scholarly journals The lingering effects of a busted myth — false time limits in stroke rehabilitation

2015 ◽  
Vol 40 (8) ◽  
pp. 858-861 ◽  
Author(s):  
Yao Sun ◽  
Joanne Boots ◽  
E. Paul Zehr
Keyword(s):  
Functional Recovery ◽  
Stroke Rehabilitation ◽  
Community Dwelling ◽  
Neurological Recovery ◽  
Functional Improvement ◽  
Present Evidence ◽  
Rehabilitation Training ◽  
Time Limits ◽  
Active Rehabilitation ◽  
Significant Functional Improvement

It was once falsely believed that neurological and functional recovery after stroke occurred only in the first 6 months after lesion. The perception of this “6-month myth” continues to negatively impact the attitudes of patients towards their rehabilitation and on the clinicians and therapists making optimal training plans. Here we briefly outline some evidence that debunked the 6-month myth, where the concept of this temporal limit may have originated, and the lingering misunderstanding that individuals with stroke reach a plateau of recovery after 6 months even with rehabilitation training. We present evidence that significant functional improvement can occur years after stroke when rehabilitation training is applied. We frame the concepts of active and passive neurological recovery and that active neurological recovery continues far beyond any temporal limit. Because the effects of this busted 6-month myth persist, we aim to remind active physicians, therapists, exercise professionals, and those with stroke to continuously seek opportunities for active rehabilitation training. Meanwhile, trained and certified exercise professionals can play critical roles in facilitating rehabilitative training for community-dwelling stroke survivors.

scholarly journals Very Early Initiation Reduces Benefits of Poststroke Rehabilitation Despite Increased Corticospinal Projections

2019 ◽  
Vol 33 (7) ◽  
pp. 538-552 ◽  
Author(s):  
Naohiko Okabe ◽  
Naoyuki Himi ◽  
Emi Nakamura-Maruyama ◽  
Norito Hayashi ◽  
Issei Sakamoto ◽  
...  
Keyword(s):  
Functional Recovery ◽  
Early Initiation ◽  
Functional Improvement ◽  
Initiation Time ◽  
Tracer Study ◽  
Time Dependency ◽  
Multiple Tasks ◽  
Use Dependency ◽  
Significant Functional Improvement ◽  
Training Protocol

Background. Although the effect of rehabilitation is influenced by aspects of the training protocol, such as initiation time and intensity of training, it is unclear whether training protocol modifications affect the corticospinal projections. Objective. The present study was designed to investigate how modification of initiation time (time-dependency) and affected forelimb use (use-dependency) influence the effects of rehabilitation on functional recovery and corticospinal projections. Methods. The time-dependency of rehabilitation was investigated in rats forced to use their impaired forelimb immediately, at 1 day, and 4 days after photothrombotic stroke. The use-dependency of rehabilitation was investigated by comparing rats with affected forelimb immobilization (forced nonuse), unaffected forelimb immobilization (forced use), and a combination of forced use and skilled forelimb training beginning at 4 days after stroke. Results. Although forced use beginning 1 day or 4 days after stroke caused significant functional improvement, immediate forced limb use caused no functional improvement. On the other hand, a combination of forced use and skilled forelimb training boosted functional recovery in multiple tasks compared to simple forced use treatment. Histological examination showed that no treatment caused brain damage. However, a retrograde tracer study revealed that immediate forced use and combination training, including forced use and skilled forelimb training, increased corticospinal projections from the contralesional and ipsilesional motor cortex, respectively. Conclusions. These results indicate that although both very early initiation time and enhanced skilled forelimb use increased corticospinal projections, premature initiation time hampers the functional improvement induced by poststroke rehabilitation.

scholarly journals Subthreshold electrical stimulation as a low power electrical treatment for stroke rehabilitation

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kyungsoo Kim ◽  
Seung-Jun Yoo ◽  
So Yeon Kim ◽  
Taeju Lee ◽  
Sung-Ho Lim ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Energy Consumption ◽  
Functional Recovery ◽  
Stroke Rehabilitation ◽  
Brain Regions ◽  
Implantable Devices ◽  
Rehabilitation Process ◽  
Neural Excitability ◽  
Spike Firing

AbstractAs a promising future treatment for stroke rehabilitation, researchers have developed direct brain stimulation to manipulate the neural excitability. However, there has been less interest in energy consumption and unexpected side effect caused by electrical stimulation to bring functional recovery for stroke rehabilitation. In this study, we propose an engineering approach with subthreshold electrical stimulation (STES) to bring functional recovery. Here, we show a low level of electrical stimulation boosted causal excitation in connected neurons and strengthened the synaptic weight in a simulation study. We found that STES with motor training enhanced functional recovery after stroke in vivo. STES was shown to induce neural reconstruction, indicated by higher neurite expression in the stimulated regions and correlated changes in behavioral performance and neural spike firing pattern during the rehabilitation process. This will reduce the energy consumption of implantable devices and the side effects caused by stimulating unwanted brain regions.

Subthreshold Electrical Stimulation as A Low Power Electrical Treatment for Stroke Rehabilitation

2021 ◽  
Author(s):  
Kyungsoo Kim ◽  
Seung-Jun Yoo ◽  
So Yeun Kim ◽  
Taeju Lee ◽  
Sung-Ho Lim ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Energy Consumption ◽  
Functional Recovery ◽  
Stroke Rehabilitation ◽  
Brain Regions ◽  
Implantable Devices ◽  
Rehabilitation Process ◽  
Neural Excitability ◽  
Spike Firing

Abstract As a promising future treatment for stroke rehabilitation, researchers have developed direct brain stimulation to manipulate the neural excitability. However, there has been less interest in energy consumption and unexpected side effect caused by electrical stimulation to bring functional recovery for stroke rehabilitation. In this study, we propose an engineering approach with subthreshold electrical stimulation (STES) to bring functional recovery. Here, we show a low level of electrical stimulation boosted causal excitation in connected neurons and strengthened the synaptic weight in a simulation study. We found that STES with motor training enhanced functional recovery after stroke in vivo. STES was shown to induce neural reconstruction, indicated by higher neurite expression in the stimulated regions and correlated changes in behavioral performance and neural spike firing pattern during the rehabilitation process. This will reduce the energy consumption of implantable devices and the side effects caused by stimulating unwanted brain regions.

Predictors of functional recovery following surgery for foot drop due to degenerative lumbar disease

2021 ◽  
pp. 1-6
Author(s):  
Assaf Berger ◽  
Laurence Mangel ◽  
Sharif Basal ◽  
Zvi Lidar ◽  
Gilad J Regev ◽  
...  
Keyword(s):  
Functional Recovery ◽  
Postoperative Period ◽  
Univariate Analysis ◽  
Degenerative Disease ◽  
Foot Drop ◽  
Functional Improvement ◽  
Lumbar Degenerative Disease ◽  
Motor Weakness ◽  
Short And Long Term

OBJECTIVE Surgery for foot drop secondary to lumbar degenerative disease is not always associated with postoperative functional improvement. It is still unclear whether early decompression results in better functional recovery and how soon surgery should be performed. This study aimed to evaluate predicting factors that affect short- and long-term recovery outcomes and to explore the relationship between timing of lumbar decompression and recovery from foot drop in an attempt to identify a cutoff time from symptom onset until decompression for optimal functional improvement. METHODS The authors collected demographic, clinical, and radiographic data on patients who underwent surgery for foot drop due to lumbar degenerative disease. Clinical data included tibialis anterior muscle (TAM) strength before and after surgery, duration of preoperative motor weakness, and duration of radicular pain until surgery. TAM strength was recorded at the immediate postoperative period and 1 month after surgery while long-term follow-up on functional outcomes were obtained at ≥ 2 years postsurgery by telephone interview. Data including degree and duration of preoperative motor weakness as well as the occurrence of pain and its duration were collected to analyze their impact on short- and long-term outcomes. RESULTS The majority of patients (70%) showed functional improvement within 1 month postsurgery and 40% recovered to normal or near-normal strength. Univariate analysis revealed a trend toward lower improvement rates in patients with preoperative weakness of more than 3 weeks (33%) compared with patients who were operated on earlier (76.5%, p = 0.034). In a multivariate analysis, the only significant predictor for maximal strength recovery was TAM strength before surgery (OR 6.80, 95% CI 1.38–33.42, p = 0.018). Maximal recovery by 1 month after surgery was significantly associated with sustained long-term functional improvement (p = 0.006). CONCLUSIONS Early surgery may improve the recovery rate in patients with foot drop caused by lumbar degenerative disease, yet the strongest predictor for the extent of recovery is the severity of preoperative TAM weakness. Maximal recovery in the short-term postoperative period is associated with sustained long-term functional improvement and independence.

scholarly journals Delayed functional improvement after near-fatal bleeding complication following endobronchial valve therapy for emphysema

2016 ◽  
Vol 81 (1-2) ◽  
Author(s):  
Sergio Baldi ◽  
Francesco Coni ◽  
Giorgio Limerutti ◽  
Massimo Baccega ◽  
Enrico Ruffini ◽  
...  
Keyword(s):  
Alternative Explanation ◽  
Volume Reduction ◽  
Functional Improvement ◽  
Randomised Study ◽  
Copd Exacerbations ◽  
Alveolar Collapse ◽  
Fatal Bleeding ◽  
Endobronchial Valve ◽  
Valve Placement ◽  
Significant Functional Improvement

<p>Endoscopic treatment of emphysema is supported by different methods, including valves, coils and sealants. The mechanism is mainly related to volume reduction of targeted area. Endobronchial valves (EBV) appear the most studied method. In a multicentre randomised study, placement of unidirectional endobronchial valves resulted in a statistically significant functional improvement in the treated cohort compared to the control. Adverse events, occurring post procedure, included COPD exacerbations, haemoptysis, pneumothorax and pneumonia. In our centre we treated 30 patients, between January 2009 and February 2012, with variable improvement of lung function and only mild postoperative complications. The case we report here appears very interesting for the unusual near-fatal complication (massive alveolar haemorrage) followed by delayed strong functional improvement (FEV1 +23%; RV -18%; 6MWD:+33%) six months after the valve placement. This improvement could be attributable to the EBV procedure, but an alternative explanation is that the lung volume reduction may have been enhanced by the complication itself, as an effect of alveolar collapse.</p>

scholarly journals Effect of age on outcomes after allogeneic disc tissue supplementation in patients with chronic discogenic low back pain in the VAST trial

2021 ◽  
Author(s):  
Corey W Hunter ◽  
Richard Guyer ◽  
Mark Froimson ◽  
Michael J DePalma
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Controlled Trial ◽  
Young Patients ◽  
Functional Improvement ◽  
Low Back ◽  
Disc Tissue ◽  
Discogenic Low Back Pain ◽  
Post Hoc ◽  
Significant Functional Improvement

Aim: To explore the effects of viable allogeneic disc tissue supplementation in younger patients with discogenic chronic low back pain (CLBP). Patients & methods: VAST was a randomized placebo-controlled trial of disc allograft supplementation in 218 patients with discogenic CLBP. We conducted a post hoc analysis of change from baseline to 12 months in Oswestry Disability Index (ODI) and visual analog scale for pain intensity scores stratified by patient age. Results: Patients aged <42 years receiving allograft experienced greater improvement in ODI (p = 0.042) and a higher ODI response rate (≥10-, ≥15- and ≥20-point reductions in ODI) than those receiving saline (p = 0.001, p = 0.002 and p = 0.021, respectively). Conclusion: Young patients with discogenic CLBP may have significant functional improvement following nonsurgical disc allograft supplementation.

scholarly journals Adherence to Post-Acute Rehabilitation Guidelines Improves Functional Recovery in Stroke

Stroke ◽  
2001 ◽  
Vol 32 (suppl_1) ◽  
pp. 333-333
Author(s):  
Pamela W Duncan ◽  
Ronnie D Horner ◽  
Dean M Reker ◽  
VA Medical Ctr ◽  
Kansas City ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Acute Stroke ◽  
Functional Recovery ◽  
Stroke Rehabilitation ◽  
Functional Independence ◽  
Case Mix ◽  
Stroke Patients ◽  
Sf 36 ◽  
Acute Rehabilitation

97 Purpose & Methods: To assess if compliance with post-stroke rehabilitation guidelines improves functional recovery. The design of the study was an inception cohort of stroke patients followed prospectively for 6 months. The setting was eleven Department of Veteran Affairs Medical Centers providing care to stroke patients. The subjects included 288 selected patients with stroke admitted between January 1998 - March 1999. Data were abstracted from medical records and telephone interviews. Primary outcome was the Functional Independence Motor Score (FIM). Secondary outcomes included Instrumental Activities of Daily Living (IADL), SF-36 physical functioning, and the Stroke Impact Scale (SIS). Acute and post-acute rehabilitation composite compliance scores (range 0–100) were derived from an algorithm. All outcomes were adjusted for case mix. Results: Average compliance scores in acute and post acute care settings were 68.2% (+ 14) and 69.5% (+ 14.4), respectively. After case-mix adjustment, level of compliance with post-acute rehabilitation guidelines was significantly associated with FIM motor, IADL, and the SIS physical domain scores. SF-36 physical function scores and mortality were not affected by compliance with post-acute rehabilitation guidelines. Level of compliance with rehabilitation guidelines in acute settings was unrelated to any of the outcome measures. Conclusion: Process of care in post-acute stroke rehabilitation affects 6-month functional recovery. Our findings support the use of guidelines as means of assessing quality of care and improving outcomes. These quality indicators are needed to ensure that quality of care is not comprised with new organizational and funding changes involving post-acute stroke care.

scholarly journals Restoration of Neurological Function Following Peripheral Nerve Trauma

2020 ◽  
Vol 21 (5) ◽  
pp. 1808 ◽  
Author(s):  
Damien P. Kuffler ◽  
Christian Foy
Keyword(s):  
Peripheral Nerve ◽  
Functional Recovery ◽  
Recovery Of Function ◽  
Sensory Nerve ◽  
Standard Technique ◽  
Neurological Function ◽  
Neurological Recovery ◽  
Nerve Grafts ◽  
Peripheral Nerve Trauma ◽  
Nerve Trauma

Following peripheral nerve trauma that damages a length of the nerve, recovery of function is generally limited. This is because no material tested for bridging nerve gaps promotes good axon regeneration across the gap under conditions associated with common nerve traumas. While many materials have been tested, sensory nerve grafts remain the clinical “gold standard” technique. This is despite the significant limitations in the conditions under which they restore function. Thus, they induce reliable and good recovery only for patients < 25 years old, when gaps are <2 cm in length, and when repairs are performed <2–3 months post trauma. Repairs performed when these values are larger result in a precipitous decrease in neurological recovery. Further, when patients have more than one parameter larger than these values, there is normally no functional recovery. Clinically, there has been little progress in developing new techniques that increase the level of functional recovery following peripheral nerve injury. This paper examines the efficacies and limitations of sensory nerve grafts and various other techniques used to induce functional neurological recovery, and how these might be improved to induce more extensive functional recovery. It also discusses preliminary data from the clinical application of a novel technique that restores neurological function across long nerve gaps, when repairs are performed at long times post-trauma, and in older patients, even under all three of these conditions. Thus, it appears that function can be restored under conditions where sensory nerve grafts are not effective.

scholarly journals Influence of New Technologies on Post-Stroke Rehabilitation: A Comparison of Armeo Spring to the Kinect System

Medicina ◽  
2019 ◽  
Vol 55 (4) ◽  
pp. 98 ◽  
Author(s):  
Adomavičienė ◽  
Daunoravičienė ◽  
Kubilius ◽  
Varžaitytė ◽  
Raistenskis
Keyword(s):  
Virtual Reality ◽  
Grip Strength ◽  
Functional Recovery ◽  
Stroke Rehabilitation ◽  
New Technologies ◽  
Functional Independence ◽  
Upper Limbs ◽  
Post Stroke ◽  
Visuospatial Abilities ◽  
Attention Memory

Background: New technologies to improve post-stroke rehabilitation outcomes are of great interest and have a positive impact on functional, motor, and cognitive recovery. Identifying the most effective rehabilitation intervention is a recognized priority for stroke research and provides an opportunity to achieve a more desirable effect. Objective: The objective is to verify the effect of new technologies on motor outcomes of the upper limbs, functional state, and cognitive functions in post-stroke rehabilitation. Methods: Forty two post-stroke patients (8.69 ± 4.27 weeks after stroke onset) were involved in the experimental study during inpatient rehabilitation. Patients were randomly divided into two groups: conventional programs were combined with the Armeo Spring robot-assisted trainer (Armeo group; n = 17) and the Kinect-based system (Kinect group; n = 25). The duration of sessions with the new technological devices was 45 min/day (10 sessions in total). Functional recovery was compared among groups using the Functional Independence Measure (FIM), and upper limbs’ motor function recovery was compared using the Fugl–Meyer Assessment Upper Extremity (FMA-UE), Modified Ashworth Scale (MAS), Hand grip strength (dynamometry), Hand Tapping test (HTT), Box and Block Test (BBT), and kinematic measures (active Range Of Motion (ROM)), while cognitive functions were assessed by the MMSE (Mini-Mental State Examination), ACE-R (Addenbrooke’s Cognitive Examination-Revised), and HAD (Hospital Anxiety and Depression Scale) scores. Results: Functional independence did not show meaningful differences in scores between technologies (p > 0.05), though abilities of self-care were significantly higher after Kinect-based training (p < 0.05). The upper limbs’ kinematics demonstrated higher functional recovery after robot training: decreased muscle tone, improved shoulder and elbow ROMs, hand dexterity, and grip strength (p < 0.05). Besides, virtual reality games involve more arm rotation and performing wider movements. Both new technologies caused an increase in overall global cognitive changes, but visual constructive abilities (attention, memory, visuospatial abilities, and complex commands) were statistically higher after robotic therapy. Furthermore, decreased anxiety level was observed after virtual reality therapy (p < 0.05). Conclusions: Our study displays that even a short-term, two-week training program with new technologies had a positive effect and significantly recovered post-strokes functional level in self-care, upper limb motor ability (dexterity and movements, grip strength, kinematic data), visual constructive abilities (attention, memory, visuospatial abilities, and complex commands) and decreased anxiety level.

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