Abstract P196: Patients Most Likely to Benefit From Home-Based Telerehabilitation After Stroke

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Sang Min Paik ◽  
Steven C Cramer
Keyword(s):  
Visual Field ◽  
Linear Regression Analysis ◽  
Multivariable Analysis ◽  
Secondary Analysis ◽  
Visual Field Defects ◽  
High Dose ◽  
Post Stroke ◽  
Home Based ◽  
Multivariable Linear Regression Analysis ◽  
Field Defects

Introduction: Higher doses of rehabilitation therapy are associated with better outcomes after stroke. Many patients do not receive high-dose therapy, however, e.g., due to limited availability and access, especially in the COVID era. Telehealth approaches can overcome many barriers, and evidence suggests that some forms of telerehabilitation are efficacious after stroke. However, uncertainty exists as to which patients are most likely to benefit from telerehabilitation. This issue was examined in the current study. Methods: Data are from patients randomized to telerehabilitation (TR) in an 11-site, assessor-blind trial (JAMA Neurol 76:1079) that provided 6 weeks of intensive arm motor therapy to hemiparetic patients with stroke 4-36 weeks prior. The primary endpoint was change in arm motor Fugl-Meyer (FM) from pre-treatment to 1-month post-treatment. Predictors of TR-related FM gain were identified using forward stepwise multivariable linear regression analysis, advancing the most significant predictor from each of 8 categories (demographics, stroke characteristics, medical history, amount of outside therapy, motivation, sensorimotor impairment, cognitive/affective status, and functional status) if it survived bivariate screening with p<0.1. Results: In patients >90 days post-stroke onset (n=44), sex (r=.33, p=.028), # hours of outside therapy post-randomization (r=.36, p=.019), spasticity (r=-.37, p=.014), and NIHSS visual field score (r=-.28, p=.068) were bivariate predictors of TR-related FM gain. In multivariable analysis, all except therapy hours survived as significant (P<0.05) predictors: TR-related FM gains were higher in females and lower in patients with spasticity or visual field defects. When the 15 patients randomized to TR ≤90 days post-stroke were added in secondary analysis, multivariable analysis found that sex, # hours of therapy post-randomization, and NIHSS neglect score were significant predictors. Conclusions: In patients with stable motor status >90 days post-stroke, behavioral gains from home-based TR were greatest in patients who were female and who had less spasticity and visual field defects. These results might be useful for patient selection and for design of future TR-based therapeutic approaches.

scholarly journals A Case Report on Treating Post-stroke Visual Impairment with Gami-banhabakchulchunma-tang and Acupuncture

2021 ◽  
Vol 42 (5) ◽  
pp. 1045-1053
Author(s):  
Jeong-hui Kim ◽  
Hae-yoong Kim ◽  
Seo-young Won ◽  
Ju-young Ryu ◽  
Eun-sun Jung ◽  
...  
Keyword(s):  
Visual Field ◽  
Herbal Medicine ◽  
Visual Impairment ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Visual Field Defects ◽  
Blurred Vision ◽  
Post Stroke ◽  
Numerical Rating ◽  
Field Defects

Objectives: This study investigated the effectiveness of acupuncture and herbal medicine (Gami-banhabakchulchunma-tang) for post-stroke visual impairment.Methods: A 79-year-old male with headache, dizziness, visual field defects, and blurred vision caused by a posterior cerebral infarction was treated with acupuncture and Gami-banhabakchulchunma-tang for three months. We used the Numerical Rating Scale (NRS) for each symptom and measured the patient’s eye-movement range.Results: Following treatment, the NRS score for headache decreased from 5 to 0, and for dizziness and blurred vision, it decreased from 5 to 1. The NRS score for visual field defects decreased from 5 to 2. The range of the patient’s left and right eye movements both improved, and no adverse side effects were observed during the admission period.Conclusions: Korean medical treatment with acupuncture and herbal medicine (Gami-banhabakchulchunma-tang) could effectively treat post-stoke visual impairment.

Saccade induced cortical activation in patients with post-stroke visual field defects

2007 ◽  
Vol 254 (9) ◽  
pp. 1244-1252 ◽  
Author(s):  
Gereon Nelles ◽  
Armin Greiff ◽  
Anja Pscherer ◽  
Philipp Stude ◽  
Michael Forsting ◽  
...  
Keyword(s):  
Visual Field ◽  
Cortical Activation ◽  
Visual Field Defects ◽  
Post Stroke ◽  
Field Defects

scholarly journals Efficacy and Feasibility of Home-Based Training for Individuals With Homonymous Visual Field Defects

2013 ◽  
Vol 28 (3) ◽  
pp. 207-218 ◽  
Author(s):  
Lina Aimola ◽  
Alison R. Lane ◽  
Daniel T. Smith ◽  
Georg Kerkhoff ◽  
Gary A. Ford ◽  
...  
Keyword(s):  
Visual Field ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Intervention Group ◽  
Computer Training ◽  
Visual Field Defects ◽  
Control Group ◽  
Home Based ◽  
Response Task ◽  
Field Defects

Background. Homonymous visual field defects (HVFDs) are one of the most common consequences of stroke. Compensatory training encourages affected individuals to develop more efficient eye movements to improve function. However, training is typically supervised, which can be time consuming and costly. Objective. To develop and evaluate the efficacy and feasibility of an unsupervised reading and exploration computer training for individuals with HVFDs. Methods. Seventy individuals with chronic HVFDs were randomly assigned to 1 of 2 groups: intervention or control. The former received 35 hours of reading and exploration training, and the latter received 35 hours of control training. Visual and attentional abilities were assessed before and after training using perimetry, visual search, reading, activities of daily living, the Test of Everyday Attention, and a Sustained Attention to Response task. Results. Eighteen individuals failed to complete the training; analyses were conducted on the remaining 28 intervention and 24 control group participants. Individuals in the intervention group demonstrated significant improvements in the primary outcomes of exploration (12.87%, 95% confidence interval [CI] = 8.44% to 17.30%) and reading (18.45%, 95% CI = 9.93% to 26.97%), which were significantly greater than those observed following the control intervention (exploration = 4.80%, 95% CI = 0.09% to 9.51%; reading = 1.95%, 95% CI = −4.78% to 8.68%). Participants in the intervention group also reported secondary subjective improvements, although these were not matched by objective gains in tasks simulating activities of daily living. Conclusions. Home-based compensatory training is an inexpensive accessible rehabilitation option for individuals with HVFDs, which can result in objective benefits in searching and reading, as well as improving quality of life.

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 Characteristics of progressive temporal visual field defects in patients with myopia

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jiyun Lee ◽  
Chan Kee Park ◽  
Kyoung In Jung
Keyword(s):  
Visual Field ◽  
Linear Regression Analysis ◽  
Common Type ◽  
Visual Field Defects ◽  
Multivariate Linear Regression Analysis ◽  
Factors Associated ◽  
Peripapillary Atrophy ◽  
Visual Field Damage ◽  
The Common ◽  
Field Defects

AbstractTemporal visual field damage (VFD) is the common type of non-glaucomatous VF defects found in eyes with myopia. However, little is known about the factors associated with its progression. We investigated the characteristic of myopic eyes with progressive temporal VF defects. This retrospective, observational study included a total of 116 eyes: 39 eyes with temporal VFDs and an axial length greater than 24.5 mm, 77 eyes with typical glaucomatous VFDs who were followed up more than 5 years. VF progression was evaluated with Trend-based global progression analysis. In the temporal VFD group, the greater tilt ratios, the higher prevalence of β-zone peripapillary atrophy (β-PPA), the substantial increase in β-PPA were found, compared to the typical glaucomatous VFD groups (all P-values ≤ 0.001). The temporal VFD group had the slower progression than the typical glaucomatous VFD group on trend-based GPA (P = 0.047). In the multivariate linear regression analysis, the change of β-PPA area over years was related to temporal VFD progression (B, − 0.000088, P = 0.003). In conclusion, myopic eyes with the temporal VFD, which come with growing β-PPA area, should be monitored with extra caution.

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