Clinical Predictors for Upper Limb Recovery after Stroke Rehabilitation: Retrospective Cohort Study

After stroke, recovery of upper limb (UL) motor function is enhanced by a high dose of rehabilitation and is supposed to be supported by attentive functions. However, their mutual influence during rehabilitation is not well known yet. The aim of this retrospective observational cohort study was to investigate the association between rehabilitation dose and motor and cognitive functions, during UL motor recovery. Inpatients with first unilateral stroke, without time restrictions from onset, and undergoing at least 15 h of rehabilitation were enrolled. Data on dose and modalities of rehabilitation received, together with motor and cognitive outcomes before and after therapy, were collected. Fugl–Meyer values for the Upper Extremity were the primary outcome measure. Logistic regression models were used to detect any associations between UL motor improvement and motor and cognitive-linguistic features at acceptance, regarding dose of rehabilitation received. Thirty-five patients were enrolled and received 80.57 ± 30.1 h of rehabilitation on average. Manual dexterity, level of independence and UL motor function improved after rehabilitation, with no influence of attentive functions on motor recovery. The total amount of rehabilitation delivered was the strongest factor (p = 0.031) influencing the recovery of UL motor function after stroke, whereas cognitive-linguistic characteristics were not found to influence UL motor gains

Telerehabilitation for neurological motor impairment: a systematic review and meta-analysis on quality of life, satisfaction, and acceptance in stroke, multiple sclerosis, and Parkinson’s disease

Telerehabilitation (TR) seems to be a viable and feasible solution to face the rehabilitative challenges posed by neurological impairments and to improve patients’ quality of life (QoL). This review aims to synthesize and analyze the evidence on the impact of physiotherapy intervention through TR on QoL in patients with stroke, Parkinson’s disease (PD), and multiple sclerosis (MS), together with an evaluation of their satisfaction and technology acceptance levels. Through a systematic search of the literature and a screening process, treatment effects were assessed with meta-analyses using the standardized mean difference, setting the confidence interval at 95%. We included 28 studies in the review, which were analyzed for methodological quality, whereas 16 studies were included in the meta-analyses. The results suggest a significant improvement in QoL in patients who underwent TR. We were unable to perform analyses for satisfaction and technology acceptance outcomes due to insufficient data. Overall, motor TR has a positive impact on the QoL of patients with neurological diseases, especially in stroke patients; although caution is needed in the interpretation of the results due to the high heterogeneity found. For PD and MS, TR seems to yield comparable results to in-person treatment

Telerehabilitation for Stroke: A Personalized Multi-Domain Approach in a Pilot Study

: Stroke, a leading cause of long-term disability worldwide, manifests as motor, speech language, and cognitive impairments, necessitating customized rehabilitation strategies. In this context, telerehabilitation (TR) strategies have emerged as promising solutions. In a multi-center longitudinal pilot study, we explored the effects of a multi-domain TR program, comprising physiotherapy, speech therapy, and neuropsychological treatments. In total, 84 stroke survivors (74 analyzed) received 20 tailored sessions per domain, addressing individual impairments and customized to their specific needs. Positive correlations were found between initial motor function, cognitive status, independence in activities of daily living (ADLs), and motor function improvement after TR. A lower initial health-related quality of life (HRQoL) perception hindered progress, but improved ADL independence and overall health status, and reduced depression correlated with a better QoL. Furthermore, post-treatment improvements were observed in the entire sample in terms of fine motor skills, upper-limb functionality, balance, independence, and cognitive impairment. This multi-modal approach shows promise in enhancing stroke rehabilitation and highlights the potential of TR in addressing the complex needs of stroke survivors through a comprehensive support and interdisciplinary collaboration, personalized for each individual's needs

Dataset related to article "Clinical Predictors for Upper Limb Recovery after Stroke Rehabilitation: Retrospective Cohort Study"

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Relationship between language and gesture and its impact on the rehabilitation for people with aphasia, through a telerehabilitation setting

Communication is a complex process that relies on intact language, speech, and hearing functions. After a brain lesion, some or all these functions can be affected, giving rise to a set of symptoms that fall under the term of aphasia. Aphasia is a multi-modal disorder affecting auditory comprehension, reading, oral-expressive language, writing and/or gesture. Due to the multi-modal aspects of aphasia, its recovery can rely on the recovery of different language impairments by fostering the use of alternative strategies we use to successfully communicate (i.e., writing and/or the use of gestures). During past years, the observation of the behaviour of people with aphasia suggested that they tended to use more gestures than healthy individuals. These findings have led researchers to question the possible role that gestures have on language, the possible relationship that may exist between motor and language functions, and how clinicians can take advantages from this knowledge to develop and implement treatment programs that can foster the ability to successfully communicate in people with aphasia. With this PhD project, we aimed to study the relationship between motor and language functions from different perspectives, at a neural level by a meta-analysis of functional magnetic resonance imaging studies on healthy subjects, at the behavioural level through a proof-of-concept study on stroke survivors, and from a rehabilitative point of view through a retrospective cohort study looking at the predictors of stroke recovery. Furthermore, we wanted to translate the knowledge on this relationship into clinical practice, through a telerehabilitation approach for aphasia which involves the use of gesture for lexical retrieval training and for the recovery of grammar and sentence production, compared to conversational face-to-face treatment in PWA. A first finding from secondary research investigating language and motor relationship confirmed that there is a shared activation at neural level of areas related to semantic processing and multimodal processing, suggesting for the presence of a link between co-speech gestures and spoken language during unimodal and bimodal communication. This evidence seems to be consistent with what observed during execution of experimental tasks highlighting a potential influence of semantically related action words on upper limb function. Indeed, the results from the experimental study showed a better reach-to-grasp movement execution when 11 performed combined with the presentation of a related action word, indicating that the presentation of a word with semantic movement-related information could in turn activates the related cortical motor representation facilitating upper limb movements. The case for a link between language and motor functions was also discussed through the assessment of language functions as predictors of upper limb recovery. The presence of language disorders (i.e., aphasia) seem to affect motor recovery, with reading abilities likely associated with improvements in activities of daily living. Finally, when translating evidence to clinical practice, in particular by a telerehabilitation training integrating gestures features with other strategies for successful communication for aphasia programs, we did not observe differences between telerehabilitation or in-person treatment delivery. Nevertheless, more research is needed to confirm findings from this project, with the aim to develop robust, evidence-based neurorehabilitation programs for treatment of aphasia that can take advantage from the multimodal aspects of everyday communication

Clinical Predictors for Upper Limb Recovery after Stroke Rehabilitation: Retrospective Cohort Study

After stroke, recovery of upper limb (UL) motor function is enhanced by a high dose of rehabilitation and is supposed to be supported by attentive functions. However, their mutual influence during rehabilitation is not well known yet. The aim of this retrospective observational cohort study was to investigate the association between rehabilitation dose and motor and cognitive functions, during UL motor recovery. Inpatients with first unilateral stroke, without time restrictions from onset, and undergoing at least 15 h of rehabilitation were enrolled. Data on dose and modalities of rehabilitation received, together with motor and cognitive outcomes before and after therapy, were collected. Fugl–Meyer values for the Upper Extremity were the primary outcome measure. Logistic regression models were used to detect any associations between UL motor improvement and motor and cognitive-linguistic features at acceptance, regarding dose of rehabilitation received. Thirty-five patients were enrolled and received 80.57 ± 30.1 h of rehabilitation on average. Manual dexterity, level of independence and UL motor function improved after rehabilitation, with no influence of attentive functions on motor recovery. The total amount of rehabilitation delivered was the strongest factor (p = 0.031) influencing the recovery of UL motor function after stroke, whereas cognitive-linguistic characteristics were not found to influence UL motor gains

The Impact of Isolation Due to COVID-19 on Physical Activity Levels in Adult Students

The lockdown with a prohibition of free mobility introduced in many countries has affected restrictions in physical activity (PA). The purpose of the study was to compare PA during restrictions and the “unfreezing” stage. The study group consisted of 89 healthy adult students. To assess the level of PA, a long version of the International Physical Activity Questionnaire (IPAQ) was used. The first evaluation was carried out in the period from 16 to 20 April 2020 at the time of the lockdown and the second in the period from 11 to 14 May 2020 during the so-called “unfreezing”. The average total PA rate during the first measurement was 8640 metabolic equivalent (MET)-min/week and in the second, 10,560 MET-min/week. The analysis of total energy expenditure showed a statistically significant difference (p < 0.029). The establishment of “unfreezing” laws for sport and recreation and the reduction of restrictions have significantly contributed to an increase in the overall level of PA. Based on our outcomes, we recommend students follow the scientific guidelines for undertaking PA (i.e., WHO) during the pandemic in order to maintain an appropriate pro-healthy dose of exercise

Language and gesture neural correlates: A meta-analysis of functional magnetic resonance imaging studies

Background: Humans often use co-speech gestures to promote effective communication. Attention has been paid to the cortical areas engaged in the processing of co-speech gestures. Aims: To investigate the neural network underpinned in the processing of co-speech gestures and to observe whether there is a relationship between areas involved in language and gesture processing. Methods & procedures: We planned to include studies with neurotypical and/or stroke participants who underwent a bimodal task (i.e., processing of co-speech gestures with relative speech) and a unimodal task (i.e., speech or gesture alone) during a functional magnetic resonance imaging (fMRI) session. After a database search, abstract and full-text screening were conducted. Qualitative and quantitative data were extracted, and a meta-analysis was performed with the software GingerALE 3.0.2, performing contrast analyses of uni- and bimodal tasks. Main contribution: The database search produced 1024 records. After the screening process, 27 studies were included in the review. Data from 15 studies were quantitatively analysed through meta-analysis. Meta-analysis found three clusters with a significant activation of the left middle frontal gyrus and inferior frontal gyrus, and bilateral middle occipital gyrus and inferior temporal gyrus. Conclusions: There is a close link at the neural level for the semantic processing of auditory and visual information during communication. These findings encourage the integration of the use of co-speech gestures during aphasia treatment as a strategy to foster the possibility to communicate effectively for people with aphasia. What this paper adds: What is already known on this subject Gestures are an integral part of human communication, and they may have a relationship at neural level with speech processing. What this paper adds to the existing knowledge During processing of bi- and unimodal communication, areas related to semantic processing and multimodal processing are activated, suggesting that there is a close link between co-speech gestures and spoken language at a neural level. What are the potential or actual clinical implications of this work? Knowledge of the functions related to gesture and speech processing neural networks will allow for the adoption of model-based neurorehabilitation programs to foster recovery from aphasia by strengthening the specific functions of these brain networks

Benefits of Telerehabilitation for Patients With Severe Acquired Brain Injury: Promising Results From a Multicenter Randomized Controlled Trial Using Nonimmersive Virtual Reality

BackgroundIn neurorehabilitation, the use of innovative technologies offers many opportunities to monitor and improve the health status of patients with severe acquired brain injury (SABI). Telerehabilitation allows for continuity of service through the entire rehabilitation cycle, including assessment, intervention, consultation, and education, affording early reintegration and positively enhancing the quality of life (QoL). ObjectiveThe main purpose of this multicenter randomized controlled trial was to test the effectiveness of advanced training provided using a nonimmersive virtual reality rehabilitation system (ie, the VRRS HomeKit device) in improving functional outcomes in patients with SABI. MethodsIn total, 40 patients with SABI and their 40 caregivers visiting 2 Italian rehabilitation centers were enrolled in the study protocol and randomized into 2 groups. Of the 40 patients, 20 (50%) underwent the experimental training using the VRRS HomeKit (teleneuro-VRRS group), whereas the other 20 (50%) were administered usual territorial rehabilitative treatments (UTRTs; control group). To investigate motor and neuropsychological functioning, patients with SABI were evaluated before (T0) and at the end of (T1) each training session by a multispecialist team through a complete clinical and psychometric battery: the Barthel Index (BI), the Tinetti Scale (TS), the Modified Ashworth Scale (MAS), the Montreal Cognitive Assessment (MoCa), the Frontal Assessment Battery (FAB), the Beck Depression Inventory II (BDI-II), the Short Form Health Survey 36 (SF-36), and the Psychological General Well-Being Index (PGWBI). In addition, the Caregiver Burden Inventory (CBI) was administered to each caregiver to investigate the emotional burden status. ResultsThe teleneuro-VRRS group achieved a statistically significant improvement in both general and motor outcomes, as well as psychological well-being and QoL, compared to the control group. In particular, the BI (P<.001), FAB (P<.001), and BDI-II (P<.001) were the outcome scales with the best improvement. The burden of caregivers also significantly improved in the teleneuro-VRRS group (CBI; P<.004). Between-group analysis showed statistical differences in the anxiety (effect size [ES]=0.85, P<.02) and self-control (ES=0.40, P<.03) subtests of the PGWBI and in the social role functioning (ES=0.85, P<.02) subtest of the SF-36, confirmed by quite medium and large ESs. ConclusionsOur results suggest that the VRRS is a suitable alternative tool or complementary tool or both to improve motor (level of functional independence) and cognitive (frontal/executive abilities) outcomes, reducing behavioral alterations (anxiety and depression symptoms) in patients with SABI, with a beneficial impact also on the caregivers’ burden distress management, mitigating distress and promoting positive aspects of caring. Trial RegistrationClinicalTrials.gov NCT03709875; https://classic.clinicaltrials.gov/ct2/show/NCT0370987