Which Road to Recovery?: Factors Influencing Postacute Stroke Discharge Destinations: A Delphi Study

Background and Purpose: The criteria for determining the level of postacute care for patients with stroke are variable and inconsistent. The purpose of this study was to identify key factors influencing the selection of postacute level of care for these patients. Methods: We used a collaborative 4-round Delphi process to achieve a refined list of factors influencing postacute level of care selection. Our Delphi panel of experts consisted of 32 panelists including physicians, physical therapists, occupational therapists, speech-language pathologists, nurses, stroke survivors, administrators, policy experts, and individuals associated with third-party insurance companies. Results: In round 1, 207 factors were proposed, with subsequent discussion resulting in consolidation into 15 factors for consideration. In round 2, 15 factors were ranked with consensus on 10 factors; in round 3,10 factors were ranked with consensus on 9 factors. In round 4, the final round, 9 factors were rated with Likert scores ranging from 5 (most important) to 1(not important). The percentage of panelists who provided a rating of 4 or above were as follows: likelihood to benefit from an active rehabilitation program (97%), need for clinicians with specialized rehabilitation skills (94%), need for active and ongoing medical management and monitoring (84%), ability to tolerate an active rehabilitation program (74%), need for caregiver training to return to the community (48%), family/caregiver support (39%), likelihood to return to community/home (39%), ability to return to physical home environment (32%), and premorbid dementia (16%). Conclusions: This study provides an expert, consensus-based set of key factors to be considered when determining where stroke patients are discharged for postacute care. These factors may be useful in developing a decision support tool for use in clinical settings.

Kinematic Assessment to Measure Change in Impairment during Active and Active-Assisted Type of Robotic Rehabilitation for Patients with Stroke

Analysis of kinematic features related to clinical assessment scales may qualitatively improve the evaluation of upper extremity movements of stroke patients. We aimed to investigate kinematic features that could correlate the change in the Fugl-Meyer Assessment (FMA) score of stroke survivors through upper extremity robotic rehabilitation. We also analyzed whether changes in kinematic features by active and active-assisted robotic rehabilitation correlated differently with changes in FMA scores. Fifteen stroke patients participated in the upper extremity robotic rehabilitation program, and nine kinematic features were calculated from reach tasks for assessment. Simple and multiple linear regression analyses were used to characterize correlations. Features representing movement speed were associated with changes in FMA scores for the group that used an active rehabilitation robot. In contrast, in the group that used an active-assisted rehabilitation robot, features representing movement smoothness were associated with changes in the FMA score. These estimates can be an important basis for kinematic analysis to complement clinical scales.

Evaluation of flexor tendon repair (zone II) with Wide Awake Anesthesia

Background Recent advances in hand surgery has been the movement away from tourniquet surgery, which often requires sedation or GA and the patient will be awake and cooperative. Wide awake approach depends on the safety of adrenaline which is now well established. This review will evaluate the role of the wide awake approach in reducing rupture and tenolysis rate after flexor tendon repair zone 2. Objective To evaluate the functional outcome of flexor tendon repair zone II (most challengeable) under wide awake anesthesia. Patients and Methods After approval of local ethical committee of faculty of medicine Ain Shams University, this Prospective study has been conducted targeting patients with acute zone II flexor tendon injuries admitted at El Sahel Teaching Hospital within the period from September 2019 till January 2020, and their follow up for minimum three months at outpatient clinic. A Written informed consent explaining the whole procedure under study in this research has been obtained from all patients and absolute confidentiality as regard the patients’ names and addresses was given special care and attention. Final outcome evaluated by Original Strickland evaluation system. Results Using the wide awake technique provides an optimal opportunity to test repair strength through Intra-operative Total Active Movement (ITAM) making the surgeon much more comfortable to initiate early active motion. Besides, rising trend toward using early active rehabilitation protocol in case of strong repair using four or more strands repairs is recently supported in literature. This study adopted early active rehabilitation protocol with slight differences among them Conclusion This preliminary study assessing the outcomes of primary tendon repair in flexor tendon injuries in zone II using the wide-awake technique demonstrates encouraging results, being satisfactory for both surgeons and patients that makes this new approach a competitive to the other approaches of flexor tendon repair implemented under conventional methods of anesthesia.

2Vita-B Physical: An Intelligent Home Rehabilitation System Based on Microsoft Azure Kinect

Active rehabilitation is an exercise-based program designed to improve the level of function of people with motor disabilities. The effectiveness of such programs is strongly influenced by the correctness of the exercise execution. An exercise done incorrectly could even lead to a worsening of the health status. For this reason, specialists are required to guide the patient during the execution of an exercise. The drastic reduction of the costs of motion tracking systems has paved the way to the implementation of virtual assistant software able to automatically assess the correctness of an exercise. In this paper 2Vita-B Physical is presented, a rehabilitation software system properly designed to support both 1) the patients, by guiding them in the correct execution of an exercise; and 2) the physiotherapists, by allowing them to remotely check the progress of a patient. The motion capturing in 2Vita-B is performed by using the recently released Microsoft Kinect Azure DK. Thus, the system is easy to use and completely non-invasive. Besides the hardware and software requirements of the system, the results of a preliminary usability evaluation of the system conducted with 29 users is also reported. The results achieved are promising and provide evidence of the high usability of 2Vita-B Physical as home rehabilitation system.

ЗАСТОСУВАННЯ Α-ГЛІЦЕРИЛФОСФОРИЛХОЛІНУ В СХЕМІ КОМПЛЕКСНОГО ЛІКУВАННЯ ДЛЯ ФУНКЦІОНАЛЬНОГО ВІДНОВЛЕННЯ ПІСЛЯ МОЗКОВОГО ПІВКУЛЬОВОГО ІШЕМІЧНОГО ІНСУЛЬТУ

The article considers the influence of α-glycerylphosphorylcholine in the scheme of comprehensive therapy on the dynamics of functional recovery in patients with cerebral hemispheric ischemic stroke. Against the background of the progressive growth of acute cerebral infarction, the problem of timely care is relevant. Timely treatment of stroke, based on evidence-based medicine, along with early activation and rehabilitation of patients is designed to reduce mortality and subsequent disability of patients. Given that cholinergic insufficiency and structural and functional damage of neurons play an important role in the pathogenesis of post-stroke disorders, the use of medicines for their correction, in particular α-glycerylphosphorylcholine, is justified. Choline alfoscerate, a precursor of acetylcholine and phosphatidylcholine, is broken down by enzymes into choline and glycerophosphate when ingested, and the choline thus obtained is able to improve neuronal functionality in patients with neurodegenerative and vascular diseases. The study revealed a significantly better recovery of impaired motor and cognitive functions after cerebral hemispheric stroke under the influence of comprehensive therapeutic and rehabilitation measures using active rehabilitation methods in conjunction with α-glycerylphosphorylcholine. The results obtained during the study allow us to report the advantage of a combination of methods of active rehabilitation and the use of the pharmacological agent α-glycerylphosphorylcholine. The feasibility and efficacy of α-glycerylphosphorylcholine are related to its ability to reduce motor and cognitive deficits after ischemic stroke. The scheme of comprehensive treatment of patients in acute and restorative periods of cerebral hemispheric ischemic stroke with the use of α-glycerylphosphorylcholine helps to increase the effectiveness of functional recovery after an acute cerebral accident, and can be used in the use of therapeutic and rehabilitation programs for patients after cerebral hemispheric ischemic stroke to reduce the post-stroke deficit.

Tackling multimorbidity: staff perceptions of the transition from single-condition rehabilitation to a specialist-generalist model

Background/aims The Healthy and Active Rehabilitation Programme is a specialist-generalist approach to targeting multimorbidity, which was developed through reconfiguring single-condition rehabilitation pathways. This project examined staff perceptions of the transition from specialist rehabilitation, to delivering this new model. Methods A total of 18 staff from the Healthy and Active Rehabilitation Programme (eight nurses, seven exercise instructors, two physiotherapists, one occupational therapist) participated in three focus groups, generating three key themes: apprehension, confidence growth, and integrated working. Results Despite initial apprehension around the Healthy and Active Rehabilitation Programme's impact on the existing service, the service users, and their clinical roles, staff developed confidence in the service and in their broader roles. Integrated working within the Healthy and Active Rehabilitation Programme has enhanced their awareness of the wider rehabilitation team, and provides valuable peer support. Conclusions This project provides valuable information for single-condition rehabilitation services that are considering delivery of specialist-generalist care to help target multimorbidity.

Deep learning analysis based on multi-sensor fusion data for hemiplegia rehabilitation training system for stoke patients

By recognizing the motion of the healthy side, the lower limb exoskeleton robot can provide therapy to the affected side of stroke patients. To improve the accuracy of motion intention recognition based on sensor data, the research based on deep learning was carried out. Eighty healthy subjects performed gait experiments under five different gait environments (flat ground, 10 ${}^\circ$ upslope and downslope, and upstairs and downstairs) by simulating stroke patients. To facilitate the training and classification of the neural network, this paper presents template processing schemes to adapt to different data formats. The novel algorithm model of a hybrid network model based on convolutional neural network (CNN) and Long–short-term memory (LSTM) model is constructed. To mitigate the data-sparse problem, a spatial–temporal-embedded LSTM model (SQLSTM) combining spatial–temporal influence with the LSTM model is proposed. The proposed CNN-SQLSTM model is evaluated on a real trajectory dataset, and the results demonstrate the effectiveness of the proposed model. The proposed method will be used to guide the control strategy design of robot system for active rehabilitation training.