The Effect of Gait Training on a Sandy Beach in Patients with Chronic Stroke: A Randomized Controlled Pilot Study.

Background: A sandy beach provides an unstable support surface and may influence walking ability in patients with stroke. Primary Study Objective: To investigate the effect of gait training on a sandy beach in patients with chronic stroke. Methods/Design: This was a randomized controlled trial. Setting: Patients were recruited from a community center. Participants: A total of 28 patients with chronic stroke participated in the study. Intervention: Patients were randomly assigned to receive gait training either on a sandy beach (sand group) or firm ground (control group). All patients received gait training for 30 minutes per session, 2 sessions every day for 5 days. Context: Primary Outcome Measures • Primary outcomes were 10-minute walk test (10MWT) and Berg Balance Scale (BBS) scores. Secondary outcomes were Functional Ambulatory Category (FAC), Timed Up and Go (TUG) and spatiotemporal parameters of gait evaluated with a wearable inertial sensor. Psychological parameters, including the Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI), were also measured. Outcome measurements were evaluated at baseline and after the intervention. Results: The 10MWT and BBS scores were significantly improved in the sand group (P < .05). Compared with the changes from pre- to post-treatment between the groups, 10MWT showed a large effect size and BBS score showed a medium effect size. Regarding spatiotemporal parameters, cadence and gait velocity were significantly higher after training than before training in the sand group (P < .05). Compared with the changes from pre- to post-treatment between groups, cadence and gait velocity showed large effect sizes and affected-side stride length showed a medium effect size. There was no difference in the changes from pre- to post-treatment in BDI and STAI between the 2 groups (P > .05). No adverse events occurred during the study. Conclusion: Gait training on a sandy beach may be beneficial for improving walking ability and balance in patients with stroke.

The effect of balance training with Tetra-ataxiometric posturography on balance function in patients with parkinsonism.

BACKGROUND: Balance impairment is a major clinical concern in patients with parkinsonism. Balance training with tetra-ataxiometric posturography (Tetrax) is known to improve balance function through visual biofeedback effects. OBJECTIVE: In this study, we evaluated the effects of balance training with Tetrax in patients with parkinsonism. METHODS: Patients with parkinsonism (idiopathic Parkinson's disease, multiple systemic atrophy, and multiple systemic atrophy) who were able to stand with or without an assistive device were recruited for the study. Twenty patients with parkinsonism were randomly assigned to one of the following two groups: (1) the Tetrax group, in which patients received Tetrax biofeedback balance training for 30 min/day for 2 weeks (10 sessions); and (2) the control group, in which patients received conventional balance training for 30 min/day for 2 weeks (10 sessions). One day before and after training, we measured patients' balance parameters using the Berg balance scale (BBS) and fall index (FI). RESULTS: The BBS and FI scores of the Tetrax group showed significant improvements after compared to before training. However, the scores in the control group were not significantly changed after vs. before conventional balance training. CONCLUSIONS: For patients with parkinsonism, Tetrax biofeedback balance training had a positive effect on balance function.

The effects of forest therapy on depression and anxiety in patients with chronic stroke.

OBJECTIVE: To assess whether forest therapy is effective for treating depression and anxiety in patients with chronic stroke by using several psychological tests. We measured reactive oxygen metabolite (d-ROM) levels and biological antioxidant potentials (BAPs) associated with psychological stress. METHODS: Fifty-nine patients with chronic stroke were randomly assigned to either a forest group (staying at a recreational forest site) or to an urban group (staying in an urban hotel); the duration and activities performed by both groups were the same. Scores on the Beck Depression Inventory (BDI), Hamilton Depression Rating Scale (HAM-D17), Spielberger State-Trait Anxiety Inventory (STAI), d-ROMs and BAPs were evaluated both before and after the treatment programs. RESULTS: In the forest group, BDI, HAM-D17 and STAI scores were significantly lower following treatment, and BAPs were significantly higher than baseline. In the urban group, STAI scores were significantly higher following treatment. Moreover, BDI, HAM-D17 and STAI scores of the forest group were significantly lower, and BAPs were significantly higher following treatment (ANCOVA, p <0.05). CONCLUSION: Forest therapy is beneficial for treating depression and anxiety symptoms in patients with chronic stroke, and may be particularly useful in patients who cannot be treated with standard pharmacological or electroconvulsive therapies.

Combination transcranial direct current stimulation and virtual reality therapy for upper extremity training in patients with subacute stroke.

OBJECTIVE: To investigate the effects of combination cathodal transcranial direct current stimulation (tDCS) and virtual reality (VR) therapy for upper extremity (UE) training in patients with subacute stroke. DESIGN: Pilot randomized controlled trial. Patients were randomly assigned to 1 of 3 groups: group A received cathodal tDCS, group B received VR, and group C received combination therapy (cathodal tDCS was simultaneously applied during VR therapy). SETTING: University hospital. PARTICIPANTS: Patients (N=59) with impaired unilateral UE motor function after stroke. INTERVENTION: Fifteen sessions of treatment over a 3-week period. MAIN OUTCOME MEASURES: The Modified Ashworth Scale, manual muscle test (MMT), Manual Function Test (MFT), Fugl-Meyer Scale (FMS), and Box and Block Test were used to assess UE function. To evaluate activities of daily living, the Korean-Modified Barthel Index (K-MBI) was used. All outcomes were measured before and immediately after treatment. RESULTS: After treatment, all groups demonstrated significant improvements in MMT, MFT, FMS, and K-MBI scores. The change in MFT and FMS scores was different between the 3 groups. Post hoc analysis revealed that the improvement of MFT and FMS scores in group C was significantly higher than those of the other 2 groups. CONCLUSIONS: In the present pilot study, the combination of brain stimulation using tDCS and peripheral arm training using VR could facilitate a stronger beneficial effect on UE impairment than using each intervention alone. This combination therapy might be a helpful method to enhance recovery of the paretic UE in patients with stroke.

Inpatient Course and Length of Hospital Stay in Patients with Brain Disorders in South Korea: A Population-based Registry Study.

OBJECTIVE: To describe inpatient course and length of hospital stay (LOS) for people who sustain brain disorders nationwide. METHOD: We interviewed 1,903 randomly selected community-dwelling patients registered as 'disabled by brain disorders' in 28 regions of South Korea. RESULTS: Seventy-seven percent were initially admitted to a Western medicine hospital, and 18% were admitted to a traditional Oriental medicine hospital. Forty-three percent were admitted to two or more hospitals. Mean LOS was 192 days. Most patients stayed in one hospital for more than 4 weeks. The transfer rate to other hospitals was 30-40%. Repeated admissions and increased LOS were related to younger onset age, higher education, non-family caregiver employment, smaller families, and more severe disability. CONCLUSION: Korean patients with brain disorders showed significantly prolonged LOS and repeated admissions. Factors increasing burden of care influenced LOS significantly.

Cathodal transcranial direct current stimulation of the right Wernicke's area improves comprehension in subacute stroke patients.

Previous studies have shown the appearance of right-sided language-related brain activity in right-handed patients after a stroke. Non-invasive brain stimulation such as transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS) have been shown to modulate excitability in the brain. Moreover, rTMS and tDCS have been found to improve naming in non-fluent post-stroke aphasic patients. Here, we investigated the effect of tDCS on the comprehension of aphasic patients with subacute stroke. We hypothesized that tDCS applied to the left superior temporal gyrus (Wernicke's area) or the right Wernicke's area might be associated with recovery of comprehension ability in aphasic patients with subacute stroke. Participants included right-handed subacute stroke patients with global aphasia due to ischemic infarct of the left M1 or M2 middle cerebral artery. Patients were randomly divided into three groups: patients who received anodal tDCS applied to the left superior temporal gyrus, patients who received cathodal tDCS applied to the right superior temporal gyrus, and patients who received sham tDCS. All patients received conventional speech and language therapy during each period of tDCS application. The Korean-Western Aphasia Battery (K-WAB) was used to assess all patients before and after tDCS sessions. After intervention, all patients had significant improvements in aphasia quotients, spontaneous speech, and auditory verbal comprehension. However, auditory verbal comprehension improved significantly more in patients treated with a cathode, as compared to patients in the other groups. These results are consistent with the role of Wernicke's area in language comprehension and the therapeutic effect that cathodal tDCS has on aphasia patients with subacute stroke, suggesting that tDCS may be an adjuvant treatment approach for aphasia rehabilitation therapy in patients in an early stage of stroke.

Effect of repetitive transcranial magnetic stimulation on cognition and mood in stroke patients: a double-blind, sham-controlled trial.

OBJECTIVE: This study examined whether repetitive transcranial magnetic stimulation applied over the left dorsolateral prefrontal cortex (DLPFC) affected cognition or mood in poststroke patients. DESIGN: The study was a single-center, prospective, double-blind, sham-controlled preliminary study. Eighteen patients (10 males and 8 females; average age, 62.9 yrs) were enrolled. All participants were randomly assigned to one of three treatment groups: low-frequency (1 Hz) stimulation, high-frequency (10 Hz) stimulation, and sham stimulation (control). Each patient underwent 10 consecutive treatment sessions (five times per week for 2 wks). A Computerized Neuropsychological Test was used to evaluate cognitive function, the Tower of London test was used to assess executive function, the Modified Barthel Index score was used to assess activity of daily living function, and the Beck Depression Inventory was used to assess mood status. These evaluations were conducted in all patients before and after treatment. RESULTS: Treatment had no significant effect on any cognitive function parameter, including the Tower of London scores, in any of the three groups. In contrast, high-frequency repetitive transcranial magnetic stimulation resulted in significantly lower Beck Depression Inventory scores compared with baseline and compared with the other two groups. The Modified Barthel Index scores significantly increased in all three groups. CONCLUSIONS: These preliminary data suggest that there was a positive effect on mood, but the study was not powered to detect any measurable effect on cognition.