Individualized home-based rehabilitation after stroke in France: a pragmatic study of a community stroke rehabilitation team.

BACKGROUND: Community stroke rehabilitation teams (CSRT) provide an individualized home-based rehabilitation service to patients recovering from stroke. OBJECTIVE: To examine whether there is an improvement in the social participation of patients who received a rehabilitation program provided by CSRT. The secondary objectives were to show if there is an improvement in the patients' quality of life and a reduction in the caregiver burden. METHODS: Retrospective cohort study, pragmatic in real-care conditions. The rehabilitation program delivered by the CSRT was adapted to the needs of the patients and caregivers. The outcome questionnaires included: the Frenchay Activity Index (FAI), the Minizarit, the EuroQol EQ5D, and the Barthel Index. The primary outcome measure was the FAI. RESULTS: We included 206 patients followed by the CSRT over the 2018-2020 study period, for whom the primary endpoint was present. The mean age was 66.3 ± 12.7 years, the post-stroke delay was 16.4 ± 32.7 months, and the Barthel index was 66.42 ± 12.6. The duration of the rehabilitation program was on average 162 ± 109 days. We observed a significant improvement in the FAI, from 12.9 ± 10.4 to 17.85 ± 12.4 (p < 0.00001); in the EuroQol, from 57.51 ± 19.96 to 66.36 ± 18.87 (p < 0.00001); in the mini-Zarit, from 2.49 ± 1.75 to 2.06 ± 1.67 (p = 0.0002); and in the Barthel index, from 66.42 ± 12.67 to 84.81 ± 23.70 (p < 0.001). CONCLUSION: Patients who received a rehabilitation program by the CSRT have an improvement in their social participation, and their informal caregivers have a reduction in their burden.

Impact of a dual task on the energy cost of walking in individuals with subacute phase stroke.

OBJECTIVE: To assess the impact of cognitive Dual Task (DT) during walking on the energy cost of walking (Cw) in individuals with subacute stroke. The secondary objective was to determine whether there is an association between the Cw and cortical activity of the prefrontal area. METHODS: Any individual with stroke localized in the temporal-parietal regions and able to walk without human assistance was included. Cw and prefrontal cortical activity, recorded by fNIRS, were measured during simple task walking activity and cognitive dual task during walking. RESULTS: Nineteen individuals with stroke (age = 67.7 ± 9.6 yrs) were included. The cognitive DT during walking resulted in an increase in Cw of 23.1%; 95%CI [13.1%; 34.5%]. The increase in Cw in cognitive DT was correlated with the Cw for the single task walking activity (r = 0.48, p < 0.01) as well as the predominance of cortical activity of the prefrontal area in the contralesional hemisphere (r = -0.33, p < 0.01). CONCLUSION: There is an increase in Cw during the cognitive DT. This increase is even more significant, as the Cw of the single task walking activity is high, and the cortical activity of the prefrontal areas predominates in the contralesional hemisphere.

First Systematic Review and Meta-analysis of the Validity and Test-Retest Reliability of Physical Activity Monitors for Estimating Energy Expenditure During Walking in Individuals With Stroke.

OBJECTIVE: To evaluate the validity and test-retest reliability of physical activity trackers (accelerometer, multisensor, smartphone, pedometer) for estimating energy expenditure during walking in individuals with stroke. DATA SOURCES: Webline, MEDLINE, Scopus, ScienceDirect, Bielefeld Academic Search Engine, and Wiley Online Library databases from 1980 to November 2020. STUDY SELECTION: The inclusion criteria were studies that examined the validity of portable physical activity trackers for estimating energy expenditure in individuals with stroke during walking activities compared to indirect calorimetry. DATA EXTRACTION: This systematic review was reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and the methodological quality of the included studies was determined with the Quality Assessment of Diagnostic Accuracy Studies. The study selection was made by 2 blind observers. DATA SYNTHESIS: We screened 3677 articles; 3647 were excluded after duplicate removal and title and abstract review. Thirty articles were included for full-text analysis. Eight articles met the inclusion criteria (184 individuals with stroke) and were included in the data synthesis and meta-analysis. For all monitors, activities, and placements, the overall level of correlation with indirect calorimetry was 0.34 (95% confidence interval [CI], 0.23-0.44). After subgroups analysis, we showed that type and placement have no effect on the level of validity. Test-retest reliability was high, with intraclass correlation equal to 0.89 (95% CI, 0.76-0.95). CONCLUSIONS: Portable physical activity monitors provided a low correlation with indirect calorimetry during walking in individuals with stroke. It seems essential to pursue studies to improve their validity in this population.

The Functional Independence of Patients With Stroke Sequelae: How Important Is the Speed, Oxygen Consumption, and Energy Cost of Walking?

OBJECTIVE: To evaluate the association between self-selected walking speed (Sfree), oxygen consumption at Sfree (Vo2free), the oxygen cost of walking (Cw) at Sfree, and mobility independence and independence for activities of daily living in individuals poststroke. DESIGN: Cross-sectional study. SETTING: Hospital. PARTICIPANTS: Individuals with stroke who were able to walk without human assistance were included. We included 90 individuals (N=90; mean age, 63.5±14.0y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Cw was captured during walking from measurements of Sfree and Vo2free. We assessed mobility independence based on the modified Functional Ambulation Classification (mFAC) and independence in activities of daily living by the Barthel Index (BI). Multiple linear regression analyses were performed to evaluate the independence of Cw, Vo2free, and Sfree from the determination of BI and mFAC among the various characteristics of the population (age, stroke delay, body mass index, motor function, spasticity). RESULTS: We reported Cw=0.36 mL/kg/m (interquartile range [IQR]=0.28 mL/kg/m), Sfree=0.60±0.32 m/s, Vo2free=11.2 mL/kg/min (IQR=1.8 mL/kg/min). The multiple linear regression analyses showed that Cw and Sfree were independently associated with the BI (P<.01) and the mFAC (P<.01) scores. Vo2free was not found to be an explanatory variable of functional independence (P>.05). CONCLUSIONS: Cw was independently associated with functional independence. This association appears to be primarily determined by Sfree and not Vo2free, underscoring the importance of evaluating and acting on Sfree to improve the functional independence of individuals with stroke.

Quantification of energy expenditure during daily living activities after stroke by multi-sensor.

Objective: To explore the validity of energy expenditure estimates using the SenseWear Armband during a sequence of four daily living activities in patients post-stroke. Method: Patients with stroke who were able to walk during 6 min without human assistance were asked to wear the SenseWear Armband on the non-paretic arm while performing transfers, a manual task, walking, and walking up and down stairs. The energy expenditure estimated using the SenseWear Armband was compared to the energy expenditure calculated from oxygen consumption, measured by a portable indirect calorimeter (Metamax 3B). The mean of energy expenditure was pooled for each task. Accuracy was explored by mean bias (MB) of Bland-Altman analysis and root mean square error (RMSE), agreement by 95% of limits of agreement (95%LoA) and coefficient of correlation (r). Results: Thirty-eight participants (65.7 ± 13.5 years) were included. The SenseWear Armband globally underestimated energy expenditure, MB = 9.77 kcal for the whole sequence. RMSE were large, accounting for 15% to 41% of the measured energy expenditure. Agreement was low with r < 0.70 and 95%LoA from 42% to 93% of the measured energy expenditure. Conclusions: This study reported a global underestimation and a low level of agreement of the energy expenditure estimated by SenseWear Armband in four daily living activities in patients after stroke. Abbreviations: EE: Energy Expenditure; NIHSS: National Institute of Health Stroke Score.

Validity of the Walked Distance Estimated by Wearable Devices in Stroke Individuals.

BACKGROUND: Health professionals need valid devices to assess a stroke individual's ability to walk. The aim was to evaluate the validity of the estimation of the walked distance by wearable devices and the impact of the sensor's position in stroke individuals. METHODS: Post-stroke patients able to walk without human assistance were equipped with several wearable devices: pedometers, Actigraph, and Sensewear Armband placed according to the manufacturers' recommendations. Participants walked for 6 min at a comfortable speed wearing all sensors at the same time. We analyzed the validity of sensor-estimated distances according to their position using Bland-Altman analysis, root-mean-square error, and coefficient of correlation. RESULTS: In total, 35 individuals were included (mean age = 65 ± 15 years). The best estimations were given by the Actigraph worn on the unaffected ankle (mean bias (MB) = 22.6 ± 32.4 m; p = 0.37) and by the pedometer worn on the unaffected hip (MB = 20.5 ± 24.6 m; p = 0.46). The other sensors and positions provided large estimation errors over 95 m (p < 0.05). CONCLUSION: This study led to a recommendation of a pedometer worn on the unaffected hip or an Actigraph worn on the unaffected ankle to get a valid estimation of the distance walked by stroke individuals.

Validity of the Actigraph GT3x and influence of the sensor positioning for the assessment of active energy expenditure during four activities of daily living in stroke subjects.

OBJECTIVE:: To explore the validity of the Actigraph and the influence of the placement of the sensor when estimating the active energy expenditure in four common daily activities (transfers, manual task, walking in overground and walking up and down stairs) in stroke survivors. DESIGN:: Cross-sectional study. SETTING:: Department of Physical Medicine and Rehabilitation. SUBJECTS:: A total of 46 subjects affected with stroke sequelae were wearing the Actigraph on three different locations-ankle, hip and wrist on the non-affected side-and performed four tasks: transfers, manual task, walking on flat ground and walking up and down stairs. MAIN MEASURES:: The values of active energy expenditure estimated by the Actigraph were compared to those measured by a portable breathing gas exchange analyzer Metamax3B. The accuracy and agreement between Actigraph and Metamax values were analyzed with mean bias, root mean square error, correlation coefficient and Bland-Altman plots for each task and each sensor location. RESULTS:: The mean bias between the Metamax and Actigraph placed on wrist, hip and ankle were, respectively, MD = 1.16 kcal (%MD = 3%), MD =-20.44 kcal (%MD =-58%) and MD = 17.64 kcal (%MD = 50%). The agreement with the Metamax was poor in general regardless of the sensor location and type of task ( r = 0.12-0.58). CONCLUSION:: This study found large differences and a poor agreement between the active energy expenditure as measured by the Actigraph and the Metamax according to the location of the sensor and the type of task performed by the subject.

Social Participation and Physical Activity Incentive at Home in Stroke Survivor: Contribution of Technologies.

Increased physical activity has been demonstrated as a relevant treatment after a stroke, with positive effects on impairment recovery, activity limitation, social participation and quality of life. Furthermore, PA is now recommended as part of the stroke recovery pathway, starting during inpatient care and extending through rehabilitation and community integration. The purpose of this presentation is to describe how current technologies may facilitate a continuity of care for stroke survivors. We present a synthesis of 8 studies that we have conducted to date to assess and monitor the activity level of post-stroke patients at home. The results of these studies show that home rehabilitation of post-stroke patients requires the use of individualized monitoring criteria to optimize patient care. To encourage the patient to increase his level of moderate physical activity and reduce his sedentary time, it would be recommended to propose a regularly monitored and structured program.

Feasibility and potential cognitive impact of a cognitive-motor dual-task training program using a custom exergame in older adults: A pilot study.

Introduction: Dual-task training may be relevant and efficient in the context of active aging. An issue in training programs lies in enhancing the adherence of participants. This can potentially be improved using games as support. We designed and developed a custom interactive exergame in this way. The objective of this pilot study was to explore the potential use of this exergame and the feasibility of our intervention, including the level of safety and adherence. The result's trends on cognitive and motor capacities, as well as on the level of motivation for physical activity, fear of falling, and quality of life of participants, were also explored. Methods: Older adults aged 65 years or older were recruited and realized 30 min of supervised training in groups of 4, 2-3 times a week for 12 weeks. Exercises consisted of incorporated cognitive and motor dual tasks, with an increased difficulty over the weeks. Our program's safety, engagement, attendance, and completion levels were evaluated. Participants' postural control in single-task and dual-task conditions, as well as their performances in mental inhibition, flexibility, working memory, mobility, and postural control, and their levels of motivation for physical activity, fear of falling, and quality of life were also assessed. We realized a per protocol statistical analysis with a p-value set at 0.05. Results: Thirty-nine participants (aged 84.6 ± 8.5 years) were recruited. No adverse events, and 89% adherence, 88% attendance, and 87% completion rates were observed. A potentially significant effect of our exergame on working memory in single-task conditions and on the cognitive aspect of dual-task conditions was also observed. We observed no differences in other parameters. Discussion: Our exergame seemed feasible and safe and was enjoyed by participants, mainly due to the gamification of our training program. Moreover, our exergame may be efficient for cognitive training in older adults, as well as for the maintenance of motor functions, motivation for physical activity, fear of falling, and quality of life levels. This constitutes the first step for our solution with interesting results that need to be further studied.

Effect of Individualized Coaching at Home on Quality of Life in Subacute Stroke Patients.

Background: Stroke causes psychological disorders and cognitive impairments that affect activities of daily living and quality of life. Physical activity (PA) in stroke recovery is beneficial. The benefits of PA on quality of life after stroke are less documented. The aim of the study was to evaluate the effect of a home-based PA incentive program at home in post-stroke patients in the subacute phase on quality of life. Methods: This is a prospective, randomized, single-blind, and monocentric clinical trial. Eighty-three patients were randomly assigned to either an experimental group (EG; n = 42) or to a control group (CG; n = 41). The experimental group followed a home-based PA incentive program for 6 months. Three incentive methods were used: daily monitoring with an accelerometer, weekly telephone calls, and home visits every three weeks. Patients were evaluated before intervention (T0) and after intervention (T1) at 6 months. The control group was a non-intervention group receiving usual care. The outcome was the quality of life with the EuroQol EQ-5D-5L evaluated at baseline and 6 months post-intervention. Results: The mean age was 62.2 years ± 13.6 with a post-stroke time of 77.9 ± 45.1 days. The mean values of the utility index (EQ-5D-5L) in the control group and experimental group at T1 were 0.721 ± 0.207 and 0.808 ± 0.193, respectively (p = 0.02). Discussion: Our study shows a significant difference in the Global QOL index (EQ-5D-5L) between the two groups of subacute stroke patients after 6 months of the individualized coaching program, which combined home visits and weekly telephone calls.

Daily socket comfort in transtibial amputee with a vacuum-assisted suspension system: study protocol of a randomized, multicenter, double-blind multiple N-of-1 trial.

BACKGROUND: The main aim of this paper is to present the feasibility of rigorously designed multiple N-of-1 design in prosthetics research. While research of adequate power and high quality is often lacking in rehabilitation, N-of-1 trials can offer a feasible alternative to randomized controlled group trials, both increasing design power at group level and allowing a rigorous, statistically confirmed evaluation of effectiveness at a single patient level. The paper presents a multiple N-of-1 trial protocol, which aim is to evaluate the effectiveness of Unity, a prosthetic add-on suspension system for amputees, on patient-reported comfort during daily activities (main outcome measure), prosthesis wearing time, perception of limb-prosthesis fitting and stump volume and functional walking parameters. METHODS: Multicenter, randomized, prospective, double-blind multiple N-of-1 trial using an introduction/withdrawal design alternating Unity connected/disconnected phases of randomized length on twenty patients with unilateral transtibial amputation. The primary outcome measure is the Prosthetic Socket Comfort Score (SCS), a validated measure of comfort, administered daily by an phone app designed for the study. Secondary outcomes measures will be collected during the 50 days period of the N-of-1 trial: (1) by the same app, daily for patient-reported limb-prosthesis fitting, stump volume variation, and daily wearing time of the prosthesis; (2) by a pedometer for the number of steps per day; (3) by blind assessors in the rehabilitation center during adjustment visits for functional walking parameter (L-Test, 6-minute walk test), and by the patient for the QUEST, and ABC-S. Effectiveness of the Unity system regarding SCS and daily secondary outcome measures will be tested by randomization test. The secondary outcome measures assessed during visits in the rehabilitation center will be analyzed by Non Overlap of All pairs. An estimate of the effect on the amputee population will be generated by aggregating each individual clinical trial (N-of-1 trial) by Hierarchical Bayesian methods. DISCUSSION: This study protocol was designed to answer the question "which device is best for THIS patient" and to conclude at a group level on the effectiveness of a new devic, using a Multiple N-of-1 trial, which is promising but underused in prosthetics research so far. TRIAL REGISTRATION: N° ID-RCB 2020-A01309-30 Clintrial.gov : NCT04804150 - Retrospectively registered March 20th 2021.

Physical factors associated with fatigue after stroke: an exploratory study.

OBJECTIVE: To look for a relationship between physical fatigue and physical parameters in patients at least 3 months post stroke. METHODS: We conducted a prospective cross-sectional study of 32 poststroke patients (average duration of stroke 40 months) who were recruited among in- and outpatients followed by the Department of Physical and Rehabilitation Medicine of a university hospital. Fatigue was defined as a Fatigue Severity Scale (FSS) score of 4 or more. The parameters studied were age, sex, time since stroke, Demeurisse Motor Index, Barthel Index score, new Functional Ambulation Category, Berg Balance Scale, 10-meter walk test, 6-minute walk test, Dijon Physical Activity Score, Montgomery and Asberg Depression Rating Scale, Epworth Sleepiness Scale, presence of pain, and length and area of the center of pressure displacement obtained posturographically. RESULTS: Two-thirds of patients (65.6%) were fatigued. The mean FSS score was 4.3 ± 1.8. Fatigue was not associated with the physical parameters studied; notably, there was no correlation with motor impairment, autonomy and walking capacity, or balance and physical activity. However, after multivariate analysis, we found an association between physical fatigue and time since the occurrence of stroke (P = .05). CONCLUSIONS: Our study revealed a relationship between pain and physical fatigue, as reported by 2 other studies. Poststroke fatigue management should include appropriate pain management. Further studies are necessary to determine the causes of physical fatigue after stroke.

Compliance with Upper Limb Home-Based Exergaming Interventions for Stroke Patients: A Narrative Review.

BACKGROUND: Telerehabilitation and follow-up techniques have been developed in recent years to assess the effectiveness of diverse intervention programmes that include exergaming technologies. For patients with upper limb impairment after stroke, motion-gaming technologies can provide effective and amusing training. Beyond efficiency, professionals must analyse patient compliance with the system for self-use at home, because patients may or may not independently perform the exercises prescribed by the therapist. Questions on the sustainable use of this type of home exercise also arise. OBJECTIVE: This review examines user compliance with exercise programmes, measured according to the training rate (percentage of prescribed sessions and minutes completed) and completion rate (number of drop-outs and discontinued interventions) reported or calculable according to the data collected. RESULTS AND DISCUSSION: Rates of compliance with training were relatively high. No group effect on compliance was found. Drop-out and discontinued intervention rates were either due to external causes or directly related to the technologies. Some studies have reported the use of supervision, most of them through home visits and remote support. Few studies performed long-term follow-up, which could provide information to help broaden practices. This narrative review considers how this field of research may evolve in the future.

Measured and Perceived Effects of Upper Limb Home-Based Exergaming Interventions on Activity after Stroke: A Systematic Review and Meta-Analysis.

After discharge from the hospital to home, stroke patients may experience weakness and reduced movement in their hemiparetic arms that limits their ability to perform daily activities. Therapists can use exercise games (exergames) to maintain functional abilities and daily use of the arm at home. A systematic review and meta-analysis was conducted to determine the efficiency of upper limb home-based rehabilitation, using exergaming on activity abilities in stroke.&nbsp;Randomized controlled trials were reviewed in the CENTRAL, MEDLINE, CINAHL, EMBASE, and SCOPUS online databases. Clinical measures of observation and self-reporting were studied in post-intervention and follow-up. Nine studies were included in this systematic review (535 participants). The Physiotherapy Evidence Database (PEDro) score was 6.6/10 (SD 1.0, range 5-8), indicating good quality. This systematic review and meta-analysis showed that upper limb home-based exergaming interventions were no more effective in terms of activity than conventional therapy after stroke, according to the observational and subjective assessments in post-intervention and follow-up. Using this same approach, future studies should focus on evaluating home-based exergames through subgroup analysis to be able to propose recommendations.

The effect of a home-based coaching program on heart rate variability in subacute stroke patients: a randomized controlled trial.

Autonomic imbalance in stroke is characterized by increased sympathetic activity and reduced vagal nerve activity. Physical activity could be a strategy to counteract autonomic control impairments after a stroke. The aim of the study was to evaluate the effect on heart rate variability of a 6-month coaching program in a home setting in subacute stroke patients. Eighty-four stroke patients participated in the study. They were randomly assigned to the experimental group or the control group. The intervention was a coaching program, consisting of physical activity, home visits and a weekly phone call. Patients were evaluated after hospital discharge (T0) and at the end of the 6-month period (T1). Heart rate variability measures were recorded in the supine and orthostatic positions. Time and frequency domain values were treated using Kubios. Distance on 6 minutes walking test (6MWT), Barthel and motricity index and modified functional ambulation categories were evaluated. No effects were found on time and frequency domain values in the supine and orthostatic positions in either group. Walking distance on 6MWT increased significantly between T0 and T1 in experimental group (377 ± 141-448 ± 140 m; P < 0.02) with no effects in control group (373.6 ± 150.6-394.6 ± 176.4 m). No other functional effects were found. A coaching program in a home setting had no effect on heart rate variability, probably due to time of recovery and exercise intensity. Future research is needed to understand the lack of changes in heart rate variability by physical activity in subacute stroke patients.

The impact of the energy cost of walking on the quality of life of post-stroke individuals: A one-year longitudinal study.

BACKGROUND: The increased energy cost of walking (Cw) for stroke patients affects the walking function and walking independence of stroke patients. However, its impact on quality of life (QoL) has never been studied. OBJECTIVE: Assess the association between Cw and QoL for post-stroke individuals in the year following hospital discharge. METHOD: Thirty-seven individuals with stroke were included. QoL was assessed by the EuroQol-5 Dimensions on the day after hospital discharge (T0), at six months (T1) and at one year after hospital discharge (T2). Concomitant an evaluation of Cw, mood disorders (HADS), fatigue, independence in activities of daily living and the presence of a family caregiver was performed. The association between QoL and the different covariates was analyzed using multiple regression analysis. RESULTS: At T2, data from 29 individuals were analyzable. Multiple regression analyses showed Cw had a significant influence on the QoL at T1 (coeff -0.42 (-0.71 to -0.12), P = .008) and T2 (coeff -0.49 (-0.71 to -0.26), P < .001). HADS score was the only other variable to significantly impact variances of QoL at T0, T1 and T2. Moreover, we showed that Cw at T0 explained 29% of variances of QoL at T1 and 42% at T2. CONCLUSION: Cw appears to be an independent factor in the QoL of individuals with stroke at six months and one year after hospital discharge. In addition, the initial Cw and HADS are predictive of QoL at one year highlighting the importance of early interventions in these two dimensions to improve QoL over the long term.

The Best Choice of Oxygen Cost Prediction Equation for Computing Post-Stroke Walking Energy Expenditure Using an Accelerometer.

BACKGROUND: The integration of oxygen cost into the accelerometer's algorithms improves accuracy of total energy expenditure (TEE) values as post-stroke individuals walk. Recent work has shown that oxygen cost can be estimated from specific prediction equations for stroke patients. OBJECTIVE: The objective is to the validity of the different oxygen cost estimation equations available in the literature for calculating TEE using ActigraphGT3x as individuals with stroke sequelae walk. METHOD: Individuals with stroke sequelae who were able to walk without human assistance were included. The TEE was calculated by multiplying the walking distance provided by an ActigraphGT3x worn on the healthy ankle and the patient's oxygen cost estimated from the selected prediction equations. The TEE values from each equation were compared to the TEE values measured by indirect calorimetry. The validity of the prediction methods was evaluated by Bland-Altman analysis (mean bias (MB) and limits of agreement (LoA) values). RESULTS: We included 26 stroke patients (63.5 years). Among the selected equations, those of Compagnat and Polese obtained the best validity parameters for the ActigraphGT3x: MBCompagnat = 1.2 kcal, 95% LoACompagnat = [-12.0; 14.3] kcal and MBPolese = 3.5 kcal, 95% LoAPolese = [-9.2; 16.1] kcal. For comparison, the estimated TEE value according to the manufacturer's algorithm reported MBManufacturer = -15 kcal, 95% LoAManufacturer = [-52.9; 22.8] kcal. CONCLUSION: The Polese and Compagnat equations offer the best validity parameters in comparison with the criterion method. Using oxygen cost prediction equations is a promising approach to improving assessment of TEE by accelerometers in post-stroke individuals.

Awakening the control of the ankle dorsiflexors in the post-stroke hemiplegic subject to improve walking activity and social participation: the WAKE (Walking Ankle isoKinetic Exercise) randomised, controlled trial.

BACKGROUND: Stroke is the leading cause of acquired disability in France. While 90% of patients recover the ability to walk, it is often limited with a steady speed of approximately 0.7 m/s. This limitation of walking activity is partly related to a decrease in strength associated with more or less significant spasticity. In particular, it seems that the strength of the dorsiflexor muscles is directly related to walking speed. We hypothesise that a protocol based on gestural repetition targeted at the ankle during the subacute phase potentiates the recovery of motor control, improving walking activity, and participates in recovering better social participation. METHODS: An estimated total of 60 patients with subacute stroke will be recruited to participate in this multicentre, interventional, prospective, randomised controlled trial. All participants will benefit from conventional rehabilitation. In addition, the experimental group will take part in an ankle isokinetic rehabilitation programme for 6 weeks (at least 25 sessions). The control group will receive the same duration of conventional rehabilitation. The primary outcome measure will be a 10-m walking speed at post-intervention. Secondary outcomes will include social participation, walking spatio-temporal parameters, and dorsiflexor strength. Outcome measurements will be taken at baseline, immediately after treatment (6 weeks), then at 6 months and 1 year of follow-up. DISCUSSION: This study aims to provide scientific evidence that a protocol based on an early over-solicitation of the ankle dorsiflexor muscles to promote their "awakening" can serve to achieve a more effective walking activity, which in turn encourages social participation following discharge from the hospital. This protocol should also help optimise physical medicine and rehabilitation practices: the more systematic use of the isokinetic dynamometer as a technique associated with, and integrated into the conventional rehabilitation protocol would allow an objective evaluation of the rehabilitation benefits and should increase the rehabilitation gain in central nervous system disorders. TRIAL REGISTRATION: Limoges University Hospital is the sponsor of this research (Unique Protocol ID: 87RI18_0010) This research is supported by the French Ministry of Health (PHRC 2020-A03328-31) and is conducted with the support of DGOS (PHRC interregional - GIRCI SOHO). The study protocol was approved by the French Human Subjects Protection Review Board (Comité de Protection des Personnes Nord-Ouest III) on February 23, 2021. The trial was registered in the ClinicalTrials.gov registry ( NCT04800601 ) on March 16, 2021.

A 6-Month Home-Based Functional Electrical Stimulation Program for Foot Drop in a Post-Stroke Patient: Considerations on a Time Course Analysis of Walking Performance.

Foot drop is a common disability in post-stroke patients and represents a challenge for the clinician. To date, ankle foot orthosis (AFO) combined with conventional rehabilitation is the gold standard of rehabilitation management. AFO has a palliative mechanical action without actively restoring the associated neural function. Functional electrical stimulation (FES), consisting of stimulation of the peroneal nerve pathway, represents an alternative approach. By providing an FES device (Bioness L-300, BIONESS, Valencia, CA, USA) for 6 months to a post-stroke 22-year-old woman with a foot drop, our goal was to quantify its potential benefit on walking capacity. The gait parameters and the temporal evolution of the speed were collected with a specific connected sole device (Feet Me®) during the 10-m walking, the time up and go, and the 6-minute walking tests with AFO, FES, or without any device (NO). As a result, the walking speed changes on 10-m were clinically significant with an increase from the baseline to 6 months in AFO (+0.14 m.s-1), FES (+0.36 m.s-1) and NO (+0.32 m.s-1) conditions. In addition, the speed decreased at about 4-min in the 6-minute walking test in NO and AFO conditions, while the speed increased in the FES conditions at baseline and after 1, 3, and 6 months. In addition to the walking performance improvement, monitoring the gait speed in an endurance test after an ecological rehabilitation training program helps to examine the walking performance in post-stroke patients and to propose a specific rehabilitation program.

Bringing rehabilitation home with an e-health platform to treat stroke patients: study protocol of a randomized clinical trial (RGS@home).

BACKGROUND: There is a pressing need for scalable healthcare solutions and a shift in the rehabilitation paradigm from hospitals to homes to tackle the increase in stroke incidence while reducing the practical and economic burden for patients, hospitals, and society. Digital health technologies can contribute to addressing this challenge; however, little is known about their effectiveness in at-home settings. In response, we have designed the RGS@home study to investigate the effectiveness, acceptance, and cost of a deep tech solution called the Rehabilitation Gaming System (RGS). RGS is a cloud-based system for delivering AI-enhanced rehabilitation using virtual reality, motion capture, and wearables that can be used in the hospital and at home. The core principles of the brain theory-based RGS intervention are to deliver rehabilitation exercises in the form of embodied, goal-oriented, and task-specific action. METHODS: The RGS@home study is a randomized longitudinal clinical trial designed to assess whether the combination of the RGS intervention with standard care is superior to standard care alone for the functional recovery of stroke patients at the hospital and at home. The study is conducted in collaboration with hospitals in Spain, Sweden, and France and includes inpatients and outpatients at subacute and chronic stages post-stroke. The intervention duration is 3 months with assessment at baseline and after 3, 6, and 12 months. The impact of RGS is evaluated in terms of quality of life measurements, usability, and acceptance using standardized clinical scales, together with health economic analysis. So far, one-third of the patients expected to participate in the study have been recruited (N = 90, mean age 60, days after stroke ≥ 30 days). The trial will end in July 2023. DISCUSSION: We predict an improvement in the patients' recovery, high acceptance, and reduced costs due to a soft landing from the clinic to home rehabilitation. In addition, the data provided will allow us to assess whether the prescription of therapy at home can counteract deterioration and improve quality of life while also identifying new standards for online and remote assessment, diagnostics, and intervention across European hospitals. TRIAL REGISTRATION: C linicalTrials.gov NCT04620707. Registered on November 3, 2020.