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 >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.

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.

Sequentially applied myoelectrically controlled FES in a task-oriented approach and robotic therapy for the recovery of upper limb in post-stroke patients: A randomized controlled pilot study

2020 ◽  
pp. 1-11
Author(s):  
Gloria Perini ◽  
Rita Bertoni ◽  
Rune Thorsen ◽  
Ilaria Carpinella ◽  
Tiziana Lencioni ◽  
...  
Keyword(s):  
Upper Limb ◽  
Standard Care ◽  
Experimental Treatment ◽  
Stroke Patients ◽  
Rehabilitation Care ◽  
Post Stroke ◽  
Robotic Therapy ◽  
Arm Rehabilitation ◽  
Point Increase ◽  
Task Oriented

BACKGROUND: Functional recovery of the plegic upper limb in post-stroke patients may be enhanced by sequentially applying a myoelectrically controlled FES (MeCFES), which allows the patient to voluntarily control the muscle contraction during a functional movement and robotic therapy which allows many repetitions of movements. OBJECTIVE: Evaluate the efficacy of MeCFES followed by robotic therapy compared to standard care arm rehabilitation for post-stroke patients. METHODS: Eighteen stroke subjects (onset ⩾ 3 months, age 60.1 ± 15.5) were recruited and randomized to receive an experimental combination of MeCFES during task-oriented reaching followed by robot therapy (MRG) or same intensity conventional rehabilitation care (CG) aimed at the recovery of the upper limb (20 sessions/45 minutes). Change was evaluated through Fugl-Meyer upperextremity (FMA-UE), Reaching Performance Scale and Box and Block Test. RESULTS: The experimental treatment resulted in higher improvement on the FMA-UE compared with CG (P= 0.04), with a 10 point increase following intervention. Effect sizes were moderate in favor of the MRG group on FMA-UE, FMA-UE proximal and RPS (0.37–0.56). CONCLUSIONS: Preliminary findings indicate that a combination of MeCFES and robotic treatment may be more effective than standard care for recovery of the plegic arm in persons > 3 months after stroke. The mix of motor learning techniques may be important for successful rehabilitation of arm function.

scholarly journals Feasibility study of the Home-based Exercises for Responsible Sex (HERS) intervention to promote correct and consistent condom use among young women

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Nicola Knights ◽  
Nicole Stone ◽  
Tom Nadarzynski ◽  
Katherine Brown ◽  
Katie Newby ◽  
...  
Keyword(s):  
Condom Use ◽  
Feasibility Study ◽  
Young Women ◽  
Self Efficacy ◽  
Repeated Measures ◽  
Recruitment Strategy ◽  
Consistent Condom ◽  
Post Intervention ◽  
Study Objective ◽  
Home Based

Abstract Background Male condoms are effective in preventing common sexually transmitted infections (STIs) and unintended pregnancy, if used correctly and consistently. However, condom use errors and problems are common and young people report negative experiences, such as reduced pleasure. The Kinsey Institute Home-Based Exercises for Responsible Sex (KIHERS) is a novel condom promotion intervention for young women, which aims to reduce condom errors and problems, increase self-efficacy and improve attitudes towards condoms, using a pleasure-focussed approach. The study objective was to test the operability, viability and acceptability of an adapted version of the KIHERS intervention with young women aged 16–25 years in the United Kingdom (UK) (Home-Based Exercises for Responsible Sex-UK (HERS-UK). Methods A repeated-measures single-arm design was used, with a baseline (T1) and two follow-up assessments (T2 and T3), conducted 4 weeks and 8 weeks post intervention over a 3-month period. Participants were provided a condom kit containing different condoms and lubricants and were asked to experiment with condoms alone using a dildo and/or with a sexual partner. Ten process evaluation interviews were conducted post intervention. Results Fifty-five young women received the intervention; 36 (65%) completed T2 and 33 (60%) completed T3. Condom use errors and problems decreased, self-efficacy increased and attitudes towards condoms improved significantly. The proportion of participants who reported using a condom for intercourse in the past 4 weeks increased from T1 (20; 47%) to T2 (27; 87%) and T3 (23; 77%) and using lubricant with a condom for intercourse increased from T1 (6; 30%) to T2 (13; 48%)) and T3 (16; 70%). However, motivation to use condoms did not change. Cronbach’s alpha scores indicated good internal consistency of measures used. Qualitative data provided strong evidence for the acceptability of the intervention. Conclusions HERS-UK was implemented as intended and the recruitment strategy was successful within a college/university setting. This feasibility study provided an early indication of the potential effectiveness and acceptability of the intervention, and the benefits of using a pleasure-focussed approach with young women. Measures used captured change in outcome variables and were deemed fit for purpose. Future research should explore cost-effectiveness of this intervention, in a large-scale controlled trial using a diverse sample and targeting young women most at risk of STIs.

scholarly journals Stroke promotes the development of brain atrophy and delayed cell death in hypertensive rats

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Mohammed A. Sayed ◽  
Wael Eldahshan ◽  
Mahmoud Abdelbary ◽  
Bindu Pillai ◽  
Waleed Althomali ◽  
...  
Keyword(s):  
Cell Death ◽  
Fold Increase ◽  
Magnetic Resonance Images ◽  
Protein Quantification ◽  
Motor Deficits ◽  
Long Term Memory ◽  
Delayed Presentation ◽  
Hypertensive Rats ◽  
Post Stroke ◽  
Delayed Cell Death

AbstractPost-stroke cognitive impairment (PSCI) is a major source of disability, affecting up to two thirds of stroke survivors with no available therapeutic options. The condition remains understudied in preclinical models due to its delayed presentation. Although hypertension is a leading risk factor for dementia, how ischemic stroke contributes to this neurodegenerative condition is unknown. In this study, we used a model of hypertension to study the development of PSCI and its mechanisms. Spontaneously hypertensive rats (SHR) were compared to normotensive rats and were subjected to 1-h middle cerebral artery occlusion or sham surgery. Novel object recognition, passive avoidance test and Morris water maze were used to assess cognition. In addition, brain magnetic resonance images were obtained 12-weeks post-stroke and tissue was collected for immunohistochemistry and protein quantification. Stroked animals developed impairment in long-term memory at 4-weeks post-stroke despite recovery from motor deficits, with hypertensive animals showing some symptoms of anhedonia. Stroked SHRs displayed grey matter atrophy and had a two-fold increase in apoptosis in the ischemic borderzone and increased markers of inflammatory cell death and DNA damage at 12 weeks post-stroke. This indicates that preexisting hypertension exacerbates the development of secondary neurodegeneration after stroke beyond its acute effects on neurovascular injury.

scholarly journals Potential Prognostic Impact of Dopamine Receptor D1 (rs4532) Polymorphism in Post-stroke Outcome in the Elderly

2021 ◽  
Vol 12 ◽  
Author(s):  
Hae-Yeon Park ◽  
Youngkook Kim ◽  
Hyun Mi Oh ◽  
Tae-Woo Kim ◽  
Geun-Young Park ◽  
...  
Keyword(s):  
Dopamine Receptor ◽  
Statistical Significance ◽  
The Elderly ◽  
Minor Allele ◽  
Prognostic Impact ◽  
Nucleotide Polymorphisms ◽  
Unique Identifier ◽  
Clinical Trial Registration ◽  
Post Stroke ◽  
Increased Risk

Background: Single-nucleotide polymorphisms (SNPs) may affect post-stroke motor recovery, and some SNPs have been implicated in swallowing disturbances after stroke. Certain SNPs may also have altered influences according to different age.Objective: This post-hoc study investigated whether SNPs have different effects on dysphagia recovery between the elderly vs. young stroke patients.Methods: Analysis was conducted from a previous study including 218 stroke subjects with dysphagia. They were stratified into two groups, aged <65 and aged ≥65 years. The primary outcome was persistence of nil per mouth (NPM) at 3 months post-stroke onset. Association between outcome and nine different SNPs were investigated.Results: The elderly group (50%, n = 103) showed poorer swallowing outcomes than the young group. The minor allele of the dopamine receptor D1 (DRD1, rs4532) polymorphism showed potential association (p = 0.022) with an increased risk of NPM at 12 weeks post-stroke in the elderly, both in the additive (OR, 2.94; 95% CI, 1.17–7.37) and dominant models (OR, 2.93; 95% CI, 1.04–8.23) but did not reach statistical significance after Bonferonni correction. Logistic regression analysis showed that in those aged ≥65 years, models including the minor allele of rs4532 predicted the risk of the poor outcome with good accuracies even after adjustment of clinical factors, such as previous pneumonia episodes (AUROC, 0.86; 95% CI, 0.79–0.93) or the National Institutes of Health Stroke Scale (AUROC, 0.82; 95% CI, 0.67–0.92). In contrast, those aged <65 years seemed not to be affected by the presence of the rs4532 polymorphism, and models that included intubation history (AUROC, 0.81; 95% CI, 0.73–0.90) or previous pneumonia episodes (AUROC, 0.77; 95% CI, 0.68–0.87) showed modest levels of accuracies in predicting NPM at 12 weeks poststroke.Conclusions: Our study suggests a possible association between the rs4532 and post-stroke swallowing recovery, primarily in those aged ≥65 years. Certain SNPs may lead to less favorable outcomes in the elderly. The gene–age interaction should be considered in post-stroke swallowing recovery.Clinical Trial Registration:https://www.clinicaltrials.gov, Unique identifier [NCT03577444].

Smartphone-Based Ecological Momentary Assessment as the New Standard Measure for Post-Stroke Functioning (Preprint)

2021 ◽  
Author(s):  
Quoc Bui ◽  
Katherine J. Kaufman ◽  
Vy Pham ◽  
Eric J. Lenze ◽  
Jin-Moo Lee ◽  
...  
Keyword(s):  
Ecological Momentary Assessment ◽  
Functional Disability ◽  
Longitudinal Research ◽  
Everyday Functioning ◽  
Post Stroke ◽  
Home Based ◽  
Mobility Devices ◽  
Ecological Momentary ◽  
Cognitive Problems ◽  
Momentary Assessment

BACKGROUND Functional disability is common after stroke. To inform new treatments, better measures are needed to advance our understanding of post-stroke functioning. Ecological momentary assessment (EMA) provides a putatively valid measure of everyday functioning by assessing patients during their lived experiences. OBJECTIVE This study aims to validate the smartphone-based EMA to characterize post-stroke everyday functioning and symptoms. METHODS Participants (N=212) with mild to moderate stroke were assessed five times daily for 14 days with EMA surveys to appraise mental, somatic, and cognitive symptoms, and what, with whom, and where participants were doing activities. Participants also completed standardized assessments during lab visits. RESULTS Most participants (median age = 60 years) were ischemic stroke (90%) and neurologically mild (median NIHSS = 2). Total 14,140 EMA surveys were analyzed. Participants were home 78% of the time and primarily participated in passive, unproductive activities, especially watching television and resting. EMA was sensitive to indicators of post-stroke disability; unemployed participants reported fewer vocational activities (W =12183.5, P < .001) but more activities of daily living (ADL) (W =6995, P < .001) and passive activities (W =7499.5, P =.003) than employed counterparts. Users of mobility devices and participants with cognitive problems spent significantly less time on vocational activities (W =2717, P< .0001 for mobility devices; W =7278, P= .03 for cognitive problems) and more on ADL (W =4807.5, P= .010 for mobility devices; W =9516.5, P< .001 for cognitive problems) than non-users and those without cognitive problems. Our data supported the validity of EMA methods in stroke, with small-to-moderate correlations of EMA with in-lab measures of daily functioning and very large correlations between EMA and in-lab measures of symptoms, especially those measuring the same constructs. CONCLUSIONS Our findings reveal that EMA tracked post-stroke functioning precisely. EMA may be beneficial in examining post-stroke functional recovery, monitoring patients for home-based interventions, and for longitudinal research. CLINICALTRIAL NA

Muscle torques and joint accelerations provide more sensitive measures of post-stroke movement deficits than joint angles.

2021 ◽  
Author(s):  
Ariel B Thomas ◽  
Erienne V Olesh ◽  
Amelia Adcock ◽  
Valeriya Gritsenko
Keyword(s):  
Motor Control ◽  
Motion Capture ◽  
Reaching Movements ◽  
Motor Deficits ◽  
Joint Angles ◽  
Active Joint ◽  
Joint Torques ◽  
Post Stroke ◽  
Muscle Moments ◽  
Muscle Torques

The whole repertoire of complex human motion is enabled by forces applied by our muscles and controlled by the nervous system. The impact of stroke on the complex multi-joint motor control is difficult to quantify in a meaningful way that informs about the underlying deficit in the active motor control and intersegmental coordination. We tested whether post-stroke deficit can be quantified with high sensitivity using motion capture and inverse modeling of a broad range of reaching movements. Our hypothesis is that muscle moments estimated based on active joint torques provide a more sensitive measure of post-stroke motor deficits than joint angles. The motion of twenty-two participants was captured while performing reaching movements in a center-out task, presented in virtual reality. We used inverse dynamics analysis to derive active joint torques that were the result of muscle contractions, termed muscle torques, that caused the recorded multi-joint motion. We then applied a novel analysis to separate the component of muscle torque related to gravity compensation from that related to intersegmental dynamics. Our results show that muscle torques characterize individual reaching movements with higher information content than joint angles do. Moreover, muscle torques enable distinguishing the individual motor deficits caused by aging or stroke from the typical differences in reaching between healthy individuals. Similar results were obtained using metrics derived from joint accelerations. This novel quantitative assessment method may be used in conjunction with home-based gaming motion-capture technology for remote monitoring of motor deficits and inform the development of evidence-based robotic therapy interventions.

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