Efficacy of Bilateral Lower Limb Training over Unilateral to Re-educate Balance and Walking in Post-stroke Survivors: A Protocol for Randomized Clinical Trial

Background: One of the significant causes of morbidity worldwide and an essential contributor to disability is Stroke. As said by the National Stroke Association, nine post-stroke survivors out of 10 experience some degree of weakness post-stroke. The hemiplegic patients with sub-acute stroke, who will undergo training to both the lower limb overtraining to only involved side will have an improvement in balance and walking. The goal of this study is to see how much training to both the lower limb improves functional recovery in patients who have had a subacute stroke compared to unilateral, more insufficient limb training. Objective: The goal of this study was to see how training to both the lower limb overtraining to the hemiparetic lower limb on balance and walking in subacute stroke patients. Methods: A randomized clinical study with assessor blinding will be conducted with participants with subacute stroke (n=40). Participants will be randomized to one of two groups after performing baseline assessments: Group A or Group B.1st group will receive training only to the hemiparetic side, i.e., Motor Relearning Programme and Proprioceptive Neuromuscular Facilitation, and 2nd group participants will receive bilateral training, i.e., Strengthening to the unaffected side along with Motor Relearning Programme and Proprioceptive Neuromuscular Facilitation to the affected side. During the therapy period, we will assess lower limb function through static and dynamic balance, walking, and gait measures. Results: The purpose of the research is to look into the effect of training to both the lower limb overtraining to the hemiparetic lower limb on balance and walking in subacute stroke patients. The results of this study will be based on the outcome measures that are static and dynamic balance in the stroke patients and walking. Conclusion: The study's findings will shed more light on the benefits of training to both the lower limb overtraining to only involved side in patients post-stroke. If this trial proves successful, it will help post-stroke patients improve their balance and walking.

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Efficacy of bilateral lower limb training over unilateral to re-educate balance and walking in post stroke survivors: a protocol for randomized clinical trial

10.21203/rs.3.pex-1497/v1 ◽

2021 ◽

Author(s):

Pallavi Harjpal ◽

Mohd Irshad Qureshi

Keyword(s):

Clinical Trial ◽

Randomized Clinical Trial ◽

Lower Limb ◽

Stroke Survivors ◽

Clinical Trial Registry ◽

Post Stroke ◽

Subacute Stroke ◽

Bilateral Training ◽

Bilateral Lower Limb ◽

Group B

Abstract Background: Stroke is the leading cause of global morbidity and a major contributor to disability. According to the National Stroke Association, as many as 9 out of 10 stroke survivors have some degree of paralysis immediately after the stroke. Aim is to evaluate the level to which the bilateral lower limb training compared to unilateral alone, reinforces the lower limb functional recovery in the subjects with sub-acute stroke.Methods: The participants (n=40) with subacute stroke will be included in assessor blinded, randomized clinical trial. Participants will be categorized into 2 groups after performing baseline assessments and equal randomization. The participants in Group A will receive only training to the affected side, and those in the Group B will receive bilateral training. We will be evaluating the improvement in lower limb function by balance and walking along with gait parameters.Discussion: Findings of the study will provide further insight into the effectiveness of bilateral training over unilateral in post stroke survivors. If this study is proved to be effective it will improve the balance and gait impairments in post stroke patients.The clinical trial registry-India(CTRI) registration number for this trial is CTRI/2021/05/033621.

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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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Exercise Stress Testing in Subacute Stroke Patients Using a Combined Upper- and Lower-Limb Ergometer

Archives of Physical Medicine and Rehabilitation ◽

10.1016/j.apmr.2005.03.002 ◽

2005 ◽

Vol 86 (9) ◽

pp. 1860-1866 ◽

Cited By ~ 17

Author(s):

Denise C. Hill ◽

Karen D. Ethans ◽

Don A. MacLeod ◽

Edmund R. Harrison ◽

Jane E. Matheson

Keyword(s):

Lower Limb ◽

Stress Testing ◽

Exercise Stress ◽

Exercise Stress Testing ◽

Stroke Patients ◽

Subacute Stroke

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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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Effects of botulinum toxin A therapy and multidisciplinary rehabilitation on lower limb spasticity classified by spastic muscle echo intensity in post-stroke patients

Annals of Physical and Rehabilitation Medicine ◽

10.1016/j.rehab.2018.05.417 ◽

2018 ◽

Vol 61 ◽

pp. e182

Author(s):

T. Hara ◽

A. Masahiro ◽

H. Hiroyoshi ◽

K. Kazushige

Keyword(s):

Botulinum Toxin ◽

Lower Limb ◽

Botulinum Toxin A ◽

Echo Intensity ◽

Stroke Patients ◽

Toxin A ◽

Multidisciplinary Rehabilitation ◽

Post Stroke ◽

Limb Spasticity ◽

Lower Limb Spasticity

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LACK OF EMPHASIS ON PSYCHOLOGICAL REHABILITATION FOR STROKE PATIENTS

Pakistan Journal of Rehabilitation ◽

10.36283/pjr.zu.1.1/009 ◽

2012 ◽

Vol 1 (1) ◽

pp. 2

Author(s):

Samina Masood Haider

Keyword(s):

Emotional Difficulties ◽

Stroke Survivors ◽

Stroke Patients ◽

Post Stroke ◽

Post Stroke Depression ◽

The Many ◽

Over Time

It has been observed that most of the patients are not aware of the dilapidating affects of post stroke depression on their recovery, survival and a return to normal activities of life. The lack of emphasis on psychological rehabilitation for stroke patients is a source of concern for me and I would like to bring to your attention about the facts regarding the implications of proper psychological rehabilitation is not undertaken. Stroke survivors report a range of emotional difficulties, most common being fear, anxiety, frustration, anger, sadness and a sense of grief for their physical and mental losses. Usually these feelings may fade over time however, some patients may struggle with adjusting to the many changes following stroke. When this happens these feelings can develop into depression. It is estimated that approximately one-third of stroke1 survivors develop post-stroke depression (PSD)

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Association among depression, cognitive impairment and executive dysfunction after stroke

Dementia & Neuropsychologia ◽

10.1590/s1980-57642012dn06030007 ◽

2012 ◽

Vol 6 (3) ◽

pp. 152-157 ◽

Cited By ~ 13

Author(s):

Luisa Terroni ◽

Matildes F.M. Sobreiro ◽

Adriana B. Conforto ◽

Carla C. Adda ◽

Valeri D. Guajardo ◽

...

Keyword(s):

Cognitive Impairment ◽

Neuropsychological Tests ◽

Executive Dysfunction ◽

Stroke Survivors ◽

Stroke Patients ◽

Adequate Treatment ◽

Post Stroke ◽

Quantitative Studies ◽

Post Stroke Depression ◽

The Relationship

ABSTRACT The relationship between depression and cognitive impairment, frequent after stroke, is complex and has not been sufficiently elucidated. Objective: To review the relationship between post-stroke depression and cognitive impairment. Methods: We performed a PubMed database search spanning the last ten years, using the terms post-stroke depression, cognitive dysfunction, cognitive impairment and neuropsychological tests. Our target studies were original quantitative studies that investigated the relationship between post-stroke depression (PSD) and cognitive impairment in stroke patients. Articles published in English, Spanish, Italian and Portuguese were considered. Selection criteria were the use of neuropsychological tests to assess cognitive function, and of either instruments to diagnose major depression, or scales to assess depressive symptoms, within the first three months after stroke. Results: Six original quantitative studies fulfilled the criteria. The prevalence of PSD within the first three months after stroke ranged from 22% to 31%. Incidence ranged from 25% to 27% and was evaluated in only two studies. PSD was associated with increased cognitive impairment. Cognitive impairment was reported in 35.2% to 87% of the patients. Post-stroke cognitive deficits were reported mostly in executive function, memory, language, and speed of processing. Conclusion: Executive dysfunction and depression occur in stroke survivors, are frequently coexistent, and also associated with worse stroke prognosis. Healthcare professionals need to address and provide adequate treatment for depression and executive dysfunctions in stroke patients early in the first three months after stroke. Future studies should evaluate the efficacy of programs evaluating the early detection and treatment of PSD and executive dysfunction in stroke survivors.

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The Role of Continuous Theta Burst TMS in the Neurorehabilitation of Subacute Stroke Patients: A Placebo-Controlled Study

Frontiers in Neurology ◽

10.3389/fneur.2021.749798 ◽

2021 ◽

Vol 12 ◽

Author(s):

Ana Dionísio ◽

Rita Gouveia ◽

João Castelhano ◽

Isabel Catarina Duarte ◽

Gustavo C. Santo ◽

...

Keyword(s):

Motor Function ◽

Primary Motor Cortex ◽

Phase Iii ◽

Repeated Measure ◽

Controlled Study ◽

Stroke Patients ◽

Post Stroke ◽

Subacute Stroke ◽

Theta Burst

Objectives: Transcranial magnetic stimulation, in particular continuous theta burst (cTBS), has been proposed for stroke rehabilitation, based on the concept that inhibition of the healthy hemisphere helps promote the recovery of the lesioned one. We aimed to study its effects on cortical excitability, oscillatory patterns, and motor function, the main aim being to identify potentially beneficial neurophysiological effects.Materials and Methods: We applied randomized real or placebo stimulation over the unaffected primary motor cortex of 10 subacute (7 ± 3 days) post-stroke patients. Neurophysiological measurements were performed using electroencephalography and electromyography. Motor function was assessed with the Wolf Motor Function Test. We performed a repeated measure study with the recordings taken pre-, post-cTBS, and at 3 months' follow-up.Results: We investigated changes in motor rhythms during arm elevation and thumb opposition tasks and found significant changes in beta power of the affected thumb's opposition, specifically after real cTBS. Our results are consistent with an excitatory response (increase in event-related desynchronization) in the sensorimotor cortical areas of the affected hemisphere, after stimulation. Neither peak-to-peak amplitude of motor-evoked potentials nor motor performance were significantly altered.Conclusions: Consistently with the theoretical prediction, this contralateral inhibitory stimulation paradigm changes neurophysiology, leading to a significant excitatory impact on the cortical oscillatory patterns of the contralateral hemisphere. These proof-of-concept results provide evidence for the potential role of continuous TBS in the neurorehabilitation of post-stroke patients. We suggest that these changes in ERS/ERD patterns should be further explored in future phase IIb/phase III clinical trials, in larger samples of poststroke patients.

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