Mobile Health (mHealth) Applications for Stroke Rehabilitation: A mini review.

Mobile Health (mHealth) applications are transforming stroke rehabilitation, through personalized care and datadriven insights. These applications employ AI-driven algorithms, tele-rehabilitation, wearable technologies, and gamification to enhance recovery process. The objective of this mini review is to explore the transformative role of Mobile Health (mHealth) applications in stroke rehabilitation, highlighting its capacity to transcend geographical barriers and establish extensive support networks connecting stroke survivors, caregivers, and healthcare professionals. Particularly in developing countries like Pakistan, where healthcare resources may be limited, mHealth offers a viable solution to bridge the gap in stroke care. By facilitating access to rehabilitation services, mHealth can significantly improve outcomes for stroke survivors in these regions. This integration of mobile technology with stroke rehabilitation not only promises personalized and more effective rehabilitation but also presents a unique blend of technology and compassion. This evolution in healthcare holds the potential to redefine stroke recovery, marking a significant milestone in the journey towards more inclusive, efficient, and compassionate care solutions.

Comparison of Nonimmersive Virtual Reality and Task-Oriented Circuit Training on Gait, Balance, and Cognition Among Elderly Population: A Single-Blind Randomized Control Trial.

Purpose: The purpose of this study was to determine the effects of nonimmersive virtual reality (VR) and task-oriented circuit training on gait, balance, cognitive domains, and quality of life among the elderly population. Methods: This is a single-blind randomized control trial in which 28 elderly individuals between 60 and 75 years were selected. The participants were divided into two groups, task-oriented circuit training and the other receiving nonimmersive VR treatment, with 14 participants in each group. To analyze the effects of both training on balance and gait time up and go test (TUGT), dynamic gait index (DGI), measures were used and for cognitive domains Montreal cognitive assessment (MoCA) scale was used. Short form 12 (SF-12) (along with two domains, Physical Component Summary and Mental Component Summary) was used for the measurement of quality of life. The treatment duration was 8 weeks for both groups. Both the pre-test and post-test readings were analyzed and compared. Results: The mean age of participants was 66.91 ± 3.79 years. Within-group comparison between the pre-test and post-test indicated that significant differences (P < 0.05) existed in all the outcome measures (TUGT, DGI, MoCA, and SF-12) in both groups. However, between-group comparison, significant differences were only found in TUGT and DGI in nonimmersive VR group. Conclusion: This study concluded that both interventions nonimmersive VR and task-oriented circuit training were beneficial for improving balance, gait, quality of life, and cognitive domains like memory, attention spans, executive functions, and so on in elderly population. However nonimmersive virtual reality training is a more effective, feasible, and safe alternative and can be proposed as a form of fall prevention exercise for the older adults. ClinicalTrials.gov Identifier: NCT05021432.

Effects of Constraint-Induced Movement Therapy and Application Time and Duration of Intervention for Lower Extremity in Stroke: A Systematic Review.

The primary aim of this review was to determine the effects of CIMT (constraint-induced movement therapy) on gait, balance, and motor functions of the lower extremity in stroke. The secondary aim was to determine the optimal dosage, application time, and duration of CIMT in the lower extremity in stroke. PubMed (1999-July 2021), Pedro (2000-December 2020), Google Scholar (1999-Febraury 2022), and Cochrane Library (2000-Febraury 2022) were searched in February 2022. The risk of bias was calculated through the criteria outlined in the (Cochrane-Handbook for Systematic-Reviews of Interventions). Eight RCTs were included in this review. CIMT was found to be effective in improving balance, gait, and motor functions of lower limbs; however, its superiority in comparison to the control group was not significant, no specific dosage was mentioned for lower limb CIMT as different studies used different durations and intensities of CIMT. Key Words: Cerebrovascular accident (CVA), Balance, Lower-extremity constraint-induced movement therapy (CIMT), Motor functions.

Task Oriented Training For Stroke Rehabilitation: A Mini Review.

Stroke is the leading global cause of death and disability and the need for stroke rehabilitation services in increasing. The usual stroke rehabilitation protocol involves a combination of therapeutic exercises, occupational therapy, speech therapy and counselling sessions depending upon the severity of the deficit and associated co-morbidities. However, there is a need for better protocols and new therapies for improving outcomes after stroke rehabilitation. The term 'task-oriented training' (TOT) refers to guided rehabilitation training of patients' limb function using goal oriented tasks, which can be used to enhance neuroplasticity in brain after injury. Task oriented training could be modified with action selection and environmental enrichment to fulfill the limitations of stroke like, holistic approach, outcome/goal based intervention, proper dosage for desirable outcomes. This mini review provides an overview of the TOT and to identify gaps and challenges in stroke rehabilitation related to integrating TOT.

Technological advancements in stroke rehabilitation.

Early, coordinated, and multidisciplinary rehabilitation plays a major part in motor recovery after stroke. The conventional stroke rehabilitation primarily includes physical therapy, occupational therapy, and speech therapy. However, with these conventional methods, many stroke survivors still have a residual functional disability which impairs their ability to perform activities of daily living. This could be attributed to the insufficient therapy dose, low engagement and motivation of the patient, and lack of objective feedback to achieve significant improvements in function. Various technology-based stroke rehabilitation interventions have been developed in the last few decades which have shown promising results in improving stroke patients' functional mobility and independence. The use of technology promotes repetitive, task-specific training, active engagement of patients, integrating constructive and concurrent feedback, and accurately measuring functional improvement. This review summarizes the important technological advances in stroke rehabilitation, including exergames, telerehabilitation, robotic-assisted systems, virtual and augmented reality, wearable sensors, and smartphone applications.

Is environmental enrichment useful for stroke and other non-progressive brain injury? A Cochrane Review summary with commentary.

BACKGROUND: Stroke and other traumatic brain injuries are the leading causes of global disability in adults. Environmental enrichment for neurological diseases is a relatively new concept within rehabilitation. These are interventions to enhance the level of somatic and social stimulation by providing an engaging environment. OBJECTIVE: To assess the effects of environmental enrichment on well-being, functional recovery, activity levels and quality of life in people who have stroke or non-progressive brain injury. METHODS: Multiple global databases were searched on 26 October 2020. Aim was to include only the randomized controlled trials that compared environmental enrichment with standard services. RESULTS: A single RCT study with 53 participants with stroke was included. It compared the environmental enrichment (physical, cognitive and social activities such as reading material, board and card games, gaming technology, music, artwork, and computer with Internet) with standard services in an inpatient rehabilitation setting. The evidence was of very low quality and follow up was of 3 months only. CONCLUSIONS: The current data are inconclusive and there is a need for well-designed large-scale trials to study the role of environmental enrichment in the functional recovery of neurological diseases.

The emerging role of virtual reality training in rehabilitation.

Virtual reality (VR) uses computer-generated simulations to create a virtual environment for users which appears, sounds, and feels like real-life objects and events. The use of VR in rehabilitation is relatively new and has demonstrated to be an effective tool in achieving desired clinical outcomes by active engagement of participants. Over the past few years, the use of VR in rehabilitation has rapidly increased because of its advantages over traditional rehabilitation techniques. These include better patient adherence to the rehabilitation protocols with high levels of engagement and motivation. This review summarises the available evidence on the role of VR in rehabilitation, its effects, and scope across different clinical conditions and outcomes. We also describe the current status of VR utilization in rehabilitation settings across Pakistan and highlight the need for further research.

Caudal Duplication Syndrome in an Asymptomatic Primi Postnatal Patient.

Caudal duplication syndrome (CDS) is a rare congenital anomaly in which a wide spectrum of malformations ranging from partial or isolated to complete duplication of caudal organs in the gastrointestinal tract (GIT), genitourinary tract (GUT), and spinal and neural systems occur. Its exact cause is unknown, however various factors such as genetic disorders and conjoined twinning are mentioned in the etiology of CDS. Second-trimester anomaly scan can diagnose this anomaly prenatally. This case report describes a primi postnatal patient with CDS without any neurological symptoms. She gave birth to a healthy baby girl by cesarean section with breech presentation as an indication.

What are the effects of strength training and aerobic exercise training for muscle disease? - A Cochrane Review summary with commentary.

The aim of this commentary is to discuss from a rehabilitation perspective the published Cochrane Review (1) by Voet NBM et al., under the direct supervision of Cochrane Neuromuscular Group. This Cochrane Corner is produced in agreement with the Journal of Rehabilitation Medicine by Cochrane Rehabilitation.

Wii Fit for Balance Training in Elderly: A Systematic Review.

Falls due to poor balance are common in elderly people and can cause fractures, head injury, soft tissue trauma; and may even result in death from these complications. Balance training is one of the strategies used to prevent falls among the elderly population. Wii Fit is a new technological approach of balance training in the community dwelling elderly. The primary aim of this systematic review is to study the effectiveness of Wii Fit as a balance-training tool in older adults using various balance and fall risk assessment scales as outcome measures. Using selected keywords in English only, online literature search was conducted from 2009 to 2019. The initial search resulted in 312 articles. After screening, 14 full text articles were included for the final review and qualitative analysis. There is evidence that Wii Fit plus is a useful, cost-effective, user-friendly, less time consuming, home-based approach for reducing the risk of fall and improving the balance and physical performance in older adults. There are few or no adverse events of using Wii Fit. The commonly used outcome measures were 8 foot up and go test, activities-specific balance confidence scale, Berg balance scale, falls efficacy scale, postural sway, times up and go test and static and dynamic balance assessment tool. Key Words: Postural balance, Rehabilitation, Video games, Virtual reality, Evidence-based medicine, Technology.

What are the effects of different modes of exercise training for intermittent claudication? - A Cochrane Review summary with commentary.

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