Posts Tagged therapy
Stroke causes 5.7 million deaths annually. This ranks stroke as the second most common cause of death and, additionally, it is a major cause of disability. Because of an ageing population, stroke incidence and costs will greatly increase in the future. This makes stroke an ongoing social and economic burden, in contrast to the only very limited therapeutic options.
In the last decade vast sums were spent on translational research focused on neuroprotective strategies in the acute phase of ischaemic stroke. A plethora of candidate agents were tested in experimental models and preclinical studies, but none was proven effective in clinical trials. This gave rise to discussions about the possible reasons for this failure, ending up mainly with criticism of methodological aspects of the preclinical and clinical studies, or of the relevance of animal studies in drug development. Indeed, the question could rather be whether neuroprotection is the right target for successful stroke treatment. In this context, a paradigm change can currently be observed: the focus of experimental and translational stroke research is shifting from early neuroprotection to delayed mechanisms such as stroke-associated comorbidities, regeneration and plasticity.
In this review we highlight a few recently emerging fields in translational stroke research. One such topic is the crosstalk between immunity and the injured brain as key pathomechanism in stroke. On one hand, innate and adaptive immune cells play an important role in the fate of injured brain tissue after stroke; on the other, peripheral immune alterations are critically involved in post-stroke comorbidities.
Another emerging research area is the analysis of mechanisms involved in regeneration and neuronal plasticity after stroke. Here, we discuss the current understanding of basic mechanisms involved after brain injury, clinical imaging approaches and therapeutic strategies to promote regeneration in stroke patients.
Stroke rehabilitation is critical to dealing with a growing burden of stroke-related disability. The most important prognostic factors predicting stroke recovery are stroke severity, age of the stroke survivor, and access to rehabilitation. Neuroplasticity with associated neurological recovery is an important concept which emphasizes the importance of stroke rehabilitation. Optimal rehabilitation outcomes are reported when rehabilitation takes place in specialized interdisciplinary stroke rehabilitation units, when rehab is initiated early and when therapy is of sufficient intensity. Outpatient rehabilitation therapy has been shown to further improve outcomes. In the future, stroke rehabilitation outcomes will improve even further through better adherence to clinical practice guidelines and the increasing use of new technologies. There is a developing evidence base supporting long-term rehabilitation management of stroke, a concept which in the past has received little in the way of resources or attention.
Background. While recent clinical trials involving robot-assisted therapy have failed to show clinically significant improvement versus conventional therapy, it is possible that a broader strategy of intensive therapy—to include robot-assisted rehabilitation—may yield clinically meaningful outcomes.
Objective. To test the immediate and sustained effects of intensive therapy (robot-assisted therapy plus intensive conventional therapy) on outcomes in a chronic stroke population.
Methods. A multivariate mixed-effects model adjusted for important covariates was established to measure the effect of intensive therapy versus usual care. A total of 127 chronic stroke patients from 4 Veterans Affairs medical centers were randomized to either robot-assisted therapy (n = 49), intensive comparison therapy (n = 50), or usual care (n = 28), in the VA-ROBOTICS randomized clinical trial. Patients were at least 6 months poststroke, of moderate-to-severe upper limb impairment. The primary outcome measure was the Fugl-Meyer Assessment at 12 and 36 weeks.
Results. There was significant benefit of intensive therapy over usual care on the Fugl-Meyer Assessment at 12 weeks with a mean difference of 4.0 points (95% CI = 1.3-6.7); P = .005; however, by 36 weeks, the benefit was attenuated (mean difference 3.4; 95% CI = −0.02 to 6.9; P = .05). Subgroup analyses showed significant interactions between treatment and age, treatment and time since stroke.
Conclusions. Motor benefits from intensive therapy compared with usual care were observed at 12 and 36 weeks posttherapy; however, this difference was attenuated at 36 weeks. Subgroups analysis showed that younger age, and a shorter time since stroke were associated with greater immediate and long-term improvement of motor function.
[REVIEW] Post-Stroke Depression | EBRSR – Evidence-Based Review of Stroke Rehabilitation – Full Text PDF
Depression is a common complication post-stroke affecting approximately one-third of patients. The presence of post-stroke depression has been associated with decreases in functional recovery, social activity and cognition. In addition, the presence of mental health disorders following stroke may be associated with increased mortality. The present review discusses the prevalence, natural history and risk factors for post-stroke depression as well as issues around its assessment and impact on rehabilitation outcomes. Strategies for the prevention and management of post-stroke depression are reviewed. Recommendations for assessment and treatment are provided based on current guidelines. A discussion of post-stroke emotionalism, its impact and treatment is also included.
Left neglect, also known as unilateral neglect or hemispatial neglect, is one of the oddest symptoms of a brain injury. It can also be one of the most troublesome symptoms. Left neglect is a deficit that occurs following an injury to the right side of the brain. Due to the injury, the brain has difficulty paying attention to items on the left side. This is generally most apparent in difficulties noticing items visually on the left side. For instance, a survivor with left neglect may bump into frames of doors on the his or her left or miss eating food on the left side of his or her plate. It appears as if he or she is blind to items on the left but this is not a true vision issue. It is an attention issue. The brain is not attending to information on the left. The survivor can have…
View original post 1,249 more words
This pilot study tested the effectiveness of an intense, short-term upper-limb robotic therapy for improvement in motor outcomes among chronic stroke patients. We enrolled 30 subjects with upper-limb deficits due to stroke of at least 6 mo duration and with a Motor Power Assessment grade of 3 or less. Over 3 wk, 18 sessions of robot-assisted task-specific therapy were delivered with the use of a robotic exercise device that simulates a conventional therapy known as skateboard therapy.
Primary outcome measures included reliable, validated impairment and disability measures of upper-limb motor function. Statistically significant improvements were observed for severely impaired participants when we compared baseline and posttreatment outcomes (p < 0.05).
These results are important because they indicate that improvement is not limited to those with moderate impairments but is possible among severely impaired chronic stroke patients as well. Moderately and severely impaired patients in our study were able to tolerate a massed-practice therapy paradigm with intensive, frequent, and repetitive treatment. This information is useful in determining the optimal target population, intensity, and duration of robotic therapy and sample size for a planned larger trial.
[ARTICLE] Robotic Therapy Provides a Stimulus for Upper Limb Motor Recovery After Stroke That Is Complementary to and Distinct From Conventional Therapy
Background. Individuals with chronic stroke often have long-lasting upper extremity impairments that impede function during activities of daily living. Rehabilitation robotics have shown promise in improving arm function, but current systems do not allow realistic training of activities of daily living. We have incorporated the ARMin III and HandSOME device into a novel robotic therapy modality that provides functional training of reach and grasp tasks.
Objective. To compare the effects of equal doses of robotic and conventional therapy in individuals with chronic stroke.
Methods. Subjects were randomized to 12 hours of robotic or conventional therapy and then crossed over to the other therapy type after a 1-month washout period. Twelve moderate to severely impaired individuals with chronic stroke were enrolled, and 10 completed the study.
Results. Across the 3-month study period, subjects showed significant improvements in the Fugl-Meyer (P = .013) and Box and Blocks tests (P = .028). The robotic intervention produced significantly greater improvements in the Action Research Arm Test than conventional therapy (P = .033). Gains in the Box and Blocks test from conventional therapy were larger than from robotic therapy in subjects who received conventional therapy after robotic therapy (P = .044).
Conclusions. Data suggest that robotic therapy can elicit improvements in arm function that are distinct from conventional therapy and supplements conventional methods to improve outcomes. Results from this pilot study should be confirmed in a larger study.
When it comes to therapy for stroke patients, we picture mundane, boring exercises that they have to perform for months, and sometimes years. How great would it be to add excitement and fun to the entire regime so that patients are actually motivated (and even look forward) to continue to exercise and feel better?
MusicGlove does just that. A glove that lets you play a Guitar Hero like game on a tablet or a bigger screen, it is meant for people who have survived strokes or have other neurological and muscular injuries that limit the movement of their hands. A study has shown that patients who use MusicGlove for therapy show significant improvement in their hand movements only after two weeks as compared to people who go through traditional therapy. It requires minimal interaction with the therapist and the patient can “play” it whenever they want to.
Plus, there’s music!…