Motor response to amphetamine treatment, task-specific training, and limited motor experience in a postacute animal stroke model No benefit from D-amphetamine when added to physiotherapy after stroke: a randomized, placebo-controlled study Amphetamine increases blood pressure and heart rate but has no effect on motor recovery or cerebral haemodynamics in ischaemic stroke: a randomized controlled trial (ISRCTN 36285333) What’s New in Stroke Rehabilitation Amphetamine fails to facilitate motor performance and to enhance motor recovery among stroke patients with mild arm paresis: interim analysis and termination of a double blind, randomised, placebo-controlled trial. Enhanced physical therapy improves recovery of arm function after stroke. A randomised controlled trial. Effect of Thermal Stimulation on Upper Extremity Motor Recovery 3 Months After Stroke From rehabilitation to recovery: protocol for a randomised controlled trial evaluating a goal-based intervention to reduce depression and facilitate participation post-stroke A New Method for Predicting Recovery After Stroke Safety of Dexamphetamine in Acute Ischemic Stroke: A Randomized, Double-Blind, Controlled Dose-Escalation Trial Amphetamine paired with physical therapy accelerates motor recovery after stroke. Further evidence. Music listening enhances cognitive recovery and mood after middle cerebral artery stroke. Arm rehabilitation in post stroke subjects: A randomized controlled trial on the efficacy of myoelectrically driven FES applied in a task-oriented approach Effects of noxious versus innocuous thermal stimulation on lower extremity motor recovery 3 months after stroke. The Ineffective Role of Cathodal tDCS in Enhancing the Functional Motor Outcomes in Early Phase of Stroke Rehabilitation: An Experimental Trial Electromyogram-triggered neuromuscular stimulation for improving the arm function of acute stroke survivors: a randomized pilot study. A Double-Blind, Placebo-Controlled, Randomized Phase II Pilot Study to Investigate the Potential Efficacy of the Traditional Chinese Medicine Neuroaid (MLC 601) in Enhancing Recovery after Stroke (TIERS) Theta Burst Stimulation in the Rehabilitation of the Upper Limb Augmented visual feedback of movement performance to enhance walking recovery after stroke: study protocol for a pilot randomised controlled trial Effects of upper limb robot-assisted therapy on motor recovery in subacute stroke patients Adding transcutaneous electrical nerve stimulation to visual scanning training does not enhance treatment effect on hemispatial neglect: a randomized, controlled, double-blind study Effects of primary caregiver participation in vestibular rehabilitation for unilateral neglect patients with right hemispheric stroke: a randomized controlled trial Influence of Continuous Positive Airway Pressure on Outcomes of Rehabilitation in Stroke Patients With Obstructive Sleep Apnea
Despite advances in acute treatment of ischemic cerebrovascular events , the most common clinical outcome is disabling neurological impairment . Despite experimental evidence that psychostimulant treatment can positively affect recovery rate after focal brain lesions , beyond rehabilitation therapies there are no currently accepted medical treatments indicated for diminishing neurological impairment after clinical ly established stroke . To test the effect of amphetamine , task-specific training , limiting motor experience , and their interaction on motor recovery in a postacute animal model of stroke , animals were nonaversively trained in beam walking before a unilateral photochemical sensorimotor cortex lesion and tested for 10 days after lesion . Animals were r and omized to groups receiving : a single session of motor training 24 h after lesion ; a single injection of amphetamine 2 mg/kg 24 h after lesion ; beam-walking experience limited to testing on days 1 and 10 after lesion ; and groups that received amphetamine treatment combined with training or combined with limited experience .  Motor recovery was maximally enhanced by training , delayed by amphetamine treatment , and most negatively affected by limiting beam-walking experience during the recovery period . These findings support physical training after stroke , indicating that limiting physical activity negatively affects motor recovery and raises questions about the role of stimulant treatment to enhance motor recovery in the postacute phase after stroke Objective : To assess the effect of D-amphetamine on the recovery of activities of daily living and motor functions after stroke , Design : R and omized , placebo-controlled study , Setting : Inpatient rehabilitation centre , Subjects : Twenty-four stroke survivors after a first ischaemic supratentorial stroke within six weeks before study onset , severely to moderately affected , with a Barthel Index ( 0–100 ) ranging from 25 to 50 , no severe concomitant internal , neurological or psychiatric diseases , and participating in a comprehensive rehabilitation programme of 10–12 weeks , Interventions : Ten sessions with 10 mg D-amphetamine ( or placebo ) every fourth day totalling 100 mg in a time period of 36 days combined with physical therapy according to the neurodevelopmental concept within 60 minutes after drug intake . Main outcome measures : Barthel Index ( 0–100 ) served as the primary outcome measure and the Rivermead Motor Assessment Score with its three sections ( gross function , leg and trunk , and arm ) as the secondary outcome measure , assessed at days 0 , 20 , 36 , 90 , 180 and 360 . Results : The two groups did not differ with respect to clinical data and outcome measures at study onset . All patients improved significantly except for arm function over the intervention period and up to day 90 after study onset . The comparison between groups did not reveal any difference at any time ; amphetamine-treated patients did not show any increase in motor function or ADL compared with the control group . Conclusions : The placebo-controlled study failed to show any effect of D-amphetamine on stroke recovery compared with control . The small number of patients , the timing and content of physical therapy were limiting factors of the present study . Further trials are warranted Amphetamine enhances recovery after experimental ischaemia and has shown promise in small clinical trials when combined with motor or sensory stimulation . Amphetamine , a sympathomimetic , might have haemodynamic effects in stroke patients , although limited data have been published . Subjects were recruited 3–30 days post-ischaemic stroke into a phase II r and omized ( 1:1 ) , double-blind , placebo-controlled trial . Subjects received dexamphetamine ( 5 mg initially , then 10 mg for 10 subsequent doses with 3- or 4-day separations ) or placebo in addition to inpatient physiotherapy . Recovery was assessed by motor scales ( Fugl – Meyer ( FM ) ) , and functional scales ( Barthel index ( BI ) and modified Rankin score ( mRS ) ) . Peripheral blood pressure ( BP ) , central haemodynamics and middle cerebral artery blood flow velocity were assessed before , and 90 min after , the first two doses . Thirty-three subjects were recruited , aged 33–88 ( mean 71 ) years , males 52 % , 4–30 ( median 15 ) days post stroke to inclusion . Sixteen patients were r and omized to placebo and seventeen to amphetamine . Amphetamine did not improve motor function at 90 days ; mean ( s.d . ) FM 37.6 ( 27.6 ) vs control 35.2 ( 27.8 ) ( P=0.81 ) . Functional outcome ( BI , mRS ) did not differ between treatment groups . Peripheral and central systolic BP , and heart rate ( HR ) , were 11.2 mm Hg ( P=0.03 ) , 9.5 mm Hg ( P=0.04 ) and 7 beats per minute ( P=0.02 ) higher , respectively , with amphetamine , compared with control . A nonsignificant reduction in myocardial perfusion ( BUI ) was seen with amphetamine . Other cardiac and cerebral haemodynamics were unaffected . Amphetamine did not improve motor impairment or function after ischaemic stroke but did significantly increase BP and HR without altering cerebral haemodynamics Stroke rehabilitation has been revolutionized in the last decade through a combination of new imaging techniques looking at brain recovery and clinical trials into what is working in stroke rehabilitation . The fear that rehabilitation was a long way from being rooted in science1 has been overcome by an increasing underst and ing of neuronal recovery processes and their modulation by various physical and pharmacological interventions . More than 300 r and omized controlled trials provide a sound foundation for evidence -based practice in stroke rehabilitation , supplementing and often confirming decades of clinical experience . This growing body of knowledge has been enriched by several studies in 2003 . Advances in basic sciences and clinical research are beginning to merge and show that the human brain is capable of significant recovery after stroke , provided that the appropriate treatments and stimuli are applied in adequate amounts and at the right time . What is particularly exciting is the introduction s of new technologies such as robotic enhancement of therapies and virtual reality to further enhance that recovery . Stroke rehabilitation is therapy intensive and one of the unresolved debates has been around the issues of quality and quantity . Evidence is building that intensity of therapy is important . This is particularly true for language recovery . Bhogal et al2 identified 8 r and omized controlled trials ( RCTs ) , which compared the intensity of speech and language therapy ( SLT ) delivered by a trained therapist versus a non-therapist or a non-SLT control . Four of the studies were positive and these studies provided a mean of 8.8 hours of therapy per week for 11.2 weeks when compared with the 4 negative trials that provide approximately 2 hours of therapy per week for a total of 22.9 weeks . On average , positive RCTs provided 98.4 hours of therapy over half the time that the negative RCTs provided 43.6 hours . Intensive therapy PURPOSE To assess the effects of d-amphetamine on motor facilitation and recovery in stroke patients with mild arm paresis receiving the Arm Ability training . METHODS Thirty-one stroke patients with mild arm paresis were r and omly assigned to either ( a. ) receiving placebo or ( b. ) d-amphetamine twice a week 2 hours before Arm Ability training sessions for three weeks . MAIN OUTCOME MEASURE time needed to perform TEMPA tasks , a measure of upper extremity performance reflecting everyday life tasks . Secondary measures : aim ed movements , tapping , and a 10 m walkway as well as motor performance during training sessions . RESULTS The interim efficacy analysis of 26 stroke patients who completed the study intervention showed overall arm motor recovery both from pre to post test after 3 weeks of training and from pre test to follow-up 1 year later . No superior effect of d-amphetamine over placebo could be substantiated for either motor facilitation during training or motor recovery ( post training or long-term ) . D-amphetamine exerted mild effects on blood pressure . Serious adverse events were not observed . CONCLUSIONS d-Amphetamine failed to facilitate motor performance during training sessions , to promote skill acquisition with training tasks , and most importantly to enhance motor recovery among patients with mild arm paresis after stroke Previous research on stroke rehabilitation has not established whether increase in physical therapy lead to better intrinsic recovery from hemiplegia . A detailed study was carried out of recovery of arm function after acute stroke , and compares orthodox physiotherapy with an enhanced therapy regime which increased the amount of treatment as well as using behavioural methods to encourage motor learning . In a single-blind r and omised trial , 132 consecutive stroke patients were assigned to orthodox or enhanced therapy groups . At six months after stroke the enhanced therapy group showed a small but statistically significant advantage in recovery of strength , range and speed of movement . This effect seemed concentrated amongst those who had a milder initial impairment . More work is needed to discover the reasons for this improved recovery , and whether further development of this therapeutic approach might offer clinical ly significant gains for some patients Background and Purpose — To examine the effect of thermal stimulation ( TS ) on upper extremity ( UE ) motor recovery in patients at least 3 months after stroke . Methods — Participants were r and omly assigned to either the experimental group or the control group . In addition to regular rehabilitation programs , the experimental group received an UE-TS protocol for 30 minutes per day ( 3 days/week for 8 weeks ) ; the control group received the same TS protocol on lower extremity . The UE subscale of the Stroke Rehabilitation Assessment of Movement and the Action Research Arm Test were primary outcome measures . The Modified Ashworth Scale and the Barthel Index were secondary outcome measures . All measures were administered at baseline , after TS , and at 1-month follow-up . Results — Twenty-three participants ( 12 in the experimental group ) completed the study . After treatment , the experimental group showed significant improvement compared to the control group in the scores of the UE subscale of the Stroke Rehabilitation Assessment of Movement and Action Research Arm Test . At follow-up examination , a significant improvement in the experimental group was observed on the UE subscale of the Stroke Rehabilitation Assessment of Movement . Conclusions — The 8-week additional UE-TS protocol improved UE motor recovery for stroke patients 3 months after onset Background There is much discourse in healthcare about the importance of client-centred rehabilitation , however in the realm of community-based therapy post-stroke there has been little investigation into the efficacy of goal -directed practice that reflects patients ' valued activities . In addition , the effect of active involvement of carers in such a rehabilitation process and their subsequent contribution to functional and emotional recovery post-stroke is unclear . In community based rehabilitation , interventions based on patients ' perceived needs may be more likely to alter such outcomes . In this paper , we describe the methodology of a r and omised controlled trial of an integrated approach to facilitating patient goal achievement in the first year post-stroke . The effectiveness of this intervention in reducing the severity of post-stroke depression , improving participation status and health-related quality of life is examined . The impact on carers is also examined . Methods / Design Patients ( and their primary carers , if available ) are r and omly allocated to an intervention or control arm of the study . The intervention is multimodal and aims to screen for adverse stroke sequelae and address ways to enhance participation in patient-valued activities . Intervention methods include : telephone contacts , written information provision , home visitation , and contact with treating health professionals , with further relevant health service referrals as required . The control involves treatment as usual , as determined by inpatient and community rehabilitation treating teams . Formal blinded assessment s are conducted at discharge from inpatient rehabilitation , and at six and twelve months post-stroke . The primary outcome is depression . Secondary outcome measures include participation and activity status , health-related quality of life , and self-efficacy . Discussion The results of this trial will assist with the development of a model for community-based rehabilitation management for stroke patients and their carers , with emphasis on goal -directed practice to enhance home and community participation status . Facilitation of participation in valued activities may be effective in reducing the incidence or severity of post-stroke depression , as well as enhancing the individual 's perception of their health-related quality of life . The engagement of carers in the rehabilitation process will enable review of the influence of the broader social context on recovery . Trial registration Australia and New Zeal and Clinical Trials Register ( ANZCTR ) : Background and Purpose — Several prognostic factors have been identified for outcome after stroke . However , there is a need for empirically derived models that can predict outcome and assist in medical management during rehabilitation . To be useful , these models should take into account early changes in recovery and individual patient characteristics . We present such a model and demonstrate its clinical utility . Methods — Data on functional recovery ( Barthel Index ) at 0 , 2 , 4 , 6 , and 12 months after stroke were collected prospect ively for 299 stroke patients at 2 London hospitals . Multilevel models were used to model recovery trajectories , allowing for day-to-day and between-patient variation . The predictive performance of the model was vali date d with an independent cohort of 710 stroke patients . Results — Urinary incontinence , sex , prestroke disability , and dysarthria affected the level of outcome after stroke ; age , dysphasia , and limb deficit also affected the rate of recovery . Applying this to the validation cohort , the average difference between predicted and observed Barthel Index was −0.4 , with 90 % limits of agreement from −7 to 6 . Predicted Barthel Index lay within 3 points of the observed Barthel Index on 49 % of occasions and improved to 69 % when patients ’ recovery histories were taken into account . Conclusions — The model predicts recovery at various stages of rehabilitation in ways that could improve clinical decision making . Predictions can be altered in light of observed recovery . This model is a potentially useful tool for comparing individual patients with average recovery trajectories . Patients at elevated risk could be identified and interventions initiated Background and Purpose — Amphetamine is reported to enhance recovery after experimental stroke , but results from the first few trials in humans are inconclusive . Limited information is available on treatment safety . This study intended to investigate the safety and tolerability of dexamphetamine in patients with acute cerebral ischemia . Methods — Forty-five patients with cerebral ischemia were enrolled within 72 hours after onset of symptoms . Patients were r and omized to 1 of 3 dose levels ( 2.5 , 5 , or 10 mg orally twice daily ) or placebo for 5 consecutive days . Adverse events , blood pressure , heart rate , body temperature , consciousness level , and functional outcome measures were followed up daily during treatment . Follow-ups were made at day 7 and 1 and 3 months after stroke . Results — Mean systolic and diastolic blood pressures and heart rate increased 14 mm Hg , 8 mm Hg , and 9 bpm , respectively , with dexamphetamine treatment compared with placebo ( P ≤0.01 ) . There was no difference between dexamphetamine and placebo  regarding adverse events , body temperature , or consciousness level . During treatment , there was a benefit of dexamphetamine in neurological and functional outcome ( P < 0.05 ) , but differences were not maintained at follow-up . Conclusions — Overall , dexamphetamine was safe and well tolerated by patients with acute cerebral ischemia , but blood pressure and heart rate increased during treatment in comparison to placebo . These observations may be important in the future planning of amphetamine trials because changes in these variables have been observed to interfere with clinical outcome . The suggestions of improvement in outcome must be confirmed in further studies BACKGROUND AND PURPOSE In animal models of brain injury , administration of numerous pharmaceuticals is reported to facilitate functional recovery . However , only drugs that increase the release of norepinephrine have been shown to promote recovery when administered late ( days to weeks ) after injury . To determine whether these findings were applicable to humans , we administered the norepinephrine stimulant dextroamphetamine , paired with physical therapy , to hemiplegic stroke patients . METHODS Ten hemiplegic patients who suffered an acute ischemic infa rct ion were entered between days 16 and 30 after onset and r and omly assigned to receive either 10 mg of dextroamphetamine or a placebo orally every fourth day for 10 sessions paired with physical therapy . The Fugl-Meyer Motor Scale was used at baseline , within each session , and for 12 months after onset as the dependent measure . Confounding medications such as alpha-adrenergic antagonists or agonists were excluded in all subjects . RESULTS Although there were no differences between the groups at baseline ( P = .599 ) , there was a significant ( P = .047 ) difference between the groups when the drug had been discontinued for 1 week and at the 12-month follow-up visit ( P = .047 ) . CONCLUSIONS Administration of dextroamphetamine paired with physical therapy increased the rate and extent of motor recovery in a small group of hemiplegic stroke patients . These data support and extend previous findings of the facilitatory aspects of certain types of drugs on recovery from brain injury . The use of neuromodulation may allow the nervous system to adapt previously unused or alternative pathways to relevant external input We know from animal studies that a stimulating and enriched environment can enhance recovery after stroke , but little is known about the effects of an enriched sound environment on recovery from neural damage in humans . In humans , music listening activates a wide-spread bilateral network of brain regions related to attention , semantic processing , memory , motor functions , and emotional processing .  Music exposure also enhances emotional and cognitive functioning in healthy subjects and in various clinical patient groups . The potential role of music in neurological rehabilitation , however , has not been systematic ally investigated . This single-blind , r and omized , and controlled trial was design ed to determine whether everyday music listening can facilitate the recovery of cognitive functions and mood after stroke . In the acute recovery phase , 60 patients with a left or right hemisphere middle cerebral artery ( MCA ) stroke were r and omly assigned to a music group , a language group , or a control group . During the following two months , the music and language groups listened daily to self-selected music or audio books , respectively , while the control group received no listening material . In addition , all patients received st and ard medical care and rehabilitation . All patients underwent an extensive neuropsychological assessment , which included a wide range of cognitive tests as well as mood and quality of life question naires , one week ( baseline ) , 3 months , and 6 months after the stroke . Fifty-four patients completed the study . Results showed that recovery in the domains of verbal memory and focused attention improved significantly more in the music group than in the language and control groups . The music group also experienced less depressed and confused mood than the control group . These findings demonstrate for the first time that music listening during the early post-stroke stage can enhance cognitive recovery and prevent negative mood . The neural mechanisms potentially underlying these effects are discussed Purpose Motor recovery of persons after stroke may be enhanced by a novel approach where residual muscle activity is facilitated by patient-controlled electrical muscle activation . Myoelectric activity from hemiparetic muscles is then used for continuous control of functional electrical stimulation ( MeCFES ) of same or synergic muscles to promote restoration of movements during task-oriented therapy ( TOT ) . Use of MeCFES during TOT may help to obtain a larger functional and neurological recovery than otherwise possible . Study design Multicenter r and omized controlled trial . Methods Eighty two acute and chronic stroke victims were recruited through the collaborating facilities and after signing an informed consent were r and omized to receive either the experimental ( MeCFES assisted TOT ( M-TOT ) or conventional rehabilitation care including TOT ( C-TOT ) . Both groups received 45 minutes of rehabilitation over 25 sessions . Outcomes were Action Research Arm Test ( ARAT ) , Upper Extremity Fugl-Meyer Assessment ( FMA-UE ) scores and Disability of the Arm Shoulder and H and question naire . Results Sixty eight subjects completed the protocol ( Mean age 66.2 , range 36.5–88.7 , onset months 12.7 , range 0.8–19.1 ) of which 45 were seen at follow up 5 weeks later . There were significant improvements in both groups on ARAT ( median improvement : MeCFES TOT group 3.0 ; C-TOT group 2.0 ) and FMA-UE ( median improvement : M-TOT 4.5 ; C-TOT 3.5 ) . Considering subacute subjects ( time since stroke < 6 months ) , there was a trend for a larger proportion of improved patients in the M-TOT group following rehabilitation ( 57.9 % ) than in the C-TOT group ( 33.2 % ) ( difference in proportion improved 24.7 % ; 95 % CI -4.0 ; 48.6 ) , though the study did not meet the planned sample size . Conclusion This is the first large multicentre RCT to compare MeCFES assisted TOT with conventional care TOT for the upper extremity . No adverse events or negative outcomes were encountered , thus we conclude that MeCFES can be a safe adjunct to rehabilitation that could promote recovery of upper limb function in persons after stroke , particularly when applied in the subacute phase OBJECTIVE To examine the effects of thermal stimulation ( TS ) on the lower extremity ( LE ) movement and function in patients with stroke . DESIGN A double-blinded r and omized controlled trial . SETTING A university hospital . PARTICIPANTS Patients ( N=34 ) at least 3 months after stroke were r and omly assigned into the experimental and the control groups . INTERVENTIONS In addition to regular rehabilitation , the experimental group received a 30-minute noxious TS protocol ( heat pain 46 - 47 ° C/cold pain 2 - 3 ° C ) 3days/wk for 8 weeks , and the control group received a 30-minute innocuous TS protocol ( heat 40 - 41 ° C/cold 23 - 24 ° C ) 3d/wk for 8 weeks . MAIN OUTCOME MEASURES The Low Extremity subscale of the Stroke Rehabilitation Assessment of Movement ( LE-STREAM ) , the Mobility subscale of STREAM ( Mob-STREAM ) , the Functional Ambulation Category ( FAC ) , the Barthel Index ( BI ) , the Postural Assessment Scale for Stroke Patients ( PASS ) , and the Modified Ashworth Scale ( MAS ) were administered by a blinded rater at baseline , posttreatment ( 8wk ) , and follow-up ( 12wk ) . RESULTS Twenty-three participants completed the study protocol and all outcome measurements . No preexisting group differences between the experimental group ( n=11 ) and the control group ( n=12 ) were found on demographic and clinical variables . Compared with baseline , the experimental group showed significant improvements at posttreatment and follow-up on the LE-STREAM , Mob-STREAM , FAC , and BI ( P<.05 ) while the control group showed no significant improvements for all outcome measures . As for the between-group comparison , significant differences were seen at follow-up ( 12wk ) on the LE-STREAM , Mob-STREAM , BI , and MAS . CONCLUSIONS Our findings indicate that an 8-week program of noxious TS combined with a traditional stroke rehabilitation program can improve the LE-related movement and function in patients with stroke for more than 3 months Transcranial direct current stimulation ( tDCS ) is a noninvasive technique that could improve the rehabilitation outcomes in stroke , eliciting neuroplastic mechanisms . At the same time conflicting results have been reported in subacute phase of stroke , when neuroplasticity is crucial . The aim of this double-blind , r and omized , and sham-controlled study was to determine whether a treatment with cathodal tDCS before the rehabilitative training might augment the final outcomes ( upper limb function , h and dexterity and manual force , locomotion , and activities of daily living ) in respect of a traditional rehabilitation for a sample of patients affected by ischemic stroke in the subacute phase . An experimental group ( cathodal tDCS plus rehabilitation ) and a control group ( sham tDCS plus rehabilitation ) were assessed at the beginning of the protocol , after 10 days of stimulation , after 30 days from ending of stimulation , and at the end of inpatient rehabilitation . Both groups showed significant improvements for all the assessed domains during the rehabilitation , except for the manual force , while no significant differences were demonstrated between groups . These results seem to indicate that the cathodal tDCS , provided in an early phase of stroke , does not lead to a functional improvement . To depict a more comprehensive scenario , further studies are needed OBJECTIVE To assess the efficacy of electromyogram (EMG)-triggered neuromuscular stimulation ( EMG-stim ) in enhancing upper extremity motor and functional recovery of acute stroke survivors . DESIGN A pilot r and omized , single-blinded clinical trial . SETTING Freest and ing inpatient rehabilitation facility . PATIENTS Nine subjects who were within 6 weeks of their first unifocal , nonhemorrhagic stroke were r and omly assigned to either the EMG-stim ( n = 4 ) or control ( n = 5 ) group . All subjects had a detectable EMG signal ( > 5 microV ) from the surface of the paretic extensor carpi radialis and voluntary wrist extension in synergy or in isolation with muscle grade of < 3/5 . INTERVENTION All subjects received two 30-minute sessions per day of wrist strengthening exercises with EMG-stim ( experimental ) or without ( control ) for the duration of their rehabilitation stay . MAIN OUTCOME MEASURES Upper extremity Fugl-Meyer motor assessment and the feeding , grooming , and upper body dressing items of the Functional Independence Measure ( FIM ) were assessed at study entry and at discharge . RESULTS Subjects treated with EMG-stim exhibited significantly greater gains in Fugl-Meyer ( 27.0 vs 10.4 ; p = .05 ) , and FIM ( 6.0 vs 3.4 ; p = .02 ) scores compared with controls . CONCLUSION Data suggest that EMG-stim enhances the arm function of acute stroke survivors Background and Objective : Previous clinical studies have shown that Neuroaid ( MLC 601 ) may be beneficial in post-stroke rehabilitation . Our aim was to investigate the efficacy of Neuroaid on motor recovery in ischemic stroke patients using rehabilitation endpoints in accordance with the International Conference on Harmonization/Good Clinical Practice guidelines , in order to provide predictive information for further larger trials . Methods : This is a phase II double-blind , placebo-controlled pilot study of 40 subjects admitted with a recent ( less than 1 month ) ischemic stroke . All subjects were given either Neuroaid or placebo , 4 capsules 3 times a day for 4 weeks . Fugl-Meyer Assessment ( FMA ) , National Institutes of Health Stroke Scale and Functional Independence Measure scores were measured at initiation of the treatment , and at 4 and 8 weeks . Results : None of the outcomes was statistically significant between the two groups . However , FMA scores showed a positive trend for improvement with Neuroaid treatment over time . Subgroup analysis of subjects with posterior circulation infa rct ion and severe stroke both showed a tendency for better recovery . Conclusion : Some positive trends were observed in the Neuroaid group . A larger multicenter trial focusing on severe stroke patients is needed to better evaluate the role of Neuroaid in aiding stroke recovery in rehabilitation Background . Noninvasive cortical stimulation could represent an add-on treatment to enhance motor recovery after stroke . However , its clinical value , including anticipated size and duration of the treatment effects , remains largely unknown . Objective . The authors design ed a small semi-r and omized clinical trial to explore whether long-lasting clinical ly important gains can be achieved by adding theta burst stimulation ( TBS ) , a form of repetitive transcranial magnetic stimulation ( TMS ) , to a rehabilitation program for the h and . Methods . A total of 41 chronic stroke patients received excitatory TBS to the ipsilesional hemisphere or inhibitory TBS to the contralesional hemisphere in 2 centers ; each active group was compared with a group receiving sham TBS . TBS was followed by physical therapy for 10 working days . Patients and therapists were blinded to the type of TBS . Primary outcome measures ( 9-hole Peg Test [ 9HPT ] , Jebsen Taylor Test [ JTT ] , and grip and pinch-grip dynamometry ) were assessed 4 , 30 , and 90 days post treatment . The clinical ly important difference was defined as 10 % of the maximum score . Results . There were no differences between the active treatment and sham groups in any of the outcome measures . All patients achieved small sustainable improvements—9HPT , 5 % of maximum ( confidence interval [ CI ] = 3%-7 % ) ; JTT , 5.7 % ( CI = 3%-8 % ) ; and grip strength , 6 % ( CI = 2%-10%)—all below the defined clinical ly important level . Conclusions . Cortical stimulation did not augment the gains from a late rehabilitation program . The effect size anticipated by the authors was overestimated . These results can improve the design of future work on therapeutic uses of TMS Background Increasing evidence suggests that use of augmented visual feedback could be a useful approach to stroke rehabilitation . In current clinical practice , visual feedback of movement performance is often limited to the use of mirrors or video . However , neither approach is optimal since cognitive and self-image issues can distract or distress patients and their movement can be obscured by clothing or limited viewpoints . Three-dimensional motion capture has the potential to provide accurate kinematic data required for objective assessment and feedback in the clinical environment . However , such data are currently presented in numerical or graphical format , which is often impractical in a clinical setting . Our hypothesis is that presenting this kinematic data using bespoke visualisation software , which is tailored for gait rehabilitation after stroke , will provide a means whereby feedback of movement performance can be communicated in a more meaningful way to patients . This will result in increased patient underst and ing of their rehabilitation and will enable progress to be tracked in a more accessible way . Methods The hypothesis will be assessed using an exploratory ( phase II ) r and omised controlled trial . Stroke survivors eligible for this trial will be in the subacute stage of stroke and have impaired walking ability ( Functional Ambulation Classification of 1 or more ) . Participants ( n = 45 ) will be r and omised into three groups to compare the use of the visualisation software during overground physical therapy gait training against an intensity-matched and attention-matched placebo group and a usual care control group . The primary outcome measure will be walking speed . Secondary measures will be Functional Ambulation Category , Timed Up and Go , Rivermead Visual Gait Assessment , Stroke Impact Scale-16 and spatiotemporal parameters associated with walking . Additional qualitative measures will be used to assess the participant ’s experience of the visual feedback provided in the study . Discussion Results from the trial will explore whether the early provision of visual feedback of biomechanical movement performance during gait rehabilitation demonstrates improved mobility outcomes after stroke and increased patient underst and ing of their rehabilitation . Trial registration Current Controlled Trials IS RCT Background and purpose There is little evidence available on the use of robot-assisted therapy in subacute stroke patients . A r and omized controlled trial was carried out to evaluate the short-time efficacy of intensive robot-assisted therapy compared to usual physical therapy performed in the early phase after stroke onset . Methods Fifty-three subacute stroke patients at their first-ever stroke were enrolled 30 ± 7 days after the acute event and r and omized into two groups , both exposed to st and ard therapy . Additional 30 sessions of robot-assisted therapy were provided to the Experimental Group . Additional 30 sessions of usual therapy were provided to the Control Group . The following impairment evaluations were performed at the beginning ( T0 ) , after 15 sessions ( T1 ) , and at the end of the treatment ( T2 ) : Fugl-Meyer Assessment Scale ( FM ) , Modified Ashworth Scale-Shoulder ( MAS-S ) , Modified Ashworth Scale-Elbow ( MAS-E ) , Total Passive Range of Motion-Shoulder/Elbow ( pROM ) , and Motricity Index ( MI ) . Results Evidence of significant improvements in MAS-S ( p = 0.004 ) , MAS-E ( p = 0.018 ) and pROM ( p < 0.0001 ) was found in the Experimental Group . Significant improvement was demonstrated in both Experimental and Control Group in FM ( EG : p < 0.0001 , CG : p < 0.0001 ) and MI ( EG : p < 0.0001 , CG : p < 0.0001 ) , with an higher improvement in the Experimental Group . Conclusions Robot-assisted upper limb rehabilitation treatment can contribute to increasing motor recovery in subacute stroke patients . Focusing on the early phase of stroke recovery has a high potential impact in clinical practice Background : Left-sided transcutaneous electrical nerve stimulation ( TENS ) increases right hemispheric activity , which may improve the rehabilitative outcome of hemispatial neglect . Objective : To examine the behavioral effect of electrical stimulation of the nerve afferents of the left h and during early neuropsychological rehabilitation of post-stroke patients with hemispatial neglect . Methods : This r and omized , controlled , double-blind study included 29 patients ( enrolled in the experimental or control group ) with left hemispatial neglect after right hemispheric stroke . For 3 weeks , patients received 15 therapeutic sessions involving TENS ( active or sham ) with a mesh glove applied on the entire left h and during the first 30 minutes of a 45-minute conventional visual scanning training ( VST ) .  Signs of hemispatial neglect were assessed using a psychometric test before and after treatment . Results : Univariate analysis of covariance revealed that differences between the control and experimental groups were not significant after treatment ( F(1 , 22 ) = 0.294 , P = 0.593 ) when adjusted for pre-treatment scores and time since stroke onset . This suggested that electrical stimulation failed to mitigate the severity of hemispatial neglect symptoms . Conclusion : Our study did not provide evidence of the effectiveness of  TENS when added to VST during early rehabilitation for patients with post-stroke hemispatial neglect . Other techniques ( applied alone or together ) should be sought to improve recovery in this population Introduction The current study aims to investigate the effects of primary caregiver participation in vestibular rehabilitation ( VR ) on improving the measures of neglect , activities of daily living ( ADL ) , balance , and falls of unilateral neglect ( UN ) patients . Methods This study is a single-blind r and omized controlled trial . Both experimental ( n = 24 ) and control groups ( n = 24 ) received conventional rehabilitation . The experimental group undertook VR for a month . During the first and second weeks , a registered nurse trained the experimental group in VR . The primary caregivers in the experimental group supervised and guided their patients in VR during the third and fourth weeks . The outcome measures were neglect , ADL , balance , and falls . Results The two groups of UN patients showed a significant improvement in neglect , ADL , and balance over time . Based on the generalized estimating equations model , an interaction was observed between groups and times . Significant interactions were observed between the VR group at days 14 and 28 in the areas of neglect , ADL , and balance . No significant difference was observed between the two groups in the number of falls . Conclusion Neglect , ADL , and balance among UN patients with right hemispheric stroke can be improved through the participation of primary caregivers in VR . Trained informal caregivers were recommended to provide VR guidance and supervision to patients who suffer from UN Background and Purpose — In stroke patients , obstructive sleep apnea ( OSA ) is associated with poorer functional outcomes than in those without OSA . We hypothesized that treatment of OSA by continuous positive airway pressure ( CPAP ) in stroke patients would enhance motor , functional , and neurocognitive recovery . Methods — This was a r and omized , open label , parallel group trial with blind assessment of outcomes performed in stroke patients with OSA in a stroke rehabilitation unit . Patients were assigned to  st and ard rehabilitation alone ( control group ) or to CPAP ( CPAP group ) . The primary outcomes were the Canadian Neurological scale , the 6-minute walk test distance , sustained attention response test , and the digit or spatial span-backward . Secondary outcomes included Epworth Sleepiness scale , Stanford Sleepiness scale , Functional Independence measure , Chedoke McMaster Stroke assessment , neurocognitive function , and Beck depression inventory . Tests were performed at baseline and 1 month later . Results — Patients assigned to CPAP ( n=22 ) experienced no adverse events . Regarding primary outcomes , compared to the control group ( n=22 ) , the CPAP group experienced improvement in stroke-related impairment ( Canadian Neurological scale score , P<0.001 ) but not in 6-minute walk test distance , sustained attention response test , or digit or spatial span-backward . Regarding secondary outcomes , the CPAP group experienced improvements in the Epworth Sleepiness scale ( P<0.001 ) , motor component of the Functional Independence measure ( P=0.05 ) , Chedoke-McMaster Stroke assessment of upper and lower limb motor recovery test of the leg ( P=0.001 ) , and the affective component of depression ( P=0.006 ) , but not neurocognitive function . Conclusions — Treatment of OSA by CPAP in stroke patients undergoing rehabilitation improved functional and motor , but not neurocognitive outcomes . Clinical Trial Registration Information— URL : http://www . clinical trials.gov . Unique identifier : NCT00221065
No evidence exists at present to support the use of amphetamine after stroke .
INTRODUCTION The use of drugs to enhance recovery ( " rehabilitation pharmacology " ) has been assessed .
Amphetamine can improve outcome in experimental models of stroke , and several small clinical trials have assessed its use in stroke .