Search

Action observation training (AOT) is a therapeutic approach used in stroke rehabilitation. Videos form the core of AOT, and knowledge of constituent parameters is essential to make the intervention robust and generalizable. Currently, there is a dearth of available information on video parameters to be used for AOT. Our purpose was to identify and describe the parameters that constitute AOT videos for stroke rehabilitation. Electronic databases like PubMed, CINAHL, Scopus, Web of Science, ProQuest, and Ovid SP from inception to date according to PRISMA-ScR guidelines. Title, abstract, and full-text screening were done independently by two authors, with a third author for conflict resolution. Data on video parameters like length, quality, perspective, speed, screen size and distance, sound, and control videos were extracted. Seventy studies were included in this review. The most-reported parameters were video length (85.71%) and perspective of view (62.85%). Movement speed (7.14%) and sound (8.57%) were the least reported. Static landscapes or geometrical patterns were found suitable as control videos. Most video parameters except for length and perspective of view remain underreported in AOT protocols. Future studies with better descriptions of video parameters are required for comprehensive AOT interventions and result generalisation. Videos shorter than 5 min may be preferred during action observation training (AOT) intervention in post-stroke. Egocentric view may be better for upper limb dexterity function and allocentric view for gross actions like walking. Choice of video disseminating device depends on its dimension as well as observer distance. Movement speed, video sound, and quality must be considered to obtain more comprehensive AOT videos. [ABSTRACT FROM AUTHOR]

Background and Purpose: Fatigue following neurological conditions negatively impacts daily activities, reducing overall quality of life. Transcranial direct current stimulation (tDCS) for fatigue management is still underexplored. This scoping review explores its use in managing fatigue among various neurological conditions. Methods: A thorough literature search was carried out using PubMed, Scopus, CINAHL, Web of Science, Embase, ProQuest, and the Cochrane Library. Google Scholar and clinicaltrials.gov were manually searched for gray literature and ongoing trials, respectively. Regardless of the study design, all studies utilizing tDCS for the management of fatigue in various neurological conditions were considered. Two reviewers independently screened all the studies, following which the data were retrieved. Results: Studies employing tDCS for fatigue management across neurological conditions is as follows: Multiple sclerosis (MS) (n = 28, 66%), stroke (n = 5, 12%), Parkinson's disease (PD) (n = 4, 10%), post‐polio syndrome (PPS) (n = 2, 5%), traumatic brain injury (TBI) (n = 2, 5%), and amyotrophic lateral sclerosis (n = 1, 2%). All the studies used anodal stimulation, with the common stimulation site being the left dorsolateral prefrontal cortex for MS, stroke, and PD. A stimulation intensity of 1.0–4.0 mA with a duration ranging from 15 to 30 min in 1 to 24 sessions were commonly reported. The Fatigue Severity Scale (n = 21) and Modified Fatigue Impact Scale (n = 17) were frequently implemented outcome measures. Regardless of the study design, 36/42 (85.7%) studies reported an improvement in fatigue scores in the tDCS group. The common adverse events noted were tingling (n = 8, 35%), headache (n = 6, 26%), and itching (n = 6, 26%). Discussion: Application of tDCS for fatigue was explored in individuals with stroke, PD, PPS, and TBI after MS. Even though a wide range of treatment parameters and outcome measures were adopted to assess and target fatigue, tDCS proves to have a promising role in alleviating this symptom. [ABSTRACT FROM AUTHOR]

Introduction: Stroke rehabilitation guidelines promoteclinical decision making, enhance quality of healthcare delivery, minimize healthcare costs, and identify gaps in current knowledge to guide future research. However, there are no published reviews that have exclusively evaluated the quality of existing Clinical Practice Guidelines (CPGs) for stroke rehabilitation from Low- and Middle-Income Countries (LMICs) or provided any insights into the cultural variation, adaptations, or gaps in implementation specific to LMICs. Objectives: To identify CPGs developed by LMICs for stroke rehabilitation and evaluate their quality using AGREE-II and AGREE-REX tool. Methods: The review protocol is prepared in accordance with the PRISMA-P guidelines and the review was registered in PROSPERO (CRD42022382486). The search was run in Medline, EMBASE, CINHAL, PEDro for guidelines published between 2000 till July 2022. Additionally, SUMSearch, Google, and other guideline portals and gray literature were searched. The included studies were then subjected to data extraction for the following details: Study ID, title of the CPG, country of origin, characteristics of CPG (Scope-national/regional, level of care, multidisciplinary/uni-disciplinary), and information on stroke rehabilitation relevant recommendations. The quality of the included CPGs will be subsequently evaluated using AGREE-II and AGREE-REX tool. Results & conclusion: This systematic review aims to explore the gaps in existing CPGs specific to LMICs and will aid in development/adaptation/contextualization of CPGs for implementation in LMICs. [ABSTRACT FROM AUTHOR]

To design and test the feasibility of context-specific activities for improving physical activity (PA) levels among Indian adults with stroke. Context-specific activities were developed after a thorough literature search and inputs from five adults with stroke and five experts. Following which 17 adults with stroke were recruited. Participants were asked to choose at least three activities from the list of context-specific activities and to perform them every day for one month. Participants' pre and post-intervention PA levels and quality of life (QoL) were assessed using the physical activity scale for individuals with physical disabilities (PASIPD) and stroke specific quality of life (SSQoL). At the end of the program, participants were also interviewed to explore their experiences with the program. The list of context-specific activities included 45 activities under aerobic, strengthening, and balance domains. Fifteen participants [mean (SD) age 56.94 (9.87)] completed the one-month intervention. Intervention adherence rate was 86.6%. No adverse events were noted, and participants were satisfied with the program. PASIPD and SSQoL (MD − 6.52) scores showed significant improvement post-intervention. Context-specific activities are designed for Indian adults with stroke. Context-specific activities are feasible, safe and help to improve PA and QoL. [ABSTRACT FROM AUTHOR]

Adherence to prescribed exercises is essential for home-based programs to be effective, but evidence for strategies to enhance exercise adherence in people with stroke is lacking. To determine the effect of adherence strategies on the proportion of people with stroke who adhere to prescribed home-based exercises and their level of adherence at 6 and 12 weeks of intervention. Our secondary objective was to determine the effect of the combined intervention on mobility and quality of life post-stroke. We conducted an RCT among people with stroke (Exp = 27, Con = 25) living in semi-urban India. Both groups received standard hospital care and a home exercise program. The experimental group also received adherence strategies delivered over five sessions. Adherence was measured using the Stroke-Specific Measure of Adherence to Home-based Exercises (SS-MAHE) , mobility using Mobility Disability Scale, and quality of life using the Stroke Impact Scale. The experimental group had better exercise adherence compared to the control group both at six (mean difference [MD] 45, 95% CI 40, 64, p <.001) and 12 weeks (MD 51, 95% CI 39, 63, p <.001). The experimental group also had better mobility at 12 weeks (median (IQR), experimental 42 (57), median (IQR), control 95 (50), p =.002). There was no difference in the quality of life scores between groups at six or 12 weeks. The adherence strategies were effective in improving exercise adherence and mobility post-stroke but did not improve quality of life. CTRI/2018/08/015212 [ABSTRACT FROM AUTHOR]

The context of implementation plays an important role in the delivery of optimal treatments in stroke recovery and rehabilitation. Considering that stroke systems of care vary widely across the globe, the goal of the present paper is to compare healthcare providers' priority of key areas in translating stroke research to clinical practice among High Income Countries, Upper Middle- and Lower Middle-Income Countries (HICs, UMICs, LMICs). We also aimed to compare perceptions regarding the key areas' feasibility of implementation, and formulate recommendations specific to each socioeconomic region. Data related to recommendations for knowledge translation in stroke, from a primary survey from the second Stroke Recovery and Rehabilitation Roundtable were segregated based on socioeconomic region. Frequency distribution was used to compare the key areas for practice change and examine the perceived feasibility of implementation of the same across HIC, UMIC and LMICs. A total of 632 responses from healthcare providers across 28 countries were received. Interdisciplinary care and access to services were high priorities across the three groups. Transitions in Care and Intensity of Practice were high priority areas in HICs, whereas Clinical Practice Guidelines were a high priority in LMICs. Interventions specific to clinical discipline, screening and assessment were among the most feasible areas in HICs, whereas Intensity of practice and Clinical Practice Guidelines were perceived as most feasible to implement in LMICs. We have identified healthcare providers' priorities for addressing international practice change across socioeconomic regions. By focusing on the most feasible key areas, we can aid the channeling of appropriate resources to bridge the disparities in stroke outcomes across HICs, UMICs and LMICs. It is pertinent to examine the differences in priorities of stroke rehabilitation professionals and the feasibility of implementing evidence-based practice across socioeconomic regions. There is an urgent necessity for the development of clinical practice guidelines for stroke rehabilitation in Low-Middle Income Countries, taking into consideration the cultural, economic and geographical constraints. In upper-middle income countries, encouraging family support and timely screening and assessment for aphasia, cognition and depression appear to be the low hanging fruits to enhance quality of life after stroke. Innovative ways to increase intensity of practice and channelling of resources to improve transitions in care may prove to be the most beneficial in advancing stroke rehabilitation in high income countries. [ABSTRACT FROM AUTHOR]

Motor recovery of the upper limb (UL) is related to exercise intensity, defined as movement repetitions divided by minutes in active therapy, and task difficulty. However, the degree to which UL training in virtual reality (VR) applications deliver intense and challenging exercise and whether these factors are considered in different centres for people with different sensorimotor impairment levels is not evidenced. We determined if (1) a VR programme can deliver high UL exercise intensity in people with sub-acute stroke across different environments and (2) exercise intensity and difficulty differed among patients with different levels of UL sensorimotor impairment. Participants with sub-acute stroke (<6 months) with Fugl-Meyer scores ranging from 14 to 57, completed 10 ∼ 50-min UL training sessions using three unilateral and one bilateral VR activity over 2 weeks in centres located in three countries. Training time, number of movement repetitions, and success rates were extracted from game activity logs. Exercise intensity was calculated for each participant, related to UL impairment, and compared between centres. Exercise intensity was high and was progressed similarly in all centres. Participants had most difficulty with bilateral and lateral reaching activities. Exercise intensity was not, while success rate of only one unilateral activity was related to UL severity. The level of intensity attained with this VR exercise programme was higher than that reported in current stroke therapy practice. Although progression through different activity levels was similar between centres, clearer guidelines for exercise progression should be provided by the VR application. VR rehabilitation systems can be used to deliver intensive exercise programmes. VR rehabilitation systems need to be designed with measurable progressions through difficulty levels. [ABSTRACT FROM AUTHOR]