Effects of augmented visual feedback during balance training in Parkinson's disease: A pilot randomized clinical trial

AbstractBackgroundBalance training has been demonstrated to improve postural control in patients with Parkinson's disease (PD). The objective of this pilot randomized clinical trial was to investigate whether a balance training program using augmented visual feedback is feasible, safe, and more effective than conventional balance training in improving postural control in patients with PD.MethodsThirty-three patients with idiopathic PD participated in a five-week training program consisting of ten group treatment sessions of 60 min. Participants were randomly allocated to (1) an experimental group who trained on workstations consisting of interactive balance games with explicit augmented visual feedback (VFT), or (2) a control group receiving conventional training. Standing balance, gait, and health status were assessed at entry, at six weeks, and at twelve weeks follow-up.ResultsSixteen patients were allocated to the control group and seventeen to the experimental group. The program was feasible to apply and took place without adverse events. Change scores for all balance measures favored VFT, but the change in the primary outcome measure, i.e. the Functional Reach test, did not differ between groups (t(28) = -0.116, p = .908). No other differences between groups were statistically significant.ConclusionsVFT proved to be a feasible and safe approach to balance therapy for patients with PD. In this proof-of-concept study VFT was not superior over conventional balance training although observed trends mostly favored VFT. These trends approached clinical relevance only in few cases: increasing the training load and further optimization of VFT may strengthen this effect.Trial registrationControlled Trials, ISRCTN47046299

Smoothness metrics for reaching performance after stroke:Part 1: which one to choose?

BACKGROUND: Smoothness is commonly used for measuring movement quality of the upper paretic limb during reaching tasks after stroke. Many different smoothness metrics have been used in stroke research, but a ‘valid’ metric has not been identified. A systematic review and subsequent rigorous analysis of smoothness metrics used in stroke research, in terms of their mathematical definitions and response to simulated perturbations, is needed to conclude whether they are valid for measuring smoothness. Our objective was to provide a recommendation for metrics that reflect smoothness after stroke based on: (1) a systematic review of smoothness metrics for reaching used in stroke research, (2) the mathematical description of the metrics, and (3) the response of metrics to simulated changes associated with smoothness deficits in the reaching profile. METHODS: The systematic review was performed by screening electronic databases using combined keyword groups Stroke, Reaching and Smoothness. Subsequently, each metric identified was assessed with mathematical criteria regarding smoothness: (a) being dimensionless, (b) being reproducible, (c) being based on rate of change of position, and (d) not being a linear transform of other smoothness metrics. The resulting metrics were tested for their response to simulated changes in reaching using models of velocity profiles with varying reaching distances and durations, harmonic disturbances, noise, and sub-movements. Two reaching tasks were simulated; reach-to-point and reach-to-grasp. The metrics that responded as expected in all simulation analyses were considered to be valid. RESULTS: The systematic review identified 32 different smoothness metrics, 17 of which were excluded based on mathematical criteria, and 13 more as they did not respond as expected in all simulation analyses. Eventually, we found that, for reach-to-point and reach-to-grasp movements, only Spectral Arc Length (SPARC) was found to be a valid metric. CONCLUSIONS: Based on this systematic review and simulation analyses, we recommend the use of SPARC as a valid smoothness metric in both reach-to-point and reach-to-grasp tasks of the upper limb after stroke. However, further research is needed to understand the time course of smoothness measured with SPARC for the upper limb early post stroke, preferably in longitudinal studies. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12984-021-00949-6

Early prediction of outcome of activities of daily living after stroke: a systematic review

Background and Purpose-Knowledge about robust and unbiased factors that predict outcome of activities of daily living (ADL) is paramount in stroke management. This review investigates the methodological quality of prognostic studies in the early poststroke phase for final ADL to identify variables that are predictive or not predictive for outcome of ADL after stroke. Methods-PubMed, Ebsco/Cinahl and Embase were systematically searched for prognostic studies in which stroke patients were included = 3 months poststroke. Risk of bias scores were used to distinguish high-and low-quality studies and a qualitative synthesis was performed. Results-Forty-eight of 8425 identified citations were included. The median risk of bias score was 17 out of 27 (range, 6-22) points. Most studies failed to report medical treatment applied, management of missing data, rationale for candidate determinants and outcome cut-offs, results of univariable analysis, and validation and performance of the model, making the predictive value of most determinants indistinct. Six high-quality studies showed strong evidence for baseline neurological status, upper limb paresis, and age as predictors for outcome of ADL. Gender and risk factors such as atrial fibrillation were unrelated to this outcome. Conclusions-Because of insufficient methodological quality of most prognostic studies, the predictive value of many clinical determinants for outcome of ADL remains unclear. Future cohort studies should focus on early prediction using simple models with good clinical performance to enhance application in stroke management and research. (Stroke. 2011;42:1482-1488.

Family-delivered rehabilitation services at home:is the glass empty?

In low-income and middle-income countries, meeting inpatient and outpatient rehabilitation needs of stroke survivors with insufficient staff and facility resources is especially challenging. Family-delivered rehabilitation services might be an innovative way to augment intensity of practice. 1 The ATTEND Collaborative Group's ATTEND trial, 2 published in The Lancet, is to our knowledge the first appropriately powered trial to investigate the effect of family-delivered, home-based rehabilitation intervention for patients with stroke in a low-middle-income country. In this prospectively randomised open trial with blinded endpoints conducted across 14 hospitals in India, populations with different languages, cultures, and health systems were assessed using the modified Rankin Scale (mRS), with death or dependency (mRS 3–6) at 6 months post stroke as a primary outcome. Patients were randomly assigned to receive additional structured rehabilitation training, delivered in three 1–h sessions in hospital and continued in up to six home visits for up to 2 months after discharge, or care as usual. The ATTEND Collaborative Group hypothesised that family-delivered rehabilitation services would increase independence and survival at 6 months after stroke. Unfortunately, the results of this pragmatic trial showed no favourable benefits when the proportion of disabled and deceased patients (285 [47%] of 607 patients) in the intervention group was compared with that in the control group (287 [47%] of 605 patients) at 6 months after stroke (odds ratio 0·98, 95% CI 0·78–1·23, p=0·87). Similarly, no surplus value was found in terms of secondary outcomes such as length of hospital stay, basic and extended activities of daily living, perceived anxiety, depression, and quality of life of patients and burden on their caregivers. These results render the ATTEND trial neutral, without any positive trends that would favour family-delivered rehabilitation services at home when compared with no therapy or a very limited number of sessions of outpatient care. The ATTEND Collaborative Group needs to be congratulated for this important, methodologically well conducted trial. The results of the ATTEND trial are in line with the cost-effectiveness of a structured inpatient training programme for caregivers after stroke,

On the functional aspects of variability in postural control

Current research in nonlinear dynamics and chaos theory has challenged traditional perspectives that associate high variability with performance decrement and pathology. It is argued that variability can play a functional role in postural control and that reduction of variability is associated with changes in balance with aging and neurological disease

Pelvic floor muscle exercise therapy with myofeedback for women with stress urinary incontinence:A meta-analysis

Involuntary urine loss can be a major social and hygienic problem for women suffering from stress urinary incontinence (SUI). A frequently applied treatment method for these women is pelvic floor muscle exercise therapy (PFE), either with or without EMG-biofeedback (myofeedback). This paper attempts to determine the efficacy of PFE using myofeedback by reviewing in a meta-analysis several studies that used this treatment method for women with SUI. An effort is also made to determine whether PFE with myofeedback deserves preference to PFE without myofeedback. The results show very few studies using a randomised control-group design with high statistical and internal validity. Although no conclusive evidence is presented, the following trend can be discerned: PFE with myofeedback is an effective treatment method for women with SUI and is more effective than PFE without myofeedback

Generalizability of the Maximum Proportional Recovery Rule to Visuospatial Neglect Early Poststroke

Background and objective. Proportional recovery of upper-extremity motor function and aphasia after stroke may suggest common mechanisms for spontaneous neurobiological recovery. This study aimed to investigate if the proportional recovery rule also applies to visuospatial neglect (VSN) in right-hemispheric first-ever ischemic stroke patients and explored the possible common underlying mechanisms. Methods. Patients with upper-limb paresis and VSN were included. Recovery defined as the change in Letter Cancellation Test (LCT) score at ∼8 days and 6 months poststroke. Potential recovery defined as LCTmax-LCTinitial = 20 â' LCTinitial. Hierarchical clustering separated fitters and nonfitters of the prediction rule. A cutoff value on LCTmax-LCTinitial was determined. The change in LCT and Fugl-Meyer Assessment Upper Extremity was expressed as a percentage of the total possible score to investigate the communality of proportional recovery. Results. Out of 90 patients, 80 displayed proportional recovery of VSN (ie, "fitters," 0.97; 95% CI = 0.82-1.12). All patients who did not follow the prediction rule for VSN (ie, "nonfitters") had ≥15 missing O's at baseline and failed to show proportional recovery of the upper limb. Conclusions. This study shows that the proportional recovery rule also applies to patients with VSN poststroke. Patients who fail to show proportional recovery of VSN are the same patients who fail to show proportional recovery of the upper limb. These findings support the idea of common intrahemispheric mechanisms underlying spontaneous neurobiological recovery in the first months poststroke. Future studies should investigate the prognostic clinical and neurobiological markers of these subgroups