Effect of acupuncture on the daytime function in patients with post-stroke sleep-wake disturbance: A randomized controlled trial

Objective:To test the hypothesis that supplementary motor area (SMA) facilitation with functional near-infrared spectroscopy mediated neurofeedback (fNIRS-NFB) augments post-stroke gait and balance recovery. Using the 3-meter-Timed Up-and-Go (TUG) test, we conducted this two-center, double-blind, randomized controlled trial involving 54 Japanese patients.Methods:Patients with subcortical stroke-induced mild-to-moderate gait disturbance more than 12 weeks from onset, underwent 6 sessions of SMA neurofeedback facilitation during gait- and balance-related motor imagery using fNIRS-NFB. Participants were randomly allocated to intervention (REAL: 28 patients) or placebo (SHAM: 26 patients) group. In the REAL group, the fNIRS signal contained participants’ cortical activation information. Primary outcome was TUG improvement, 4 weeks post intervention.Results:The REAL group showed greater improvement in the TUG test (12.84 ± 15.07 s, 95% CI: 7.00-18.68) than the SHAM group (5.51± 7.64 s, 95% CI: 2.43 – 8.60; group difference 7.33 s, 95% CI: 0.83 – 13.83; p = 0.028), even after adjusting for covariates (group × time interaction; F1.23,61.69 = 4.50, p = 0.030, partial η2 = 0.083). Only the REAL group showed significantly increased imagery-related SMA activation and enhancement of resting-state connectivity between SMA and ventrolateral premotor area. Adverse effects associated with fNIRS-mediated neurofeedback intervention were absent.Conclusion:SMA facilitation during motor imagery using fNIRS neurofeedback may augment post-stroke gait and balance recovery by modulating the SMA and its related network.Classification of Evidence:This study provides Class III evidence that for patients with gait disturbance from subcortical stroke, SMA neurofeedback facilitation improves TUG time.

Download Full-text

The ESCAPS study: a feasibility randomized controlled trial of early electrical stimulation to the wrist extensors and flexors to prevent post-stroke complications of pain and contractures in the paretic arm

Clinical Rehabilitation ◽

10.1177/0269215519868834 ◽

2019 ◽

Vol 33 (12) ◽

pp. 1919-1930

Author(s):

Joanna C Fletcher-Smith ◽

Dawn-Marie Walker ◽

Kate Allatt ◽

Nikola Sprigg ◽

Marilyn James ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Electrical Stimulation ◽

Data Collection ◽

Usual Care ◽

Controlled Trial ◽

Cost Effective ◽

Outcome Data ◽

Attrition Rates ◽

Post Stroke ◽

Randomized Controlled

Objective: To establish feasibility of initiating electrical stimulation treatment of wrist extensors and flexors in patients early after stroke to prevent muscle contractures and pain. Design: Feasibility randomized controlled trial with economic evaluation. Setting: A specialist stroke unit in Nottinghamshire. Subjects: A total of 40 patients recruited within 72 hours post-stroke with arm hemiparesis. Interventions: Participants were randomized to receive usual care or usual care and electrical stimulation to wrist flexors and extensors for 30 minutes, twice a day, five days a week for three months. Initial treatment was delivered by an occupational therapist or physiotherapist who trained participants to self-manage subsequent treatments. Measures: Measures of feasibility included recruitment and attrition rates, completion of treatment, and successful data collection. Outcome data on wrist range of motion, pain, arm function, independence, quality of life, and resource use were measured at 3-, 6-, and 12-months post-randomization. Results: A total of 40 participants (of 215 potentially eligible) were recruited in 15 months (20 men; mean age: 72 (SD: 13.0)). Half the participants lacked mental capacity and were recruited by consultee consent. Attrition at three-month follow-up was 12.5% (death ( n = 2), end-of-life care ( n = 2), and unable to contact ( n = 1)). Compliance varied (mean: 65 (SD: 53)) and ranged from 10 to 166 treatments per patient (target dosage was 120). Data for a valid economic analysis can be adequately collected. Conclusion: Early initiation of electrical stimulation was acceptable and feasible. Data collection methods used were feasible and acceptable to participants. A large definitive study is needed to determine if electrical stimulation is efficacious and cost effective.

Download Full-text