Abstract WP193: A Pilot Study of Expanded Home-Based Telerehabilitation After Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Steven C Cramer ◽  
Lucy Dodakian ◽  
Vu Le ◽  
Alison McKenzie ◽  
JIll See ◽  
...  
Keyword(s):  
Social Networks ◽  
Augmented Reality ◽  
Current System ◽  
Geriatric Depression Scale ◽  
Depression Scale ◽  
Smart Devices ◽  
Motor Deficits ◽  
Post Stroke ◽  
Home Based ◽  
High Doses

Introduction: High doses of activity-based rehabilitation therapy help but many patients do not receive this, e.g., due to access, cost, and low compliance. Home-based telerehabilitation (TR) can address these issues. A prior study found 6 weeks of TR targeting arm motor deficits after stroke comparably efficacious vs. therapy delivered in-clinic. Here, we evaluated a program expanded in TR dose and scope. Methods: Adults with stroke and arm motor deficits saw a licensed OT/PT who performed a live exam then supervised home-based TR (6 days/week, 1 hour/day) through games, exercises, and education. New features examined herein included (a) extending therapy to 12 weeks, (b) treating both arm and leg motor deficits, (c) augmented reality games, (d) wireless smart devices, (e) ingesting a daily experimental (placebo) pill, (f) using functional objects, (g) evaluating social networks, and (h) automated actionable reports. Results: Patients (n=13) were median age 61 [IQR=52-65.5], and 129 [52-486] days post-stroke. Patients initiated therapy on 79.9% of the 72 assigned days and completed >30 min on 65.7% of days, for a 12-week total therapy dose of 50.4 [33.3 - 56.7] hours. Non-compliant days during weeks 7-12 were double those of weeks 1-6. Modified Rankin scores improved by 1 level in 6/13 patients, 3 of whom were > 3month post-stroke. Fugl-Meyer motor scores increased by 6 [2.5-12.5] points in the arm and 1 [-0.5 - 5] point in the leg, mainly in weeks 1-6. Geriatric Depression Scale scores fell from 3 [1-5] at baseline (3/13 with depression) to 1 [0-4] (0/13 with depression) at week 12. Augmented reality gaming and functional objects were well received. Communication with smart devices was challenging. The experimental pill was taken, with photo verification, on 90.9% of days. Enrollees had large social networks. Automatic reports reliably notified study personnel when compliance was low or behavioral scores were concerning. Conclusions: High doses of home-based TR targeting arm and leg motor deficits are feasible and improve functional outcomes, motor deficits, and mood. The current system automates experimental pill ingestion and actionable reports to clinicians. Compliance declined over time, suggesting the need for novel approaches to extended periods of TR.

scholarly journals Socio-Demographic Characteristics of the Patients with a Post Stroke Depression from the Municipality of Tetovo, Republic of Macedonia

2018 ◽  
Vol 6 (5) ◽  
pp. 782-785 ◽  
Author(s):  
Danijela Vojtikiv-Samoilovska ◽  
Anita Arsovska
Keyword(s):  
Risk Factors ◽  
Occupational Status ◽  
Geriatric Depression Scale ◽  
Depression Scale ◽  
Demographic Characteristics ◽  
Depression Symptoms ◽  
Post Stroke ◽  
Republic Of Macedonia ◽  
Significant Dependence ◽  
Post Stroke Depression

BACKGROUND: Although post-stroke depression (PSD) is the most common neuro-psychiatric consequence after a stroke there is still some obscurity regarding its aetiology and risk factors, which complicates its management. A better knowledge of the predictors will enable better prevention and treatment.AIM: The aim of this work was the identification of the risk factors for PSD, typical for the Macedonian population, which will help in early prediction, timely diagnosis and treatment of the disease.MATERIALS AND METHODS:  We carried out a prospective study at the Clinical Hospital in Tetovo, the Republic of Macedonia to determine the prevalence of PSD and to analyse the socio-demographic characteristics as possible risk factors in 100 patients on discharge and after 5 months. The depression symptoms were quantified using the Hamilton Depression Ranking Scale (HAM-d) and the Geriatric Depression Scale (GDS).RESULTS: The average age of the patients with PSD on the first examination is 65.0 ± 8.3, whereas on the second examination is 64.5 ± 9.2. According to the Mann-Whitney U test, the difference between the average ages on both examinations is statistically insignificant for p > 0.05. On both examinations, the statistically significant dependence of p > 0.05 between PSD and the occupational status and PSD and education is not recorded. On both examinations, the PSD in male patients was 78.0% and 62.7%, while in female patients it was 85.4% and 68.3% not recording the statistically significant dependence of p < 0.05 between PSD and the gender.CONCLUSION: The socio-demographic characteristics of the patients with PSD cannot be considered as predictors of the disease.

scholarly journals Hyperconnectivity and altered dynamic interactions of a nucleus accumbens network in post-stroke depression

2021 ◽  
Author(s):  
Lena KL Oestreich ◽  
Paul Wright ◽  
Michael J O'Sullivan
Keyword(s):  
Prefrontal Cortex ◽  
Nucleus Accumbens ◽  
Functional Connectivity ◽  
Network Dynamics ◽  
Geriatric Depression Scale ◽  
Depression Scale ◽  
Posterior Cingulate Cortex ◽  
Grey Matter Volume ◽  
Post Stroke ◽  
Post Stroke Depression

Background Post-stroke depression (PSD) is a common complication after stroke. To date, no consistent locus of injury is associated with this complication. Here, we probed network dynamics in four functional circuits tightly linked to major depressive disorder and investigated structural alterations within these networks in PSD. Methods Forty-four participants with recent stroke and 16 healthy volunteers were imaged with 3T structural, diffusion and resting-state functional MRI and completed the Geriatric Depression Scale (GDS). Associations between GDS and functional connectivity were investigated within networks seeded from nucleus accumbens (NAc), amygdala and dorsolateral prefrontal cortex. In addition, the default mode network (DMN) was identified by connectivity with medial prefrontal cortex (mPFC) and posterior cingulate cortex (PCC). Circuits that exhibited altered activity associated with GDS were further investigated by extracting within-network volumetric and microstructural measures from structural images. Results Functional connectivity within the NAc-seeded network and DMN correlated positively with depressive symptoms. Normal anticorrelations between these two networks were absent in patients with PSD. PCC grey matter volume as well as microstructural measures in mPFC and the medial forebrain bundle, a major projection pathway interconnecting the NAc-seeded network and links to mPFC, were associated with GDS scores. Conclusions Depression after stroke is marked by reduced mutual inhibition between functional circuits involving NAc and DMN as well as volumetric and microstructural changes within these networks. Aberrant network dynamics present in patients with PSD are therefore likely to be influenced by secondary, pervasive alterations in grey and white matter, remote from the site of injury.

scholarly journals Psychosocial assessment of geriatric subjects in Abha City, Saudi Arabia

2001 ◽  
Vol 7 (3) ◽  
pp. 481-491 ◽  
Author(s):  
M. A. Abolfotouh ◽  
A. A. Daffallah ◽  
M. Y. Khan ◽  
M. S. Khattab ◽  
I. Abdulmoneim
Keyword(s):  
Geriatric Depression Scale ◽  
Depression Scale ◽  
Structured Interview ◽  
Depression Score ◽  
Psychosocial Assessment ◽  
Short Version ◽  
Perceived Health Status ◽  
Geriatric Population ◽  
Home Based ◽  
Catchment Areas

Psychosocial assessment of geriatric subjects was carried out through a home-based survey of people aged 65 years and over [n = 810] in the catchment areas of 3 primary health care centres. All the participants had a structured interview and were given a short version of the geriatric depression scale. Depression was found in 17.5% of the subjects, more commonly in women [27.7% versus 12.7%]. The combined effect of impaired perceived health status [52.4%] and functional capacity [26.6%], loneliness [4.5%], single status [24.3%], and lack of education [80.5%] explained 23.7% of the variance in depression score by multiple regression analysis. Depression is a problem among the geriatric population in the region, especially women. Periodic home psychosocial screening of geriatrics is recommended.

scholarly journals A Feasibility Study of Expanded Home-Based Telerehabilitation After Stroke

2021 ◽  
Vol 11 ◽  
Author(s):  
Steven C. Cramer ◽  
Lucy Dodakian ◽  
Vu Le ◽  
Alison McKenzie ◽  
Jill See ◽  
...  
Keyword(s):  
Feasibility Study ◽  
Holistic Approach ◽  
Motor Deficits ◽  
Limb Weakness ◽  
Clinical Trial Registration ◽  
Rehabilitation Care ◽  
Rehabilitation Therapy ◽  
Post Stroke ◽  
Home Based ◽  
Real Objects

Introduction: High doses of activity-based rehabilitation therapy improve outcomes after stroke, but many patients do not receive this for various reasons such as poor access, transportation difficulties, and low compliance. Home-based telerehabilitation (TR) can address these issues. The current study evaluated the feasibility of an expanded TR program.Methods: Under the supervision of a licensed therapist, adults with stroke and limb weakness received home-based TR (1 h/day, 6 days/week) delivered using games and exercises. New features examined include extending therapy to 12 weeks duration, treating both arm and leg motor deficits, patient assessments performed with no therapist supervision, adding sensors to real objects, ingesting a daily experimental (placebo) pill, and generating automated actionable reports.Results: Enrollees (n = 13) were median age 61 (IQR 52–65.5), and 129 (52–486) days post-stroke. Patients initiated therapy on 79.9% of assigned days and completed therapy on 65.7% of days; median therapy dose was 50.4 (33.3–56.7) h. Non-compliance doubled during weeks 7–12. Modified Rankin scores improved in 6/13 patients, 3 of whom were &gt;3 months post-stroke. Fugl-Meyer motor scores increased by 6 (2.5–12.5) points in the arm and 1 (−0.5 to 5) point in the leg. Assessments spanning numerous dimensions of stroke outcomes were successfully implemented; some, including a weekly measure that documented a decline in fatigue (p = 0.004), were successfully scored without therapist supervision. Using data from an attached sensor, real objects could be used to drive game play. The experimental pill was taken on 90.9% of therapy days. Automatic actionable reports reliably notified study personnel when critical values were reached.Conclusions: Several new features performed well, and useful insights were obtained for those that did not. A home-based telehealth system supports a holistic approach to rehabilitation care, including intensive rehabilitation therapy, secondary stroke prevention, screening for complications of stroke, and daily ingestion of a pill. This feasibility study informs future efforts to expand stroke TR.Clinical Trial Registration:Clinicaltrials.gov, # NCT03460587.

Predicting motor gains with home-based telerehabilitation after stroke

2021 ◽  
pp. 1357633X2110233
Author(s):  
Sang Min Paik ◽  
Steven C Cramer
Keyword(s):  
Secondary Analysis ◽  
Arm Movement ◽  
Visual Field Defects ◽  
Motor Deficits ◽  
Total N ◽  
Rehabilitation Therapy ◽  
Post Stroke ◽  
Female Sex ◽  
Home Based ◽  
Affective Deficits

Introduction Telerehabilitation (TR) may be useful for rehabilitation therapy after stroke. However, stroke is a heterogeneous condition, and not all patients can be expected to derive the same benefit from TR, underscoring the need to identify predictors of response to TR. Methods A prior trial provided patients with 6 weeks of intensive rehabilitation therapy targeting arm movement, randomly assigned to be provided in the home via TR (current focus) or in clinic. Eligible patients had moderate arm motor deficits and were in the subacute–chronic stage post stroke. Behavioral gains were measured as change in the arm motor Fugl-Meyer score from baseline to 30 days post therapy. To delineate predictors of TR response, multivariable linear regression was performed, advancing the most significant predictor from each of eight categories: patient demographics, stroke characteristics, medical history, rehabilitation therapy outside of study procedures, motivation, sensorimotor impairment, cognitive/affective deficits, and functional status. Results The primary focus was on patients starting TR >90 days post stroke onset ( n = 44), among whom female sex, less spasticity, and less visual field defects predicted greater motor gains. This model explained 39.3% of the variance in treatment-related gains. In secondary analysis that also included TR patients enrolled ≤90 days post stroke (total n = 59), only female sex was a predictor of treatment gains. A separate secondary analysis examined patients >90 days post stroke ( n = 34) randomized to in-clinic therapy, among whom starting therapy earlier post stroke and less ataxia predicted greater motor gains. Discussion Response to TR varies across patients, emphasizing the need to identify characteristics that predict treatment-related behavioral gain. The current study highlights factors that might be important to patient selection for home-based TR after stroke.

scholarly journals CCR5-Δ32 polymorphism: a possible protective factor for post-stroke depressive symptoms

2021 ◽  
Vol 46 (4) ◽  
pp. E431-E440
Author(s):  
Oren Tene ◽  
Hen Hallevi ◽  
Jeremy Molad ◽  
Saly Usher ◽  
Estelle Seyman ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Sex Education ◽  
Protective Factor ◽  
Geriatric Depression Scale ◽  
Depression Scale ◽  
Loss Of Function ◽  
Multiprofessional Team ◽  
Post Stroke ◽  
Antidepressant Use ◽  
Ischemic Attack

Background: A naturally occurring loss-of-function mutation in the gene for C-C chemokine receptor type 5 (CCR5-Δ32) has recently been reported as a protective factor in post-stroke motor and cognitive recovery. We sought to examine whether this mutation also prevented the development of depressive symptoms up to 2 years after a stroke. Methods: Participants were survivors of a first-ever mild to moderate ischemic stroke or transient ischemic attack from the TABASCO prospective study who underwent a 3 T MRI at baseline and were examined by a multiprofessional team 6, 12 and 24 months after the event, including an evaluation of depressive symptoms using the Geriatric Depression Scale. Results: CCR5-Δ32 status and a baseline depression evaluation were available for 435 patients. Compared with noncarriers, CCR5-Δ32 carriers (16.1%) had fewer depressive symptoms at admission (p = 0.035) and at 6 months (p < 0.001), 12 months (p < 0.001) and 24 months (p = 0.006) after the index event. This association remained significant at 6 and 12 months after adjustment for age, sex, education, antidepressant use, ethnicity and the presence of cortical infarcts. These findings were more robust in women. Compared to baseline, depressive symptoms in CCR5-Δ32 noncarriers tended to remain stable or grow worse over time, but in CCR5-Δ32 carriers, symptoms tended to improve. Limitations: A limitation of this study was the exclusion of patients who had a severe stroke or who had pre-stroke depression. Conclusion: Carriers of the CCR5-Δ32 allele had a lower tendency to develop depressive symptoms post-stroke, and this phenomenon was more prominent in women. These findings could have clinical implications; they suggest a mechanism-based treatment target for post-stroke depression. Drugs mimicking this loss-of-function mutation exist and could serve as a novel antidepressant therapy.

Geriatric Depression Scale

1983 ◽  
Author(s):  
Jerome A. Yesavage ◽  
T. L. Brink ◽  
Terence L. Rose ◽  
Owen Lum ◽  
Virginia Huang ◽  
...  
Keyword(s):  
Geriatric Depression Scale ◽  
Depression Scale ◽  
Geriatric Depression

Geriatric Depression Scale--5 Item Version

1999 ◽  
Author(s):  
M. Trinidad Hoyl ◽  
Cathy A. Alessi ◽  
Judith O. Harker ◽  
Karen R. Josephson ◽  
Fern M. Pietruszka ◽  
...  
Keyword(s):  
Geriatric Depression Scale ◽  
Depression Scale ◽  
Geriatric Depression

Efektifitas Emotional Freedom Technique (EFT) Terhadap Penurunan Tingkat Depresi Pada Lansia

2017 ◽  
Vol 6 (1) ◽  
pp. 01
Author(s):  
Emy Sutiyarsih ◽  
Sr. Felisitas A Sri S
Keyword(s):  
Experimental Design ◽  
Geriatric Depression Scale ◽  
Depression Scale ◽  
Strong Relationship ◽  
Severe Case ◽  
Test Design ◽  
Geriatric Depression ◽  
Post Test ◽  
Scale Test ◽  
Elder People

Depression in eldery couldn’t be easily detected because physical complaint was more often than emotional complaint. In severe case, depression could cause suicidal behaviour (Irawan, 2013). Therefore, elderly need assistance to deal with depression, and Emotional Freedom Technique (EFT) is one of the solution. Research design is pre-experimental design, using pre-test and post-test design. Before intervention, Geriatric Depression Scale test were given to one group of elder people. EFT intervention were given two times for four weeks, and Geriatric Depression Scale test were tested after intervention. Population was elder people who fulfill inclusion criterias, and 30 elderly were obatained. The significancy result was 0,000 (α = 0,05), it could be inferred that EFT has a strong relationship to depression scale. EFT could significantly reduce depression scale in elderly, so it can bes used effectively.

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