The effectiveness of mindfulness-based cognitive therapy during poststroke rehabilitation: a randomized controlled trial.

Stroke can have a range of physical, psychological, cognitive, and social impacts that are challenging for survivors. This study aimed to evaluate the efficacy of a group-based mindfulness intervention integrated into an inpatient rehabilitation program compared to standard care. A single-center, randomized, controlled trial was conducted in 93 poststroke patients. The intervention group received 6-weeks of mindfulness-based cognitive therapy (MBCT) and standard care; the control group received standard care. Primary outcomes were depression and trait anxiety; secondary outcomes were trait mindfulness and attention. Participants completed questionnaires at baseline, and postintervention (6 weeks). Mixed-effect model repeated measures analysis of variance was conducted between groups and across time. A total of 80 participants (intervention n = 43; standard care n = 37) were included in the postintervention analysis. There were no statistically significant differences in the primary outcomes between the groups over time. An improvement was found, however, on the trait mindfulness observing subscale in favor of the intervention group. Eight sessions of MBCT integrated into an inpatient stroke rehabilitation program over 6 weeks was not effective in improving depression and anxiety compared to standard care. Lack of follow-up and low to moderate pathological symptoms at baseline may have limited the effectiveness of this intervention.

[An overview of treatment options for a rare disease, aneurysm of the popliteal vein, in connection with a case]. / Egy ritka kórkép, a vena poplitea aneurysma kezelési lehetoségeinek áttekintése egy eset kapcsán.

INTRODUCTION: Popliteal vein aneurysm is a rare, but potentially life-threatening condition that can lead to deep vein thrombosis and/or pulmonary embolism. It is often asymptomatic, but symptoms may include pain, post-thrombotic syndrome or chronic venous insufficiency. An experienced physician may be able to detect a palpable mass in the popliteal fossa. Duplex ultrasound is the first line of diagnosis. CT or MR venography play a role in the diagnosis. OBJECTIVE: To review the international literature, explain the possible treatment options, and present our case. CASE REPORT: A 62-year-old female patient had a recurrent pulmonary embolism while on direct-acting oral anticoagulant therapy. Duplex ultrasound and MR angiography were performed and confirmed a partially thrombosed aneurysm of the right popliteal vein. Aneurysm resection and venorrhaphy were performed as treatment. At follow-up, ultrasound showed adequate flow in the deep venous system. 6 months later, the control MR angiography showed good flow without stenosis. There were no postoperative complications. Discussion and literature review: The pathomechanism of the disease remains unclear. Treatment options are conservative therapy and/or surgical intervention, but there is no consensus regarding the therapy of symptomatic or asymptomatic cases. There is no clear statement regarding the method and duration of postoperative anticoagulant therapy. CONCLUSION: In the case of recurrent pulmonary embolism, the possibility of a popliteal vein aneurysm should be considered. Ultrasound is a non-invasive, widely available initial diagnostic tool. In addition to conservative treatment, the possibility of surgical intervention can be considered. The surgical procedure described in our case was successful. Orv Hetil. 2023; 164(39): 1544-1549.

Physical exercise induces mental flow related to catecholamine levels in noncompetitive, but not competitive conditions in men.

The study aimed to reveal physical exercise conditions and catecholamine response-dependent differences while an individual experiences a flow state (FS) following noncompetitive and competitive running drills. Urine laboratory catecholamine levels were measured using a standard clinical method during pre- and post-physical exercises. The noncompetitive task involved intermittent running drills, from an absolute beginning up through exhaustion. Initially, the drill is performed individually then later competing alongside other runners. Twenty-two males (mean age: 40.27; SD: 5.4; min-max: 31-49 years) were selected in accordance to the following criterion: healthy status without using medication, routine forms of training (running, cycling or swimming) ideally performed with regularity, at least three times per week, 45 min per session. During the noncompetitive task, a high FS experience was associated with a low level of catecholamines, (noradrenaline and adrenaline) while in parallel, the high FS was associated with a low concentration of homovallinic acid. During competitive conditions, the FS-related catecholamine level changes have not yet been found. In conclusion, the low concentration of the circulating catecholamines supports the transient hypofrontality hypothesis regarding the FS experiences. Furthermore, synchronized noradrenaline and adrenaline neurosecretion play an essential role in the manifestation and the prolongation of FS in noncompetitive exercise conditions.

Changes in skeletal muscle mass index and fat mass index during rehabilitation for traumatic brain injury and stroke measured by bioelectrical impedance analysis.

Although malnutrition may negatively impact the outcomes of rehabilitation and increase the cost of care, there are still no valid nutritional assessment methods appropriate for specific groups of patients undergoing rehabilitation. This study aimed to determine if a multifrequency bioelectrical impedance is suitable for monitoring the changes in body composition of brain-injured patients for whom individualized nutritional goals were set during rehabilitation. Fat mass index (FMI) and skeletal muscle mass index (SMMI) were examined by Seca mBCA515 or portable Seca mBCA525 device within 48 h of admission and before discharge in 11 traumatic brain injury (TBI) and 11 stroke patients with admission Nutritional Risk Screening 2002 scores ≥2. The changes in outcomes and plausible interactions were examined between the admission values and the values estimated for the 18th day (minimum length of stay in the sample) using a repeated measure mixed-sample analysis of covariance. In patients with low FMI at admission (mainly younger, TBI patients, with longer ICU stay), there was no change over time whereas, in those with high admission FMI (older, stroke patients, with shorter ICU stay), a decrease was observed (significant interaction F(1,19) = 9.224 P  = 0.007 Part. η² = 0.327). The SMMI significantly increased over time (F(1,19) = 5.202 P  = 0.034 Part. η² = 0.215) independently of gender, age, days spent in ICU and cause of brain injury. Our results suggest that bioelectrical impedance analysis is feasible and informative for monitoring the changes in body composition during rehabilitation, which also requires consideration of demographic and pre-rehabilitation characteristics.

Methods to assess the effectiveness and acceptance of information and communication technology-based assistive technology for older adults: a scoping review.

An aging society is a growing challenge for families, social and rehabilitation service providers, and economies. Information and communication technology-based assistive technology can bolster the independence of older adults (65 years and above) and reduce their burden on caregivers. Currently, there is no unified methodology to assess the effectiveness and acceptance of these technologies. The present study undertakes a scoping review to (1) identify and characterize the methods for assessing the acceptability and usability of information and communication technology-based assistive technologies, (2) explore the advantages and disadvantages of the assessment methods, (3) determine the possibilities of combining the assessment methods and (4) define the most commonly used assessment method and set of outcome measures. The literature was searched in MEDLINE, Scopus, IEEE Cochrane and Web of Science bibliographic databases using the keywords defined by reviewers for articles in English published between 2011 and 2021. Of the 1696 matches, 31 met the inclusion criteria. It was found that a combination of different assessment methods was common in outcome measurements. Of the 31 studies, assessment methods were combined in 21 studies and multiple questionnaires were used in 11 studies. The most common technique of outcome measurement was the use of questionnaires (81%), conducting interviews (48%) and recording usability-performance measures (39%). The advantages and disadvantages of the assessment methods could not be determined in the selected studies in this scoping review.

[The effects of mindfulness-based interventions in post-stroke rehabilitation]. / A tudatos jelenlét alapú beavatkozások hatásai a stroke utáni rehabilitációban.

Stroke is nowadays one of the most prevalent diseases worldwide causing devastating impairments and negative consequences for survivors. It is a main cause of adult onset disability and it can have a negative impact on psychological health, cognitive function and quality of life. Post-stroke rehabilitation may reduce long-term disability, and in recent years several innovations have emerged to improve recovery. Decades of research suggest that mindfulness-based interventions support a greater capacity to live with chronic medical conditions and contribute to lowering stress levels. Previous works report positive results amoung stroke survivors, improvements in mood, mental fatigue and in some degree in cognitive and physical functioning, plus represent a promising option in secon­dary prevention. Since the early 2000s, numerous clinical studies have investigated the efficacy of mindfulness-based interventions in post-stroke rehabilitation. In this paper the main results of the relevant international research is reviewed and also, the main modalities of the mindfulness-based interventions are presented. Our primary goal is to evaluate the results in order to draw attention to the importance of rehabilitation of patients with stroke and hopefully the theoretical and practical knowledge of the review will contribute to development effective and secure protocols in future research. Mindfulness-based techniques can become clinically valuable complementary therapeutic interventions in post-stroke rehabilitation. More research in this area is warranted: to evaluate these specific practices and their suitability; using randomized, controlled, follow up designs, rigorous methods, and different treatment settings; expanding outcomes to include physiological, health care use, and health-related outcomes; exploring mediating factors; and discerning dose effects and optimal frequency and length of practice. 

A Technology-Based Intervention to Support Older Adults in Living Independently: Protocol for a Cross-National Feasibility Pilot.

Innovative technologies can support older adults with or without disabilities, allowing them to live independently in their environment whilst monitoring their health and safety conditions and thereby reducing the significant burden on caregivers, whether family or professional. This paper discusses the design of a study protocol to evaluate the acceptance, usability, and efficiency of the SAVE system, a custom-developed information technology-based elderly care system. The study will involve older adults (aged 65 or older), professional and lay caregivers, and care service decision-makers representing all types of users in a care service scenario. The SAVE environmental sensors, smartwatches, smartphones, and Web service application will be evaluated in people's homes situated in Romania, Italy, and Hungary with a total of 165 users of the three types (cares, elderly, and admin). The study design follows the mixed method approach, using standardized tests and questionnaires with open-ended questions and logging all the data for evaluation. The trial is registered to the platform ClinicalTrials.gov with the registration number NCT05626556. This protocol not only guides the participating countries but can be a feasibility protocol suitable for evaluating the usability and quality of similar systems.

Reward Dependence-Moderated Noradrenergic and Hormonal Responses During Noncompetitive and Competitive Physical Activities.

The aim of this study was to reveal whether increased reward dependence (RD) plays a role in the catecholamine neurotransmitter release and testosterone hormone regulation during physical activities among healthy trained participants. Twenty-two male participants (mean age: 40.27 ± 5.4 years) participated in this study. Two conditions were constructed, namely, a noncompetitive and a competitive running task (RT), which were separated by a 2-week interval. Urine and blood samples were collected prior to and following the running tasks. Noradrenaline (NA), adrenaline (A), dopamine (D), and their metabolites, vanillylmandelic acid (VMA) and homovanillic acid (HVA), were measured from urine, while testosterone levels were analyzed from blood samples. RD was assessed using the Cloninger's Personality Inventory (PI). Mental health was evaluated using the WHO Well-Being, Beck Depression, and Perceived Life Stress Questionnaires. According to our findings, levels of NA, A, D, VMA, and testosterone released underwent an increase following physical exertion, independently from the competitive condition of the RT, while HVA levels experienced a decrease. However, we found that testosterone levels showed a significantly lower tendency to elevate in the competitive RT, compared with the noncompetitive condition (p = 0.02). In contrast, HVA values were higher in the competitive compared with the noncompetitive condition (p = 0.031), both before and after the exercise. Considering the factor RD, in noncompetitive RT, its higher values were associated with elevated NA levels (p = 0.007); however, this correlation could not be detected during the competitive condition (p = 0.233). Among male runners, the NA and testosterone levels could be predicted to the degree of RD by analyzing competitive and noncompetitive physical exercises.

The effects of eccentric hamstring exercise training in young female handball players.

PURPOSE: The multidimensional role of hamstring muscle group strength in athletic performance and injury prevention is well documented, and nordic hamstring exercise (NHE) is a popular method for the development of hamstring strength. Our aim was to examine the EMG characteristics of the eccentric NHE as well as the effects of long-term eccentric NHE training on muscle strength and vertical jump performance in 10- to 11-year-old female handball players. METHODS: Players from the same handball team were randomly assigned to an eccentric NHE training (13 players) or a control group (10 players). Both groups continued their regular handball training routine, but the NHE group performed additional eccentric NHE exercises once or twice a week, with progressively increasing volume, over 20 weeks. To test training effects, countermovement jump (CMJ) height, eccentric hamstring impulse, peak torque, and angle of peak torque were evaluated before, during and after the training period. In the pre-exercise test, EMG activity of the medial and lateral hamstring muscle was also assessed during NHE. RESULTS: Hamstring activities ranged between 98 and 129%. Lateral hamstring activity was greater than medial only in the right leg during NHE. Eccentric hamstring impulse improved in both legs at 10 weeks in both groups. Then, at 20 weeks, it remained unchanged in the NHE but decreased in controls. A similar adaptation was seen in eccentric hamstring torque, without change in the optimum knee angle. CMJ height improved only in the NHE. CONCLUSION: It is concluded that NHE activates the hamstring musculature effectively, and a favourable mechanical adaptation to long-term NHE exercise in girls can be triggered as early as 11 years of age.

Neglect syndrome in post-stroke conditions: assessment and treatment (scoping review).

There is no consensus about the definition or most effective treatment for neglect syndrome. The aim of this review was therefore to evaluate the results of trials that investigated different treatment methods for neglect syndrome. A systematic literature search in PubMed and Web of Science databases was performed to identify studies that investigated the effects of neglect therapies. Authors followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Studies were selected by two assayers, and disagreement was resolved by a third reviewer. The literature search identified 202 articles: 19 met the inclusion criteria and were included for data extraction. Thirty-five different kinds of assessments were used in these studies, and 17 treatment methods were applied. Successful treatments were reported at least in some parts of the assessments in 12 studies: mirror therapy (in two trials), transcranial magnetic stimulation, street crossing test in virtual reality, smooth pursuit eye movement training, saccadic eye movement therapy, direct current stimulation, eye patching therapy, prism adaptation treatment, socially assistive pet-type therapeutic robot (PARO), Kinesiological Instrument for Normal and Altered Reaching Movement robotic device therapy, transcutaneous electrical nerve stimulation, and optokinetic stimulation (the last two methods in the same trial). No success was shown in seven trials, which contained not only single treatments but combined ones also. Authors concluded that there are no convincing results for or against any of the different therapies used for neglect syndrome. The quality of the trials is questionable, and the numbers of included patients are small in the trials.

Histological and Mechanical Assessment of Decellularized Porcine Biografts, and Its Biological Evaluation following Aortic Implantation during Mid-Term Follow-Up.

AIMS: Prosthetic graft infection frequently requires graft replacement. Among other options, a biological graft could serve as an alternative choice. Decellularization reduces tissue immunogenicity. Our aim was to determine an efficient decellularization method and to evaluate the decellularized porcine biografts' adaptability. METHODS: Four different protocols were implemented to decellularize porcine aortic segments (n = 4). Cell removal effectiveness and matrix structure preservation were histologically examined. Mechanical tests were performed. Decellularized porcine grafts were interpositioned in a porcine aorta. After a 6-month period, implanted samples were removed and evaluated using light and electron microscopy. RESULTS: Histological results showed complete removal of cells and preserved connective tissue fiber structure following decellularization, using sodium dodecyl sulfate and sodium azide. Pressure tests demonstrated similar compliance to fresh vessels. In 9 out of 10 cases, pigs survived the follow-up period. Graft rejection, intimal hyperplasia, reocclusion and/or aneurysm formation were not observed. Presence of host cells and neoendothelialization were microscopically confirmed. CONCLUSIONS: This decellularization protocol enables a cost-effective preparation of biological grafts featuring reduced immunogenicity. The implanted grafts did not degenerate during the 6-month follow-up period, the lack of graft rejection suggests acceptable immunological tolerance, while recipient cells migrate into, proliferate and differentiate, thus creating the possibility for further use as an optional vascular graft.

Evidence-based position paper on Physical and Rehabilitation Medicine professional practice for persons with acute and chronic pain. The European PRM position (UEMS PRM Section).

BACKGROUND: Pain is a frequent complaint from patients undergoing rehabilitation. It can be a major problem and can lead to several activity limitations and participation restrictions. For this reason, when the Professional Practice Committee (PPC) of the Physical and Rehabilitation Medicine (PRM) Section of the European Union of Medical Specialists (UEMS) decided to prepare evidence-based practice position papers (EBPPs) on the most relevant fields of PRM, a paper on the role of the PRM specialist on pain conditions was also included. The goals of this paper are to provide recommendations on the PRM physician's role in pain management; how to address this major problem and what is the best evidence-based approach for the PRM physician in acute and chronic pain conditions. This paper follows the methodology defined by the Professional Practice Committee of the UEMS-PRM Section. METHODS: A systematic literature search in PubMed was carried out and the results obtained from filtered papers were subjected to four Delphi rounds. RESULTS: Fifteen recommendations were obtained from the Consensus Process and systematic review and were approved by all of the delegates of the UEMS-PRM Section. It is recommended that PRM physicians focus on pain as a primary aim of their interventions, in whatever field they are applying their competencies. It is also recommended that the approach to pain focuses either on reducing the symptoms and improving functioning/reducing disability or recurrences and improving the health condition in the long term avoiding chronicity. CONCLUSIONS: Every PRM specialist encounters the problem of pain and some specialize in this field and their role is greater than that of the regular PRM doctor. Based on the evidence available, it is reasonable to determine the role of the physiatrist in managing pain.

Quantification of the Upper Extremity Motor Functions of Stroke Patients Using a Smart Nine-Hole Peg Tester.

This paper introduces a smart nine-hole peg tester (s-9HPT), which comprises a standard nine-hole peg test pegboard, but with light-emitting diodes (LEDs) next to each hole. The s-9HPT still supports the traditional nine-hole peg test operating mode, in which the order of the peg placement and removal can be freely chosen. Considering this, the s-9HPT was used in lab research to analyze the traditional procedure and possible new procedures. As this analysis required subjects with similar levels of dexterity, measurement data from 16 healthy subjects (seven females, nine males, 25-80 years old) were used. We consequently found that illuminating the LEDs in various patterns facilitated guided tests of diverse complexity levels. Next, to demonstrate the clinical application of the s-9HPT, the improvement in the hand dexterity of 12 hospitalized stroke patients (45-80 years old, six females and six males) was monitored during their rehabilitation. Here, we used traditional and guided tests validated by healthy subjects. Consequently, improvements were found to be patient specific. At the beginning of rehabilitation, traditional tests suitably indicate improvements, while guided tests are beneficial following improvements in motor functions. Further, the guided tests motivated certain patients, meaning the rehabilitation was more effective for these individuals.

Precise isometric hand grip learning of hemiparetic stroke patients.

Rehabilitation of hand movements after stroke aims at skills that can be well retained and transferred to novel conditions. These functions may be altered by training schedules such as constant and variable practice. A total of 36 participants with hemiparesis completed one of these schedules counterbalanced. Precise isometric hand grip force production was practiced for 4 days with a target force of 25% maximum voluntary contraction. The constant group practiced only the target force, whereas the variable group practiced the same amount including ±5 and 10% maximum voluntary contraction. Target force presentation and feedback were provided visually. Results indicated that both practice schedule led to learning. Variable practice resulted in a superior performance in retention and transfer tests, suggesting that it may be effective not only in the healthy population but also in stroke rehabilitation.

[Thoracic aortic stentgraft implantations in Hungary from 2012 to 2016]. / Mellkasiaortastentgraft-beültetések Magyarországon 2012 és 2016 között.

Thoracic aortic endograft implantation has become a widespread procedure in recent years, yet no report is available about Hungarian outcomes. Examination of our results is crucial to define further treatment strategies. Analysis of perioperative data from Hungarian thoracic endograft implantations based on the experience of 5 years is presented. Our retrospective, multicentric study analysed voluntarily reported data from all Hungarian institutions where thoracic endograft implantations are performed. Information was collected from every procedure performed in 5 years. Between 2012 and 2016, 131 thoracic stent graft implantations were performed in Hungary (67.18% male, mean age 62.80 years). 25.19% of the procedures were acute. 13.74% of the patients were diabetic. Indications for the procedure were aneurysm (64.89%), dissection (17.56%), aortic trauma (6.87%) and other conditions (10.69%). 73.91% of the dissection cases were acute. 16.47% of repaired aneurysms were ruptured. Additional preoperative revascularization (debranching) was performed in 26.72% of the cases. Postoperative stroke occured in 4.58%, temporary hemodialysis was needed in 1.53%, bowel ischaemia was present in 2.29% and reoperation within 30 days was needed in 5.34% of all cases. Thirty-day mortality of the procedure was 9.92%, 5-year long-term mortality reached 16.03%. Endovascular repair of the thoracic aorta is an effective procedure and our national data comfirmed its advantages compared to open thoracic surgery. Further use of the procedure in Hungary depends on the centralised care in vascular surgery and financial matters. Multidisciplinary cooperation and proper logistics are needed to provide patients with optimal treatment. Orv Hetil. 2018; 159(2): 53-57.

Evaluation of a companion robot based on field tests with single older adults in their homes.

The growing number of older adults places insurmountable load on family members and professional caregivers. Assistive technology with the aid of robots can present a possible solution. The goal of this article was to test a companion robot supporting older adults in their home environments. Eight senior volunteers were involved in the field test. They all lived alone and were self-supporting. The robot was capable of providing cognitive assistance to manage the user's daily routine. Each participant used the robot for 94.9 ± 19.6 days. The primary communication modality was voice communication in their natural language, while the touch screen display was also available for interaction with the robot. The assistance given in daily living was evaluated by subjective (the user's opinion) and objective (logged data) criteria. The most useful and the least reliable robot functions according to the users were the navigation and the verbal communication. Entertainment, locomotion, and weather forecast were the most frequently used functions, while the shopping list was the least popular. The companion robot used in the test was accepted enthusiastically by the senior subjects. Specific robot functions (mainly navigation in the apartment and the speech recognition) require improvement to better accommodate real circumstances.

Exercising daily living activities in robot-mediated therapy.

[Purpose] Investigation of the efficacy of robot-mediated therapy of the upper limb in patients with chronic stroke, in task-oriented training activities of daily living in real environment. [Subjects and Methods] 20 patients, each more than one year post-stroke (13-71 months) received 20 sessions of upper limb robot-mediated therapy. No other treatment was given. Each therapy session consisted of a passive motion and an active task therapy. During the active therapy, subjects exercised 5 activities of daily living. Assessments of the subjects were blind, and conducted one month prior to, at the start, at the end, and three months after the therapy course. The following outcome measures were recorded: Fugl-Meyer Scale-upper extremity subsection, Modified Ashworth Scale, Action Research Arm Test, Functional Independence Measure, Barthel Index. [Results] Significant improvements were observed between the start and the end of the therapy, except for Modified Ashworth Scale and Barthel Index. Results still held up at the follow-up visit three months later. [Conclusion] Practicing activities of daily living in real environment with robot-mediated physical therapy can improve the motor and functional ability of patients, even with relatively good initial functions, and even years post-stroke.