RESUMO
OBJECTIVE: The objective of this study was to analyze the safety and efficacy of using a robotic hip exoskeleton designed by Samsung Electronics Co., Ltd., Korea, called the Gait Enhancing and Motivating System-Hip (GEMS-H), in assistance mode only with the poststroke population in an outpatient-rehabilitation setting. METHODS: Forty-one participants with an average age of 60 and average stroke latency of 6.5 years completed this prospective, single arm, interventional, longitudinal study during the COVID-19 pandemic. Significant modifications to the traditional outpatient clinical environment were made to adhere to organizational physical distancing policies as well as guidelines from the Centers for Disease Control. All participants received gait training with the GEMS-H in assistance mode for 18 training sessions over the course of 6-8 weeks. Performance-based and self-reported clinical outcomes were assessed at four time points: baseline, midpoint (after 9 training sessions), post (after 18 training sessions), and 1-month follow up. Daily step count was also collected throughout the duration of the study using an ankle-worn actigraphy device. Additionally, corticomotor excitability was measured at baseline and post for 4 bilateral lower limb muscles using transcranial magnetic stimulation. RESULTS: By the end of the training program, the primary outcome, walking speed, improved by 0.13 m/s (p < 0.001). Secondary outcomes of walking endurance, balance, and functional gait also improved as measured by the 6-Minute Walk Test (47 m, p < 0.001), Berg Balance Scale (2.93 points, p < 0.001), and Functional Gait Assessment (1.80 points, p < 0.001). Daily step count significantly improved with and average increase of 1,750 steps per day (p < 0.001). There was a 35% increase in detectable lower limb motor evoked potentials and a significant decrease in the active motor threshold in the medial gastrocnemius (-5.7, p < 0.05) after training with the device. CONCLUSIONS: Gait training with the GEMS-H exoskeleton showed significant improvements in walking speed, walking endurance, and balance in persons with chronic stroke. Day-to-day activity also improved as evidenced by increased daily step count. Additionally, corticomotor excitability changes suggest that training with this device may help correct interhemispheric imbalance typically seen after stroke. TRIAL REGISTRATION: This study is registered with ClinicalTrials.gov (NCT04285060).
Assuntos
Exoesqueleto Energizado , Reabilitação do Acidente Vascular Cerebral , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Marcha/fisiologia , Quadril , Estudos Longitudinais , Pacientes Ambulatoriais , Estudos Prospectivos , Acidente Vascular Cerebral , Reabilitação do Acidente Vascular Cerebral/instrumentação , Reabilitação do Acidente Vascular Cerebral/métodos , Estimulação Magnética Transcraniana/instrumentação , Resultado do TratamentoRESUMO
OBJECTIVE: Interlimb coordination during walking is impaired after stroke, with unknown effects on walking function. This cross-sectional study determined associations of interlimb coordination and temporal symmetry with walking function and motor impairment. DESIGN: During walking, participants wore wireless sensors to detect heel strikes. We calculated interlimb coordination as the phase coordination index and temporal symmetry as the ratio of contralesional (i.e., paretic) to ipsilesional (i.e., non-paretic) stance times. Associations with walking speed (10-meter walk test), walking endurance (6-minute walk test), dynamic balance (Mini Balance Evaluation Systems Test), and motor impairment (Fugl Meyer Lower Extremity assessment) were assessed. RESULTS: 56 individuals with chronic stroke were tested. Worse interlimb coordination was correlated with slower comfortable (R = -0.38, p = 0.004) and maximal (R = -0.36, p = 0.006) walking speed and worse motor function (R = -0.45, p = 0.001). Worse temporal symmetry was correlated with worse motor function (R = 0.39, p = 0.004). Interlimb coordination had stronger associations than temporal symmetry with comfortable (R: -0.38 vs. 0.08) and maximal walking speeds (R: -0.36 vs. 0.12). CONCLUSION: Poor interlimb coordination was associated with slow walking and motor impairment and had stronger associations with walking speeds than temporal symmetry did. Interlimb coordination may provide unique insights into walking function and a target for walking rehabilitation after stroke.
RESUMO
BACKGROUND: Women have a higher risk of stroke and related disability than men but are underrepresented in stroke clinical trials. Identifying modifiable recruitment and enrollment barriers for women can improve study generalizability, statistical power, and resource utilization. OBJECTIVE: In a post-stroke neuromodulation study, we determined the impact of sex on the occurrence of exclusion criteria and compared the sex distribution of screened and enrolled individuals with a broader stroke-affected population. METHODS: A total of 335 individuals with chronic stroke were screened for a study examining how neuromodulation and high-intensity treadmill training affect walking speed and corticomotor excitability. Demographics and exclusions were retrospectively gathered as a secondary dataset. Exclusion criteria consisted of 6 categories (not target population, unable to do treadmill protocol, unable to do non-invasive brain stimulation, insufficient ankle motion and disinterest, and cognitive impairment). Incidence of each exclusion criterion was compared between women and men. The sex distribution was compared to a dataset from Chicago primary stroke centers. RESULTS: A total of 81 individuals were enrolled and 254 were not. The percentage of women excluded was significantly greater than that of men (P = .04). No individual exclusion criterion or categories excluded women more frequently than men. Screened and enrolled individuals had a lower proportion of women and younger age than a representative stroke population (P < .001). CONCLUSIONS: We identified exclusion criteria (ie, headaches, cognitive scores, and age) that are modifiable barriers to enrollment of women in this post-stroke neuromodulation study. Addressing underrepresentation of women in stroke research is pivotal for enhancing generalizability, achieving statistical power, and optimizing resources.
Assuntos
Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Masculino , Humanos , Feminino , Reabilitação do Acidente Vascular Cerebral/métodos , Estudos Retrospectivos , Acidente Vascular Cerebral/terapia , Acidente Vascular Cerebral/complicações , Caminhada , Velocidade de CaminhadaRESUMO
PURPOSE: Action observation training (AOT) is a therapeutic approach used in stroke rehabilitation. Videos form the core of AOT, and knowledge of constituent parameters is essential to make the intervention robust and generalizable. Currently, there is a dearth of available information on video parameters to be used for AOT. Our purpose was to identify and describe the parameters that constitute AOT videos for stroke rehabilitation. METHOD: Electronic databases like PubMed, CINAHL, Scopus, Web of Science, ProQuest, and Ovid SP from inception to date according to PRISMA-ScR guidelines. Title, abstract, and full-text screening were done independently by two authors, with a third author for conflict resolution. Data on video parameters like length, quality, perspective, speed, screen size and distance, sound, and control videos were extracted. RESULTS: Seventy studies were included in this review. The most-reported parameters were video length (85.71%) and perspective of view (62.85%). Movement speed (7.14%) and sound (8.57%) were the least reported. Static landscapes or geometrical patterns were found suitable as control videos. CONCLUSION: Most video parameters except for length and perspective of view remain underreported in AOT protocols. Future studies with better descriptions of video parameters are required for comprehensive AOT interventions and result generalisation.
Videos shorter than 5 min may be preferred during action observation training (AOT) intervention in post-stroke.Egocentric view may be better for upper limb dexterity function and allocentric view for gross actions like walking.Choice of video disseminating device depends on its dimension as well as observer distance.Movement speed, video sound, and quality must be considered to obtain more comprehensive AOT videos.
Assuntos
Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Humanos , Reabilitação do Acidente Vascular Cerebral/métodos , Movimento , Acidente Vascular Cerebral/terapiaRESUMO
BACKGROUND: Walking speed is often measured with a stopwatch throughout stroke recovery. Wearable sensors also have been used recently to measure walking speed and provide information about spatiotemporal characteristics of walking. RESEARCH QUESTION: Do walking speeds measured with stopwatch and APDM wearable sensors have concurrent validity? METHODS: Individuals with chronic stroke (n = 62) performed the 10-meter walk test at comfortable and maximal speeds. Walking speeds were measured with a stopwatch and APDM Opal wireless wearable sensors (3-unit). Tests of concurrent validity between stopwatch and APDM (Bland-Altman plots, systematic and proportional bias, and intraclass correlations) and test-retest reliability between trials (intraclass correlations, standard error of measurement, and minimal detectable change) were performed. RESULTS: Walking speeds measured with APDM were â¼0.07 m/s slower than those measured with stopwatch (systematic bias; t ≥ 13.1, p < 0.001). Intraclass correlations ranged from poor to excellent. There were greater differences in walking speeds between APDM and stopwatch for individuals with faster walking speeds (proportional bias). Test-retest reliability was excellent for both APDM and stopwatch (intraclass correlation≥0.94). Standard error of measurement ranged from 0.04 to 0.07 m/s and minimal detectable change ranged from 0.10 to 0.19 m/s. SIGNIFICANCE: It may be inappropriate to use walking speed measurements from APDM sensors and stopwatch interchangeably in individuals with chronic stroke. Differences in walking speeds may reflect stopwatch error or the derivation of walking speed from wearable sensors. Test-retest reliability was excellent for both stopwatch and APDM, but minimal detectable change values were large. Large changes in walking speed may be required to be confident that the change is a true and clinically meaningful change and not measurement error. The validity and reliability of measuring walking speed with wearable sensors in individuals with chronic stroke has important implications for determining community ambulation, assessing improvements after rehabilitation, and developing exercise prescriptions.
Assuntos
Acidente Vascular Cerebral , Dispositivos Eletrônicos Vestíveis , Humanos , Velocidade de Caminhada , Teste de Caminhada , Reprodutibilidade dos Testes , Caminhada , MarchaRESUMO
PURPOSE: Muscle activation often occurs in muscles ipsilateral to a voluntarily activated muscle and to a greater extent after stroke. In this study, we measured muscle activation in non-target, ipsilateral leg muscles and used transcranial magnetic stimulation (TMS) to provide insight into whether corticomotor pathways contribute to involuntary activation. MATERIALS AND METHODS: Individuals with stroke performed unilateral isometric ankle dorsiflexion, ankle plantarflexion, knee extension, and knee flexion. To quantify involuntary muscle activation in non-target muscles, muscle activation was measured during contractions from the ipsilateral tibialis anterior (TA), medial gastrocnemius (MG), rectus femoris (RF), and biceps femoris (BF) and normalized to resting muscle activity. To provide insight into mechanisms of involuntary non-target muscle activation, TMS was applied to the contralateral hemisphere, and motor evoked potentials (MEPs) were recorded. RESULTS: We found significant muscle activation in nearly every non-target muscle during isometric unilateral contractions. MEPs were frequently observed in non-target muscles, but greater non-target MEP amplitude was not associated with greater non-target muscle activation. CONCLUSIONS: Our results suggest that non-target muscle activation occurs frequently in individuals with chronic stroke. The lack of association between non-target TMS responses and non-target muscle activation suggests that non-target muscle activation may have a subcortical or spinal origin. Non-target muscle activation has important clinical implications because it may impair torque production, out-of-synergy movement, and muscle activation timing.
RESUMO
Cross-education, a phenomenon where unilateral strength (or skill) training enhances strength (or skill) in the contralateral untrained limb, has been well studied in able-bodied individuals. Cross-education effect accompanies bilateral changes of corticomotor activity in the motor cortex (M1). Recent reports demonstrated greater cross-education effect in stroke survivors compared to healthy individuals, however, corticomotor responses to cross-education in stroke remains unclear. This study aimed to determine the effects of non-paretic leg movements on corticomotor excitability (CME) and reaction time of the paretic leg in severely impaired stroke survivors. Seventeen post stroke individuals with severe leg motor impairment (Fugl-Meyer lower extremity score less than 21 and absence of motor evoked potential in the paretic leg) performed three 20-min motor trainings using their non-paretic ankle: skill (targeted dynamic movements), strength (isometric resistance) and sham (sub-threshold electrical nerve stimulation). During training, verbal instructions were given to the participants to limit their movement to the non-paretic leg and this was confirmed with visual observation of the paretic leg. Transcranial magnetic stimulation measured CME of the contralateral pathways from the non-lesioned M1 to the non-paretic tibialis anterior (TA) muscle, ipsilateral pathways to the paretic TA and transcallosal inhibition (TCI) from the non-lesioned to lesioned M1. Paretic ankle reaction time was measured using a reaction time paradigm. All outcomes were measured before, immediately post, 30-min post and 60-min post priming. CME of the non-paretic TA increased after skill (.08 ± .10 mV) and strength (.06 ± .05 mV) training (p < .01). Ipsilateral CME of the paretic TA (.02 ± .01 mV) and TCI (.01 ± .01 s, ipsilateral silent period; more inhibition to the lesioned M1) increased after skill (p < .05) but not strength training. Reaction time of the paretic ankle improved after skill and strength training (-.11 ± .2 and -.13 ± .20 s, respectively; p < .05) and was sustained at 60 min. No changes were observed during the sham condition. Our findings may inform future studies for using non-paretic leg movements as a priming modality, especially for those who are contraindicated to other priming paradigms (e.g., brain stimulation) or unable to perform paretic leg movements. Conclusion: Non-paretic leg movements can be used as a priming modality, especially for those who are contraindicated to other priming paradigms (e.g., brain stimulation) or unable to perform paretic leg movements.
Assuntos
Transtornos Motores , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Humanos , Perna (Membro)/fisiologia , Acidente Vascular Cerebral/complicações , Extremidade Inferior , Estimulação Magnética Transcraniana , Potencial Evocado Motor/fisiologiaRESUMO
Objectives: The purpose of this systematic review is to analyze primary studies investigating the effects of telerehabilitation on walking outcomes for the treatment of adult stroke survivors. Methods: Data sources included PubMed, Embase and CINAHL searched until August 2022, using combinations of several keywords such as "telerehabilitation", "stroke", and "gait". Studies were required to have bidirectional form of videoconferencing with assessor presence, and include assessment of walking function (speed, endurance and/or balance). Data extraction was performed from each full text by one author, and quality and bias were assessed using the Physiotherapy Evidence Database (PEDro). Results: Eight studies involving 248 participants met the inclusion criteria. Seven reported significant improvements in outcomes of balance and two showed improvements in endurance after telerehabilitation. Two studies observed greater balance improvements in the telerehabilitation group compared to control and/or in-person therapy. Differences in frequency, training duration, intervention type, and absence of an in-person therapy control group were identified as causes of variation between studies. Conclusions: The effectiveness of telerehabilitation as a mode of therapy for walking could not be definitively determined due to the limited number of studies that directly measured walking speed or endurance. However, strong evidence was found for the use of telerehabilitation for balance improvements, which has implications for walking recovery. Impact statement: Telerehabilitation appears to be safe, feasible and demonstrated high adherence. Our results highlighted limited studies using real-time supervision to administer telerehabilitation and lack of studies focusing on outcomes of walking speed and endurance, needed to fully determine the role of telerehabilitation for gait recovery. Systematic review registration number: PROSPERO number CRD42021238197.
RESUMO
BACKGROUND: Transcranial direct current stimulation (tDCS) has been demonstrated to facilitate motor performance in healthy individuals; however, results are variable. The neuromodulatory effects of tDCS during visuomotor tasks may be influenced by extrinsic visual feedback. However, this interaction between tDCS and visual feedback has not been explored for the lower limb. Hence, our objective was to explore if tDCS over the primary lower limb motor cortex differentially facilitates motor performance based on the availability of visual feedback. METHODS: Twenty-two neurotypical adults performed ankle plantarflexion and dorsiflexion movements while tracking a sinusoidal target. Spatiotemporal, spatial, and temporal error were calculated between the ankle position and target. Participants attended two sessions, a week apart, with (Stim) and without (No-Stim) anodal tDCS. Sessions were divided into two blocks containing randomized visual feedback conditions: full, no, and blindfold. During Stim sessions, the first block included the application of tDCS to the lower limb M1. RESULTS: Spatiotemporal and spatial error increased as feedback faded (p < .001). A two-way repeated-measures analysis of variance showed a significant interaction between tDCS and visual feedback (p < .05) on spatiotemporal error. Post hoc analyses revealed a significant improvement in spatiotemporal error when visual feedback was absent (p < .01). Spatial and temporal errors were not significantly affected by stimulation or visual feedback. DISCUSSION: Our results suggest that tDCS enhances spatiotemporal ankle motor performance only when visual feedback is not available. These findings indicate that visual feedback may play an important role in demonstrating the effectiveness of tDCS.
Assuntos
Tornozelo , Estimulação Transcraniana por Corrente Contínua , Adulto , Humanos , Tornozelo/fisiologia , Estimulação Transcraniana por Corrente Contínua/métodos , Retroalimentação Sensorial , Extremidade Inferior/fisiologia , Articulação do TornozeloRESUMO
Current stroke rehabilitation interventions focus on intensive task specific training of the paretic limb, which may not be feasible for individuals with higher levels of impairment or in the early phase of stroke. Cross-education, a mechanism that improves strength or skill of the untrained limb following unilateral motor training, has high clinical relevance for stroke rehabilitation. Despite its potential benefits, our knowledge on the application and efficacy of cross-education in stroke is limited. We performed a scoping review to synthesize the current evidence regarding neurophysiological and motor effects of cross-education training in stroke. Low to strong evidence from five studies demonstrated strength gains ranging from 31-200% in the untrained paretic limb following non-paretic muscle training. Neurophysiological mechanisms underlying cross-education were unclear as the three studies that used transcranial magnetic stimulation to probe functional connectivity demonstrated mixed results in low sample size. Our review suggests that cross-education is a promising clinical approach in stroke, however high quality studies focusing on neurophysiological mechanisms are required to establish the efficacy and underlying mechanisms of cross-education in stroke. Recommendations regarding future directions and clinical utility are provided.
Assuntos
Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Humanos , Acidente Vascular Cerebral/complicações , Extremidade Superior , Adaptação Fisiológica , Estimulação Magnética Transcraniana/métodosRESUMO
BACKGROUND: Higher gait variability after stroke increases risk of falls and compromises safe community ambulation. Corticomotor connectivity plays an important role in walking after stroke, however, its relation to gait variability remains unknown. RESEARCH QUESTION: Do corticomotor characteristics of the proximal and distal lower limb muscles predict gait variability in individuals with chronic stroke? METHODS: Retrospective analysis of data from 30 individuals with chronic stroke was conducted. Corticomotor characteristics were measured in the paretic and non-paretic tibialis anterior (TA, distal muscle) and rectus femoris (RF, proximal muscle) using transcranial magnetic stimulation. We calculated corticomotor excitability ratio of paretic TA and RF (CMETA/RF), corticomotor excitability symmetry (CMEsym) between hemispheres for the TA and RF, and ipsilateral corticomotor excitability (ICE) of the paretic TA. Gait variability was quantified as the coefficient of variation of the paretic step length (spatial) and step time (temporal) during comfortable walking. Relations between corticomotor characteristics and gait variability were tested with multiple linear regression. RESULTS: CMETA/RF and CMEsym of RF were significant predictors of spatial gait variability. Greater corticomotor input to the paretic RF compared to the paretic TA and greater symmetry of RF were related to higher spatial gait variability. There were no significant predictors of temporal gait variability. SIGNIFICANCE: Corticomotor inputs to the proximal RF may be important for spatial gait variability, reflecting a compensatory role of RF in walking after stroke. Stroke survivors with relatively greater corticomotor input to the paretic RF may adopt compensatory strategy to enhance propulsion and achieve foot clearance, but it may also increase spatial gait variability, particularly when combined with impaired motor control of the paretic TA. These findings may provide novel rehabilitative targets to decrease gait variability and promote safe ambulation in individuals with stroke.
Assuntos
Córtex Motor , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Humanos , Paresia/etiologia , Córtex Motor/fisiologia , Estudos Retrospectivos , Marcha/fisiologia , Acidente Vascular Cerebral/complicações , Extremidade Inferior , Caminhada/fisiologia , Músculo Esquelético/fisiologiaRESUMO
BACKGROUND: Motor evoked potentials (MEPs) induced via transcranial magnetic stimulation (TMS) demonstrate trial-to-trial variability limiting detection and interpretation of changes in corticomotor excitability. This study examined whether performing a cognitive task, voluntary breathing, or static stretching before TMS could reduce MEP variability. METHODS: 20 healthy young adults performed no-task, a cognitive task (Stroop test), deep breathing, and static stretching before TMS in a randomized order. MEPs were collected in the non-dominant tibialis anterior muscle at 130% active motor threshold. Variability of MEP amplitude was quantified as coefficient of variation (CV). RESULTS: MEP CV was greater after no-task (25.4 ± 7.0) than after cognitive task (23.3 ± 7.2; p < 0.05), deep breathing (20.1 ± 6.3; p < 0.001), and static stretching (20.9 ± 6.0; p = 0.004). MEP CV was greater after cognitive task than after deep breathing (p = 0.007) and static stretching (p = 0.01). There was no effect of condition on MEP amplitude. CONCLUSIONS: Performing brief cognitive, voluntary breathing, and stretching tasks before TMS can reduce MEP variability with no effect on MEP amplitude in the tibialis anterior of healthy, young adults. Similar tasks could be incorporated into research and clinical settings to improve detection of changes, normative data, and clinical predictions.
Assuntos
Córtex Motor , Exercícios de Alongamento Muscular , Adulto Jovem , Humanos , Potencial Evocado Motor/fisiologia , Estimulação Magnética Transcraniana , Córtex Motor/fisiologia , Eletromiografia , Músculo Esquelético/fisiologia , CogniçãoRESUMO
Migration research tends to treat childrearing as a secondary role for migrants. By prioritising the economic objectives of migration, most models present migrants as either delaying childbearing or, if they have young children, not living with them. However, migration has become increasingly feminised, the types of mobility more varied, while the returns to migration remain uncertain at best. At the same time, norms around childrearing are shifting, and the capacity of kin to take care of children may be weakening. In such contexts, migrants may not want to or be able to be separated from their children. Confronting such difficult decisions and their consequences may be reflected in poor sleep health for the migrant parent. We draw on data from the Migration and Health Follow-Up Study (MHFUS) in South Africa to examine the following questions: (i) To what extent is children's coresidence associated with sleep health for migrant parents? (ii) Do effects vary by sex of migrant? and (iii) Do effects vary by location of migrant? Results from propensity score matching confirm that migrants who coreside with all their young children are more likely to experience healthy sleep compared to those who have nonresident or no young children. However, stratified analysis shows that these effects are only significant for women and those not living in Gauteng province. The value of these findings is underscored by the need for research on the well-being of migrant parents who are negotiating multiple agendas in economically precarious and physically insecure destinations.
RESUMO
Introduction: Cognition impairments often occur after a traumatic brain injury and occur at higher rates in military members. Cognitive symptoms impair daily function, including balance and life quality, years after the TBI. Current treatments to regain cognitive function after TBI, including medications and cognitive rehabilitation, have shown limited effectiveness. Transcranial direct current stimulation (tDCS) is a low-cost, non-invasive brain stimulation intervention that improves cognitive function in healthy adults and people with neuropsychologic diagnoses beyond current interventions. Despite the available evidence of the effectiveness of tDCS in improving cognition generally, only two small TBI trials have been conducted based on the most recent systematic review of tDCS effectiveness for cognition following neurological impairment. We found no tDCS studies that addressed TBI-related balance impairments. Methods: A scoping review using a peer-reviewed search of eight databases was completed in July 2022. Two assessors completed a multi-step review and completed data extraction on included studies using a priori items recommended in tDCS and TBI research guidelines. Results: A total of 399 results were reviewed for inclusion and 12 met the criteria and had data extracted from them by two assessors using Google Forms. Consensus on combined data results included a third assessor when needed. No studies using tDCS for cognition-related balance were found. Discussion: Guidelines and technology measures increase the identification of brain differences that alter tDCS effects on cognition. People with mild-severe and acute-chronic TBI tolerated and benefited from tDCS. TBI-related cognition is understudied, and systematic research that incorporates recommended data elements is needed to advance tDCS interventions to improve cognition after TBI weeks to years after injury.
RESUMO
Background: Movement-based priming has been increasingly investigated to accelerate the effects of subsequent motor training. The feasibility and acceptability of this approach at home has not been studied. We developed a game-based priming system (DIG-I-PRIMETM) that engages the user in repeated ankle movements using serious games. We aimed to determine the feasibility, acceptability, and preliminary motor benefits of an 8-week remotely supervised telerehabilitation program utilizing game-based movement priming combined with functional lower limb motor training in chronic stroke survivors. Methods: Three individuals with stroke participated in a telerehabilitation program consisting of 20-min movement-based priming using the DIG-I-PRIMETM system followed by 30-min of lower limb motor training focusing on strength and balance. We evaluated feasibility using reported adverse events and compliance, and acceptability by assessing participant perception of the game-based training. Motor gains were assessed using the 10-m walk test and Functional Gait Assessment. Results: All participants completed 24 remotely supervised training sessions without any adverse events. Participants reported high acceptability of the DIG-I-PRIMETM system, reflected by high scores on satisfaction, enjoyment, user-friendliness, and challenge aspects of the system. Participants reported overall satisfaction with our program. Post-training changes in the 10-m walk test (0.10-0.31 m/s) and Functional Gait Assessment (4-7 points) exceeded the minimal clinically important difference. Conclusion: Our results indicate that a remotely supervised game-based priming and functional lower limb exercise program is feasible and acceptable for stroke survivors to perform at home. Also, improved walking provides preliminary evidence of game-based priming to be beneficial as a telerehabilitation strategy for stroke motor recovery.
RESUMO
Motor overflow (involuntary muscle activation) is common after stroke, particularly in the non-paretic upper limb. Two potential cortical mechanisms are as follows: (1) The contralesional hemisphere controls both limbs, and (2) inhibition from the ipsilesional to the contralesional hemisphere is diminished. Few studies have differentiated between these hypotheses or investigated motor overflow in the lower limb after stroke. To investigate these potential mechanisms, individuals with chronic stroke performed unilateral isometric and dynamic dorsiflexion. Motor overflow was quantified in the contralateral, resting (non-target) ankle. Transcranial magnetic stimulation (TMS) was applied, and responses were measured in both legs. Relations between motor overflow, excitability of ipsilateral motor pathways, and interhemispheric inhibition were assessed. Non-target muscle activity (motor overflow) was greater during isometric and dynamic conditions than rest in both legs (p ≤ 0.001) and was higher in the non-paretic than the paretic leg (p = 0.03). Some participants (25%) had motor overflow >4SD above the group mean in the non-paretic leg. Greater motor overflow in the non-paretic leg was associated with lesser inhibition from the ipsilesional to the contralesional hemisphere (p = 0.04). In both legs, non-target TMS responses were greater during the isometric and dynamic than the rest condition (p ≤ 0.01) but not when normalized to background muscle activity. Overall, motor overflow occurred in both legs after stroke, suggesting a common bilateral mechanism. Our correlational results suggest that alterations in interhemispheric inhibition may contribute to motor overflow. Furthermore, the lack of differences in non-target motor evoked potentials MEPs between rest, isometric, and dynamic conditions suggests that subcortical and/or spinal pathways may contribute to motor overflow.
Assuntos
Córtex Motor , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Potencial Evocado Motor/fisiologia , Lateralidade Funcional/fisiologia , Humanos , Extremidade Inferior/fisiologia , Córtex Motor/fisiologia , Acidente Vascular Cerebral/complicações , Reabilitação do Acidente Vascular Cerebral/métodos , Estimulação Magnética Transcraniana/métodosRESUMO
Background: Individuals with stroke face a distinct set of challenges, barriers and facilitators that need to be understood to streamline efficacy of stroke clinical trials and improve participant retention. Few long-term stroke rehabilitation trials have evaluated participant perception of their laboratory experience. Methods: We collected data regarding trial satisfaction from 33 individuals with stroke who participated in 12 sessions of treadmill training which included pre, post and follow-up non-invasive brain stimulation and clinical assessments. We evaluated factors such as overall trial satisfaction, burden of testing, perceived benefits, perceived barriers, and perceived support using a participant satisfaction questionnaire (PSQ) that assessed participants' overall trial experience. Results: 97% of our participants found participating in the study to be rewarding and would recommend it to other persons with stroke. Transcranial magnetic stimulation (TMS) testing was found to be the major perceived burden of participation while travelling to the lab was found to be the major perceived barrier to participation. Significant correlations were found between various items of the PSQ and clinical assessments. Conclusions: This study helped us get a preliminary perspective into the benefits and barriers faced by persons with stroke enrolled in a 4-week long clinical trial. We observed that participant satisfaction was driven by various factors including functional status, personal relevance to the research, perceptive physical and mental health improvements, interaction with research personnel, and ease of testing protocols.
RESUMO
ABSTRACT: The purpose of this systematic review was to determine the number of treadmill training sessions needed to make a meaningful change in gait speed for chronic stroke survivors. Relevant databases were searched up through February 2020. Articles were included if they fit the following criteria: stroke onset more than 5 mos, intention to treat with traditional treadmill training, and gait speed included as an outcome. Change in gait speed after intervention was used to classify treadmill groups as responders (at least 0.1 m/sec change) or nonresponders (less than 0.1 m/sec change). Seventeen articles met our criteria, resulting in a total of 19 intervention groups. Ten groups were classified as responders and completed a mean of 30.5 sessions within 6 wks, whereas nonresponders completed 20.4 sessions within 10 wks, indicating that at least 30 treadmill sessions (preferably in a period of 10 wks and at least 40 mins per session) is necessary to reach a meaningful change in gait speed. Although these trends were noted between the responder and nonresponder groups, no firm conclusions can be drawn regarding the "magic" number of sessions chronic stroke survivors should perform given the low correlation between number of sessions and change in gait speed.
Assuntos
Transtornos Neurológicos da Marcha , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Terapia por Exercício/métodos , Marcha , Transtornos Neurológicos da Marcha/etiologia , Humanos , Reabilitação do Acidente Vascular Cerebral/métodos , Resultado do Tratamento , Caminhada , Velocidade de CaminhadaRESUMO
Internal migration has been an institutionalized part of life for Black South Africans from the 1800s, when men left their rural homes to work in mines, through apartheid and into the present. Like other settings in the Global South, we know surprisingly little about the emotional well-being of migrants, especially in sub-Saharan African contexts. We investigate changes in the emotional well-being of 2281 working-age Black South Africans after migration, drawing on four waves of data, from 2008 to 2015, from the nationally representative National Income Dynamics Study. Fixed-effects regressions show that migrants exhibit changes in life satisfaction as well as proclivity towards depression but that these outcomes vary by distance of move and type of move-moving within or between provinces. As South Africa's health policies expand beyond addressing infectious diseases, it is important to consider mental health particularly of those who face the necessity of migration to sustain a livelihood.