Chapter 22: Future and Impact of Rehabilitation Robotics on Post-stroke Care and Recovery

2020 ◽  
pp. 353-372
Author(s):  
Anindo Roy ◽  
Prasad Mavuduri
Keyword(s):  
Stroke Care ◽  
Rehabilitation Robotics ◽  
Post Stroke

scholarly journals Implementation of a Bordeaux-Montreal community of practice: An option for optimal post-stroke care

2012 ◽  
Vol 55 ◽  
pp. e18-e19
Author(s):  
L. Poissant ◽  
É. Sorita ◽  
J.-M. Caire ◽  
P. Dehail
Keyword(s):  
Community Of Practice ◽  
Stroke Care ◽  
Post Stroke

Abstract 137: Neighborhood Income and 30-day Readmissions for Stroke and Transient Ischemic Attack

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Judith H Lichtman ◽  
Erica C Leifheit-Limson ◽  
Yun Wang ◽  
Larry B Goldstein
Keyword(s):  
Transient Ischemic Attack ◽  
Stroke Care ◽  
Stroke Incidence ◽  
Logistic Regression Models ◽  
Post Stroke ◽  
Explanatory Factors ◽  
Nationally Representative ◽  
Ischemic Attack ◽  
The Relationship ◽  
Income Quartile

Background: Residence in a socioeconomically challenged neighborhood is associated with increased stroke incidence and shorter post-stroke survival. Little is known about the relationship between socioeconomic status and 30-day post-stroke readmissions. We used a nationally representative readmission database that includes both insured and uninsured patients to determine whether there is a relationship between community-level income and 30-day readmissions after stroke and transient ischemic attack (TIA). Methods: Hospitalizations were identified in the 2013 Nationwide Readmissions Database for patients aged ≥18y with subarachnoid hemorrhage (SAH; ICD-9 430), intracerebral hemorrhage (ICH; ICD-9 431), ischemic stroke (IS; ICD-9 433, 434, 436), and TIA (ICD-9 435). We used mixed logistic regression models with hospital-specific random effects to assess the relationship between community income level (measured according to the median household income quartile for a patient’s ZIP code) and 30-day readmissions. Models were stratified by age and adjusted for demographic and clinical characteristics. Results: There were 7,061 hospitalizations for SAH, 17,325 for ICH, 212,306 for IS, and 67,606 for TIA. In unadjusted analyses, 30-day readmission rates decreased with increasing income quartile for younger patients hospitalized with IS and SAH (figure). In adjusted analyses, this association persisted only among those with IS aged 18-44y for whom each quartile increase in income was associated with a 7% decrease in 30-day readmission (figure). There were no significant associations between income and 30-day readmission for SAH, ICH, and TIA. Conclusions: Overall, community income was not associated with readmission for hemorrhagic stroke and TIA, but higher income was associated with lower 30-day readmission for younger IS patients. Possible explanatory factors such as better access to post-stroke care warrant further research for this subgroup.

Abstract TP347: The Stroke Transitions Education and Prevention (STEP) Clinic: A Learning Healthcare Model for Post-Stroke Care

Stroke ◽  
2019 ◽  
Vol 50 (Suppl_1) ◽  
Author(s):  
Evelyn Hinojosa ◽  
Munachi N Okpala ◽  
Gail Cooksey ◽  
M C Denny ◽  
Sean I Savitz ◽  
...  
Keyword(s):  
Stroke Care ◽  
Post Stroke ◽  
Healthcare Model

scholarly journals Gothenburg Very Early Supported Discharge study (GOTVED): a randomised controlled trial investigating anxiety and overall disability in the first year after stroke

BMC Neurology ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Lena Rafsten ◽  
Anna Danielsson ◽  
Asa Nordin ◽  
Ann Björkdahl ◽  
Asa Lundgren-Nilsson ◽  
...  
Keyword(s):  
Multidisciplinary Team ◽  
Controlled Trial ◽  
Stroke Care ◽  
Secondary Outcome ◽  
Outpatient Rehabilitation ◽  
Control Group ◽  
Stroke Patients ◽  
Post Stroke ◽  
Early Supported Discharge ◽  
Significant Difference

Abstract Background and purpose Early supported discharge (ESD) has been shown to be efficient and safe as part of the stroke care pathway. The best results have been seen with a multidisciplinary team and after mild to moderate stroke. However, how very early supported discharge (VESD) works has not been studied. The aim of this study was to investigate whether VESD for stroke patients in need of ongoing individualized rehabilitation affects the level of anxiety and overall disability for the patient compared with ordinary discharge routine. Methods A randomized controlled trial was performed with intention to treat analyses comparing VESD and ordinary discharge from hospital. All patients admitted at the stroke care unit at Sahlgrenska University Hospital of Gothenburg between August 2011 and April 2016 were screened. Inclusion occurred on day 4 using a block randomization of 20 and with a blinded assessor. Assessments were made 5 days post-stroke and 3 and 12 months post-stroke. Patients in the VESD group underwent continued rehabilitation in their homes with a multidisciplinary team from the stroke care unit for a maximum of 1 month. The patients in the control group had support as usual after discharge when needed such as home care service and outpatient rehabilitation. The primary outcome was anxiety as assessed by the Hospital Anxiety and Depression Scale-Anxiety subscale (HADS-A). The secondary outcome was the patients’ degree of overall disability, measured by the modified Rankin Scale (mRS). Results No significant differences were found between the groups regarding anxiety at three or 12 months post-stroke (p = 0.811). The overall disability was significantly lower in the VESD group 3 months post-stroke (p = 0.004), compared to the control group. However, there was no significant difference between the groups 1 year post-stroke. Conclusions The VESD does not affects the level of anxiety compared to ordinary rehabilitation. The VESD leads to a faster improvement of overall disability compared to ordinary rehabilitation. We suggest considering coordinated VESD for patients with mild to moderate stroke in addition to ordinary rehabilitation as part of the service from a stroke unit. Trial registration Clinical Trials.gov: NCT01622205. Registered 19 June 2012 (retrospectively registered).

scholarly journals Clinical Considerations of Post Stroke Care in Taiwan

2020 ◽  
Vol 119 (8) ◽  
pp. 1333-1334
Author(s):  
Andrew Fung ◽  
Pengyi Zhu ◽  
Shivam Patel ◽  
Benjamin K.P. Woo
Keyword(s):  
Stroke Care ◽  
Post Stroke ◽  
Clinical Considerations

scholarly journals Trial design and pilot phase results of a cluster-randomised intervention trial to improve stroke care after hospital discharge – The structured ambulatory post-stroke care program (SANO)

2020 ◽  
pp. 239698732091059 ◽  
Author(s):  
Felizitas A Eichner ◽  
Christopher J Schwarzbach ◽  
Moritz Keller ◽  
Karl Georg Haeusler ◽  
Gerhard F Hamann ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Secondary Prevention ◽  
Hospital Discharge ◽  
Complex Intervention ◽  
Trial Design ◽  
National Level ◽  
Stroke Care ◽  
Pilot Phase ◽  
Post Stroke ◽  
Hospitalised Patients

Introduction Previous studies showed insufficient control of cardiovascular risk factors (CVRF) and high stroke recurrence rates among ischemic stroke patients in Germany. Currently, no structured secondary prevention program exists in clinical routine. We present the trial design and pilot phase results of a complex intervention to improve stroke care after hospital discharge in Germany. Patients and methods SANO is a cluster-randomized trial with 30 participating regions across Germany aiming to enrol 2,790 patients (drks.de, DRKS00015322). Study intervention combines both structural and patient-centred elements. Study development was based on the Medical Research Council framework for complex interventions. In 15 intervention regions, a cross-sectoral multidisciplinary network is established to enhance CVRF control as well as detection and treatment of post-stroke complications. Recommendations on CVRF are based on high-quality secondary prevention guidelines. Study physicians use motivational interviewing and agree with patients on therapeutic targets. While hospitalised, patients also receive dietary counselling and a health-passport to track their progress. During regular visits, CVRF management and potential complications are monitored. The intervention is compared to 15 regions providing usual care. The primary endpoint is the combination of recurrent stroke, myocardial infarction and death assessed 12 months after enrolment and adjudicated in a blinded manner. Results Eighteen patients were enrolled in a pilot phase that demonstrated feasibility of patient recruitment and study procedures. Conclusion SANO is investigating a program to reduce outcome events after ischemic stroke by implementing a complex intervention. If successful, the program may be implemented in routine care on national level in Germany.

scholarly journals U-Limb: A multi-modal, multi-center database on arm motion control in healthy and post-stroke conditions

GigaScience ◽  
2021 ◽  
Vol 10 (6) ◽  
Author(s):  
Giuseppe Averta ◽  
Federica Barontini ◽  
Vincenzo Catrambone ◽  
Sami Haddadin ◽  
Giacomo Handjaras ◽  
...  
Keyword(s):  
Data Collection ◽  
Upper Limb ◽  
Brain Activity ◽  
Rehabilitation Robotics ◽  
Human Machine Interaction ◽  
Post Stroke ◽  
Upper Limb Movements ◽  
Arm Motion ◽  
And Control ◽  
Human Upper Limb

Abstract Background Shedding light on the neuroscientific mechanisms of human upper limb motor control, in both healthy and disease conditions (e.g., after a stroke), can help to devise effective tools for a quantitative evaluation of the impaired conditions, and to properly inform the rehabilitative process. Furthermore, the design and control of mechatronic devices can also benefit from such neuroscientific outcomes, with important implications for assistive and rehabilitation robotics and advanced human-machine interaction. To reach these goals, we believe that an exhaustive data collection on human behavior is a mandatory step. For this reason, we release U-Limb, a large, multi-modal, multi-center data collection on human upper limb movements, with the aim of fostering trans-disciplinary cross-fertilization. Contribution This collection of signals consists of data from 91 able-bodied and 65 post-stroke participants and is organized at 3 levels: (i) upper limb daily living activities, during which kinematic and physiological signals (electromyography, electro-encephalography, and electrocardiography) were recorded; (ii) force-kinematic behavior during precise manipulation tasks with a haptic device; and (iii) brain activity during hand control using functional magnetic resonance imaging.

scholarly journals Changes in Muscle Activity with Assistance Level During Exoskeletal Gait in Acute Stroke

2021 ◽  
Author(s):  
Ben P.F. O'Callaghan ◽  
Matthew W. Flood ◽  
Michele Tonellato ◽  
Caitríona Fingleton ◽  
Madeleine M Lowery ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Lower Limb ◽  
Muscle Activity ◽  
Stroke Care ◽  
Acute Stage ◽  
Plantar Flexors ◽  
Post Stroke ◽  
Paretic Side ◽  
Gait Parameters ◽  
Cord Injury

Abstract BackgroundThe level of assistance provided to the user is an important decision in rehabilitation training using robotic devices. Both fully assistive and assist-as-needed paradigms have shown benefits in functional outcomes in healthy individuals and users with chronic stroke and spinal cord injury. The effect of assistance level on muscle activity and kinematic gait parameters has not yet been directly examined during overground exoskeletal gait in a stroke population. Furthermore, it is not clear whether an assist-as-needed approach could elicit increased voluntary activity in individuals in the acute stages of stroke. The aim of this study was to examine the effect of assistance level on muscle activity and kinematic parameters during exoskeleton gait in individuals in the acute stage of stroke care.MethodsNine individuals in the acute stage of post-stroke care performed walking tasks in the EKSO GTTM exoskeleton using both maximal assistance and adaptive assistance control paradigms. Temporal gait parameters and muscle activity were recorded using accelerometers and surface EMG on the lower limb muscles.ResultsShorter swing times and longer double support times were observed on the non-paretic side during adaptive assist mode than with maximum assist mode (p<0.0065). No significant effect of exoskeleton mode was observed on the remaining temporal gait parameters. On the paretic side, proximal lower limb muscles (RF and ST) and plantar-flexors (SO) (p<0.00125) exhibited greater activation in adaptive assist mode than in maximum assist mode. On the non-paretic side however, the lower limb distal muscles (TA and SO) displayed greater activity during maximum assist mode than adaptive assist mode (p<0.00125). ConclusionsThe level of assistance provided by an exoskeleton in the acute stages of stroke care is an important clinical decision. The results indicate that an adaptive or assist-as-needed approach elicits higher levels of activation in muscles acting around the knee joint and plantar-flexors on the paretic side than a maximal, fixed assistance paradigm, in the acute stage post-stroke. Increased activity around the ankle joint during maximum assistance mode was also noted. Improved understanding of the effect of assistance level can help inform future control paradigms for exoskeleton gait in acute stroke.

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