American Heart Association


Article Commentary: “Tailored Sitting Tai Chi Program for Subacute Stroke Survivors”

Farah Aleisa, MD

Zhao J, Chau JPC, Chan AWK, Meng Q, Choi KC, Xiang X, Zhao Y, He R, Li Q. Tailored Sitting Tai Chi Program for Subacute Stroke Survivors: A Randomized Controlled Trial. Stroke. 2022.

Ancient Chinese medicine suggests that Chi is aligned with our body fluids and stability of the nervous system, and it delivers functional and healing resources to all parts of the body, including the brain. It believes in the resting alert status of the body to activate circulation and facilitate oxygenation to the organs and cells. Its main outcome is harmonizing the nervous system. There are many energy channels connecting organs, glands, and cells, which are equivalent to the chemical and nervous signals. One of the modern definitions of Chi is the functionality of the chemical interactions in different body systems through enzymes, hormones, and even neurotransmitters; the methodology of Chi depends on the mind focus, breathing exercise, and specific body movements that all collaborate to enhance the efficiency of the inner chemical activities.

Dr. Zhao and his team studied the efficacy of a tailored Tai Chi rehabilitation program among stroke survivors who suffered from residual disabilities post-stroke events. The best time for rehabilitation for stroke patients is the first few days, post-stroke event, and the highest rate of recovery is up to 6 months. Beyond the 6 months period, recovery is still possible but in a much slower rate. This is the first study designed as an assessor-blind randomized controlled trial looking for the benefits of tailored Tai Chi exercises in the subacute stroke population. It enrolled patients from April 2020 to August 2020. Four separate inpatient neurology units of two tertiary A-level traditional Chinese medicine (TCM) hospitals in Kunming, China, included stroke survivors aged over 18 years, with a clinical diagnosis of ischemic stroke, with history of first-ever stroke, in the subacute stage of stroke, who can sit independently with or without cushions, use and raise at least one arm while sitting, and who are able to communicate. Few exclusion criteria were applied, like severe stroke with NIH stroke scale >16, cognitive impairment, hearing or visual disabilities, and pregnant women. Participants were randomized on a 1:1 ratio to the intervention or control groups with a block size of 8 stratified by NIHSS score (< 6 or ≥ 6) by an independent statistician according to a computer-generated randomization sequence.

By |May 6th, 2022|clinical, rehabilitation|Comments Off on Article Commentary: “Tailored Sitting Tai Chi Program for Subacute Stroke Survivors”

Proportional Recovery and Health-Related Quality of Life Outcomes

Melissa Bailey, MD

Lin C, Martin K, Arevalo Y, Harvey R, Prabhakaran S. Association of Proportional Recovery After Stroke with Health-Related Quality of Life. Stroke. 2021;52:2968–2971.

When anticipating the degree of recovery after stroke, motor deficit improvement has been well predicted by the proportional recovery rule. Post-stroke, many patients will regain 70% of the motor function that was lost, though this number often does not apply to those with severe initial deficits. However, return to prior motor functioning is only part of the recovery process, and measures of quality of life after stroke are also important in understanding a patient’s return to functionality after stroke. In a study by Lin et al., the authors sought to investigate whether achieving the 70% proportional recovery threshold was associated with improved health-related quality of life scores.

By |October 18th, 2021|clinical, rehabilitation|Comments Off on Proportional Recovery and Health-Related Quality of Life Outcomes

ISC 2021: Daily Step Count in Stroke Rehabilitation: A Useful Tool That Predicts Future Physical Activity

Csilla Manoczki, MD

International Stroke Conference 2021
March 17–19, 2021
Poster P198

Handlery R, Regan EW, Stewart JC, Pellegrini C, Monroe C, Hainline G, Handlery K, Fritz SL. Predictors of Daily Steps at 1-Year Poststroke: A Secondary Analysis of a Randomized Controlled Trial. Stroke. 2021.

With wearable technologies becoming widely available, daily step count can be easily measured and utilized to track the patient’s physical activity in the home environment. Understanding which factors contribute to achieving a higher daily step count can help with tailoring interventions in the individual’s rehabilitation process.

A previous study showed that achieving a step count of at least 6000 steps a day decreases the risk of future cardiovascular events in patients after stroke; hence, the authors selected 6000 steps as target at 1 year post stroke with the potential of improved long-term health outcomes.

By |March 17th, 2021|clinical, Conference, rehabilitation|Comments Off on ISC 2021: Daily Step Count in Stroke Rehabilitation: A Useful Tool That Predicts Future Physical Activity

ESO-WSO 2020: Vagus Nerve Stimulation Paired With Rehabilitation for Upper Limb Motor Recovery After Stroke

Kate Hayward, PhD PT

European Stroke Organisation-World Stroke Organization 2020 Virtual Conference
November 7-9, 2020

ESO-WSO 2020 Large Clinical Trials & Awards
Presenter: Professor Jesse Dawson
Presentation title: Vagus nerve stimulation paired with rehabilitation for upper limb motor function after ischaemic stroke (VNS-Rehab): A randomised, blinded, pivotal, Phase III device trial

There is much work occurring to identify adjuvants that may boost post-stroke motor recovery — particularly upper limb recovery, which often remains an unmet need for many stroke survivors long-term. The current work focused on vagus nerve stimulation (VNS) as an adjunct to motor rehabilitation and built upon two prior pilot randomized controlled trials of this intervention.1,2 The pilot trials suggested potential for a functional benefit of VNS when combined with intensive motor rehabilitation. The mechanistic rationale put forward to underpin this intervention was that VNS activates release of neuromodulators, which may facilitate behavioral and physiological changes that support motor recovery.

In this randomised, blinded, Phase III trial,3 eligible participants had to have experienced a unilateral ischemic stroke 9 months to 10 years prior to enrolment and demonstrated a Fugl Meyer Assessment Upper Extremity (FMA-UE) score of 20 to 50 points (out of 66 points). This is consistent with moderate to moderately-severe impairment as all participants would be expected to demonstrate some movement if scoring within this range. All enrolled participants had a VNS device implanted and were randomized to receive an active or sham stimulation protocol. Of note, all participants received 5 active stimulations (varying intensities) at the commencement of each in-clinic session, which was designed to expose everyone to a very small volume of VNS and to maintain blinding. All participants received 6 weeks of in-clinic rehabilitation (3 session per week for 2 hours aiming for >300 repetitions) followed by 90 days of at home-rehabilitation (daily therapist prescribed home exercises). Follow up occurred at 1, 30, and 90 days post completion of in-clinic rehabilitation.

By |December 4th, 2020|clinical, Conference, rehabilitation|Comments Off on ESO-WSO 2020: Vagus Nerve Stimulation Paired With Rehabilitation for Upper Limb Motor Recovery After Stroke

Higher Intensity, Higher Dose Aerobic Exercise Training After Stroke

Kate Hayward, PhD, PT

Klassen TD, Dukelow SP, Bayley MT, Benavente O, Hill MD, Krassioukov A, Liu-Ambrose T, Pooyania S, Poulin MJ, Schneeberg A, et al. Higher Doses Improve Walking Recovery During Stroke Inpatient Rehabilitation. Stroke. 2020;51:2639-2648.

Stroke recovery and rehabilitation trials have received much criticism for underdosing the tested intervention,1 which remains an important consideration when interpreting past trials in the field.2

In this trial of aerobic exercise during inpatient rehabilitation by Klassen et al.,3 the intensity (heart rate reserve during training and walking steps) and amount (minutes of training) of aerobic exercise were increased from usual care. The control group (usual care) typically received 1 hour, 5 days/week, while the Determining Optimal Post-Stroke Exercise 1 (DOSE1) group received 1 hour, 5 days/week (with a target of double the intensity of the control group), and the DOSE2 group received 2 hours, 5 days/week (with a target of quadruple the intensity of the control group), each for a 4-week duration (20 sessions).

By |September 30th, 2020|clinical, rehabilitation|Comments Off on Higher Intensity, Higher Dose Aerobic Exercise Training After Stroke

Article Commentary: “Movement Behavior Patterns in People With First-Ever Stroke”

Tamaya Van Criekinge, PT

Wondergem R, Veenhof C, Wouters EMJ, de Bie RA, Visser-Meily JMA, Pisters MF. Movement Behavior Patterns in People With First-Ever Stroke. Stroke. 2019;50:3553–3560.

Are you reaching the recommended daily step goal of 10,000 steps for achieving a desirable level of physical activity? During routine daily activities, this is already considered a difficult task, and it becomes harder when having to deal with activity impairments. People living with stroke spend only half of the recommended time being active as compared to healthy individuals and are subsequently at high risk of developing sedentary behavior. Since prolonged sedentary behavior can damage your physical and mental health, it is important to gain insight into these unhealthy movement behavior patterns of people living with stroke. As the authors suggest, this provides health care providers with important information regarding the identification of the right persons with specific behaviors for targeted interventions.

By |February 14th, 2020|clinical, rehabilitation|Comments Off on Article Commentary: “Movement Behavior Patterns in People With First-Ever Stroke”

Article Commentary: “Contributions of Stepping Intensity and Variability to Mobility in Individuals Poststroke: A Randomized Clinical Trial”

Tamaya Van Criekinge, PT

Hornby TG, Henderson CE, Plawecki A, Lucas E, Lotter J, Holthus M, et al. Contributions of Stepping Intensity and Variability to Mobility in Individuals Poststroke: A Randomized Clinical Trial. Stroke. 2019;50:2492–2499.

Recovery of gait after stroke is considered one of the most important therapy goals for both patients and therapists, to assure independency and the ability to ambulate in the community. However, over 20% of stroke survivors do not reach independent walking, which necessitates the implementation of more intensive gait rehabilitation strategies. As Hornby et al. correctly state, rehabilitation staff are often too reserved, as they are scared of potential adverse effects, such as cardiovascular events and abnormal kinematic movements strategies.

In this study, Hornby and colleagues questioned if the benefits after high-intensity training in motor recovery outweigh the possible adverse events. In total, 97 chronic stroke patients were randomized in three groups: 1) High-intensity in high variable contexts (speed-dependent and skill-dependent multiple direction treadmill training, overground training and stair climbing at 70-80% of the heart rate reserve); 2) High-intensity with minimal variability (forward stepping treadmill and overground training at 70-80% of heart rate reserve); and 3) Low-intensity in high variable contexts (similar variable contexts as group one, yet performing exercises at 30-40% of heart rate reserve). Primary walking outcomes assessed were self-selected and fasted speed, single-limb stance and step-length asymmetry at self-selected and fasted speed, and six-minute walking test at fasted speed.

Recovery Post-Stroke: Proportional or Not?

Kathryn S. Hayward, PhD, PT

Hawe RL, Scott SH, Dukelow SP. Taking Proportional Out of Stroke Recovery. Stroke. 2019;50:204–211.

In this entry, I discuss a recent publication by Rachel Hawe and colleagues (1) regarding the potential biases of the mathematical properties of the proportional recovery rule and how this may impact application in the field of stroke recovery. Proportional recovery is the idea that most individuals post-stroke (“fitters” to the rule) will recover 70% of their potential on a given outcome (see paper for rule equation). The authors cite multiple studies that have demonstrated proportional recovery for upper limb motor impairment using a single outcome (Fugl Meyer Upper Limb assessment, out of 66 points), and recent work extending this rule to lower limb, aphasia and hemispatial neglect recovery outcomes.

The principal mathematical concept discussed as a limitation of the proportional recovery rule is mathematical coupling. This concept refers to when one variable directly or indirectly contains all or a part of another. For example, in the case of proportional recovery of the upper limb post-stroke, the initial score on Fugl Meyer Upper Limb assessment is part of both the independent and dependent variables of the proportional recovery rule.

By |June 7th, 2019|clinical, rehabilitation|Comments Off on Recovery Post-Stroke: Proportional or Not?

Is Circuit Training Useful After Stroke?

Stephen Makin, PhD

English C, Hillier S, Lynch E. Circuit Class Therapy for Improving Mobility After Stroke. Stroke. 2017

There are few things in life I find more boring than going to the gym. Running on a treadmill or lifting weights for what seems like hours just doesn’t interest me.

Circuit class can be fun though. You get to try lots of different exercises and move onto the next one before they get boring.

But could they also work in the stroke unit gym? After all, that’s nothing like a usual gym.

This is something people have been asking for a while. The first study of circuit training in stroke rehabilitation was carried out in 2000. English and colleagues have updated the Cochrane review on circuit training after stroke.

By |November 24th, 2017|rehabilitation|Comments Off on Is Circuit Training Useful After Stroke?

Breakthroughs in Neurorehabilitation: Using Brain Computer Interfaces for Stroke Recovery

Gurmeen Kaur, MBBS

Bundy DT, Souders L, Baranyai K, Leonard L, Schalk G, Coker R, et al. Contralesional Brain–Computer Interface Control of a Powered Exoskeleton for Motor Recovery in Chronic Stroke Survivors. Stroke. 2017

Brain computer interfaces (BCIs) are defined as systems which take biological signal from a person and predict some abstract aspect of the person’s cognitive state. The goal of the BCI technology is to give severely paralyzed people a way to communicate.

While BCIs can use several input-signals, including EEG, EMG, and fMRIs, the BCI technology developed for chronic stroke rehabilitation has been focused on demonstrating motor improvement with the use of EEG input. Recent studies have shown that BCI-controlled orthoses or functional electric stimulators can lead to improvements in motor function in chronic stroke survivors.

In this study, the authors recruited 10 subjects with chronic hemiparesis involving the upper extremity for a home-based BCI powered exoskeleton. Previous experimenters had used EEG signals derived from “perilesional” cortex, contralateral to the arm involvement—which means the area next to that affected by the stroke. The problem with use of perilesional cortex was that if the infarct size is large, with extensive cortical damage, the perilesional cortex was not able to produce sufficient EEG signal to power the exoskeleton. To overcome this, the authors used “contralesional” cortex, ipsilateral to the affected arm. This is the first study to look at the use of the unaffected hemicortex in chronic stroke recovery and aimed to see if plasticity could be triggered.

By |July 5th, 2017|clinical, rehabilitation|Comments Off on Breakthroughs in Neurorehabilitation: Using Brain Computer Interfaces for Stroke Recovery