Functional Improvement After 4-Week Rehabilitation Therapy and Effects of Attention Deficit in Brain Tumor Patients: Comparison With Subacute Stroke Patients

Objectives: To study the effects of therapeutic intensity on functional gains of stroke patients in inpatient rehabilitation. Design: A retrospective cohort study. Setting: An inpatient rehabilitation hospital (IRH) in northern California. Participants: Three hundred and sixty stroke patients discharged from the IRH in 2007. Interventions: Average number of minutes of rehabilitation therapy per day, including physical therapy (PT), occupation therapy (OT), speech language therapy (SLT), and total treatment. Main Outcome Measures: Functional gain measured by the Functional Independence Measure (FIM TM ), including activities of daily living (ADL), mobility, cognition, and total FIM TM scores. Results: The study sample had a mean age of 64.8 years (SD=13.8), and was 57.4% male, and 61.4% White. About three quarter of the patients had an ischemic stroke; 61.4% had one or more significant comorbid conditions. Median IRH length-of-stay (LOS) was 20 days. The mean total therapy time was 190.3 minutes per day (PT 114.0, OT 42.8, and SLT 33.8). The mean total functional gain was 26.0 (ADL 9.1, mobility 11.4, and cognition 6.2). A longer therapeutic duration per day was significantly associated with functional improvement (r=0.20, p<.001). However, patients who received total therapy time of less than 3 hours per day showed significantly lower total functional gain than those treated 3 hours or longer. There was no significant difference in total functional gain between patients treated 3-3.5 hours and over 3.5 hours per day. Intensity of PT, OT, and SLT in hours per day of treatment time was also significantly associated with corresponding sub-scale functional improvements. Figure 1 presents age and gender adjusted therapeutic intensity and FIM TM Gain. Multiple linear regression analyses showed that young age, hemorrhagic stroke, earlier admission to IRH, and longer IRH stay were independent predictors of functional improvement. Conclusions: The study demonstrated a significant relationship between therapeutic intensity and functional gain during IRH stay and provides evidence of treatment intensity thresholds for optimal functional outcomes for stroke patients in inpatient rehabilitation. Key Words: Stroke, rehabilitation therapy, intensity, functional outcomes.

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The Effect of Prolonged Inpatient Rehabilitation Therapy in Subacute Stroke Patients

Annals of Rehabilitation Medicine ◽

10.5535/arm.2012.36.1.16 ◽

2012 ◽

Vol 36 (1) ◽

pp. 16 ◽

Cited By ~ 9

Author(s):

Jong Hwa Lee ◽

Sang Beom Kim ◽

Kyeong Woo Lee ◽

Ji Yeong Lee

Keyword(s):

Inpatient Rehabilitation ◽

Stroke Patients ◽

Rehabilitation Therapy ◽

Subacute Stroke

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Motor improvement estimation and task adaptation for personalized robot-aided therapy: a feasibility study

10.1101/728725 ◽

2019 ◽

Author(s):

Christian Giang ◽

Elvira Pirondini ◽

Nawal Kinany ◽

Camilla Pierella ◽

Alessandro Panarese ◽

...

Keyword(s):

Motor Impairment ◽

Motor Deficits ◽

Pilot Test ◽

Stroke Patients ◽

Rehabilitation Therapy ◽

Model Based ◽

Link Type ◽

Upper Limb Exoskeleton ◽

Subacute Stroke ◽

Motor Improvement

AbstractBackgroundIn the past years, robotic systems have become increasingly popular in both upper and lower limb rehabilitation. Nevertheless, clinical studies have so far not been able to confirm superior efficacy of robotic therapy over conventional methods. The personalization of robot-aided therapy according to the patients’ individual motor deficits has been suggested as a pivotal step to improve the clinical outcome of such approaches.MethodsHere, we present a model-based approach to personalize robot-aided rehabilitation therapy within training sessions. The proposed method combines the information from different motor performance measures recorded from the robot to continuously estimate patients’ motor improvement for a series of point-to-point reaching movements in different directions and comprises a personalization routine to automatically adapt the rehabilitation training. We engineered our approach using an upper limb exoskeleton and tested it with seventeen healthy subjects, who underwent a motor-adaptation paradigm, and two subacute stroke patients, exhibiting different degrees of motor impairment, who participated in a pilot test.ResultsThe experiments illustrated the model’s capability to differentiate distinct motor improvement progressions among subjects and subtasks. The model suggested personalized training schedules based on motor improvement estimations for each movement in different directions. Patients’ motor performances were retained when training movements were reintroduced at a later stage.ConclusionsOur results demonstrated the feasibility of the proposed model-based approach for the personalization of robot-aided rehabilitation therapy. The pilot test with two subacute stroke patients further supported our approach, while providing auspicious results for the applicability in clinical settings.Trial registrationThis study is registered in ClinicalTrials.gov (NCT02770300, registered 30 March 2016, https://clinicaltrials.gov/ct2/show/NCT02770300).

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Poster 464 The Effects of Prolonged Inpatient Rehabilitation Therapy in Subacute Stroke Patients

PM&R ◽

10.1016/j.pmrj.2011.08.494 ◽

2011 ◽

Vol 3 ◽

pp. S336-S337

Author(s):

Jong Hwa Lee ◽

Min Ah Kim ◽

Sang Beom Kim

Keyword(s):

Inpatient Rehabilitation ◽

Stroke Patients ◽

Rehabilitation Therapy ◽

Subacute Stroke

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Different Brain Connectivity between Responders and Nonresponders to Dual-Mode Noninvasive Brain Stimulation over Bilateral Primary Motor Cortices in Stroke Patients

Neural Plasticity ◽

10.1155/2019/3826495 ◽

2019 ◽

Vol 2019 ◽

pp. 1-10 ◽

Cited By ~ 11

Author(s):

Jungsoo Lee ◽

Ahee Lee ◽

Heegoo Kim ◽

Mina Shin ◽

Sang Moon Yun ◽

...

Keyword(s):

Brain Stimulation ◽

Primary Motor Cortex ◽

Functional Improvement ◽

Patient Specific ◽

Stroke Patients ◽

Noninvasive Brain Stimulation ◽

Network Characteristics ◽

Subacute Stroke ◽

Motor Network ◽

Interhemispheric Connectivity

Noninvasive brain stimulation (NBS), such as repetitive transcranial magnetic stimulation (rTMS) or transcranial direct current stimulation (tDCS), has been used in stroke patients with motor impairment. NBS can help recovery from brain damage by modulating cortical excitability. However, the efficacy of NBS varies among individuals. To obtain insights of responsiveness to the efficacy of NBS, we investigated characteristic changes of the motor network in responders and nonresponders of NBS over the primary motor cortex (M1). A total of 21 patients with subacute stroke (13 males, mean age 59.6±11.5 years) received NBS in the same manner: 1 Hz rTMS on the contralesional M1 and anodal tDCS on the ipsilesional M1. Participants were classified into responders and nonresponders based on the functional improvement of the affected upper extremity after applying NBS. Twelve age-matched healthy controls (8 males, mean age 56.1±14.3 years) were also recruited. Motor networks were constructed using resting-state functional magnetic resonance imaging. M1 intrahemispheric connectivity, interhemispheric connectivity, and network efficiency were measured to investigate differences in network characteristics between groups. The motor network characteristics were found to differ between both groups. Specifically, M1 intrahemispheric connectivity in responders showed a noticeable imbalance between affected and unaffected hemispheres, which was markedly restored after NBS. The responders also showed greater interhemispheric connectivity and higher efficiency of the motor network than the nonresponders. These results may provide insight on patient-specific NBS treatment based on the brain network characteristics in neurorehabilitation of patients with stroke. This trial is registered with trial registration number NCT03390192.

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