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1.
Medicine (Baltimore) ; 99(14): e19495, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32243365

RESUMEN

INTRODUCTION: Upper extremity motor impairment is one of the major sequelae of stroke, resulting in limitations of activities of daily living. Recently, contralesional cortical activation has been reported to be important for motor recovery in stroke patients with severe upper extremity hemiparesis due to the extensive corticospinal tract involvement. We therefore designed this study to investigate the effects of contralesional anodal transcranial direct current stimulation (tDCS), which induces cortical activation, in stroke patients with severe upper extremity motor impairment. METHODS AND ANALYSIS: We will recruit patients with subacute stroke (<3 months after onset) with unilateral upper extremity weakness who meet the following criteria: Shoulder Abduction and Finger Extension (SAFE) score below 8, Fugl-Meyer Assessment for upper extremity (FMA-UE) score ≤25, and absent motor evoked potential (MEP) response on the affected extensor carpi radialis muscle. Subjects will be randomly allocated to either the intervention (n = 18) or the control group (n = 18). The intervention group will undergo 10 sessions of robotic arm rehabilitation with simultaneous anodal tDCS over the contralesional premotor area, whereas the control group will receive sham tDCS during the same sessions. One daily session consists of 25 minutes.The primary outcome measure of this study is the Fugl-Meyer Assessment score of the upper extremity; the secondary outcome measures are the Korean version of the Modified Barthel Index, the Brunnstrom stage of the affected arm and hand, the Box and Block Test, the Modified Ashworth Scale, the Manual Muscle Power Test, and the patient's encephalographic laterality index. DISCUSSION: Findings of this study will help to establish an individualized tDCS protocol according to the stroke severity and to find out the EEG parameters to predict the better recovery in subacute stroke patients with severe upper extremity hemiparesis. ETHICS AND DISSEMINATION: The study was approved by the Seoul National University Bundang Hospital Institutional Review Board (IRB No. B-1806-475-006) and will be carried out in accordance with the approved guidelines. The results of the trial will be submitted for publication in a peer-reviewed journal.


Asunto(s)
Paresia/rehabilitación , Rehabilitación de Accidente Cerebrovascular/métodos , Estimulación Transcraneal de Corriente Directa/métodos , Extremidad Superior , Actividades Cotidianas , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Método Doble Ciego , Potenciales Evocados Motores , Femenino , Lateralidad Funcional , Humanos , Masculino , Persona de Mediana Edad , Corteza Motora/fisiopatología , Recuperación de la Función , Adulto Joven
2.
Zh Nevrol Psikhiatr Im S S Korsakova ; 120(3. Vyp. 2): 16-22, 2020.
Artículo en Ruso | MEDLINE | ID: mdl-32307425

RESUMEN

Cognitive impairment is common in poststroke patients. Today in rehabilitation programs the specialists use the vestibular stimulation including biological feedback to supporting reaction for treatment poststroke cognitive impairment. These studies show the relationship of vestibular function with memory, attention, spatial orientation, navigation, mental representation of three-dimensional space and other cognitive functions. It makes possible to build rehabilitation programs for patients with stroke.


Asunto(s)
Biorretroalimentación Psicológica , Disfunción Cognitiva/complicaciones , Disfunción Cognitiva/terapia , Rehabilitación de Accidente Cerebrovascular/métodos , Accidente Cerebrovascular/complicaciones , Pruebas de Función Vestibular , Atención , Cognición , Humanos , Memoria , Percepción Espacial , Navegación Espacial
3.
Zh Nevrol Psikhiatr Im S S Korsakova ; 120(3. Vyp. 2): 23-28, 2020.
Artículo en Ruso | MEDLINE | ID: mdl-32307426

RESUMEN

Over the past decade, non-invasive brain stimulation, in particular transcranial stimulation by direct electric current (TES), has been increasingly included in the array of methods used for rehabilitation of patients with post-stroke impairments (motor, speech, cognitive). Development of stimulation protocols with determination of the zones of exposure, as well as better understanding of the patterns of restoration of functional systems, became possible due to basic research using functional MRI paradigm. However, the complexity of the organization of the speech system, the variety of forms of aphasia that occur when it is damaged, the individual variability of neuroplastic processes, motivated a search for optimal stimulation protocols that contribute to the personification of the rehabilitation process. Portability, low cost of equipment, a good safety and tolerance profile, as well as a proven effect on neuroplasticity processes, are the undoubted advantages of TES-therapy. There is reason to believe that further study and clinical testing of this technique will turn it into the promising tool for enhancing the effectiveness of classical speech therapy approaches in patients with post-stroke aphasia.


Asunto(s)
Afasia/complicaciones , Afasia/terapia , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular/complicaciones , Estimulación Transcraneal de Corriente Directa , Estimulación Magnética Transcraneal , Encéfalo/fisiología , Encéfalo/fisiopatología , Humanos , Accidente Cerebrovascular/terapia
4.
Zh Nevrol Psikhiatr Im S S Korsakova ; 120(3. Vyp. 2): 49-53, 2020.
Artículo en Ruso | MEDLINE | ID: mdl-32307430

RESUMEN

AIM: To evaluate the efficacy of including cytoflavin in rehabilitation measures in the early recovery period of patients with ischemic stroke. MATERIAL AND METHODS: Results of rehabilitation measures of 100 patients (50 women and 50 men, aged 18 to 85 years) in the early recovery period of ischemic stroke were analyzed. Psychological testing included NIHSS, MMSE, Rankin scale, Rivermead mobility index, exercise tolerance test. Depending on the rehabilitation scheme, patients were divided into the main group (n=50), who received a verticalization course and cytoflavin (intravenously, drip 20.0 ml in 250.0 ml 5% glucose for 14 days). The control group (n=50) included patients who received standard treatment. RESULTS AND CONCLUSION: Inclusion of cytoflavin in the rehabilitation scheme for patients with ischemic stroke increased the effectiveness of treatment, which was manifested by a decrease in the severity of neurological disorders assessed with NIHSS by 17.6% in the main group versus 10.8% in the control group (p<0.05) and recovery of cognitive functions assessed with MMSE by 5.8% versus 1.6%, respectively (p<0.05). In addition, there was a positive dynamics in the restoration of blood pressure (by 37.1% in the main group versus 30.6% in the control group (p<0.05)).


Asunto(s)
Isquemia Encefálica/terapia , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Presión Sanguínea/efectos de los fármacos , Isquemia Encefálica/metabolismo , Cognición/efectos de los fármacos , Combinación de Medicamentos , Femenino , Mononucleótido de Flavina/administración & dosificación , Mononucleótido de Flavina/farmacología , Mononucleótido de Flavina/uso terapéutico , Humanos , Inosina Difosfato/administración & dosificación , Inosina Difosfato/farmacología , Inosina Difosfato/uso terapéutico , Masculino , Persona de Mediana Edad , Niacinamida/administración & dosificación , Niacinamida/farmacología , Niacinamida/uso terapéutico , Accidente Cerebrovascular/metabolismo , Succinatos/administración & dosificación , Succinatos/farmacología , Succinatos/uso terapéutico , Resultado del Tratamiento , Adulto Joven
6.
Medicine (Baltimore) ; 99(11): e19512, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32176098

RESUMEN

To investigate the relationships between grip strengths and self-care activities in stroke patients using a non-linear support vector machine (SVM).Overall, 177 inpatients with poststroke hemiparesis were enrolled. Their grip strengths were measured using the Jamar dynamometer on the first day of rehabilitation training. Self-care activities were assessed by therapists using Functional Independence Measure (FIM), including items for eating, grooming, dressing the upper body, dressing the lower body, and bathing at the time of discharge. When each FIM item score was ≥6 points, the subject was considered independent. One thousand bootstrap grip strength datasets for each independence and dependence in self-care activities were generated from the actual grip strength. Thereafter, we randomly assigned the total bootstrap datasets to 90% training and 10% testing datasets and inputted the bootstrap training data into a non-linear SVM. After training, we used the SVM algorithm to predict a testing dataset for cross-validation. This validation procedure was repeated 10 times.The SVM with grip strengths more accurately predicted independence or dependence in self-care activities than the chance level (mean ±â€Šstandard deviation of accuracy rate: eating, 0.71 ±â€Š0.04, P < .0001; grooming, 0.77 ±â€Š0.03, P < .0001; upper-body dressing, 0.75 ±â€Š0.03, P < .0001; lower-body dressing, 0.72 ±â€Š0.05, P < .0001; bathing, 0.68 ±â€Š0.03, P < .0001).Non-linear SVM based on grip strengths can prospectively predict self-care activities.


Asunto(s)
Evaluación de la Discapacidad , Fuerza de la Mano , Paresia/rehabilitación , Autocuidado , Rehabilitación de Accidente Cerebrovascular , Anciano , Femenino , Humanos , Aprendizaje Automático , Masculino , Paresia/fisiopatología , Alta del Paciente , Valor Predictivo de las Pruebas
7.
Medicine (Baltimore) ; 99(10): e19121, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32150052

RESUMEN

About 11% to 13% of patients with acute dysphagia induced by stroke remain chronic dysphagia 6 months after stroke which usually leads to many severe complications and poor quality of life.To investigate the effect of transcranial direct current stimulation (tDCS) on swallowing function in the patients with chronic dysphagia after stroke.26 post-stroke patients with chronic dysphagia who received tDCS were identified by electronic medical records between July 2016 and April 2018. Of which, 13 were treated by unilateral hemispheric anodal tDCS at affected pharyngeal motor cortex. 13 eligible patients only treated by conventional therapies but without tDCS were randomly selected by matching on date of admission (±2 weeks) of the patients receiving unilateral tDCS. The swallowing function and quality of life were evaluated before and 2 weeks after treatment.The patients in three groups were comparable. The swallowing function and quality of life of the patients in all the 3 groups had been improved over time. Comparing to the group without tDCS, both the groups with unilateral or bilateral tDCS had shorter oral transit time (1.69 ±â€Š0.95, 0.97 ±â€Š0.71 seconds, respectively) and higher scores of quality of life (159.76 ±â€Š12.59, 179.69 ±â€Š11.81, respectively) after treatment.Both unilateral and bilateral hemispheric anodal tDCS combined with conventional therapies are helpful for recovery of swallowing function in patients with chronic dysphagia induced by stroke, but bilateral anodal tDCS substantially improve more.


Asunto(s)
Trastornos de Deglución/terapia , Corteza Motora/fisiopatología , Rehabilitación de Accidente Cerebrovascular , Estimulación Transcraneal de Corriente Directa , Estudios de Cohortes , Trastornos de Deglución/fisiopatología , Trastornos de Deglución/psicología , Femenino , Humanos , Masculino , Registros Médicos , Persona de Mediana Edad , Calidad de Vida , Estudios Retrospectivos , Resultado del Tratamiento
8.
Brain Nerve ; 72(3): 203-213, 2020 Mar.
Artículo en Japonés | MEDLINE | ID: mdl-32152254

RESUMEN

The author (hereafter referred to as I) is a speech-language-hearing pathologist and former professor of neuropsychology at Kobe University, who had been engaged in neuropsychological rehabilitation and research of conditions, such as aphasia and unilateral spatial neglect, for 37 years. In July 2009, I experienced right hemispheric infarction in Kobe City, and developed left-sided hemiparesis and various symptoms of cognitive dysfunctions, which was previously my field of expertise. As a neuropsychological rehabilitation expert, I focused my efforts on recovery and I have recovered the majority of my cognitive and neurologic functions. This is my story of recovery from stroke, in which functional magnetic resonance imaging (fMRI) studies of my arithmetic ability are described. I had been an excellent abacus user with brilliant achievements since elementary school. Premorbidly, I could use the right hemisphere of my brain to visualize a clear image of an abacus. However, my ability to visualize the abacus disappeared following the stroke. Two experiments were conducted involving calculation and digit memory tasks using fMRI. This may be the most important aspect of my story. My recovery process for other cognitive deficits is also delineated here.


Asunto(s)
Mapeo Encefálico , Encéfalo/diagnóstico por imagen , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular , Encéfalo/fisiopatología , Humanos , Imaginación , Imagen por Resonancia Magnética , Memoria , Pruebas Neuropsicológicas
9.
Am J Phys Med Rehabil ; 99(4): 330-337, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32195716

RESUMEN

OBJECTIVE: The aims of the study were to investigate the kinetic effects of sit-to-stand training in various foot positions on the coronal plane in patients with strokes and to suggest appropriate exercises. DESIGN: Thirty-six poststroke subjects participated in this study. The subjects performed three sit-to-stand trials in the following foot positions: (a) symmetric foot positioning (symmetric), (b) affected foot placed to the side (asymmetric 1), and (c) and less affected foot placed to the side (asymmetric 2). They were asked to perform sit-to-stand training at a spontaneous velocity and remain standing for 5 secs, whereas the vertical ground reaction force was measured using force platforms. The activation of lower limb muscles was evaluated using surface electromyography, and the peak and mean vertical ground reaction force and weight-bearing symmetry ratio were evaluated using force platforms. RESULTS: Our results showed significant increases in the muscle activation, peak and mean vertical ground reaction force, and weight-bearing symmetry ratio of the lower limbs using the asymmetric 2 strategy (P < 0.05). CONCLUSIONS: Our results suggest that sit-to-stand training with the less affected foot placed to the side by the width of the subject's foot may be the most beneficial in the rehabilitation of patients with hemiparetic stroke.


Asunto(s)
Hemiplejía/rehabilitación , Posicionamiento del Paciente/métodos , Rehabilitación de Accidente Cerebrovascular/métodos , Accidente Cerebrovascular/fisiopatología , Electromiografía , Femenino , Pie/fisiopatología , Hemiplejía/etiología , Hemiplejía/fisiopatología , Humanos , Cinética , Extremidad Inferior/fisiopatología , Masculino , Persona de Mediana Edad , Postura , Accidente Cerebrovascular/complicaciones , Soporte de Peso
10.
Medicine (Baltimore) ; 99(9): e19386, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32118788

RESUMEN

Case-control studies have shown that noxious thermal stimulation (TS) can improve arm function in patients with stroke. However, the neural mechanisms underlying this improvement are largely unknown. We explored functional neural activation due to noxious and innocuous TS intervention applied to the paretic arm of patients with stroke. Sixteen participants with unilateral cortical infarctions were allocated to one of two groups: noxious TS (8 patients; temperature combination: hot pain 46°C to 47°C, cold pain 7°C-8°C) or innocuous TS (n = 8; temperature combination: hot 40°C-41°C, cold 20°C-21°C). All subjects underwent fMRI scanning before and after 30 min TS intervention and performed a finger tapping task with the affected hand. Immediate brain activation effects were assessed according to thermal type (noxious vs. innocuous TS) and time (pre-TS vs post-TS). Regions activated by noxious TS relative to innocuous TS (P < .05, adjusted for multiple comparisons) were related to motor performance and sensory function in the bilateral primary somatosensory cortices, anterior cingulate cortex, insula, thalamus, hippocampus and unilateral primary motor cortex, secondary somatosensory cortex at the contralateral side of lesion, and unilateral supplementary motor area at the ipsilateral side of lesion. Greater activation responses were observed in the side contralateral to the lesion, suggesting a significant intervention effect. Our preliminary findings suggest that noxious TS may induce neuroplastic changes unconstrained to the local area.Trial registration: NCT01418404.


Asunto(s)
Calor/uso terapéutico , Estimulación Física/métodos , Rehabilitación de Accidente Cerebrovascular/métodos , Adulto , Anciano , Análisis de Varianza , Estudios de Casos y Controles , Femenino , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Estimulación Física/instrumentación , Accidente Cerebrovascular/fisiopatología , Accidente Cerebrovascular/terapia , Rehabilitación de Accidente Cerebrovascular/instrumentación
11.
12.
Nihon Ronen Igakkai Zasshi ; 57(1): 45-52, 2020.
Artículo en Japonés | MEDLINE | ID: mdl-32074560

RESUMEN

AIM: To clarify risk factors for aspiration pneumonia and the effects of aspiration pneumonia on the recovery after stroke in elderly stroke patients in a convalescent rehabilitation ward. METHODS: We conducted a retrospective study of 463 stroke patients with dysphagia who were ≥65 years of age (mean age, 80.2±8.1 years) who were admitted to our convalescent rehabilitation ward. Information was obtained from medical charts. A multivariate analysis was performed to clarify risk factors for aspiration pneumonia and the association between aspiration pneumonia and increased functional oral intake scale and functional independence measure motor scores. For the increase in functional independence measure motor score, values of ≥16 points and ≤15 points were coded as 1 and 0, respectively. RESULTS: Aspiration pneumonia developed in 52 patients. The multivariate analysis revealed that male sex (odds ratio [OR] 3.07, 95% confidence interval [CI] 1.59-5.95, p<0.001), geriatric nutritional risk index (OR for one unit increase 0.94, 95% CI 0.90-0.97, p<0.001) and tube feeding (OR 3.89, 95% CI 1.71-8.83, p=0.001) on admission were significant predictors of aspiration pneumonia. Aspiration pneumonia was associated with increased functional oral intake scale scores (OR 0.29, 95% CI 0.12-0.66, P=0.003) and increased functional independence measure motor scores (OR 0.23, 95% CI 0.09-0.55, P=0.001). CONCLUSIONS: Male sex, undernutrition and tube feeding on admission are risk factors for aspiration pneumonia. Aspiration pneumonia is suggested to be associated with recovery of the oral intake of food and activities of daily living.


Asunto(s)
Neumonía por Aspiración , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular , Actividades Cotidianas , Anciano , Anciano de 80 o más Años , Humanos , Masculino , Neumonía por Aspiración/etiología , Estudios Retrospectivos , Factores de Riesgo , Accidente Cerebrovascular/complicaciones
13.
Sheng Wu Yi Xue Gong Cheng Xue Za Zhi ; 37(1): 129-135, 2020 Feb 25.
Artículo en Chino | MEDLINE | ID: mdl-32096386

RESUMEN

In order to stimulate the patients' active participation in the process of robot-assisted rehabilitation training of stroke patients, the rehabilitation robots should provide assistant torque to patients according to their rehabilitation needs. This paper proposed an assist-as-needed control strategy for wrist rehabilitation robots. Firstly, the ability evaluation rules were formulated and the patient's ability was evaluated according to the rules. Then the controller was designed. Based on the evaluation results, the controller can calculate the assistant torque needed by the patient to complete the rehabilitation training task and send commands to motor. Finally, the motor is controlled to output the commanded value, which assists the patient to complete the rehabilitation training task. The control strategy was implemented to the wrist function rehabilitation robot, which could achieve the training effect of assist-as-needed and could avoid the surge of assistance torque. In addition, therapists can adjust multiple parameters in the ability evaluation rules online to customize the difficulty of tasks for patients with different rehabilitation status. The method proposed in this paper does not rely on the information from force sensor, which reduces development costs and is easy to implement.


Asunto(s)
Robótica , Rehabilitación de Accidente Cerebrovascular/instrumentación , Muñeca/fisiología , Humanos , Modalidades de Fisioterapia
14.
Sheng Wu Yi Xue Gong Cheng Xue Za Zhi ; 37(1): 169-173, 2020 Feb 25.
Artículo en Chino | MEDLINE | ID: mdl-32096391

RESUMEN

Neurological damage caused by stroke is one of the main causes of motor dysfunction in patients, which brings great spiritual and economic burdens for society and families. Motor imagery is an important assisting method for the rehabilitation of patients after stroke, which is easy to learn with low cost and has great significance in improving the motor function and the quality of patient's life. This paper mainly summarizes the positive effects of motor imagery on post-stroke rehabilitation, outlines the physiological performance and theoretical model of motor imagery, the influencing factors of motor imagery, the scoring criteria of motor imagery and analyzes the shortcomings such as the few kinds of experimental subject, the subjective evaluation method and the low resolution of the experimental equipment in the process of rehabilitation of motor function in post-stroke patients. It is hopeful that patients with stroke will be more scientifically and effectively using motor imagery therapy.


Asunto(s)
Imágenes en Psicoterapia , Rehabilitación de Accidente Cerebrovascular/psicología , Accidente Cerebrovascular/terapia , Humanos , Recuperación de la Función
15.
Medicina (B Aires) ; 80(1): 54-68, 2020.
Artículo en Español | MEDLINE | ID: mdl-32044742

RESUMEN

It is estimated that two thirds of people who have suffered a stroke have sequels that condition their quality of life. The rehabilitation of the stroke is a complex process, which requires the multidisciplinary approach of specialized professionals (doctors, kinesiologists, nurses, occupational therapists, phonoaudiologists, neuropsychologists and nutritionists). Currently, the practices carried out are a consequence of the combination of evidence and consensus, most of them through international stroke rehabilitation guides. The objective of this review is to adjust the international recommendations on stroke rehabilitation to what is applied to daily practice, in order to unify the criteria of the recommendations and to reduce the variability of the practices carried out. This work is a review of the literature on stroke rehabilitation guides developed in the last 10 years. Each section was supervised by different professionals specialized in these areas. We analyze the time and organization necessary to develop rehabilitation, recommendations for motor, cognitive and visual rehabilitation, the management of dysphagia and nutrition, the approach of comorbidities (venous thrombosis, skin ulcers, pain, psychiatric disorders and osteoporosis) and the necessary tasks to favor the return to the activities of daily life.


Asunto(s)
Rehabilitación de Accidente Cerebrovascular/métodos , Accidente Cerebrovascular/fisiopatología , Adulto , Disfunción Cognitiva/fisiopatología , Disfunción Cognitiva/rehabilitación , Humanos , Atención Dirigida al Paciente/métodos , Factores de Riesgo
16.
Neuron ; 105(4): 604-620, 2020 02 19.
Artículo en Inglés | MEDLINE | ID: mdl-32078796

RESUMEN

Stroke is one of the leading causes of long-term disability. Advanced technological solutions ("neurotechnologies") exploiting robotic systems and electrodes that stimulate the nervous system can increase the efficacy of stroke rehabilitation. Recent studies on these approaches have shown promising results. However, a paradigm shift in the development of new approaches must be made to significantly improve the clinical outcomes of neurotechnologies compared with those of traditional therapies. An "evolutionary" change can occur only by understanding in great detail the basic mechanisms of natural stroke recovery and technology-assisted neurorehabilitation. In this review, we first describe the results achieved by existing neurotechnologies and highlight their current limitations. In parallel, we summarize the data available on the mechanisms of recovery from electrophysiological, behavioral, and anatomical studies in humans and rodent models. Finally, we propose new approaches for the effective use of neurotechnologies in stroke survivors, as well as in people with other neurological disorders.


Asunto(s)
Estimulación Encefálica Profunda/métodos , Destreza Motora/fisiología , Plasticidad Neuronal/fisiología , Recuperación de la Función/fisiología , Corteza Sensoriomotora/fisiología , Rehabilitación de Accidente Cerebrovascular/métodos , Estimulación Encefálica Profunda/instrumentación , Humanos , Enfermedades del Sistema Nervioso/diagnóstico por imagen , Enfermedades del Sistema Nervioso/fisiopatología , Enfermedades del Sistema Nervioso/rehabilitación , Rehabilitación Neurológica/instrumentación , Rehabilitación Neurológica/métodos , Corteza Sensoriomotora/diagnóstico por imagen , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/fisiopatología , Accidente Cerebrovascular/terapia , Rehabilitación de Accidente Cerebrovascular/instrumentación
19.
Am J Occup Ther ; 74(1): 7401205050p1-7401205050p14, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32078516

RESUMEN

IMPORTANCE: Despite advancements in stroke rehabilitation research, occupational therapy practitioners still face challenges with implementing research into routine practice. Although the development of evidence-based practices (EBPs) is one critical step along the knowledge translation continuum for the population of people with stroke, research is also needed to identify the most effective strategies for implementing EBPs with stroke survivors who are receiving occupational therapy services. OBJECTIVE: To synthesize research related to occupational therapy practitioners' implementation of EBPs in adult stroke rehabilitation. DATA SOURCES: We searched four electronic databases-CINAHL, MEDLINE, PubMed, and Academic Search Complete-and the peer-reviewed journal Implementation Science to identify relevant research studies. STUDY SELECTION AND DATA COLLECTION: Studies that met the following inclusion criteria were included in the scoping review: published between January 2003 and January 2018, addressed the adult stroke population, and examined the implementation of occupational therapy interventions. Data were abstracted on the basis of recommendations from the seminal review framework established by Arksey and O'Malley (2005). Thematic analysis identified themes that emerged from the included studies. FINDINGS: Twenty-five articles satisfied our inclusion parameters. Our analyses yielded three overarching themes: barriers to implementation, facilitators of implementation, and implementation strategies. Implementation strategies often consisted of multimodal knowledge translation training programs. CONCLUSION AND RELEVANCE: Although the stroke rehabilitation literature appears to have established the barriers to and facilitators of EBP implementation, greater attention to the identification of effective implementation strategies that promote the uptake of EBPs by occupational therapy practitioners is needed. WHAT THIS ARTICLE ADDS: This article summarizes the contextual factors and effective strategies that may influence practitioners' implementation of stroke research findings in real-world practice.


Asunto(s)
Terapia Ocupacional , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular , Adulto , Práctica Clínica Basada en la Evidencia , Humanos , Accidente Cerebrovascular/fisiopatología , Investigación en Medicina Traslacional
20.
Med Clin North Am ; 104(2): 199-211, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32035564

RESUMEN

This article summarizes stroke rehabilitation, with a particular focus on rehabilitation from acute diagnosis to chronic impairments of stroke. The emphasis is on both pharmacologic and nonpharmacologic intervention and interdisciplinary collaboration.


Asunto(s)
Comunicación Interdisciplinaria , Manejo de Atención al Paciente/métodos , Rehabilitación de Accidente Cerebrovascular/métodos , Humanos
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