Rehabilitation and Biomarkers of Stroke Recovery: Study Protocol for a Randomized Controlled Trial

Background: Stroke is a leading cause of disability. Nonetheless, the care pathway for stroke rehabilitation takes partially into account the needs of chronic patients. This is due in part to the lack of evidence about the mechanisms of recovery after stroke, together with the poor knowledge of related and influencing factors. Here we report on the study protocol “Rehabilitation and Biomarkers of Stroke Recovery,” which consists of 7 work-packages and mainly aim to investigate the effects of long-term neurorehabilitation on stroke patients and to define a related profile of (clinical-biological, imaging, neurophysiological, and genetic-molecular) biomarkers of long-term recovery after stroke. The work-package 1 will represent the main part of this protocol and aims to compare the long-term effects of intensive self-rehabilitation vs. usual (rehabilitation) care for stroke.Methods: We planned to include a total of 134 adult subacute stroke patients (no more than 3 months since onset) suffering from multidomain disability as a consequence of first-ever unilateral ischemic stroke. Eligible participants will be randomly assigned to one of the following groups: intensive self-rehabilitation (based on the principles of “Guided Self-Rehabilitation Contract”) vs. usual care (routine practice). Treatment will last 1 year, and patients will be evaluated every 3 months according to their clinical presentation. The following outcomes will be considered in the main work-package: Fugl-Meyer assessment, Cognitive Oxford Screen Barthel Index, structural and functional neuroimaging, cortical excitability, and motor and somatosensory evoked potentials.Discussion: This trial will deal with the effects of an intensive self-management rehabilitation protocol and a related set of biomarkers. It will also investigate the role of training intensity on long-term recovery after stroke. In addition, it will define a set of biomarkers related to post-stroke recovery and neurorehabilitation outcome in order to detect patients with greater potential and define long-term individualized rehabilitation programs.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT04323501.

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Postural Control Disturbances Induced by Virtual Reality in Stroke Patients

Applied Sciences ◽

10.3390/app11041510 ◽

2021 ◽

Vol 11 (4) ◽

pp. 1510

Author(s):

Charles Morizio ◽

Maxime Billot ◽

Jean-Christophe Daviet ◽

Stéphane Baudry ◽

Christophe Barbanchon ◽

...

Keyword(s):

Virtual Reality ◽

Postural Control ◽

Virtual Environments ◽

Center Of Pressure ◽

Dynamic Condition ◽

Static Condition ◽

Stroke Patients ◽

Post Stroke ◽

Subacute Stroke

People who survive a stroke are often left with long-term neurologic deficits that induce, among other impairments, balance disorders. While virtual reality (VR) is growing in popularity for postural control rehabilitation in post-stroke patients, studies on the effect of challenging virtual environments, simulating common daily situations on postural control in post-stroke patients, are scarce. This study is a first step to document the postural response of stroke patients to different challenging virtual environments. Five subacute stroke patients and fifteen age-matched healthy adults were included. All participants underwent posturographic tests in control conditions (open and closed eyes) and virtual environment without (one static condition) and with avatars (four dynamic conditions) using a head-mounted device for VR. In dynamic environments, we modulated the density of the virtual crowd (dense and light crowd) and the avoidance space with the avatars (near or far). Center of pressure velocity was collected by trial throughout randomized 30-s periods. Results showed that more challenging conditions (dynamic condition) induced greater postural disturbances in stroke patients than in healthy counterparts. Our study suggests that virtual reality environments should be adjusted in light of obtaining more or less challenging conditions.

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P60. Direct and long term influence of cardiovascular training on cognition in subacute stroke patients

Clinical Neurophysiology ◽

10.1016/j.clinph.2018.04.696 ◽

2018 ◽

Vol 129 (8) ◽

pp. e91-e92

Author(s):

T. Rackoll ◽

A. Nave ◽

U. Grittner ◽

H. Mousa ◽

K. Villringer ◽

...

Keyword(s):

Stroke Patients ◽

Subacute Stroke ◽

Cardiovascular Training

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Brain stimulation for arm recovery after stroke (B-STARS): protocol for a randomised controlled trial in subacute stroke patients

BMJ Open ◽

10.1136/bmjopen-2017-016566 ◽

2017 ◽

Vol 7 (8) ◽

pp. e016566

Author(s):

Eline C C van Lieshout ◽

Johanna M A Visser-Meily ◽

Sebastiaan F W Neggers ◽

H Bart van der Worp ◽

Rick M Dijkhuizen

Keyword(s):

Motor Cortex ◽

Upper Limb ◽

Brain Stimulation ◽

Primary Outcome ◽

Primary Motor Cortex ◽

Repetitive Transcranial Magnetic Stimulation ◽

Stroke Patients ◽

Post Stroke ◽

Subacute Stroke

IntroductionMany patients with stroke have moderate to severe long-term sensorimotor impairments, often including inability to execute movements of the affected arm or hand. Limited recovery from stroke may be partly caused by imbalanced interaction between the cerebral hemispheres, with reduced excitability of the ipsilesional motor cortex while excitability of the contralesional motor cortex is increased. Non-invasive brain stimulation with inhibitory repetitive transcranial magnetic stimulation (rTMS) of the contralesional hemisphere may aid in relieving a post-stroke interhemispheric excitability imbalance, which could improve functional recovery. There are encouraging effects of theta burst stimulation (TBS), a form of TMS, in patients with chronic stroke, but evidence on efficacy and long-term effects on arm function of contralesional TBS in patients with subacute hemiparetic stroke is lacking.Methods and analysisIn a randomised clinical trial, we will assign 60 patients with a first-ever ischaemic stroke in the previous 7–14 days and a persistent paresis of one arm to 10 sessions of real stimulation with TBS of the contralesional primary motor cortex or to sham stimulation over a period of 2 weeks. Both types of stimulation will be followed by upper limb training. A subset of patients will undergo five MRI sessions to assess post-stroke brain reorganisation. The primary outcome measure will be the upper limb function score, assessed from grasp, grip, pinch and gross movements in the action research arm test, measured at 3 months after stroke. Patients will be blinded to treatment allocation. The primary outcome at 3 months will also be assessed in a blinded fashion.Ethics and disseminationThe study has been approved by the Medical Research Ethics Committee of the University Medical Center Utrecht, The Netherlands. The results will be disseminated through (open access) peer-reviewed publications, networks of scientists, professionals and the public, and presented at conferences.Trial registration numberNTR6133

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P25.17 Long-term effects on cortical excitability and motor recovery induced by repeated muscle vibration in chronic stroke patients

Clinical Neurophysiology ◽

10.1016/s1388-2457(11)60636-6 ◽

2011 ◽

Vol 122 ◽

pp. S176

Author(s):

B. Marconi ◽

G.M. Filippi ◽

G. Koch ◽

V. Giacobbe ◽

C. Pecchioli ◽

...

Keyword(s):

Cortical Excitability ◽

Chronic Stroke ◽

Motor Recovery ◽

Muscle Vibration ◽

Long Term Effects ◽

Stroke Patients

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Cortical excitability of motor anticipatory in subacute stroke patients after virtual reality training: A preliminary movement-related potential study

Annals of Physical and Rehabilitation Medicine ◽

10.1016/j.rehab.2018.05.050 ◽

2018 ◽

Vol 61 ◽

pp. e23

Author(s):

L. Chen ◽

H. Dong Feng

Keyword(s):

Virtual Reality ◽

Cortical Excitability ◽

Virtual Reality Training ◽

Stroke Patients ◽

Potential Study ◽

Subacute Stroke

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P250: Cortical excitability modifications in subacute stroke patients after upper limb rehabilitative treatment

Clinical Neurophysiology ◽

10.1016/s1388-2457(14)50375-6 ◽

2014 ◽

Vol 125 ◽

pp. S114-S115

Author(s):

C. Chisari ◽

G. Lamola ◽

F. Aprigliano ◽

C. Fanciullacci ◽

B. Rossi

Keyword(s):

Upper Limb ◽

Cortical Excitability ◽

Stroke Patients ◽

Rehabilitative Treatment ◽

Subacute Stroke

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Best Conventional Therapy Versus Modular Impairment-Oriented Training for Arm Paresis After Stroke: A Single-Blind, Multicenter Randomized Controlled Trial

Neurorehabilitation and Neural Repair ◽

10.1177/1545968309335974 ◽

2009 ◽

Vol 23 (7) ◽

pp. 706-716 ◽

Cited By ~ 58

Author(s):

Thomas Platz ◽

Stefanie van Kaick ◽

Jan Mehrholz ◽

Ottmar Leidner ◽

Christel Eickhof ◽

...

Keyword(s):

Conventional Therapy ◽

Controlled Trial ◽

Motor Recovery ◽

Long Term Effects ◽

Stroke Patients ◽

Anterior Circulation ◽

Subacute Stroke ◽

Multicenter Randomized Controlled Trial ◽

Active Motor

Background. The study investigated whether passive splinting or active motor training as either individualized best conventional therapy or as standardized impairment-oriented training (IOT) would be superior in promoting motor recovery in subacute stroke patients with mildly or severely paretic arms. Methods. A total of 148 anterior circulation ischemic stroke patients were randomly assigned to 45 minutes of additional daily arm therapy over 3 to 4 weeks as either ( a) passive therapy with inflatable splints or active arm motor therapy as either ( b) individualized best conventional therapy (CONV) or ( c) standardized IOT, that is Arm BASIS training for severe paresis or Arm Ability training for mild paresis. Main outcome measures included the following: Fugl-Meyer arm motor score (severely paretic arms) and the TEMPA time scores (mildly affected arms). Pre—post (immediate effects) and pre—4 weeks follow-up analyses (long-term effects) were performed. Results. Overall improvements were documented (mean baseline and change scores efficacy: Fugl-Meyer, arm motor scores, 24.4, +9.1 points; TEMPA, 119, −26.6 seconds; P < .0001), but with no differential effects between splint therapy and the combined active motor rehabilitation groups. Both efficacy and effectiveness analyses indicated, however, bigger immediate motor improvements after IOT as compared with best conventional therapy (Fugl-Meyer, arm motor scores: IOT +12.3, CONV +9.2 points; TEMPA: IOT −31.1 seconds, CONV −20.5 seconds; P = .0363); for mildly affected patients long-term effects could also be substantiated. Conclusions. Specificity of active training seemed more important for motor recovery than intensity (therapy time). The comprehensive modular IOT approach promoted motor recovery in patients with either severe or mild arm paresis.

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