Is motor learning of stroke patients in non-immersive virtual environment influenced by laterality of injury? A preliminary study.

BACKGROUND: Stroke is the leading cause of long-term disability in adults, causing residual sensorimotor deficits in many survivors. Patients may have different impairments according to laterality of injury, as well as different responses to some therapies. OBJECTIVE: This preliminary study sought to investigate motor learning in rehabilitation of stroke patients with non-immersive virtual environment by process (electroencephalography) and product (performance) measures in stroke patients with left and right cerebral hemispheres damage. METHODS: The study included 10 chronic stroke patients; 5 with left brain injury (LI), mean age 48.8 years (±4.76), and 5 with right brain injury (RI), mean age 52 years (±10.93). Patients were evaluated for electroencephalographic activity (alpha and beta frequencies) and performance (absolute error) in a darts game on XBOX Kinect (Microsoft®). Then they underwent a virtual darts game training task, 12 sessions for 4 weeks (acquisition stage). After training, they were revaluated (long-term retention). RESULTS: RI group increased alpha power and decreased beta in ipsilesional areas, increased activation on left hemisphere and decreased the absolute error of performance; LI group increased right hemisphere activation and did not decrease the absolute error. CONCLUSIONS: Patients with right brain injury reduce neural effort and errors after virtual darts training, which did not happen to patients with left brain injury. Therefore, the laterality of lesion should be considered in studies that use virtual reality for stroke rehabilitation.

Functional activities habits in chronic stroke patients: A perspective based on ICF framework.

BACKGROUND: Functional autonomy and social inclusion are of key importance for stroke patient's rehabilitation. OBJECTIVE: To evaluate activity and participation of chronic stroke patients by means of basic (BADL), instrumental (IADL) and social (SADL) activities of daily living. METHODS: Forty individuals, 24 patients and 16 healthy individuals fill in a functional activities habits questionnaire. RESULTS: Regarding BADL, 25% of the patients did not get out of bed and 70.8% did not use toilet by themselves. Considering IADL, 29.2% of the patients did not dial the telephone, 70.8% did not wash dishes and clothes, 58.3% did not cook, 100% did not sew, 87.5% did not carry out repairs, 41.7% did not go to the bank, 54.2% did not shop and 45.8% did not write (all p < 0.05). Regarding SADL, 87.5% of the patients were not working professionally, 41.7% did not visit friends or relatives, 75% did not travel and go to the beach and 95.8% did not dance (all p < 0.05). CONCLUSIONS: Chronic stroke patients have limitations in activity and restrictions to participation, even after few years of stroke onset, particularly regarding applying knowledge, use of communication devices, domestic life, major life areas and community, social and civic life.

Circadian activity rhythm and fragmentation are associated with sleep-wake patterns and sleep quality in patients with stroke.

BACKGROUND: Activity levels and disturbances of the sleep-wake pattern affect health and quality of life and need to be further explored in patients with stroke. OBJECTIVE: To evaluate activity levels and their association with sleep-wake patterns in patients with stroke. METHODS: Ten adults with (51±6 years) and 10 without stroke (52±7 years) participated in the study; they were matched on age, sex and educational level. Neurological status, motor function, sleep quality, and activity levels were measured. The groups were compared using Student t-tests and the association between the measures was assessed using Pearson's correlation. RESULTS: Compared to people without stroke, those with stroke had worse sleep quality (p = 0.044), twice lower 24h-activity levels (p < 0.0001), higher interdaily stability and intradaily variability, lower activity during the most active 10 h and during the least active 5 h. Sleep quality was associated with activity level (r= -0.72) and with within-day activity variability (r= 0.53). CONCLUSIONS: Activity level and fragmentation are associated with sleep-wake patterns and sleep quality in patients with stroke.

Effects of inclined treadmill training on functional and cardiovascular parameters of stroke patients: study protocol for a randomized controlled trial.

BACKGROUND: Treadmill training has been widely used for gait recovery after stroke. Gait re-establishment is one of the main objectives of rehabilitation programs after stroke, aiming to acquire more functional patterns and increase walking speed, along with improvement in cardiovascular function. The aim of this study is to evaluate the effects of a treadmill gait training protocol on functional and cardiovascular variables in patients with chronic stroke. METHODS: A single-blind randomized clinical trial will be conducted. The sample will consist of 36 patients, who will be allocated in three groups: control group (n = 12), experimental group 1 (n = 12), and experimental group 2 (n = 12). The intervention will occur for 6 consecutive weeks, three times a week, 30 min each session, in all groups. The control group will perform a treadmill gait training without inclination, experimental group 1 will perform a treadmill gait training with anterior inclination of 5%, and experimental group 2 will perform a treadmill gait training with anterior inclination of 10%. All participants will be assessed for sample characterization measures, gait speed, functional capacity, systemic arterial blood pressure, heart rate, peripheral oxygen saturation, exercise capacity, neuromuscular torque, and quality of life. Evaluations of outcome measures will occur at the end of the interventions (post-training) and after 1 month and 1 year after the end of the interventions (short- and long-term follow-up). Statistical analysis will be performed descriptively and inferentially. Alpha equals 5% will be considered for inferential analysis. Mixed analysis of variance with repeated measures will be used to compare outcome measures between groups and between baseline, post-training, and follow-up. Normality test (Shapiro-Wilk) and subsequently t test (or Mann-Whitney) will be used to compare groups during the same training session. DISCUSSION: It is believed that treadmill training, especially treadmill training with anterior inclination, may result in improved exercise capacity in patients with stroke, reduced blood pressure and heart rate values, and an improvement in functional parameters with increased gait speed, functional capacity, quadriceps muscle torque, and quality of life. TRIAL REGISTRATION: Registration in Brazilian Registry of Clinical Trials (ReBEC) identifier RBR-5ffbxz , date of registration October 25 2017.