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Background: Sexual dysfunction (SD) is experienced by 50% of stroke survivors, and it is identified as critical in their rehabilitation management, but often remains unaddressed., Objective: To evaluate the effectiveness and adverse events of currently available interventions for SD following stroke., Methods: A summary of the Cochrane Review by Stratton et al. 2020, with comments from a rehabilitation perspective., Results: Three randomized control trials with a total of 212 participants were included. Evidence quality was very low for all assessed interventions (pharmacological, psycho-educational and physical therapy). The efficacy of pelvic floor muscle training for lower urinary tract symptoms and erectile dysfunction remains uncertain. Pharmacological interventions may improve sexual functioning, while psychoeducation show little to no difference on sexual functioning outcomes., Conclusions: The effectiveness of current rehabilitation interventions for SD following stroke remains uncertain due to the low quality of evidence and limited sample size. Further studies with improved methodology should investigate rehabilitation interventions for SD in stroke survivors to improve their quality of life.

Background: Stroke is a major cause of disability worldwide, with an expected rise of global burden in the next twenty years throughout Europe. This EBPP represents the official position of the European Union through the UEMS Physical and Rehabilitation Medicine (PRM) Section and designates the professional role of PRM physicians for people with stroke. The aim of this study is to improve PRM physicians' professional practice for persons with stroke in order to promote their functioning and enhance quality of life., Methods: A systematic review of the literature including a ten-year period and a consensus procedure by means of a Delphi process has been performed involving the delegates of all European countries represented in the UEMS PRM Section., Results: The systematic literature review is reported together with 78 recommendations resulting from the Delphi procedure., Conclusions: The professional role of PRM physicians for persons with stroke is to improve specialized rehabilitation services worldwide in different settings and to organize and manage the comprehensive rehabilitation programme for stroke survivors considering all impairments, comorbidities and complications, activity limitations and participation restrictions as well as personal and environmental factors.

Background: No long-term studies have been reported on the effect of training programs on driving after stroke., Objectives: The authors' primary aim was to determine the effect of simulator versus cognitive rehabilitation therapy on fitness-to-drive at 5 years poststroke. A second aim was to investigate differences in clinical characteristics between stroke survivors who resumed and stopped driving., Methods: In a previously reported randomized controlled trial, 83 stroke survivors received 15 hours of simulator training (n = 42) or cognitive therapy (n = 41). In this 5-year follow-up study, 61 participants were reassessed. Fitness-to-drive decisions were obtained from medical, visual, neuropsychological, and on-road tests; 44 participants (simulator group, n = 21; cognitive group, n = 23) completed all assessments. The primary outcome measures were fitness-to-drive decision and current driving status., Results: The authors found that 5 years after stroke, 18 of 30 participants (60%) in the simulator group were considered fit to drive, compared with 15 of 31 (48%) in the cognitive group (P = .36); 34 of 61 (56%) participants were driving. Current drivers were younger (P = .04), had higher Barthel scores (P = .008), had less comorbidity (P = .01), and were less severely depressed (P = .02) than those who gave up driving., Conclusions: The advantage of simulator-based driving training over cognitive rehabilitation therapy, evident at 6 months poststroke, had faded 5 years later. Poststroke drivers were younger and less severely affected and depressed than nondrivers.

Background: Visual inattention is a major cause of road accidents and is a problem commonly experienced after stroke., Purpose: This study investigated the effects of 2 training programs on performance in the Useful Field of View (UFOV), a validated test of driving-related visual attention skills., Method: Data from 69 first-ever, moderately impaired stroke survivors who participated in a randomized controlled trial (RCT) to determine the effects of simulator training on driving after stroke were analyzed. In addition to regular interventions at a rehabilitation center, participants received 15 hours of either simulator-based driving-related training or non-computer-based cognitive training over 5 weeks., Results: Total percentage reduction in UFOV and performance in divided and selective attention and speed of processing subtests were documented at 6 to 9 weeks (pretraining), 11 to 15 weeks (posttraining), and 6 months post stroke (follow-up). Generalized estimating equation (GEE) model revealed neither group effects nor significant interaction effects of group with time in the UFOV total score and the 3 subtests. However, there were significant within-group improvements from pre- through posttraining to follow-up for all the UFOV parameters. Post-hoc GEE analysis revealed that most improvement in both groups occurred from pre- to posttraining., Conclusion: Both training programs significantly improved visual attention skills of moderately impaired stroke survivors after 15 hours of training and retention of benefit lasted up to 6 months after stroke. Neither of the training programs was better than the other.

Background: Several driving retraining programs have been developed to improve driving skills after stroke. Those programs rely on different rehabilitation concepts., Objectives: The current study sought to examine the specific carryover effect of driving skills of a comprehensive training program in a driving simulator when compared with a cognitive training program., Methods: Further analysis from a previous randomized controlled trial that investigated the effect of simulator training on driving after stroke. Forty-two participants received simulator-based driving training, whereas 41 participants received cognitive training for 15 hours. Overall performance in the on-road test and each of its 13 items were compared between groups immediately posttraining and at 6 months poststroke., Results: Generalized estimating equation analysis showed that the total score on the on-road test and each item score improved significantly over time for both groups. Those who received driving simulator training achieved better results when compared with the cognitive training group in the overall on-road score and the items of anticipation and perception of signs, visual behavior and communication, quality of traffic participation, and turning left. Most of the differences in improvement between the 2 interventions were observed at 6 months poststroke., Conclusions: Contextual training in a driving simulator appeared to be superior to cognitive training to treat impaired on-road driving skills after stroke. The effects were primarily seen in visuointegrative driving skills. Our results favor the implementation of driving simulator therapy in the conventional rehabilitation program of subacute stroke patients with mild deficits.

Objective: The aim of this prospective study was to confirm the accuracy of a short assessment battery, used previously in a study to predict fitness-to-drive after stroke, in a new cohort of stroke survivors without severe deficits., Design: A prospective study., Subjects: A total of 43 (39 men and 4 women) consecutive survivors after stroke who were not severely impaired and who performed the pre-driving assessment, which included a standardized on-road test at the Belgian Road Safety Institute in Brussels, Belgium. On average, participants were 6 months post-stroke, independently ambulant with or without assistive devices, possessed valid drivers' licenses and actively drove prior to stroke onset., Methods: Fitness-to-drive decisions based on performance in 15 tests of a full-scale assessment battery were predicted using only the scores from the 3 predictive tests previously identified., Results: When the discriminant equation from the previous study including performance in the 3 tests (figure of Rey, visual neglect (lateralized mean reaction time) and on-road test) was applied, 37 (86%) of the 43 participants were correctly predicted to pass or fail the pre-driving assessment. The sensitivity and specificity of the predictions were 77% and 92%, respectively., Conclusion: This study shows that the short assessment battery is a good predictor of fitness-to-drive in stroke survivors with moderate physical and cognitive impairments.

Objectives: To determine the validity of a road test performed by stroke patients in Belgium and to reestablish its reliability., Design: Prospective study of a predriving evaluation., Setting: University hospital in Belgium., Participants: Thirty-eight patients with sequelae of first-ever stroke., Interventions: Not applicable., Main Outcome Measures: Performance in the Stroke Driver Screening Assessment (SDSA) and on a road test., Results: Interrater reliability of the road test subitems was moderate to substantial (weighted kappa range, .44-.78). Item-per-item reliability varied from moderately high (intraclass correlation coefficient [ICC]=.63) to very high (ICC=.87). The reliability of the overall performance in the road test was very high (ICC=.83). For the criterion validity of the road test, 78.9% of the subjects were correctly classified when the judgments of the principal evaluator were compared with outcomes of the SDSA. Agreement in classification between the principal evaluator and a state-registered evaluator's judgments was 81.6%. The sensitivity and specificity of the agreement were very high (80.6%) and perfect (100%), respectively., Conclusions: The road test is a reliable and valid test of driving ability after stroke.

Background and Purpose: Several studies have investigated the effect of therapeutic interventions for the arm in the acute phase after stroke, with follow-ups at a maximum of 12 months. The aim of this study was to examine the effect of repetitive sensorimotor training of the arm at 5 years after stroke., Subjects and Methods: One hundred consecutive stroke patients were randomly allocated either to an experimental group that received daily additional sensorimotor stimulation of the arm or to a control group. The intervention period was 6 weeks. Assessments of the patients were made before, midway, and after intervention, and at 6 and 12 months after stroke. In this study, 62 patients were reassessed at 5 years after stroke. The Brunnström-Fugl-Meyer (BFM) test, Action Research Arm (ARA) test, and Barthel index (BI) were used as the primary outcome measures., Results: At the 5-year follow-up, there was a statistically significant difference for both the BFM and ARA tests in favor of the experimental group. The mean differences in improvement between the groups from the initial evaluation to the 5-year assessment corresponded to 17 points on the BFM and 17.4 on the ARA. No effect was found for the BI. The treatment was most effective in patients with a severe initial motor deficit., Conclusions: Adding a specific intervention for the arm during the acute phase after a stroke resulted in a clinically meaningful and long-lasting effect on motor function. The effect can be attributed to early, repetitive, and targeted stimulation.

Objective: To determine the reliability of the road test performed by stroke patients., Design: Prospective study of a 6-month predriving evaluation., Setting: Driving safety center in Belgium., Participants: Thirty patients with sequelae of stroke., Interventions: Not applicable., Main Outcome Measures: Results of driving performance as judged by 2 assessors from the Center for Determination of Fitness to Drive and Car Adaptations (CARA), in a car fitted with a video camera. A third assessor also evaluated all the video recordings. Interrater reliability was evaluated by comparing results from real-life performance and video recording, as judged by the CARA assessors and video judgments between CARA assessors and the third assessor., Results: Most subitems of the road test showed more than 80% scoring agreement between the various evaluations. Intraclass correlation coefficients (ICCs) of the items varied from -.08 to 1.0. The ICC of the overall performance was.62 when real-life scores were compared with video evaluations and.80 in video versus video comparison., Conclusion: The reliability of assessing overall performance of stroke patients in the road test is moderately high and better when assessed using the same evidence. Yet, the reliability of some items needs further attention.

Objectives: To quantify changes in spastic hypertonia during repeated passive isokinetic knee movements in stroke patients and to assess the role of muscle activity., Design: A between-groups design with repeated measures., Setting: Rehabilitation center for stroke patients., Participants: Ten stroke patients with hypertonia and 10 healthy subjects matched for age and gender., Intervention: With an isokinetic apparatus, movements were imposed on the knee in series of 10 repetitions at speeds of 60 degrees /s, 180 degrees /s, and 300 degrees /s., Main Outcome Measures: Spastic hypertonia was assessed on the basis of torque measurement and electromyographic activity of the quadriceps, hamstrings, and gastrocnemius muscles., Results: Compared with the controls, stroke patients presented a significantly stronger torque reduction during the mid- and endphases of movements at all speeds tested (P<.05). The strongest torque decline occurred during knee flexion and during the first movements. The effect increased toward the end phase of movements and with increasing speeds. The effect of movement repetitions on torque measurements was unchanged after electromyographic activity was included in the statistical analysis, except during extension movements at 180 degrees /s and 300 degrees /s., Conclusion: Passive movements of the knee induced a decrease of spastic hypertonia in stroke patients through a combination of reflexive and mechanical factors. The role of these mechanisms is velocity dependent and differs for flexion and extension movements., (Copyright 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation)

BACKGROUND: Dysphagia is a common impairment in patients with acute stroke and is associated with an increased risk of complications such as aspiration pneumonia, malnutrition and dehydration, as well as with poor outcome and higher mortality. Therefore, immediate screening for aspiration risk is recommended, using a bedside swallow screening tool. OBJECTIVE: To determine the diagnostic accuracy and the sensitivity and specificity of bedside screening tests for detecting risk of aspiration associated with dysphagia in people with acute stroke. METHODS: A summary of the Cochrane Review by Boaden et al. 2021, with comments from a rehabilitation perspective. RESULTS: The review included 25 studies with 3953 participants and 37 screening tests. No single study demonstrated 100% sensitivity and specificity with low risk of bias for all domains. The best performing swallow screening tools were the Bedside Aspiration test (combined water swallow and instrumental tool), the Gugging Swallowing Screen (GUSS, water plus other consistencies) and the Toronto Bedside Swallowing Screening Test (TOR-BSST, water only). However, these tests were based on single studies with small sample sizes. It was not possible to explore the influence of sources of heterogeneity. CONCLUSIONS: No single swallow screening tool with high accuracy as well as good quality evidence could be identified, but recommendations for further high-quality research are offered. [ABSTRACT FROM AUTHOR]