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BACKGROUND: Uncertain prognosis presents a challenge for therapists in determining the most efficient course of rehabilitation treatment for individual patients. Cortical Sensorimotor network connectivity may have prognostic utility for upper extremity motor improvement because the integrity of the communication within the sensorimotor network forms the basis for neuroplasticity and recovery. OBJECTIVE: To investigate if pre-intervention sensorimotor connectivity predicts post-stroke upper extremity motor improvement following therapy. METHODS: Secondary analysis of a pilot triple-blind randomized controlled trial. Twelve chronic stroke survivors underwent 2-week task-practice therapy, while receiving vibratory stimulation for the treatment group and no stimulation for the control group. EEG connectivity was obtained pre-intervention. Motor improvement was quantified as change in the Box and Block Test from pre to post-therapy. The association between ipsilesional sensorimotor connectivity and motor improvement was examined using regression, controlling for group. For negative control, contralesional/interhemispheric connectivity and conventional predictors (initial clinical motor score, age, time post-stroke, lesion volume) were examined. RESULTS: Greater ipsilesional sensorimotor alpha connectivity was associated with greater upper extremity motor improvement following therapy for both groups (p

Objective Stroke is one of the most debilitating neurological disorders that commonly results in both cognitive and motor dysfunctions. Although the recovery of gait is one of the main goals of patients with stroke, only 50–60% of the patients commonly reach this target. This study aimed to evaluate the effects of action observation training, based on mirror neurons, as an add-on therapy to the conventional physical rehabilitation on the gait performance of patients with stroke. Methods Fourteen patients with chronic stroke were randomly assigned to the sham or the experimental group. Both groups received a 40-min conventional physical training following a 12-min observation training depicting exercises for the experimental group but nature pictures for the sham group each session. The patients’ walking was recorded using a motion analysis system at baseline and after the 12-session intervention. Spatiotemporal parameters of gait and ground reaction forces were measured. Results Significant improvements were found in most measured spatiotemporal parameters of gait on the unaffected side of the patients in the experimental group, while in the sham group, the recovery was observed only in the percentage of the stance phase. Regarding the affected side, the stride and step length of the patients in the experimental group were parameters with a significant amelioration. Conclusion The results of this study showed that the action observation training had the potential to improve the walking quality of the patients with hemiplegia in the chronic phase of stroke.

Motor-cognitive intervention concepts are promising to counteract residual gait and cognitive impairments in chronic stroke. There is, however, considerable variation in motor-cognitive intervention types, which may lead to different effects. This systematic review strived to summarize and compare the effects of different motor-cognitive intervention concepts on gait and cognitive functions in chronic stroke. The systematic search identified twenty-nine articles, which were allocated to three types of motor-cognitive training concepts; SEQUENTIAL, SIMULTANEOUS-ADDITIONAL, and SIMULTANEOUS-INCORPORATED. Random-effects meta-analyses revealed that motor-cognitive interventions may be better than non-combined training approaches for improving gait function in chronic stroke (e.g. gait speed: g = 0.43, 95 % CI [0.22, 0.64], p < 0.0001). SIMULTANEOUS-INCORPORATED motor-cognitive training seems the most promising concept. As very few articles measured both, spatiotemporal gait parameters and cognitive outcomes, future studies are warranted to investigate the effects of motor-cognitive intervention concepts on gait control and cognitive functions in chronic stroke., Neuroscience & Biobehavioral Reviews, 132, ISSN:0149-7634, ISSN:1873-7528

INTRODUCTION The study evaluated the feasibility, and compliance of a dance-based exergaming (DBExG) on postural stability (PS) and lower extremity (LE) kinematics, along with post-intervention changes in gait function and falls self-efficacy in people with chronic stroke (PwCS). METHODS Fifteen PwCS underwent DBExG for six weeks using Kinect "Just Dance 3." Pre- to post- changes were recorded during DBExG assessment on a fast-paced song (130 bpm) using an 8-camera motion capture system to assess PS (center of mass [CoM] excursions [EXs] in the anterior-posterior [AP] and mediolateral [ML] directions) and LE kinematics (hip, knee, and ankle joint angle EXs). Gait function was also assessed with gait parameters, such as gait speed, cadence, and gait symmetry on an electronic walkway. Falls self-efficacy was recorded with Falls Efficacy Scale (FES). RESULTS The AP and ML CoM EXs and paretic joint angle EXs significantly increased pre- to post- DBExG assessment (p

Patients with poor upper limb motor recovery after stroke are likely to develop increased resistance to passive wrist extension, i.e., wrist hyper-resistance. Quantification of the underlying neural and non-neural elastic components is of clinical interest. This cross-sectional study compared two methods: a commercially available device (NeuroFlexor (R)) with an experimental EMG-based device (Wristalyzer) in 43 patients with chronic stroke. Spearman's rank correlation coefficients (r) between components, modified Ashworth scale (MAS) and range of passive wrist extension (PRoM) were calculated with 95% confidence intervals. Neural as well as elastic components assessed by both devices were associated (r = 0.61, 95%CI: 0.38-0.77 and r = 0.53, 95%CI: 0.28-0.72, respectively). The neural component assessed by the NeuroFlexor (R) associated significantly with the elastic components of NeuroFlexor (R) (r = 0.46, 95%CI: 0.18-0.67) and Wristalyzer (r = 0.36, 95%CI: 0.06-0.59). The neural component assessed by the Wristalyzer was not associated with the elastic components of both devices. Neural and elastic components of both devices associated similarly with the MAS (r = 0.58, 95%CI: 0.34-0.75 vs. 0.49, 95%CI: 0.22-0.69 and r = 0.51, 95%CI: 0.25-0.70 vs. 0.30, 95%CI: 0.00-0.55); elastic components associated with PRoM (r = -0.44, 95%CI: -0.65- -0.16 vs. -0.74, 95%CI: -0.85- -0.57 for NeuroFlexor (R) and Wristalyzer respectively). Results demonstrate that both methods perform similarly regarding the quantification of neural and elastic wrist hyper-resistance components and have an added value when compared to clinical assessment with the MAS alone. The added value of EMG in the discrimination between neural and non-neural components requires further investigation.

This study was conducted to investigate the effect of affected side one leg standing training with PNF sprinter and skater patterns, which have a pattern like that of actual gait, on the balance function and gait function of chronic hemiplegic patients due to stroke. 23 inpatients diagnosed with stroke due to hemiplegia at a rehabilitation hospital located in South Korea. The patients were randomly divided into a experimental group and a control group. The experimental group performed PNF Sprinter and Skater Pattern training, and the control group performed balance pad training. Each group was trained for 30 minutes three times a week for six weeks. Static balance was measured using Biorescue, while dynamic balance was measured using the TUG. Gait function was measured using 10MWT, 6MWT. Both groups exhibited statistically significant improvements in static and dynamic balance function after the training (p

Background After a stroke, 80% of the chronic patients have difficulties to use their paretic upper limb (UL) in activities of daily life (ADL) even after rehabilitation. Virtual reality therapy (VRT) and anodal transcranial direct current stimulation (tDCS) are two innovative methods that have shown independently to positively impact functional recovery of the paretic UL when combined with conventional therapy. The objective of the project will be to evaluate the impact of adding anodal high-definition (HD)-tDCS during an intensive 3-week UL VRT and conventional therapy program on paretic UL function in chronic stroke. Methods The ReArm project is a quadruple-blinded, randomized, sham-controlled, bi-centre, two-arm parallel, and interventional study design. Fifty-eight chronic (> 3 months) stroke patients will be recruited from the Montpellier and Nimes University Hospitals. Patients will follow a standard 3-week in-patient rehabilitation program, which includes 13 days of VRT (Armeo Spring, 1 × 30 min session/day) and conventional therapy (3 × 30 min sessions/day). Twenty-nine patients will receive real stimulation (4x1 anodal HD-tDCS montage, 2 mA, 20 min) to the ipsilesional primary motor cortex during the VRT session and the other 29 patients will receive active sham stimulation (2 mA, 30 s). All outcome measures will be assessed at baseline, at the end of rehabilitation and again 3 months later. The primary outcome measure will be the wolf motor function test. Secondary outcomes will include measures of UL function (Box and Block Test), impairment (Fugl Meyer Upper Extremity), compensation (Proximal Arm Non-Use), ADL (Actimetry, Barthel Index). Other/exploratory outcomes will include pain, fatigue, effort and performance, kinematics, and motor cortical region activation during functional motor tasks. Discussion This will be the first trial to determine the impact of adding HD-tDCS during UL VRT and conventional therapy in chronic stroke patients. We hypothesize that improvements in UL function will be greater and longer-lasting with real stimulation than in those receiving sham. Trial registration The ReArm project was approved by The French Research Ethics Committee, (Comité de Protection des Personnes-CPP SUD-EST II, N°ID-RCB: 2019-A00506-51, http://www.cppsudest2.fr/). The ReArm project was registered on ClinicalTrials.gov (NCT04291573, 2nd March 2020.

Objective: The purpose of the present study was to verify the validity of the Turkish version of the Postural Assessment Scale for Stroke Patients (PASS) in chronic stroke, and to compare its validity, reliability, and responsiveness characteristics with Berg Balance Scale (BBS), Brunel Balance Assessment (BBA).Method: 49 chronic stroke patients were included in the study. Those participating in the study were applied PASS, BBS and BBA on the first day. To measure the test-retest reliability, the second assessment for the scales was performed by the same physiotherapist 1 week after the initial evaluation.Results: According to the correlation analysis, a very high level of correlation was found between the PASS first and second assessment scores (r = 0.984). Cronbach Alpha Coefficient was found to be 0.995 (excellent). The Intraclass Correlation Coefficient (ICC) value for PASS was 0.995. A high level of correlation was found between PASS, BBS and BBA. No ceiling and floor effects were observed for PASS.Conclusion: The results of our study showed that Turkish version of PASS is a valid and reliable scale in chronic stroke patients and all these three scales, which are commonly used to assess balance in stroke patients are, made repeatable measurements in patients with chronic stroke. The test re-test reliability values of these three scales were found to be excellent. Minimal detectable change values, which are used to determine a real change in balance in stroke patients by clinicians, were found to be close to each other for these balance scales.

Asymmetry during walking may be explained by impaired interlimb coordination. We examined these associations: (1) propulsive symmetry with interlimb coordination during walking, (2) work symmetry with interlimb coordination during pedaling, and (3) work symmetry and interlimb coordination with clinical impairment.Nineteen individuals with chronic stroke and 15 controls performed bilateral, lower limb pedaling with a conventional device and a device with a bisected crank and upstroke assistance. Individuals with stroke walked on a split-belt treadmill. Measures of symmetry (%Propulsionwalk, %Workped) and interlimb phase coordination index (PCIwalk, PCIped) were computed. Clinical evaluations were the lower extremity Fugl-Meyer (FMLE) and walking speed. Associations were assessed with Spearman's rank correlations.Participants with stroke displayed asymmetry and impaired interlimb coordination compared with controls (P ≤ 0.001). There were significant correlations between asymmetry and impaired interlimb coordination (walking: R2 = 0.79, P0.001; pedaling: R2 = 0.62, P0.001) and between analogous measures across tasks (%Workped, %Propulsionwalk: R2 = 0.41, P = 0.01; PCIped, PCIwalk: R2 = 0.52, P = 0.003). Regardless of task, asymmetry and interlimb coordination were correlated with FMLE (R2 ≥ 0.48, P ≤ 0.004) but not walking speed. There was larger within group variation for %Propulsionwalk than %Workped (Z = 2.6, P = 0.005) and for PCIped than PCIwalk (Z = 3.6, P = 0.003).Pedaling may provide useful insights about walking, and impaired interlimb coordination may contribute to asymmetry in walking. Pedaling and walking provide distinct insights into stroke-related impairments, related to whether the task allows compensation (walkingpedaling) or compels paretic limb use (pedalingwalking). Pedaling a device with a bisected crank shaft may have therapeutic value.Video Abstract available for more insight from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A365).

Background Ankle joint mobilization with movement has been speculated to be an important intervention for enhancing range of motion, balance, and gait functions in chronic stroke survivors. Nonetheless, there is a scarcity of recent conclusive evidence that evaluates its efficacy in chronic stroke patients. The purpose of this review was to synthesize existing evidence on the efficacy of mobilization with movement therapy on range of motion, balance, and gait performance in subjects after stroke. Methods A comprehensive systematic search of literature was performed using the following databases: PubMed/Medline, CINAHL, AMED, PEDro, Cochrane Library, and Scopus. Physiotherapy Evidence Database (PEDro) scale was used to evaluate the methodological quality of included trials. The primary outcome measures of this review were dorsiflexion range of motion (DF-ROM), and Berg balance scale (BBS). This review was reported in accordance with PRISMA statement guidelines. Due to variations in relevant trials, meta-analysis was not carried out. Results and Conclusions Seven randomized controlled trials with a total of 224 subjects were analyzed. Evidence of overall quality was graded from moderate to high. This review found that mobilization with movement therapy could be an alternative rehabilitative intervention for subjects with chronic stroke to increase range of motion, balance, and gait ability. However, the evidence remains preliminary due to the small number of participants. Large-scale RCTs in the future are warranted to investigate the efficacy of mobilization with movement in subgroups of chronic stroke subjects.

BACKGROUND: Adequate muscle strength is essential for walking performance in individuals with stroke. OBJECTIVE: To investigate the accuracy of different forms of muscle knee extension strength analysis to identify high or low walking performance in individuals with chronic stroke. METHODS: Twenty-eight participants with a chronic stroke for more than six months participated. Independence for walking was judged by measurement of walking performance assessed for comfortable walking speed (CWS), maximum walking speed (MWS), and the Six Minute Walk Test (6MWT). Peak knee extension torque of the paretic side, non-paretic side, sum of the sides (SS), and difference in the sides (DS) was assessed during concentric movements using an isokinetic dynamometer. RESULTS: The equation with greatest predictive capacity for CWS and MWS included the DS as the main predictor (R(2) of 0.65 and 0.71, respectively, p

INTRODUCTION Individuals with stroke experience residual walking disabilities, as the inability to increase walking speed (walking speed reserve - WSR), and frequently present decreasing in functional capacity. The relation between functional capacity and walking ability may contribute to more specific functional management of stroke. OBJECTIVE To investigate the association between WSR and functional capacity in individuals with chronic stroke and compare functional capacity between individuals who can increase walking speed or not. METHODS Cross-sectional study, where functional capacity was assessed with the Duke Activity Status Index (DASI), in metabolic equivalent (METS). WSR was assessed through the difference between fast and self-selected speed (in m/s). The individuals were assigned into two groups: able (WSR ≥ 0.2 m/s) and unable (WSR

Background High-intensity occupational therapy can improve arm function after stroke, but many people lack access to such therapy. Home-based therapies could address this need, but they don't typically address abnormal muscle co-activation, an important aspect of arm impairment. An earlier study using lab-based, myoelectric computer interface game training enabled chronic stroke survivors to reduce abnormal co-activation and improve arm function. Here, we assess feasibility of doing this training at home using a novel, wearable, myoelectric interface for neurorehabilitation training (MINT) paradigm. Objective Assess tolerability and feasibility of home-based, high-dose MINT therapy in severely impaired chronic stroke survivors. Methods Twenty-three participants were instructed to train with the MINT and game for 90 min/day, 36 days over 6 weeks. We assessed feasibility using amount of time trained and game performance. We assessed tolerability (enjoyment and effort) using a customized version of the Intrinsic Motivation Inventory at the conclusion of training. Results Participants displayed high adherence to near-daily therapy at home (mean of 82 min/day of training; 96% trained at least 60 min/day) and enjoyed the therapy. Training performance improved and co-activation decreased with training. Although a substantial number of participants stopped training, most dropouts were due to reasons unrelated to the training paradigm itself. Interpretation Home-based therapy with MINT is feasible and tolerable in severely impaired stroke survivors. This affordable, enjoyable, and mobile health paradigm has potential to improve recovery from stroke in a variety of settings. Clinicaltrials.gov: NCT03401762.

Objective To systematically review how patient characteristics and/or transcranial direct current stimulation (tDCS) parameters influence tDCS effectiveness in respect to upper limb function post-stroke. Methods Three electronic databases were searched for sham-controlled randomised trials using the Fugl-Meyer Assessment for upper extremity as outcome measure. A meta-analysis and nine subgroup-analyses were performed to identify which tDCS parameters yielded the greatest impact on upper limb function recovery in stroke patients. Results Eighteen high-quality studies (507 patients) were included. tDCS applied in a chronic stage yields greater results than tDCS applied in a (sub)acute stage. Additionally, patients with low baseline upper limb impairments seem to benefit more from tDCS than those with high baseline impairments. Regarding tDCS configuration, all stimulation types led to a significant improvement, but only tDCS applied during therapy, and not before therapy, yielded significant results. A positive dose–response relationship was identified for current/charge density and stimulation duration, but not for number of sessions. Conclusion Our results demonstrate that tDCS improves upper limb function post-stroke. However, its effectiveness depends on numerous factors. Especially chronic stroke patients improved, which is promising as they are typically least amenable to recovery. Significance The current work highlights the importance of several patient-related and protocol-related factors regarding tDCS effectiveness.

Background: In this trial we combined the effect of purposeful activity and electrical stimulation therapy (PA-EST) to promote transition of severely hemiparetic upper limb to auxiliary upper limb in chronic stroke survivors in a single-case study. Objective: The purpose of this study was to examine the effect of PA-EST on the upper limb motor function in a crossover randomized controlled trial. Methods: The study included eight stroke survivors (age: 63.1±10.9 years) who were receiving home-based visiting occupational therapy. The average time since stroke onset was 8.8±5.6 years. All participants had severely hemiparetic upper limb, with the Fugl–Meyer Assessment upper extremity (FMA-U) score of 21.3±8.5. Participants were randomly assigned to group A or B. Group A received PA-EST for 3 months (phase 1), followed by standard stretching and exercise for 3 months (phase 2), whereas group B had the inverse order of treatments. To avoid carry-over effect, 1-month washout period was provided between the phase 1 and 2. Two-way analysis of variance (ANOVA) with repeated measures was used for the analysis. The primary outcome was FMA-U, and the secondary outcomes were, Motor Activity Log (MAL; amount of use [AOU] and quality of movement [QOM]), and Goal attainment scale-light (GAS-light). Results: Repeated measures-ANOVA revealed a significant interaction between type of intervention and time for FMA-U (F = 16.303, P = 0.005), MAL AOU (F = 7.966, P = 0.026) and QOM (F = 6.408, P = 0.039), and GAS-light (F = 6.905, P = 0.034), where PA-EST was associated with significantly improved motor function and goal achievement compared with standard stretching. Conclusions: The PA-EST may have greater effects than stretch/exercise in the recovery of hand function as reflected in FMA-U, MAL, and GAS-light. Our results suggest that PA-EST is an important and useful home-based rehabilitation program for promoting the use of the severely hemiparetic upper limb in chronic stroke survivors.

To systematically review the available randomized controlled trials in the literature concerning the application of virtual reality (VR) rehabilitation interventions compared to conventional physical therapy, in regaining the upper limb motor function among patients with chronic stroke. A systematic electronic database search was conducted for related studies published from inauguration and until June 25, 2020 in nine databases. Another new search was done on February 1, 2021 and no new studies were identified. Six studies were included in the analysis. Significant improvement was seen following the VR therapy in patients with chronic stroke, compared to their scores prior to it (SMD = 0.28; 95% CI = 0.03–0.53; p = .03). There was neither heterogeneity (I2 = 0% and P = .5) nor a risk of bias (P = .8) among the included studies. VR interventions produced a comparable effectiveness to that of the conventional rehabilitation, with no statistically significant difference (SMD = 0.15; 95% CI = −0.14–0.44; P = .3). There was neither heterogeneity (I2 = 40% and P = .1) nor a risk of bias (P = .5) among the included studies. The upper limb motor function of patients with chronic stroke who underwent VR-based rehabilitative intervention showed significant improvement as compared to the pre-treatment state. Our analysis also revealed no superiority of VR interventions over conservative therapies; however, the difference observed did not accomplish statistical significance.

Perturbation-based balance training (PBT) has been shown to improve reactive balancing abilities in chronic stroke. To inform future investigations in the subacute phase of stroke, the objective of this series of N-of-1 studies was to investigate the range of balancing responses to unexpected mechanical perturbations applied to the pelvis during walking on an instrumented treadmill before and after PBT training. Three subacute stroke subjects were assessed on each occasion with clinical tests and biomechanical measurements following perturbations applied in forward, backward, inward and outward directions. After 15 daily sessions of PBT, most clinical mobility outcomes showed improvements in all three subjects. Assessment of reactive balancing also showed improvements in all subjects when responding to perturbations in backward and inward directions whereas the changes following perturbations in forward and outward directions were subject-specific. The results suggest that PBT should be individually tailored to target balance deficiencies identified through a serial biomechanical assessment.

Objective: To examine the effects of the provision of a cane, delivered to ambulatory people with chronic stroke, for improving walking and social participation. Design: Two-arm, randomized trial. Setting: Community-based. Participants: Ambulatory individuals with chronic stroke. Interventions: The experimental intervention was the provision of a single-point cane during one month. The control group received a placebo intervention. Outcome measures: Walking speed, step length, cadence, walking capacity, and walking confidence were measured without the cane to examine its rehabilitative effect. Walking speed was also measured with the cane for inclusiveness, and social participation was measured for examining carry over effects. Outcomes were measured at baseline, and after one and two months. Results: Fifty individuals were included. In the experimental group, mean age was 69 years (SD 14), and walking speed was 0.58 m/s (SD 0.17). In the control group, mean age was 68 years (SD 13), and walking speed was 0.63 m/s (SD 0.15). When walking without the cane, after one and after two months, there were no between-group differences in any measures. When walking with the cane, after one month, the experimental group walked 0.14 m/s (95% CI 0.05–0.23) faster than the control group and after two months, they were still walking 0.18 m/s (95% CI 0.06–0.30) faster. Conclusion: Use of a cane improved walking speed, only when participants walked with the cane. Use of cane for one month did not improve walking outcomes, when walking without the cane. People with stroke would need to continue to use the cane to maintain any benefits in walking speed.

Background: Literature shows that intensive Functional Electrical Stimulation facilitates upper limb motor recovery after Stroke. Aim: To assess the effects of 4 weeks of FES therapy on right upper limb motor functions in patient with Chronic Stroke. Materials and Methods: The participant was thirty year old male Right Hemiparesis who had experienced Chronic Ischemic Stroke. FES therapy was given for forty five minutes per session, three sessions a week for complete four weeks. The pre and post intervention score were measured with Fugl Meyer Assessment, Voluntary Control Grading and MAS. Results: The Fugl Meyer Assessment score for right upper limb showed improvement with progression in stage of VCG for right upper limb and hand. Also improved MAS score was noted for right shoulder, elbow and hand muscles. Conclusion: The current study confirms that application of FES therapy improves upper limb motor functions in Chronic stage of Stroke after 4 weeks.

This study examined the effect of core stability exercises on trunk control, core muscle strength, standing weight-bearing symmetry, and balance confidence of people with chronic stroke.This was an assessor-blinded randomized controlled trial involving 84 ambulatory patients with middle cerebral artery stroke, randomly assigned to three training groups. Two experimental groups practiced core stability exercises either on stable or on unstable support surfaces. In contrast, the control group received standard physiotherapy. All the participants underwent an hour-long training session a day, thrice a week over a 6-wk duration, and followed-up after 12 mos. Trunk Impairment Scale, core muscle strength, weight-bearing asymmetry in standing, and Activities-specific Balance Confidence scale were the outcome measures.Compared with the control group, the two experimental groups demonstrated a significant improvement on all the outcome measures from baseline to posttraining and from baseline to 12-mo follow-up (P0.001). The two experimental groups demonstrated no significant difference between them on all the measures (P0.05).Core stability exercises on stable and unstable support surfaces are equally beneficial in improving trunk control, core muscle strength, standing weight-bearing symmetry, and balance confidence of ambulatory patients with chronic stroke than the standard physiotherapy.

Objective To investigate the effects of perturbation-based pinch task training on the sensorimotor performance of the upper extremities of patients with chronic stroke via a novel vibrotactile therapy system. Design A single-blinded randomized controlled trial. Setting A university hospital. Participants Patients with chronic stroke (N=19) randomly assigned into either an experimental group or a control group completed the study. Interventions In addition to 10 minutes of traditional sensorimotor facilitation, each participant in the experimental group received 20 minutes of perturbation-based pinch task training in each treatment session, and the controls received 20 minutes of task-specific motor training twice a week for 6 weeks. Main Outcome Measures The scores for the primary outcome, Semmes-Weinstein monofilament (SWM), and those for the secondary outcomes, Fugl-Meyer Assessment (FMA), amount of use, quality of movement (QOM) on the Motor Activity Log (MAL) scale, and box and block test (BBT), were recorded. All outcome measures were recorded at pretreatment, post treatment, and 12-week follow-up. Results There were statistically significant between-group differences in the training-induced improvements revealed in the SWM results (P=.04) immediately after training and in the BBT results (P=.05) at the 12-week follow-up. The changes in muscle tone and in the QOM, SWM, and BBT scores indicated statistically significant improvements after 12 sessions of treatment for the experimental group. For the control group, a significant statistical improvement was found in the wrist (P Conclusions This study indicated that the perturbation-based pinch task training has beneficial effects on sensory restoration of the affected thumb in patients with chronic stroke.

Background Stroke survivors need continuing exercise intervention to maintain functional status. This study assessed the feasibility and efficacy of an interactive telerehabilitation exergaming system to improve balance in individuals with chronic stroke, compared to conventional one-on-one rehabilitation. Methods In this prospective case–control pilot study, 30 Taiwanese individuals with chronic stroke were enrolled and randomly allocated to an experimental group and a control group. All participants received intervention 3 times per week for 4 weeks in the study hospital. The experiment group underwent telerehabilitation using a Kinect camera-based interactive telerehabilitation system in an independent room to simulate home environment. In contrast, the control group received conventional one-on-one physiotherapy in a dedicated rehabilitation area. The effectiveness of interactive telerehabilitation in improving balance in stroke survivors was evaluated by comparing outcomes between the two groups. The primary outcome was Berg Balance Scale (BBS) scores. Secondary outcomes were performance of the Timed Up and Go (TUG) test, Modified Falls Efficacy Scale, Motricity Index, and Functional Ambulation Category. Results Comparison of outcomes between experimental and control groups revealed no significant differences between groups at baseline and post-intervention for all outcome measures. However, BBS scores improved significantly in both groups (control group: p = 0.01, effect size = 0.49; experimental group: p = 0.01, effect size = 0.70). Completion times of TUG tests also improved significantly in the experimental group (p = 0.005, effect size = 0.70). Conclusion The Kinect camera-based interactive telerehabilitation system demonstrates superior or equal efficacy compared to conventional one-on-one physiotherapy for improving balance in individuals with chronic stroke. Trial registration ClinicalTrials.gov. NCT03698357. Registered October 4, 2018, retrospectively registered.

To identify the impact of upper limb spasticity on stroke survivors by linking their shared experience to the International Classification of Functioning, Disability, and Health (ICF).Ten community dwelling adults with a chronic stroke and spasticity, who had completed an upper limb rehabilitation trial participated in semi-structured interviews. Data were analysed using content analysis and linked to the ICF Comprehensive Core Set for stroke using standard linking rules.Four hundred and thirty-nine meaningful concepts eligible for linking were identified. The majority (Half of the Comprehensive Core Set categories for stroke were relevant, but to adequately capture experience an additional eight were needed. The ICF category profile may be unique to our participants or may suggest further research is needed to determine if additions to core set categories are required.Implications for rehabilitationOur ICF mapping demonstrated that the Brief Core Set for stroke was not sufficient to capture the range of experience for stroke survivors with upper limb spasticity, instead the Comprehensive Core Set for stroke supplemented with eight clinical-cohort specific second-level-categories should be used.Our findings suggest that rehabilitation may better reflect lived experience if it focuses on Body Function (Chapters 1, 2, 4, 7), Activity and Participation (Chapters 1-9), and Environment (Chapters 1, 2, 3, 5) because Body Structure was rarely mentioned in this or previous post-stroke ICF mapping research.

BackgroundHoMEcare aRm rehabiLItatioN (MERLIN) is an unactuated version of the robotic device ArmAssist combined with a telecare platform. Stroke patients are able to train the upper limb function using serious games at home. The aim of this study is to investigate the effect of MERLIN training on the upper limb function of patients with unilateral upper limb paresis in the chronic phase of stroke (> 6 months post stroke).MethodsPatients trained task specific serious games for three hours per week during six weeks using an unactuated version of a robotic device. Progress was monitored and game settings were tailored through telerehabilitation. Measurements were performed six weeks pre-intervention (T0), at the start (T1), end (T2) and six weeks post-intervention (T3). Primary outcome was the Wolf Motor Function Test (WMFT). Secondary outcomes were other arm function tests, quality of life, user satisfaction and motivation.ResultsTwelve patients were included, ten completed the training. From start of the intervention to six weeks follow up, WMFT improved significantly with 3.8 points (p = .006), which is also clinically relevant. No significant changes in quality of life were observed. Patients were overall satisfied with the usability of the device. Comfort and the robustness of the system need further improvements.ConclusionPatients in the chronic phase of stroke significantly improved their upper limb function with the MERLIN training at home.Trial registrationThis study is registered at the Netherlands Trial Register (NL7535). Registered 18–02-2019,https://www.trialregister.nl/trial/7535.

This study aimed to determine the effects of home-based dual-hemispheric transcranial direct current stimulation (dual-tDCS) combined with exercise on motor performance in patients with chronic stroke.We allocated 24 participants to the active or sham group. They completed 1-h home-based exercise after 20-min dual-tDCS at 2-mA, thrice a week for 4 weeks. The patients were assessed using the Fugl-Meyer Assessment (FMA), Wolf Motor Function Test, Timed Up and Go test, Five Times Sit-to-Stand Test, Six-meter Walk Test, and muscle strength assessment.Compared with the sham group, the active group showed improved FMA scores, which were sustained for at least 1 month. There was no between-group difference in the outcomes of the functional tasks.Home-based dual-tDCS could facilitate motor recovery in patients with chronic stroke with its effect lasting for at least 1 month. However, its effects on functional tasks remain unclear. tDCS is safe and easy for home-based self-administration for patients who can use their paretic arms. This could benefit patients without access to health care centres or in situations requiring physical distancing. This home-based tDCS combined with exercise has the potential to be incorporated into telemedicine in stroke rehabilitation.IMPLICATIONS FOR REHABILITATIONTwelve sessions of home-based dual-tDCS combined with exercises (3 days/week for 4 weeks) facilitated upper and lower limb motor recovery in patients with chronic stroke compared with exercise alone, with a post-effect for at least 1 month.Home-based tDCS could be safe and easily self-administrable by patients who can use their paretic arms.This intervention could be beneficial for patients living in the community without easy access to a health care centre or in situations where physical distancing is required.

STUDY OBJECTIVES: Sleep-wake dysfunction is bidirectionally associated with the pathogenesis and evolution of stroke. Longitudinal and prospective measurement of sleep after chronic stroke remains poorly characterized because of a lack of validated objective and ambulatory sleep measurement tools in neurological populations. This study aimed to validate a multisensor sleep monitor, the SenseWear Armband (SWA), in patients with ischemic stroke and control patients using at-home polysomnography. METHODS: Twenty-eight radiologically confirmed patients with ischemic stroke (aged 69.61 ± 7.35 years; mean = 4.1 years poststroke) and 16 control patients (aged 73.75 ± 7.10 years) underwent overnight at-home polysomnography in tandem with the SWA. Lin’s concordance correlation coefficient and reduced major axis regressions were employed to assess concordance of SWA vs polysomnography-measured total sleep time, sleep efficiency, sleep onset latency, and wake after sleep onset. Subsequently, data were converted to 30-second epochs to match at-home polysomnography. Epoch-by-epoch agreement between SWA and at-home polysomnography was estimated using crude agreement, Cohen’s kappa, sensitivity, and specificity. RESULTS: Total sleep time was the most robustly quantified sleep-wake variable (concordance correlation coefficient = 0.49). The SWA performed poorest for sleep measures requiring discrimination of wakefulness (sleep onset latency; concordance correlation coefficient = 0.16). The sensitivity of the SWA was high (95.90%) for patients with stroke and for control patients (95.70%). The specificity of the SWA was fair-moderate for patients with stroke (40.45%) and moderate for control patients (45.60%). Epoch-by-epoch agreement rate was fair (78%) in patients with stroke and fair (74%) in controls. CONCLUSIONS: The SWA shows promise as an ambulatory tool to estimate macro parameters of sleep-wake; however, agreement at an epoch level is only moderate-fair. Use of the SWA warrants caution when it is used as a diagnostic tool or in populations with significant sleep-wake fragmentation. CITATION: Gottlieb E, Churilov L, Werden E, et al. Sleep-wake parameters can be detected in patients with chronic stroke using a multisensory accelerometer: a validation study. J Clin Sleep Med. 2021:17(2):167–175.

BACKGROUND: Studies demonstrate the benefits of aerobic cycling training in subacute and chronic stroke subjects, but there is a lack in the literature about its effects on the acute phase. OBJECTIVE: Verify the effects of aerobic cycling training on lower limbs muscle strength, gait speed, balance, mobility and functionality of acute stroke subjects. METHODS: Control group (CG) performed conventional physiotherapy twice a day and the intervention group (IG) performed a conventional physiotherapy and a cycle ergometer session, for five consecutive days. Subjects were assessed for muscle strength by a digital dynamometer, gait speed by the 10-meter-walk-test, balance by the Berg Balance Scale, mobility by the ICU-Mobility-Scale and functionality by the Perme Score. RESULTS: Twenty subjects were enrolled in the study, 10 in the CG and 10 in the IG. Lower limbs muscle strength, the main endpoint, was better in the IG compared to the CG. The same was found in the secondary endpoints. The intragroup analysis was also positive for the CG in the mobility and functionality. CONCLUSIONS: Conventional physiotherapy combined with cycling exercise showed better results in the improvement of muscle strength of lower limbs, mobility and functionality of subjects who suffered from acute stroke.

BACKGROUND: Few quantitative analyses have been performed on muscle activation and gait function according to cane dependence. OBJECTIVE: The purpose of this study was to measure changes in the lower limb muscle activation and gait function according to reduced cane dependence using a weight-bearing feedback cane (WBFC) that had been designed to quantitatively measure cane dependence in stroke patients during walking. METHODS: Twenty-four subjects were recruited from a local rehabilitation hospital. The WBFC measured the average weight support (AWS, kg) loaded on the cane during walking through a Bluetooth connection to laptop software. All subjects walked 20 m using a WBFC set in the three levels of weight support (WSR, 100%, 60%, and 20%) based on the measured AWS. Paretic lower limb muscle activation and gait function (velocity, cadence, paretic side stride length, and symmetry index) were measured using wireless surface EMG and a 3-axis accelerometer during walking. RESULTS: The paretic side lower limb muscle activation of the 20% WSR on the cane was significantly higher than that of the 100% WSR on the cane (p< 0.05). Gait functions of the 20% WSR on the cane were significantly lower than those of the 100% WSR on the cane (p< 0.05). CONCLUSION: These findings suggest that indiscreet weight support on the cane during walking can interfere with lower limb muscle activation and gait function. Therefore, in a clinical setting, reducing cane dependence during stroke gait training should be carefully considered.

To design and test the feasibility of context-specific activities for improving physical activity (PA) levels among Indian adults with stroke. Context-specific activities were developed after a tho...

Mirror therapy (MT) has been proposed as an essential component of upper limb neuro-rehabilitation, using mirror illusion of the unaffected hand movement and superimposing it on the affected hand to improve neuroplasticity for improving motor recovery in stroke patients. In this paper, we developed a virtual reality mirror therapy (VRMT) system, and examined the performance of the proposed VRMT system. The VRMT system consists of a motion-tracking device, a VR goggle, and a VRMT software. Young, healthy participants, and stroke patients with mild-to-severe hemiparesis were recruited in this study, to validate the effectiveness of the proposed VRMT system. Experimental results based on the pinch-holding-up activity (PHUA) test revealed a significant effect on the precision pinch performance of young-healthy participants receiving VRMT, whereas traditional MT could not improve the precision pinch performance in young-healthy participants (Wilcoxon signed-rank test, $Z= -2.693$ , $p=0.007$ ). For patients having suffered a stroke and being treated with VRMT, significant beneficial effects examined by mixed effect model were found on the total score of FMA ( $p=0.033$ ) and hand part of FMA ( $p=0.008$ ). The findings in this study indicate that the VRMT system has a potentially positive effects on the sensorimotor performance of hands in healthy participants. In addition, add-on effect of VR to MT provides beneficial effects on motor function of the upper extremity in chronic stroke patients.

Various neurological disorders, such as stroke and Alzheimer's disease (AD), involve neuroinflammatory responses. The advent of the gut‐brain axis enhances our understanding of neurological disease progression and secondary cell death. Gut microbiomes, especially those associated with inflammation, may reflect the dysbiosis of both the brain and the gut, opening the possibility to utilize inflammatory microbiomes as biomarkers and therapeutic targets. The gut‐brain axis may serve as a contributing factor to disease pathology and offer innovative approaches in cell‐based regenerative medicine for the treatment of neurological diseases. In reviewing the pathogenesis of stroke and AD, we also discuss the effects of gut microbiota on cognitive decline and brain pathology. Although the underlying mechanism of primary cell death from either disease is clearly distinct, both may be linked to gut‐microbial dysfunction as a consequential aberration that is unique to each disease. Targeting peripheral cell death pathways that exacerbate disease symptoms, such as those arising from the gut, coupled with conventional central therapeutic approach, may improve stroke and AD outcomes., Gut microbiota and stroke. A potential stroke therapy involves modification of the gut microbiota via prebiotics and probiotics, triggering the production of therapeutic metabolites (i.e., anti‐inflammatory factors) that may sequester the secondary cell death associated with stroke.

Purpose: The purpose of this study was to verify the effect of applying clam exercise on improving trunk control and balance ability in stroke patients. Based on this, we tried to provide clinical information. Methods: In this study, 18 patients with chronic stroke were recruited from a rehabilitation hospital. The patients were divided into two groups: a clam exercise group (9 patients) and a control group (9 patients). After 30 minutes of neuro-development therapy, they performed clam exercise or bridge exercise for 3 weeks, 5 times a week for 30 minutes. A trunk impairment scale (TIS) and a postural assessment scale for stroke patients-trunk control (PASS-TC) were performed to evaluate the subjects’ ability to control trunk before and after intervention. Balance ability was measured by Balancia before and after intervention. Results: After the training periods, area 95% COP and weight distribution of the affected side were significantly different from the clam exercise group compared to the control group (p

Background Considerable evidence indicates that the functional connectome of the healthy human brain is highly stable, analogous to a fingerprint. Objective We investigated the stability of functional connectivity across tasks and sessions in a cohort of individuals with chronic stroke using a supervised machine learning approach. Methods Twelve individuals with chronic stroke underwent functional magnetic resonance imaging (fMRI) seven times over 18 weeks. The middle 6 weeks consisted of intensive aphasia therapy. We collected fMRI data during rest and performance of 2 tasks. We calculated functional connectivity metrics for each imaging run, then applied a support vector machine to classify data on the basis of participant, task, and time point (pre- or posttherapy). Permutation testing established statistical significance. Results Whole brain functional connectivity matrices could be classified at levels significantly greater than chance on the basis of participant (87.1% accuracy; P < .0001), task (68.1% accuracy; P = .002), and time point (72.1% accuracy; P = .015). All significant effects were reproduced using only the contralesional right hemisphere; the left hemisphere revealed significant effects for participant and task, but not time point. Resting state data could also be used to classify task-based data according to subject (66.0%; P < .0001). While the strongest posttherapy changes occurred among regions outside putative language networks, connections with traditional language-associated regions were significantly more positively correlated with behavioral outcome measures, and other regions had more negative correlations and intrahemispheric connections. Conclusions Findings suggest the profound importance of considering interindividual variability when interpreting mechanisms of recovery in studies of functional connectivity in stroke.