scholarly journals Reactive Exercises with Interactive Objects: Interim Analysis of a Randomized Trial on Task-Driven NMES Grasp Rehabilitation for Subacute and Early Chronic Stroke Patients

Sensors ◽  
2021 ◽  
Vol 21 (20) ◽  
pp. 6739
Author(s):  
Andrea Crema ◽  
Ivan Furfaro ◽  
Flavio Raschellà ◽  
Mauro Rossini ◽  
Johannes Zajc ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Technology Acceptance ◽  
Interim Analysis ◽  
Clinical Investigation ◽  
Training System ◽  
Control Group ◽  
Hand Rehabilitation ◽  
Stroke Patients ◽  
Open Label ◽  
Perceived Usability

Enriched environments and tools are believed to promote grasp rehabilitation after stroke. We designed S2, an interactive grasp rehabilitation system consisting of smart objects, custom orthoses for selective grasp constraining, and an electrode array system for forearm NMES. Motor improvements and perceived usability of a new enriched upper limb training system for sub-acute stroke patients was assessed in this interim analysis. Inclusion criteria: sub-acute stroke patients with MMSE>20, ipsilesional MI>80%, and contralesional MI<80%. Effects of 30-min therapy supplements, conventional vs. S2 prototype, are compared through a parallel two-arms dose-matched open-label trial, lasting 27 sessions. Clinical centres: Asklepios Neurologische Klinik Falkenstein, Königstein im Taunus, Germany, and Clinica Villa Beretta, Costa Masnaga, Italy. Assessment scales: ARAT, System Usability, and Technology Acceptance. Methodology: 26 participants were block randomized, allocated to the study (control N=12, experimental N=14) and underwent the training protocol. Among them, 11 participants with ARAT score at inclusion below 35, n = 6 in the experimental group, and n = 5 in the control group were analysed. Results: participants in the enriched treatment group displayed a larger improvement in the ARAT scale (+14.9 pts, pval=0.0494). Perceived usability differed between clinics. No adverse effect was observed in relation to the treatments. Trial status: closed. Conclusions: The S2 system, developed according to shared clinical directives, was tested in a clinical proof of concept. Variations of ARAT scores confirm the feasibility of clinical investigation for hand rehabilitation after stroke.

scholarly journals Clinical Efficacy of a New Robot-assisted Gait Training System for Acute Stroke Patients

2021 ◽  
Author(s):  
Andy Chien ◽  
Fei-Chun Chang ◽  
Nai-Hsin Meng ◽  
Pei-Yu Yang ◽  
Ching Huang ◽  
...  
Keyword(s):  
Sleep Quality ◽  
Acute Stroke ◽  
Quality Index ◽  
Pittsburgh Sleep Quality Index ◽  
Gait Training ◽  
Training System ◽  
Control Group ◽  
Stroke Patients ◽  
Robot Assisted ◽  
Significant Difference

Abstract Purpose Robot-assisted gait rehabilitation has been proposed as a plausible supplementary rehabilitation strategy in stroke rehabilitation in the last decade. However, its exact benefit over traditional rehabilitation remain sparse and unclear. It is therefore the purpose of the current study to comparatively investigate the clinical benefits of the additional robot-assisted training in acute stroke patients compared to standard hospital rehabilitation alone. Methods Ninety acute stroke patients (< 3 month) were recruited. All participants received the standard hospital neurorehabilitation comprises 45–60 min sessions daily for 3 weeks. Sixty patients also received an additional 30 min of robot-assisted gait training with the HIWIN MRG-P100 gait training system after each of the standard neurorehabilitation session. Outcome measures included: 1. Berg Balance Scale (BBS); 2. Brunnstrom Stage; 3. Pittsburgh Sleep Quality Index and 4. Taiwanese Depression Questionnaire (TDQ) which were assessed pre-treatment and then after every five training sessions. Results Both groups demonstrated significant improvement pre- and post-treatment for the BBS (robotic group p = 0.023; control group p = 0.033) but no significant difference (p > 0.1) between the groups were found. However, the robotic training group had more participants demonstrating larger BBS points of improvement as well as greater Brunnstrom stage of improvement, when compared to the control group. No significant within and between group statistical differences (p > 0.3) were found for Pittsburgh Sleep Quality Index and Taiwanese Depression Questionnaire. Conclusion The addition of robotic gait training on top of standard hospital neurorehabilitation for acute stroke patients appear to produce a slightly greater improvement in clinical functional outcomes, which is not transferred to psychological status.

scholarly journals TeleNeurological evaluation and Support for the Emergency Department (TeleNS-ED): protocol for an open-label clinical trial

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e048293
Author(s):  
Jessica Mandrioli ◽  
Mario Santangelo ◽  
Antonio Luciani ◽  
Stefano Toscani ◽  
Elisabetta Zucchi ◽  
...  
Keyword(s):  
Emergency Department ◽  
Clinical Investigation ◽  
Neurological Diseases ◽  
Medical Personnel ◽  
Primary Objective ◽  
Control Group ◽  
National Guidelines ◽  
Open Label ◽  
Time Saving ◽  
Hospital Networks

IntroductionThe COVID-19 pandemic compelled health systems to protect patients and medical personnel during transit in hospitals by minimising transfers, prompting the use of telehealth systems. In the field of neurology, telemedicine has been used in emergency settings for acute stroke management between spoke and hub hospital networks, where good outcomes have been achieved. However, data on the use of telemedicine in non-stroke acute neurological conditions accessing the emergency department (ED) are currently missing.Methods and analysesThis is an interventional, open-label trial on the use of teleconsultation in the ED for neurological diseases other than stroke. The study aims to develop a remote consultancy system (TeleNeurological Evaluation and Support, TeleNS) for patients with acute neurological symptoms referred to hospital facilities without a 24-hour availability of a neurologist consultant (spoke hospitals). The study population will include 100 ED patients referred to two spoke hospitals in 6 months, who will be asked to perform teleconsultation instead of inperson visits. As a control group, retrospectively available data from patients admitted to the ED of spoke hospitals during the same time period over the last 2 years will be evaluated. The primary objective is to assess whether a TeleNS for the ED guarantees a faster but qualitatively non-inferior diagnostic/therapeutic work-up if compared with inperson examination, assuring the availability of all the necessary examinations and treatments with consistent time-saving.Ethics and disseminationThe trial was designed following the national guidelines on clinical investigation on telemedicine provided by the Italian Ministry of Health and according to the Standard Protocol Items for Randomized Trials statement guidelines. This research protocol was approved by Comitato Etico Area Vasta Emilia Nord in September 2020 (number/identification: 942/2020/DISP/AOUMO SIRER ID 805) and was written without patient involvement. Patients’ associations will be involved in the dissemination of study design and results. The results of the study will be presented during scientific symposia or published in scientific journals.Trial registration numberNCT04611295.

scholarly journals EFFICACY OF FUNCTIONAL NEUROMUSCULAR ELECTRICAL STIMULATION (FNMES) IN THE IMPROVEMENT OF HAND FUNCTIONS IN ACUTE STROKE SURVIVALS

2012 ◽  
Vol 02 (04) ◽  
pp. 16-21
Author(s):  
Mohamed Faisal C. K. ◽  
Priyabandani Neha Om Prakash ◽  
Ajith S.
Keyword(s):  
Electrical Stimulation ◽  
Acute Stroke ◽  
Hand Function ◽  
Neuromuscular Electrical Stimulation ◽  
Control Group ◽  
Stroke Patients ◽  
Hand Functions ◽  
Conventional Physiotherapy ◽  
Block Test ◽  
Experimental Group

AbstractStroke is a worldwide health problem. Hand function is one of the important factors which are affected in stroke. Stroke patients are usually given a conventional physiotherapy but if an additional FNMES is given it might show better improvement. By keeping these facts in view, the present study aims at evaluating and comparing the efficacy of conventional physiotherapy and adding FNMES will make any better outcome in the acute stroke survivals. The subjects were randomly assigned to any of the two groups; control group consisted of 15 subjects who received only conventional therapy for 4 weeks and experimental group consisting of 15 subjects who received an additional FNMES along with conventional physiotherapy for 4 weeks. The hand function was assessed on day 1 and to know the recovery, at the end of four weeks of intervention with the help of action research arm test (ARAT) and box and block test (BBT). At the end of 4 weeks of intervention both the groups showed significant improvements. On ARAT, control group showed a mean of 10.2000 whereas, experimental group showed mean of 20.8000 with p = 0.001 (p ≤ 0.05) and on BBT, the control group showed a mean of 21.666 and experimental group showed 30.933 with p = 0.41 (p ≤ S 0.05). Therefore the study concludes that, though there was improvement in both the groups, the experimental group who received an additional FNMES along with conventional physiotherapy showed better improvement in hand functions in the acute stroke survivals.

The impact of environmental enrichment in an acute stroke unit on how and when patients undertake activities

2018 ◽  
Vol 33 (4) ◽  
pp. 784-795 ◽  
Author(s):  
Ingrid CM Rosbergen ◽  
Rohan S Grimley ◽  
Kathryn S Hayward ◽  
Sandra G Brauer
Keyword(s):  
Acute Stroke ◽  
Stroke Unit ◽  
Environmental Enrichment ◽  
Control Group ◽  
Activity Levels ◽  
Stroke Patients ◽  
Group Activities ◽  
Acute Stroke Unit ◽  
Communal Areas ◽  
The Impact

Objectives: To explore the effect of environmental enrichment within an acute stroke unit on how and when patients undertake activities, and the amount of staff assistance provided, compared with a control environment (no enrichment). Design: This is a substudy of a controlled before–after observational study. Setting: The study was conducted in an Australian acute stroke unit. Participants: The study included stroke patients admitted to (1) control and (2) environmental enrichment period. Intervention: The control group received standard therapy and nursing care, which was delivered one-on-one in the participants’ bedroom or a communal gym. The enriched group received stimulating resources and communal areas for mealtimes, socializing and group activities. Furthermore, participants and families were encouraged to increase patient activity outside therapy hours. Main measures: Behavioral mapping was performed every 10 minutes between 7.30 a.m. and 7.30 p.m. on weekdays and weekends to estimate activity levels. We compared activity levels during specified time periods, nature of activities observed and amount of staff assistance provided during patient activities across both groups. Results: Higher activity levels in the enriched group ( n = 30, mean age 76.7 ± 12.1) occurred during periods of scheduled communal activity ( P < 0.001), weekday non-scheduled activity ( P = 0.007) and weekends ( P = 0.018) when compared to the control group ( n = 30, mean age 76.0 ± 12.8), but no differences were observed on weekdays after 5 p.m. ( P = 0.324). The enriched group spent more time on upper limb ( P < 0.001), communal socializing ( P < 0.001), listening ( P = 0.007) and iPad activities ( P = 0.002). No difference in total staff assistance during activities was observed ( P = 0.055). Conclusion: Communal activities and environmental resources were important contributors to greater activity within the enriched acute stroke unit.

Abstract WMP3: Direct Transfer to Angio-suite to Reduce Door-to-puncture Time in Thrombectomy for Acute Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Marc Ribo ◽  
Alejandro Tomasello ◽  
Sandra Boned ◽  
Pilar Coscojuela ◽  
Jesus Juega ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Control Group ◽  
Direct Transfer ◽  
Stroke Patients ◽  
Primary Stroke Center ◽  
Femoral Puncture ◽  
Procedural Time ◽  
Baseline Characteristics ◽  
Stroke Center ◽  
Race 4

Background: We aim to evaluate the feasibility and safety of a direct transfer to the angio-suite protocol for acute stroke patients candidates for endovascular treatment (EVT). Methods: Starting June 2016, patients with pre-hospital stroke code activation (RACE≥4) admitted within 4.5h from symptoms-onset were directly transferred on admission to angio-suite (DTA) bypassing the emergency room. After Xpert-CT in the angio-suite for parenchymal evaluation, femoral puncture and EVT were performed as usual. Patients following DTA were compared to all patients with same admission criteria treated with EVT in the previous 2 years (control group, CG). Results: Of the 16 patients that followed DTA, 1 (6%) showed an intracranial hemorrhage (ICH) on Xpert-CT and 15 underwent EVT, representing 50% of EVT admitted within 4.5h or 34% of all EVT performed in the study period. 56% of DTA patients had previous neuroimaging at a primary stroke center, 44% were primary admissions with no previous neuroimaging. Baseline characteristics including age (71 Vs 72 years; p=0.71) and admission NIHSS (18.5 Vs 18;p=0.68) were comparable. Median time from admission to groin puncture was significantly shorter in DTA patients (15 minutes IQR:13-19 Vs 65 IQR:45-10;p<0.01). Rate of no treatable occlusion on initial angiogram was 13.3% in DTA Vs 2.4% in CG (p=0.17). Procedural time (36 Vs 55 minutes;p=0.034) was shorter in the DTA group, while recanalization (TICI 2b-3: 86% Vs 81%;p=0.24) and symptomatic ICH rates(6.7% Vs 6.6%;p=0.98) and 24h NIHSS (10 Vs 10.5; p=0.81) were comparable. The total time from admission to recanalization was significantly shorter when DTA was applied (median 52 Vs 123;p<0.01). Conclusion: In a subgroup of acute stroke patients presenting in the early window, direct transfer and triage in the angio-suite seems feasible, safe and achieves a significant reduction in hospital workflow times.

scholarly journals Early home-supported discharge for patients with stroke in Portugal: a randomised controlled trial

2016 ◽  
Vol 31 (2) ◽  
pp. 197-206 ◽  
Author(s):  
Silvina Santana ◽  
José Rente ◽  
Conceição Neves ◽  
Patrícia Redondo ◽  
Nina Szczygiel ◽  
...  
Keyword(s):  
Stroke Unit ◽  
Controlled Trial ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Primary Outcome Measure ◽  
Control Group ◽  
Stroke Patients ◽  
Control Groups ◽  
Open Label

Objective: To evaluate an early home-supported discharge service for stroke patients. Design: We carried out a prospective, randomised, open-label, blinded-endpoint trial (allocation ratio of 1:1) with patients assigned to either an early home-supported discharge service or usual care. Setting: The study was undertaken in Aveiro, Portugal, between April 2009 and April 2013. Subjects: We included stroke patients aged 25–85 years admitted to the stroke unit with an initial Functional Independence Measure of up to 100, who gave informed consent. Interventions: Patients in the early home-supported discharge group began their rehabilitation intervention in the stroke unit and the early home-supported discharge team worked with them at home for a maximum of one month. Patients in the control group received usual services. Main measures: The primary outcome measure was the Functional Independence Measure at six months after stroke. Results: We randomised 190 patients of whom 34 were lost to follow-up. There were no significant differences (p > 0.5) in the average scores of Functional Independence Measure between the early home-supported discharge (69 ±22; mean ±SD) and the control groups (71 ±17) measured at baseline; and between the early home-supported discharge (107 ±20) and the control groups (107 ±25) measured at six months. The number of individuals with a low Functional Independence Measure score (<60) in the early home-supported discharge group compared with the control group was higher at admission (34/95 vs. 26/95) and lower at follow-up (2/74 vs. 5/78). Conclusions: It was feasible to implement early home-supported discharge procedures in a Southern European setting, but we have not shown convincing differences in disability at six months.

Abstract W P337: Using Simulation Mannequins to Train Nurses in Stroke Dysphagia Screening

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Tonya Freeland ◽  
Racquell Garrett ◽  
Shweta Pathak ◽  
Jane A Anderson ◽  
Stephanie K Daniels
Keyword(s):  
Acute Stroke ◽  
Control Group ◽  
Stroke Patients ◽  
Procedural Skills ◽  
Exact Test ◽  
Didactic Training ◽  
Service Training ◽  
Swallowing Screening ◽  
Main Component ◽  
Experimental Group

Background and Purpose: Screening patients admitted with stroke symptoms for risk of dysphagia is often the responsibility of registered nurses (RNs). Simulation technology has become a widely used evidence-based form of training for healthcare professionals. Simulation mannequins allow for training in a controlled environment, eliminating the need for practice of skills with live patients. The purpose of this pilot study was to compare effectiveness of in-service training to a comprehensive training method utilizing a medical simulation mannequin as a main component to teach administration of swallowing screening items. Methods: RNs (N=32) were randomly assigned to one of two training groups. Both groups received a 20 minute didactic training in administration and interpretation of non-swallow (dysarthria, wet voice, abnormal volitional cough) and water swallow (cough, throat clear, wet voice) screening components. The control group (n=16) received only didactic training. The experimental group (n=16) received didactic training plus additional training with a medical mannequin programmed to simulate auditory elements of acute stroke patients, e.g., dysarthria, cough after swallow. Acquisition of skills was evaluated for both groups using the medical mannequin simulated with various stroke patient profiles. Fisher’s Exact Test was used to assess the association between type of training and acquisition of skills. Results: No significant association was evident for acquisition of interpretation or procedural skills between groups. Raw data revealed that the experimental group achieved accurate interpretation and procedural skills in fewer trials than the control group. This was particularly evident for procedural skills in which 69% in the experimental group achieved accurate administration within one trial while only 31% in the control group demonstrated accuracy. Conclusion: Results indicate that simulation training is a feasible method to teach and evaluate obtainment of skills necessary to accurately complete dysphagia screenings in acute stroke patients. Further research should focus on retention of skills learned and translation of skills from the simulated patient to live patients admitted with stroke symptoms.

The Effectiveness of Mirror Therapy to Upper Extremity Rehabilitation in Acute Stroke Patients

2021 ◽  
Author(s):  
Phassakorn Klinkwan ◽  
Chalunda Kongmaroeng ◽  
Sombat Muengtaweepongsa ◽  
Wiroj Limtrakarn
Keyword(s):  
Acute Stroke ◽  
Upper Extremity ◽  
Upper Limb ◽  
Conventional Therapy ◽  
Motor Recovery ◽  
Stroke Recovery ◽  
Home Exercise ◽  
Control Group ◽  
Mirror Therapy ◽  
Stroke Patients

Rehabilitation is a crucial part of stroke recovery to help them regain use of their limb. The aim of this article was to compare the effectiveness of long-term training of mirror therapy with conventional rehabilitation therapy on neurological and recovery of upper limb in acute stroke patients. In this randomized and assessor-blinded control study, 20 acute stroke patients were analyzed in this study and allocated to a case (n = 10, 50.6 ± 17.90 years) and control group (n = 10, 55.9 ± 11.25 years). All the participants performed daily home exercise during 12 weeks. The patients in the control group were treated with conventional therapy (CT) and a group of cases were treated with mirror therapy (MT) alone program. The outcome measurements were assessed by a therapist blinded assessor using Fugl-Meyer Assessment (FMA) upper extremity score, Brunnstrom recovery stages (BRS), Modified Ashworth Scale (MAS) and Muscle Strength to evaluate upper limb motor function and motor recovery. Data were analyzed using Wilcoxon and Mann-Whitney U tests to compare within-groups and between-group differences. The results revealed that, after 12 weeks of treatment, patients of both groups presented statistically significant improvements in all the variables measured (p < 0.05). Compared with the control group, the patients of the MT group had greater improvement in the proximal movement portion of the FMA upper extremity mean score change (15.8 ± 3.2 versus 10.0 ± 2.7, p = 0.002) while there were no differences in other variables (p > 0.05). There were also no adverse events. It suggests that 12 weeks training of mirror therapy alone was likely to improve the motor recovery of the upper limb and activity of daily living in acute stroke patients than conventional therapy, if treated early.

Preventive Antibiotics in Stroke Study (PASS)

Neurology ◽  
2018 ◽  
Vol 90 (18) ◽  
pp. e1553-e1560 ◽  
Author(s):  
Willeke F. Westendorp ◽  
Elles Zock ◽  
Jan-Dirk Vermeij ◽  
Henk Kerkhoff ◽  
Paul J. Nederkoorn ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Acute Stroke ◽  
Resource Use ◽  
Institutional Care ◽  
Cost Effective ◽  
Quality Adjusted Life Year ◽  
Cost Utility ◽  
Control Group ◽  
Open Label ◽  
The Cost

ObjectiveTo evaluate the cost-effectiveness of preventive ceftriaxone vs standard stroke unit care without preventive antimicrobial therapy in acute stroke patients.MethodsIn this multicenter, randomized, open-label trial with masked endpoint assessment, 2,550 patients with acute stroke were included between 2010 and 2014. Economic evaluation was performed from a societal perspective with a time horizon of 3 months. Volumes and costs of direct, indirect, medical, and nonmedical care were assessed. Primary outcome was cost per unit of the modified Rankin Scale (mRS) and per quality-adjusted life year (QALY) for cost-effectiveness and cost-utility analysis. Incremental cost-effectiveness analyses were performed.ResultsA total of 2,538 patients were available for the intention-to-treat analysis. For the cost-effectiveness analysis, 2,538 patients were available for in-hospital resource use and 1,453 for other resource use. Use of institutional care resources, out-of-pocket expenses, and productivity losses was comparable between treatment groups. The mean score on mRS was 2.38 (95% confidence interval [CI] 2.31–2.44) vs 2.44 (95% CI 2.37–2.51) in the ceftriaxone vs control group, the decrease by 0.06 (95% CI −0.04 to 0.16) in favor of ceftriaxone treatment being nonsignificant. However, the number of QALYs was 0.163 (95% CI 0.159–0.166) vs 0.155 (95% CI 0.152–0.158) in the ceftriaxone vs control group, with the difference of 0.008 (95% CI 0.003–0.012) in favor of ceftriaxone (p = 0.006) at 3 months. The probability of ceftriaxone being cost-effective ranged between 0.67 and 0.89. Probability of 0.75 was attained at a willing-to-pay level of €2,290 per unit decrease in the mRS score and of €12,200 per QALY.ConclusionsPreventive ceftriaxone has a probability of 0.7 of being less costly than standard treatment per unit decrease in mRS and per QALY gained.

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