Comment on: “Perispinal Etanercept for Post-Stroke Neurological and Cognitive Dysfunction: Scientific Rationale and Current Evidence”

Abstract Background Robotic-Assisted Gait Training (RAGT) may enable high-intensive and task-specific gait training post-stroke. The effect of RAGT on gait movement patterns has however not been comprehensively reviewed. The purpose of this review was to summarize the evidence for potentially superior effects of RAGT on biomechanical measures of gait post-stroke when compared with non-robotic gait training alone. Methods Nine databases were searched using database-specific search terms from their inception until January 2021. We included randomized controlled trials investigating the effects of RAGT (e.g., using exoskeletons or end-effectors) on spatiotemporal, kinematic and kinetic parameters among adults suffering from any stage of stroke. Screening, data extraction and judgement of risk of bias (using the Cochrane Risk of bias 2 tool) were performed by 2–3 independent reviewers. The Grading of Recommendations Assessment Development and Evaluation (GRADE) criteria were used to evaluate the certainty of evidence for the biomechanical gait measures of interest. Results Thirteen studies including a total of 412 individuals (mean age: 52–69 years; 264 males) met eligibility criteria and were included. RAGT was employed either as monotherapy or in combination with other therapies in a subacute or chronic phase post-stroke. The included studies showed a high risk of bias (n = 6), some concerns (n = 6) or a low risk of bias (n = 1). Meta-analyses using a random-effects model for gait speed, cadence, step length (non-affected side) and spatial asymmetry revealed no significant differences between the RAGT and comparator groups, while stride length (mean difference [MD] 2.86 cm), step length (affected side; MD 2.67 cm) and temporal asymmetry calculated in ratio-values (MD 0.09) improved slightly more in the RAGT groups. There were serious weaknesses with almost all GRADE domains (risk of bias, consistency, directness, or precision of the findings) for the included outcome measures (spatiotemporal and kinematic gait parameters). Kinetic parameters were not reported at all. Conclusion There were few relevant studies and the review synthesis revealed a very low certainty in current evidence for employing RAGT to improve gait biomechanics post-stroke. Further high-quality, robust clinical trials on RAGT that complement clinical data with biomechanical data are thus warranted to disentangle the potential effects of such interventions on gait biomechanics post-stroke.

Download Full-text

Rehabilitation of Post Stroke Sensory Dysfunction—A Scoping Review

Journal of Stroke Medicine ◽

10.1177/2516608520984296 ◽

2021 ◽

pp. 251660852098429

Author(s):

Dorcas B. C. Gandhi ◽

Ivy Anne Sebastian ◽

Komal Bhanot

Keyword(s):

Motor Behavior ◽

Sensory Modality ◽

Sensory System ◽

Sensory Stimulation ◽

Current Evidence ◽

Cochrane Library ◽

Post Stroke ◽

Sensory Dysfunction ◽

Electronic Database Search ◽

External Stimuli

Sensory dysfunction is one of the common impairments that occurs post stroke. With sensory changes in all modalities, it also affects the quality of life and incites suicidal thoughts. The article attempts to review and describe the current evidence of various approaches of assessment and rehabilitation for post-stroke sensory dysfunction. After extensive electronic database search across Medline, Embase, EBSCO, and Cochrane library, it generated 2433 results. After screening according to inclusion and exclusion criteria, we included 11 studies. We categorized data based on type of sensory deficits and prevalence, role of sensory system on motor behavior, type of intervention, sensory modality targeted, and dosage of intervention and outcome measures used for rehabilitation. Results found the strong evidence of involvement of primary and secondary motor areas involved in processing and responding to somatosensation, respectively. We divided rehabilitation approaches into sensory stimulation approach and sensory retraining approach focused on using external stimuli and relearning, respectively. However, with varied aims and targeted sensory involvement, the study applicability is affected. Thus, this emerges the need of extensive research in future for evidence-based practice of assessments and rehabilitation on post-stroke sensory rehabilitation.

Download Full-text

Imaging of brain glucose uptake by PET in obesity and cognitive dysfunction: life-course perspective

Endocrine Connections ◽

10.1530/ec-19-0348 ◽

2019 ◽

Vol 8 (11) ◽

pp. R169-R183 ◽

Cited By ~ 3

Author(s):

Patricia Iozzo ◽

Maria Angela Guzzardi

Keyword(s):

Insulin Resistance ◽

Life Course ◽

Glucose Uptake ◽

Cognitive Dysfunction ◽

Brain Metabolism ◽

Life Course Perspective ◽

Whole Body ◽

Current Evidence ◽

Brain Glucose

The prevalence of obesity has reached epidemic proportions and keeps growing. Obesity seems implicated in the pathogenesis of cognitive dysfunction, Alzheimer’s disease and dementia, and vice versa. Growing scientific efforts are being devoted to the identification of central mechanisms underlying the frequent association between obesity and cognitive dysfunction. Glucose brain handling undergoes dynamic changes during the life-course, suggesting that its alterations might precede and contribute to degenerative changes or signaling abnormalities. Imaging of the glucose analog 18F-labeled fluorodeoxyglucose (18FDG) by positron emission tomography (PET) is the gold-standard for the assessment of cerebral glucose metabolism in vivo. This review summarizes the current literature addressing brain glucose uptake measured by PET imaging, and the effect of insulin on brain metabolism, trying to embrace a life-course vision in the identification of patterns that may explain (and contribute to) the frequent association between obesity and cognitive dysfunction. The current evidence supports that brain hypermetabolism and brain insulin resistance occur in selected high-risk conditions as a transient phenomenon, eventually evolving toward normal or low values during life or disease progression. Associative studies suggest that brain hypermetabolism predicts low BDNF levels, hepatic and whole body insulin resistance, food desire and an unfavorable balance between anticipated reward from food and cognitive inhibitory control. Emerging mechanistic links involve the microbiota and the metabolome, which correlate with brain metabolism and cognition, deserving attention as potential future prevention targets.

Download Full-text

Abstract T P307: Similar Rates of Early Cognitive Dysfunction after Intracerebral Hemorrhage and Acute Ischemic Stroke

Stroke ◽

10.1161/str.46.suppl_1.tp307 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

M. Carter Denny ◽

Suhas S Bajgur ◽

Kim Y Vu ◽

Rahul R Karamchandani ◽

Amrou Sarraj ◽

...

Keyword(s):

Logistic Regression ◽

Ischemic Stroke ◽

Intracerebral Hemorrhage ◽

Acute Ischemic Stroke ◽

Cognitive Dysfunction ◽

Hospital Setting ◽

Stroke Severity ◽

Regression Analyses ◽

Post Stroke ◽

Poor Outcome

Introduction: Post-stroke cognitive dysfunction (CD) affects at least 1/3 of acute ischemic stroke (AIS) patients when assessed at 3 months. Limited data exists on CD in intracerebral hemorrhage (ICH). The role of early, in-hospital cognitive screening using the brief Montreal Cognitive Assessment (mini MoCA) is being investigated at our center. Hypothesis: We assessed the rates of early CD in ICH and AIS and hypothesized that even minor deficits from these disorders causes significant CD. Methods: 1218 consecutive stroke patients admitted from 2/13 to 12/13 were reviewed; 610, 442 with AIS and 168 with ICH, with admission NIHSS and mini MoCAs were included in the final analyses. CD was defined as mini MoCA <9 (max 12). Poor outcome was defined as discharge mRS 4-6. Stroke severity was stratified by NIHSS score of 0-5, 6-10, 11-15, 16-20, 21-42 as in ECASS-I . Chi-squared tests and univariate logistic regression analyses were performed. Results: Baseline characteristics are shown in table 1. AIS and ICH groups were similar with regard to race, gender and stroke severity. ICH patients were younger, had longer stroke service lengths of stay and poorer outcomes than AIS patients (p=0.03, p<0.001, p<0.001). No difference was seen in rates of CD between AIS and ICH patients (60% vs. 57%, p=0.36, OR 1.2 (CI 0.8-1.7)). CD rates ranged from 36% for NIHSS 0-5 to 96% for 21-42 (figure 1). Older patients were twice as likely to have CD (p<0.001, OR 2.2 (CI 1.6 - 3.0)). Patients with CD had five times the odds of having a poor outcome compared to the cognitively intact (p<0.001, OR 5.2 (CI 3.4-7.7)). In univariate logistic regression analyses, age was a significant predictor of CD in AIS, but not in ICH (p= <0.001, p=0.06). Conclusion: Post-stroke CD is common across all severities and occurs at similar rates in AIS and ICH. More than 1/3 of patients with minor deficits (NIHSS 0-5) had CD in the acute hospital setting. Whether early CD is predictive of long term cognitive outcomes deserves further study.

Download Full-text

Swallowing Exercises in Patients Post-Stroke: What Is the Current Evidence?

Perspectives of the ASHA Special Interest Groups ◽

10.1044/persp2.sig13.4 ◽

2017 ◽

Vol 2 (13) ◽

pp. 4-12

Author(s):

Balaji Rangarathnam ◽

Gary H. McCullough

Keyword(s):

Clinical Trials ◽

Current Evidence ◽

Exercise Programs ◽

Post Stroke ◽

Task Specificity ◽

Swallowing Exercises ◽

Diagnosis Age

The act of swallowing is “multidimensional” and involves contributions from several neuroanatomical structures. A stroke affecting any of these areas is likely to cause some amount of physiologic impairment in deglutition. This paper explores current and emerging evidence for rehabilitative exercises for physiological impairments in deglutition due to stroke. Evidence is more emerging than current. However, focus on task specificity and muscle load, along with the use of resistance that can be measured in an increasing number of ways, is encouraging. Results are supporting exercises at specific increments of maximum values using exercises that are as task-specific as possible. Clinical trials on patients post-stroke are challenging and require scrutiny toward diagnosis, age, severity, and type of dysphagia, as well as judicious use of controls. More research is needed to define effective exercise programs for swallowing impairments post-stroke.

Download Full-text