Posts Tagged stroke recovery

[Abstract+References] Non-invasive Cerebellar Stimulation: a Promising Approach for Stroke Recovery?


Non-invasive brain stimulation (NIBS) combined with behavioral training is a promising strategy to augment recovery after stroke. Current research efforts have been mainly focusing on primary motor cortex (M1) stimulation. However, the translation from proof-of-principle to clinical applications is not yet satisfactory. Possible reasons are the heterogeneous properties of stroke, generalization of the stimulation protocols, and hence the lack of patient stratification. One strategy to overcome these limitations could be the evaluation of alternative stimulation targets, like the cerebellum. In this regard, first studies provided evidence that non-invasive cerebellar stimulation can modulate cerebellar processing and linked behavior in healthy subjects. The cerebellum provides unique plasticity mechanisms and has vast connections to interact with neocortical areas. Moreover, the cerebellum could serve as a non-lesioned entry to the motor or cognitive system in supratentorial stroke. In the current article, we review mechanisms of plasticity in the cortico-cerebellar system after stroke, methods for non-invasive cerebellar stimulation, and possible target symptoms in stroke, like fine motor deficits, gait disturbance, or cognitive impairments, and discuss strategies for multi-focal stimulation.


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via Non-invasive Cerebellar Stimulation: a Promising Approach for Stroke Recovery? | SpringerLink


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[ARTICLE] Functional Electrical Stimulation with Augmented Feedback Training Improves Gait and Functional Performance in Individuals with Chronic Stroke: A Randomized Controlled Trial – Full Text

Purpose: The purpose of this study was to compare the effects of the FES-gait with augmented feedback training to the FES alone on the gait and functional performance in individuals with chronic stroke.
Methods: This study used a pretest and posttest randomized control design. The subjects who signed the agreement were randomly divided into 12 experimental groups and 12 control groups. The experimental groups performed two types of augmented feedback training (knowledge of performance and knowledge of results) together with FES, and the control group performed FES on the TA and GM without augmented feedback and then walked for 30 minutes for 40 meters. Both the experimental groups and the control groups received training five times a week for four weeks.
Results: The groups that received the FES with augmented feedback training significantly showed a greater improvement in single limb  support (SLS) and gait velocity than the groups that received FES alone. In addition, timed up and go (TUG) test and six minute walk test (6MWT) showed a significant improvement in the groups that received FES with augmented feedback compared to the groups that received FES alone.
Conclusion: Compared with the existing FES gait training, augmented feedback showed improvements in gait parameters, walking ability, and dynamic balance. The augmented feedback will be an important method that can provide motivation for motor learning to stroke patients.

Continue —>  Functional Electrical Stimulation with Augmented Feedback Training Improves Gait and Functional Performance in Individuals with Chronic Stroke: A Randomized Controlled Trial (PDF Download Available)

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[WEB SITE] The Brunnstrom Stages of Stroke Recovery – Saebo


The Brunnstrom Stages of Stroke Recovery


Life after a stroke can be challenging. Many patients wonder if they will ever fully recover their muscle coordination, or how long or difficult the process of recovery may be. Fortunately, the field of occupational and physical therapy has come a long way in developing approaches that help patients regain controlled muscle movements after a stroke.
There are seven recognized stages of stroke recovery through which most patients progress. Also known as the Brunnstrom Approach, the seven stages framework views spastic and involuntary muscle movement as part of the process and uses them to aid in rehabilitation.


What Is The Brunnstrom Approach?

The Brunnstrom Approach was developed in the 1960’s by Signe Brunnstrom, an occupational and physical therapist from Sweden. With seven stages, the Brunnstrom Approach breaks down how motor control can be restored throughout the body after suffering a stroke.

Normally, muscle movements are the result of different muscle groups working together. Researchers have termed this collaboration between muscles as “synergies”. The brain has the delicate task of coordinating these movements, many of which become severely affected after a stroke.

After the stroke has occurred, your muscles become weak due to the lack of coordination between the brain and body. This causes the muscle synergies to move in abnormal patterns. Most treatments offered to stroke patients will focus on trying to inhibit atypical muscle synergies and movements. The Brunnstrom Approach, on the other hand, teaches patients how to use the abnormal synergy patterns to their advantage.
This approach has become a popular choice among both occupational and physical therapists as well as patients since its inception. It can be effective in clinical settings and can dramatically improve voluntary muscle movements after suffering a stroke.


Stage 1: Flaccidity 

The first stage in Brunnstrom’s Approach is the initial period of shock immediately after stroke where flaccid paralysis sets in. Flaccid paralysis (flaccidity) is the medical term for a complete lack of voluntary movement. This paralysis is caused by nerve damage that prevents the muscles from receiving appropriate signals from the brain, whether or not the brain is still capable of moving those muscles.

In the early state of flaccid paralysis, the stroke survivor cannot initiate any muscle movements on the affected side of their body. If this continues for long enough without intervention or physical therapy, the unused muscles become much weaker, and begin to atrophy. Simply put, muscles need to be used in order to retain their tone and definition, and flaccid paralysis prevents muscles from doing this important work.

Stroke recovery stage 1 left side of brain / right side of brain paralysis

The medical term for this loss of muscle tone is hyptonia. Hyptonia causes weakness and sometimes numbness that seriously interferes with a patient’s quality of life. In addition to therapy exercises and treatments that reduce the severity of hypotonia, this Stage 1 condition also requires lifestyle modifications to protect the affected limbs from injury.

Stroke recovery stage 1 - muscle atrophy suffering
Though stroke does serious neurological damage, other healthy brain cells and muscles can help make up for some of this damage. In fact, the patient’s own body is full of tools that reduce complications and increase their likelihood of entering new stages of recovery. It’s never too early to start retraining the body and brain after stroke, even if patients are still experiencing flaccid paralysis and hypotonia.


Stage 2: Dealing with the Appearance of Spasticity

The second stage in stroke recovery marks the redevelopment of some basic limb synergies as certain muscles are stimulated or activated and other muscles in the same system begin to respond. Muscles begin to make small, spastic, and abnormal movements during this stage. While these movements are mostly involuntary, they can be a promising sign during your recovery. Minimal voluntary movements might or might not be present in stage two.

Muscle synergies result from muscles coordinating movements to perform different tasks. These synergies allow common patterns of movement that involve either cooperative or reciprocal activation of muscle. Because the muscles are linked, one activated muscle may lead to partial or complete responses in other muscles. These synergies may limit patient’s muscles to certain movements, preventing them from completing the voluntary movements they want to make. However, as neurological development and cell regrowth occurs after a stroke, some new connections may be formed to impaired muscle tissue.


flexor-and-extensor-synergies during stage 2 of stroke recovery

Two limb synergies determine a patient’s reactions to cell regrowth during Stage 2 of recovery. The first, the flexor synergy, includes the external rotation of the shoulder, flexion of the elbow, and supination of the forearm. The second, the extensor synergy, includes internal rotation of the shoulder with elbow extension and pronation of the forearm. These synergies may produce one or both of the following postures, which indicate varying levels of brain trauma after stroke.

Coupled with the presence of muscle synergies, between 30 and 40 percent of stroke survivors also experience spasticity. This is a velocity-dependent increase in your normal stretch reflexes, and during Stage 2, it presents as aresistance to passive movement. Stage 2 spasticity contributes to the jerky upper body movements characteristic of the flexor and extensor synergies.

Unused limbs still need stimulation to maintain or form connections to neurons. Though the nerves and connections that originally controlled your affected limbs may be damaged too much to create voluntary movements, it could still be possible to regain movement in later stages of recovery. In order to leave this possibility open and prevent the body’s tendency toward learned non-use, it’s important to continue using and moving your affected limbs and muscles as much as possible.



Stage 3: Increased Spasticity

Spasticity in muscles increase during stage three of stroke recovery, reaching its peak. Spasticity is a feeling of unusually stiff, tight, or pulled muscles. It is caused by damage from a stroke to nerve pathways within the brain or spinal cord that control muscle movement. The lack of ability to restrict the brain’s motor neurons causes muscles to contract too often. Spasticity causes an abnormal increase in muscle stiffness and tone that can interfere with movement, speech, or cause discomfort and pain.

During stage 3, synergy patterns also start to emerge and minimal voluntary movements should be expected. The increase in voluntary movement is due to being able to initiate movement in the muscle, but not control it (yet). The appearance of synergy patterns and coordination between muscles facilitate the voluntary movements which become stronger with occupational and physical therapy.

Muscles with severe spasticity, like the ones in stage 3 of stroke recovery, are likely to be more limited in their ability to exercise and may require help to do this. Patients and family/caregivers should be educated about the importance of maintaining range of motion and doing daily exercises. It is important to minimize highly stressful activities this early in training.

motion-excercise-stretch during stage 3 of stroke recovery

Passive exercises, also known as passive range-of-motion (PROM) exercises, should be continued during this stage to improve your range of motion. Treatment includes how far the therapist can move your joints in different directions, like raising your hand over your head or bending your knee toward your chest.


Stage 4: Decreased Spasticity

During stage four of stroke recovery, spastic muscle movement begins to decline. Patients will regain control mostly in the extremities, and they will have a limited ability to move normally. The movements may still be out of sync with muscle synergies, but this will improve quickly over the length of this stage.

The focus during this stage is to strengthen and improve muscle control. Now that you are regaining motor control and can start to make normal, controlled movements on a limited basis, you can start to build strength back in your limbs and continue work on your range of motion. Continuing to stretch out your muscles is still important in this stage.

Physiotherapist helping her patient with arm exercise Rehabilitation concept during stage 4 of stroke recovery


Therapists use active-assisted range of motion (AAROM) exercises when a stroke patient has some ability to move but still needs help to practice the exercises or complete the movement. A therapist may help guide the movement with their own body (hold the limb, for example) or use bands and other exercise equipment to support the patient. Gravity-assisted devices such as the SaeboMAS, are beneficial in helping the patient perform the movements.



Female therapist assisting senior couple with exercises in the medical office during stage 4 of stroke recovery



You can begin active range-of-motion (AROM) exercises once you have regained some muscle control and can perform some exercises without assistance. They often involve moving a limb along its full range of motion, like bending an elbow or rotating a wrist. AROM exercises increase flexibility, muscle strength, and endurance. Range-of-motion exercises should be practiced equally on both the affected and unaffected sides of the body.

Of course, when it comes to building a stage 4 stroke recovery exercise program, you should always consult with a professional physical or occupational therapist. They can help you with exercise specifics, finding the right tools and equipment, and, of course, to provide assistance, especially in the beginning.


Stage 5: Complex Movement Combinations

In stage 5, spasticity continues to decline and synergy patterns within the muscles also become more coordinated, allowing voluntary movements to become more complex. Abnormal movements also start to decline dramatically during stage 5, but some may still be present.

The patient will be able to make more controlled and deliberate movements in the limbs that have been affected by the stroke. Isolated joint movements might also be possible.

All voluntary movements involve the brain, which sends out the motor impulses that control movement. These motor signals are initiated by thought and must also involve a response to sensory stimuli. The sensory stimuli that trigger voluntary responses are dealt with in many parts of the brain.

 stage 5 of stroke recovery - patient ready for complex movement
Voluntary movements are purposeful and goal directed. They are learned movements that improve with repetition or practice and require less attention. Some examples include combing hair, swinging a bat, driving a car, swimming, and using eating utensils.


Stage 6: Spasticity Disappears

At stage six, spasticity in muscle movement disappears completely. You are able to move individual joints, and synergy patterns become much more coordinated. Motor control is almost fully restored, and you can coordinate complex reaching movements in the affected extremities. Abnormal or spastic movements have ceased, and a full recovery may be on the horizon.


Stage 7: Normal Function Returns

The last stage in Brunnstrom’s Approach is when you regain full function in the areas affected by the stroke. You are now able to move your arms, legs, hands, and feet in a controlled and voluntary manner.

Since you have full control over your muscle movements, synergy patterns have also returned to normal. Reaching stage seven is the ultimate goal for therapists and patients alike.



Stroke Recovery In 7 Stages: Spasticity As A Process

With the seven stages of recovery, Brunnstrom effectively changed the way stroke recovery is approached by occupational and physical therapists. She theorized that spastic and primitive muscle movements were a natural part of the recovery process after a stroke. Moreover, she developed an approach that allows patients to use these involuntary movements to their advantage instead of trying to inhibit them.

During each phase, an increasing amount of synergies are available to use. Using the Brunnstrom Approach, occupational and physical therapists will teach you how to use the synergies that are currently available to you. These techniques are used to improve movement and regain motor control.

There is no one approach to stroke recovery, and the stages laid out in these guides may not apply to everyone. Since the Brunnstrom Approach can be effective, however, therapists still use this method to help patients recover after suffering a stroke. Thanks to new medical technology, therapists can use the Brunnstrom Approach in conjunction with tools like the SaeboGloveSaeboReach, and SaeboMAS to help patients reach new levels of independence.

via The Brunnstrom Stages of Stroke Recovery | Saebo

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[BLOG POST] The Best Apps to Help With Stroke Recovery – Saebo

Recovering after a stroke requires hard work from the survivor and their caretakers. Though this can be intimidating, there is good news: with new technology in apps, patients have more help than ever regaining abilities after their stroke.

The great thing about apps is that they can level the playing field for people recovering from stroke by boosting their chances of success during the recovery period. An app on your own smartphone or tablet can now help you regain your ability to speak, keep track of your medications and appointments, and even help manage diabetes. Plus, apps are becoming more and more accessible, so it’s not hard to find one you like. You can basically pick and choose which ones work best for you to customize your “app rehab.”

 Best Apps for Stroke Recovery

Speech Therapy Apps/Aphasia

Tactus Therapy

Tactus Therapy has a variety of speech therapy apps that can help stroke survivors with aphasia, dysphagia, cognition, and more. Whatever your speech-related impairment is, Tactus Therapy likely has an app for you.


Constant Therapy

The Constant Therapy app has a library of more than 100,000 exercises to help stroke survivors with cognition, language, and communication. The app provides instant feedback on tasks and creates a map of the each individual’s strengths and weaknesses, allowing for personalized therapy.



The SmallTalk™ Family of Communication apps from Lingraphica is a collection of 14 different free apps for individuals suffering from aphasia or dysphasia. There are apps that can help with practicing speech and apps that help people with aphasia or dysphasia communicate.



Proloquo2Go is a communication solution for people with limited speech or those who have lost the ability to speak altogether. This app uses symbol-supported communication to help stroke survivors with aphasia communicate.


Hand Recovery Apps

Balloon Frenzy

With Balloon Frenzy, you can pop balloons without the mess or noise! This game starts out simple with only a few balloons to pop, then gradually increases in difficulty as more balloons are added. Challenge your motor skills as you try to keep up with popping the virtual balloons.



Dexteria turns your iOS device into a therapeutic tool that helps you improve your motor control, coordination, and dexterity. With engaging repeatable exercises and a tracking and reporting feature, it is easier than ever to add hand exercises to your recovery program.


iOT Session

iOT Session was created by an award winning occupational therapist. The app is designed to improve deficits in visual tracking, bilateral coordination, visual perception, fine motor/dexterity, visual scanning, and handwriting/correct letter formation. The game like format helps keep the patient’s attention.


Hit It!

Improve your dexterity with the Hit It! app. This game is all about quick fingers. Touch and move as quickly as you can to beat all the levels.


Apps for Cognitive Deficits


What’s the Difference?

Look at and analyze the difference between two different photos with the What’s the Difference? App. As you progress the challenges get harder helping you challenge your perception skills.


Thinking Time Pro

Thinking Time Pro was designed with Harvard and UC Berkeley neuroscientists. This app trains memory, attention, reasoning and key cognitive skills through 4 scientific games.The dynamic skills levels make it easy to match to any skill level.


Fit Brains Trainer

Fit Brains Trainer is a free brain training app that is designed to stimulate your cognitive & emotional intelligence. The system has 60+ fun games, 500+ workout sessions, and in-depth performance reports to help track your progress.

Having trouble with your memory after your stroke? Eidetic uses a technique called spaced repetition to help you memorize anything from important phone numbers to interesting words or facts.


Apps for Vision Loss

Captain Lazy Eye

Captain Lazy Eye was designed in cooperation with ophthalmologists with experience in successful amblyopic treatment, and it is the first iPad App designed to assist in keeping visual acuity and assisting in amblyopic correction.


Vision Tap

Vision Tap was designed to assist with vision problems including eye-hand coordination, reaction time, as well as reading and learning issues.


BigMagnify Free

Turn your iOS device into a magnifying glass using BigMagnify Free. This advanced magnifying glass offers cutting-edge features while being simple to use. You can use the entire screen as a magnifying glass, and even freeze and share the magnified image.

TapTapSee is designed to help the blind and visually impaired identify objects they encounter in their daily lives. Simply double tap the screen to take a photo of anything, at any angle, and hear the app speak the identification back to you.


Lifestyle Apps


The Cozi app is an organizer designed for families to keep multiple schedules in sync. Cozi is the perfect app for caregivers to manage their schedules, especially if a stroke survivor has multiple caregivers. It can also help track important medical appointments.


The Medisafe Pill Reminder & Medication Tracker helps make sure you never miss a dose of your medication. Get reminded when it is time to take your medication and when you need to renew your prescription.



Lumosity is a brain-training app that claims to measure and challenge your cognitive ability. The games can help improve things like memory and focus, which can be weakened by stroke.



Stress and strokes do not get along, which is why stress-relieving apps like Breathe2Relax can help. Breathe2Relax is a deep-breathing app that coaches you through deep-breathing exercises with the goal of improving mood, controlling anger and anxiety, and reducing stress.


Health Apps

<30 Days

<30 Days is an app from the Heart and Stroke Foundation of Canada designed to promote heart health and help individuals prevent stroke. The app helps you find out what unhealthy habits you have, and then it challenges you to break them in 30 days or less.



Diabetes:M helps individuals with diabetes manage their condition. Some of the features include a logbook to keep track of glucose and insulin levels, a reminder system to help you remember to check, and a graph to let you see blood sugar changes over time. Diabetes increases your stroke risk, so managing it carefully is important.


Blood Pressure (BP) Watch

Lowering high blood pressure is important for preventing a second stroke. Blood Pressure (BP) Watch helps you keep track of your blood pressure, pulse, and weight all in one convenient app.


7 Minute Workout Challenge

Exercising can help prevent a recurrent stroke, but it can be hard to know how to get started. The 7 Minute Workout Challenge challenges you to complete 12 high-intensity exercises in 7 minutes that can all be done with no equipment. Not having time is no longer an excuse. You can fit this workout in anytime and anywhere.


New Resources

Apps are becoming an important resource in the stroke survivor’s rehab repertoire. Caretakers and patients alike have easy access to programs that make communication and organization easier, and trying out deep breathing and fitness activities simpler. By trying one of these apps or combining them, patients may add more structure to their routines, track their progress, and have fun.

Disclaimer: Our company is not endorsing these apps. We list them with the intention of providing stroke survivors and their caretakers with additional resources.

Source: The Best Apps to Help With Stroke Recovery | Saebo

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[WEB SITE] Benefits of Virtual Reality for Stroke Rehabilitation – Saebo

Virtual reality (VR) is the new must-have technology tool for gaming, training, or just trying to immerse yourself in a new and virtual environment. From Google Cardboard to Oculus Rift, this technology is becoming more and more accessible to the everyday person. Now anyone can put on a headset and suddenly be transported to a world where they have full control and no consequences.

VR technology isn’t just useful for gaming. It has been shown to help in a variety of applications, from military training activities to treatment for anxiety disorders and phobias to functioning as an art form. Another application where VR shows a lot of promise is stroke recovery.

Virtual Reality and Stroke Recovery

Virtual Reality has emerged as a new approach to treatment in stroke rehabilitation settings over the last ten years. By simulating real-life activities, stroke patients are able to work on self-care skills in a setting that is usually impossible to create in a hospital environment.

There are two main types of VR:


In immersive VR, the virtual environment is delivered by equipment worn by the user (like goggles) or the person is situated within a virtual environment. This fully immersive system gives the user a strong sense of presence through the use of head-mounted displays, special gloves, and large, concave screen projections to create the sense of immersion.


Non-immersive VR is usually two-dimensional and delivered through a computer screen. The user can control what is happening on screen by using a device such as a joystick, mouse, or sensor.

After a stroke, mass practice, task-oriented arm training of the upper and lower limbs can help the brain “re-program” itself and form new neural connections. These new connections stimulate recovery of motor skills in patients following stroke. So VR may be useful to augment rehabilitation of the upper and lower limbs in patients suffering from stroke and other neurological injuries.

In some studies, therapists have manipulated the image onscreen to make the patient’s limb appear to be moving faster and more accurately than it was in real life. Doing this increased the patient’s confidence and made them more likely to use their affected limb spontaneously. Spontaneous use of the affected limb can help the limb recover more completely.


SaeboVR is the world’s only virtual rehabilitation system exclusively focusing on ADL’s (activities of daily living). The proprietary platform was specifically designed to engage clients in both physical and cognitive challenges involving daily functional activities. In addition to interacting with meaningful every-day tasks, the SaeboVR uses a virtual assistant that appears on the screen to educate and facilitate performance by providing real-time feedback.



SaeboVR’s ADL-focused virtual world provides clients with real-life challenges. Users will incorporate their impaired upper limb to perform simulated self-care tasks that involve picking up, transferring, and manipulating virtual objects.


Why SaeboVR?

  • It’s the only virtual system available that focuses on real-life self-care tasks.
  • Let’s you practice repetitive movements with fun and motivating activities.
  • Activities are adaptable to the individual client to maximize success and outcomes.
  • ADL tasks can be customized to challenge endurance, speed, range of motion, coordination, timing, and cognitive demand.
  • It includes a clinical provider dashboard to view client performance and participation trends.
  • Reports are graphically displayed for easy viewing.

Saebo’s other products can also be used in conjunction with the SaeboVR to facilitate recovery. The SaeboMAS and SaeboMAS mini use unweighting technology that will allow clients with proximal weakness to participate in proven treatment techniques that would otherwise have been impossible. The SaeboGlove can engage and position the hand so it can be incorporated in virtual grasp-and-release activities.

The Future of Stroke Rehabilitation

Virtual reality is here to stay, and we have likely only scratched the surface of its medical applications. It’s having a powerful impact on those who have had strokes. Stroke survivors are taking advantage of how VR enables them to practice necessary routine activities, create new connections in the brain, and build up their confidence. With more and more survivors retraining their limbs using this technology, the future of VR in stroke recovery looks bright.


All content provided on this blog is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, call your doctor or 911 immediately. Reliance on any information provided by the Saebo website is solely at your own risk.

Source: Benefits of Virtual Reality for Stroke Rehabilitation | Saebo

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[ARTICLE] Enhancing the alignment of the preclinical and clinical stroke recovery research pipeline: Consensus-based core recommendations from the Stroke Recovery and Rehabilitation Roundtable translational working group – Full Text

Stroke recovery research involves distinct biological and clinical targets compared to the study of acute stroke. Guidelines are proposed for the pre-clinical modeling of stroke recovery and for the alignment of pre-clinical studies to clinical trials in stroke recovery.


Moving treatments from the preclinical to the clinical realms is notoriously difficult. For all diseases, only 10% of agents that enter phase 1 trials result in a clinically used drug.1,2 The success rate in stroke and traumatic brain injury is also low and well-documented.35 The translational failure in stroke has been attributed to the narrow therapeutic window and to mistakes such as very broad inclusion criteria, and imprecise, global outcome measures.35 On the preclinical side, depth and rigor of study design, analysis and interpretation have received special focus.

Stroke recovery involves distinct biological principles and a very different time window compared to stroke neuroprotection.68 Unlike acute stroke, post-stroke behavioral activity shapes recovery and can be manipulated to promote recovery, or to negatively interact with recovery.6,9 In addition, stroke recovery involves a unique biology of altered synaptic signaling, enhanced synaptic plasticity and changes in neuronal circuits that provide novel drug and cellular targets but also raise special considerations in clinical translation. The special considerations include: the animal stroke models, the tissue and behavioral outcome measures, imaging biomarkers and conceptual management of the full translational pipeline.

Recent conceptual and technological developments in neuroscience are bringing promising physical, pharmacological and cellular therapies to the field of neurorehabilitation and brain repair. This paper outlines a series of guidelines and recommendations specifically tailored to enhance the quality and rigor of preclinical stroke recovery research.

The task of the translational working group of the Stroke Recovery and Rehabilitation Roundtable (SRRR)10 was to develop a set of guidelines and recommendations appropriate for preclinical stroke recovery research. Existing preclinical stroke research recommendation papers (e.g. STAIR, STEPS) focus chiefly on acute stroke.11,12 Although cognitive impairments and depression are common after stroke,13 the SRRR working groups concluded that these topics require a subsequent roundtable discussion so the emphasis here is on preclinical sensorimotor recovery. The ultimate goal of the translational group was to align preclinical to clinical stroke recovery studies so as to avoid past mistakes and maximize clinical translation.

Continue —> Enhancing the alignment of the preclinical and clinical stroke recovery research pipeline: Consensus-based core recommendations from the Stroke Recovery and Rehabilitation Roundtable translational working groupInternational Journal of Stroke – Dale Corbett, S Thomas Carmichael, Timothy H Murphy, Theresa A Jones, Martin E Schwab, Jukka Jolkkonen, Andrew N Clarkson, Numa Dancause, Tadeusz Weiloch, Heidi Johansen-Berg, Michael Nilsson, Louise D McCullough, Mary T Joy, 2017

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[ARTICLE] Stroke recovery and rehabilitation in 2016: a year in review of basic science and clinical science – Full Text


Advances in acute stroke treatment and the widespread establishment of dedicated stroke units have resulted in an increase in poststroke survival and life expectancy. However, stroke remains a leading cause of long-term disability worldwide, making the improvement of poststroke outcomes a chief healthcare goal for many countries. The current strategies strive to reduce the initial injury by acutely implementing thrombolytic and/or endovascular interventions, to better understand the major determinants that influence the stroke recovery and to search for innovative, effective and accessible recovery and rehabilitation modalities that can mitigate various poststroke deficits and enhance the quality of life. These approaches require a collaboration and integration of fundamental and clinical science research to more efficiently translate benchwork results into therapeutic bedside interventions. Due to a variety of stroke research advances in both the basic and clinical sciences over the last few years, especially in 2016, the field of stroke recovery and rehabilitation has celebrated many hopes and progresses. Our goal was to explore these studies and better identify, understand and integrate key findings for the purpose of identifying new targets that could be translated into clinically rewarding therapeutic interventions in future.

We manually searched professional journals with an average 5-year impact factor >3 (from 2012 to 2016) that were known to publish manuscript with topics in stroke recovery and rehabilitation. We aimed to selectively highlight relevant basic and clinical science stroke recovery research published between December 2015 and December 2016 in these journals. Certain selection biases cannot be completely ruled out and omissions are possible. The list of journals are Science, Nature, Nature Neuroscience, Neuron, Proceedings of the National Academy of Sciences of the United States of America, Neurobiology of Disease, Scientific Report, PLOS ONE, Acta Neuropathologica, Journal of Neuroscience, Annals of Neurology, Neurology, JAMA Neurology, Stroke, The Lancet, Lancet of Neurology, JAMA, Brain, Brain Stimulation, Stem Cells, Cell Death and Differentiation, Neurorehabilitation and Neural Repair, Journal of Cerebral Blood Flow and Metabolism and New England Journal of Medicine.

Continue —> Stroke recovery and rehabilitation in 2016: a year in review of basic science and clinical science | Stroke and Vascular Neurology


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[ARTICLE] Agreed definitions and a shared vision for new standards in stroke recovery research: The Stroke Recovery and Rehabilitation Roundtable taskforce – Full Text

A major point of agreement of the SRRR expert group was to focus on progress of stroke recovery research in the next decade and beyond. ‘Rehabilitation’ as a blanket term for all therapy-based interventions post-stroke was considered problematic, vague and an impediment to progress. Rehabilitation reflects a process of care, while recovery reflects the extent to which body structure and functions, as well as activities, have returned to their pre-stroke state. With that, the term ‘recovery’ can be represented in two ways: (1) the change (mostly improvement) of a given outcome that is achieved by an individual between two (or more) timepoints, or (2) the mechanism underlying this improvement in terms of behavioural restitution or compensation strategies.6,7 We used the definition of rehabilitation developed by the British Society of Rehabilitation Medicine,8 “a process of active change by which a person who has become disabled acquires the knowledge and skills needed for optimum physical, psychological and social function.” Stroke rehabilitation is most often delivered by a multidisciplinary team, defined by the World Health Organisation (WHO)9 to encompass the coordinated delivery of intervention(s) provided by two or more disciplines in conjunction with medical professionals. This team aims to improve patient symptoms and maximise functional independence and participation (social integration) using a holistic biopsychosocial model, as defined by the International Classification of Functioning Disability (ICF).9

Continue —>  Agreed definitions and a shared vision for new standards in stroke recovery research: The Stroke Recovery and Rehabilitation Roundtable taskforceInternational Journal of Stroke – Julie Bernhardt, Kathryn S Hayward, Gert Kwakkel, Nick S Ward, Steven L Wolf, Karen Borschmann, John W Krakauer, Lara A Boyd, S Thomas Carmichael, Dale Corbett, Steven C Cramer, 2017

Figure 1. Framework that encapsulates definitions of critical timepoints post stroke that link to the currently known biology of recovery.


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[Abstract] Safety and Tolerability of Transcranial Direct Current Stimulation to Stroke Patients – A Phase I Current Escalation Study.


tDCS currents >2 mA have not been investigated in stroke patients.

This phase I dose escalation study establishes safety of up to 4 mA in stroke patients.

No predefined major response was noted at any current level.

Skin temperature did not rise, and skin barrier function remained intact.

Transient skin redness without injury was a common finding irrespective of dose level.


Background and Objective

A prior meta-analysis revealed that higher doses of transcranial direct current stimulation (tDCS) have a better post-stroke upper-extremity motor recovery. While this finding suggests that currents greater than the typically used 2 mA may be more efficacious, the safety and tolerability of higher currents have not been assessed in stroke patients. We aim to assess the safety and tolerability of single session of up to 4 mA in stroke patients.


We adapted a traditional 3+3 study design with a current escalation schedule of 1>>2>>2.5>>3>>3.5>>4 mA for this tDCS safety study. We administered one 30-minute session of bihemispheric montage tDCS and simultaneous customary occupational therapy to patients with first-ever ischemic stroke. We assessed safety with pre-defined stopping rules and investigated tolerability through a questionnaire. Additionally, we monitored body resistance and skin temperature in real-time at the electrode contact site.


Eighteen patients completed the study. The current was escalated to 4 mA without meeting the pre-defined stopping rules or causing any major safety concern. 50% of patients experienced transient skin redness without injury. No rise in temperature (range 26°C-35°C) was noted and skin barrier function remained intact (i.e. body resistance >1 kΩ).


Our phase I safety study supports that single session of tDCS with current up to 4 mA is safe and tolerable in stroke patients. A phase II study to further test the safety and preliminary efficacy with multi-session tDCS at 4 mA (as compared with lower current and sham stimulation) is a logical next step.

Source: Safety and Tolerability of Transcranial Direct Current Stimulation to Stroke Patients – A Phase I Current Escalation Study

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[ARTICLE] Strength of ~20-Hz Rebound and Motor Recovery After Stroke – Full Text


Background. Stroke is a major cause of disability worldwide, and effective rehabilitation is crucial to regain skills for independent living. Recently, novel therapeutic approaches manipulating the excitatory-inhibitory balance of the motor cortex have been introduced to boost recovery after stroke. However, stroke-induced neurophysiological changes of the motor cortex may vary despite of similar clinical symptoms. Therefore, better understanding of excitability changes after stroke is essential when developing and targeting novel therapeutic approaches.

Objective and Methods. We identified recovery-related alterations in motor cortex excitability after stroke using magnetoencephalography. Dynamics (suppression and rebound) of the ~20-Hz motor cortex rhythm were monitored during passive movement of the index finger in 23 stroke patients with upper limb paresis at acute phase, 1 month, and 1 year after stroke.

Results. After stroke, the strength of the ~20-Hz rebound to stimulation of both impaired and healthy hand was decreased with respect to the controls in the affected (AH) and unaffected (UH) hemispheres, and increased during recovery. Importantly, the rebound strength was lower than that of the controls in the AH and UH also to healthy-hand stimulation despite of intact afferent input. In the AH, the rebound strength to impaired-hand stimulation correlated with hand motor recovery.

Conclusions. Motor cortex excitability is increased bilaterally after stroke and decreases concomitantly with recovery. Motor cortex excitability changes are related to both alterations in local excitatory-inhibitory circuits and changes in afferent input. Fluent sensorimotor integration, which is closely coupled with excitability changes, seems to be a key factor for motor recovery.

Approximately 75% of stroke survivors suffer from permanent disability; thus, stroke causes significant human suffering and poses a major economic burden on the society.1 Recovery from stroke is based on brain’s plasticity. Studies in both animals and humans have shown that a period of enhanced plasticity occurs 1-4 weeks after stroke.25 After this sensitive period, the effectiveness of poststroke rehabilitation diminishes dramatically. Recently, there have been promising attempts to prolong or enhance the sensitive period with pharmacological manipulations68 or with noninvasive brain stimulation,9,10 both aiming at changing the cortical excitation-inhibition balance. However, patients with initially similar clinical symptoms may recover differently, possibly because the underlying neurophysiological changes vary between these patients. Thus, understanding and monitoring recovery-related neurophysiological mechanisms and their temporal evolution is crucial for developing efficient, personalized rehabilitation.

Fluent upper limb motor function is important for independency in daily life. Integration of proprioceptive and tactile input with motor plans forms the basis of smooth and precise movements.11 Afferent input mediates its effect on motor functions by modulating the motor cortex excitability.12 Accordingly, our previous study in healthy subjects indicated that proprioceptive input strongly modulates the ~20-Hz motor cortex rhythm, causing an initial suppression followed by a strong and robust rebound.13 Prior studies have suggested that the ~20-Hz rebound reflects deactivation or inhibition of the motor cortex.1417 Moreover, a combined magnetiencephalography (MEG) and magnetic resonance spectroscopy study showed that the ~20-Hz rebound strength is associated with the concentration of the inhibitory neurotransmitter GABA (γ-aminobutyric acid).18

To study alterations in motor cortex excitability after stroke and its association with motor recovery, we measured the dynamics of ~20-Hz motor cortex oscillations during passive movement of the index fingers in 23 stroke patients at the acute phase and during 1-year recovery. The motivation of this study was to understand the neurophysiological mechanisms underlying stroke recovery, which is instrumental for developing novel therapeutic interventions.

Continue —> Strength of ~20-Hz Rebound and Motor Recovery After Stroke – Feb 04, 2017


Figure 1. (A) Setup for passive movement. (B) Representative signals of 1 patient at T0 (1-7 days), T1 (1 month), and T2 (12 months) after stroke. Two upper rows: Magnetoencephalography signals from a single gradiometer channel (raw and filtered to 15-25 Hz over the primary sensorimotor cortex. The ~20-Hz modulation is observable even to a single movement. Third row: Magnitude of acceleration. Total duration of the movement highlighted in gray.

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