Posts Tagged rehabilitation

[Abstract] A soft supernumerary robotic finger and mobile arm support for grasping compensation and hemiparetic upper limb rehabilitation

Abstract

In this paper, we present the combination of our soft supernumerary robotic finger i.e. Soft-SixthFinger with a commercially available zero gravity arm support, the SaeboMAS. The overall proposed system can provide the needed assistance during paretic upper limb rehabilitation involving both grasping and arm mobility to solve task-oriented activities. The Soft-SixthFinger is a wearable robotic supernumerary finger designed to be used as an active assistive device by post stroke patients to compensate the paretic hand grasp. The device works jointly with the paretic hand/arm to grasp an object similarly to the two parts of a robotic gripper. The SaeboMAS is a commercially available mobile arm support to neutralize gravity effects on the paretic arm specifically designed to facilitate and challenge the weakened shoulder muscles during functional tasks. The proposed system has been designed to be used during the rehabilitation phase when the arm is potentially able to recover its functionality, but the hand is still not able to perform a grasp due to the lack of an efficient thumb opposition. The overall system also act as a motivation tool for the patients to perform task-oriented rehabilitation activities.

With the aid of proposed system, the patient can closely simulate the desired motion with the non-functional arm for rehabilitation purposes, while performing a grasp with the help of the Soft-SixthFinger. As a pilot study we tested the proposed system with a chronic stroke patient to evaluate how the mobile arm support in conjunction with a robotic supernumerary finger can help in performing the tasks requiring the manipulation of grasped object through the paretic arm. In particular, we performed the Frenchay Arm Test (FAT) and Box and Block Test (BBT). The proposed system successfully enabled the patient to complete tasks which were previously impossible to perform.

Source: A soft supernumerary robotic finger and mobile arm support for grasping compensation and hemiparetic upper limb rehabilitation

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[Conference paper] Usage of VR Headsets for Rehabilitation Exergames – Abstract+References

Abstract

The work presented here is part of a large project aimed at finding new ways to tackle exergames used for physical rehabilitation. The preferred user group consists of physically impaired who normally cannot use commercially available games; our approach wants to fill a niche and allow them to get the same playing experience like healthy. Four exercises were implemented with the Blender Game engine and connected to a motion capture device (Kinect) via a modular middleware. The games incorporate special features that enhance weak user movements, such that the avatar reacts in the same way as for persons without physical restrictions. Additionally, virtual reality glasses have been integrated to achieve a more immersive feeling during play. In this work, we compare the results of preliminary user tests, performed with and without VR glasses. Test outcomes are good for motion amplification in some of the games but do not present generally better results when using the VR glasses.

Source: Usage of VR Headsets for Rehabilitation Exergames | SpringerLink

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[Abstract] Motor compensation and its effects on neural reorganization after stroke

Abstract

Stroke instigates a dynamic process of repair and remodelling of remaining neural circuits, and this process is shaped by behavioural experiences. The onset of motor disability simultaneously creates a powerful incentive to develop new, compensatory ways of performing daily activities. Compensatory movement strategies that are developed in response to motor impairments can be a dominant force in shaping post-stroke neural remodelling responses and can have mixed effects on functional outcome. The possibility of selectively harnessing the effects of compensatory behaviour on neural reorganization is still an insufficiently explored route for optimizing functional outcome after stroke.

Source: Motor compensation and its effects on neural reorganization after stroke : Nature Reviews Neuroscience : Nature Research

Figure 1: The motor cortex and its descending projection pathways are often affected by strokes that result in upper-extremity impairments.

The motor cortex and its descending projection pathways are often affected by strokes that result in upper-extremity impairments.

a | Simplified illustrations of motor cortical regions of a human (left), and of motor cortical regions of a naive rat, derived using intracortical microstimulation (right), are shown. The colours show the cortical territories that are…

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[ARTICLE] Spasticity, Motor Recovery, and Neural Plasticity after Stroke – Full Text

Spasticity and weakness (spastic paresis) are the primary motor impairments after stroke and impose significant challenges for treatment and patient care. Spasticity emerges and disappears in the course of complete motor recovery. Spasticity and motor recovery are both related to neural plasticity after stroke. However, the relation between the two remains poorly understood among clinicians and researchers. Recovery of strength and motor function is mainly attributed to cortical plastic reorganization in the early recovery phase, while reticulospinal (RS) hyperexcitability as a result of maladaptive plasticity, is the most plausible mechanism for post-stroke spasticity. It is important to differentiate and understand that motor recovery and spasticity have different underlying mechanisms. Facilitation and modulation of neural plasticity through rehabilitative strategies, such as early interventions with repetitive goal-oriented intensive therapy, appropriate non-invasive brain stimulation, and pharmacological agents, are the key to promote motor recovery. Individualized rehabilitation protocols could be developed to utilize or avoid the maladaptive plasticity, such as RS hyperexcitability, in the course of motor recovery. Aggressive and appropriate spasticity management with botulinum toxin therapy is an example of how to create a transient plastic state of the neuromotor system that allows motor re-learning and recovery in chronic stages.

Introduction

According to the CDC, approximately 800,000 people have a stroke every year in the United States. The continued care of seven million stroke survivors costs the nation approximately $38.6 billion annually. Spasticity and weakness (i.e., spastic paresis) are the primary motor impairments and impose significant challenges for patient care. Weakness is the primary contributor to impairment in chronic stroke (1). Spasticity is present in about 20–40% stroke survivors (2). Spasticity not only has downstream effects on the patient’s quality of life but also lays substantial burdens on the caregivers and society (2).

Clinically, poststroke spasticity is easily recognized as a phenomenon of velocity-dependent increase in tonic stretch reflexes (“muscle tone”) with exaggerated tendon jerks, resulting from hyperexcitability of the stretch reflex (3). Though underlying mechanisms of spasticity remain poorly understood, it is well accepted that there is hyperexcitability of the stretch reflex in spasticity (47). Accumulated evidence from animal (8) and human studies (918) supports supraspinal origins of stretch reflex hyperexcitability. In particular, reticulospinal (RS) hyperexcitability resulted from loss of balanced inhibitory, and excitatory descending RS projections after stroke is the most plausible mechanism for poststroke spasticity (19). On the other hand, animal studies have strongly supported the possible role of RS pathways in motor recovery (2036), while recent studies with stroke survivors have demonstrated that RS pathways may not always be beneficial (37, 38). The relation between spasticity and motor recovery and the role of plastic changes after stroke in this relation, particularly RS hyperexcitability, remain poorly understood among clinicians and researchers. Thus, management of spasticity and facilitation of motor recovery remain clinical challenges. This review is organized into the following sessions to understand this relation and its implication in clinical management.

• Poststroke spasticity and motor recovery are mediated by different mechanisms

• Motor recovery are mediated by cortical plastic reorganizations (spontaneous or via intervention)

• Reticulospinal hyperexcitability as a result of maladaptive plastic changes is the most plausible mechanism for spasticity

• Possible roles of RS hyperexcitability in motor recovery

• An example of spasticity reduction for facilitation of motor recovery

Continue —> Frontiers | Spasticity, Motor Recovery, and Neural Plasticity after Stroke | Stroke

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[Abstract] Educational and Vocational Issues in Traumatic Brain Injury 

This article describes some of the current issues related to return to school and employment for individuals with traumatic brain injury. A strong, collaborative partnership between an individual’s health care providers and key stake holders is essential toa smooth transition back to school or work. Ways to improve current practices andensure more timely and appropriate educational and employment services and supports for individuals with traumatic brain injury are described. Some recommendations on areas for future research are also offered.

Source: Educational and Vocational Issues in Traumatic Brain Injury – Physical Medicine and Rehabilitation Clinics

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[ARTICLE] Body-Machine Interfaces after Spinal Cord Injury: Rehabilitation and Brain Plasticity – Full Text HTML

Abstract

The purpose of this study was to identify rehabilitative effects and changes in white matter microstructure in people with high-level spinal cord injury following bilateral upper-extremity motor skill training. Five subjects with high-level (C5–C6) spinal cord injury (SCI) performed five visuo-spatial motor training tasks over 12 sessions (2–3 sessions per week). Subjects controlled a two-dimensional cursor with bilateral simultaneous movements of the shoulders using a non-invasive inertial measurement unit-based body-machine interface. Subjects’ upper-body ability was evaluated before the start, in the middle and a day after the completion of training. MR imaging data were acquired before the start and within two days of the completion of training. Subjects learned to use upper-body movements that survived the injury to control the body-machine interface and improved their performance with practice. Motor training increased Manual Muscle Test scores and the isometric force of subjects’ shoulders and upper arms. Moreover, motor training increased fractional anisotropy (FA) values in the cingulum of the left hemisphere by 6.02% on average, indicating localized white matter microstructure changes induced by activity-dependent modulation of axon diameter, myelin thickness or axon number. This body-machine interface may serve as a platform to develop a new generation of assistive-rehabilitative devices that promote the use of, and that re-strengthen, the motor and sensory functions that survived the injury.

1. Introduction

Despite progress in the field of assistive technologies for people who suffered an injury to the spinal cord, most of the current devices to control computers and wheelchairs are set in place to require as little physical effort from the user as possible, and little attention has been paid to maintaining and strengthening the neural and muscular resources that survived the injury [1,2,3,4]. Spinal cord injury (SCI) leads to motor impairment, weakness, muscular and cortical atrophy and altered reflexes, and these have been shown to progress further with lack of exercise [5,6,7,8,9,10]. Even in individuals with injuries to the cervical spinal cord, some motor and sensory capacities may remain available in the upper body. Several studies have shown that using their remaining functions and keeping an active body is critical for people with SCI in order to avoid the collateral effects of paralysis and to potentially recover some of the lost mobility [5,6,7,11]. Therefore, it is crucial to develop the next generation of assistive-rehabilitative devices that promote learning through upper-body coordination.
Acquisition, retention and refinement of motor skills all rely on the capability of the nervous system to create new patterns of neural activation for accomplishing new tasks and for recovering lost motor functions [12]. Recent advances in neural imaging have allowed learning studies on juggling [13], balance [14] and body-machine interfaces (BMIs) by our group [15], to demonstrate motor skill learning-induced structural changes of cortical and subcortical areas in both gray matter and white matter by using diffusion tensor imaging (DTI). DTI non-invasively measures the direction and rate of water diffusion within tissue. White matter integrity is commonly measured by fractional anisotropy (FA), a normalized measure of the variance of the diffusion ellipsoid at each voxel [16]. FA values for white matter tissue have been shown to be affected by physiological parameters, such as axon diameter, axon number and myelin thickness [17].
Loss of somatosensory afference leads to functional cortical reorganization [18,19,20]. SCI has been shown to lead to spinal cord atrophy, cortical atrophy of primary and sensory cortex [8], descending motor tracts [9] and cortical reorganization of the sensorimotor system [8,10], and the degree of cortical reorganization is associated with the level of disability. Although the goal of most SCI treatments is to re-establish neural connections in order to restore motor function, it is unclear whether the anatomical and functional changes that follow injury can be reversed.
In this study, we investigated the rehabilitative effects and learning-induced changes in the brain white matter microstructure of people with high-level SCI after they practiced coordinated upper-body movements to control a computer cursor through a novel body-machine interface. Subjects learned to use the remaining ability of their shoulders and upper arms to perform movements that controlled a computer cursor to complete different related tasks. Complementary to [15], the purpose of this study was to identify changes in motor function and white matter by comparing clinical scores and FA values pre- and post-bilateral upper-body motor skill training in people with a high-level spinal cord injury. We started from the assumption that motor learning is likely to be associated with different brain reorganization in unimpaired subjects compared to subjects with tetraplegia, in consideration also of the greater need for the reorganization of motor functions in the latter group.

Continue —> Brain Sciences | Free Full-Text | Body-Machine Interfaces after Spinal Cord Injury: Rehabilitation and Brain Plasticity | HTML

Figure 5. Regions showing lower fractional anisotropy (FA) in spinal cord injury (SCI) subjects compared to controls. (A) Brain regions associated with motor function used to perform tract-based spatial statistics (TBSS) and ROI analyses; (B) TBSS results. Regions showing significantly higher (red-yellow) and lower (blue-light blue) FA values in SCI versus control subjects overlaid over the standard Montreal Neurological Institute (MNI)152 T1-weighted anatomical scan (p < 0.05, uncorrected). The location of each slice in Montreal Neurological Institute space is shown at the lower left section. a-s-pCR, anterior, superior and posterior corona radiata; CG, cingulum; g-bCC, genu and body of corpus callosum; a-pIC, anterior and posterior limbs of internal capsule.

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[Abstract] Targeting interhemispheric inhibition with neuromodulation to enhance stroke rehabilitation

Highlights

  • This review focuses on interhemispheric inhibition and its role in the healthy and stroke lesioned brain.
  • Measurement method and movement phase should be considered when comparing studies associating interhemispheric inhibition with functional recovery.
  • Neuromodulation of interhemispheric inhibition to augment stroke recovery requires the targeting of specific neural circuitry. We discuss the effectiveness of current and novel neurostimulation techniques at targeting interhemispheric inhibition and enhancing stroke rehabilitation.

Abstract

Background/Objectives

Interhemispheric inhibition in the brain plays a dynamic role in the production of voluntary unimanual actions. In stroke, the interhemispheric imbalance model predicts the presence of asymmetry in interhemispheric inhibition, with excessive inhibition from the contralesional hemisphere limiting maximal recovery. Stimulation methods to reduce this asymmetry in the brain may be promising as a stroke therapy, however determining how to best measure and modulate interhemispheric inhibition and who is likely to benefit, remain important questions.

Methods

This review addresses current understanding of interhemispheric inhibition in the healthy and stroke lesioned brain. We present a review of studies that have measured interhemispheric inhibition using different paradigms in the clinic, as well as results from recent animal studies investigating stimulation methods to target abnormal inhibition after stroke.

Main findings/Discussion

The degree to which asymmetric interhemispheric inhibition impacts on stroke recovery is controversial, and we consider sources of variation between studies which may contribute to this debate. We suggest that interhemispheric inhibition is not static following stroke in terms of the movement phase in which it is aberrantly engaged. Instead it may be dynamically increased onto perilesional areas during early movement, thus impairing motor initiation. Hence, its effect on stroke recovery may differ between studies depending on the technique and movement phase of eliciting the measurement. Finally, we propose how modulating excitability in the brain through more specific targeting of neural elements underlying interhemispheric inhibition via stimulation type, location and intensity may raise the ceiling of recovery following stroke and enhance functional return.

Source: Targeting interhemispheric inhibition with neuromodulation to enhance stroke rehabilitation – Brain Stimulation: Basic, Translational, and Clinical Research in Neuromodulation

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[ARTICLE] Bobath and traditional approaches in post-stroke gait rehabilitation in adults – Full Text PDF

Summary

Study aim: The aim of this study was to compare the outcomes of a study of post-stroke gait reeducation using the Bobath neuro-developmental treatment (NDT-Bobath) method and the traditional approach.

Material and methods: The study included 30 adult patients after ischemic stroke, aged 32–82. Patients were randomly assigned to one of the treatment groups: the study group (treated with the NDT-Bobath method combined with the traditional approach, ten sessions), and a reference group (treated with the traditional method only, ten sessions). The measurements (spatio-temporal gait parameters based on 10 m walking test: gait velocity, normalized gait velocity, cadence, normalized cadence, stride length, and normalized stride length) were administered twice: on admission (before the therapy) and after the last therapy session.

Results: Statistically significant and favorable changes in the gait velocity, cadence and stride length regarding their normalized values were observed. Moderate and high correlations among changes of assessed spatio-temporal gait parameters were observed in both groups.

Conclusions: The NDT-Bobath method may be regarded as a more effective form of gait post-stroke rehabilitation in young adults compared to traditional rehabilitation.

Introduction

Despite stroke incidence and mortality rates slowly decreasing in selected countries (especially developed Western Europe countries) [6, 7], stroke is still regarded as one of the leading causes of death and long-term disability. Ischemic stroke cases constitute approximately 70–80% of all stroke cases [6, 7]. Post-stroke gait disorder reduces mobility of patients, their independence, participation in activities of daily living and community life. Gait disorders may be reflected in spatio-temporal gait parameters. Their assessment may be a useful basic or supplementary way to assess general efficiency of gait function restoration during a neurorehabilitation program.

The Bobath neuro-developmental treatment (NDTBobath) method for adults is still one of the most popular therapeutic methods in neurorehabilitation, including gait relearning [8, 21]. Current studies concerning its use in post-stroke gait relearning have methodological concerns related to study/treatment fidelity and measurement [16]. For this moment there is insufficient evidence (especially from randomized controlled trials – RCTs) to conclude that a particular physiotherapy method (including NDT-Bobath) is more effective in promoting recovery of gait than any other approach. Moreover, combined use of NDT-Bobath and components of any other approaches may diminish the aforementioned picture. The assumption that rehabilitation using a proper mix of components derived from different approaches may be more effective than no treatment control in attaining gait function following stroke may be true [18]. Research on various mixed/eclectic approaches constitute an important step toward patient-tailored therapy and the need for further support. Current evidence concerning combined use of the NDT-Bobath method and components of another therapeutic approach is weak. Evidence of favorable combined use of the NDT-Bobath method is as follows:

− successful use of mixed rehabilitative procedures, including NDT-Bobath, in an individual training package [17],

− therapy based on the NDT-Bobath concept supported by task practice is more effective than task practice alone [9],

− injection of botulinum toxin type A combined with NDT-Bobath therapy showed improvements in lower limb spasticity, gait and balance in post-stroke patients greater than use of botulinum toxin type A alone [11].

The aim of this study was compare the outcomes of a study of post-stroke gait rehabilitation using the NDTBobath method for adults combined with the traditional approach and the sole traditional approach.

Full Text PDF

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[ARTICLE] Competitive and cooperative arm rehabilitation games played by a patient and unimpaired person: effects on motivation and exercise intensity – Full Text

Abstract

Background

People with chronic arm impairment should exercise intensely to regain their abilities, but frequently lack motivation, leading to poor rehabilitation outcome. One promising way to increase motivation is through interpersonal rehabilitation games, which allow patients to compete or cooperate together with other people. However, such games have mainly been evaluated with unimpaired subjects, and little is known about how they affect motivation and exercise intensity in people with chronic arm impairment.

Methods

We designed four different arm rehabilitation games that are played by a person with arm impairment and their unimpaired friend, relative or occupational therapist. One is a competitive game (both people compete against each other), two are cooperative games (both people work together against the computer) and one is a single-player game (played only by the impaired person against the computer). The games were played by 29 participants with chronic arm impairment, of which 19 were accompanied by their friend or relative and 10 were accompanied by their occupational therapist. Each participant played all four games within a single session. Participants’ subjective experience was quantified using the Intrinsic Motivation Inventory questionnaire after each game, as well as a final questionnaire about game preferences. Their exercise intensity was quantified using wearable inertial sensors that measured hand velocity in each game.

Results

Of the 29 impaired participants, 12 chose the competitive game as their favorite, 12 chose a cooperative game, and 5 preferred to exercise alone. Participants who chose the competitive game as their favorite showed increased motivation and exercise intensity in that game compared to other games. Participants who chose a cooperative game as their favorite also showed increased motivation in cooperative games, but not increased exercise intensity.

Conclusions

Since both motivation and intensity are positively correlated with rehabilitation outcome, competitive games have high potential to lead to functional improvement and increased quality of life for patients compared to conventional rehabilitation exercises. Cooperative games do not increase exercise intensity, but could still increase motivation of patients who do not enjoy competition. However, such games need to be tested in longer, multisession studies to determine whether the observed increases in motivation and exercise intensity persist over a longer period of time and whether they positively affect rehabilitation outcome.

Trial registration

The study is not a clinical trial. While human subjects are involved, they participate in a single-session evaluation of a rehabilitation game rather than a full rehabilitation intervention, and no health outcomes are examined.

Keywords

Rehabilitation ,Virtual reality ,Multiplayer games, Interpersonal rehabilitation games ,Social interaction ,Motivation ,Exercise intensity

Background

Home rehabilitation technology

Diseases such as stroke have a massively debilitating effect on people’s lives. It is estimated that one in six people will experience a stroke in their lifetime [1], and 88% of survivors report some impairment of their limb function [2]. In the United States, approximately 795,000 individuals suffer a new or recurrent stroke every year, leading to an estimated combined direct and indirect cost of $68.9 billion [3]. Intensive training delivered by a therapist soon after the injury can effectively restore motor functions needed for independent life. However, even top hospitals only devote a limited amount of time to rehabilitation of motor functions [4]. The situation is even worse in most other hospitals and health centers, where patients are idle for most of the day due to a shortage of qualified medical staff [4]. After leaving the hospital, patients thus need to exercise at home without therapist supervision in order to fully regain their abilities.

Several technologies, ranging from consumer devices such as the Microsoft Kinect [5] to complex exoskeletons [6], have been deployed for motor rehabilitation at home. These technologies usually combine limb tracking with virtual environments presented on a personal computer, which allow patients to perform a variety of simulated activities of daily living [7]. Furthermore, they incorporate game-like elements such as automated difficulty adaptation, score displays and cognitive challenges [8, 9, 10, 11]. However, despite promising technical achievements, the effectiveness of home rehabilitation technology remains limited. A recent study showed that, even if a therapist prescribes a technology-supported exercise, only about 30% of unsupervised patients will comply with the rehabilitation regimen [12].

This lack of compliance is due to lack of motivation for rehabilitation, which is known to be a key determinant of rehabilitation outcome: patients who are unmotivated will not exercise frequently or intensely enough [13, 14]. Studies outside rehabilitation have already shown that motivational interventions improve compliance with the therapy regimen [15], and recent home rehabilitation studies have emphasized the importance of motivational elements that would increase the duration and intensity of exercise [16, 17]…

Continue —> Competitive and cooperative arm rehabilitation games played by a patient and unimpaired person: effects on motivation and exercise intensity | Journal of NeuroEngineering and Rehabilitation | Full Text

Fig. 1 The BiMeo used unimanually without support (top left), unimanually on a table (top right), bimanually without support (bottom left), and bimanually on a table (bottom right)

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[ARTICLE] Effectiveness of a structured sexual rehabilitation programme following stroke: A randomized controlled trial – Full Text

Abstract

Background: Sexual activity is an integral part of life; it is important to address sexual health after stroke, but this is often poorly done.

Objective: To assess the effectiveness of a structured sexual rehabilitation programme compared with written information alone regarding sexual and psychological functioning (anxiety, depression, stress), functional independence and quality of life in an Australian stroke cohort.

Methods: A total of 68 participants were randomized to a structured sexual rehabilitation programme (treatment group; n = 35) or to written information alone (control group; n = 33). Outcome measures included: Sexual Functioning Questionnaire Short Form; Depression, Anxiety Stress Scale; Functional Independence Measure, and Stroke and Aphasia Quality of Life Scale-39 Generic. Assessments were performed at baseline, 6 weeks and 6 months after the intervention. Participant’s preferences regarding how they would like to receive information, who from, and how frequently, were collected at baseline.

Results: There was no difference between groups for any outcome measures. Half of the participants (51%) wished to receive information and were divided equally into preferring written information vs face-to-face counselling, with the majority (54%) preferring information after discharge from an inpatient setting.

Conclusion: Provision of written information alone appears to be as effective as a 30-min individualized sexual rehabilitation programme in an inpatient setting. Further research is needed regarding longer term outcomes and outpatient settings.

Stroke is a leading cause of death and disability (1). Sexual dysfunction is common after stroke, and has multifactorial causes: damage to the brain (causing decline in sexual desire/interest and coital frequency for both sexes, decline in vaginal lubrication and orgasm in females, and in erection and ejaculation in males, and physical changes, such as hemiplegia with resulting impairment of mobility) together with medical issues, such as medications and premorbid medical conditions (diabetes, hypertension, cardiac issues) and psychological factors (fear of new stroke, loss of self-esteem, role/relationship changes) are major contributors (2–5).

Sexuality is a broad concept and may be experienced and expressed in a variety of ways; including thoughts, fantasies, desires, beliefs, attitudes, values, behaviours, practices, roles, and relationships (6). Sexual activity is an integral part of life and the importance of addressing sexual health after stroke is well accepted (7). Despite this, it is common for sexuality to be poorly addressed, not just in stroke, but also in other neurological conditions, such as spina bifida (8) and spinal cord injury (9). The 2012 Australian National Stroke Audit Rehabilitation Services Report (10), which included 2,789 post-stroke patients across 111 Australian public and private hospitals, showed that only 17% of patients received information on sexuality. This is despite the opportunities provided through the staffing complement in rehabilitation settings. In practice, allied healthcare providers could have a primary or secondary role in sexual rehabilitation; they could be the sole providers of intervention or provide further intervention in their specific areas of expertise, such as physiotherapy training to optimize mobility in bed for sexual positioning, nursing education for catheter management, and dyspraxia training with speech therapy for sexual activities such as kissing. In addition, although current guidelines recommend the assessment and management of post-stroke sexual dysfunction (7), it is unclear what types of intervention (timing, content, intensity, setting) should be provided and how effective they are. The only intervention study currently available in the literature that addresses the impact of intervention on sexual activity following stroke suggests that a sexual rehabilitation intervention programme prior to hospital discharge increased sexual satisfaction and frequency of sexual activity one month post-discharge, but did not promote sexual knowledge (11). This study was conducted with culturally homogenous 40–49-year-old Korean couples and had significant methodological limitations (generalizability, pre-post design, and short follow-up). Patient’s preferences relating to sexual counselling, such as the timing of such counselling, also varied, creating further challenges for optimization of care (12, 13). Some studies show that most participants feel overwhelmed in the early adjustment period and that the best time to address sexual adjustment issues is towards the end of an acute rehabilitation hospitalization or shortly after discharge. In a pilot randomized controlled trial (RCT) conducted in 2014, the feasibility and importance of providing sexual rehabilitation following stroke was demonstrated; however, the “pilot” nature of the study did not allow for conclusive findings to be drawn (14).

The primary aim of this RCT was to assess the effectiveness of a comprehensive structured sexual rehabilitation programme compared with written information alone, on sexual and psychological (anxiety, depression, stress) function, and on functional independence and quality of life in an Australian stroke cohort. Building on the previous pilot RCT, to our knowledge this will be the first adequately powered RCT in this area. The findings will provide evidence that may lead to improved care.

Continue —> Journal of Rehabilitation Medicine – Effectiveness of a structured sexual rehabilitation programme following stroke: A randomized controlled trial – HTML

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