[ARTICLE] A combination of multimodal physical exercises in real and virtual environments for individuals after chronic stroke: study protocol for a randomized controlled trial – Full Text

Abstract

Background

Multimodal physical exercises already have well-established benefits for the post-stroke population that influence gait functional capacity, balance, gait, cognition, and quality of life. This type of intervention can be performed in both real and virtual environments. Considering the characteristics of both environments, it is questioned to what extent the combination of interventions in real and virtual environments could result in improvement in post-stroke impairments.

Methods/design

We will conduct a randomized clinical trial with three groups: a real multimodal group (RMG), a virtual multimodal group (VMG), and a combined multimodal group (CMG). It was estimated that we will need a sample of 36 participants (12 per group). RMG individuals will only perform multimodal physical exercises in a real environment two times per week for 60 min per session for 15 weeks. VMG individuals will perform exercises of the same duration over the same time frame but only in a virtual environment. CMG individuals will hold a weekly session in a real environment and another weekly session in virtual environment. The primary outcome measure will be health-related quality of life, evaluated using the Stroke Impact Scale; effects on cognition (Montreal Cognitive Assessment), balance (Berg Balance Scale), mobility (Timed Up & Go), self-selected gait speed (10-meter walk test), and gait functional capacity (6-min walk test) will be investigated as secondary outcome measures. Participants will be evaluated before the beginning of the intervention, immediately after the end of the intervention, and at 1-month follow-up without exercise. If the data meet the assumptions of the parametric analysis, the results will be evaluated by analysis of variance (3 × 3) for the group factor, with repeated measures while taking into account the time factor. The post hoc Tukey test will be used to detect differences (α = 0.05).

Discussion

This study represents the first clinical trial to include three groups considering physical exercise in real and virtual environments, isolated and combined, that counterbalances the intensity and volume of training in all groups. This study also includes a control of progression in all groups along the 15-week intervention. The outcome measures are innovative because, according to International Classification of Functioning, Disability and Health, activity and participation are the targets for effectiveness evaluation.

Background

The diverse impairments observed after a stroke, associated with the reduction of intrinsic motivation and the presence of preexisting or acquired comorbidities, lead to a vicious cycle of decreased activity and increased exercise intolerance. As a consequence, secondary complications, such as reduced cardiorespiratory fitness, muscle atrophy, osteoporosis, and circulation impairment in the lower extremities, may occur and generate greater dependence in the activities of daily living and impact the social interactions of these individuals [1].

Different modalities of physical exercises already have well-established benefits for individuals after chronic stroke, including repercussions for cardiovascular capacity [2], muscle strength [3, 4], balance [5, 6], gait [7, 8], and cognition [9]. In order to maximize the effects of the exercises, there is a tendency to investigate the effects of multimodal protocols. According to Saunders et al. [10], a multimodal protocol refers to interventions based on the combination of physical exercises of different components, such as cardiorespiratory, muscular strength, and flexibility.

Multimodal physical exercises can be performed in both real and virtual reality environments. The interventions performed in real environments are the most commonly used in the clinical context. Characteristics of interventions performed in real environments include a high interactive relationship between the professional and the patient, high ecological validity, the possibility of individual or group applications, not requiring technological resources, and the ability to be applied in the home according to each patient’s needs.

Conversely, virtual reality-based interventions present features such as an environment rich in visual and auditory information with immediate and multisensory feedback [11], real-time simulation of tasks or environments, three-dimensional interactive and immersive experiences, a computerized interface, active and safe patient participation [12], and the ability to provide information with an external focus of attention [13, 14]. In a systematic review, Laver et al. [15] found that the addition of virtual reality to conventional methods resulted in improved upper limb function. However, they also found insufficient evidence regarding the superiority of virtual reality for promoting walking speed and balance. They were unable to pool results related to cognition, improvement of social participation, and health-related quality of life (HRQoL) because few studies included assessments of cognition and HRQoL to achieve meta-analysis requirements for these outcomes [15]. Therefore, these parameters should be investigated in future studies; in addition, the authors also emphasized the need for training lasting longer than 15 h of intervention and that future studies should set the number of participants screened for eligibility criteria.

Considering the characteristics of both environments, it is questioned to what extent the combination of interventions in the real and virtual environments could result in improvement in post-stroke impairments. There are few studies that have sought to find answers to this question. In the Shin et al. [16] study, the control group performed 1 h of occupational therapy per session, and the experimental group performed 30 min of occupational therapy plus 30 min of virtual reality. The results showed positive effects in both groups, except for the domain related to the limitations due to physical problems measured by the Short Form Health Survey scores, in which experimental group (EG) obtained greater benefits. Rajaratnam et al. [17] found positive results for balance and mobility measurements for the group that performed 40 min of conventional therapy plus 20 min of self-directed virtual reality balance training per session, compared with the control group, which performed 60 min of conventional therapy.

Saposnik and Levin [18] claimed there were few publications regarding the combination of multimodal physical exercises in real and virtual environments. Most of the existing studies did not investigate long-term effects, including follow-up, and added intervention time to the experimental groups, which provided them with an advantage in the total intervention time received. In addition, there is an important diversity in the literature regarding the profile characteristics of individuals with stroke, considering acute, subacute, and chronic patients. Thus, the results found in the previous studies [19,20,21,22,23,24] do not allow consistent conclusions to be made about the effects of the combination of multimodal exercises in real and virtual environments in individuals after chronic stroke.

This study seeks to answer whether the combination of multimodal physical exercises in real and virtual environments could bring additional benefits to the quality of life, cognition, gait, and balance of individuals after chronic stroke. We also intend to clarify the effects of interventions with multimodal physical exercises when performed only in a real environment or only in a virtual environment and to investigate whether the possible effects remain after 1 month without participating in physical exercises.

This study aims to investigate the effects of a protocol of multimodal physical exercises in real and virtual environments for individuals who have survived a stroke.[…]

 

Continue —-> A combination of multimodal physical exercises in real and virtual environments for individuals after chronic stroke: study protocol for a randomized controlled trial | Trials | Full Text

Virtual reality games selected for the odd-game sessions and individuals’ practice

[ARTICLE] Effects of acquired chronic brain injury on quality of life: A preliminary study in patients with a left or right-sided lesion – Full Text PDF

Highlights

• Quality of life comprises physical, emotional, cognitive, social, & general health
• Left hemisphere injured patients are less satisfied with their cognitive function
• Right hemisphere patients are less satisfied with their physical function
• Age, education, and lesion size influence perceived quality of life after injury
• Lesion location may mediate which aspects of quality of life are adversely impacted

Abstract

Objectives

To test the hypothesis that quality of life (QOL) is made up of different components and each of these has different anatomic and demographic contributors.

Design

Questionnaire-based study ;

Setting

Center for Cognitive Neuroscience, University of Pennsylvania

Participants

52 people with chronic brain injury volunteered for the study. After excluding patients with severe communication deficits, bilateral lesions, and incomplete data, 42 patients with focal lesions were included in the final study: 22 patients with left hemisphere injury, LHI (9 females and 13 males; mean age 60.6 years (SD=11.2; Range: 36-83) mean chronicity 11.5 years (SD=4.2)) and 20 patients with right hemisphere injury, RHI (16 females and 4 males; mean age 62.7 years (SD= 12.8; Range: 31-79); mean chronicity 10.1 years (SD=4.3)).

Main Outcome Measures

We administered the RAND36-Item Health Survey (RAND-Version-1.0), Stroke Impact Scale (SIS-Version 3.0), Positive Affect and Negative Affect Scale (PANAS) and Distress Thermometer (DT) to measure QOL in LHI and RHI patients. Exploratory Factor Analysis (EFA) with principal component method reduced these measures to five factors, roughly categorized as— 1. Physical functioning, 2.General health, 3. Emotional health, 4. Social functioning, and 5. Cognitive functioning. Exploratory analyses attempted to relate these factor scores to demographic variables, neuroanatomical data, and neuropsychological measures.

Results

Physical functioning was the biggest contributor to reduced QOL, explaining 32.5%, of the variance. Older age, less education, and larger lesion size predicted poorer physical functioning (p < .001). Age also affected emotional health. (p=.019). Younger patients reported poorer emotional health than older patients. LHI patients reported less satisfaction with their cognitive functioning (p=.009) and RHI patients with their physical functioning (p=.06). Exploratory neuroanatomical analyses hinted at brain areas that may be associated with the perception of disability in each QOL component.

Conclusions

QOL is comprised of five components. Clinical and demographic factors appear to differentially impact these aspects of patients’ perceived quality of life, providing hypotheses for further testing and suggesting potential relationships for therapeutic interventions to consider.

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via Effects of acquired chronic brain injury on quality of life: A preliminary study in patients with a left or right-sided lesion – ScienceDirect

[Abstract] Water-Based Exercise on Functioning and Quality of Life in Poststroke Persons: A Systematic Review and Meta-Analysis

Abstract

OBJECTIVE:

To investigate the effects of water-based exercise on functioning and quality of life in poststroke persons.

DATA SOURCES:

We searched the following electronic database: MEDLINE, PeDro, Scielo, and the Cochrane Central Register of Controlled Trials up to September 2018 Study Selection: Only randomized controlled trials were included. Two review authors screened the titles and abstracts and selected the trials independently.

DATA EXTRACTION:

Two review authors independently extracted data of the included trials, using standard data-extraction model. We analyzed the pooled results using weighted mean differences, and standardized mean difference and 95% confidence intervals (CIs) were calculated.

DATA SYNTHESIS:

Twenty-four studies met the study criteria, but only 15 studies were included on meta-analyses. The studies presented moderate methodological quality, due to the lack of blinding of subjects and therapists and the nonperformance of the intention-to-treat analysis. Water-based exercise compared with land exercise had a positive impact on: muscle strength balance gait speed and mobility aerobic capacity and functional reach. Combined water-based exercise and land exercise was more effective than land exercise for improving balance, gait speed, and functional reach. The meta-analysis showed significant improvement in role limitations due to physical functioning and emotional problems, in vitality general mental health, social functioning, and bodily pain for participants in the water-based exercise and land exercise group versus land exercise group.

CONCLUSIONS:

Water-based exercise may improve muscle strength, balance, mobility, aerobic capacity, functional reach, joint position sense, and quality of life in poststroke persons and could be considered for inclusion in rehabilitation programs.

via Water-Based Exercise on Functioning and Quality of Life in Poststroke Persons: A Systematic Review and Meta-Analysis. – PubMed – NCBI

[ARTICLE] Effects of virtual reality-based planar motion exercises on upper extremity function, range of motion, and health-related quality of life: a multicenter, single-blinded, randomized, controlled pilot study – Full Text

Abstract

Background

Virtual reality (VR)-based rehabilitation is considered a beneficial therapeutic option for stroke rehabilitation. This pilot study assessed the clinical feasibility of a newly developed VR-based planar motion exercise apparatus (Rapael Smart Board™ [SB]; Neofect Inc., Yong-in, Korea) for the upper extremities as an intervention and assessment tool.

Methods

This single-blinded, randomized, controlled trial included 26 stroke survivors. Patients were randomized to the intervention group (SB group) or control (CON) group. During one session, patients in the SB group completed 30 min of intervention using the SB and an additional 30 min of standard occupational therapy; however, those in the CON group completed the same amount of conventional occupational therapy. The primary outcome was the change in the Fugl–Meyer assessment (FMA) score, and the secondary outcomes were changes in the Wolf motor function test (WMFT) score, active range of motion (AROM) of the proximal upper extremities, modified Barthel index (MBI), and Stroke Impact Scale (SIS) score. A within-group analysis was performed using the Wilcoxon signed-rank test, and a between-group analysis was performed using a repeated measures analysis of covariance. Additionally, correlations between SB assessment data and clinical scale scores were analyzed by repeated measures correlation. Assessments were performed three times (baseline, immediately after intervention, and 1 month after intervention).

Results

All functional outcome measures (FMA, WMFT, and MBI) showed significant improvements (p < 0.05) in the SB and CON groups. AROM showed greater improvements in the SB group, especially regarding shoulder abduction and internal rotation. There was a significant effect of time × group interactions for the SIS overall score (p = 0.038). Some parameters of the SB assessment, such as the explored area ratio, mean reaching distance, and smoothness, were significantly associated with clinical upper limb functional measurements with moderate correlation coefficients.

Conclusions

The SB was available for improving upper limb function and health-related quality of life and useful for assessing upper limb ability in stroke survivors.

Background

Virtual reality (VR)-based rehabilitation is being increasingly used for post-stroke rehabilitation [1]. A recent systematic review mentioned that VR is an emerging treatment option for upper limb rehabilitation among stroke patients [2]. The benefits of VR include real-time feedback, easy adaptability, and the provision of safe environments that mimic the real world [3, 4]. The gaming property of VR allows patients to experience fun, active participation, positive emotions, and engagement [5, 6]. Therefore, rehabilitation with VR enables more intense and repetitive training, which is important for rehabilitation and the promotion of neural plasticity [7].

VR systems commonly used in the entertainment industry, such as Wii and Kinect, could be used for rehabilitation. However, these game-like systems are only applicable to patients with muscle strength above a certain value, thus limiting their use by more affected patients. Therefore, adjunct therapies, such as functional electrical stimulation and robotics, have been combined with these systems [8, 9, 10, 11]. However, those adjunct therapies are costly and require continuous monitoring by healthcare professionals because of safety concerns [12, 13]. Therefore, their use is restricted to clinical settings, and they are not actively used for telerehabilitation or home-based rehabilitation. A non-motorized or non-assisted device is required for more active use of VR for rehabilitation.

We developed the Rapael Smart Board™ (SB; Neofect Inc., Yong-in, Korea), which is a VR-based rehabilitation device incorporating planar motion exercise that does not require additional gravity compensation. This two-dimensional planar movement with full gravitational support, which lessens the need for antigravity muscle facilitation, allows for much easier participation than three-dimensional movement under gravity. Additionally, it is known to be safe and easy to learn, and it has been shown to improve motor ability with less aggravation of shoulder pain and spasticity; therefore, it is useful to patients with reduced motor ability [14]. Planar motion exercises provoke less maladaptive compensatory movements. Additionally, the nearly zero friction of the linear guides enable a wide range of repetitive active range of motion (AROM) exercises. Furthermore, the SB adopted Rapael Clinic software that was originally developed for patients with disabilities and has proven efficacy for stroke rehabilitation [9, 15]. Therefore, the SB, which has multiple advantages because of its hardware and software, might be beneficial for the functional improvement of the upper extremities. Moreover, the SB could have a role as an assessment tool because VR has been reported to be useful for objective kinematic measurements of the upper extremities [16].

The present pilot study aimed to assess the availability of this newly developed VR-based rehabilitation device incorporating planar exercises for the upper extremities as an intervention and assessment tool among stroke patients in the chronic phase of recovery. To assess the availability in terms of clinical effectiveness, we compared the effects of an intervention involving the SB and that involving dose-matched occupational therapy (OT) on upper extremity function and health-related quality of life (HRQoL). We also investigated the correlations between kinematic data from the SB and data from clinical scales regarding upper extremity function.

[…]

Continue —>  Effects of virtual reality-based planar motion exercises on upper extremity function, range of motion, and health-related quality of life: a multicenter, single-blinded, randomized, controlled pilot study | SpringerLink

Fig. 1Hardware of the Smart Board. The board and forearm-supported controller. Three linear guides with an H-shape configuration enable two-dimensional planar motion of the handlebar, which is attached to the horizontal linear guide

[ARTICLE] Mirror Therapy Using Gesture Recognition for Upper Limb Function, Neck Discomfort, and Quality of Life After Chronic Stroke: A Single-Blind Randomized Controlled Trial – Full Text

Abstract

Background

Mirror therapy for stroke patients was reported to be effective in improving upper-extremity motor function and daily life activity performance. In addition, game-based virtual reality can be realized using a gesture recognition (GR) device, and various tasks can be presented. Therefore, this study investigated changes in upper-extremity motor function, quality of life, and neck discomfort when using a GR device for mirror therapy to observe the upper extremities reflected in the mirror.

Material/Methods

A total of 36 subjects with chronic stroke were randomly divided into 3 groups: GR mirror therapy (n=12), conventional mirror therapy (n=12), and control (n=12) groups. The GR therapy group performed 3D motion input device-based mirror therapy, the conventional mirror therapy group underwent general mirror therapy, and the control group underwent sham therapy. Each group underwent 15 (30 min/d) intervention sessions (3 d/wk for 5 weeks). All subjects were assessed by manual function test, neck discomfort score, and Short-Form 8 in pre- and post-test.

Results

Upper-extremity function, depression, and quality of life in the GR mirror therapy group were significantly better than in the control group. The changes of neck discomfort in the conventional mirror therapy and control groups were significantly greater than in the GR mirror therapy group.

Conclusions

We found that GR device-based mirror therapy is an intervention that improves upper-extremity function, neck discomfort, and quality of life in patients with chronic stroke.

Background

In patients with acute stroke that occurred >6 months previously, 85% have upper-limb disorders, and 55% to 75% have upper-limb disorders [1]. The upper-limb movement function is decreased due to weakening of upper-limb muscles, which is primarily caused by changes in the central nervous system and secondarily by weakness due to inactivity and reduced activity [2,3].

Activities of daily living are limited due to body dysfunction, and most stroke patients have limited social interaction; these disorders reduce the quality of life [4–6]. In addition, stroke patients may experience depression due to reduced motivation [6]. Depression results in loss of interest and joy, anxiety, fear, hostility, sadness, and anger, which negatively affect functional recovery and rehabilitation in stroke patients [7].

Constraint-induced movement therapy, action observation training, and mirror therapy have been recently studied as therapies for upper-extremity motor function [8]. These interventions are used to increase the use of paralyzed limbs to overcome disuse syndromes, observe and imitate movement, and change the neural network involved in movement. Providing various tasks in upper-extremity rehabilitation is necessary and virtual reality is used as a method for providing various tasks [9,10].

Interventions using virtual reality require cognitive factors, such as judgment and memory, as the task progresses. It can use visual and auditory stimuli, and can induce interest and motivation, helping stroke patients to be mentally stable and motivated [11]. Gesture recognition (GR) is a topic that studies the reading of these movements using algorithms. These GR algorithms mainly focus on the movement of arm, hands, eyes, legs, and other body parts. The main idea is to capture body movements using capture devices and send the acquired data to a computer [12]. A remarkable example is shown in physical rehabilitation, where the low-cost hardware and algorithms accomplish outstanding results in therapy of patients with mobility issues. A 3D motion input device is required for upper-body rehabilitation in virtual reality. The Leap motion controller, a GR input device, has been recently released, which monitors hand and finger movements and reflects them on the monitor [13]. In addition, game-based virtual reality can be realized using a GR device, and various tasks can be presented.

Mirror therapy has been used as a therapeutic intervention for phantom pain in amputees. The painful and paralyzed body parts are covered with a mirror. The mirror is placed in the center of the body, and the movement of the paralyzed body is viewed through the mirror. The patient has a visual illusion that the paralyzed side is normally moving [14]. Mirror therapy for stroke patients was reported to be effective in upper-extremity motor function and daily life activity performance [15]. However, conventional mirror therapy methods require high concentration and can become tedious, making active participation difficult [16]. In addition, conventional mirror therapy differs from the actual situation wherein a mirror positioned at the center of the body should be viewed with the head sideways. Because patients are in a suboptimal posture, they may have neck discomfort after mirror therapy. The body has muscle strength disproportion when maintaining poor posture for a long time. This results in inadequate tension on adjacent muscles and joints, resulting in movement restriction, reduced flexibility, pain, and changes in bone and soft tissue [17].

This study investigated the effect on upper-extremity motor function, quality of life, and neck discomfort by using GR device mirror therapy in patients with chronic stroke, and evaluated the efficacy of this technique.

[…]

 

Continue —>  Mirror Therapy Using Gesture Recognition for Upper Limb Function, Neck Discomfort, and Quality of Life After Chronic Stroke: A Single-Blind Randomized Controlled Trial

Figure 2
(A) Gesture recognition mirror therapy group, (B) Conventional mirror therapy, (C) Control group.

[Abstract] The Work Disability Functional Assessment Battery (WD-FAB) – Physical Medicine and Rehabilitation Clinics

Abstract

Accuracy in measuring function related to one’s ability to work is central to public confidence in a work disability benefits system. In the United States, national disability programs are challenged to adjudicate millions of work disability claims each year in a timely and accurate manner. The Work Disability Functional Assessment Battery (WD-FAB) was developed to provide work disability agencies and other interested parties a comprehensive and efficient approach to profiling a person’s function related to their ability to work. The WD-FAB is grounded by the International Classification of Functioning, Disability, and Health conceptual framework.

 

via The Work Disability Functional Assessment Battery (WD-FAB) – Physical Medicine and Rehabilitation Clinics

[ARTICLE] Levetiracetam for epilepsy: an evidence map of efficacy, safety and economic profiles – Full Text

Objective: To evaluate the efficacy, safety and economics of levetiracetam (LEV) for epilepsy.
Materials and methods: PubMed, Scopus, the Cochrane Library, OpenGrey.eu and ClinicalTrials.gov were searched for systematic reviews (SRs), meta-analyses, randomized controlled trials (RCTs), observational studies, case reports and economic studies published from January 2007 to April 2018. We used a bubble plot to graphically display information of included studies and conducted meta-analyses to quantitatively synthesize the evidence.
Results: A total of 14,803 records were obtained. We included 30 SRs/meta-analyses, 34 RCTs, 18 observational studies, 58 case reports and 2 economic studies after the screening process. The included SRs enrolled patients with pediatric epilepsy, epilepsy in pregnancy, focal epilepsy, generalized epilepsy and refractory focal epilepsy. Meta-analysis of the included RCTs indicated that LEV was as effective as carbamazepine (CBZ; treatment for 6 months: 58.9% vs 64.8%, OR=0.76, 95% CI: 0.50–1.16; 12 months: 54.9% vs 55.5%, OR=1.24, 95% CI: 0.79–1.93), oxcarbazepine (57.7% vs 59.8%, OR=1.34, 95% CI: 0.34–5.23), phenobarbital (50.0% vs 50.9%, OR=1.20, 95% CI: 0.51–2.82) and lamotrigine (LTG; 61.5% vs 57.7%, OR=1.22, 95% CI: 0.90–1.66). SRs and observational studies indicated a low malformation rate and intrauterine death rate for pregnant women, as well as low risk of cognitive side effects. But psychiatric and behavioral side effects could not be ruled out. LEV decreased discontinuation due to adverse events compared with CBZ (OR=0.52, 95% CI: 0.41–0.65), while no difference was found when LEV was compared with placebo and LTG. Two cost-effectiveness evaluations for refractory epilepsy with decision-tree model showed US$ 76.18 per seizure-free day gained in Canada and US$ 44 per seizure-free day gained in Korea.

Conclusion: LEV is as effective as CBZ, oxcarbazepine, phenobarbital and LTG and has an advantage for pregnant women and in cognitive functions. Limited evidence supports its cost-effectiveness

Background

Epilepsy ranks fourth after tension-type headache, migraine and Alzheimer disease in the world’s neurological disorders burden.¹ A systematic review (SR) and meta-analysis of international studies reported that the point prevalence of active epilepsy was 6.38 per 1,000 people, while the lifetime prevalence was 7.60 per 1,000 people. The annual cumulative incidence of epilepsy was 67.77 per 100,000 people, while the incidence rate was 61.44 per 100,000 person-years.² As a fairly common clinical condition affecting all ages and requiring long-term, sometimes lifelong, treatment, epilepsy incurs high health care costs for the society.¹ In 2010, the total annual cost for epilepsy was 13.8 billion and the total cost per patient was €5,221 in Europe.³ Meanwhile, in the USA, epilepsy-related costs ranged from $1,022 to $19,749 per person annually.⁴ What is more, drug-refractory epilepsy was a major cost driver,⁵ with main costs from anticonvulsants, hospitalization and early retirement.⁶

Currently, antiepileptic drugs (AEDs) are the main treatment method for epilepsy patients, and it was reported that approximately two-thirds of epileptic seizures were controlled by AEDs.⁷ Conventional AEDs such as carbamazepine (CBZ) and sodium valproate (VPA) have been proven to have good therapeutic effects and low treatment cost. However, some adverse events (AEs) related to these drugs, such as Stevens–Johnson syndrome, menstrual disorder and memory deterioration seriously affect the tolerance and compliance of patients. Compared with conventional AEDs, new AEDs have the potential to be safer, but also more expensive.⁸

Levetiracetam (LEV) is a novel AED that has been approved as an adjunctive therapy for adults with focal epilepsy since 1999 in the US. In 2006, it was licensed as monotherapy for adults and adolescents above 16 years of age with newly diagnosed focal-onset seizures with or without secondary generalization in Europe. Also, it has been indicated as an adjunctive therapy for partial-onset seizures in patients above 4 years of age in China since 2007. Although the precise mechanism of LEV is still unclear, current researches suggest that its pharmacological mechanism is different from those of other AEDs. It may bind to the synaptic vesicle protein 2A (SV2A), which presents on the synaptic vesicles and some neuroendocrine cells. SV2A may participate in the exocytosis of synaptic vesicles and regulate the release of neurotransmitters, especially the release of excitatory amino acids, and thus depress the epilepsy discharge.^9,10 Other possible mechanisms of LEV include the following: selective inhibition of voltage-dependent N-type calcium channels in hippocampal pyramidal cells and reduction of the negative allosteric agents’ inhibition, such as zinc ions and B-carbolines, on glycine and γ-aminobutyric acid neurons, which results in indirectly increasing central nervous system inhibition.¹¹

LEV is almost completely absorbed after oral administration and the absorption is unaffected by food. The bioavailability is nearly 100% and the steady-state concentrations are achieved in 2 days if LEV is taken twice daily. Sixty-six percent of LEV is renally excreted unchanged and its major metabolic pathway is enzymatic hydrolysis of the acetamide group, which is independent of liver CYP/CYP450; so, no clinically meaningful drug–drug interactions with other AEDs were found.¹² One published SR of LEV suggested LEV has an equal efficacy compared with conventional AEDs and it is well tolerated for long-term therapy without significant effect on the immune system.¹³ But in recent years, apart from the most frequent AEs of LEV, such as nausea, gastrointestinal symptoms, dizziness, irritability and aggressive behavior, some rare AEs of LEV have been reported, including eosinophilic pneumonia, rhabdomyolysis, thrombocytopenia, elevated kinase and reduced sperm quality.^14–17

Thus, we conducted a mapping review to evaluate the efficacy, safety and economic profiles of LEV compared with all other AEDs for epilepsy, to provide evidence-based information for the rational use of LEV and research agendas.

[…]

 

Continue —>  [Full text] Levetiracetam for epilepsy: an evidence map of efficacy, safety and ec | NDT

[Abstract] Accelerating Stroke Recovery: Body Structures and Functions, Activities, Participation, and Quality of Life Outcomes From a Large Rehabilitation Trial

Abstract

Background. Task-oriented therapies have been developed to address significant upper extremity disability that persists after stroke. Yet, the extent of and approach to rehabilitation and recovery remains unsatisfactory to many.

Objective. To compare a skill-directed investigational intervention with usual care treatment for body functions and structures, activities, participation, and quality of life outcomes.

Methods. On average, 46 days poststroke, 361 patients were randomized to 1 of 3 outpatient therapy groups: a patient-centered Accelerated Skill Acquisition Program (ASAP), dose-equivalent usual occupational therapy (DEUCC), or usual therapy (UCC). Outcomes were taken at baseline, posttreatment, 6 months, and 1 year after randomization. Longitudinal mixed effect models compared group differences in poststroke improvement during treatment and follow-up phases.

Results. Across all groups, most improvement occurred during the treatment phase, followed by change more slowly during follow-up. Compared with DEUCC and UCC, ASAP group gains were greater during treatment for Stroke Impact Scale Hand, Strength, Mobility, Physical Function, and Participation scores, self-efficacy, perceived health, reintegration, patient-centeredness, and quality of life outcomes. ASAP participants reported higher Motor Activity Log–28 Quality of Movement than UCC posttreatment and perceived greater study-related improvements in quality of life. By end of study, all groups reached similar levels with only limited group differences.

Conclusions. Customized task-oriented training can be implemented to accelerate gains across a full spectrum of patient-reported outcomes. While group differences for most outcomes disappeared at 1 year, ASAP participants achieved these outcomes on average 8 months earlier (ClinicalTrials.gov: Interdisciplinary Comprehensive Arm Rehabilitation Evaluation [ICARE] Stroke Initiative, at www.ClinicalTrials.gov/ClinicalTrials.gov. Identifier: NCT00871715).

via Accelerating Stroke Recovery: Body Structures and Functions, Activities, Participation, and Quality of Life Outcomes From a Large Rehabilitation Trial – Rebecca Lewthwaite, Carolee J. Winstein, Christianne J. Lane, Sarah Blanton, Burl R. Wagenheim, Monica A. Nelsen, Alexander W. Dromerick, Steven L. Wolf, 2018

[BOOK] 22 ANNUAL CONFERENCE OF THE INTERNATIONAL FUCTIONAL ELECTRICAL STIMULATION SOCIETY – Abstracts

Enhancing quality of life
through electrical stimulation technology

22. ANNUAL CONFERENCE OF THE
INTERNATIONAL FUNCTIONAL
ELECTRICAL STIMULATION SOCIETY

All of the abstracts presented are available on line at http://ifess2018.com/down/IFESS2018_program.pdf

 

 

 

[Abstract + References] Changes in sexual functioning following traumatic brain injury: An overview on a neglected issue

Highlights

• Sexuality has a significant impact on interpersonal relationships and psychological well-being.
• Up to 50% of patients with moderate to severe TBI report sexual problems.
• Sexual disorders in TBI are closely dependent on the damaged brain area.
• TBI patients and their caregivers should be provided with information useful to achieve a better sexual health.

Abstract

Traumatic brain injury (TBI) is any damage to the skull and/or the brain and its frameworks due to an external force. Following TBI, patients may report cognitive, physiological and psychosocial changes with a devastating impact on important aspects of the patient’s life, such as sexual functioning. Although sexual dysfunction (SD) occurs at a significantly greater frequency in individuals with TBI, it is not commonly assessed in the clinical setting and little information is available on this crucial aspect of patients’ quality of life. As the number of people with TBI is on the rise, there is a need for better management of TBI problems, including SD, by providing information to patients and their caregivers to achieve sexual health, with a consequent increase in their quality of life. Discussing and treating sexual problems in TBI patients enters the framework of a holistic approach. The purpose of this narrative review is provide clinicians with information concerning changes in sexual functioning and relationships in individuals with TBI, for a better management of patient’s functional outcomes and quality of life.

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