Smart post-stroke virtual assessment using A1-driven anaytics

In the United States, the incidence rate of new or recurrent stroke is approximately 795 000 per year, and stroke prevalence for individuals over the age of 20 years is estimated at 6.5 million.1 Mortality rates in the first 30 days after stroke have decreased because of advances in emergency medicine and acute stroke care. In addition, there is strong evidence that organized postacute, inpatient stroke care delivered within the first 4 weeks by an interdisciplinary healthcare team results in an absolute reduction in the number of deaths.2,3 Despite these positive achievements, stroke continues to represent the leading cause of long-term disability in Americans: An estimated 50 million stroke survivors worldwide currently cope with significant physical, cognitive, and emotional deficits, and 25% to 74% of these survivors require some assistance or are fully dependent on caregivers for activities of daily living (ADLs).4,5 Notwithstanding the substantial progress in acute stroke care over the past 15 years, the focus of stroke medical advances and healthcare resources has been on acute and subacute recovery phases, which has resulted in substantial health disparities in later phases of stroke care. Additionally, healthcare providers (HCPs) are often unaware of not only patients’ potential for improvement during more chronic recovery phases but also common issues that stroke survivors and their caregivers experience. Furthermore, even with evidence that documents neuroplasticity potential regardless of age and time after stroke,6 the mean lifetime cost of ischemic stroke (which accounts for 87% of all strokes) in the United States is an estimated $140 000 (for inpatient, rehabilitation, and follow-up costs), with 70% of first-year stroke costs attributed to acute inpatient hospital care1; therefore, fewer financial resources appear to be dedicated to providing optimal care during the later phases of stroke recovery. Because there remains a …

Stroke survivors face various problems that affect their health-related quality of life (HRQoL). Reduced activities of daily living (ADL) may contribute to post-stroke depression (PSD) and low HRQoL, and depression might be associated with low HRQoL. However, these relationships are not well known. This study aimed to analyze correlations among ADL, PSD, and HRQoL in stroke survivors and further explore the mediating role of PSD between ADL and HRQoL. This study utilized meta-analytic structural equation modeling (MASEM) on systematically searched articles from six electronic databases, namely PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure (China), Wanfang database (China), and SinoMed (China), from inception up to July 31, 2021. Two researchers independently assessed study eligibility, and data from the eligible studies were encoded and assessed for quality. MASEM was utilized to examine correlations among ADL, PSD, and HRQoL, with an estimation of a pooled correlation matrix under a random-effects model. The matrix was directly fitted to a structural equation model using webMASEM. In total, 8580 articles were screened, and data from 27 studies involving 33 effect sizes were used in the MASEM analysis. Correlations among the three variables were significant (both P < 0.01). Furthermore, PSD partially mediated the correlation between ADL and HRQoL (β = 0.24, 95% confidence interval 0.15-0.30). The findings suggest that both decreased ADL and PSD may reduce HRQoL, while a decrease in ADL tends to cause depression after stroke. Therefore, ADL and PSD reductions should be improved to achieve better HRQoL of stroke survivors. Future studies should continue to discuss other factors affecting HRQoL to achieve optimal recovery in stroke survivors.

The objective of this work is to study the functional hand strength for ADL rehabilitation tasks based on EMG signals and gripping/pinch force measurement via multivariate data analysis (MVA): Principal Components Analysis (PCA) and Projections to Latent Structures (PLS). The study allows us to identify weak muscles of patients with motor weakness, such as spinal cord injury (SCI) and post-stroke patients. We can then focus on rehabilitation activities to strengthen specific muscles. This analysis can also provide useful data for objective and quantitative assessment, towards control applications on the hand rehabilitation device being developed. From the study, subjects' group and age are shown as dominant factors compared with other factors, such as gender, BMI and frequency of exercise. The PLS model is created to predict the outcome of the EMG results from the gripping/pinch force for the subjects showing with difficulties in EMG measurement.

Little attention has been paid to screening of depression among stroke survivors in outpatient physiotherapy clinics. Post-stroke depression is reported to have a negative impact on functional recovery. However, the exact influence on the outcome of rehabilitation such as level of functional independence remains controversial. This study aims at ascertaining the influence of post-stroke depression on functional independence in activities of daily living. The study is a cross sectional survey of stroke survivors attending outpatient physiotherapy clinics of the University of Nigeria Teaching Hospital (UNTH) Enugu, and the Enugu State University Teaching Hospital (ESUTH). Participants were evaluated for socio-demographic characteristics. Post-stroke depression and level of functional recovery in Activities of Daily Living were assessed using the Hamilton Depression Rating Scale and the Barthel Index respectively. Data was analyzed using SPSS version 23, with α set at 0.01. A total of 66 participants, 42 females and 24 males, were purposively recruited into the study. Over 80% (56) of the participant had depression, with over 50% (32) being severely depressed. Post-stroke depression was associated with less functional independence in activities of daily living (p=0.000). A significant difference was found in the level of functional independence between participants with and without depression (p=0.00). Participants with post-stroke depression have less independence in activities of daily living. A longitudinal study with a larger sample size is, however, recommended so as to improve the external validity. In the mean time, outpatient rehabilitation of depressed stroke survivors should include pharmacological and psychological components.

The purpose of this study was to evaluate the effect of body weight-supported (BWS) gait training on restoration of walking, activities of daily living (ADL) and quality of life (QoL) in persons with an incomplete spinal cord injury (SCI). Datasources: Cochrane, MEDLINE, EMBASE, CINAHL, PEDro and DocOnline. Studies were assessed for methodological quality and described regarding population, training protocol and effects on walking ability, ADL and QoL. A descriptive and quantitative synthesis was conducted. 18 articles/17 studies were included. Two randomized controlled trials (RCTs) showed that subjects with American Spinal Injury Association Impairment Scale (AIS) C or D of less than one year duration reached higher scores on the locomotor item of the Functional Independence Measure (FIM-L, range 1-7) in the over-ground training group than in the BWS treadmill training group at the end of training, mean difference 0.80 (0.04-1.56). There were no differences regarding walking velocity and hardly data on ADL or QoL. Concluded was that subjects with subacute SCIs classified AIS C or D reached a higher level of independent walking after over-ground training compared to BWS treadmill training. More RCTs are needed to clarify the effectiveness of BWS gait training on walking, ADL and QoL for subgroups of persons with incomplete SCIs.

Purpose: This study attempts to determine a causal relationship among balance self-efficacy, balance, and activities of daily living (ADL) in community residents with stroke. Method: A cross-sectional descriptive correlation study was conducted with a convenience sample comprising 105 stroke patients living in the community. Data were collected using self-reporting questionnaires, including the Activities-specific Balance Confidence (ABC) scale and the Korean version of the Modified Barthel Index (K-MBI). The Berg Balance Scale was used to measure balance ability. A path model was tested to investigate the causal relations between variables, using the AMOS 17.0 statistical program to analyze the models, to obtain maximum-likelihood estimates of model parameters and to provide goodness-of-fit indices. Results: The proposed path model showed good fit indices. The direct path was significant between balance self-efficacy and balance (0.583), between balance and ADL (0.455). The indirect path was significant between balance self-efficacy and ADL (0.015). Conclusion: Our results support the link between balance efficacy, balance, and ADL in stroke patients. The proposed conceptual model was a good fit for the data and provided a plausible framework for understanding the relationship among these factors in stroke patients. Our model may also guide the intervention of functional rehabilitation for stroke patients.Implications for RehabilitationBalance self-efficacy, a psychological factor, should not be overlooked in attempting to improve functional outcomes in stroke survivors because balance self-efficacy impact ADL through the mediation of balance abilityIt would be appropriate to assess the balance efficacy as well as balance ability for maximizing performing tasks such as ADLs for individual with strokeInterventions that use a combination of balance training and balance self-efficacy enhancement could be the most effective for improving ADL in the case of community-dwelling stroke patients

The current study aims to examine the impact of occupational therapy on motor function and activities of daily living in stroke survivors. It presents a quasi-experimental study assessing the effect of occupational therapy on enhancing motor function and ADLs in stroke survivors. The study involved 30 participants divided into control and experimental groups. The measures include Fugl-Meyer Assessment (FMA) and Katz Index of Independence in Activities of Daily Living (ADL). Significant improvements were observed in the experimental group in both motor function and ADLs, as shown by ANOVA and post-hoc tests. The findings highlight the efficacy of occupational therapy in facilitating recovery and improving quality of life post-stroke, integrating traditional approaches with innovative technologies. The study also shows the necessity of occupational therapy in stroke rehabilitation and its holistic impact on physical recovery and patient well-being. For healthcare systems, these findings show the importance of allocating resources towards occupational therapy services for stroke survivors. This includes investing in advanced rehabilitation equipment and ensuring adequate staffing. Additionally, healthcare systems should consider developing collaborative models of care that involve multidisciplinary teams, including occupational therapists, to provide comprehensive and holistic treatment for stroke survivors.

Effect of Mirror Therapy on Recovery of Stroke Survivors: A Systematic Review and Network Meta-analysis

Apraxia is a cognitive-motor planning disorder that expresses itself as an inability to perform purposeful and skilled movements in the absence of sensory or motor loss and hampers patients' ability to perform activities of daily living (ADL). ADL is a set of everyday tasks required for personal care and independent living, executed through a complex interaction between sensorimotor integration and motor learning. We have designed a ‘Strategy training’ program for apraxia patients by reviewing the existing clinical trial literature on the above-said topic per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Strategy training is an evidence-based standardized occupational therapy program to improve ADL in apractic patients by teaching them a variety of compensatory strategies to combat impairment and improve activity performance. Three basic steps of strategy training include: 1) initiation-development of an action plan, 2) execution-performance of the plan, and 3) control-assessment and result of action performed. The patient group suggested for strategy training comprises post-stroke (past 20 weeks) apraxia patients aged 40-90 years of both genders, highly motivated and fit to perform ADL. After preliminary assessment, ‘strategy training’ will be specifically executed through an exclusively visual feedback approach in which apraxia patients learn eight ADLs in 8 weeks (three sessions of 30 minutes/week for 8 weeks). They practice two ADLs for 15 minutes each in every session, thus a total of six sessions will be allocated to learn two ADLs simultaneously followed by the next set of ADLs. Strategy training for brushing teeth is described in detail to show how each step of this training program is implemented for a specific ADL. As this strategy training program is based on individual care, attention, and augmenting motivational aspects, it is expected to teach patients compensatory strategies to learn and perform ADL more smoothly, swiftly, and most importantly independently. The program is not aimed at treating clinical motor symptoms of apraxia per se but to help patients function more independently post apractic motor impairment.

Functional Goals of Individuals With Cervical Spinal Cord Injury Undergoing Surgical Reconstruction for Elbow Extension and Their Representation in Standard Assessments.

Independent sitting is a major milestone and is also a prerequisite for optimal performance of activities of daily living (ADLs). Development of sitting posture control is a dynamic process involving control of degrees of freedom of head and trunk. Traditionally, trunk has been modeled as a single unit (segment). However, recent studies have suggested that it is made up multiple spinal units, controlled by a combination of trunk muscles. During typical development, posture control of trunk is different for different trunk segments. This motor development of trunk control is a complex process due to constant interaction between the nervous system and environment. Any interruption in the normal processes would further complicate it, affecting the typical development of the child. Poor trunk control and respiratory complications are characteristic features among children, adolescents, and adults with neuromuscular disorders. Pediatric spinal cord injuries (SCIs) also pose a unique challenge compared to SCI in adults because of the continuous physical and cognitive development. Children with SCI exhibit deficits in trunk motor control, which impair their ability to sit or ambulate. These motor deficits can lead to compensatory changes in other segments of the body, which cause further deviations from typical postures. Trunk muscles have the dual function of supporting both, breathing and trunk posture. Therefore, in children with SCI, impairment of posture control will also affect respiratory functions. Depending on level and severity of the injury, can potentially lead to severe respiratory insufficiency. Symptoms of respiratory insufficiency are highly correlated with the level and severity of spinal lesions. Injury at higher cervical and thoracic cord levels causes paresis and paralysis of most of the respiratory muscles, which increase the workload of breathing. As a result, respiratory complications are the leading cause of death among children with SCI. Therefore, impairment of posture control following SCI also affects respiratory functions. Lack of appropriate tools to evaluate trunk motor control following SCI restricts the ability to understand its development and therefore it is a challenge to design treatments and strategies to slow down or prevent the progress of long-term effects of SCI in children. In this dissertation, we studied the postural control using a Segmental Assessment Trunk Control (SATCo) test and respiratory motor control using Respiratory Motor Control Assessment (RMCA) protocol in typically developing (TD) children and compared their results to age-matched children with SCI.

Remote patient monitoring (RPM) devices are a novel method for physicians to monitor their patients after discharge and long after they have gone home. Usually RPM devices are bulky, relatively...

Stroke survivors often experience varying levels of psychological stress, depression, and anxiety, which can exacerbate their physical impairments and adversely affect their recovery process. Virtual reality (VR) technology has been proven to be effective for patients with depression, garnering significant interest from researchers focused on stroke rehabilitation. However, the precise impact of VR on stroke-related psychology remains unclear. This meta-analysis aimed to appraise the effect of VR on depression, anxiety, and the abilities of daily living in stroke survivors. The research involved a search of six electronic databases, including the Cochrane Library, Embase, Web of Science, PubMed, CINAHL, and PsycINFO, from the inception of the databases to June 2, 2024. Two investigators independently screened the databases based on the inclusion and exclusion criteria, extracted data from the included studies, and tested their methodological quality using Cochrane's risk of bias tool. The intervention effect was estimated using Review Manager 5.4 to calculate the standard mean difference (SMD) and 95% confidence interval (CI). This review identified 16 studies out of the 4439 records retrieved, consisting of a total of 756 stroke patients. Post-intervention analysis provided low certainty evidence that VR training reduced depression (SMD = -0.47; 95% CI: -0.88, -0.05, p = 0.03), but there was no significant effect on anxiety (SMD = -0.25; 95% CI: -0.53, 0.03, p = 0.08) and activities of daily living (SMD = 0.34; 95% CI: -0.05, 0.73, p = 0.09). Subgroup analysis indicated that participants under 60 years old who received VR intervention had a significant reduction in depression scores (SMD = -1.13; 95% CI: -1.89, -0.37, p = 0.004) compared with the control group. Those with moderate depression (SMD = -1.02; 95% CI = -1.96 to -0.07, p = 0.04) and intervention that lasted more than 6 weeks (SMD = -1.16; 95% CI: -1.87, -0.44, p = 0.002) also showed lower scores. Due to heterogeneity concerns and the poor quality of included studies, our meta-analysis that provided evidence with very low certainty indicates that VR technology may be a beneficial approach for improving the psychological health issues faced by stroke survivors, helping to reduce their depression, but has no significant effect on reducing anxiety and improving their activities of daily life. However, additional comprehensive research is required to reinforce these conclusions. Specifically, future research needs to involve larger scale and more rigorous approaches, utilizing tailored VR interventions to further improve patient well-being. PROSPERO Registration: CRD42024575981, https://www.crd.york.ac.uk/PROSPERO/view/CRD42024575981.

People with mid-cervical spinal cord injury (SCI) often have difficulty in performing activities of daily living due to weakness or paralysis in the flexor muscles. The inability to perform activities requiring fine motor control, such as eating, brushing, writing, unlocking doors, etc., affects overall quality of life negatively. To perform such tasks, appropriate movement of the hands, specifically at the wrist, is essential. For SCI patients, wrist orthotics are considered a viable option with which to perform general tasks. Wrist orthotics, used for rehabilitating people with SCI, help to maintain proper wrist and hand positioning; however, patients must frequently change these orthotic devices as per separate activity requirements. This becomes difficult and cumbersome for such patients. In this work, a passive 3D-printed upper-extremity dynamic orthosis was developed to assist SCI patients in their activities of daily living. The orthosis works on the principle of a worm-gear-based mechanism to produce pronation/supination motions at the wrist. To test the developed multipurpose customized orthosis, ten patients with cervical SCI were recruited and prescribed the 3D-printed splint for a period of four weeks. It was assessed through the QUEST questionnaire and a task completion assessment for its performance. The developed multipurpose customized orthotic device was found to provide an appropriate range of motion, ease in performing tasks, and took less time to complete tasks compared to previous works. The results indicated satisfactory performance, thereby improving quality of life. The multipurpose customized orthotic device successfully assisted the subjects with their daily activities, thus making them more independent in their rehabilitative period.

The aim of this study was to explore the factors associated with the ability to perform activities of daily living (ADL) among post-stroke patients participating in outpatient physical rehabilitation programmes in community hospital in southern Thailand. In this cross-sectional study, data were collected from 258 patients diagnosed with stroke through the HOSxP programme from 2018 to 2022. Patients' ADL were assessed using the Barthel Index measurement. Characteristics were described by percentages and medians (IOR). Associations of categorical variables were examined using the chi-squared test, and multiple logistic regressions were employed to identify factors predicting Barthel Index scores among stroke patients. Patients' capacity levels were categorised based on Barthel Index scores and rehabilitation criteria, and unadjusted and adjusted odds ratios (OR/AOR) were presented, with a significance level of 0.05. Of the 258 stroke patients, 59.30% were male, with a median age of 67 years old. Significant differences in Barthel Index scores were found with respect to gender, age, marital status, comorbidities and duration of rehabilitation (P < 0.05). Binary logistic regression analysis indicated that male stroke patients (AOR = 1.89; 95% confidence interval [CI]: 1.10, 3.26), individuals with single marital status (AOR = 4.62; 95% CI: 1.58, 13.49), absence of comorbidities (AOR = 0.53; 95% CI: 0.29, 0.98), and rehabilitation duration of less than five days (AOR = 4.38; 95% CI: 2.14, 8.96) were more likely to achieve independence in ADL with higher Barthel Index scores (P < 0.05). Several factors contribute to the effective planning of care and rehabilitation for stroke patients in rural area. Stroke rehabilitation programmes in this region should consider various elements, including patient characteristics, family involvement and clinical factors, to improve ADL performance.