Moving rehabilitation research forward: Developing consensus statements for rehabilitation and recovery research

International Journal of Stroke, Journal Year: 2016, Volume and Issue: 11(4), P. 454 - 458

Published: April 12, 2016

Stroke recovery is the next frontier in stroke medicine. While growth rehabilitation and research exponential, a number of barriers hamper our ability to rapidly progress field. Standardized terminology absent both animal human research, methods are poorly described, biomarkers not well defined, we lack consistent timeframes or measures examine outcomes. Agreed conventions for developing, monitoring, evaluating reporting interventions directed at improving lacking, current approaches often underpinned by biology. We urgently need better understand biology its time course animals humans translate evidence from basic science into clinical trials. A new international partnership experts has committed advancing agenda. In May 2016, first Recovery Rehabilitation Roundtable will be held, with aim achieving an agreed approach development, conduct research. range used achieve consensus four priority areas: pre-clinical research; recovery; intervention monitoring reporting; measurement hope foster global network researchers this exciting challenging many survivors. They deserve effective treatments evolving understanding brain behaviour. Working together, can develop game-changing improve quality life those living stroke.

Language: Английский

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A Home-Based Telerehabilitation Program for Patients With Stroke

Neurorehabilitation and neural repair, Journal Year: 2017, Volume and Issue: 31(10-11), P. 923 - 933

Published: Oct. 1, 2017

Background. Although rehabilitation therapy is commonly provided after stroke, many patients do not derive maximal benefit because of access, cost, and compliance. A telerehabilitation-based program may overcome these barriers. We designed, then evaluated a home-based telerehabilitation system in with chronic hemiparetic stroke. Methods. Patients were 3 to 24 months poststroke stable arm motor deficits. Each received 28 days using delivered their home. day consisted 1 structured hour focused on individualized exercises games, stroke education, an free play. Results. Enrollees (n = 12) had baseline Fugl-Meyer (FM) scores 39 ± 12 (mean SD). Compliance was excellent: participants engaged 329/336 (97.9%) assigned days. Arm repetitions across the averaged 24,607 9934 per participant. status showed significant gains (FM change 4.8 3.8 points, P .0015), half exceeding minimal clinically important difference. tests computer literacy declined age ( r −0.92; < .0001), neither nor amount use varied literacy. Daily education via associated 39% increase prevention knowledge .0007). Depression obtained person correlated 16 later 0.88; .0001). In-person blood pressure values closely matched those this 0.99; Conclusions. This effective providing telerehabilitation, secondary participants. Use computer-based interface offers opportunities monitor improve health

Language: Английский

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Biomarkers of Stroke Recovery: Consensus-Based Core Recommendations from the Stroke Recovery and Rehabilitation Roundtable

Neurorehabilitation and neural repair, Journal Year: 2017, Volume and Issue: 31(10-11), P. 864 - 876

Published: Oct. 1, 2017

The most difficult clinical questions in stroke rehabilitation are “What is this patient’s potential for recovery?” and the best strategy person, given her/his profile?” Without answers to these questions, clinicians struggle make decisions regarding content focus of therapy, researchers design studies that inadvertently mix participants who have a high likelihood responding with those do not. Developing implementing biomarkers distinguish patient subgroups will help address issues unravel factors important recovery process. goal present paper provide consensus statement current state evidence biomarkers. Biomarkers motor, somatosensory, cognitive language domains across timeline post-stroke considered; on brain structure function, exclusion blood markers genetics. We considered ready be included trials, as well others promising but not so represent developmental priority. conclude an example illustrates utility research, demonstrating how inclusion biomarker may enhance future trials. In way, we propose way forward when where can include advance efficacy practice of, research into, after stroke.

Language: Английский

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Targeted Vagus Nerve Stimulation for Rehabilitation After Stroke

Frontiers in Neuroscience, Journal Year: 2019, Volume and Issue: 13

Published: March 29, 2019

Stroke is a leading cause of disability worldwide, and in approximately 60% individuals, upper limb deficits persist 6 months after stroke. These adversely affect the functional use restrict participation day to activities. An important goal stroke rehabilitation improve quality life by enhancing independence Since are one best predictors stroke, effective interventions targeting these may represent means life. increased understanding neurobiological processes underlying recovery has led development targeted approaches motor deficits. One such strategy uses brief bursts Vagus Nerve Stimulation (VNS) paired with enhance plasticity support function chronic vagus nerve triggers release promoting neuromodulators, as acetylcholine norepinephrine, throughout cortex. Timed engagement neuromodulators concurrent training drives task-specific cortex provides basis for VNS therapy. A number studies preclinical models ischemic demonstrated that rehabilitative significantly improved forelimb compared without VNS. The improvements were associated synaptic reorganization cortical networks recruitment residual neurons controlling impaired forelimb, demonstrating putative mechanisms function. provided conducting two multi-site, randomized controlled pilot trials individuals moderate severe weakness In both studies, alone. 120-patient pivotal study designed evaluate efficacy therapy This manuscript will discuss rationale therapy, provide an in-depth discussion animal human outline challenges opportunities future

Language: Английский

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Effects of a Brain-Computer Interface With Virtual Reality (VR) Neurofeedback: A Pilot Study in Chronic Stroke Patients

Frontiers in Human Neuroscience, Journal Year: 2019, Volume and Issue: 13

Published: June 19, 2019

Rehabilitation for stroke patients with severe motor impairments (e.g., inability to perform wrist or finger extension on the affected side) is burdensome and difficult because most current rehabilitation options require some volitional movement retrain side. However, although these participate in therapy requiring movement, previous research has shown that they may receive modest benefits from action observation, virtual reality (VR), brain-computer interfaces (BCIs). These approaches have success strengthening key pathways thought support recovery after stroke, absence of movement. The purpose this study was combine principles VR BCI a platform called REINVENT assess its effects four chronic across different levels impairment. acquires post-stroke EEG signals indicate an attempt move drives avatar arm, allowing patient-driven observation neurofeedback VR. In addition, synchronous electromyography (EMG) data were also captured monitor overt muscle activity. Here we tested survivors show EEG-based can be safely used over repeated sessions by wide range disabilities. Finally, individual results suggest more benefit neurofeedback, while mild EMG-based feedback, harnessing existing sensorimotor pathways. We note work promising, due small sample size, are preliminary. Future needed confirm findings larger diverse population.

Language: Английский

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Utility of EEG measures of brain function in patients with acute stroke

Journal of Neurophysiology, Journal Year: 2016, Volume and Issue: 115(5), P. 2399 - 2405

Published: March 2, 2016

EEG has been used to study acute stroke for decades; however, because of several limitations EEG-based measures rarely inform clinical decision-making in this setting. Recent advances hardware, recording electrodes, and software could overcome these limitations. The present examined how well dense-array (256 electrodes) EEG, acquired with a saline-lead net analyzed whole brain partial least squares (PLS) modeling, captured extent behavioral deficits varied relation injury. In 24 patients admitted ischemic stroke, 3 min resting-state was at bedside, including the ER ICU. Traditional quantitative (power specific lead, any frequency band) showed modest association [NIH Stroke Scale (NIHSS) score] bivariate models. However, PLS models delta or beta power across correlated strongly NIHSS score (R(2) = 0.85-0.90) remained robust when further cross-validation 0.72-0.73). Larger infarct volume associated higher power, bilaterally; contralesional findings were not attributable mass effect, indicating that captures significant information about effects available from MRI. We conclude 1) data are feasible as bedside measure function stroke; 2) high-dimension superior traditional single-lead metrics regard; 3) injury structural imaging.

Language: Английский

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Enhancing endogenous capacity to repair a stroke-damaged brain: An evolving field for stroke research

Progress in Neurobiology, Journal Year: 2018, Volume and Issue: 163-164, P. 5 - 26

Published: Feb. 21, 2018

Stroke represents a severe medical condition that causes stroke survivors to suffer from long-term and even lifelong disability. Over the past several decades, vast majority of research targets neuroprotection in acute phase, while little work has been done enhance recovery at later stage. Through reviewing current understanding brain plasticity, pathology, emerging preclinical clinical restorative approaches, this review aims provide new insights advance field for recovery. Lifelong plasticity offers long-lasting possibility repair stroke-damaged brain. impairs structural functional integrity entire networks; approaches containing multi-components have great potential maximize by rebuilding normalizing stroke-disrupted networks functioning. The window is much longer than previously thought. optimal time appears be stage rather earlier It expected these will our assist developing next generation enhancing after stroke.

Language: Английский

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Neuroplasticity and network connectivity of the motor cortex following stroke: A transcranial direct current stimulation study

Human Brain Mapping, Journal Year: 2018, Volume and Issue: 39(8), P. 3326 - 3339

Published: April 14, 2018

Abstract Transcranial direct current stimulation (tDCS) is a noninvasive brain technique that has potential for clinical utility in neurorehabilitation. However, recent evidence indicates the responses to tDCS are highly variable. This study investigated whether electroencephalographic (EEG) measures of functional connectivity target network were associated with response ipsilesional anodal stroke survivors. Ten chronic patients attended two experimental sessions randomized cross‐over trial and received or sham tDCS. Single‐pulse transcranial magnetic was used quantify change corticospinal excitability following At beginning each session, estimated using debiased‐weighted phase lag index from EEG recordings at rest. Magnetic resonance imaging identified lesion location volume. Partial least squares regression models which maximally accounted variance responses. Stronger seed approximating stimulated motor cortex, clusters electrodes parietal cortex contralesional frontotemporal alpha band (8–13 Hz) strongly greater increase association not observed stimulation. Addition structural measure(s) injury (lesion volume) provided an improved model fit between electrode but cortex. TDCS greatly assist rehabilitation appears robust specific biomarker may translation this therapy.

Language: Английский

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Low-Frequency Oscillations Are a Biomarker of Injury and Recovery After Stroke

Stroke, Journal Year: 2020, Volume and Issue: 51(5), P. 1442 - 1450

Published: April 17, 2020

Background and Purpose— Low-frequency oscillations reflect brain injury but also contribute to normal behaviors. We examined hypotheses relating electroencephalography measures, including low-frequency oscillations, motor recovery poststroke. Methods— Patients with stroke completed structural neuroimaging, a resting-state recording clinical testing. A subset admitted an inpatient rehabilitation facility underwent serial recordings. The relationship that measures (power coherence leads overlying ipsilesional primary cortex [iM1]) had status was assessed, focusing on delta (1–3 Hz) high-beta (20–30 bands. Results— Across all patients (n=62), larger infarct volume related higher band power in bilateral hemispheres between iM1 regions. In chronic stroke, bilaterally correlated better status. subacute areas poorer These findings were confirmed recordings from 18 facility. Here, interhemispheric contralesional M1 elevated at admission compared healthy controls (n=22), declining control levels over time. Decreases recovery. Conclusions— Delta greater subacutely, while chronically. both after may be useful biomarkers rehabilitation.

Language: Английский

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Perspectives and Challenges in Robotic Neurorehabilitation

Applied Sciences, Journal Year: 2019, Volume and Issue: 9(15), P. 3183 - 3183

Published: Aug. 5, 2019

The development of robotic devices for rehabilitation is a fast-growing field. Nowadays, thanks to novel technologies that have improved robots’ capabilities and offered more cost-effective solutions, are increasingly being employed during clinical practice, with the goal boosting patients’ recovery. Robotic also widely used in context neurological disorders, where it often provided variety different fashions, depending on specific function be restored. Indeed, effect robot-aided neurorehabilitation can maximized when combination proper training regimen (based motor control paradigms) or non-invasive brain machine interfaces. Therapy-induced changes neural activity behavioral performance, which may suggest underlying plasticity, quantified by multimodal assessments both sensorimotor performance brain/muscular pre/post intervention. Here, we provide an overview most common upper lower limb describe aforementioned scenarios. We review assessment techniques evaluation therapy. Additional exploitation these research areas will highlight crucial contribution robotics promoting recovery answering questions about reorganization functions response disease.

Language: Английский

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