subsequent rounds ascertained levels of agreement with statements derived from Round One.

Results:

Section 1. Complete lateropulsion resolution was recorded in 69.4% of those admitted with mild lateropulsion, 49.3% of those with moderate lateropulsion, and 18.8% of those with severe lateropulsion. Average FIM change was lower in those admitted with severe lateropulsion than those without lateropulsion (p < 0.001). Higher admission 4PPS was associated with reduced FIM efficiency (p < 0.001), longer LOS (p < 0.001), and reduced likelihood of discharge home (p < 0.001). Reported LOS exceeding AN-SNAP-predicted LOS was associated with greater admission lateropulsion severity. Greater FIM improvement was associated with reported LOS exceeding AN-SNAP-predicted LOS (p < 0.001).

Section 2. Eighty-two participants (56.9%) had lateropulsion on admission. Stroke lesion volume was not associated with lateropulsion presence or resolution. Haemorrhagic stroke was associated with lateropulsion presence (p=0.002) and long-term persistence (p=0.015). Odds of resolved lateropulsion increased longitudinally from discharge for people who participated in rehabilitation-focused physiotherapy (p < 0.001).

Section 3. Twenty international experts completed four rounds of the process. There was ‘some agreement’ (50%) that ‘lateropulsion’ was the recommended term to describe the condition. Consensus ( ≥ 75% agreement) was achieved regarding 119 rehabilitation recommendations.

Conclusions:

Given a sufficient duration of skilled rehabilitation, people with post-stroke lateropulsion can achieve meaningful short- and long-term improvements. The consensus-based recommendations provide guidance in selecting rehabilitation approaches that will likely facilitate the best possible outcomes in people with post-stroke lateropulsion.

Rehabilitation Robotics and Machine Learning for Stroke Severity Classification

I'm finding graduate level theses are better than most researchers, probably because the professors involved are more up-to-date on existing research

Rehabilitation Robotics and Machine Learning for Stroke Severity Classification

Raymond GreenfieldFollow

Date of Award

Fall 12-16-2022

Degree Type

Thesis

Degree Name

Master of Science (MS)

Department

Mathematics and Statistics

First Advisor

Igor Belykh

Abstract

Stroke therapy is essential to reduce impairments and improve motor movements by engaging autogenous neuroplasticity. This study uses supervised learning methods to address an autonomous classification via stroke severity labeled data by a clinician. Thirty-three patients with chronic stroke performed a variety of rehabilitation activities while utilizing the Motus Nova rehabilitation technology to capture upper and lower body motion. Based on the minimum, maximum, and mean of the range of motion and pressure as well as the number of movements, force flexion, and extension for each game and session provided from the sensor data. Supervised learning methods were applied to a harmonized dataset of roughly 32,000 patient sessions based on the maximum score per session per game. With this approach using light gradient boosting methods we achieved an average of 94% accuracy with 10-fold cross-validation to prevent overfitting. This thesis shows objectively-measured rehabilitation training, enabling the identification of the stroke severity class with the hopes to have patients have a less severe class in the future.

Over the last 10 years robotic rehabilitation has been utilized in inpatient therapy. Robotic rehabilitation has been shown to be effective in improving the severity of stroke in some cases. In particular, robotic devices can be used to help stroke survivors regain movement, improve their functional abilities and improve depression (11). These devices can provide a high level of precision and repeatability, allowing patients to perform therapeutic exercises with greater accuracy and consistency (1). Additionally, because robotic devices can be programmed to provide different levels of assistance, they can be tailored to the individual needs of each patient. This allows for a more personalized and effective rehabilitation in-home program (21).

Recommended Citation

Greenfield, Raymond, "Rehabilitation Robotics and Machine Learning for Stroke Severity Classification." Thesis, Georgia State University, 2022.
https://scholarworks.gsu.edu/math_theses/176

Focal Vibration for Upper Limb Rehabilitation After Stroke

 Since nothing seems to have occurred with this earlier at least this graduate student came up with a design of a focal vibration device, but a protocol will need to be created which is the responsibility of stroke leadership.

• focal muscle vibration (2 posts to May 2020)

This line needs a protocol written about: I need this, where is it?

Vibratory stimuli were used to decrease muscle spasticity in stroke patients.

Focal Vibration for Upper Limb Rehabilitation After Stroke

 88 pages, hopefully your doctor takes it to heart.  You can ask your doctor how to get one of these if approved  and prescribed. There are a few commercially available wearable focal vibration devices: Myovolt (Myovolt, Christchurch, New Zealand), VibraCool (Pain Care Labs, Atlanta, Georgia), and Equistasi (Equistasi, Gorgonzola, Italy. Page 36 has a picture of the device

Using Micro-Ultrasound to Investigate the Effectiveness of Short-Term Rehabilitation following Focal Ischemic Stroke

46 pages for your doctor's edification.

Using Micro-Ultrasound to Investigate the Effectiveness of Short-Term Rehabilitation following Focal Ischemic Stroke

 A thesis submitted in conformity with the requirements for the degree of Master of Science Medical Biophysics University of Toronto © Copyright by Johnson Yu 2021 ii Using Micro-Ultrasound to Investigate the Effectiveness of ShortTerm Rehabilitation following Focal Ischemic Stroke Johnson Yu Master of Science Medical Biophysics University of Toronto 2021 

Abstract 

Ischemic stroke leaves 40% of survivors with moderate to severe impairment. Understanding how rehabilitation affects brain structure and function will be critical in its effective application to individual patients and in its combination with promising new interventions. In this work we investigated the impact of two weeks of skilled reaching rehabilitation on motor function, cerebrovascular tortuosity, cerebral blood flow and neuronal activity on a rodent model. Micro-ultrasound, intracerebral array electrophysiology and Montoya staircase testing were used to characterize changes in the brain and motor function following stroke. Perilesional vessels were significantly more tortuous than vessels in the contralesional cortex with a further abolishment of hypercapnia-elicited homogenization of microbubble velocities in perilesional arterioles. Rehabilitation significantly improved skilled reaching and elevated neuronal power ratios. This current project highlights functional motor recovery and neuronal plasticity in the subacute stage following stroke in the absence of cerebrovascular changes using a dual imaging modality setup.

Effects of Altered Somatosensory Input on Lower Limb Mechanics via Different Shoes and Barefoot Walking in Individuals with Chronic Post-Stroke Hemiparesis

I very seldom do barefoot walking. With my curled toes they tend to scrape along the floor. I have zero paretic propulsion and no idea how to generate that. 

 Effects of Altered Somatosensory Input on Lower Limb Mechanics via Different Shoes and Barefoot Walking in Individuals with Chronic Post-Stroke Hemiparesis

Aaron Abraham Simon, University of Nevada, Las VegasFollow
Jynelle Marie Guerrero Arches, University of Nevada, Las VegasFollow
Megan Leigh Keohane, University of Nevada, Las VegasFollow
Wee Jin Jed Lee, University of Nevada, Las VegasFollow

Award Date

Spring 5-14-2021

Degree Type

Doctoral Project

Degree Name

Doctor of Physical Therapy (DPT)

Department

Physical Therapy

Advisor 1

Daniel Young, Ph.D

First Committee Member

Jing Nong Liang, Ph.D

Second Committee Member

Kai-Yu Ho, Ph.D

Third Committee Member

Merrill Landers, Ph.D

Number of Pages

45

Abstract

[Purpose/Hypothesis] Stroke is a leading cause of disability that results in various neurological deficits. Stroke can cause impaired somatosensory input, which results in decreased balance and gait speed, ultimately increasing fall risks. Therapies to increase somatosensory input have shown promise for people with stroke as well as other neurological populations. However, few studies have systematically investigated varying somatosensory input via different footwear to improve walking in people post-stroke. The purpose of this study was to investigate the effects of altering somatosensory input via different types of footwear (i.e., barefoot, self-selected shoes, and memory foam shoes) on gait kinetics and ankle kinematics during gait in individuals with chronic post-stroke hemiparesis. We hypothesized that increased somatosensory input via barefoot walking would improve paretic propulsive force, reduce paretic braking force, and improve paretic ankle kinematics. [Number of Subjects] 9 individuals post-stroke (62.9±11.2 years old; 5.9±4.4 years post-stroke) and 5 non-neurologically impaired (53.4±17.0 years old) individuals. 

[Methods/Materials] Reflective markers were placed over lower extremities landmarks, and surface electromyography sensors over ankle muscles. Participants then walked over a dual belt instrumented treadmill for 5 minutes, under self-selected walking speed, wearing self-selected shoes. Subsequently, trials were conducted barefoot and with memory foam shoes, in randomly assigned order. Peak propulsive force, peak braking force, peak plantarflexion angle at push-off, and peak dorsiflexion angle during swing phase were assessed using a 3 (Limbs: paretic, non-paretic, and non-impaired) X 3 (Shoes: self-selected footwear, memory foam shoes, and barefoot) mixed factorial ANOVA. A priori significance was set at p < 0.05. 

[Results] A statistically significant interaction was observed for Shoes x Limb for peak propulsive force (p=0.04). Additionally, simple main effects revealed that in non-impaired legs, greater propulsive forces were generated when wearing self-selected shoes compared to memory foam or barefoot. A statistically significant main effect of Shoes was observed for ankle angle at toe off (p < 0.01), suggesting that regardless of limb, wearing self-selected shoes increases plantarflexion at toe off, whereas wearing memory foam shoes increases dorsiflexion at toe off. A statistically significant main effect of Shoes was observed for peak dorsiflexion during swing (p < 0.01), indicating that regardless of limb, wearing memory foam shoes causes more dorsiflexion during swing than self-selected shoes. 

[Conclusion] We found that memory foam shoes can encourage paretic ankle dorsiflexion during swing phase of gait, which could be used to address foot-drop in post-stroke gait training. If the goal of gait training was to target propulsive force to increase walking speed, then memory foam shoes or barefoot is not recommended. [Clinical Relevance] Findings can help inform clinicians on appropriate footwear recommendations to ensure safety for community ambulation and may be incorporated into gait training paradigms in rehabilitation.

 

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

 

Computational Simulation and Analysis of Neuroplasticity

 This graduate student has a better idea of what to do to EXACTLY know how neuroplasticity works than anything I've seen. That great stroke leader needs to hire them to make neuroplasticity repeatable on demand. It is only 99 pages, every stroke doctor in the world needs to analyze this and create repeatable neuroplasticity protocols. EVERY DOCTOR since we have fucking failures of stroke associations that can't do this once and distribute the protocol worldwide. Do you really think your doctor is up to the task of creating neuroplasticity protocols?

Computational Simulation and Analysis of Neuroplasticity

Yancey, Madison E. M.S., Department Computer Science and Engineering, Wright
State University, 2021. Computational Simulation and Analysis of Neuroplasticity
 

Homeostatic synaptic plasticity is the process by which neurons alter their activity
in response to changes in network activity. Neuroscientists attempting to understand
homeostatic synaptic plasticity have developed three different mathematical methods
to analyze collections of event recordings from neurons acting as a proxy for neuronal
activity. These collections of events are from control data and treatment data,
referring to the treatment of neuron cultures with pharmacological agents that augment
or inhibit network activity. If the distribution of control events can be functionally
mapped to the distribution of treatment events, a better understanding of the biological
processes underlying homeostatic synaptic plasticity can be achieved. The aim of
this project was to create a tool that allows researchers to quickly process, visualize,
and then analyze the homeostatic synaptic plasticity data using the three analysis
methods, as well as evaluate the viability of a fourth method.

Cooperative Hand Movements and their Potential for Stroke Rehabilitation

 You can read the 134 page thesis on your own.

Cooperative Hand Movements and their Potential for Stroke Rehabilitation

DESC glove: Prototyping a novel wearable device for post-stroke hand rehabilitation

While this is a thesis from Delft University, the thesis advisor should have informed them that soft gloves are impossible to get on hands that are spastic. And what is even worse is testing on healthy subjects. I have never been able to get on fingered soft gloves, I can however with much swearing and gnashing of teeth get on fingerless biking and paddling gloves.  This would have completely failed as a thesis in my view.

 DESC glove: Prototyping a novel wearable device for post-stroke hand rehabilitation

Abstract

The human brain integrates tactile sensory information from the fingertips to efficiently manipulate objects. Sensory impairments due to neurological disorders, e.g. stroke, largely reduce hand dexterity and the ability to perform daily living activities. Several feedback augmentation techniques have been investigated for rehabilitative purposes with promising outcomes. However, they often require the use of unpractical, expensive, or complex devices. In this work we propose the delivery of vibrotactile feedback based on the Discrete Event-driven Sensory feedback Control (DESC)to promote motor learning in post stroke rehabilitation. For this purpose, we prototyped a novel wearable device, namely the DESC glove. It consisted of a soft glove instrumented with PolyVinylidene Fluoride (PVDF) sensors at the fingertips and eccentric-mass vibration actuators to be worn on the forearm. We proceeded with the characterization of the device, which resulted in promising outcomes. The DESC glove was tested with ten healthy participants subsequently in a pick and lift timed task. The effects of augmented vibrotactile feedback were assessed comparing it to a baseline, consisting of wearing the device unpowered. The results of this pilot study showed a decrease in the time necessary to perform the task, a reduction in the time delay from load force to grip force activation and a diminishing of the grip force applied on the object, which led to a lower breakage rate in the intervention condition. These promising outcomes encourage further experiments with stroke survivors to validate the effectiveness of the device to improve hand dexterity and promote stroke rehabilitation.

 

 

Rehabilitation for survivors of severe stroke

You can see that even a Ph.D candidate can't find stroke protocols with advisors help.  

Rankin scale is worthless, not objective except for 6 - death.

You still don't know that the NIHSS subjective stroke scale is worthless?

 

Rehabilitation for survivors of severe stroke 

Mohapatra, Sushmita (2019) Rehabilitation for survivors of severe stroke. PhD thesis, University of Nottingham.

PDF (Thesis - as examined) - Repository staff only - Requires a PDF viewer such as GSview, Xpdf or Adobe Acrobat Reader Download (5MB)

Abstract

Providing appropriate rehabilitation for stroke survivors with severe disabilities can be challenging. This is due to the magnitude of neurological impairment early after stroke as well as the complexity of delivering long-term care post-hospital discharge. Severe stroke survivors have limited access to rehabilitation as a likely result of uncertainty related to their potential for functional gains. They are also likely to require greater health and social care resources for long-term care with significant cost implications. Rehabilitation following stroke has been proven beneficial after a severe stroke; however, recovery remains ambiguous. Several clinical and non-clinical factors are evidenced to influence the provision of rehabilitation interventions. However, it is not known how the decisions are made in practice for service provision, what service they receive and how they relate to the stroke survivors’ recovery and rehabilitation.(So everything in stroke rehab is just a wild-assed guess. Hope you are OK with that level of incompetency. Maybe you want to ask for an anxiety reducing protocol.)

Aims

This thesis aimed to explore the recovery and rehabilitation of severe stroke survivors by investigating the decision-making process for determining rehabilitation and service provided as a result. The study also evaluated the functional recovery made by severe stroke survivors in the first six months and investigated their caregivers’ perspectives on rehabilitation services they received.

Methods

A prospective design with a fixed convergent mixed method approach was chosen to investigate the research questions. Three independent studies were conducted concurrently in two distinctive phases with independent sets of results.

A qualitative approach was taken in the first phase to explore the decision-making process using semi-structured interviews with 22 hospital staff responsible for determining rehabilitation for severe stroke survivors. Functional recovery was investigated in the second phase using an observational cohort study. Patient outcomes were longitudinal measured using validated tools in 52 severe stroke survivors (NIHSS ≥ 10 and mRS ≥4 at admission). Information was also obtained on rehabilitation services accessed post-hospital discharge in the first six months post-stroke. The second part of the study also used semi-structured interviews with 18 caregivers to investigate their experience of the rehabilitation received post-stroke.

All data were collected from a single hospital site, covering a selected region in the East Midlands. The data were analysed separately and integrated using a structured triangulation method in the interpretation stage complement, validate and strengthen the overall findings.

Results

Results established a complex, dynamic, temporal process of decision-making for post-stroke rehabilitation of people with severe functional disability. This required multiple stages of corroborations amongst key decision makers to evaluate the impacts of several social and external factors, additional to severity of stroke. Severity of stroke was defined for rehabilitation purposes and a clinically meaningful change in functional abilities was evidenced in 69% of stroke survivors with severe disabilities with no causal relationship with the initial severity. A noticeable involvement of healthcare professionals during this period suggested the possible contribution of rehabilitation in the early phase post stroke. Rehabilitation was valued for recovery; however, an integrated, client-centred approach was identified as lacking for managing severe disabilities after stroke. This, along with limited shared-planning for rehabilitation led to a low confidence of caregivers in the current healthcare system.

Conclusions

The overall findings of the thesis established a complex, dynamic, cognitive process of clinical reasoning amongst hospital staff for deciding rehabilitation of severe stroke survivors. The study quantified the recovery made in the first six months and suggested that a significant functional improvement is possible in the severely disabled patients that could influence their rehabilitation plan. Thesis findings also highlighted the potential inadequacies in rehabilitation services provided and emphasized the need for incorporating the service users’ expert knowledge in shaping future models of care for severe stroke survivors and their caregivers.

Item Type:	Thesis (University of Nottingham only) (PhD)
Supervisors:	Fisher, Rebecca Walker, Marion
Keywords:	Severe stroke; Rehabilitation
Subjects:	W Medicine and related subjects (NLM Classification) > WL Nervous system
Faculties/Schools:	UK Campuses > Faculty of Medicine and Health Sciences > School of Medicine
Item ID:	56449
Depositing User:	Mohapatra, Sushmita
Date Deposited:	21 Aug 2019 14:25
Last Modified:	22 Aug 2019 08:17
URI:	http://eprints.nottingham.ac.uk/id/eprint/56449

Understanding the impact of pre - existing dementia on stroke rehabilitation

This is so easy. Stroke rehab requires vast amounts of intelligence on the stroke survivors part. First to research what needs to be done, then to set up a program and conscientiously follow thru. I'm not a Ph. D candidate and I can tell you why in these couple sentences that 200 pages didn't do. 

Understanding the impact of pre - existing dementia on stroke  rehabilitation

Monitoring stroke rehabilitation of arm movement outside of the clinical setting

I know this is just a thesis but the supervising professor and thesis advisor should have nixed this because the monitoring should have been of RESULTS not activity and use. Until we get the whole stroke research world to focus on recovery results all this stroke research is wasted. Only 144 pages of waste. 

Monitoring stroke rehabilitation of arm movement outside of the clinical setting