Monitoring Neuro-Motor Recovery From Stroke With High-Resolution EEG, Robotics and Virtual Reality: A Proof of Concept.

A novel system for the neuro-motor rehabilitation of upper limbs was validated in three sub-acute post-stroke patients. The system permits synchronized cortical and kinematic measures by integrating high-resolution EEG, passive robotic device and Virtual Reality. The brain functional re-organization was monitored in association with motor patterns replicating activities of daily living (ADL). Patients underwent 13 rehabilitation sessions. At sessions 1, 7 and 13, clinical tests were administered to assess the level of motor impairment, and EEG was recorded during rehabilitation task execution. For each session and rehabilitation task, four kinematic indices of motor performance were calculated and compared with the outcome of clinical tests. Functional source maps were obtained from EEG data and projected on the real patients' anatomy (MRI data). Laterality indices were calculated for hemispheric dominance assessment. All patients showed increased participation in the rehabilitation process. Cortical activation changes during recovery were detected in relation to different motor patterns, hence verifying the system's suitability to add quantitative measures of motor performance and neural recovery to classical tests. We conclude that this system seems a promising tool for novel robot-based rehabilitation paradigms tailored to individual needs and neuro-motor responses of the patients.

Evaluation of sexual changes after stroke.

BACKGROUND: Sexual difficulties may arise after stroke. This study was aimed at evaluating and quantifying sexual changes 1 year after stroke. METHOD: Sixty-eight stroke patients, consecutively admitted to our rehabilitation unit, were enrolled in the study. Sixty-two patients were available for response after 1 year--46 men and 16 women with a mean age of 64 years (SD = 9.2). Time interval between stroke event and admission to rehabilitation unit was 15 days. None of the patients presented with lack of comprehension. Methods of data collection at admission were clinical examination, computed tomographic scan or magnetic resonance imaging, the Cumulative Illness Rating Scale, laboratory data, and data collection on sexual life from patients and, separately, from their partners. After 1 year, they were interviewed again to assess sexual performance; the Center for Epidemiologic Studies-Depression scale, Structured Clinical Interview for DSM-IV, and Functional Independence Measure were also performed. A questionnaire designed for this study was also administered for collecting data on patients' private lives. RESULTS: Sexual decline was common in the post-stroke period. Age (p =.009) and disability (p =.0059) were significant variables. There was no correlation between sexual decline and gender, nor injured hemisphere. There was also no correlation to marriage duration, education duration, or depression. Evaluation and analysis of the questionnaires revealed, however, that patients' partners played a substantial role in the decline of sexual activity. Many partners experienced fear of relapse, anguish, lack of excitation, or even horror, which withheld them from encouraging sexual activities. CONCLUSION: Data from this study demonstrated that sexual decline in the aftermath of stroke is pronounced. Patients suffer from their sexual impairment, but do not conceal that problem. Psychological, rather than medical, aspects account for discontinuity of sexual activity in stroke survivors, and proper counseling is clearly warranted.

Gait in stabilized hemiplegic outpatients in rehabilitation.

PURPOSE: Hemiplegic patients generally expect an improvement of their gait even at 1 year after stroke. This open and prospective study was addressed to detect even subtle changes in gait characteristics in stabilized patients in rehabilitation treatment by using an opto-electronic system of analysis (ELITE). METHODS: Forty-two hemiplegic patients were entered on this study, and mean age was 63.2 years (SD 9.9). The gait measures were obtained four times for each patient; at time of baseline, at the 15th, 30th and 90th day from the beginning of rehabilitation treatment. Plantar flexion moment and ankle joint power were always recorded. Forty healthy volunteers served as controls. Four stride characteristics were examined: duration, length, frequency and speed. ANOVA for repeated measures was used. RESULTS: In spite of rehabilitation treatment no results in gait were observed after 3 months. A study on patients' expectancy was also done. At the beginning they were given a simple questionnaire along with DSM-IV CISD-1. None of the patients presented with major depression. At admission 38 (90%) patients expected an improvement of the gait. At the end of the rehabilitation treatment, 36 (85%) patients were still confident about therapy and believed in further improvements of their locomotion, whilst six (15%) were dubious. CONCLUSIONS: The study shows discrepancies between objective results and subjective feelings. Psychological factors account for the patients' request of long training periods and alleged favourable outcome.