Neurorehabilitation and Neural Repair最新文献

{"title":"Multimodal Agility-Based Exercise Training for Persons With Multiple Sclerosis: A New Framework.","authors":"Florian Wolf,&nbsp;Mareike Eschweiler,&nbsp;Annette Rademacher,&nbsp;Philipp Zimmer","doi":"10.1177/15459683221131789","DOIUrl":"https://doi.org/10.1177/15459683221131789","url":null,"abstract":"<p><strong>Introduction: </strong>Multimodal agility-based exercise training (MAT) has been described as a framework for fall prevention in the elderly but might also be a valuable concept for exercise training in persons with Multiple Sclerosis (pwMS).</p><p><strong>The problem: </strong>Current recommendations advise pwMS to perform a multitude of different exercise training activities, as each of these has its separate evidence. However, pwMS struggle even more than the general population to be physically active. Additionally, Multiple Sclerosis often leads to co-occurring mobility and cognitive dysfunctions, for which simultaneous, time-efficient, and engaging training approaches are still limited in clinical practice and healthcare.</p><p><strong>The solution: </strong>The MAT framework has been developed to integratively improve cardiovascular, neuromuscular, and cognitive function by combining aspects of perception and orientation, change of direction, as well as stop-and-go patterns (ie, agility), in a group-training format. For pwMS, the MAT framework is conceptualized to include 3 Components: standing balance, dynamic balance (including functional leg strength), and agility-based exercises. Within these Components sensory, cognitive, and cardiovascular challenges can be adapted to individual needs.</p><p><strong>Recommendations: </strong>We recommend investigating multimodal exercise interventions that go beyond easily standardized, unimodal types of exercise (eg, aerobic or resistance exercise), which could allow for time-efficient training, targeting multiple frequent symptoms of persons with mild disability at once. MAT should be compared to unimodal approaches, regarding sensor-based gait outcomes, fatigue-related outcomes, cognition, as well as neuroprotective, and (supportive) disease-modifying effects.</p>","PeriodicalId":56104,"journal":{"name":"Neurorehabilitation and Neural Repair","volume":"36 12","pages":"777-787"},"PeriodicalIF":4.2,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10789998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Moderate-to-Vigorous Physical Activity is Related With Retinal Neuronal and Axonal Integrity in Persons With Multiple Sclerosis.","authors":"Jeongwoon Kim,&nbsp;Rachel E Bollaert,&nbsp;Jonathan Cerna,&nbsp;Brynn C Adamson,&nbsp;Connor M Robbs,&nbsp;Naiman A Khan,&nbsp;Robert W Motl","doi":"10.1177/15459683221131787","DOIUrl":"https://doi.org/10.1177/15459683221131787","url":null,"abstract":"<p><strong>Background: </strong>Moderate-to-vigorous physical activity (MVPA) may confer benefits for axonal and/or neuronal integrity in adults with multiple sclerosis (MS).</p><p><strong>Purpose: </strong>Examine the association between device-measured MVPA with optical coherence tomography (OCT) metrics of retinal nerve fiber layer (RNFL) thickness and total macular volume (TMV) in persons with and without MS.</p><p><strong>Methods: </strong>Adults with MS (N = 41), along with sex-matched healthy control (HC) participants (N = 79), underwent measurements of retinal morphology via OCT and wore an accelerometer for a period of 7 days as a measure of MVPA.</p><p><strong>Results: </strong>Persons with MS had significantly lower MVPA, RNFL thickness, and TMV compared with HCs. MVPA was correlated with RNFL (<i>r</i> = .38, <i>P</i> < .01) thickness and TMV (<i>r</i> = .49, <i>P</i> < .01). Hierarchical linear regression analyses indicated that addition of MVPA attenuated the Group effect on RNFL and TMV. MVPA accounted for 8% and 3% of the variance in TMV (β = .343, <i>P</i> < .01) and RNFL thickness (β = .217, <i>P</i> = .03), respectively.</p><p><strong>Conclusion: </strong>MVPA was positively associated with axonal and neuronal integrity assessed by OCT and partially explained group differences in those metrics. These results present possible future targets for MS management by increasing MVPA.</p>","PeriodicalId":56104,"journal":{"name":"Neurorehabilitation and Neural Repair","volume":"36 12","pages":"810-815"},"PeriodicalIF":4.2,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10422854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conducting Implementation Research in Stroke Rehabilitation: A Case Example and Considerations for Study Design.","authors":"Lisa A Juckett,&nbsp;Lauren R Wengerd,&nbsp;Meredith Banhos,&nbsp;Amy R Darragh","doi":"10.1177/15459683221138747","DOIUrl":"https://doi.org/10.1177/15459683221138747","url":null,"abstract":"<p><p>As neurorehabilitation research continues to grow, the field must ensure its scientific discoveries are implemented into routine clinical care. Without targeted efforts to increase the implementation of evidence into practice, patients may never see the benefits of interventions, assessments, and technologies developed in the confines of empirical studies. This article serves as a response to Lynch et al's 2018 Point of View piece in <i>Neurorehabilitation and Neural Repair</i> that underscored the urgent need for implementation studies to expedite the application of neurorehabilitation evidence in practice. To address this need, we provide the following 4 considerations investigators should contemplate when designing their own studies at the intersection of implementation and neurorehabilitation research: (a) consideration of guiding theories, models, and frameworks, (b) consideration of implementation strategies, (c) considerations of target outcomes, and (d) consideration of hybrid effectiveness-implementation designs. To conclude, we also provide a study exemplar to depict how these considerations can be integrated into the neurorehabilitation research field to narrow the evidence-to-practice gap.</p>","PeriodicalId":56104,"journal":{"name":"Neurorehabilitation and Neural Repair","volume":"36 12","pages":"770-776"},"PeriodicalIF":4.2,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10483224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corticospinal Excitability Quantification During a Visually-Guided Precision Walking Task in Humans: Potential for Neurorehabilitation.","authors":"Charline Dambreville,&nbsp;Cécilia Neige,&nbsp;Catherine Mercier,&nbsp;Andreanne K Blanchette,&nbsp;Laurent J Bouyer","doi":"10.1177/15459683221124909","DOIUrl":"https://doi.org/10.1177/15459683221124909","url":null,"abstract":"<p><p>The corticospinal tract has been shown to be involved in normal walking in humans. However, its contribution during more challenging locomotor tasks is still unclear. As the corticospinal tract can be a potential target to promote gait recovery after neurological injury, it is of primary importance to quantify its use during human walking. The aims of the current study were to: (1) quantify the effects of precision walking on corticospinal excitability as compared to normal walking; (2) assess if corticospinal modulation is related to task difficulty or participants' performance. Sixteen healthy participants walked on a treadmill during 2 tasks: regular walking (simple task) and stepping onto virtual targets (precision task). Virtual targets appeared randomly at 3 different step lengths: preferred, and ±20%. To assess corticospinal excitability, 25 motor evoked potentials (MEPs) were recorded from the tibialis anterior muscle in each task during walking. Performance for each participant (global success score; % of target hit) and task difficulty related to step length adjustments (success score for each step length) were also calculated. MEP size was larger during the precision task in all participants (mean increase of 93% ± 72%; <i>P</i> < .05) compared to the simple task. There was a correlation between MEP facilitation and individual performance (<i>r</i> = -.64; <i>P</i> < .05), but no difference in MEP size associated with task difficulty (<i>P</i> > .05). In conclusion, corticospinal excitability exhibits a large increase during the precision task. This effect needs to be confirmed in neurological populations to potentially provide a simple and non-invasive approach to increase corticospinal drive during gait rehabilitation.</p>","PeriodicalId":56104,"journal":{"name":"Neurorehabilitation and Neural Repair","volume":"36 10-11","pages":"689-700"},"PeriodicalIF":4.2,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10402645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rehabilitation to Improve Gaze and Postural Stability in People With Multiple Sclerosis: A Randomized Clinical Trial.","authors":"Brian J Loyd,&nbsp;Annie Fangman,&nbsp;Daniel S Peterson,&nbsp;Eduard Gappmaier,&nbsp;Anne Thackeray,&nbsp;Michael C Schubert,&nbsp;Leland E Dibble","doi":"10.1177/15459683221124126","DOIUrl":"10.1177/15459683221124126","url":null,"abstract":"<p><strong>Background: </strong>People with multiple sclerosis (PwMS) frequently experience dizziness and imbalance that may be caused by central vestibular system dysfunction. Vestibular rehabilitation may offer an approach for improving dysfunction in these people.</p><p><strong>Objective: </strong>To test the efficacy of a gaze and postural stability (GPS) retraining intervention compared to a strength and endurance (SAE) intervention in PwMS.</p><p><strong>Methods: </strong>About 41 PwMS, with complaints of dizziness or history of falls, were randomized to either the GPS or SAE groups. Following randomization participants completed 6-weeks of 3×/week progressive training, delivered one-on-one by a provider. Following intervention, testing was performed at the primary (6-weeks) and secondary time point (10-weeks). A restricted maximum likelihood estimation mixed effects model was used to examine changes in the primary outcome of the Dizziness Handicap Inventory (DHI) between the 2 groups at the primary and secondary time point. Similar models were used to explore secondary outcomes between groups at both timepoints.</p><p><strong>Results: </strong>Thirty-five people completed the study (17 GPS; 18 SAE). The change in the DHI at the primary time point was not statistically different between the GPS and SAE groups (mean difference = 2.33 [95% CI -9.18, 12.85]). However, both groups demonstrated significant improvement from baseline to 6-weeks (GPS -8.73; SAE -7.31). Similar results were observed for secondary outcomes and at the secondary timepoint.</p><p><strong>Conclusions: </strong>In this sample of PwMS with complaints of dizziness or imbalance, 6-weeks of GPS training did not result in significantly greater improvements in dizziness handicap or balance compared to 6-weeks of SAE training.</p>","PeriodicalId":56104,"journal":{"name":"Neurorehabilitation and Neural Repair","volume":"36 10-11","pages":"678-688"},"PeriodicalIF":4.2,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10518217/pdf/nihms-1927759.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10112600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcranial-Direct-Current-Stimulation Accelerates Motor Recovery After Cortical Infarction in Mice: The Interplay of Structural Cellular Responses and Functional Recovery.","authors":"Helene Luise Walter,&nbsp;Anton Pikhovych,&nbsp;Heike Endepols,&nbsp;Steffen Rotthues,&nbsp;Johannes Bärmann,&nbsp;Heiko Backes,&nbsp;Mathias Hoehn,&nbsp;Dirk Wiedermann,&nbsp;Bernd Neumaier,&nbsp;Gereon Rudolf Fink,&nbsp;Maria Adele Rueger,&nbsp;Michael Schroeter","doi":"10.1177/15459683221124116","DOIUrl":"https://doi.org/10.1177/15459683221124116","url":null,"abstract":"<p><strong>Background: </strong>Transcranial direct current stimulation (tDCS) promotes recovery after stroke in humans. The underlying mechanisms, however, remain to be elucidated. Animal models suggest tDCS effects on neuroinflammation, stem cell proliferation, neurogenesis, and neural plasticity.</p><p><strong>Objective: </strong>In a longitudinal study, we employed tDCS in the subacute and chronic phase after experimental focal cerebral ischemia in mice to explore the relationship between functional recovery and cellular processes.</p><p><strong>Methods: </strong>Mice received photothrombosis in the right motor cortex, verified by Magnetic Resonance Imaging. A composite neuroscore quantified subsequent functional deficits. Mice received tDCS daily: either 5 sessions from day 5 to 9, or 10 sessions with days 12 to 16 in addition. TDCS with anodal or cathodal polarity was compared to sham stimulation. Further imaging to assess proliferation and neuroinflammation was performed by immunohistochemistry at different time points and Positron Emission Tomography at the end of the observation time of 3 weeks.</p><p><strong>Results: </strong>Cathodal tDCS at 198 kC/m² (220 A/m²) between days 5 and 9 accelerated functional recovery, increased neurogenesis, decreased microglial activation, and mitigated CD16/32-expression associated with M1-phenotype. Anodal tDCS exerted similar effects on neurogenesis and microglial polarization but not on recovery of function or microglial activation. TDCS on days 12 to 16 after stroke did not induce any further effects, suggesting that the therapeutic time window was closed by then.</p><p><strong>Conclusion: </strong>Overall, data suggest that non-invasive neuromodulation by tDCS impacts neurogenesis and microglial activation as critical cellular processes influencing functional recovery during the early phase of regeneration from focal cerebral ischemia.</p>","PeriodicalId":56104,"journal":{"name":"Neurorehabilitation and Neural Repair","volume":"36 10-11","pages":"701-714"},"PeriodicalIF":4.2,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10402644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ASNR meeting Abstracts","authors":"Emmanuel Adehunoluwa, Joseph Epperson, C. Swank, Christie Stevens, Dannae Arnold, J. Gillespie, Erina, Sarker, Jane Wigginton, Michael Foreman, R. Naftalis, R. Hamilton, Amy Porter, R. Rennaker, S. Hays, Michael Kilgard","doi":"10.1177/15459683221123387","DOIUrl":"https://doi.org/10.1177/15459683221123387","url":null,"abstract":"Background: Wearable sensors (e.g. accelerometers) for tracking human physical activity have allowed for measurement of objective activity performance of the upper limb in daily life. Data extracted from accelerometers can be used to quantify multiple variables measuring different aspects of upper limb performance in one or both limbs. Work to date has focused on single variables, but upper limb performance is likely multidimensional. Here, we propose multivariate categories of upper limb performance, derived from wearable sensor data, as a potential solution for improving stroke rehabilitation care. Methods: This study analyzed data extracted from bimanual, wrist-worn triaxial accelerometers in adults from three previous cohorts (N=211), two samples of persons with stroke and one sample from neurologically intact adult controls. Data used were upper limb performance variables calculated from accelerometer data, associated clinical measures, and participant demographics. A total of 12 cluster solutions (3-, 4-, or 5-clusters based with 12, 9, 7, or 5 input variables) were calculated to systematically evaluate the most parsimonious solution. Quality metrics and principal component analysis of each solution were calculated to arrive at a locally-optimal solution with respect to number of input variables and number of clusters. Data from earlier time points will be evaluated for their potential to predict eventual cluster membership. Results/Anticipated Results: Across different numbers of input variables, two principal components consistently explained the most variance. Across the models with differing numbers of upper limb input performance variables, a 5-cluster solution explained the most overall total variance (79%) and had the best model-fit (AIC improvement of 184, compared to the next best model). The clusters are named by the amount of overall upper limb activity and integration of the upper limbs into daily activity. The category names in order of increasing upper limb performance are: Minimal Activity/Rare Integration, Minimal Activity/Limited Integration, Moderate Activity/Moderate Integration, Moderate Activity/Full Integration, and High Activity/ Full Integration. People from the stroke cohorts ended up in all 5 categories while the adult controls ended up in the moderate to high categories. Variables that may predict eventual cluster membership of those in stroke cohort will be provided. Discussion/Significance: We identified 5 categories of upper limb performance formed from 5 upper limb performance variables in cohorts with and without neurological upper limb deficits. Following validation on a larger, heterogeneous sample, these categories may be used as outcomes in upper limb stroke research and implemented into clinical rehabilitation practice.","PeriodicalId":56104,"journal":{"name":"Neurorehabilitation and Neural Repair","volume":"36 1","pages":"NP1 - NP38"},"PeriodicalIF":4.2,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48649902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Cognitive Impairment on Robot-Based Upper-Limb Motor Assessment in Chronic Stroke.","authors":"Kevin D Bui,&nbsp;Breanna Lyn,&nbsp;Matthew Roland,&nbsp;Carol A Wamsley,&nbsp;Rochelle Mendonca,&nbsp;Michelle J Johnson","doi":"10.1177/15459683221110892","DOIUrl":"https://doi.org/10.1177/15459683221110892","url":null,"abstract":"<p><strong>Background: </strong>Chronic upper extremity motor deficits are present in up to 65% of stroke survivors, and cognitive impairment is prevalent in 46-61% of stroke survivors even 10 years after their stroke. Robot-assisted therapy programs tend to focus on motor recovery and do not include stroke patients with cognitive impairment.</p><p><strong>Objective: </strong>This study aims to investigate performance on the individual cognitive domains evaluated in the MoCA and their relation to upper-limb motor performance on a robotic system.</p><p><strong>Methods: </strong>Participants were recruited from the stroke population with a wide range of cognitive and motor levels to complete a trajectory tracking task using the Haptic TheraDrive rehabilitation robot system. Motor performance was evaluated against standard clinical cognitive and motor assessments. Our hypothesis is that the cognitive domains involved in the visuomotor tracking task are significant predictors of performance on the robot-based task and that impairment in these domains results in worse motor performance on the task compared to subjects with no cognitive impairment.</p><p><strong>Results: </strong>Our results support the hypothesis that visuospatial and executive function have a significant impact on motor performance, with differences emerging between different functional groups on the various robot-based metrics. We also show that the kinematic metrics from this task differentiate cognitive-motor functional groups differently.</p><p><strong>Conclusion: </strong>This study demonstrates that performance on a motor-based robotic assessment task also involves a significant visuospatial and executive function component and highlights the need to account for cognitive impairment in the assessment of motor performance.</p>","PeriodicalId":56104,"journal":{"name":"Neurorehabilitation and Neural Repair","volume":"36 9","pages":"587-595"},"PeriodicalIF":4.2,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9946708/pdf/nihms-1816962.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10751030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of a Cognitively Challenging Agility Boot Camp Program on Balance and Gait in People With Parkinson's Disease: Does Freezing of Gait Status Matter?","authors":"Vrutangkumar V Shah, Rodrigo Vitorio, Naoya Hasegawa, Patricia Carlson-Kuhta, John G Nutt, Laurie A King, Martina Mancini, Fay B Horak","doi":"10.1177/15459683221119757","DOIUrl":"10.1177/15459683221119757","url":null,"abstract":"<p><strong>Background and aim: </strong>Individuals with Parkinson's disease (PD) with and without freezing of Gait (FoG) may respond differently to exercise interventions for several reasons, including disease duration. This study aimed to determine whether both people with and without FoG benefit from the Agility Boot Camp with Cognitive Challenges (ABC-C) program.</p><p><strong>Methods: </strong>This secondary analysis of our ABC-C trial included 86 PD subjects: 44 without FoG (PD-FoG) and 42 with FoG (PD + FoG). We collected measures of standing sway balance, anticipatory postural adjustments, postural responses, and a 2-minute walk with and without a cognitive task. Two-way repeated analysis of variance, with disease duration as covariate, was used to investigate the effects of ABC-C program. Effect sizes were calculated using standardized response mean (SRM) for PD-FoG and PD + FoG, separately.</p><p><strong>Results: </strong>The ABC-C program was effective in improving gait performance in both PD-FoG and PD + FoG, even after controlling for disease duration. Specifically, dual-task gait speed (<i>P</i> < .0001), dual-cost stride length (<i>P</i> = .012), and these single-task measures: arm range of motion (<i>P</i> < .0001), toe-off angle (<i>P</i> = .005), gait cycle duration variability (<i>P</i> = .019), trunk coronal range of motion (<i>P</i> = .042), and stance time (<i>P</i> = .046) improved in both PD-FoG and PD + FoG. There was no interaction effect between time (before and after exercise) and group (PD-FoG/PD + FoG) in all 24 objective measures of balance and gait. Dual-task gait speed improved the most in PD + FoG (SRM = 1.01), whereas single-task arm range of motion improved the most in PD-FoG (SRM = 1.01).</p><p><strong>Conclusion: </strong>The ABC-C program was similarly effective in improving gait (and not balance) performance in both PD-FoG and PD + FoG.</p>","PeriodicalId":56104,"journal":{"name":"Neurorehabilitation and Neural Repair","volume":"36 9","pages":"603-612"},"PeriodicalIF":4.3,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11561861/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9160135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increasing the Amount and Intensity of Stepping Training During Inpatient Stroke Rehabilitation Improves Locomotor and Non-Locomotor Outcomes.","authors":"Christopher E Henderson, Abbey Plawecki, Emily Lucas, Jennifer K Lotter, Molly Scofield, Angela Carbone, Jeong H Jang, T George Hornby","doi":"10.1177/15459683221119759","DOIUrl":"10.1177/15459683221119759","url":null,"abstract":"<p><strong>Background: </strong>The efficacy of traditional rehabilitation interventions to improve locomotion post-stroke, including providing multiple exercises targeting impairments and activity limitations, is uncertain. Emerging evidence rather suggests attempts to prioritize stepping practice at higher cardiovascular intensities may facilitate greater locomotor outcomes.</p><p><strong>Objective: </strong>The present study was designed to evaluate the comparative effectiveness of high-intensity training (HIT) to usual care during inpatient rehabilitation post-stroke.</p><p><strong>Methods: </strong>Changes in stepping activity and functional outcomes were compared over 9 months during usual-care (n = 131 patients < 2 months post-stroke), during an 18-month transition phase with attempts to implement HIT (n = 317), and over 12 months following HIT implementation (n = 208). The transition phase began with didactic and hands-on education, and continued with meetings, mentoring, and audit and feedback. Fidelity metrics included percentage of sessions prioritizing gait interventions and documenting intensity. Demographics, training measures, and outcomes were compared across phases using linear or logistic regression analysis, Kruskal-Wallis tests, or χ² analysis.</p><p><strong>Results: </strong>Across all phases, admission scores were similar except for balance (usual-care>HIT; <i>P</i> < .02). Efforts to prioritize stepping and achieve targeted intensities during HIT vs transition or usual-care phases led to increased steps/day (<i>P</i> < .01). During HIT, gains in 10-m walk [HIT median = 0.13 m/s (interquartile range: 0-0.35) vs usual-care = 0.07 m/s (0-0.24), <i>P</i> = .01] and 6-min walk [50 (9.3-116) vs 2.1 (0-56) m, <i>P</i> < .01] were observed, with additional improvements in transfers and stair-climbing.</p><p><strong>Conclusions: </strong>Greater efforts to prioritize walking and reach higher intensities during HIT led to increased steps/day, resulting in greater gains in locomotor and non-locomotor outcomes.</p>","PeriodicalId":56104,"journal":{"name":"Neurorehabilitation and Neural Repair","volume":"36 9","pages":"621-632"},"PeriodicalIF":3.7,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10189784/pdf/nihms-1826948.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9835460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}