Post-Stroke Rehabilitation Intervention: Effect of Spinal Stabilization with Visual Feedback on the Mobility of Stroke Survivors

Stroke is a debilitating condition that impairs one's ability to live independently while also greatly decreasing one's quality of life. For these reasons, stroke rehabilitation is important. Engagement is a crucial part of rehabilitation, increasing a stroke survivor's recovery rate and the positive outcomes of their rehabilitation. For this reason, virtual reality (VR) has been widely used to gamify stroke rehabilitation to support engagement. Given that VR and the serious games that form its basis may not necessarily be engaging in themselves, ensuring that their design is engaging is important. This chapter discusses 39 principles that may be useful for engaging stroke survivors with VR-based rehabilitation post-stroke. This chapter then discusses a subset of the game design principles that are likely to engage stroke survivors with VR designed for upper limb rehabilitation post-stroke.

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Individual differences in locomotor function predict the capacity to reduce asymmetry and modify the energetic cost of walking post-stroke

10.1101/197582 ◽

2017 ◽

Cited By ~ 2

Author(s):

Natalia Sánchez ◽

James M. Finley

Keyword(s):

Individual Differences ◽

Visual Feedback ◽

Metabolic Cost ◽

Step Length ◽

Energetic Cost ◽

Stroke Survivors ◽

Locomotor Function ◽

Post Stroke ◽

Paretic Limb ◽

Over Ground Walking

AbstractChanges in the control of the lower extremities post-stroke lead to persistent biomechanical asymmetries during walking. These asymmetries are associated with an increase in energetic cost, leading to the possibility that reduction of asymmetry can improve economy. However, the influence of asymmetry on economy may depend on the direction and cause of asymmetry. For example, impairments with paretic limb advancement may result in shorter paretic steps while deficits in paretic support or propulsion result in shorter non-paretic steps. Given differences in the underlying impairments responsible for each type of step length asymmetry, the capacity to reduce asymmetry, and the associated changes in energetic cost may not be consistent across this population. Here, we identified factors explaining individual differences in the capacity to voluntarily reduce step length asymmetry and modify energetic cost during walking. Twenty-four individuals post-stroke walked on a treadmill with visual feedback of their step lengths to aid explicit modification of asymmetry. We found that individuals who naturally took longer paretic steps had a greater capacity to reduce asymmetry, and were better able to transfer the effects of training to over-ground walking. In addition, baseline energetic cost was negatively correlated with reductions in cost, such that participants with a more economical gait were more likely to reduce energetic cost by improving symmetry. These results demonstrate that many stroke survivors retain the capacity to voluntarily walk more symmetrically on a treadmill and over-ground. However, whether reductions in asymmetry reduce metabolic cost depends on individual differences in impairments affecting locomotor function.

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Intention to Return to Work after Stroke Following Rehabilitation in Ontario

Canadian Journal of Occupational Therapy ◽

10.1177/0008417420905706 ◽

2020 ◽

Vol 87 (3) ◽

pp. 221-226

Author(s):

Patrick K. Duong ◽

Mary Y. Egan ◽

Matthew J. Meyer ◽

Tricia L. Morrison

Keyword(s):

Return To Work ◽

Stroke Rehabilitation ◽

Reporting System ◽

Secondary Analysis ◽

Stroke Survivors ◽

Post Stroke ◽

Mild Disability ◽

Returning To Work ◽

System Data ◽

Intention To Return

Background. Returning to work is important for many people following stroke. An estimate of the prevalence of people intending to return to work post-stroke would be helpful in planning services supporting work reintegration. Purpose. This study examined the prevalence of intention to return to work after discharge among stroke rehabilitation inpatients. Methods. We performed secondary analysis of National Rehabilitation Reporting System data for all stroke rehabilitation inpatients across Ontario (2012–2017). Intention to return to work was examined by gender, age, and level of disability. Findings. Among 25,691 stroke rehabilitation inpatients, 4,668 (18.2%) were employed pre-stroke and 2,039 (43.7%) of them intended to return to work. Intention to return to work was somewhat higher among younger and middle-aged stroke survivors and those with mild disability. Implications. Providers and planners should be aware that almost half of previously employed stroke-rehabilitation inpatients may be seeking services to assist with return to work.

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Inflammatory Signaling in Post-Stroke Fatigue and Depression

European Neurology ◽

10.1159/000494988 ◽

2018 ◽

Vol 80 (3-4) ◽

pp. 138-148 ◽

Cited By ~ 8

Author(s):

Hongmei Wen ◽

Kristianna B. Weymann ◽

Lisa Wood ◽

Qing Mei Wang

Keyword(s):

Quality Of Life ◽

Independent Living ◽

Stroke Rehabilitation ◽

Sickness Behavior ◽

The United States ◽

Stroke Survivors ◽

Post Stroke ◽

Efficient Management ◽

Inflammatory Processes

Background: In the United States, stroke continues to be the cause for long-term disability. Of the patients with a first stroke, up to 75% will experience post-stroke fatigue (PSF) in the first year following stroke. PSF is one of the most disabling symptoms in stroke survivors; it decreases quality of life, increases mortality, and is a barrier to stroke rehabilitation. Given the incidence of stroke and the prevalence and detrimental impact of PSF on quality of life, independent living, and overall survival, efficient management of PSF must be a priority in stroke rehabilitation. The cause of PSF remains unknown. The burden of fatigue in stroke survivors is influenced by other stroke-related symptoms, most notably post-stroke depression (PSD). It is well known that stroke induces a systemic inflammatory response that is the trigger for sickness behavior, of which fatigue and depression are predominant symptoms. Summary: To date, only a handful of studies have sought to explore the relationship between stroke-induced inflammation and PSF and PSD. In this review, we describe this evidence, highlight the strengths and weaknesses of these existing studies, and suggest further experiments that may further support the association between stroke-related inflammatory processes and stroke-related symptoms. Key Messages: The current concept and further research are important for a more specific therapeutic intervention for PSF and PSD.

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Abstract T P128: Ethnicity and the Availability of Rehabilitation Facilities in the Brain Attack Surveillance in Corpus Christi Project

Stroke ◽

10.1161/str.46.suppl_1.tp128 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Sarah Reeves ◽

Micah Aaron ◽

Michael Fuentes ◽

Lewis Morgenstern ◽

Lynda Lisabeth

Keyword(s):

Ethnic Differences ◽

Mexican Americans ◽

Stroke Rehabilitation ◽

Inpatient Rehabilitation ◽

Population Based ◽

Stroke Survivors ◽

Market Area ◽

Post Stroke ◽

Corpus Christi ◽

Rehabilitation Facilities

Background: Mexican Americans (MAs) have worse stroke outcomes than non-Hispanic whites (NHWs). One explanation may be ethnic differences in post-stroke rehabilitation; despite its effectiveness, non-clinical factors such as geographic availability may influence use of certain rehabilitation venues. We investigated ethnic differences in availability of stroke rehabilitation venues in a bi-ethnic community. Methods: Stroke survivors were identified through the population-based Brain Attack Surveillance in Corpus Christi (BASIC) Project from 2011-2013 in Nueces County, a bi-ethnic, mostly urban community in southeast Texas with a population of 340,000. Addresses of inpatient rehabilitation facilities (IRFs) and skilled nursing facilities (SNFs) providing stroke rehabilitation were identified by phone/internet and geocoded. Availability was defined as distance to and supply of each type of venue in relation to the survivor’s home. Supply was calculated as the count of each type of venue within a given radius (defined as the 90th percentile of distribution of distances to reflect a reasonable market area). Associations between availability and ethnicity were modeled using linear regression adjusted for census tract-level median household income, proportion <65 years, and population density as obtained from the 2012 American Community Survey. Results: A total of 942 survivors were eligible (62% MA, 38% NHW); 3 IRFs and 21 SNFs were identified. The average distances from the survivors’ homes to an IRF or SNF were 5 miles (SD=6) and 2 miles (SD=3), respectively. Supply was calculated within radii of 16 miles for IRFs and 4 miles for SNFs. The average count of rehabilitation venues within these radii was 2.6 IRFs (SD=0.9) and 7.9 SNFs (SD=4.7). There were no ethnic differences in the distance or supply of IRFs; however, MAs were on average 1 mile (CI:0.6-1.5) closer to and had 0.8 (CI:0.2,1.3) more SNFs within the radius than NHWs. Conclusions: Availability of rehabilitation venues was high for both ethnic groups; however, MAs have greater availability of SNFs compared to NHWs. Additional study is necessary to understand how the availability and quality of services within rehabilitation venues impact post-stroke rehabilitation among MA stroke survivors.

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Effectiveness of post-stroke social rehabilitation in patients with moderate impairments

Bulletin of Russian State Medical University ◽

10.24075/brsmu.2021.012 ◽

2021 ◽

Author(s):

VV Khramov ◽

KP Kogaeva ◽

LU Arkhipova ◽

VO Alekseeva ◽

MI Lukyanova

Keyword(s):

Stroke Rehabilitation ◽

Social Activity ◽

Rehabilitation Program ◽

Social Adaptation ◽

Stroke Survivors ◽

Emotional States ◽

Post Stroke ◽

Social Rehabilitation ◽

Group 2 ◽

Group 1

The importance of post-stroke rehabilitation cannot be overestimated. The aim of this study was to assess the effectiveness of a standardized post-stroke rehabilitation program for patients with moderate impairments. A total of 122 stroke survivors participated in the study. Group 1 (the comparison group) consisted of 59 patients undergoing standard rehabilitation. Group 2 (the main group) consisted of 63 patients participating in a specially designed social rehabilitation program. The functional, cognitive, psychological and emotional states and the level of social activity were monitored for 6 months. Group 2 demonstrated more pronounced improvement than group 1 after 6 months of follow-up, confirmed by higher Rivermead (p = 0.011) and SS-QOL (p < 0.05) scores and lower DASH and Beck scores (p = 0.015 and p < 0.001, respectively). In both groups, MMSE (cognitive function) scores slightly increased, but the differences between the groups were insignificant. The proposed post-stroke rehabilitation program is effective in helping patients regain their independence and improve social adaptation. The scales and scores used in the study, especially DASH and SS-QOL, are sensitive to changes in the functional state of stroke survivors with moderate impairments.

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Complementary and integrative health interventions in post-stroke rehabilitation: a systematic PRISMA review

Disability and Rehabilitation ◽

10.1080/09638288.2020.1830440 ◽

2020 ◽

pp. 1-10

Author(s):

Alysha A. Walter ◽

Marieke Van Puymbroeck ◽

Pamela Bosch ◽

Arlene A. Schmid

Keyword(s):

Stroke Rehabilitation ◽

Health Interventions ◽

Post Stroke ◽

Integrative Health

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Post-stroke fatigue: an exploratory study with patients and health professionals to develop a patient-reported outcome measure

Journal of Patient-Reported Outcomes ◽

10.1186/s41687-021-00307-z ◽

2021 ◽

Vol 5 (1) ◽

Author(s):

Ingrid Johansen Skogestad ◽

Marit Kirkevold ◽

Petra Larsson ◽

Christine Råheim Borge ◽

Bent Indredavik ◽

...

Keyword(s):

Future Development ◽

Health Professionals ◽

Outcome Measure ◽

Patient Reported Outcome ◽

Stroke Survivors ◽

Structured Interviews ◽

Post Stroke ◽

Patient Reported Outcome Measure ◽

Patient Reported ◽

Initial Hospital

Abstract Background Post-stroke fatigue (PSF) is commonly reported and described as disabling by patients recovering from stroke. However, a major challenge is how to accurately diagnose and assess PSF. Therefore, the aim of this study was to explore PSF as it is experienced by stroke survivors and described by health professionals to guide future development of a PSF-specific PROM. Methods Individual semi-structured interviews were conducted with stroke survivors experiencing PSF (n = 9) and three focus groups were conducted with health professionals (n = 16). Data were analyzed through inductive content analysis. Results The analysis revealed four themes illustrating the experience and descriptions of PSF: 1) PSF characteristics, 2) interfering and aggravating factors, 3) management, and 4) PSF awareness, which refers to stroke survivors first becoming aware of PSF after their initial hospital admission. Conclusion This study highlights the complexity and multidimensionality of PSF. The results from this study will guide future development of a PSF-PROM and support its content validity.

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‘Somebody stuck me in a bag of sand’: Lived experiences of the altered and uncomfortable body after stroke

Clinical Rehabilitation ◽

10.1177/02692155211000740 ◽

2021 ◽

pp. 026921552110007

Author(s):

Hannah Stott ◽

Mary Cramp ◽

Stuart McClean ◽

Ailie Turton

Keyword(s):

Support Groups ◽

Phenomenological Study ◽

Community Support ◽

Phenomenological Approach ◽

The Body ◽

Stroke Survivors ◽

Post Stroke ◽

Personal Perceptions ◽

Psychological Sense ◽

Qualitative Phenomenological

Objective: This study explored stroke survivors’ experiences of altered body perception, whether these perceptions cause discomfort, and the need for clinical interventions to improve comfort. Design: A qualitative phenomenological study. Setting: Participants’ homes. Participants: A purposive sample of 16 stroke survivors were recruited from community support groups. Participants (median: age 59; time post stroke >2 years), were at least six-months post-stroke, experiencing motor or sensory impairments and able to communicate verbally. Interventions: Semi-structured, face-to-face interviews were analysed using an interpretive phenomenological approach and presented thematically. Results: Four themes or experiences were identified: Participants described (1) a body that did not exist; (2) a body hindered by strange sensations and distorted perceptions; (3) an uncontrollable body; and (4) a body isolated from social and clinical support. Discomfort was apparent in a physical and psychological sense and body experiences were difficult to comprehend and communicate to healthcare staff. Participants wished for interventions to improve their comfort but were doubtful that such treatments existed. Conclusion: Indications are that altered body perceptions cause multifaceted physical and psychosocial discomfort for stroke survivors. Discussions with patients about their personal perceptions and experiences of the body may facilitate better understanding and management to improve comfort after stroke.

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