bluuebunny/crossref_metadata_2025_split huggingface dataset:
Safety and feasibility of post-stroke care and exercise after minor ischemic stroke or transient ischemic attack: MotiveS & MoveIT
Authors: Boss H.M. , Van Schaik S.M. , Deijle I.A. , de Melker E.C. , van den Berg B.T.J. , Scherder E.J.A. , Bosboom W.M.J. , Weinstein H.C. , Van den Berg-Vos R.M. 
Published: December 2019

Background: Despite the beneficial effect of cardiac rehabilitation after myocardial infarction, a rehabilitation program to improve cardiorespiratory fitness and influence secondary prevention has not been implemented for ischemic stroke and transient ischemic attack (TIA). Objective: To investigate the safety and feasibility of a post-stroke care including an exercise program after minor ischemic stroke or TIA. Methods: In a randomised controlled trial, 20 patients with a recent minor stroke or TIA without cardiac contraindications were randomly assigned to one of the two interventions; post-stroke care without exercise or post-stroke care with exercise. Patients were evaluated at baseline, 6 and 12 months. Results: Eighteen patients completed the intervention. In none of the patients cardiopulmonary contraindications for the maximal exercise test and exercise program were found. No cardiovascular events occurred during the maximal exercise tests and exercise program. After one year, significantly more patients in the post-stroke care with exercise group achieved the composite endpoint of optimal medical therapy. Conclusions: Post-stroke care including an exercise program is safe and feasible in the acute phase after minor stroke or TIA and might be a way to increase effectiveness of secondary stroke prevention. We are currently conducting a larger trial to validate these results.
High doses of a new botulinum toxin type A (NT-201) in adult patients with severe spasticity following brain injury and cerebral palsy
Authors: Intiso Domenico , Simone Valentina , Di Rienzo Filomena , Iarossi Andrea , Pazienza Luigi , Santamato Andrea , Maruzzi Giuseppe , Basciani Mario 
Published: December 2019

Background: Spasticity can be a severe disabling disorder requiring high-dose injections of botulinum toxin type A (BoNT-A). Efficacy and safety of high BoNT-A doses in reducing multi-level spasticity of subjects with brain injury and cerebral palsy were investigated. Pain and functional outcome were also assessed. Method: High doses (up to 840 IU) of incobotulinumtoxinA were injected in adult subjects with severe spasticity of the upper and lower limbs due to brain injury (BI) and cerebral palsy (CP). The Modified Ashworth Scale, Visual Analogue scale, Glasgow Outcome Scale, Franchay Arm Test (FAT) and Barthel Scale were employed to assess spasticity, pain and functional outcome at baseline, and 4 and 16 weeks after BoNT-A injection. Results: Twenty-two (12 M, 10 F; mean age 38.1 ± 13.7 years) subjects – 16 subjects with BI and 6 with CP – were enrolled. Elbow, wrist, fingers and ankle muscles showed significant spasticity reduction after BoNT-A injections. The mean FAT score improved, but the benefit was not significant. Three (13.6%) subjects complained of mild adverse events. Conclusion: High-dose BoNT-A injections were effective and safe in reducing spasticity of BI and CP subjects. A significant reduction of the pain was also observed, but global functionality and arm dexterity were unchanged.
Effectiveness of eccentric viewing training for daily visual activities for individuals with age-related macular degeneration: A systematic review and meta-analysis
Authors: Hong Seung Pyo , Park HaeYean , Kwon Jae-Sung , Yoo Eunyoung 
Published: December 2019

Background: Eccentric viewing training can be successfully applied in the clinical setting based on positive evidence. Nonetheless, published research should be integrated to provide a conclusive perspective of the efficacy of eccentric viewing training. Objective: Meta-analysis was conducted to examine effectiveness of eccentric viewing training on daily visual activities for individuals with age-related macular degeneration (AMD). Methods: The papers used in this study were located through PubMed, Ovid, ProQuest, EBSCOhost, RISS, and KMbase on studies published between January, 1990 and December, 2012. The keywords for searching were “age-related macular degeneration” and “eccentric viewing”, “eccentric fixation”, “peripheral vision” or “preferred retinal loci”. The effect sizes were calculated using Comprehensive Meta-Analysis 2.0 and interpreted according to Cohen's criteria. Results: A total of 258 studies were found, among which five papers suited the main selection criteria for final analysis. The entire effect size was 0.660 (95% CI, 0.232 ~ 1.088), indicating a moderate effect size of the eccentric viewing training for individuals with AMD in their daily visual activities (p < 0.05). Conclusions: The results of this study demonstrated the clinical effectiveness of eccentric viewing training for individuals with AMD. This result should be interpreted cautiously, though, given the possibility of publication bias.
A new hand assessment instrument for severely affected stroke patients
Authors: Broetz Doris , Del Grosso Nicholas A. , Rea Massimiliano , Ramos-Murguialday Ander , Soekadar Surjo R. , Birbaumer Niels 
Published: December 2019

Background: Standard assessment instruments cannot differentiate patients with minimal residual hand function after stroke. As a result, changes in motor recovery are difficult to document using currently-available tests. In a controlled study with chronic stroke patients without residual finger extension, a new hand function test has been developed. This instrument, called Broetz Hand Test (BzH), allows to assess small variations in hand function in severely paralyzed stoke patients. The instrument is easy to use, and was developed using principles of motor learning and behavioral assessment. Methods: The instrument consists of seven daily life-oriented tasks, each of which asks for movement of the paralyzed hand. BzH of 20 patients after stroke was evaluated before and after a behavioral physiotherapy treatment. Sensitivity, inter-observer reliability, test-retest reliability and construct validity was calculated. Results: Two-tailed paired-samples t-test before and after treatment demonstrated sufficient sensitivity. Mean agreement between the raters resulted in an excellent interrater-reliability. Test-retest reliability between the pre- and post-treatment scores was 0.9. The correlation between BzH and standard test scores was statistically significant and demonstrated sufficient validity. Conclusion: The BzH is a valid and reliable tool to assess changes in hand function in severely paralyzed patients after stroke.
Spinal cord injury secondary to front rolls as part of military physical training: A case report
Authors: Bin Ayaz Saeed , Ikram Muhammad , Matee Sumeera , Ahmad Khalil 
Published: December 2019

Objective: To report an unusual case of cervical spinal cord injury. Study design: Case report of a 23 year old soldier who sustained spinal cord injury in front rolls during a military training program. Settings: Spinal Cord Injuries Unit, Armed Forces Institute of Rehabilitation Medicine (AFIRM), Rawalpindi, Pakistan. Case report: A 23 year old soldier, who voluntarily joined a military training program, suffered spinal cord injury in doing front rolls resulting in tetraplegia and incontinence for bowel and bladder corresponding to the injury level of C5 ASIA Impairment Scale C with Functional Independence Measure Score of 40/126. His Magnetic Resonance Imaging showed posterior displacement of CV3 resulting in cord compression and swelling at CV3 and CV4 levels. He was managed conservatively by comprehensive rehabilitation and improved to spinal cord injury C5 ASIA Impairment Scale D with Functional Independence Measure Score of 76/126. Conclusion: This case report describes spinal cord injury secondary to front-rolls. As front-rolls are part and parcel of military training, awareness and coaching to ensure safety must be exercised from the beginning of any training program.
Effects of the addition of transcranial direct current stimulation to virtual reality therapy after stroke: A pilot randomized controlled trial
Authors: Viana R.T. , Laurentino G.E.C. , Souza R.J.P. , Fonseca J.B. , Silva Filho E.M. , Dias S.N. , Teixeira-Salmela L.F. , Monte-Silva K.K. 
Published: December 2019

Background: Upper limb (UL) impairment is the most common disabling deficit following a stroke. Previous studies have suggested that transcranial direct current stimulation (tDCS) enhances the effect of conventional therapies. Objective: This pilot double-blind randomized control trial aimed to determine whether or not tDCS, combined with Wii virtual reality therapy (VRT), would be superior to Wii therapy alone in improving upper limb function and quality of life in chronic stroke individuals. Methods: Twenty participants were randomly assigned either to an experimental group that received VRT and tDCS, or a control group that received VRT and sham tDCS. The therapy was delivered over 15 sessions with 13 minutes of active or sham anodal tDCS, and one hour of virtual reality therapy. The outcomes included were determined using the Fugl-Meyer scale, the Wolf motor function test, the modified Ashworth scale (MAS), grip strength, and the stroke specific quality of life scale (SSQOL). Minimal clinically important differences (MCID) were observed when assessing outcome data. Results: Both groups demonstrated gains in all evaluated areas, except for the SSQOL-UL domain. Differences between groups were only observed in wrist spasticity levels in the experimental group, where more than 50% of the participants achieved the MCID. Conclusions: These findings support that tDCS, combined with VRT therapy, should be investigated and clarified further.
Functional status and quality of life of stroke survivors undergoing rehabilitation programmes in a hospital setting
Authors: Tramonti Francesco , Fanciullacci Chiara , Giunti Giulia , Rossi Bruno , Chisari Carmelo 
Published: December 2019

Background: While the positive effects of rehabilitation on physical functioning are well documented in stroke literature, more controversial results arise from the evaluation of the impact on quality of life. Objective: The aim of the present study is to examine the associations among functional status and different measures of quality of life in a sample of inpatients undergoing rehabilitation programmes, and to consider the role of psychological distress, coping strategies and social support. Methods: Twenty-nine stroke survivors were evaluated at the admission to a hospital-based Rehabilitation Unit and just before discharge. Questionnaires for the evaluation of functional status, health-related QoL, individualised QoL, psychological distress, coping strategies and social support were administered to them. Results: While functional status improves significantly after treatment, individualised evaluations of QoL seem to be less affected. Adaptive coping strategies and social support showed significant correlations with positive outcomes on specific QoL domains, whereas psychological distress was associated with negative outcomes. Conclusions: The data from the present study support the evidence that different measures of QoL and functional status are not strongly associated one another, and that psychological distress, coping strategies and social support can be significantly related to specific outcome measures.
Onabotulinumtoxin-A injection for disabling lower limb flexion in hemiplegic patients
Authors: Rousseaux Marc , Daveluy Walter , Kozlowski Odile , Allart Etienne 
Published: December 2019

Background: Hemiplegic patients with supraspinal spasticity can present with a flexor pattern at the hip and knee that hampers both passive and active functions. Objective: To investigate the efficacy of OnabotulinumtoxinA injections on this flexor scheme. Methods: This open-label observational study included eleven patients who had suffered a unilateral stroke or traumatic brain injury. All had impairment in the activities of daily living caused by severe hip and knee flexion. OnabotulinumtoxinA injections of 300–400U (total dose) were administered to the iliopsoas (iliacus) and knee flexors and, when necessary, to other muscles of the hip and knee. Evaluations were performed pre-treatment (weeks −4 to −8, and day 1) and post-treatment (week 10 and week 21): spasticity, range of motion, limb positioning, passive functions and pain. Results: A modest improvement in hip and knee extension was observed, as evidenced by the Modified Ashworth Score and range of passive extension movements. Limb positioning was also improved. Clear benefits were found on passive functioning, including toileting, dressing and bed facilities, as well as pain levels. Active functions remained unchanged. More definite improvement was found in patients with severe difficulties. Conclusions: OnabotulinumtoxinA injection can contribute to reducing the consequences of disabling lower limb flexion.
Effects of galvanic vestibular stimulation combined with physical therapy on pusher behavior in stroke patients: A case series
Authors: Nakamura Junji , Kita Yorihiro , Yuda Tomohisa , Ikuno Koki , Okada Yohei , Shomoto Koji 
Published: December 2019

Background: A recent study investigated the effects of galvanic vestibular stimulation (GVS) on pusher behavior (PB) in post-stroke patients. However, there have been no reports about the effects of multisession GVS on PB. Objective: The purpose of this study was to investigate the feasibility and effects of multisession GVS combined with physical therapy for PB in stroke patients. Methods: Two stroke patients who showed PB were enrolled. The ABAB single-case design was used. Each phase lasted 1 wk. In phases A1 and A2, the patients underwent a 60-min-long physical therapy session 5 days a week. In phases B1 and B2, they underwent GVS for 20 min before each physical therapy session, and then the same physical therapy program as in phases A1 and A2 were performed. PB was evaluated using the Scale for Contraversive Pushing (SCP) and the Burke Lateropulsion Scale (BLS). Outcomes were tested at the baseline and after each phase. Results: In both patients, the SCP scores were reduced only during phase B2. Although the BLS scores improved at the A1 phase, a larger improvement was seen at the two B phases. Conclusions: Multisession GVS combined with physical therapy may have positive effects on PB in clinical setting.
Can stroke survivors with severe upper arm disability achieve a clinically important change in arm function during inpatient rehabilitation? A multicentre, prospective, observational study
Authors: Hayward Kathryn S. , Kuys Suzanne S. , Barker Ruth N. , Brauer Sandra G. 
Published: December 2019

Background: Severe arm disability is considered to indicate poor potential to recover arm function. Objective: Determine if stroke survivors with severe upper arm disability can achieve a clinically important change in arm function on discharge from inpatient rehabilitation. Methods: 618 stroke survivors from 16 inpatient rehabilitation units were assessed on admission and discharge using the Motor Assessment Scale Item 6 Upper Arm Function (MAS6). Admission scores defined participants with severe (MAS6 ≤2) and mild/moderate (MAS6 >2) upper arm disability. A clinically important change was evaluated according to: 1) statistical significance; 2) minimal clinical importance difference (MCID); and 3) shift in disability status i.e., severe to mild/moderate. Achievers of a MCID and shift were compared to non-achievers. Results: Stroke survivors with severe upper arm disability (n = 226) demonstrated a significant improvement in arm function (p < 0.001) at discharge. A MCID was achieved by 68% (n = 155) and a shift from severe to mild/moderate upper arm disability on discharge by 45% (n = 102) of participants. Achievers had a significantly shorter interval from stroke onset to inpatient rehabilitation admission (p < 0.002). Conclusion: Stroke survivors with severe upper arm disability can achieve a clinically important change during inpatient rehabilitation.
Working memory training and poetry-based stimulation programs: Are there differences in cognitive outcome in healthy older adults?
Authors: Zimmermann Nicolle , Netto Tania Maria , Amodeo Maria Teresa , Ska Bernadette , Fonseca Rochele Paz 
Published: December 2019

Background: Neuropsychological interventions have been mainly applied with clinical populations, in spite of the need of preventing negative changes across life span. Among the few studies of cognitive stimulation in elderly, surprisingly there is no enough research comparing direct and indirect active stimulation programs. Objective: This study aims to verify wheter there are differences between two cognitive interventions approaches in older adults: a structured Working Memory (WM) Training Program versus a Poetry-based Stimulation Program. Methods: Fourteen older adults were randomly assigned to participate into one of the two intervention groups. The assessed neurocognitive components were attention, episodic and working memory, communicative and executive functions. WM Training activities were based on Baddeley's model; Poetry-based Stimulation Program was composed by general language activities. Data were analyzed with one-way ANCOVA with Delta scores and pre and post-training tests raw scores. Results: WM group improved performance on WM, inhibition, and cognitive flexibility measures, while Poetry group improved on verbal fluency and narrative discourse tasks. Discussion: Both approaches presented benefits; however WM Training improved its target function with transfer effects to executive functions, being useful for future studies with a variety of dementias. Poetry-based Stimulation also improved complex linguistic abilities. Both approaches may be helpful as strategies to prevent dysfunctional aging changes.
Is the basic trunk control recovery different between stroke patients with right and left hemiparesis?
Authors: Pappalardo A. , Ciancio M.R. , Patti F. 
Published: December 2019

Background: Basic trunk movement control is often impaired after stroke and its recovery is a “miliary stone” in rehabilitation. Objective: In this prospective, observational, parallel-group study, we investigated whether there are differences in terms of post-stroke recovery of basic trunk control between patients with left or with right hemiparesis. Methods: We recruited 94 patients with loss of postural trunk control due to stroke. Patients were divided into Group A (48 patients with left hemiparesis) and Group B (46 patients with right hemiparesis). We administered the Trunk Control Test (TCT) and the 13 motor items included on the Functional Independence Measure. Evaluation was performed at admission (To) and discharge (T1). Results: TCT increased respectively from 46.7 ± 23.3 to 62.6 ± 19.5 (mean ± standard deviation-SD, p < 0.0001) in Group A and from 49.4 ± 23.2 to 79.1 ± 14.4 (mean ± SD, p < 0.0001) in Group B. TCT resulted significantly higher in Group B than in Group A, at T1 (p < 0.0001). No significant difference was found for motFIM at T1. Conclusion: Side of hemiparesis could affect the degree of recovery of basic trunk control after stroke. Patients with right hemiparesis benefit more than those with left hemiparesis. Improvement of basic trunk control was not responsible for an advantage on functional independence.
Temporal recovery of activities of daily living in the first year after ischemic stroke: A prospective study of patients admitted to a rehabilitation unit
Authors: Kong Keng-He , Lee Jeanette 
Published: December 2019

Background: The ability to perform basic activities of daily living (ADL) independently is a marker of functional recovery after a stroke. However, there few studies documenting their long-term recovery. Objective: To document temporal recovery of activities of daily living (ADL) and establish predictors of ADL in a cohort of ischemic stroke patients in the first year after stroke. Methods: Prospective cohort study of 163 patients with first-ever ischemic stroke admitted to a rehabilitation centre. The Modified Barthel Index (MBI) was used to measure the patient's ability to perform the following 10 ADLs: feeding, grooming, dressing, bathing, toileting, bladder and bowel continence, transfers, ambulation and stair climbing. It was assessed on rehabilitation admission, discharge, and at 3, 6 and 12 months after stroke. The Motricity Index was used to measure motor power of the hemiplegic limb. Results: The mean age was 63.8 (10.7) years, with 111 males and 52 females. The mean total MBI scores on rehabilitation admission, rehabilitation discharge, 3, 6 and 12 months after stroke were 41.3 (24.6), 72.9 (20.5), 88.4 (18.6), 90.5 (17.2) and 84.2 (20.4) respectively. Median scores of feeding, grooming, toileting, bladder/bowel continence, transfers and ambulation plateaued by 3 months after stroke. Median scores of dressing and stair climbing plateaued at 6 months and that for bathing, 12 months after stroke. None of the patients were functionally independent (defined as MBI score of 100) on rehabilitation admission, but this improved to 8.6% on discharge, and 32.1%, 41.4% and 50.3% at 3, 6 and 12 months after stroke respectively. The MBI and Motricity scores were strongly correlated at all periods of follow up (r = 0.67 to 0.69, p < 0.0001). Univariate analysis showed that age, neglect, a cortical stroke, admission MBI, NIHSS, Motricity Index and Abbreviated Mental Score scores were predictors of functional independence at 12 months after stroke. On logistic regression, only age remained significant, younger patients being more likely than older patients to be functionally independent. Conclusion: Most recovery of ADL occurs by 3 months after stroke. For individual ADLs, dressing, stair climbing and bathing appear to take a longer time to recover. Older age was a negative predictor of functional dependence at 12 months after stroke.
Metacognitive knowledge and online awareness in persons with multiple sclerosis
Authors: Goverover Yael , Genova Helen , Griswold Hali , Chiaravalloti Nancy , DeLuca John 
Published: December 2019

Background: Recent models of self-awareness draw a distinction between intellectual awareness (metacognitive knowledge of disabilities) and online awareness of errors (emergent and anticipatory awareness). Objective: The present study compared these two types of self-awareness (metacognitive knowledge of disabilities and online awareness) in individuals with multiple sclerosis (MS) and healthy participants. The relationship between self-awareness and functional performance was also examined. Methods: Participants included 18 individuals with MS and 16 healthy controls (HC) between the ages of 27 and 60. Intellectual awareness was assessed via discrepancy scores on the Functional Behavior Profile (FBP) between participants and their informants. Online Awareness was examined using self-prediction and self-assessment of performance on a functional task. Results: Participants with MS had significantly lower levels of intellectual awareness relative to HCs. The MS group demonstrated worse prediction online awareness than HCs. However, assessment online awareness did not differ between groups, indicating that experience with a task can improve online awareness in persons with MS. Conclusion: This study highlights the necessity of adopting a multidimensional approach to assessing the multifaceted phenomenon of self-awareness in MS. In addition, it provides initial evidence to support a self-awareness treatment model for persons with MS.