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Lesion–symptom mapping studies have reported a temporal versus frontal dissociation between semantic and letter fluency, and mixed evidence regarding the role of white matter. Mass-univariate and multivariate lesion–symptom mapping was used to identify regions associated with semantic and letter fluency deficits in post-stroke aphasia. Multivariate LSM revealed broad networks including underlying white matter, and substantial overlap between both types of fluency, suggesting that semantic fluency and letter fluency largely rely on the same neural system. All data are available on OSF.

Cognitive disorders will greatly interfere with activity in patients with a history of stroke. This will be exacerbated by chronic stress conditions. The design of this study is descriptive analytic with cross sectional approach with 75 post-stroke patients as outpatients at X Hospital. The instruments used in this study are standard instruments, DASS for stress questionnaires and MMSE for cognitive impairment. The results obtained are based on characteristic data, namely age over 46 years (98.7%), female gender (52%), high school graduate education (40%), not working (54.7%) and bivariate test results obtained p value 0.020. the conclusion of this study is that there is a close relationship between stress and cognitive impairment in post-stroke patients. The expectation of this research is to be an important illustration that stress theory and cognitive function can be a reference in the process of solving problems that occur in post-stroke patients

Virtual reality (VR) are user-computer interface platforms that implement real-time simulation of an activity or environment, allowing user interaction via multiple sensory modalities. VR therapy may be an effective intervention for improving cognitive function following stroke. The aim of this systematic review was to examine the effectiveness of exercise-based VR therapy on cognition post-stroke. Electronic databases were searched for terms related to ���stroke���, ���virtual reality���, ���exercise��� and ���cognition���. Studies were included if they: (1) were randomized-controlled trials; (2) included VR-based interventions; (3) included individuals with stroke; and (4) included outcome measures related to cognitive function. Data from included studies were synthesised qualitatively and where possible, random effects meta-analyses were performed. Eight studies involving 196 participants were included in the review, of which five were included in meta-analyses (n = 124 participants). Studies varied in terms of type (combination of VR therapy and conventional therapy, combination of VR therapy and computer-based cognitive training, VR therapy alone) and duration of interventions (20���180 min), sample size (n = 12���42), length of the interventions (4���8 weeks), and cognitive outcomes examined. VR therapy was not more effective than control for improving global cognition (n = 5, SMD = 0.24, 95%CI:���0.30,0.78, p = .38), memory (n = 2 studies, SMD= 0.00, 95%CI: ���0.58, 0.59, p = .99), attention (n = 2 studies, MD = 8.90, 95%CI: ���27.89, 45.70, p = .64) or language (n = 2 studies, SMD = 0.56, 95%CI: ���0.08,1.21, p = .09). VR therapy was not superior to control interventions in improving cognition in individuals with stroke. Future research should include high-quality and adequately powered trials examining the impact of virtual reality therapy on cognition post-stroke.Implications for rehabilitationVirtual reality therapy is a promising new form of technology that has been shown to increase patient satisfaction towards stroke rehabilitation.Virtual reality therapy has the added benefits of providing instant feedback, and the difficulty can be easily modified, underscoring the user-friendliness of this form of rehabilitation.Virtual reality therapy has the potential to improve various motor, cognitive and physical deficits following stroke, highlighting its usefulness in rehabilitation settings. Virtual reality therapy is a promising new form of technology that has been shown to increase patient satisfaction towards stroke rehabilitation. Virtual reality therapy has the added benefits of providing instant feedback, and the difficulty can be easily modified, underscoring the user-friendliness of this form of rehabilitation. Virtual reality therapy has the potential to improve various motor, cognitive and physical deficits following stroke, highlighting its usefulness in rehabilitation settings.

Lateralized inattention is a typical sign of neglect and related to poor functional outcome. Knowledge of the long-term course of this phenomenon is limited. The purpose of this study was to investigate presence and predictors for signs of lateralized inattention 7 years after stroke.From a cohort of acute ischemic stroke patients, aged 18-69 years (n = 297), a consecutive series of 188 survivors without recurrent stroke at follow-up 7 years later were included. Within the first week after stroke onset, stroke severity was assessed according to the Scandinavian Stroke Scale. Target omissions, asymmetry of omissions, and perceptual speed according to Star- and Letter Cancellation Tests were also assessed. Presence of lateralized inattention at the 7-year follow-up was investigated with the Star- and Letter Cancellation Tests and with the neglect item in the National Institutes of Health Stroke Scale.At the follow-up, 22 (11.7%) participants had lateralized inattention and the multivariable regression showed that independent significant baseline predictors were total omissions in target cancellations (P .001) and inferior baseline performance on visual processing speed (P = .008).About one of ten individuals exhibited signs of lateralized inattention 7 years after stroke. Baseline performance in perceptual processing speed and target omissions independently predicted presence of late signs of lateralized inattention. This is the first time processing speed is recognized as a significant predictor of lateralized inattention several years after the stroke incidence, indicating that the longitudinal course of processing speed following stroke is a critical subject for future research.

The article presents a biotechnical system for researching the cerebral cortex stimulation through receptor systems by exposure to sound and light of changing color. The system allows simultaneous exposure of both eyes, the difference in the frequencies of stimulation of the left and right eyes being close to brain wave frequencies. It also allows local stimulation of neural fields of the cerebral cortex and hippocampus with modulated magnetic fields. Tests showed that the developed system could be used for rehabilitation and restoration of both long-term and short-term memory in post-stroke patients.

Introduction Over the past decade, yoga has gained popularity in health care. The benefits of yoga can go beyond the physical to address the psychosocial and emotional. Such gains can be beneficial for people who have had a stroke. As a leading cause of disability, stroke can lead to challenges returning to daily activities. Occupational therapists may use yoga to promote engagement in daily activities after stroke. This study aimed to understand how and why occupational therapists integrate yoga into stroke rehabilitation. Methods This study involved occupational therapists practicing in the United States. Ten occupational therapists using yoga in practice participated in a semi-structured interview. Interview data were transcribed and analyzed using deductive and inductive coding. Themes emerged from the data related to the benefits of using yoga in stroke rehabilitation. Results According to this study, yoga is currently being used as a treatment technique and merged with occupational therapy. Yoga may promote client-centered recovery; bring “context” to therapy; and address physical, emotional, and psychosocial needs following stroke. Conclusion Individuals who have had a stroke may face challenges related to both physical and psychosocial engagement. The use of yoga in occupational therapy may be beneficial after stroke for both physical and psychosocial rehabilitation.

Background: The traditional inhibition of contralesional primary motor area (cM1) with low frequency repetitive transcranial magnetic stimulation (rTMS) fails to improve post-stroke severe motor impairment. The role of contralesional motor areas in post-stroke motor recovery is still questionable. While the previous data suggested that cM1 exerts transcallosal inhibitory effect on ipsilesional M1 (iM1) following stroke, there isan evidence that contralesional motor areas, particularly the contralesional dorsal premotor area (cPMd), have compensatory roles in severely impaired patients who have extensive ipsilesional damage. Objectives: To study whether facilitating cPMd with high frequency rTMS as a novel approach, instead of conventionally suppressing cM1, has beneficial effect on motor recovery of post-stroke severely impaired upper extremity (UE) or not. Patients and Methods: Forty right handed, first ever stroke patients (3 months post event) with severe stroke symptoms, severe motor deficit, and radio logically evident massive right cerebral infarctions at baseline were randomly assigned to two equal groups, to receive, as adjunct to ordinary rehabilitation techniques, ten consecutive sessions of either: (1) High frequency rTMS at 5 Hz on cPMd; or (2) Sham rTMS. The Medical Research Council (MRC) for muscle strength and UE- Fugl Meyer Assessment (UE-FMA) were assessed before and after the intervention. Results: By using the one way analysis of covariance (ANCOVA), we found significant improvements in grand means of MRC in the active rTMS group in relation to the sham group. The improvements included in particular the mean proximal MRC, whereas no significant improvement in the mean distal MRC. Similarly, we found that the UE-FMA totals were markedly improved in the active group in relation to the sham group, mainly in the proximal UE-FMA. Stepwise regression showed that lower baseline MRC of the affected UE muscles is an independent predictor of better response to the novel rTMS approach. Conclusion: Applying high frequency rTMS to cPMd can improve motor functions of the disabled UE, mainly proximal functions, in more severely impaired stroke patients.

Sit-to-stand (STS) motion is an important daily activity and many post-stroke patients have difficulty in performing the STS motion. Post-stroke patients who can perform STS independently, still utilize four muscle synergies (synchronized muscle activation) as seen in healthy people. In addition, temporal muscle synergy features can reflect motor impairment of post-stroke patients. However, it has been unclear whether post-stroke patients improve their STS movements in short-term rehabilitation and which muscle synergy features can estimate this improvement. Here, we demonstrate that temporal features of muscle synergies which contribute to body extension and balance maintenance can estimate the effect of short-term rehabilitation based on machine learning methods. By analyzing muscle synergies of post-stroke patients (n = 33) before and with the intervention of physical therapists, we found that about half of the patients who were severely impaired, improved activation timing of muscle synergy to raise the hip with the intervention. Additionally, we identified the temporal features that can estimate whether severely impaired post-stroke patients improve. We conclude that temporal features of muscle synergies can estimate the motor recovery in short-term rehabilitation of post-stroke patients. This finding may lead to new rehabilitation strategies for post-stroke patients that focus on improving activation timing of different muscle synergies.

To evaluate the clinical efficacy of the Governor Vessel-unblocking and mind-regulating acupuncture method plus repetitive transcranial magnetic stimulation (rTMS) in the treatment of post-stroke insomnia. A total of 72 patients with post-stroke insomnia were randomly divided into 2 groups, with 36 cases in each group. The control group received rTMS treatment with a frequency of 1 Hz and a motion threshold value of 90%. The observation group received acupuncture with Governor Vessel-unblocking and mind-regulating method based on the rTMS treatment of the control group. The points were Baihui (GV 20), Shenting (GV 24), Yintang (GV 29), Fengfu (GV 16), Sishencong (EX-HN 1), Shenmen (HT 7), Sanyinjiao (SP 6), Shenmai (BL 62) and Zhaohai (KI 6). The treatment was performed once a day for 5 d a week followed by 2 d of rest for 4 weeks. The improvements of Pittsburgh sleep quality index (PSQI), self-rating anxiety scale (SAS) and self-rating depression scale (SDS) scores were observed after treatment, and the clinical efficacy was compared between the two groups. After 4 weeks of treatment, the PSQI, SAS, and SDS scores of the two groups were all reduced, and the intra-group differences were statistically significant (all P

Stroke affects 33 million individuals worldwide every year and is one of the prime causes of paralysis. Due to partial or full paralysis, most of the patients affected by stroke depend on caregivers for the rest of their lives. Easy and efficient communication from the patient to the caregiver is a vital parameter determining the quality of life during rehabilitation. Several solutions, such as brain–computer interface (BCI) systems and exoskeletons, are proposed for post-stroke rehabilitation. But, most of these devices are expensive, sophisticated, and put an additional burden on the patient. Also, the communication between the patient and the caregiver is insecure. In this article, the brain-to-brain interface technique is integrated with an efficient encryption algorithm to enable secure transmission of information from the patient’s brain to the caregiver. When a patient thinks of a word or a number, the thought is transmitted with the help of an electroencephalogram (EEG) headset through a wireless medium to the recipient, who correctly interprets the thoughts conveyed by the sender and types the same alphabet on the keyboard at his/her end. The transmitted message at the edge is encrypted with a lightweight novel tiny symmetric algorithm (NTSA), which can only be decrypted at the edge receiver. The Internet of Things integrated system is also flexible to send signals to multiple caregivers at the same time. The proposed method tested on ten users gave an average effective concentration percentage of 78.9% along with the secure transmission, which is a significant result compared with existing solutions.

Objective: Soft robotic exosuits can improve the mechanics and energetics of walking after stroke. Building on this prior work, we evaluated the effects of the first prototype of a portable soft robotic exosuit. Methods: Exosuit-induced changes in the overground walking speed, distance, and energy expenditure of individuals post-stroke were evaluated statistically with alpha set to 0.05 and compared to minimal clinically important difference scores. Results: Compared to baseline walking without the exosuit worn, the

Introduction: The aim of this study was to evaluate the effects of video-based virtual reality exercises performed using the LeapMotion (R) device and Fizyosoft (R) software on the hand and upper extremity functions of patients with hemiplegia.

Background: The pattern of post-stroke aphasia in Spanish speakers has not previously been reported. Furthermore, the association between aphasia type and demographic variables is not clearly under...

The aim of this systematic review was to investigate if sex moderated the effect of exercise on cognition in adults post-stroke. A systematic review was conducted of randomized controlled trials that involved adults ���18 years with stroke, any exercise intervention, and reported any outcome related to cognitive function. We compared effect sizes of cognitive outcomes between studies of lower and higher proportion of females (CRD42018092757). The effects of exercise did not differ between studies of higher and lower female proportions with respect to memory (��2 =1.52, p = 0.22), executive function (��2 = 0.56, p = 0.45; Chi2 = 0.00, p = 0.98), language (Chi2 = 3.17, p = 0.08) or global cognition (��2 = 0.88, p = 0.35). There were no sex differences in the effects of exercise on memory, executive functioning, language or global cognition in individuals with stroke. Further research is warranted to address sex differences in individuals with stroke to enable better targeting, prevention, and interventions in stroke rehabilitation.IMPLICATIONS FOR REHABILITATIONUnderstanding sex differences and potentially similarities in the relationship between exercise and cognition is an important step in enhancing stroke rehabilitation and the development of optimal, sex-specific rehabilitation.Although our findings suggest that there is no clear rationale for incorporating sex into our clinical decision making, it is still imperative to consider sex factors in research and report results in the literature disaggregated by sex to help inform clinical practice. Understanding sex differences and potentially similarities in the relationship between exercise and cognition is an important step in enhancing stroke rehabilitation and the development of optimal, sex-specific rehabilitation. Although our findings suggest that there is no clear rationale for incorporating sex into our clinical decision making, it is still imperative to consider sex factors in research and report results in the literature disaggregated by sex to help inform clinical practice.

Aphasic discourse has been investigated through two major approaches: a micro-linguistic approach and a macro one, but the separate analysis of the micro and macro aspects of aphasic discourse has led to a noticeable gap between them. Cohesion analysis is one of the possible ways that can directly connect these two aspects. However, few studies have investigated cohesion in aphasic discourse in an integrated manner. The present study employs a mixed-methods approach to examine whether and how patients with fluent and non-fluent stroke-induced aphasia differ from normal individuals in the cohesion of their discourse, aiming to provide a more comprehensive understanding of this issue. We compared the use of cohesive devices in the discourse of 7 non-fluent aphasics (4 males, mean age = 70.9) and 9 fluent aphasics (4 males, mean age = 70.7) against 16 non-aphasic controls (NACs) (8 males, mean age = 71.0). Transcripts were analysed and conclusions were drawn based on the combination of quantitative and qualitative observations. As predicted, discourse by aphasic participants is less cohesive than that by non-aphasic participants and the three groups' discourse differs from each other in the distribution of cohesion categories, with non-fluent aphasics having more trouble in using grammatical cohesive devices while fluent aphasics more severely affected in constructing lexical cohesion. Results suggest that cohesion in post-stroke aphasic discourse may vary between different aphasia types and thus can be rather complicated. Additional work involving more aphasia types and more dimensions of discourse cohesion is needed to provide further insight into this question.

Zusammenfassung Hintergrund Und Zielsetzung Datenlinkage-Verfahren sind von erheblicher Bedeutung für die Evaluation von Therapieregimes chronischer Erkrankungen, bei denen Patient/inn/en zwischen verschiedenen Versorgungssektoren navigieren. Ein umfassendes Bild langfristiger Effekte und der Kosten-Effektivität der Behandlung kann nur gezeichnet werden, wenn Daten verschiedener Provenienz miteinander verknüpft werden. Methodische Probleme und Herausforderungen Am Beispiel der post-akuten Versorgung des Schlaganfalls veranschaulicht die vorliegende Studie, wie per exaktem deterministischem Datenlinkage klinische Patient/inn/endaten (Primärdaten) mit Routineabrechnungsdaten (Sekundärdaten) der Tiroler Gebietskrankenkasse (TGKK) verknüpft werden können. Die von Datenlinkage-Projekten bekannten Herausforderungen traten auch beim StrokeCard-Projekt der Medizinischen Universität Innsbruck auf, insgesamt jedoch begünstigten die Spezifika des österreichischen Gesundheitssystems (ein Großteil der Population ist in der Gebietskrankenkasse des jeweiligen Bundeslandes pflichtversichert) das Datenlinkage-Vorhaben. Ergebnisse Im Rekrutierungszeitraum 01/2014–12/2015 konnten n=540 Pat. identifiziert und dem operativen Datensatz zugespielt werden. Davon waren n=367 Teil der StrokeCard-Gruppe (d. h. der Interventionsgruppe), n=173 gehörten der Standardversorgungsgruppe an (d. h. der Kontrollgruppe); n=11 Pat. haben das 1-Jahres-Follow-up nicht beendet (n=7 Pat. der Interventionsgruppe vs. n=4 Pat. der Kontrollgruppe); n=7 Pat. verstarben während der Studie (n=5 Pat. der Interventionsgruppe vs. n=2 Pat. der Kontrollgruppe). Für alle 540 Pat. waren TGKK-Routinedaten für 1 Jahr vor Rekrutierung bis 1 Jahr nach Entlassung aus der Klinik verfügbar. Alle Daten konnten für die gesundheitsökonomische Evaluation verwendet werden. Schlussfolgerungen Mit diesem Projekt wurde die Machbarkeit der Verknüpfung von Primär- und Sekundärdaten unterschiedlicher Herkunft untersucht. Trotz günstiger Rahmenbedingungen hat die österreichische Versorgungsforschung nur begrenzte Erfahrungen auf diesem Gebiet. Die Ergebnisse zeigen, dass ein unter Datenschutzkautelen betriebenes Linkage gelingen kann und aufgrund der Verfügbarkeit relevanter Informationen aus Abrechnungsdaten eine empirische Bereicherung insbesondere für gesundheitsökonomische Analysen darstellt. Dies sollte als Anregung verstanden werden, in Evaluationsstudien Datenlinkage-Prozeduren in Zukunft in verstärktem Maße einzusetzen.

Introduction Previous studies showed insufficient control of cardiovascular risk factors (CVRF) and high stroke recurrence rates among ischemic stroke patients in Germany. Currently, no structured secondary prevention program exists in clinical routine. We present the trial design and pilot phase results of a complex intervention to improve stroke care after hospital discharge in Germany. Patients and methods SANO is a cluster-randomized trial with 30 participating regions across Germany aiming to enrol 2,790 patients (drks.de, DRKS00015322). Study intervention combines both structural and patient-centred elements. Study development was based on the Medical Research Council framework for complex interventions. In 15 intervention regions, a cross-sectoral multidisciplinary network is established to enhance CVRF control as well as detection and treatment of post-stroke complications. Recommendations on CVRF are based on high-quality secondary prevention guidelines. Study physicians use motivational interviewing and agree with patients on therapeutic targets. While hospitalised, patients also receive dietary counselling and a health-passport to track their progress. During regular visits, CVRF management and potential complications are monitored. The intervention is compared to 15 regions providing usual care. The primary endpoint is the combination of recurrent stroke, myocardial infarction and death assessed 12 months after enrolment and adjudicated in a blinded manner. Results Eighteen patients were enrolled in a pilot phase that demonstrated feasibility of patient recruitment and study procedures. Conclusion SANO is investigating a program to reduce outcome events after ischemic stroke by implementing a complex intervention. If successful, the program may be implemented in routine care on national level in Germany.

Hemiparesis resulting from stroke presents characteristic spatiotemporal gait patterns. This study aimed to clarify the spatiotemporal gait characteristics of hemiparetic patients by comparing them with height-, speed-, and age-matched controls while walking at various speeds. The data on spatiotemporal gait parameters of stroke patients and that of matched controls were extracted from a hospital gait analysis database. In total, 130 pairs of data were selected for analysis. Patients and controls were compared for spatiotemporal gait parameters and the raw value (RSI) and absolute value (ASI) of symmetry index and coefficient of variation (CV) of these parameters. Stroke patients presented with prolonged nonparetic stance (patients vs. controls: 1.01 ± 0.41 vs. 0.83 ± 0.25) and paretic swing time (0.45 ± 0.12 vs. 0.39 ± 0.07), shortened nonparetic swing phase (0.35 ± 0.07 vs. 0.39 ± 0.07), and prolonged paretic and nonparetic double stance phases [0.27 ± 0.13 (paretic)/0.27 ± 0.17 (nonparetic) vs. 0.22 ± 0.10]. These changes are especially seen in low-gait speed groups (

Self-reported outcomes provide unique insights about an individual’s perceived manual ability after stroke. This study aimed at determining how the relationship between objective kinematic variables obtained from the target-to-target pointing task and self-reported manual ability varies during the first year in individuals after stroke. Sixty-six individuals from the Stroke Arm Longitudinal study at the University of Gothenburg (SALGOT) cohort were assessed using ABILHAND questionnaire and kinematic analysis at five timepoints between the 10th day and 12th month after stroke. Kinematic analysis was performed using a target-to-target pointing task in a virtual environment. Spearman’s correlation was used to determine the extent of correlation between ABILHAND logits and kinematic variables. The correlations varied with time within the first year after stroke. The correlations were low or very low early after stroke and became moderate to high after 6 months for objective measures of movement time and smoothness, but remained low to moderate for mean velocity and low for peak velocity. Due to this discrepancy between self-perceived and objective assessments of arm function, a combination of self-reported and objective assessments of upper limb should be used as outcome measures, especially in the acute and subacute stages after stroke.

Objective The aims of this systematic review are to review studies on the patient's family readiness in caring for stroke patients at home, the instruments used to assess family readiness and the factors that influence family readiness. Methods The method used is an electronic database that has been published through PubMed, ScienceDirect, and Wiley online library. The keywords used for article searching is based on the study question. Results The review of six research articles stated that family readiness in stroke patients is essential to note that the instrument most often used in family preparedness assessments is the Preparedness Caregiver Scale (PCS) instrument. Factors that influence family readiness include Pre-stroke caregiver experience, the strength of caregiver relationships with patients, family understanding and involvement in care, caregiver roles and responsibilities. Conclusion Family preparedness assessment is critical to note especially for health workers, and the selection of the right instruments will significantly affect the caregiver's family readiness in treating stroke patients at home.

Objective To evaluate the longitudinal changes of swallowing kinematics based on videofluoroscopic swallowing studies (VFSSs) in subacute stroke patients grouped according to the method of dietary intake.Methods Sixty-nine subacute stroke patients who had taken at least 2 successive VFSSs were included. Subjects were allocated into 3 groups according to the degree of swallowing function recovery—not improved group (tube feeding recommended to patients at both studies), improved group (tube feedings recommended initially to patients and oral feeding recommended at follow-up study), and well-maintained group (oral feeding at both studies recommended to patients). Initial VFSS was performed during the subacute stage of stroke, 1 to 12 weeks after the onset of stroke, and follow-up VFSS was performed at least once. Kinematic variables were calculated by two-dimensional motion analysis of multiple structures, including the hyoid bone, epiglottis, and vocal cord. Changes of kinematic variables were analyzed in serial VFSSs.Results At the initial VFSS, the well-maintained group showed significantly larger angles of epiglottic folding than the not improved group, while at the follow-up VFSS, the improved and the well-maintained groups showed significantly larger epiglottic folding angles than the not improved group. The distribution of epiglottic folding angles was in a dichotomous pattern, and each cluster was related to the swallowing function.Conclusion This study showed that improved epiglottic folding angles are associated with the recovery of the swallowing process and suitability for oral feeding among various kinematic variables in subacute stroke patients.

Background: Group therapy has shown benefit in language recovery in patients with aphasia (PWA). However, many in the field question its role in improving quality of life for PWA, as well as whethe...

PURPOSE OF REVIEW: This paper aims to review non-invasive brain stimulation (NIBS) methods to augment speech and language therapy (SLT) for patients with post-stroke aphasia. RECENT FINDINGS: In the past five years there have been more than 30 published studies assessing the effect of transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS) for improving aphasia in people who have had a stroke. Different approaches to NIBS treatment have been used in post-stroke aphasia treatment including different stimulation locations, stimulation intensity, number of treatment sessions, outcome measures, type of aphasia treatment, and time post-stroke. SUMMARY: This review of NIBS for post-stroke aphasia shows that both tDCS and TMS can be beneficial for improving speech and language outcomes for patients with stroke. Prior to translating NIBS to clinical practice, further studies are needed to determine optimal tDCS and TMS parameters as well as the mechanisms underlying tDCS and TMS treatment outcomes.

Introduction Few stroke survivors receive upper limb constraint-induced movement therapy (CIMT). The aims of this study were to evaluate whether a behaviour change program for occupational therapists increased the number of stroke survivors receiving CIMT, describe the time and process involved in delivering the first program, any adverse events, fidelity and dose of CIMT provided, and upper limb outcomes. Methods A feasibility pre-post implementation study design was used, with intervention and measures for therapists and stroke survivors. Intervention for occupational therapists was informed by the Behaviour Change Wheel and included CIMT training, barrier identification, mentoring and a community of practice. Therapists delivered 2-week CIMT programs with 1:1 supervision, first assisting stroke survivors to identify upper limb goals using the Canadian Occupational Performance Measure. The primary outcome was change in the number of stroke survivors receiving CIMT (program reach). Hours associated with program delivery, adverse events and participant repetitions were recorded (program fidelity and dose). Change in motor function was measured (fidelity) using the Motor Assessment Scale (Upper Limb), Box and Block Test, Nine Hole Peg Test and Motor Activity Log at baseline, program completion (2 weeks), 1 and 12 months. Results Program reach: Sixteen stroke participants were recruited (mean 15.3 months post-stroke, SD 11.9) and six CIMT programs conducted over 24 months, compared to none pre-implementation. The first CIMT program required a mean of 242 hours for preparation and delivery. All programs were student-assisted. Fidelity and dose: Stroke participants completed a mean of 360.6 repetitions/hour (SD 183.7), and 12,719.6 repetitions/program (SD 6,872.8). Statistically significant changes in upper limb motor function were recorded; some changes were clinically important. Conclusions The behaviour change program resulted in multiple CIMT programs being delivered safely and with fidelity. Capacity building and skill development took many hours, as did preparation for the first CIMT program.

Background Bilateral priming, device assisted bilateral symmetrical wrist flexion/extension, is a noninvasive neuromodulation technique that can be used in the clinic. Objective We examined the additive effect of bilateral motor priming and task specific training in individuals with severe upper limb hemiparesis. Methods This is a parallel assignment, single-masked, randomized exploratory pilot study with three timepoints (pre-/post-intervention and follow up). Participants received either bilateral motor priming or health care education followed by task specific training. Sixteen participants who were at least 6 months post-stroke and had a Fugl Meyer Upper Extremity (FMUE) score between 23 and 38 were randomized. Our primary and secondary measures were Chedoke Arm & Hand Activity Index 9 (CAHAI-9) and the FMUE respectively. We determined changes in interhemispheric inhibition using transcranial magnetic stimulation. We hypothesized that improvement in the priming group would persist at follow up. Results There was no between-group difference in the CAHAI. The improvement in the FMUE was significantly greater in the experimental group at follow up (t = 2.241, p = 0.045). Conclusions Both groups improved in the CAHAI. There was a significant between-group difference in the secondary outcome measure (FMUE) where the bilateral priming group had an average increase of 10 points from pre-intervention to follow up.

Introduction This study explored the impact of HIV on the functional recovery of personal activities of daily living of stroke survivors. This assisted in identifying possible implications for the rehabilitation of stroke survivors who are also HIV-positive. Method A quantitative, descriptive, longitudinal comparative research design was used to determine the change in personal activities of daily living scores of HIV-negative and HIV-positive stroke survivors from admission to 1 month after discharge. Data were collected at a rehabilitation unit using the South African Database Functional Measure. Results There was no difference in the rate and nature of functional recovery of personal activities of daily living between the two groups between admission and discharge. A difference was noticed during the period from admission to 1 month after discharge, during which the HIV-negative group continued to show improvement, while the HIV-positive group showed little improvement or a decline in personal activities of daily living scores. Conclusions While the rate and nature of functional recovery related to personal activities of daily living for HIV-positive and HIV-negative stroke survivors is similar during inpatient care, discharge planning for the HIV-positive group needs to consider the decline in personal activities of daily living functioning post discharge. Regular follow-ups and the inclusion of the stroke survivors in an outpatient treatment programme is recommended.

Dysphagia can occur in geriatric patients and is found in post-stroke patients. Dysphagia is a swallowing disorder that can cause dehydration and disruption of daily activities. PSD is thought to be due to damage to the cortex and subcortical structures. After hospitalization, patients are expected to perform daily activities independently. The rehabilitative therapy that can be performed for post-stroke dysphagia patients is the Mendelsohn maneuver. The patient is asked to swallow food as usual, and when the food reaches the laryng, hold it up for 2-3 seconds with the throat muscles before finishing swallowing. Several studies have shown that there is an increased function in swallowing and a reduction in the incidence of aspiration.

Handgrip Dynamometer is a tool used to view the strength of the hand muscles post-stroke patients. In this study Handgrip Dynamometer created to look at the hand grip strength in real time and find out the hand grip strength criteria, there are three indicators: the criteria of mild, moderate or strong. Handgrip dynamometer using the Arduino Uno control over the entire system and Load Cell as a sensor. Load Cell Output will be boosted by Analog Signal conditioner HX711 and then processed in the microcontroller, then will be displayed on the LCD. Berdasarlan weight measurement results obtained by the result of error by 0% By comparison to using weights, sehingga can be concluded that the tool can be used according to its function.

To observe the clinical efficacy of Jin’s three-needle therapy on post-stroke cognitive impairment (PSCI) and the effect on neuroelectrophysiology (event-related potentials). A total of 60 PSCI patients were selected and divided into a treatment group and a control group according to the method of random number table, with 30 cases in each group. The patients in the control group received routine treatment while the patients in the treatment group received additional Jin’s three-needle therapy. The treatment for both groups lasted four weeks. Mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA) scores as well as amplitude and latency of potential 300 (P300) were adopted to compare the between-group results before and after treatment. Before treatment, there were no significant differences (all P>0.05) in MMSE and MoCA scores, P300 latency and P300 amplitude between the two groups. After 4 weeks of treatment, the MMSE and MoCA scores and P300 amplitudes were improved in both groups, and the P300 latencies became shorter. The results showed significant intra-group and between-group differences (all P

Introduction Urinary incontinence is a prognostic indicator of mortality and functional recovery in stroke. There is a small evidence base that early intervention within the first three months may improve continence status and subsequent physical and psychological consequences. Methods Utilising a proforma and PDSA, data was collected on the identification and assessment of urinary continence status for patients admitted to a stroke unit. Five agreed standards from NICE (2012) and RCP (2016) guidelines formed the basis of audit. Three cycles of prospective data for a total of 66 patients was collected over four months, implementing quality improvement measures after each cycle. Results 22 participants per cycle. Cycle one demonstrated continence status was identified by the nursing team (100%), and the medical team (41%). However, standards regarding further care planning and assessment (22%), MDT input (11%) and subsequent behavioural and practical interventions (11%) was low. Change strategy, i) awareness training, ii) development of MDT prompt sheet. Cycle two, medical identification (82%), MDT discussion (100%), and continence specific interventions (66%), care planning decreased from 22% to 0%. Change strategy, incontinent patients receive an individualised assessment within 7 days by the advanced nurse practitioner, this assessment should consider all available evidence-based interventions, with the aim of reducing urinary incontinence within the early phases of stroke. Cycle three showed an overwhelming improvement to all five standards, nursing and medical identification (100%, 91. Conclusions PDSA style audit led to quality improvement. The identification of urinary continence status post stroke was high, but due to multifactorial elements often did not progress to assessment or intervention from the MDT. Utilising the existing role of the trainee advanced practitioner patients received evidence-based continence reviews in a timely manner, with no additional cost impact to the service.

Background: Writing ability is of increasing importance in our computerised societies, yet research into functional text writing in persons with aphasia (PWA) remains scarce. Knowledge is limited o...

Dance improves physical, psychosocial, and cognitive function, while increasing community participation among community-dwelling individuals post-stroke. Yet little is known about how to structure community-based dance classes to optimize benefits and participation. This study aims to gain stakeholders' perspectives about how to optimally structure community-based dance classes for individuals with chronic stroke.A qualitative descriptive approach utilizing focus group methods was implemented. Two focus groups were undertaken with each of three stakeholder groups: persons post-stroke (This study identified three main themes/topics requiring consideration when structuring community-based dance programs: the environment, flow of the class, and qualities of the dance instructor. The study findings highlight that the pedagogical skills and teaching philosophy of the dance instructor are integral for a successful dance program, as the dance instructor directly mediates both the environment and flow of classes.Recommendations generated from our study can inform the development of community-based dance programs that are practical, optimize health benefits, and meet the needs and interests of people post-stroke.IMPLICATIONS FOR REHABILITATIONDance is an effective way to improve physical, psychosocial, and cognitive function for persons post-stroke while also promoting meaningful social relationships within the community.A dance instructor who is a skilled communicator and is willing to adapt to the needs of the class, is the most important factor for a successful dance class.Creating a safe and inviting environment for a dance program, includes both the physical and emotional aspects of environment facilitating individuals to create connections with others and feel more confident in themselves.The structure of a dance class, based on the abilities, interests, and goals of dancers, should include elements of predictability and variability to keep dancers progressing and motivated, and be two times a week for 3 months lasting 1-2 h.

Our study aimed to explore the association between serum C-reactive protein (CRP) and post-stroke depressive symptoms. We prospectively recruited 572 patients with ischemic stroke or transient ischemic attack in whom serum CRP level was measured within 48 h after stroke onset. Depressive symptoms were assessed at day 8 and 3 months after stroke in 405 and 306 patients, respectively. Patients with greater depressive symptoms at day 8 and patients with greater depressive symptoms 3 months after stroke had higher CRP level (median: 7.9 vs 4.3 mg/L, P 9.2 mg/L was associated with depressive symptoms at day 8 (OR: 2.06, 95%CI: 1.30–3.28, P 4.3 mg/L was associated with depressive symptoms 3 months after stroke (OR: 1.79, 95%CI: 1.06–3.02, P = 0.03). In the multivariate analysis, higher CRP level was related to depressive symptoms at day 8 (OR: 2.23, 95%CI: 1.28–3.90, P

Objective To test the feasibility and efficacy of multimodality stimulation combined with motor tasking as a corrective strategy for hemineglect following right hemispheric ischemic strokes. Material and methods A prospective randomized controlled single blinded clinical trial was conducted over eighteen months from January 2017. All patients with right hemispheric ischemic strokes were screened for hemineglect and those fulfilling criteria were recruited and randomized. Patients under the therapy group (TG) received the intervention based on a structured protocol in addition to standard physiotherapy. The control group (CG) received standard physiotherapy alone. NIHSS, mRS and Neuropsychological test scores were recorded at different time points. The primary outcome measures (neuropsychological test scores) were compared between the two groups (Student's t-test to find out the difference in outcome measures) at one and three months post-stroke. Results Of the 14 patients recruited, data from 12 were available for analysis, 5 patients in TG and 7 in CG. There was a trend for better hemineglect and functional outcomes in TG. Conclusion Multimodality stimulation, in addition to standard physiotherapy, is feasible and potentially results in better neurocognitive and functional recovery following right hemispheric ischemic strokes. However, larger studies are warranted to prove these preliminary observations beyond doubt.

Introdução: A ausculta cervical caracteriza-se como um exame complementar à avaliação clínica da disfagia. Objetivo: Estabelecer o perfil sonoro dos ruídos da deglutição de um grupo de pacientes pós-AVC. Método: Estudo clínico de caráter transversal, cuja coleta e análise acústica foram realizadas através do estetoscópio eletrônico da marca Littman (modelo 4100) e avaliação clínica da disfagia, com a coleta de 45 deglutições de líquidos e nove deglutições secas. Resultados: Amostra composta por nove sujeitos pós-AVC com idade média de 54,33 anos; 55,6% dos pacientes com alteração de deglutição. As frequências variaram entre 20-500 Hz, as frequências da deglutição seca ocorreram em 250 Hz na deglutição sem alteração e entre 20 Hz a 249 Hz na alterada; para a deglutição de líquidos entre 20 Hz a 249 Hz sem alteração e de 250 Hz na alterada. O tempo médio da deglutição seca se deu em 110,3 ms (dp ±38,6 ms) e com líquidos em 111,6 ms (dp ± 36,5 ms). O tempo médio entre os eventos de deglutição seca foi de 125 ms (dp ± 54,74 ms) na deglutição sem alteração e de 98,60 ms (dp ± 18,66 ms) na alterada; na deglutição líquida foi de 100,20 ms (dp ± 31,01 ms) sem alteração e de 120,68 ms ± 38,52 ms na deglutição alterada. Conclusão: O estetoscópio digital mostrou-se como uma possibilidade instrumental para a coleta, contudo para a análise acústica se mostrou pouco objetivo. Os resultados encontrados com a deglutição seca e com a consistência líquida foram: tempo médio em torno de 110 ms e em frequência baixa, variando entre 20 Hz e 500 Hz para ambas as consistências, junto aos pacientes pós-AVC.

Paretic syndrome in the hand motor function is noted in 80% of stroke patients, and in half of them the paresis persists for life. The using of non-invasive BCI based on EEG - data for rehabilitation and quality of life improvement is a promising and rapidly developing direction. Today, such devices actively advance in the direction of developing control systems for patients’ imaginary motor activity. The purpose of this study is to assess the post-stroke patients’ special characteristics of the brain bioelectrical activity in real and image movements processes.

Study Objective: To evaluate dose-dependent effects of adjunctive treatment with ethylmethylhydroxypyridine succinate within a comprehensive course of rehabilitation, in cerebral stroke patients with movement disorders in the second stage of rehabilitation. Study Design: This was a randomized study. Materials and Methods: Forty ischemic stroke patients were examined, and divided into three groups. Ethylmethylhydroxypyridine succinate was given intramuscularly to 18 patients: 250 mg/day (5 mL) in Group 1 (n = 9) and 100 mg/day (2 mL) in Group 2 (n = 9). In Group 3 (n = 22) patients did not receive this drug. All patients underwent a complete examination, including assessment of the following parameters: static and dynamic balance, as assessed by the Standing Balance Test and the Berg Balance Test; walking (Hauser Ambulation Index); and emotional (Hospital Anxiety and Depression Scale), cognitive (Montreal Cognitive Assessment), and sensory (Fugl-Meyer Assessment Scale) functions. Patients’ balance status was objectively assessed using stabilometric parameters. Study Results: Group 1 patients showed a significant increase in Berg Balance Test scores (from 44.00 [42.00; 47.00] to 46.00 [42.00; 49.00]) and a decrease in statokinesigram area (with eyes closed) (from 910.92 [36.20; 2,633.50] mm2 to 620.98 [213.40; 1,676.30] mm2 (p < 0.05). All groups exhibited trends toward improvement of static balance, quality of walking, and cognitive and sensory functions, but only the changes in the Montreal Cognitive Assessment in Group 1 were statistically significant (from 24.67 [19; 27] to 26.67 [22; 29]). Conclusion: Adjunctive ethylmethylhydroxypyridine succinate, 5 mL (250 mg/day), within a course of rehabilitation improved patients’ balance status and cognitive functions. Patients who received this medication at a dose of 2 mL (100 mg/day) and those who did not receive it showed no significant improvement during rehabilitation. Keywords: stroke, balance, neurometabolic therapy, ethylmethylhydroxypyridine succinate.

Возникновение эпилептических приступов и эпилепсии после инсульта является примером их тесной связи с цереброваскулярной патологией. По данным разных исследователей, эпилептические приступы у пациентов, перенесших инсульт, встречаются с частотой от 3–6 до 12%. Постин-сультные приступы могут возникать в остром периоде инсульта или в более поздние сроки. Эпилепсия у больных с инсультом значительно ухудшает качество их жизни, замедляет бытовую, социальную и профессиональную адаптацию. В статье рассматриваются терминологические, эпидемио-логические, патофизиологические аспекты, факторы риска и предикторы эпилептических приступов и эпилепсии у больных с инсультом. Ключевые слова: инсульт, эпилептические приступы и постинсультная эпилепсия. Для цитирования: Максимова М.Ю., Шалиманова Е.В., Брутян А.Г. Эпилептические приступы и эпилепсия у больных с инсультом. Consilium Medicum. 2020; 22 (9): 38–45. DOI: 10.26442/20751753.2020.9.200273

Purpose: This systematic review examines intervention studies using extracorporeal shock wave therapy (ESWT) application in post-stroke muscle spasticity with particular emphasis on the comparison of two different types of radial (rESWT) and focused shock waves (fESWT). Methods: PubMed, PEDro, Scopus, and EBSCOhost databases were systematically searched. Studies published between the years 2000 and 2019 in the impact factor journals and available in the English full-text version were eligible for inclusion. All qualified articles were classified in terms of their scientific reliability and methodological quality using the PEDro criteria. The PRISMA guidelines were followed and the registration on the PROSPERO database was done. Results: A total of 17 articles were reviewed of a total sample of 303 patients (age: 57.87 ±10.45 years and duration of stroke: 40.49±25.63 months) who were treated with ESWT. Recent data confirm both a subjective (spasticity, pain, and functioning) and objective (range of motion, postural control, muscular endurance, muscle tone, and muscle elasticity) improvements for post-stroke spasticity. The mean difference showing clinical improvement was: Δ=34.45% of grade for fESWT and Δ=34.97% for rESWT that gives a slightly better effect of rESWT (Δ=0.52%) for spasticity (p

Purpose: The randomized controlled trial (RCT) is considered a reliable experimental design, able to detect the effect of an intervention. However, a criticism frequently levelled at RCTs by clinicians is their lack of generalizability. This study aimed to evaluate the generalizability of findings from RCTs of physiotherapy interventions for individuals with stroke. Method: A sample of RCTs of physiotherapy interventions after stroke indexed in the PEDro database was selected, and the reported inclusion and exclusion criteria were analyzed. Results: We reviewed 100 articles, which included 7,366 participants (41.6% women, with a mean weighted age of 65.5 years). The most frequent criteria for exclusion were comorbidity (83%), cognitive impairments (69%), communication skills (55%), recurrent stroke (53%), low functional level (47%) and being elderly (25%). Conclusions: A variety of cohorts of individuals who have had a stroke are excluded from RCTs published in the field of physiotherapy. Because they represent a substantial proportion of the real-world population with stroke, and consequently treated in clinical practice, more vulnerable cohorts of participants should be included in RCTs.

Post-stroke urinary incontinence (UI) is one of the sequelae of stroke. This situation affects all aspects of the patient’s life both physically, psychologically, socially, and spiritually. Post-stroke UI as a chronic disease requires holistic treatment. Many chronic health problems will respond well when handled from a holistic perspective. The holistic health view focuses on the patient’s health care needs, not only needs related to the patient’s physical condition of health, but also subjective aspects related to social representation of his/her health conditions. Developing a holistic post-stroke UI management model and continuous care at the patient’s home needs to be done. This chapter includes model components which are also interventions that can be done to overcome post-stroke UI. These interventions include information and understanding of post-stroke UI; ways to overcome post-stroke UI; conduct self-control and stay motivated; perform daily activities independently according to ability; and get family support and peer attention. This model was developed based on previous qualitative studies and literature studies related to post-stroke urinary incontinence. Intervention in this model is aimed at patients who have passed the acute phase of stroke, when they will be discharge from the hospital and continued at the patient’s home.

Background We applied Motivational Interviewing (MI) techniques, early after stroke, to facilitate psychological adjustment to life post-stroke. In our trial, MI-plus-usual-care increased the likelihood of normal mood at 3-months post-stroke, compared to usual-care alone. Whilst appropriate training, manuals, and supervision may increase adherence to core principles of this complex intervention, unintended variability in implementation inevitably remains. We aimed to explore the impact of variability on participant outcome. Methods Using our trial data (411 participants), we explored variation in MI delivery, examining: therapist characteristics (stroke care expertise/knowledge, psychology training); MI content (fidelity to MI techniques assessed with Motivational Interviewing Treatment Integrity code, describing therapist behaviours as MI-consistent, MI-neutral or MI-inconsistent); and MI dose (number/duration of sessions). Results The four MI therapists (two nurses/two psychologists) had varying expertise and MI delivery. Across therapists, mean average session duration ranged 29.5–47.8 min. The percentage of participants completing the per-protocol four sessions ranged 47%–74%. These variations were not related to participant outcome. There were uniformly high frequencies (>99%) of MI-consistent and MI-neutral interactions, and low frequencies (

BACKGROUND AND PURPOSE Dual-task (DT) walking assessments allow for the simultaneous evaluation of cognitive and motor performance. During DT walking, individuals may experience interference in one or both tasks, known as cognitive-motor interference (CMI). The primary purpose of this study was to compare CMI between individuals post-stroke and healthy persons group during single- and dual-motor and cognitive tasks, using 2 distinct walking tasks. METHODS Motor performance was quantified as the total time for the Timed Up and Go (TUG) and gait speed for the 90-second walk (90W). Cognitive performance was measured as the correct response rate (CRR) during serial 7 subtractions. Participants performed the motor and cognitive tasks in isolation for the single-task (ST) and simultaneously for DT conditions, TUG-DT and 90W-DT. A repeated-measures analysis of variance assessed group (poststroke and healthy) by condition (ST and DT) interactions for the TUG, 90W, and CRR. RESULTS There were significant main effects of group and condition for both the TUG and the 90W (P < 0.05). There was also an interaction effect for the TUG, with individuals post-stroke demonstrating a larger decrement in TUG-DT performance compared with healthy persons (P < 0.05). Furthermore, a significant interaction effect was observed for the CRR, in which healthy individuals exhibited a greater decrement in performance from the ST to the 90W-DT (P < 0.05). DISCUSSION AND CONCLUSIONS Individuals post-stroke were susceptible to greater motor interference during the more complex motor task, the TUG-DT. However, the only decrements observed in cognitive performance from the ST to DT occurred in healthy individuals during the 90W-DT.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A367).

Introduction In Ireland it is estimated that there are 30,000 persons living with residual effects of stroke.1 The Irish National Audit of Stroke Care, carried out in 2007, identified substantial deficits in a number of areas including discharge planning, rehabilitation, on-going secondary prevention, and communication with patients and families.2 The present study builds on the findings of the audit. It explores in detail the current needs of people post stroke in Ireland who are living in the community. It also provides a profile of many possible problems that stroke can cause. In addition it provides a comprehensive review of the literature. Aim This report contains two distinct pieces of research: Firstly, a systematic review and qualitative synthesis (metasynthesis) of the literature was conducted. The aim of the systematic review was to identify perceived barriers and facilitators to community re-integration in the first 12 months after stroke, from the perspective of persons with stroke Secondly, a national survey of stroke survivors who experienced their stroke up to 5 years previously was carried out. The aim of the survey was to document the experiences and levels of self-reported long-term need among community-dwelling stroke survivors in Ireland Methods of the National Survey Stroke survivors were recruited to take part in the survey primarily though the Irish Heart Foundation National Stroke Support Group Network and non-statutory organisations that provide support after acquired brain injury. The survey was also advertised online to a broader stroke population. A questionnaire was developed to assess respondents’ own perceptions of their recovery, community re-integration and on-going needs from existing validated questionnaires with the permission of the original authors.3 Data collection took place between June and October 2013. Main findings: Systematic Review Eighteen articles, using qualitative methodology, were included in the final review. Four primary themes that were perceived to act as barriers or facilitators to community re-integration for individuals in the first year after stroke were identified from the included studies: Primary effects of stroke Personal factors Social factors Relationships with professionals National Survey A total of 196 stroke survivors, aged between 24 and 89 years, responded to the surve Mobility difficulties were reported by eighty-three per cent of respondents. Emotional problems, fatigue, concentration and arm dysfunction were reported almost as commonly Of the 150 individuals with emotional difficulties only eleven per cent received psychological services Sixty per cent of respondents felt that their household finances were affected by their stroke. Thirty-six per cent of respondents reported paying privately for rehabilitation. Thirty-four per cent of respondents had to pay privately to adapt their home Over half of respondents needed help with personal care and two thirds needed help with household tasks since their stroke. Family provided most of this help Forty-two per cent of respondents who were in a relationship at the time of the survey felt that it has been significantly affected by their stroke Less than a quarter of respondents under the age of 66 have worked in a full or part-time capacity since their stroke, while sixty per cent of drivers have returned to driving Conclusions Stroke had a personal, social and economical impact on the lives of many respondents. Successful return to work levels after stroke, as reported, were particularly low. Emotional distress and fatigue were common and were barriers to many activities. Satisfaction with the level of help available for these problems was poor.