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Brain Sciences
Special Issues
Post-stroke Rehabilitation
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Post-stroke Rehabilitation

A special issue of Brain Sciences (ISSN 2076-3425). This special issue belongs to the section "Neurorehabilitation".

Deadline for manuscript submissions: 21 June 2024 | Viewed by 13492

Special Issue Editors

Prof. Dr. Noureddin Nakhostin Ansari

E-Mail Website
Guest Editor
Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
Interests: physiotherapy; neurorehabilitation; stroke; spasticity; dry needling; electrophysical agents
Prof. Dr. Gholamreza Hassanzadeh

E-Mail Website
Co-Guest Editor
Department of Anatomy, Tehran University of Medical Sciences, Tehran, Iran
Interests: neuroscience; spinal cord injury; neuroinflammation
Dr. Ardalan Shariat

E-Mail Website
Co-Guest Editor
Department of Digital Health, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Interests: occupational therapy; exercise therapy; neurorehabilitation

Special Issue Information

Dear Colleagues,

Stroke is one of the leading causes of mortality and long-term disability worldwide. Rehabilitation plays a critical role in the recovery of patients and quality of life post-stroke. This Special Issue explores the latest research and advancements in post-stroke rehabilitation and its implications for clinical practice.  

This Special Issue brings together a collection of articles on cutting-edge research, original research, reviews, and clinical perspectives that cover a wide range of topics in stroke rehabilitation. Some topics covered include assessment tools, physical therapy and neurorehabilitation interventions, spasticity, dose–response issues, innovative interventions and technologies such as dry needling, mirror therapy, virtual reality, wearable devices, telerehabilitation and nanorehab in post-stroke rehabilitation.

This Special Issue may be a valuable resource for researchers, clinicians, and healthcare professionals active in post-stroke rehabilitation. We hope the research and insights presented in this Special Issue can contribute to the ongoing efforts to improve the quality of care and the long-term outcomes for stroke survivors. 

Prof. Dr. Noureddin Nakhostin Ansari
Prof. Dr. Gholamreza Hassanzadeh
Dr. Ardalan Shariat
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Brain Sciences is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • stroke
  • rehabilitation
  • nanorehab
  • dry needling
  • spasticity

Published Papers (11 papers)

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Editorial

Jump to: Research, Review, Other

3 pages, 184 KiB  
Editorial
Telestroke: A Novel Approach for Post-Stroke Rehabilitation
by Noureddin Nakhostin Ansari, Fatemeh Bahramnezhad, Albert T. Anastasio, Gholamreza Hassanzadeh and Ardalan Shariat
Brain Sci. 2023, 13(8), 1186; https://doi.org/10.3390/brainsci13081186 - 10 Aug 2023
Cited by 2 | Viewed by 943
Abstract
Despite the tremendous technologic advancements of recent years, the prevalence of stroke has increased significantly worldwide from 1990 to 2019 (a 70 [...] Full article
(This article belongs to the Special Issue Post-stroke Rehabilitation)

Research

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11 pages, 1444 KiB  
Article
Association of the Neutrophil-to-Lymphocyte Ratio with 90-Day Functional Outcomes in Patients with Acute Ischemic Stroke
by Licong Chen, Lulu Zhang, Yidan Li, Quanquan Zhang, Qi Fang and Xiang Tang
Brain Sci. 2024, 14(3), 250; https://doi.org/10.3390/brainsci14030250 - 04 Mar 2024
Viewed by 808
Abstract
The neutrophil-to-lymphocyte ratio (NLR), an inflammatory marker, plays an important role in the inflammatory mechanisms of the pathophysiology and progression of acute ischemic stroke (AIS). The aim of this study was to identify the potential factors associated with functional prognosis in AIS. A [...] Read more.
The neutrophil-to-lymphocyte ratio (NLR), an inflammatory marker, plays an important role in the inflammatory mechanisms of the pathophysiology and progression of acute ischemic stroke (AIS). The aim of this study was to identify the potential factors associated with functional prognosis in AIS. A total of 303 AIS patients were enrolled in this study; baseline information of each participant, including demographic characteristics, medical history, laboratory data, and 90-day functional outcome, was collected. Multivariate logistic regression analysis revealed that NLR, systolic blood pressure (SBP) and National Institutes of Health Stroke Scale (NIHSS) score were found to be independent factors for poor functional outcomes. Receiver operating characteristic (ROC) curve analysis was performed to estimate the predictive value of the NLR for 90-day functional outcome, with the best predictive cutoff value being 3.06. In the multivariate logistic regression analysis, three models were constructed: Model 1, adjusted for age, sex, SBP, and TOAST classification (AUC = 0.694); Model 2, further adjusted for the NIHSS score at admission (AUC = 0.826); and Model 3, additionally adjusted for the NLR (AUC = 0.829). The NLR at admission was an independent predictor of 90-day prognosis in patients with AIS. The risk factors related to poor 90-day functional outcomes were higher SBP, higher NLR, and a greater NIHSS score. Full article
(This article belongs to the Special Issue Post-stroke Rehabilitation)
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10 pages, 1864 KiB  
Article
The Effect of Uni-Hemispheric Dual-Site Anodal tDCS on Brain Metabolic Changes in Stroke Patients: A Randomized Clinical Trial
by Somaye Azarnia, Kamran Ezzati, Alia Saberi, Soofia Naghdi, Iraj Abdollahi and Shapour Jaberzadeh
Brain Sci. 2023, 13(7), 1100; https://doi.org/10.3390/brainsci13071100 - 20 Jul 2023
Viewed by 1068
Abstract
Uni-hemispheric concurrent dual-site anodal transcranial direct current stimulation (UHCDS a-tDCS) of the primary motor cortex (M1) and the dorsolateral prefrontal cortex (DLPFC) may enhance the efficacy of a-tDCS after stroke. However, the cellular and molecular mechanisms underlying its beneficial effects have [...] Read more.
Uni-hemispheric concurrent dual-site anodal transcranial direct current stimulation (UHCDS a-tDCS) of the primary motor cortex (M1) and the dorsolateral prefrontal cortex (DLPFC) may enhance the efficacy of a-tDCS after stroke. However, the cellular and molecular mechanisms underlying its beneficial effects have not been defined. We aimed to investigate the effect of a-tDCSM1-DLPFC on brain metabolite concentrations (N-acetyl aspartate (NAA), choline (Cho)) in stroke patients using magnetic resonance spectroscopy (MRS). In this double-blind, sham-controlled, randomized clinical trial (RCT), 18 patients with a first chronic stroke in the territory of the middle cerebral artery trunk were recruited. Patients were allocated to one of the following two groups: (1) Experimental 1, who received five consecutive sessions of a-tDCSM1-DLPFC M1 (active)-DLPFC (active). (2) Experimental 2, who received five consecutive sessions of a-tDCSM1-DLPFC M1 (active)-DLPFC (sham). MRS assessments were performed before and 24 h after the last intervention. Results showed that after five sessions of a-tDCSM1-DLPFC, there were no significant changes in NAA and Cho levels between groups (Cohen’s d = 1.4, Cohen’s d = 0.93). Thus, dual site a-tDCSM1-DLPFC did not affect brain metabolites compared to single site a-tDCS M1. Full article
(This article belongs to the Special Issue Post-stroke Rehabilitation)
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11 pages, 836 KiB  
Article
Convergent Validity of the Timed Walking Tests with Functional Ambulatory Category in Subacute Stroke
by Alex Martino Cinnera, Serena Marrano, Daniela De Bartolo, Marco Iosa, Alessio Bisirri, Enza Leone, Alessandro Stefani, Giacomo Koch, Irene Ciancarelli, Stefano Paolucci and Giovanni Morone
Brain Sci. 2023, 13(7), 1089; https://doi.org/10.3390/brainsci13071089 - 18 Jul 2023
Cited by 1 | Viewed by 1042
Abstract
Determining the walking ability of post-stroke patients is crucial for the design of rehabilitation programs and the correct functional information to give to patients and their caregivers at their return home after a neurorehabilitation program. We aimed to assess the convergent validity of [...] Read more.
Determining the walking ability of post-stroke patients is crucial for the design of rehabilitation programs and the correct functional information to give to patients and their caregivers at their return home after a neurorehabilitation program. We aimed to assess the convergent validity of three different walking tests: the Functional Ambulation Category (FAC) test, the 10-m walking test (10MeWT) and the 6-minute walking test (6MWT). Eighty walking participants with stroke (34 F, age 64.54 ± 13.02 years) were classified according to the FAC score. Gait speed evaluation was performed with 10MeWT and 6MWT. The cut-off values for FAC and walking tests were calculated using a receiver-operating characteristic (ROC) curve. Area under the curve (AUC) and Youden’s index were used to find the cut-off value. Statistical differences were found in all FAC subgroups with respect to walking speed on short and long distances, and in the Rivermead Mobility Index and Barthel Index. Mid-level precision (AUC > 0.7; p < 0.05) was detected in the walking speed with respect to FAC score (III vs. IV and IV vs. V). The confusion matrix and the accuracy analysis showed that the most sensitive test was the 10MeWT, with cut-off values of 0.59 m/s and 1.02 m/s. Walking speed cut-offs of 0.59 and 1.02 m/s were assessed with the 10MeWT and can be used in FAC classification in patients with subacute stroke between the subgroups able to walk with supervision and independently on uniform and non-uniform surfaces. Moreover, the overlapping walking speed registered with the two tests, the 10MeWT showed a better accuracy to drive FAC classification. Full article
(This article belongs to the Special Issue Post-stroke Rehabilitation)
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17 pages, 2221 KiB  
Article
Clinical, Neuroimaging and Robotic Measures Predict Long-Term Proprioceptive Impairments following Stroke
by Matthew J. Chilvers, Deepthi Rajashekar, Trevor A. Low, Stephen H. Scott and Sean P. Dukelow
Brain Sci. 2023, 13(6), 953; https://doi.org/10.3390/brainsci13060953 - 15 Jun 2023
Cited by 1 | Viewed by 1306
Abstract
Proprioceptive impairments occur in ~50% of stroke survivors, with 20–40% still impaired six months post-stroke. Early identification of those likely to have persistent impairments is key to personalizing rehabilitation strategies and reducing long-term proprioceptive impairments. In this study, clinical, neuroimaging and robotic measures [...] Read more.
Proprioceptive impairments occur in ~50% of stroke survivors, with 20–40% still impaired six months post-stroke. Early identification of those likely to have persistent impairments is key to personalizing rehabilitation strategies and reducing long-term proprioceptive impairments. In this study, clinical, neuroimaging and robotic measures were used to predict proprioceptive impairments at six months post-stroke on a robotic assessment of proprioception. Clinical assessments, neuroimaging, and a robotic arm position matching (APM) task were performed for 133 stroke participants two weeks post-stroke (12.4 ± 8.4 days). The APM task was also performed six months post-stroke (191.2 ± 18.0 days). Robotics allow more precise measurements of proprioception than clinical assessments. Consequently, an overall APM Task Score was used as ground truth to classify proprioceptive impairments at six months post-stroke. Other APM performance parameters from the two-week assessment were used as predictive features. Clinical assessments included the Thumb Localisation Test (TLT), Behavioural Inattention Test (BIT), Functional Independence Measure (FIM) and demographic information (age, sex and affected arm). Logistic regression classifiers were trained to predict proprioceptive impairments at six months post-stroke using data collected two weeks post-stroke. Models containing robotic features, either alone or in conjunction with clinical and neuroimaging features, had a greater area under the curve (AUC) and lower Akaike Information Criterion (AIC) than models which only contained clinical or neuroimaging features. All models performed similarly with regard to accuracy and F1-score (>70% accuracy). Robotic features were also among the most important when all features were combined into a single model. Predicting long-term proprioceptive impairments, using data collected as early as two weeks post-stroke, is feasible. Identifying those at risk of long-term impairments is an important step towards improving proprioceptive rehabilitation after a stroke. Full article
(This article belongs to the Special Issue Post-stroke Rehabilitation)
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Review

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14 pages, 279 KiB  
Review
Remapping and Reconnecting the Language Network after Stroke
by Victoria Tilton-Bolowsky, Melissa D. Stockbridge and Argye E. Hillis
Brain Sci. 2024, 14(5), 419; https://doi.org/10.3390/brainsci14050419 - 24 Apr 2024
Viewed by 271
Abstract
Here, we review the literature on neurotypical individuals and individuals with post-stroke aphasia showing that right-hemisphere regions homologous to language network and other regions, like the right cerebellum, are activated in language tasks and support language even in healthy people. We propose that [...] Read more.
Here, we review the literature on neurotypical individuals and individuals with post-stroke aphasia showing that right-hemisphere regions homologous to language network and other regions, like the right cerebellum, are activated in language tasks and support language even in healthy people. We propose that language recovery in post-stroke aphasia occurs largely by potentiating the right hemisphere network homologous to the language network and other networks that previously supported language to a lesser degree and by modulating connection strength between nodes of the right-hemisphere language network and undamaged nodes of the left-hemisphere language network. Based on this premise (supported by evidence we review), we propose that interventions should be aimed at potentiating the right-hemisphere language network through Hebbian learning or by augmenting connections between network nodes through neuroplasticity, such as non-invasive brain stimulation and perhaps modulation of neurotransmitters involved in neuroplasticity. We review aphasia treatment studies that have taken this approach. We conclude that further aphasia rehabilitation with this aim is justified. Full article
(This article belongs to the Special Issue Post-stroke Rehabilitation)
17 pages, 701 KiB  
Review
Exploring the Prospects of Transcranial Electrical Stimulation (tES) as a Therapeutic Intervention for Post-Stroke Motor Recovery: A Narrative Review
by Hao Meng, Michael Houston, Yingchun Zhang and Sheng Li
Brain Sci. 2024, 14(4), 322; https://doi.org/10.3390/brainsci14040322 - 27 Mar 2024
Viewed by 812
Abstract
Introduction: Stroke survivors often have motor impairments and related functional deficits. Transcranial Electrical Stimulation (tES) is a rapidly evolving field that offers a wide range of capabilities for modulating brain function, and it is safe and inexpensive. It has the potential for widespread [...] Read more.
Introduction: Stroke survivors often have motor impairments and related functional deficits. Transcranial Electrical Stimulation (tES) is a rapidly evolving field that offers a wide range of capabilities for modulating brain function, and it is safe and inexpensive. It has the potential for widespread use for post-stroke motor recovery. Transcranial Direct Current Stimulation (tDCS), Transcranial Alternating Current Stimulation (tACS), and Transcranial Random Noise Stimulation (tRNS) are three recognized tES techniques that have gained substantial attention in recent years but have different mechanisms of action. tDCS has been widely used in stroke motor rehabilitation, while applications of tACS and tRNS are very limited. The tDCS protocols could vary significantly, and outcomes are heterogeneous. Purpose: the current review attempted to explore the mechanisms underlying commonly employed tES techniques and evaluate their prospective advantages and challenges for their applications in motor recovery after stroke. Conclusion: tDCS could depolarize and hyperpolarize the potentials of cortical motor neurons, while tACS and tRNS could target specific brain rhythms and entrain neural networks. Despite the extensive use of tDCS, the complexity of neural networks calls for more sophisticated modifications like tACS and tRNS. Full article
(This article belongs to the Special Issue Post-stroke Rehabilitation)
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17 pages, 492 KiB  
Review
Outcome Measures Utilized to Assess the Efficacy of Telerehabilitation for Post-Stroke Rehabilitation: A Scoping Review
by Ardalan Shariat, Mahboubeh Ghayour Najafabadi, Noureddin Nakhostin Ansari, Albert T. Anastasio, Kian Bagheri, Gholamreza Hassanzadeh and Mahsa Farghadan
Brain Sci. 2023, 13(12), 1725; https://doi.org/10.3390/brainsci13121725 - 17 Dec 2023
Viewed by 1293
Abstract
Introduction: Outcome measures using telerehabilitation (TR) in the context of post-stroke rehabilitation are an area of emerging research. The current review assesses the literature related to TR for patients requiring post-stroke rehabilitation. The purpose of this study is to survey the outcome measures [...] Read more.
Introduction: Outcome measures using telerehabilitation (TR) in the context of post-stroke rehabilitation are an area of emerging research. The current review assesses the literature related to TR for patients requiring post-stroke rehabilitation. The purpose of this study is to survey the outcome measures used in TR studies and to define which parts of the International Organization of Functioning are measured in trials. Methods: TR studies were searched in Cochrane Central Register of Controlled Trials, PubMed, Embase, Scopus, Google Scholar, and Web of Science, The Cochrane Central Register of Controlled Trials (Cochrane Library), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Physiotherapy Evidence Database (PEDro) from 2016 to June 2023. Two reviewers individually assessed the full text. Discrepancies regarding inclusion or exclusion were resolved by an additional reviewer. Results: A total of 24 studies were included in the current review. The findings were synthesized and presented taking into account their implications within clinical practice, areas of investigation, and strategic implementation. Conclusions: The scoping review has recognized a broad range of outcome measures utilized in TR studies, shedding light on gaps in the current literature. Furthermore, this review serves as a valuable resource for researchers and end users (such as clinicians and policymakers), providing insights into the most appropriate outcome measures for TR. There is a lack of studies examining the required follow-up after TR, emphasizing the need for future research in this area. Full article
(This article belongs to the Special Issue Post-stroke Rehabilitation)
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14 pages, 1830 KiB  
Review
The Application of Soft Robotic Gloves in Stroke Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
by Ming-Jian Ko, Ya-Chi Chuang, Liang-Jun Ou-Yang, Yuan-Yang Cheng, Yu-Lin Tsai and Yu-Chun Lee
Brain Sci. 2023, 13(6), 900; https://doi.org/10.3390/brainsci13060900 - 02 Jun 2023
Cited by 2 | Viewed by 2307
Abstract
Wearable robotic devices have been strongly put into use in both the clinical and research fields of stroke rehabilitation over the past decades. This study aimed to explore the effectiveness of soft robotic gloves (SRGs) towards improving the motor recovery and functional abilities [...] Read more.
Wearable robotic devices have been strongly put into use in both the clinical and research fields of stroke rehabilitation over the past decades. This study aimed to explore the effectiveness of soft robotic gloves (SRGs) towards improving the motor recovery and functional abilities in patients with post-stroke hemiparesis. Five major bibliographic databases, PubMed, Embase, Cochrane Library, Web of Science, and the Physiotherapy Evidence Database, were all reviewed for enrollment regarding comparative trials prior to 7 March 2023. We included adults with stroke and compared their rehabilitation using SRGs to conventional rehabilitation (CR) on hand function in terms of the Fugl-Meyer Upper Extremity Motor Assessment (FMA-UE), Fugl-Meyer Distal Upper Extremity Motor Assessment (FMA-distal UE), box and blocks test score, grip strength test, and the Jebsen–Taylor hand function test (JTT). A total of 8 studies, comprising 309 participants, were included in the analysis. Compared to CR, rehabilitation involving SRGs achieved better FMA-UE (MD 6.52, 95% CI: 3.65~9.39), FMA-distal UE (MD 3.27, 95% CI: 1.50~5.04), and JJT (MD 13.34, CI: 5.16~21.53) results. Subgroup analysis showed that stroke latency of more than 6 months and training for more than 30 min offered a better effect as well. In conclusion, for patients with stroke, rehabilitation using SRGs is recommended to promote the functional abilities of the upper extremities. Full article
(This article belongs to the Special Issue Post-stroke Rehabilitation)
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Other

14 pages, 662 KiB  
Systematic Review
Effects of Resistance Training on Spasticity in People with Stroke: A Systematic Review
by Juan Carlos Chacon-Barba, Jose A. Moral-Munoz, Amaranta De Miguel-Rubio and David Lucena-Anton
Brain Sci. 2024, 14(1), 57; https://doi.org/10.3390/brainsci14010057 - 06 Jan 2024
Viewed by 1919
Abstract
Resistance training induces neuromuscular adaptations and its impact on spasticity remains inadequately researched. This systematic review (PROSPERO: CRD42022322164) aimed to analyze the effects of resistance training, compared with no treatment, conventional therapy, or other therapies, in people with stroke-related spasticity. A comprehensive search [...] Read more.
Resistance training induces neuromuscular adaptations and its impact on spasticity remains inadequately researched. This systematic review (PROSPERO: CRD42022322164) aimed to analyze the effects of resistance training, compared with no treatment, conventional therapy, or other therapies, in people with stroke-related spasticity. A comprehensive search was conducted up to October 2023 in PubMed, PEDro, Cochrane, Web of Science, and Scopus databases. Selection criteria were randomized controlled trials involving participants with stroke-related spasticity intervened with resistance training. The PEDro scale was used to evaluate the methodological quality. From a total of 274 articles, 23 full-text articles were assessed for eligibility and nine articles were included in the systematic review, involving 225 participants (155 males, 70 females; mean age: 59.4 years). Benefits were found to spasticity after resistance training. Furthermore, studies measuring spasticity also reported benefits to function, strength, gait, and balance. In conclusion, resistance training was superior to, or at least equal to, conventional therapy, other therapies, or no intervention for improving spasticity, as well as function, strength, gait, and balance. However, the results should be taken with caution because of the heterogeneity of the protocols used. Further research is needed to explore the effects of resistance training programs on people with stroke. Full article
(This article belongs to the Special Issue Post-stroke Rehabilitation)
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8 pages, 270 KiB  
Brief Report
Translation, Adaptation, and Determining the Intra-Rater Reliability of the Balance Evaluation Systems Test (BESTest) for Persian Patients with Chronic Stroke
by Mansoureh Sadat Dadbakhsh, Afarin Haghparast, Noureddin Nakhostin Ansari, Amin Nakhostin-Ansari and Soofia Naghdi
Brain Sci. 2023, 13(12), 1674; https://doi.org/10.3390/brainsci13121674 - 04 Dec 2023
Viewed by 778
Abstract
This study aimed to translate and culturally adapt the BESTest to the Persian language and evaluate its intra-rater reliability in Iranian patients with stroke. A forward-backward translation and expert panel review method was followed. Eighteen patients post-stroke (15 men, 3 female) were included [...] Read more.
This study aimed to translate and culturally adapt the BESTest to the Persian language and evaluate its intra-rater reliability in Iranian patients with stroke. A forward-backward translation and expert panel review method was followed. Eighteen patients post-stroke (15 men, 3 female) were included which were assessed by a physiotherapist two times with a one-week interval. The mean total score for the test and retest were 83.66 (SD = 11.98) and 82 (SD = 13.23), respectively. There were no floor and ceiling effects. The intra-rater ICC for the total score was 0.88 (95% CI = 0.73–0.95). The ICC for the BESTest sections ranged from 0.55 (95% CI = 0.12–0.80) to 0.89 (95% CI = 0.55–0.96). The standard error of measurement and the smallest detectable change of the BESTest total score were 8.33 and 22.82, respectively. Our findings confirm the intra-rater reliability of the Persian BESTest for balance assessment of patients with chronic stroke. Full article
(This article belongs to the Special Issue Post-stroke Rehabilitation)
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