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Optimal upper extremity motor control and range of motion are necessary to achieve even the basic activities of daily living (ADL) function. Stroke, with resulting hemiparesis, can significantly and negatively impact an individuals ADL function. Functional Independence Measure (FIM) self-care score can provide an assessment of what aspects and to what degree ADL functions are impaired. FIM self-care assessment can also track changes in ADL function during stroke recovery and rehabilitation. Recently, the sensor-acquired 3D motion analysis of stroke patients upper extremity has shown promise as a potential alternative to assess ADL function. This observational study evaluates whether the sensor-acquired upper extremity reachable workspace (RWS) measure correlates with clinician-evaluated FIM self-care score in stroke patients. Seventeen patients with stroke were enrolled in the study. FIM self-care, NeuroQoL upper extremity, and reachable workspace outcome measures (relative surface area, RSA) were collected upon rehabilitation hospital admission, at discharge, and at the 3-month visit. Pearson and Spearmans rank correlation coefficients as well as multiple linear regression analyses were used to determine the relationships between FIM self-care, NeuroQoL, and reachable workspace RSAs. Moderately strong correlation between total reachable workspace RSA and total FIM self-care score at discharge and at 3 months were noted (r = 0.619, r = 0.661, p < 0.05), and similarly strong correlation was also noted with the upper extremity NeuroQoL total score (r = 0.690, r = 0.815, p < 0.05). Multiple linear regression analyses revealed a change in average bilateral total RSA of 0.1 unit from admission to the 3-month follow-up correlated with a respective change in the FIM self-care score of 2.011 points (95%CI: 0.663-3.360). Longitudinal improvement in ADL function during stroke rehabilitation and recovery process is correlated with improvement in reachable workspace.

Wearable activity sensors typically count movement quantity, such as the number of steps taken or the number of upper extremity (UE) counts achieved. However, for some applications, such as neurologic rehabilitation, it may be of interest to quantify the quality of the movement experience (QOME), defined, for example, as how diverse or how complex movement epochs are. We previously found that individuals with UE impairment after stroke exhibited differences in their distributions of forearm postures across the day and that these differences could be quantified with kurtosis-an established statistical measure of the peakedness of distributions. In this paper, we describe further progress toward the goal of providing real-time feedback to try to help people learn to modulate their movement diversity. We first asked the following: to what extent do different movement activities induce different values of kurtosis? We recruited seven unimpaired individuals and evaluated a set of 12 therapeutic activities for their forearm postural diversity using kurtosis. We found that the different activities produced a wide range of kurtosis values, with conventional rehabilitation therapy exercises creating the most spread-out distribution and cup stacking the most peaked. Thus, asking people to attempt different activities can vary movement diversity, as measured with kurtosis. Next, since kurtosis is a computationally expensive calculation, we derived a novel recursive algorithm that enables the real-time calculation of kurtosis. We show that the algorithm reduces computation time by a factor of 200 compared to an optimized kurtosis calculation available in SciPy, across window sizes. Finally, we embedded the kurtosis algorithm on a commercial smartwatch and validated its accuracy using a robotic simulator that wore the smartwatch, emulating movement activities with known kurtosis. This work verifies that different movement tasks produce different values of kurtosis and provides a validated algorithm for the real-time calculation of kurtosis on a smartwatch. These are needed steps toward testing QOME-focused, wearable rehabilitation.

BACKGROUND: In the United States, there are over seven million stroke survivors, with many facing gait impairments due to foot drop. This restricts their community ambulation and hinders functional independence, leading to several long-term health complications. Despite the best available physical therapy, gait function is incompletely recovered, and this occurs mainly during the acute phase post-stroke. Therapeutic options are limited currently. Novel therapies based on neurobiological principles have the potential to lead to long-term functional improvements. The Brain-Computer Interface (BCI) controlled Functional Electrical Stimulation (FES) system is one such strategy. It is based on Hebbian principles and has shown promise in early feasibility studies. The current study describes the BCI-FES clinical trial, which examines the safety and efficacy of this system, compared to conventional physical therapy (PT), to improve gait velocity for those with chronic gait impairment post-stroke. The trial also aims to find other secondary factors that may impact or accompany these improvements and establish the potential of Hebbian-based rehabilitation therapies. METHODS: This Phase II clinical trial is a two-arm, randomized, controlled, longitudinal study with 66 stroke participants in the chronic (> 6 months) stage of gait impairment. The participants undergo either BCI-FES paired with PT or dose-matched PT sessions (three times weekly for four weeks). The primary outcome is gait velocity (10-meter walk test), and secondary outcomes include gait endurance, range of motion, strength, sensation, quality of life, and neurophysiological biomarkers. These measures are acquired longitudinally. DISCUSSION: BCI-FES holds promise for gait velocity improvements in stroke patients. This clinical trial will evaluate the safety and efficacy of BCI-FES therapy when compared to dose-matched conventional therapy. The success of this trial will inform the potential utility of a Phase III efficacy trial. TRIAL REGISTRATION: The trial was registered as BCI-FES Therapy for Stroke Rehabilitation on February 19, 2020, at clinicaltrials.gov with the identifier NCT04279067.

Upper extremity (UE) impairment is common after stroke resulting in reduced arm use in daily life. A few studies have examined the use of wearable feedback of the quantity of arm movement to promote recovery, but with limited success. We posit that it may be more effective to encourage an increase in beneficial patterns of movement practice - i.e. the overall quality of the movement experience - rather than simply the overall amount of movement. As a first step toward testing this idea, here we sought to identify statistical features of the distributions of daily arm movements that become more prominent as arm impairment decreases, based on data obtained from a wrist IMU worn by 22 chronic stroke participants during their day. We identified several measures that increased as UE Fugl-Meyer (UEFM) score increased: the fraction of movements achieved at a higher speed, forearm postural diversity (quantified by kurtosis of the tilt-angle), and forearm postural complexity (quantified by sample entropy of tilt angle). Dividing participants into severe, moderate, and mild impairment groups, we found that forearm postural diversity and complexity were best able to distinguish the groups (Cohens D =1.1, and 0.99, respectively) and were also the best subset of predictors for UEFM score. Based on these findings coupled with theories of motor learning that emphasize the importance of variety and challenge in practice, we suggest that using these measures of diversity and complexity in wearable rehabilitation could provide a basis to test whether the quality of the daily movement experience is therapeutic.

Purpose: The study objective was to investigate how health care providers in stroke teams reason about their clinical reasoning process in collaboration with the patient and next of kin. Materials and methods: An explorative qualitative design using stimulated recall was employed. Audio-recordings from three rehabilitation dialogs were used as prompts in interviews with the involved staff about their clinical reasoning. A thematic analysis approach was employed. Results: A main finding was the apparent friction between profession-centered and person-centered clinical reasoning, which was salient in the data. Five themes were identified: the importance of different perspectives for a rich picture and well-informed decisions; shared understanding in analysis and decision-making – good intentions but difficult to achieve; the health care providers' expertise directs the dialog; the context's impact on the rehabilitation dialog; and insights about missed opportunities to grasp the patient perspective and arrive at decisions. Conclusions: Interprofessional stroke teams consider clinical reasoning as a process valuing patient and next of kin perspectives; however, their professional expertise risks preventing individual needs from surfacing. There is a discrepancy between professionals' intentions for person-centeredness and how clinical reasoning plays out. Stimulated recall can unveil person-centered practice and enhance professionals' awareness of their clinical reasoning. IMPLICATIONS FOR REHABILITATION: The findings provide insights into the clinical reasoning process of interprofessional stroke teams, which can increase awareness and support the development of competencies among health care providers. To increase patient participation in the clinical reasoning process, stroke teams are recommended to clarify the function of goals and the decision-making process in management. Stimulated recall is recommended as a reflective activity in the work of stroke teams to develop awareness and skills in clinical reasoning performed in collaboration between health care providers and patients. [ABSTRACT FROM AUTHOR]

Background: Irrespective of the severity, survival of a stroke has become commonplace, but many experience long-term physical, cognitive, and emotional difficulties, with walking difficulties being a frequent challenge. The community-based model of gait training is an innovative and holistic approach to neurorehabilitation that focuses on restoring mobility and enhancing the overall quality of life of stroke survivors. Aims: To assess the impact of community-based stroke rehabilitation programs from existing literatures. Objectives: To identify community-based stroke rehabilitation programs that are effective in improving function in stroke survivors. Methods: We conducted a scoping review of peer-reviewed articles to understand the impact of the community-based rehabilitation model of mobility training after stroke. We searched five different databases: PsycINFO, PubMed, CINAHL complete, Embase, and SCOPUS using topic-specific keywords. Only studies published in the English language from 2013 to 2023 were included. Results: Thirty-five articles met the inclusion criteria. Mobility training using either a treadmill or overground surfaces improved mobility. Orthotics use improved gait and balance among stroke survivors. Adapted video games for rehabilitation improved gait speed, balance, and mobility while the use of transcutaneous electrical nerve stimulation (TENS) aided functional recovery. The use of music or sound incorporated with exercises improved mobility, gait speed, and balance. Engaging in group exercises improved walking capacity, balance, walking speed, cardiovascular function, and community integration. Conclusion: Some community-based rehabilitation programs are effective in improving the physical and social recovery of stroke survivors. This concept can be considered when planning a recovery program for stroke survivors who do not have the ability to access a hospital rehabilitation setting. [ABSTRACT FROM AUTHOR]

Background: Transcranial direct current stimulation (tDCS) and foot drop stimulators (FDS) are widely used for stroke rehabilitation. However, no study has investigated if tDCS could boost the effects of FDS and gait training in improving clinical parameters and neuroplasticity biomarkers of chronic post-stroke subjects. Objective: To investigate the effects of combining tDCS and FDS on motor impairment, functional mobility, and brain-derived neurotrophic factor (BDNF) serum levels. Also, to evaluate the effects of this protocol on the insulin-like growth factor-1 (IGF-1), insulin growth factor–binding proteins-3 (IGFBP-3), interleukin (IL) 6 and 10, and tumor necrosis factor-α (TNF-α) levels. Methods: Thirty-two chronic post-stroke individuals were randomized to tDCS plus FDS or sham tDCS plus FDS groups. Both groups underwent ten gait training sessions for two weeks using a FDS device and real or sham tDCS. Blood samples and clinical data were acquired before and after the intervention. Motor impairment was assessed by the Fugl-Meyer Assessment and functional mobility using the Timed up and Go test. Results: Both groups improved the motor impairment and functional mobility and increased the BDNF levels. Both groups also increased the IL-10 and decreased the cortisol, IL-6, and TNF-α levels. No difference was observed between groups. Conclusion: tDCS did not add effect to FDS and gait training in improving clinical parameters and neuroplasticity biomarkers in chronic post-stroke individuals. Only FDS and gait training might be enough for people with chronic stroke to modify some clinical parameters and neuroplasticity biomarkers. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has profoundly affected healthcare systems, particularly post-stroke rehabilitation centers. The elevated severity of strokes and delayed hospital admissions caused numerous hurdles to rehabilitation administration during the peri-pandemic period. This study surveyed healthcare professionals' knowledge and perceptions of post-stroke rehabilitation during this period. An online cross-sectional survey was administered from September 17, 2023 to February 23, 2024, utilizing the SurveyMonkey platform. The questionnaire included 30 questions addressing participant baseline characteristics, knowledge of definitions and experiences, post-stroke rehabilitation procedures, obstacles encountered during the peri-pandemic period, and the utilization of telerehabilitation. Only complete responses from health professionals were considered. This report utilized convenience sampling. Data were analyzed via descriptive statistics and chi-square tests, with a significance threshold of p < 0.05. A total of 79 health professionals, predominantly physiatrists, neurologists, and physiotherapists, from eight countries participated in the study. Over half of the participants (64.6%) indicated the existence of a dedicated department for post-stroke rehabilitation. Significant obstacles comprised an absence of advanced rehabilitative treatments (60.8%), inadequately skilled workers (50.6%), and restricted space for rehabilitation (46.8%). Telerehabilitation was regarded as a feasible option by 45.6% of participants; nonetheless, obstacles, including patients' telecommunication proficiency and the possibility of diagnostic inaccuracies, were acknowledged. Complementary therapies, such as music and dance therapy, received favorable evaluations from 67.1% to 63.3% of respondents, respectively. The pandemic reduced rehabilitation admissions due to infection concerns (75.9%) and increased multimorbidity cases among patients (48.1%). The study underscores the pandemic's negative effect on post-stroke rehabilitation, emphasizing the necessity for multidisciplinary, customized therapy and enhanced integration of telerehabilitation to overcome access barriers. Addressing obstacles regarding infrastructure, training, and access to advanced approaches, particularly in a post-pandemic context, is essential to improving rehabilitation outcomes. [ABSTRACT FROM AUTHOR]

Background: Post-stroke clinical changes not only affect extremities and trunk muscles but also the respiratory muscles. Purpose: To determine the effect of robot-assisted arm training with conventional rehabilitation (CombT) on respiratory muscle strength, activities of daily living (ADL), and quality of life in patients with stroke and to compare the results with conventional rehabilitation (CR). Methods: It was a two-arm, single-blinded, randomized controlled trial in which 66 patients were randomly allocated to either CombT or CR to receive 30 sessions (5/week) over 6 weeks. The respiratory muscle strength (maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP)), activities of daily life (ABILHAND questionnaire), and quality of life (Stroke Impact Scale (SIS)) were measured before and 6 weeks after training. Results: The CombT group showed significantly better MIP, MEP, and performance in ADLs after 6 weeks of training compared to the CR group (p <.01). The effect size was large for MIP (d = 0.9) and MEP (d = 0.9), whereas medium for performance in ADLs (d = 0.62). Also, the SIS-arm strength (p <.01), hand function (p =.04), ADLs (p =.02), and recovery (p =.04) were significantly better in CombT group with a medium (d = 0.6, d = 0.5, d = 0.5, and d = 0.5, respectively) effect size compared with CR group. Conclusions: Both CombT and CR groups improved respiratory muscle strength, performance in ADLs, and quality of life in patients with stroke. However, CombT appears to offer more comprehensive benefits, highlighting its valuable role in respiratory and functional recovery after stroke. [ABSTRACT FROM AUTHOR]

Background: Illness perceptions are an important factor affecting the prognosis of stroke patients. Evaluating the illness perceptions of stroke patients is of great importance for predicting their health behaviour and rehabilitation outcomes. However, there is no specific tool for assessing illness perceptions in stroke patients in China. Objectives: The objective of this study is to translate the Stroke Illness Perception Questionnaire‐Revised (SIPQ‐R) into Chinese and to psychometrically test the Chinese version of the scale in the population of Chinese stroke patients. Methods: This was a methodological study. We investigated 593 stroke patients in the neurology department of a hospital in China from March to September 2021. We translated the SIPQ‐R and adapted it to the cultural context, after which we evaluated the reliability and validity of the Chinese version of SIPQ‐R. Results: Exploratory factor analysis identified eight common factors that accounted for 71.74% of the total variance, and the factor loadings ranged from 0.530 to 0.933. Confirmatory factor analysis confirmed the eight‐factor structure (χ2/df = 1.765, root mean square error of approximation = 0.053, incremental fit index = 0.906, comparative fit index = 0.905 and Tucker–Lewis index = 0.900). Internal consistency was confirmed by a Cronbach's alpha coefficient of 0.982. The test–retest reliability was 0.762. The results showed good content validity (the scale level content validity index was 0.940, and the item level content validity index values ranged from 0.860 to 0.960). There were no missing responses and floor or ceiling effects. The standard error of measurement and the smallest detectable change for the SIPQ‐R were 45.49 and 126.10, respectively. Conclusions: The results of this study provide empirical evidence for the reliability and validity of the Chinese version of the SIPQ‐R for stroke patients. Summary statement: What is known about this topic? Illness perceptions are an important factor affecting the prognosis of stroke patients. Evaluating the illness perceptions of stroke patients is of great importance for predicting their health behaviour and rehabilitation outcomes.Currently, there is no specific illness perception scale for stroke patients in China.SIPQ‐R is a stroke‐specific version of the illness perception questionnaire. What this paper adds? The Chinese version of the SIPQ‐R has the same factor structure as the English version using confirmatory factor analysis.The scale was adjusted to reduce the number of items, which may have improved its clinical applicability and compatibility.All the indexes verified by the model reached the standard. Implications of this paper: The results of this study provide empirical evidence for the reliability and validity of the Chinese version of the SIPQ‐R for stroke patients.This study translated the SIPQ‐R into Chinese and tested its reliability and validity to provide a reliable tool for assessing illness perception in a group of Chinese stroke patients.SIPQ‐R can be used as a measure of the illness perceptions of stroke patients in the clinic to provide a basis for patients' rehabilitation. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the effects of adding interactive videogames to conventional rehabilitation programmes on radiological progression and upper extremity functional status. Patients and Methods: A total of 18 patients with hemiplegic stroke were randomized into two groups as conventional rehabilitation (control) group (n = 9), and the conventional rehabilitation + interactive videogames (intervention) group (n = 9). Each group received a 4-week program (5 days/week). Radiological progression (diffuse tensor imaging), and upper extremity functional status (upper extremity motor functioning part of the Fugl Meyer Assessment, self-care part of the Functional Independence Measure (FIM), and Motor Activity Log) were assessed at baseline and 4-week later. Results: While no changes were detected in radiological status in the intervention group (p > 0.05), some regions on the affected side were improved significantly in the control group (p < 0.05). Total upper extremity motor functioning part of the Fugl Meyer Assessment scores and the self-care part of the FIM scores significantly improved in both groups (p < 0.05). No differences were detected in the amount of changes between groups (p > 0.05). Conclusion: According to our results, adding videogames to a conventional rehabilitation program does not seem enhancing the radiological progression or the functional status of the upper extremities. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the course of basic activities of daily living (ADL) from admission up to six months after the stroke and the longitudinal associations between stroke-related neurological deficits at admission to the stroke unit and course of basic ADL. Materials and Methods: 180 individuals with a first-ever stroke were assessed at admission to the stroke unit and at follow-ups of three and six months. Stroke-related neurological deficits were assessed at admission with the National Institutes of Stroke Scale (NIHSS). Independence in basic ADL was assessed at admission and three and six months after the stroke by the Modified Barthel Index (MBI). Generalized Estimating Equations (GEE) were performed. Results: Dependence in basic ADL reduced overtime, with most changes occurring over the first three months. Individuals, who had moderate/severe stroke-related neurological deficits (NIHSS ≥6) at admission, had higher chances of becoming more dependent in activities related to feeding (OR:1.27;95%CI = 1.03-1.55;p = 0.021), bathing (OR:1.30;95%CI = 1.11-1.50;p = 0.0005), dressing (OR:1.19;95%CI = 1.04-1.36;p = 0.010), transfers (OR:1.24;95%CI = 1.05-1.46;p = 0.0072), stair climbing (OR:1.46;95%CI = 1.27-1.66;p < 0.0001), and ambulation (OR:1.21;95%CI = 1.02-1.43;p < 0.0001). Conclusions: Decreases in dependence in basic ADL occurred mainly over three months after the stroke and showed different patterns for specific ADL. Baseline moderate/severe stroke-related neurological deficits were associated with poor functional status in basic ADL over the follow-up period. IMPLICATIONS FOR REHABILITATION: Stroke survivors experience dependence in basic activities of daily living (ADL) which is reduced over six months after the stroke and showed different individual variability in patterns of recovery. Patients with moderate/severe stroke-related neurological deficits had higher chances of becoming dependent in activities related to feeding, bathing, dressing, transfers, stair climbing, and ambulation. Rehabilitation professionals should consider assessing stroke-related neurologic deficits within the first hours after stroke, with particular attention to individuals with moderate/severe impairments. [ABSTRACT FROM AUTHOR]

Purpose: To examine the associations between the composition of movement-related behaviours (sedentary behaviour, sleep, standing, and stepping) and functional outcomes post-stroke. Methods: This study included 34 adults with stroke (mean age: 64.6 ± 12.5 years; time since stroke: 3.5 ± 1.1 months) who underwent an 8-week sedentary behaviour intervention. Functional outcomes were assessed using the timed up and go (TUG) and gait speed tests. Compositional data analysis was used to investigate the relationships between movement-related behaviours and functional outcomes. Results: The baseline composition of movement-related behaviours showed significant associations with changes in TUG (F = 4.28, p = 0.01) and gait speed (F = 4.63, p = 0.01) after the 8-week reducing sedentary behaviour intervention. Reallocating ≥ 30 min/day to stepping, while proportionally decreasing other movement-related behaviours, was associated with a significant change in TUG. Similarly, a relative reallocation of ≥ 40 min/day to stepping was associated with a clinically meaningful change in gait speed. Conclusions: This study highlights the importance of considering movement-related behaviours in relation to functional outcomes post-stroke. Reallocating at least 30 min per day to stepping, relative to a reduction in other movement-related behaviours, is associated with significant and meaningful change in functional outcomes. IMPLICATIONS FOR REHABILITATION: Reallocating at least 30 minutes/day to stepping, relative to a decrease in other movement-related behaviours, is associated with a positive change in functional mobility after an 8-week post-stroke sedentary behaviour intervention. Relative to a decrease in other movement-behaviours, reallocating ≥ 40 minutes/day to stepping is associated with a meaningful change in gait speed. Reallocating time to standing or sleep at the expense of other movement behaviours is not associated with better functional mobility or gait speed. Finding the optimal balance in movement-related behaviours that favours more stepping may lead to improvements in both functional mobility and gait speed. [ABSTRACT FROM AUTHOR]

Purpose: Telerehabilitation is emerging as a means for delivering stroke rehabilitation to address unmet lower extremity rehabilitation needs. However, there is currently limited and low-quality evidence supporting the use telerehabilitation interventions for lower extremity recovery after stroke. Thus, we developed an exercise-based telerehabilitation program (TRAIL) for safe and effective promotion of lower extremity function after stroke. This study reports on the qualitative findings from the feasibility study of the TRAIL program. Methods: An interpretive description methodology and inductive thematic analysis approach were undertaken. One-on-one semi-structured interviews were conducted on a subset of participants who completed the TRAIL feasibility study. Participants were recruited via email and enrolled into the study based on pre-determined purposeful sampling strategies. Results: Ten participants (6 men, 4 women) completed a semi-structured interview. Two main themes emerged: (i) TRAIL ingredients for success and (ii) telerehabilitation is a viable option for stroke rehabilitation. Conclusion: Exercise-based telerehabilitation appears to be well-received by men and women post-stroke when social support, professional guidance, and program resources are offered. TRAIL may also prolong the continuum of care that individuals receive once they are discharged back into the community, and contribute to improvements in mobility, lower extremity strength and balance. IMPLICATIONS FOR REHABILITATION: Exercise-based telerehabilitation for individuals with stroke can be delivered safely when clinicians are trained, and social support and program resources are available. Exercise-based telerehabilitation may be viable and accessible for men and women with stroke to extend the opportunity for rehabilitation services within the first year post-event. Synchronously delivered telerehabilitation programs using user-friendly videoconference software is recommended for optimal participant satisfaction. [ABSTRACT FROM AUTHOR]

Purpose: Stroke survivors must complete large amounts of practice to achieve functional improvements but spend many hours inactive during their rehabilitation. We conducted a mixed methods process evaluation exploring factors affecting the success of a 6-month behaviour change intervention to increase use of ward-based practice books. Methods: Audits of the presence, quality and use of ward based-practice books were conducted, alongside focus groups with staff (n = 19), and interviews with stroke survivors (n = 3) and family members (n = 4). Quantitative data were analysed descriptively. Focus group and interview transcripts were analysed using qualitative analysis. Results: Personal (patient-related) factors (including severe weakness, cognitive and communication deficits of stroke survivors), staff coaching skills, understanding and beliefs about their role, affected practice book use. Staff turnover, nursing shift work and a lack of action planning reduced success of the behaviour change intervention. Conclusions: Staff with the necessary skills and understanding of their role in implementing ward practice overcame personal (patient-related) factors and assisted stroke survivors to successfully practice on the ward. To improve success of the intervention, repeated training of new staff is required. In addition to audit and feedback, team action planning is needed around the presence, quality, and use of ward practice books. IMPLICATIONS FOR REHABILITATION: Ward-based practice books are one evidence-based strategy that can be used by rehabilitation teams to increase the amount of practice completed by stroke survivors during inpatient rehabilitation. Stroke survivors' personal factors (including severe weakness, cognitive and communication deficits), staff beliefs about their role and coaching skills, affected stroke survivors ability to practice on the ward using practice books. Staff with the necessary skills, understanding and belief about their role in implementing ward practice can overcome personal (patient related) factors (such as severe weakness) and assist stroke survivors to successfully practice on the ward. To increase the success of ward practice, repeated booster training of staff is required along with audit and feedback and team action planning on the presence, quality, and use of ward practice books. [ABSTRACT FROM AUTHOR]

Purpose: Transcutaneous auricular vagus nerve stimulation (taVNS) is an emerging non-invasive neuromodulation therapy. This study aimed to explore the therapeutic use of taVNS, optimal stimulation parameters, effective sham protocols, and safety. Methods: A scoping review was conducted. Five databases and grey literature were searched. The data extracted included stimulation parameters, adverse events (AEs), and therapeutic effects on clinical outcomes. Results: 109 studies were included. taVNS was used across 21 different clinical populations, most commonly in psychiatric, cardiac, and neurological disorders. Overall, 2,214 adults received active taVNS and 1,017 received sham taVNS. Reporting of stimulation parameters was limited and inconsistent. taVNS appeared to have a favourable therapeutic effect across a wide range of clinical populations with varied parameters. Three sham protocols were reported but their effectiveness was documented in only two of the 54 sham-controlled studies. Most reported adverse events were localised to stimulation site. Conclusion: There is growing evidence for taVNS therapeutic effect. taVNS appears safe and tolerable. Sham protocols need evaluation. Standardised and comprehensive reporting of both stimulation parameters and adverse events is required. Two different questionnaires have been proposed to evaluate adverse events and the effectiveness of sham methods in blinding participants. IMPLICATIONS FOR REHABILITATION: Transcutaneous auricular vagus nerve stimulation (taVNS) showed therapeutic effect across a wide range of clinical populations including depression, epilepsy, and stroke There is a preliminary indication that daily/weekly dose and overall duration of treatment are important to show therapeutic effectiveness When using taVNS as an intervention, the questionnaires proposed in this review should be used to evaluate blinding effectiveness and adverse events [ABSTRACT FROM AUTHOR]

Purpose: To investigate the responsiveness of ABILOCO-Benin questionnaire, a West-African adapted questionnaire of performance in locomotion-related daily-life activities in adults with stroke. Materials and methods: We conducted a longitudinal study involving 81 stroke patients (mean (SD) age: 54.6 (10.8) years; 58% male, mean (SD) time after stroke onset: 4.3 (2.5) weeks). Participants were assessed at baseline (T1), two-month later (T2), and on average of 1.5 (0.5) years after stroke (T3), with the ABILOCO-Benin questionnaire, functional ambulation classification (FAC), six-minute walking test, ACTIVLIM-Stroke questionnaire, modified Rankin Scale, and Stroke Impairment Assessment Scale. Global-, sub-group- (stable and improved based on FAC scores), and individual-based analysis of changes were performed. Results: Participants showed significantly larger improvement for all outcomes during the acute phase (T1–T2). Changes in the ABILOCO-Benin measures were significantly correlated with changes in other outcome measures. ABILOCO-Benin questionnaire detected a significant improvement in both the stable and improved groups at both T2 and T3 in the sub-group approach. Individual-based analysis with ABILOCO-Benin measures showed a significantly higher proportion of stable patients (n = 55) and lower proportion of improved ones (n = 23) between T2 and T3 (LR(df) = 15.52(4), p = 0.004). Conclusions: ABILOCO-Benin is responsive to changes in adult stroke patients within both acute and chronic phases. IMPLICATIONS FOR REHABILITATION: ABILOCO-Benin questionnaire is highly responsive to changes in locomotion abilities of stroke patients within both acute (<6 months) and chronic (≥6 months) phases. It can be used in clinical and research practice to track changes in stroke patients after interventions in African settings and beyond. [ABSTRACT FROM AUTHOR]

Purpose: To provide updated evidence about the effects of MT with ES for recovering upper extremities motor function in people with stroke. Methods: Systematic review and meta-analysis were completed. Methodological quality was assessed using the version 2 of the Cochrane risk-of-bias tool. The GRADE approach was employed to assess the certainty of evidence. Results: A total of 16 trials with 773 participants were included in this review. The results demonstrated that MT with ES was more effective than sham (standardized mean difference [SMD], 1.89 [1.52–2.26]) and ES alone (SMD, 0.42 [0.11–0.73]) with low quality of evidence, or MT alone (SMD, 0.47[0.04–0.89]) with low quality of evidence for improving upper extremity motor control assessed using Fugl-Meyer Assessment. MT with ES had significant improvement of (MD, 6.47 [1.92–11.01]) the upper extremity gross gripping function assessed using the Action Research Arm Test compared with MT alone with low quality of evidence. MT combined with ES was more effective than sham group (SMD, 1.17 [0.42–1.93) for improving the ability to perform activities of daily living with low quality of evidence assessed using Motor Activity Log. Conclusion: MT with ES may be effective in improving upper limb motor recovery in people with stroke. IMPLICATION FOR REHABILITATION: Combining Mirror Therapy (MT) and Electrical Stimulation (ES) modality could improve upper limb motor control, gross gripping function, and performance in ADLs based on ICF for people with stroke. Those individuals with subacute stroke are recommended as the optimal target group for the combined MT and ES. [ABSTRACT FROM AUTHOR]

Background: Goal-setting is essential for a person-centered approach to stroke rehabilitation. Understanding this challenging and heterogeneous practice can contribute to optimising rehabilitation outcomes. However, valid, and reliable tools are lacking for its investigation. This study aimed to develop a self-report measure to assess attitudes, practices, and factors related to goal-setting in physiotherapists working with stroke rehabilitation. Materials and Methods: A questionnaire was developed based on the literature and submitted for content and face validity with a committee of experts and physiotherapists. Selected items were considered to create scales for attitudes and practices towards goal-setting. The factor structure and internal consistency of these scales were examined. Results: All three dimensions had satisfactory content validity. Exploratory factor analysis yielded a two-factor structure for the Attitudes towards Goal-setting Scale (A-GS) ('Role' and 'Participation', together explaining 55% of the variance of the total score) and for Practices towards Goal-setting Scale (P-GS) ('Procedures' and 'Documentation', together explaining 56% of the variance of the total score). Cronbach alpha values and mean inter-item correlations indicated adequate internal consistency. Conclusions: This study provides preliminary support for the adequacy of this newly developed measure, which can be used as an assessment tool to determine physiotherapists' attitudes and practices towards goal-setting in stroke rehabilitation and related factors. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to explore the personal stroke and rehabilitation experiences of older adults with chronic stroke living in a mid-sized Northwestern Ontario city in Canada during the COVID-19 pandemic. Methods: A qualitative descriptive approach with a constructivist worldview was used. In addition, a semi-structured interview guide was used to gather the participants' perspectives on their experiences throughout stroke recovery. Ten participants were interviewed, including six males and four females. The interviews were completed, transcribed, and analysed using inductive and deductive content analysis. Multiple steps were taken to enhance data trustworthiness. Results: Six main themes and eight related subthemes emerged. These included: getting help is complex, the effects of stroke are multifaceted, losing rehabilitation services during the COVID-19 pandemic, overcoming hardships but not alone, "If you don't use it, you lost it": rehabilitative success is based on one's actions, and "look at me now": the importance of taking pride in one's successes. Conclusions: One unique finding was that the participants used this study as an opportunity to teach and advocate for future stroke survivors which is not often seen in qualitative stroke rehabilitation research. Future stroke research should place emphasis on both the positive and negative experiences of this population. [ABSTRACT FROM AUTHOR]

Background: Much of the childhood stroke literature has not distinguished impacts for adolescents from those of younger children. Research has also focused on body impairments. With adolescence being a unique period, this scoping review aimed to identify the impacts of childhood stroke on activity, participation, and quality of life for adolescents 13–18 years, and identify how these impacts were determined. Method: This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Data pertaining to non-impairment impacts of childhood stroke for adolescents, participant and study characteristics, and measurement instruments were extracted. Results: Following screening, 79 articles were included, and 33 measurement instruments identified. Only 6 studies reported separate data for adolescents, identifying difficulties with daily activities, social and academic impacts, and reduced quality of life. Impacts of post-stroke communication difficulties on daily activities and schooling were also noted. Measurement instruments developed specifically for adolescents with stroke are lacking. Interpretation: The review identified limited research reporting non-impairment impacts of childhood stroke for adolescents. Further research specific to this population and the development of measurement instruments for adolescents who have experienced childhood stroke is required to support future research and clinicians working with this population. [ABSTRACT FROM AUTHOR]

Ischemic Conditioning (IC) is a procedure involving brief periods of occlusion followed by reperfusion in stationary limbs. Blood Flow Restriction with Exercise (BFR-E) is a technique comprising blood flow restriction during aerobic or resistance exercise. Both IC and BFR-E are Blood Flow Modulation (BFM) strategies that have shown promise across various health domains and are clinically relevant for stroke rehabilitation. Despite their potential benefits, our knowledge on the application and efficacy of either intervention in stroke is limited. This scoping review aims to synthesize the existing literature on the impact of IC and BFR-E on motor and neurophysiological outcomes in individuals post-stroke. Evidence from five studies displayed enhancements in paretic leg strength, gait speed, and paretic leg fatiguability after IC. Additionally, BFR-E led to improvements in clinical performance, gait parameters, and serum lactate levels. While trends toward motor function improvement were observed post-intervention, statistically significant differences were limited. Neurophysiological changes showed inconclusive results. Our review suggests that IC and BFR-E are promising clinical approaches in stroke, however high-quality studies focusing on neurophysiological mechanisms are required to establish the efficacy and underlying mechanisms of both in stroke. Recommendations regarding future directions and clinical utility are provided. [ABSTRACT FROM AUTHOR]

Objective: This pilot study aims to evaluate the combined impact of peripheral nerve mobilization (PNM) and virtual reality (VR) game-based gait training on gait parameters in chronic anterior cerebral artery (ACA) stroke patients. Methods: Eight chronic ACA stroke patients were randomized into experimental (PNM + VR) and control (conventional exercises) groups. Interventions were conducted for 45 min per session, five times a week, over 4 weeks. Gait parameters were measured using the OpenPose-based Markerless Gait Analysis System. Results: Both groups showed significant improvements in post-intervention measurements. The control group exhibited a mean increase in gait speed from 0.46 m/s to 0.62 m/s (p < 0.001), while the intervention group showed improvements from 0.41 m/s to 0.54 m/s (p < 0.001). Between-group analyses revealed significant differences in gait parameters post-intervention (p < 0.05). Conclusion: PNM and VR game-based gait training emerge as effective interventions for enhancing gait parameters in ACA stroke rehabilitation. [ABSTRACT FROM AUTHOR]

Purpose: The effectiveness of reactive responses to a sudden loss of balance is a critical factor that determines whether a fall will occur. We examined the strategies and kinematics associated with successful and unsuccessful balance recovery following lateral loss of balance in people with stroke (PwS). Methods: Eleven PwS were included in the analysis. They were exposed to unannounced right and left horizontal surface translations and demonstrated both successful and unsuccessful balance responses at the same perturbation magnitude. Reactive step strategies and kinematics were investigated comparatively in successful and unsuccessful recovery tests. Results: The crossover strategy was used in most of the unsuccessful tests (7/11) while the unloaded-leg side-step in the successful tests (6/11). There were no significant differences in the reactive step initiation time in unsuccessful vs. successful tests. However, the step execution time, step length and center of mass displacement were significantly higher during the first recovery step in unsuccessful tests. Conclusions: PwS have difficulties in controlling and decelerating the moving center of mass following a lateral loss of balance. The increased step time and step length of the first reactive step in unsuccessful vs. successful tests suggest the crossover step strategy may be ineffective for PwS. [ABSTRACT FROM AUTHOR]

Background: There are very few standard instruments currently available for measuring upper extremity (UE) functions for patients with stroke in Thailand. Objectives: This study aims to examine the concurrent validity, construct validity, and stability reliability of the Functional Test for Hemiplegic Upper Extremity (FTHUE)-Thai version for patients with stroke. Methods: Thirty hemiplegic participants from five community rehabilitation centers in Chiang Mai province and 30 healthy subjects were recruited. The FTHUE-Thai version and the Fugl-Meyer Assessment for the Upper Extremity (FMA-UE) were the instruments used. Concurrent validity was determined by investigating the relationship between the FTHUE-Thai version and the FMA-UE. Construct validity was investigated by comparing the performance of FTHUE-Thai version between stroke participants and healthy subjects. The stability reliability of the FTHUE-Thai version, which measured the UE function of stroke participants twice in a two-week's period, was also investigated. The statistics used were Spearman's correlation coefficient and the Mann-Whitney test. Results: There were significant correlations between the UE function, as measured by the FTHUE-Thai version, and the arm, and hand sub-scores, as well as the total scores of the FMA-UE (r = 0. 93, r = 0. 84, and r = 0. 95, respectively), indicating good concurrent validity. Stability reliability was also good (r = 0. 98, weighted kappa = 0. 94). A known group technique test revealed significantly different scores between stroke patients and healthy subjects (p <. 001), indicating good construct validity. Conclusion: The FTHUE-Thai version could be a reliable measurement tool for the UE function in stroke patients in the Thai context. [ABSTRACT FROM AUTHOR]

Background: Balance self-efficacy is a strong predictor of fall risk after stroke and is related to performance on balance and walking tests. The use of telerehabilitation for delivering stroke rehabilitation has increased in recent years and there is a need to adapt common clinical assessments to be administered in virtual formats, but the association between balance self-efficacy and virtually administered clinical tests of balance performance has yet to be established. This study examined the association between the Activities-specific Balance Confidence (ABC) Scale and virtually administered Timed Up and Go (TUG), Tandem Stand, and Functional Reach tests (FRT) in individuals with stroke. Methods: This was a secondary analysis of baseline data from two telerehabilitation trials with individuals with stroke. All assessments were administered by trained physical therapists through videoconferencing software. Multivariate regression analyses were used to examine the associations between the ABC scale and TUG test, Tandem Stand test, and FRT, adjusted for age and number of comorbidities. Results: Data from 51 participants (n = 11 female, median age = 64 [IQR: 18] years, 9.3 ± 4.6 months poststroke) were analyzed. The ABC scores were associated with TUG (R2 = 0.56, F(3,47) = 20.26, p < 0.01), but not Tandem Stand (R2 = 0.18, F(5,45) = 1.93, p = 0.11) or FRT (R2 = 0.14, F(3,47) = 2.55, p = 0.07) tests. Conclusion: We observed associations between the ABC scores and virtual TUG, but not with Tandem Stand or FRT, which may be attributed to the context-specificity of balance self-efficacy. As virtual administration of outcomes assessments becomes part of common practice in stroke rehabilitation, our study supports the use of virtually administered TUG in stroke. [ABSTRACT FROM AUTHOR]

Background: Post-stroke lateropulsion is prevalent and has been associated with varied lesion locations, but existing imaging studies are limited by small participant cohorts. Evidence to guide lateropulsion rehabilitation is also limited. Improved understanding of lesion localization associated with lateropulsion post-stroke may inform more targeted intervention approaches. Objectives: This study investigated the associations between stroke neuroimaging data and presence of lateropulsion at inpatient rehabilitation admission. Methods: This prospective, observational study included participants aged ≥65 years, admitted for inpatient stroke rehabilitation. Using routinely collected clinical neuroimaging data, stroke type, location, and volume were reported, and their association with lateropulsion presence (Four-Point Pusher Score − 4PPS) at admission was explored. Results: Of 144 included participants, 82 (56.9%) had lateropulsion (4PPS ≥1). Lateropulsion presence was univariately associated with hemorrhagic stroke (p = 0.002), frontal cortical involvement (OR = 2.17, 95%CI 1.02–6.46), and white matter involvement (OR = 2.45, 95%CI 1.24–4.85), particularly frontal white matter (p = 0.021). Lesions involving the posterior limb of the internal capsule (OR = 2.88, 95% CI 1.14–7.27) and those involving the entire thalamus (OR = 1.0, p = 0.03) were associated with lateropulsion presence. When stratified by stroke type, no specific location was significantly associated with lateropulsion presence in hemorrhagic strokes. Among participants with ischemic stroke, involvement of the pre-central gyrus (OR = 2.45, 95%CI 1.05–5.76), post-central gyrus (OR = 2.76, 95%CI 1.15–6.60), inferior parietal cortex (OR = 3.95, 95%CI 1.43–10.90), and supramarginal gyrus (OR = 3.73, 95%CI 1.25–11.13) were associated with lateropulsion presence. The stroke laterality and size were not significantly associated with lateropulsion presence. Conclusions: The findings indicate a role of network disconnection in the post-stroke lateropulsion presence. Future, larger-cohort lesion-network mapping studies are recommended. [ABSTRACT FROM AUTHOR]

Background: Post-stroke lateropulsion is prevalent and associated with poor rehabilitation outcomes; however, data regarding long-term function associated with lateropulsion are lacking. Objectives: This study aimed to explore lateropulsion resolution and associations between lateropulsion, functional outcomes, and fall occurrence up to 12 months post-stroke. Methods: Participants for this prospective, longitudinal cohort study were recruited from a Stroke Rehabilitation Unit (SRU). Assessments were conducted at SRU admission, at discharge, and at three, six, nine, and twelve months post-stroke. Outcomes included the Four-Point Pusher Score (4PPS), Functional Independence Measure (FIM), and fall occurrence. Longitudinal outcomes were modeled using generalized linear mixed-effects models. Results: The final analyses included data from 144 participants. Eighty-two participants (56.9) had lateropulsion (4PPS ≥ 1) on admission. Odds of resolved lateropulsion (4PPS = 0) increased longitudinally from discharge for people who participated in rehabilitation physiotherapy (OR: 9.7, 28.1, 43.1, 81.3: <0.001 at three, six, nine, and twelve months respectively). The greatest FIM improvement among participants in all 4PPS categories occurred during the SRU inpatient phase. The probability of falls post-discharge was greatest among participants with 4PPS = 1 at three months, when compared with 4PPS = 0 (p= 0.022). Conclusions: This study showed that lateropulsion can continue to resolve up to one year post-stroke. Earlier lateropulsion resolution was associated with ongoing rehabilitation physiotherapy participation. Long-term functional gains were maintained among people discharged home, whereas functional status deteriorated after six months among those in residential care. Study findings will allow rehabilitation and service providers to better plan for and accommodate the long-term rehabilitation and care needs of people with post-stroke lateropulsion. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to make the Turkish cultural adaptation of the the Stroke Activity Scale (SAS). Method: This study was designed as a methodological research. The psychometric properties of the SAS scale were evaluated by validity and reliability analyses. Results: The average age of 84 stroke patients (mean ± SD) was 59.52 ± 14.03 years. Kaiser-Meyer-Olkin (0.816) and Bartlett's Test of Sphericity (χ2 = 288.968, df = 10, p < 0.001) showed that the data set can be factored. A one-factor structure was obtained with Principal Component Analysis (PCA). The factor loads of the items obtained with PCA and Confirmatory Factor Analysis (CFA) were found to be statistically significant. The obtained chi-square statistics (χ2 = 2.227, p = 0.694), normalized chi-square/freedom (χ2/sd) value (0 ≤ 0.557 ≤ 2) and other goodness of fit indices showed good compliance. The positive highly significant correlation (r = 0.846, p < 0.001) between the SAS and Rivermead Mobility Index (RMI) scales confirmed the Concurrent validity. Cronbach's alpha (0.864) value showed high reliability and Intraclass Correlation Coefficient (ICC) value (0.983, p < 0.001) showed excellent agreement. Conclusions: In this study, which was conducted for the Turkish adaptation of the SAS scale, the 5-item and 1-factor structure was evaluated as a valid and reliable scale for evaluating the balance abilities of stroke patients living in Turkey. [ABSTRACT FROM AUTHOR]

Background: Physical activity decreases after stroke due to various factors and the causes and effects of these factors remain unclear. Objectives: This study aimed todetermine the effects of kinesiophobia, fatigue, and quality of life on physical activity in patients with stroke. Methods: The study included 32 patients (13 females/19 males), all evaluated using the Stroke Rehabilitation Assessment of Movement, Barthel Index, Tampa Kinesiophobia Scale-fatigue, Fatigue Impact Scale and Stroke-Specific Quality of Life Scale. The SenseWear multisensory activity monitor was worn on the arm of the patients for 1 week to evaluate active energy expenditure, step count, and rest periods in relation to physical activity. Multiple linear regression analysis was used to examine the effects of the independent variables kinesiophobia, fatigue, and quality of life on the dependent variables of active energy expenditure, step count, and rest periods. Results: The mean age of the patients was 52.31 ± 14.76 years. According to the multiple regression analysis results, kinesiophobia (p = 0.011) and quality of life (p = 0.009) are significant determinants of active energy expenditure and quality of life (p = 0.001) is a significant determinant of the step count in patients with stroke. Kinesiophobia, fatigue, and quality of life were not determinants of rest periods (p > 0.05). Conclusions: The study results showed that kinesiophobia and quality of life are important determinants of physical activity in patients with stroke. Combined evaluation in the clinic of motor findings and non-motor factors, which are often ignored, and the application of target-oriented approaches to these problems will make a significant contribution to the success of stroke rehabilitation. [ABSTRACT FROM AUTHOR]

Introduction: The Stroke Impact Scale 3.0 appears to be a promising measure of health-related quality of life for stroke patients. However, the lack of a cross-cultural adaptation in Arabic dialect may limit its use in the Moroccan context. The objective of this study was to carry out a transcultural adaptation and pilote validation of the Stroke Impact Scale 3.0 in Moroccan Arabic dialect, commonly called « Darija ». Patients and methods: A cross-sectional design was used for this study. The cross-cultural adaptation of the SIS 3.0 scale into Moroccan Darija was carried out following the guidelines proposed by Beaton et al (2000). Ceiling and floor effects were calculated for all scales. The internal consistency of multi-item scales was assessed using Cronbach's α coefficient. Convergent and divergent validity were evaluated using the Multi-Trait Multi-Method Correlation Matrix method. Results: A total of 102 patients, with a mean age of 49 ± 12.9 years, participated in the study. The results revealed that the dimensions of the translated scale had no floor effect and no ceiling effect. The internal consistency of SIS 3.0 (Cronbach's alpha) was calculated, and all dimensions had good reliability, above the threshold of 0.70 (between 0.705 and 0.945). The results showed that the dimensions and their own items had correlation coefficients greater than 0.4, with good convergent and divergent validity. Conclusion: The darija version appears to be culturally acceptable with good psychometric properties and can be used to measure the quality of life of stroke survivors in Morocco. [ABSTRACT FROM AUTHOR]

Purpose: An increasing number of individuals with stroke are having difficulties in returning to work, having a significant impact on both individuals and society. The aims of this meta-analysis were to summarize the interventions to support the return to work (RTW) for individuals with stroke and to quantitatively evaluate the efficacy of each type of intervention. Methods: A systematic review and meta-analysis were conducted according to PRISMA guidelines. PubMed, Embase, Cochrane Library, CINAHL, and PsycINFO were searched until 26 June 2023, and the list of references of the initially included articles was also searched. Two researchers independently performed the search, screening, selection, and data extraction. The primary outcome was RTW rate (the RTW rate was defined as the proportion of individuals who returned to work in each group (intervention and control) at the endpoint). Pooled risk ratio (RR) was estimated using a random-effects model with 95% confidence intervals (CIs). Results: A total of 13 studies representing 4,282 individuals with stroke were included in our study. Results showed that physiological interventions could improve the RTW rate of individuals with stroke (RR: 1.19, 95% CI: 1.01 to 1.42, I2 = 72%). And receiving intravenous thrombolytic therapy was beneficial in promoting the RTW in individuals with stroke. Subgroup analysis and meta-regression analysis showed that the individuals' functional status during hospitalization was the only source of heterogeneity. Psychological interventions had little or no effect on the RTW rate of individuals with stroke (RR: 1.20, 95% CI: 0.58 to 2.51, I2 = 30%). Work-related interventions had little or no effect on the RTW rate of the individuals with stroke (RR:1.36,95%CI: 0.99 to 1.88, I2 = 73%). The subgroup analysis showed that country, age, and follow-up method were the sources of heterogeneity. Conclusion: Physiological intervention promoted the RTW of individuals with stroke. But, the effect of psychological and work-related interventions in promoting the RTW of individuals with stroke was not significant. We anticipate that these findings may inform the design of future interventions. For future research, we recommend that more high-quality randomized controlled trials be conducted to further promote the RTW of individuals with stroke. Systematic Review Registration: PROSPERO Registration Number, CRD42023443668. [ABSTRACT FROM AUTHOR]

Background: Robot-assisted upper-limb rehabilitation has been studied for many years, with many randomised controlled trials (RCTs) investigating the effects of robotic-assisted training on affected limbs. The current trend directs towards end-effector devices. However, most studies have focused on the effectiveness of rehabilitation devices, but studies on device sizes are relatively few. Goal: Systematically review the effect of a portable rehabilitation robot (PRR) on the rehabilitation effectiveness of paralysed upper limbs compared with non-robotic therapy. Methods: A meta-analysis was conducted on literature that included the Fugl-Meyer Assessment (FMA) obtained from the PubMed and Web of Science (WoS) electronic databases until June 2023. Results: A total of 9 studies, which included RCTs, were completed and a meta-analysis was conducted on 8 of them. The analysis involved 295 patients. The influence on upper-limb function before and after treatment in a clinical environment is analysed by comparing the experimental group using the portable upper-limb rehabilitation robot with the control group using conventional therapy. The result shows that portable robots prove to be effective (FMA: SMD = 0.696, 95% = 0.099 to .293, p < 0.05). Discussion: Both robot-assisted and conventional rehabilitation effects are comparable. In some studies, PRR performs better than conventional rehabilitation, but conventional treatments are still irreplaceable. Smaller size with better portability has its advantages, and portable upper-limb rehabilitation robots are feasible in clinical rehabilitation. Conclusion: Although portable upper-limb rehabilitation robots are clinically beneficial, few studies have focused on portability. Further research should focus on modular design so that rehabilitation robots can be decomposed, which benefits remote rehabilitation and household applications. [ABSTRACT FROM AUTHOR]

Introduction: Dose (number of repetitions) has been suggested as a key element in the effectiveness of rehabilitation exercises to promote motor recovery of the hemiparetic upper limb. However, rehabilitation exercises tend to be monotonous and require significant motivation to continue, making it difficult to increase the exercise dose. To address this issue, gamification technology has been implemented in exercises to promote self-engagement for people with hemiparesis in continuing monotonous repetitive movements. This study aimed to investigate how subjective perspectives, specifically enjoyability, motivation to continue, and expectancy of effectiveness, change through continuous daily exercise using a developed gamified exercise system. Materials and Method: Ten people with stroke suffering upper limb dysfunction underwent daily gamified exercise for seven days. The gamified exercise consisted of an electromyography (EMG)-controlled operating system that enabled users to play virtual games using repetitive finger movements. The participants performed conventional self-exercise on the same day as the control exercise, and rated their subjective perspectives on both exercises on a numerical rating scale on each exercise day. Results: Ratings for enjoyability and motivation to continue consistently showed significantly higher scores for the gamified exercise than for conventional self-exercise on all exercise days. A similar trend was observed in the ratings for the expectancy of effectiveness. No changes over time were found in any of the ratings throughout the exercise period. Conclusions: Exercise using the developed EMG-controlled gamified system may have the potential to maintain motivation and enjoyment in people with stroke to continue monotonous repetitive finger movements. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the acceptability of two co-designed mobile applications Mit Sygehus [a knowledge-based solution] and Genoptræn.dk [a self-training solution] to support a cross-sectoral, person-centred and empowering stroke rehabilitation. Setting: The applications were implemented and tested throughout two stroke rehabilitation trajectories in Southern Denmark, comprising two acute, two sub-acute and two municipal stroke rehabilitation settings. Methods, participants and analysis: A process evaluation focusing on acceptability was conducted. Individual and dyadic interviews were performed with ten stroke survivors (three women and seven men, aged 50-84) with moderate stroke and seven significant others (five women and two men, aged 50-78) post-rehabilitation. A constructivist Grounded Theory analysis was used to explore what, why, when, and how the apps worked or did not work throughout the stroke rehabilitation trajectory and if adaptions were needed. Results: Participants found that Mit Sygehus provided adequate and sufficient knowledge and was easy to use, however, acceptability of Mit Sygehus declined throughout the rehabilitation process. Also, knowledge on 'return-to-work' and 're-gaining driver's license/permission to drive' needed to be developed. The content in Genoptræn.dk was perceived as acceptable, through content being person-centred, motivating and meaningful. Genoptræn.dk furthermore, supported the transfer between rehabilitation settings, provided a sense of progress throughout the rehabilitation process, facilitated positive habits regarding self-training, and relieved the burden on significant others. Genoptræn.dk was perceived most acceptable in the sub-acute rehabilitation setting and declined when rehabilitation continued in the municipal setting. Conclusion: Stroke survivors and their significant others found Mit Sygehus and Genoptræn.dk acceptable to support cross-sectoral, person-centred and empowering stroke rehabilitation, however acceptability declined throughout the rehabilitation process. Further investigations are required to determine how cognitive rehabilitation can play a greater role in app-supported stroke rehabilitation and how the need for more long-term follow-up can be supported. [ABSTRACT FROM AUTHOR]

Background: Stroke is a critical complication of cardiac surgery that results in increased mortality and morbidity. Limited treatment options are available for patients with severe neurological deficits, such as impaired consciousness. Acupuncture is a well-known integrative management method for stroke patients. However, there are no extensive reports discussing the benefit of acupuncture in stroke patients after cardiac surgery. The aim of this study was to demonstrate the role of acupuncture in the neurological recovery of these patients and to identify the factors that provide greater benefit. Methods: This self-controlled case series utilized inpatient data from stroke patients after cardiac surgery who received acupuncture in a single center from 2013 to 2019. The primary outcomes included the Glasgow Coma Scale, muscle strength grading scale, and Barthel Index. Wilcoxon signed-rank test was used to compare the neurological differences between pre-acupuncture and post-acupuncture. Results: Fifty-one patients who met the criteria showed significant improvement of the severity of neurological impairment, including the Glasgow Coma Scale, muscle strength grading scale, and Barthel Index (p < 0.05). The group that underwent aortic dissection repair and the group that started acupuncture within 7 days after stroke showed greater improvement (p < 0.01). No adverse events were reported. Three patients with profound neurological impairment who received acupuncture intervention were described. Conclusions: Acupuncture has a potential benefit in improving neurological impairment and reducing mortality in stroke patients after cardiac surgery, especially within 7 days of the event. Further larger prospective studies with control groups are needed to provide convincing evidence. [ABSTRACT FROM AUTHOR]

Background: Stroke in adolescents and young adults are uncommon, and unlike in older adults, the etiology can be a challenging puzzle to solve. Patients often lack traditional risk factors such as hypertension or may be too young for suspected atherosclerotic disease. Additionally, among this group, various stroke mimics exist that can cloud physician judgment, leading to under- or overtreatment. Aim: There is a significant gap in the current literature and clinical evidence regarding stroke in this population. This review of the literature aims to extract important information surrounding the etiology, risk factors, diagnosis, management, and complications of stroke in younger people and address stroke mimics and how they can appear similar and different from ischemic or hemorrhagic stroke. Additionally, we discuss the importance of furthering research in this specific population in all areas due to a concerning rise in stroke frequency and unique associated disabilities. Conclusion: The acute treatment of stroke in young patients is similar to older adults. While stroke mimics may complicate suspicion and cause hesitance, delays in stroke care should be avoided. There remains a need for research in the areas of diagnosis, management, and assessment of long-term care and challenges in this population of patients. [ABSTRACT FROM AUTHOR]

Background: Stroke is the second leading cause of death and the third leading cause of disability worldwide. Motor dysfunction is a common sequela, which seriously affects the lives of patients. Theta burst stimulation (TBS) is a new transcranial magnetic therapy for improving motor dysfunction after stroke. However, there remains a lack of studies on the mechanism, theoretical model, and effectiveness of TBS in improving motor dysfunction following stroke. Objective: This paper provides a comprehensive overview and assessment of the current impact of TBS on motor rehabilitation following stroke and analyzes potential factors contributing to treatment effect disparities. The aim is to offer recommendations for further refining the TBS treatment approach in subsequent clinical studies while also furnishing evidence for devising tailored rehabilitation plans for stroke patients. Methods: This study was conducted following PRISMA guidelines. PubMed, Embase, Web of Science, and the Cochrane Library were searched systematically from the establishment of the database to February 2024. Relevant studies using TBS to treat patients with motor dysfunction after stroke will be included. Data on study characteristics, interventions, outcome measures, and primary outcomes were extracted. The Modified Downs and Black Checklist was used to assess the potential bias of the included studies, and a narrative synthesis of the key findings was finally conducted. Results: The specific mechanism of TBS in improving motor dysfunction after stroke has not been fully elucidated, but it is generally believed that TBS can improve the functional prognosis of patients by regulating motor cortical excitability, inducing neural network reorganization, and regulating cerebral circulation metabolism. Currently, most relevant clinical studies are based on the interhemispheric inhibition model (IHI), the vicariation model, and the bimodal balance-recovery model. Many studies have verified the effectiveness of TBS in improving the motor function of stroke patients, but the therapeutic effect of some studies is controversial. Conclusion: Our results show that TBS has a good effect on improving motor function in stroke patients, but more large-scale, high-quality, multicenter studies are still necessary in the future to further clarify the mechanism of TBS and explore the optimal TBS treatment. [ABSTRACT FROM AUTHOR]

Background: Stroke survivors exhibit persistent abnormal gait patterns, particularly in diminished walking ability and stability, limiting mobility and increasing the risk of falling. The purpose of the study was to determine the effects of repetitive transcranial magnetic stimulation (rTMS) coupled with cycling exercise on walking ability and stability in patients with stroke and explore the potential mechanisms underlying motor cortex recovery. Methods: In this double‐blinded randomized pilot trial, 32 stroke patients were randomly separated into the real‐rTMS group (RG, receiving rTMS during active cycling exercise) and the sham‐rTMS group (SG, receiving sham rTMS during active cycling exercise). Participants completed 10 exercise sessions (5 times per week). Lower extremity function was measured using the Fugl‐Meyer assessment of lower extremity (FMA‐LE), and functional balance ability was measured by the Berg balance scale (BBS). The 2‐min walk test (2MWT) and standing balance test were employed to evaluate walking and balance ability. Motor evoked potentials (MEPs) were measured to evaluate cortical excitability. The above assessments were administered at baseline and after the intervention. Additionally, the cycling exercise performance was recorded after the initial and final exercise sessions to evaluate the motor control during exercise. Results: The RG showed significant improvements in lower extremity function (FMA‐LE) and functional balance ability (BBS) compared to the SG at postintervention. The walking and balance abilities, as well as the motor asymmetry of cycling exercise, significantly improved in RG. Additionally, participants in RG exhibited a higher elicitation rate of ipsilesional MEPs than that in SG. The improvements in motor asymmetry of cycling exercise in RG were significantly associated with increases in FMA‐LE scores and walking ability. Conclusion: The combination of rTMS and cycling exercise effectively improves walking ability and walking stability in patients with stroke, which may be related to the excitability modulation of the motor cortex induced by rTMS. Trial Registration: Clinical Trial Registry identifier: ChiCTR2400079360. [ABSTRACT FROM AUTHOR]

Disruption of somatosensorimotor integration (SMI) after stroke is a significant obstacle to achieving precise motor restoration. Integrating somatosensory input into motor relearning to reconstruct SMI is critical during stroke rehabilitation. However, current robotic approaches focus primarily on precise control of repetitive movements and rarely effectively engage and modulate somatosensory responses, which impedes motor rehabilitation that relies on SMI. This article discusses how to effectively regulate somatosensory feedback from target muscles through peripheral and central neuromodulatory stimulations based on quantitatively measured somatosensory responses in real time during robot-assisted rehabilitation after stroke. Further development of standardized recording protocols and diagnostic databases of quantitative neuroimaging features in response to post-stroke somatosensory stimulations for real-time precise detection, and optimized combinations of peripheral somatosensory stimulations with robot assistance and central nervous neuromodulation are needed to enhance the recruitment of targeted ascending neuromuscular pathways in robot-assisted training, aiming to achieve precise muscle control and integrated somatosensorimotor functions, thereby improving long-term neurorehabilitation after stroke. [ABSTRACT FROM AUTHOR]

Robotic devices are commonly used to quantify sensorimotor function of the upper limb after stroke; however, the availability and cost of such devices make it difficult to facilitate implementation in clinical environments. Tablets (e.g. iPad) can be used as devices to facilitate rehabilitation but are rarely used as assessment tools for the upper limb. The current study aimed to implement a tablet-based Maze Navigation Task to examine complex upper-limb movement in individuals with chronic stroke. We define complex upper-limb movement as reaching movements that require multi-joint coordination in a dynamic environment. We predicted that individuals with stroke would have more significant spatial errors, longer movement times, and slower speeds compared to controls with increasing task complexity. Twenty individuals with chronic stroke who had a variety of arm and hand function (Upper extremity Fugl-Myer 52.8 ± 18.3) and twenty controls navigated eight pseudorandomized mazes on an iPad using a digitizing stylus. The task was designed to elicit reaching movements engaging both the shoulder and elbow joints. Each maze became increasingly complex by increasing the number of 90° turns. We instructed participants to navigate each maze as quickly and accurately as possible while avoiding the maze's boundaries. Sensorimotor behavior was quantified using the following metrics: Error Time (time spent hitting or outside boundaries), Peak Speed, Average Speed, and Movement Time, Number of Speed Peaks. We found that individuals with stroke had significantly greater Error Time for all maze levels (all, p < 0.01), while both speed metrics, Movement Time and Number of Speed Peaks were significantly lower for several levels (all, p < 0.05). As maze complexity increased, the performance of individuals with stroke worsened only for Error Time while control performance remained consistent (p < 0.001). Our results indicate that a complex movement task on a tablet can capture temporal and spatial impairments in individuals with stroke, as well as how task complexity impacts movement quality. This work demonstrates that a tablet is a suitable tool for the assessment of complex movement after stroke and can serve to inform rehabilitation after stroke. [ABSTRACT FROM AUTHOR]

Background: Motor impairments limit the functional abilities of patients after stroke; it is important to identify low-cost rehabilitation avenues. The aim of this study is to determine the effectiveness of thermal stimulation in addition to conventional therapy for functional recovery in post-stroke patients. Methods: An electronic search was performed in the MEDLINE, Scopus, Web of Science, EMBASE, CINAHL, SPORTDiscus, Epistemonikos, LILACS, and PEDro databases. The eligibility criterion was randomized clinical trials that analyzed the clinical effects of thermal stimulation plus conventional therapy. Two authors independently performed the search, study selection, data extraction, and risk of bias assessment. Results: Eight studies met the eligibility criteria, and six studies were included in the quantitative synthesis. For thermal stimulation plus conventional therapy versus conventional therapy alone, the mean difference (MD) for function was 6.92 points (95% CI = 4.36–9.48; p < 0.01), for motor function was 6.31 points (95% CI = 5.18–7.44; p < 0.01), for balance was 4.41 points (95% CI = −2.59–11.4; p = 0.22), and for walking was 1.01 points (95% CI = 0.33–1.69; p < 0.01). For noxious thermal stimulation versus innocuous thermal stimulation, the MD for activities of daily living was 1.19 points (95% CI = −0.46–2.84; p = 0.16). Conclusions: In the short term, adding thermal stimulation to conventional therapy showed statistically significant differences in functional recovery in post-stroke patients. The quality of evidence was high to very low according to GRADE rating. The studies included varied in the frequency and dosage of thermal stimulation, which may affect the consistency and generalizability of the results. A larger quantity and a better quality of clinical studies are needed to confirm our findings. PROSPERO registration: CRD42023423207. [ABSTRACT FROM AUTHOR]

Purpose: To investigate how functional cognition of people post-stroke is evaluated and reported by occupational therapists in Ireland. Functional cognition refers to the use and integration of cognitive skills for daily function. Methods: This study used a qualitative design. Six focus groups and one individual interview were conducted with 20 occupational therapists purposively sampled for variation across different clinical grades. Data were analysed according to the Braun and Clark thematic analysis framework. Results: Participants felt that assessment of functional cognition was an integral feature of occupational therapy assessment in stroke care but acknowledged that terminology used by occupational therapists for functional cognition was inconsistent. Non-standardised observational assessment was routinely used by participants. Challenges were reported with respect to written documentation of non-standardised observations. Participants reported that use of standardised cognitive assessments required considered clinical reasoning before administration. Standardised performance-based assessments were not widely implemented by participants. Conclusion: Occupational therapists in Ireland reported a multi-component assessment process to evaluate functional cognition post-stroke. Establishing practice guidelines for the assessment of functional cognition may be of benefit to occupational therapists working in stroke care. Further research is needed to quantify procedures in this assessment process to account for variation in practice. IMPLICATIONS FOR REHABILITATION: The assessment of functional cognition in stroke rehabilitation is integral to occupational therapy practice. Occupational therapists described the assessment of functional cognition as a multi-component assessment drawing from three main modalities: standardised cognitive assessments; non-standardised observations; and performance-based assessments. Professional education in, and practice guidelines, for the assessment and reporting of functional cognition could be beneficial for occupational therapists in stroke care to streamline their assessment and reporting of functional cognition. [ABSTRACT FROM AUTHOR]

Purpose: To identify barriers and facilitators to accessing post-stroke rehabilitation services six months after discharge from the stroke unit of a Brazilian public hospital. Materials and Methods: This cross-sectional and descriptive study collected sociodemographic and clinical-functional data during hospitalization. Then, barriers and facilitators for accessing the post-stroke rehabilitation services were collected six months after discharge. We considered economic conditions and displacement, the quality and organization of post-stroke rehabilitation services, and personal conditions. Results: A total of 174 patients were included. Among the 20 aspects analyzed, 17 (85.0%) were reported as facilitators, while three (15.0%) were as barriers. The identified barriers included financial income available for healthcare (49.4%), waiting time to schedule or to be seen (47.0%), and process to scheduling (45.4%). The main facilitators (> 79.0%) were the expectation of the patient with the treatment and assistance from family and friends. Moreover, most patients indicated as facilitators all aspects related to the quality of post-stroke rehabilitation services. Conclusion: Access to post-stroke rehabilitation services presented more facilitators than barriers. Public policies to subsidize health costs, optimize waiting time, and process for scheduling post-stroke rehabilitation services should be considered to reduce barriers. Likewise, human and financial resources must promote the facilitators. Implications for Rehabilitation: Public policies to subsidize health costs, optimize waiting times and scheduling in post-stroke rehabilitation services should be considered to facilitate access to rehabilitation services for post-stroke patients. The involvement of family and friends in the treatment of post-stroke patients should be encouraged. Patients' motivation and positive expectations can facilitate access to post-stroke rehabilitation services. [ABSTRACT FROM AUTHOR]

Purpose: To identify Capabilities, Opportunities, and Motivational factors influencing movement behaviour throughout the day in people with stroke who are highly sedentary and inactive to enable intervention development. Methods: A qualitative study was conducted using semistructured interviews with people with stroke. The interview guide was based on the Capabilities, Opportunities, and Motivation Behavioural model. Results: Eleven interviews were conducted. Participants reported a lack of knowledge regarding healthy movement behaviour patterns, a lack of insight into their own movement behaviour, and some physical and cognitive limitations to engage in certain physical activities. Several social and environmental elements affecting movement behaviours were mentioned, their impact on movement behaviour varied among participants. Movement behaviour was mostly driven by habits and daily routine, without conscious regulation. Conclusion: Our findings show that people with stroke are unaware of their own movement behaviour or of the consequences of these behaviours on health. Movement behaviour is, for the most part, based on daily routine and personal habits. This indicates the need for a behaviour change intervention. Such interventions will need to include providing information about healthy movement behaviour, feedback on individual's movement behaviour and individualized support, taking into account the social and environmental context and personal capabilities. Implications for Rehabilitation: There is a need to provide insight and feedback regarding individuals' movement behaviour and information about healthy movement behaviour to enable people with stroke who are highly sedentary and inactive to improve their movement behaviour. Movement behaviour is, for the most part, based on daily routine and personal habits. People need individualised support, and personal capabilities, the social and environmental context need to be taken into account to support sustainable movement behaviour change. These findings can be used in clinical practise and to inform intervention development to support movement behaviour change in people after stroke who are highly sedentary and inactive. [ABSTRACT FROM AUTHOR]

Purpose: To map and summarise available literature on the effectiveness or other benefits of group- and individual-based interventions provided for adults living with stroke or ischaemic heart disease (IHD) in the community. Material and Methods: The review was conducted based on JBI methodology and reported using Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Articles were retrieved from: Medline, PsychInfo, Embase, Scopus, and CINAHL from 2002–2022. Extracted data from eligible studies included type of health outcomes (e.g., impairments), retention and adherence, social connectedness, and the costs associated with group- and individual-based interventions. Results: After screening, five articles (representing 4 unique studies) comparing a group- and individual-based intervention were included (total sample size n = 87). Three types of interventions were assessed: exercise (3/5), communication (1/5), and occupational therapy (1/5). Effectiveness of group- and individual-based interventions at improving health outcomes (i.e. physical ability, communication, motivation, and quality of life) is unclear. Currently there is insufficient evidence to guide clinical practice. Conclusions: There is limited evidence comparing interventions delivered in a group and individual modality for adults living with stroke or IHD. Adequately powered studies are needed to determine if mode of delivery is equivalent or more cost effective. IMPLICATIONS FOR REHABILITATION: Rehabilitation interventions can be offered individually or in group settings with clinicians choosing the most appropriate modality. Both group- and individual-based interventions have advantages and disadvantages, with clinical, practical, and economic factors as important considerations when deciding between the two modalities. Based on this scoping review, the authors conclude that there is currently insufficient evidence to guide clinical practice in deciding which mode of delivery (group or individual) is optimal. There is insufficient research evidence to guide clinicians in their choice between offering rehabilitation interventions for stroke or IHD in groups or individually. [ABSTRACT FROM AUTHOR]

AbstractPurposeMethodsResultsConclusionsTrial registrationThis study aimed to determine if the Promoting Optimal Physical Exercise for Life (PROPEL) program increases participation in physical activity up to six months post-discharge from stroke rehabilitation, compared to participation in group cardiorespiratory exercise (GCE) alone.This was a stepped-wedge cluster superiority randomised controlled trial. People with sub-acute stroke participated in the PROPEL (n = 107) or GCE (n = 65) intervention phases. The primary outcome was adherence to physical activity guidelines over seven days at six months post-discharge from rehabilitation. Secondary outcomes were exercise self-efficacy (Short Self-Efficacy for Exercise scale), exercise-related beliefs and attitudes (Short Outcome Expectation for Exercise scale), and perceived barriers to physical activity (Barriers to Being Active Quiz).Fifty-seven participants (PROPEL, n = 29; GCE, n = 28) were included in the analysis. At six months post-discharge, 6/17 PROPEL participants and 9/22 GCE participants met the guidelines for intensity and duration of physical activity; the odds of meeting physical activity guidelines did not differ between phases (p > 0.84). PROPEL participants reported higher self-efficacy for exercise than GCE participants (p = 0.0047).While PROPEL participants reported higher self-efficacy for exercise than those who completed GCE alone, we were unable to find evidence that this translated to increased odds of meeting physical activity guidelines.NCT02951338IMPLICATIONS FOR REHABILITATIONIntegration of cardiorespiratory exercise with behaviour modification strategies to improve physical activity participation after discharge from stroke rehabilitation increases self-efficacy for exercise when compared to cardiorespiratory exercise alone.Increased self-efficacy for exercise may not increase the odds of meeting physical activity guidelines post-stroke.Improving self-efficacy for exercise during stroke rehabilitation may encourage participation in moderate to vigorous physical activity up to 6-months post-discharge from rehabilitation.Integration of cardiorespiratory exercise with behaviour modification strategies to improve physical activity participation after discharge from stroke rehabilitation increases self-efficacy for exercise when compared to cardiorespiratory exercise alone.Increased self-efficacy for exercise may not increase the odds of meeting physical activity guidelines post-stroke.Improving self-efficacy for exercise during stroke rehabilitation may encourage participation in moderate to vigorous physical activity up to 6-months post-discharge from rehabilitation. [ABSTRACT FROM AUTHOR]

Introduction: Stroke is a leading cause of mortality and long-term disability worldwide, often resulting in low levels of physical activity post-discharge. A comprehensive exercise program could be a safe method to increase stroke patients' physical activity and exercise volume. This pilot study examines the effectiveness, safety, and feasibility of a comprehensive exercise regimen for stroke patients residing in the community after discharge. Methods: This single-group pilot study included patients who received inpatient rehabilitation for motor impairment following a stroke. Community-dwelling participants engaged in a comprehensive exercise program, which was structured and individualized, consisting of stretching, aerobic exercise, strength training, and balance exercises, conducted under the supervision of a health exercise specialist in a dedicated living lab within the hospital. The program involved 20 sessions, each lasting 50 min, conducted three to five times weekly. The pre- and post-intervention evaluations were comprehensive, including safety and validity assessments, along with physical function tests such as cardiopulmonary exercise testing and various fitness tests (6 min walk test, timed up and go test, chair stand test, figure-of-8 walk test, grip strength test, and sit-and-reach test). Depression levels were assessed using the Geriatric Depression Scale (GDS). Results: A total of 22 subjects were recruited, with 21 completing the study after one dropout due to fatigue and visiting distance. Among the 21 completers, one subject experienced a mild adverse event (hypoglycemia), which was not serious, confirming the program's safety. The exercise participation rate was 95.5%, and the adherence rate averaged 95.2%, with all completers achieving over 80% adherence. Significant improvements were observed in VO2 peak (p = 0.000), 6 min walk test (p = 0.000), timed up and go test (p = 0.000), chair stand test (p = 0.000), figure-of-8 walk test (p = 0.000), and grip strength (p = 0.001). However, changes in the peak respiratory exchange ratio (p = 0.078), sit-and-reach test (p = 0.228) and GDS scores (p = 0.275) were not significant. Conclusion: This study demonstrates that the comprehensive exercise program is sufficiently safe and valid for stroke rehabilitation patients. The program significantly enhances cardiopulmonary endurance, walking ability, balance, muscle strength, muscle endurance, and coordination. Further research with larger sample sizes and control groups is needed to confirm these findings and explore additional benefits. [ABSTRACT FROM AUTHOR]

Background: the effects of gait training based on the positioning of affected foot muscle activity, gait parameters, and balance ability were investigated in patients with subacute stroke. Material and Methods: Forty-five patients with subacute stroke were randomly assigned to three groups: straight gait training (SGT) group (n = 15), outward curved gait training group (OCGT) with the paretic foot positioned laterally (n = 15), or inward curved gait training (ICGT) group with the paretic foot positioned medially (n = 15). All groups received 30 min interventions, comprising 15 min of gait training, five times per week for four weeks. Outcomes were measured in terms of muscle activation of the gluteus maximus (GM), vastus medialis, and vastus lateralis; five gait parameters (step length, stance phase, swing phase, velocity, and maximum force); and balance ability assessed using the timed up and go (TUG) test. Results: All groups exhibited significant improvements in all variables after the four-week intervention period (p < 0.05). Specifically, the overall muscle activation and gait parameters for each group increased as follows: the SGT showed increases of 38.8% and 5.7%, respectively; the OCGT exhibited improvements of 38.9% and 7.4%; and the ICGT demonstrated enhancements of 59.8% and 9.2%. However, except for comparisons between the SGT and ICGT groups in terms of GM muscle activity and TUG, no significant differences were observed between the groups for the other variables (p > 0.05). Conclusions: although patients with subacute stroke can improve their overall physical function regardless of the gait training method, ICGT may be more effective in enhancing muscle activity and balance ability. [ABSTRACT FROM AUTHOR]

Background: Shared decision-making is recommended for stroke rehabilitation. However, the complexity of the rehabilitation modalities exposes patients to decision-making conflicts, exacerbates their disabilities, and diminishes their quality of life. This study aimed to explore the experiences and needs of older patients with stroke in China during rehabilitation decision-making, providing a reference for developing decision-support strategies. Methods: A qualitative phenomenological design was used to explore the experiences and needs of older patients with stroke in China. Purposive sampling was used to recruit 31 older Chinese patients with stroke. The participants participated in face-to-face, semi-structured, and in-depth interviews. Data were analyzed using inductive thematic analysis. Results: The key themes identified include (1) mixed feelings in shared decision-making, (2) multiple barriers hinder the possibility of participating in shared decision-making, (3) Delegating rehabilitation decisions to surrogates, (4) gaps between reality and expectation, and (5) decision fatigue from lack of continuity in the rehabilitation health care system. Conclusions: Older patients with stroke in China have complex rehabilitation decision-making experiences and needs and face multiple obstacles when participating in shared decision-making. They lack an effective shared decision-making support system to assist them. Providing patients with comprehensive support (such as emotional and informational), strengthening the construction of a continuous rehabilitation system, alleviating economic pressure, and promoting patient participation in rehabilitation decision-making are necessary. [ABSTRACT FROM AUTHOR]