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3 pages, 197 KiB

Open AccessEditorial

The Future of Neurorehabilitation: Putting the Brain and Body Together Again

by Marco Iosa, Stefano Paolucci and Giovanni Morone

Brain Sci. 2023, 13(12), 1617; https://doi.org/10.3390/brainsci13121617 - 22 Nov 2023

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Abstract

The neurorehabilitation of cerebrovascular diseases is a challenging scientific topic that has rapidly grown in recent decades [...] Full article

(This article belongs to the Special Issue Neurorehabilitation of Cerebrovascular Diseases and Related Cognitive Complications)

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8 pages, 642 KiB

Open AccessFeature PaperArticle

Prognostic Factors in Neurorehabilitation of Stroke: A Comparison among Regression, Neural Network, and Cluster Analyses

by Marco Iosa, Giovanni Morone, Gabriella Antonucci and Stefano Paolucci

Brain Sci. 2021, 11(9), 1147; https://doi.org/10.3390/brainsci11091147 - 29 Aug 2021

Cited by 15 | Viewed by 3239

Abstract

There is a large body of literature reporting the prognostic factors for a positive outcome of neurorehabilitation performed in the subacute phase of stroke. Despite the recent development of algorithms based on neural networks or cluster analysis for the identification of these prognostic [...] Read more.

There is a large body of literature reporting the prognostic factors for a positive outcome of neurorehabilitation performed in the subacute phase of stroke. Despite the recent development of algorithms based on neural networks or cluster analysis for the identification of these prognostic factors, the literature lacks a rigorous comparison among classical regression, neural network, and cluster analysis. Moreover, the three methods have rarely been tested on a sample independent from that in which prognostic factors have been identified. This study aims at providing this comparison on a wide sample of data (1522 patients) and testing the results on an independent sample (1000 patients) using 30 variables. The accuracy was similar among regression, neural network, and cluster analyses on the analyzed sample (76.6%, 74%, and 76.1%, respectively), but on the test sample, the accuracy of neural network decreased (70.1%). The three models agreed in identifying older age, severe impairment, unilateral spatial neglect, and total anterior circulation infarcts as important prognostic factors. The binary regression analysis also provided solid results in the test sample, especially in terms of specificity (81.8%). Cluster analysis also showed a high sensitivity in the test sample (82.6%) and allowed a meaningful easy-to-use classification tree to be obtained. Full article

(This article belongs to the Special Issue Neurorehabilitation of Cerebrovascular Diseases and Related Cognitive Complications)

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14 pages, 1629 KiB

Open AccessArticle

Efficacy of a Training on Executive Functions in Potentiating Rehabilitation Effects in Stroke Patients

by Vincenza Tarantino, Francesca Burgio, Roberta Toffano, Elena Rigon, Francesca Meneghello, Luca Weis and Antonino Vallesi

Brain Sci. 2021, 11(8), 1002; https://doi.org/10.3390/brainsci11081002 - 29 Jul 2021

Cited by 17 | Viewed by 3772

Abstract

Cognitive impairment after a stroke has a direct impact on patients’ disability. In particular, impairment of Executive Functions (EFs) interferes with re-adaptation to daily life. The aim of this study was to explore whether adding a computer-based training on EFs to an ordinary [...] Read more.

Cognitive impairment after a stroke has a direct impact on patients’ disability. In particular, impairment of Executive Functions (EFs) interferes with re-adaptation to daily life. The aim of this study was to explore whether adding a computer-based training on EFs to an ordinary rehabilitation program, regardless of the specific brain damage and clinical impairment (motor, language, or cognitive), could improve rehabilitation outcomes in patients with stroke. An EF training was designed to have minimal motor and expressive language demands and to be applied to a wide range of clinical conditions. A total of 37 stroke patients were randomly assigned to two groups: a training group, which performed the EF training in addition to the ordinary rehabilitation program (treatment as usual), and a control group, which performed the ordinary rehabilitation exclusively. Both groups were assessed before and after the rehabilitation program on neuropsychological tests covering multiple cognitive domains, and on functional scales (Barthel index, Functional Independence Measure). The results showed that only patients who received the training improved their scores on the Attentional Matrices and Phonemic Fluency tests after the rehabilitation program. Moreover, they showed a greater functional improvement in the Barthel scale as well. These results suggest that combining an EF training with an ordinary rehabilitation program potentiates beneficial effects of the latter, especially in promoting independence in activities of daily living. Full article

(This article belongs to the Special Issue Neurorehabilitation of Cerebrovascular Diseases and Related Cognitive Complications)

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21 pages, 1581 KiB

Open AccessArticle

Success of Hand Movement Imagination Depends on Personality Traits, Brain Asymmetry, and Degree of Handedness

by Elena V. Bobrova, Varvara V. Reshetnikova, Elena A. Vershinina, Alexander A. Grishin, Pavel D. Bobrov, Alexander A. Frolov and Yury P. Gerasimenko

Brain Sci. 2021, 11(7), 853; https://doi.org/10.3390/brainsci11070853 - 25 Jun 2021

Cited by 7 | Viewed by 3235

Abstract

Brain-computer interfaces (BCIs), based on motor imagery, are increasingly used in neurorehabilitation. However, some people cannot control BCI, predictors of this are the features of brain activity and personality traits. It is not known whether the success of BCI control is related to [...] Read more.

Brain-computer interfaces (BCIs), based on motor imagery, are increasingly used in neurorehabilitation. However, some people cannot control BCI, predictors of this are the features of brain activity and personality traits. It is not known whether the success of BCI control is related to interhemispheric asymmetry. The study was conducted on 44 BCI-naive subjects and included one BCI session, EEG-analysis, 16PF Cattell Questionnaire, estimation of latent left-handedness, and of subjective complexity of real and imagery movements. The success of brain states recognition during imagination of left hand (LH) movement compared to the rest is higher in reserved, practical, skeptical, and not very sociable individuals. Extraversion, liveliness, and dominance are significant for the imagination of right hand (RH) movements in “pure” right-handers, and sensitivity in latent left-handers. Subjective complexity of real LH and of imagery RH movements correlates with the success of brain states recognition in the imagination of movement of LH compared to RH and depends on the level of handedness. Thus, the level of handedness is the factor influencing the success of BCI control. The data are supposed to be connected with hemispheric differences in motor control, lateralization of dopamine, and may be important for rehabilitation of patients after a stroke. Full article

(This article belongs to the Special Issue Neurorehabilitation of Cerebrovascular Diseases and Related Cognitive Complications)

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12 pages, 506 KiB

Open AccessArticle

Serotonin Levels and Cognitive Recovery in Patients with Subacute Stroke after Rehabilitation Treatment

by Mariacristina Siotto, Marco Germanotta, Massimo Santoro, Valeria Cipollini, Giulia Guardati, Dionysia Papadopoulou, Elisa Bray, Alessia Mastrorosa and Irene Aprile

Brain Sci. 2021, 11(5), 642; https://doi.org/10.3390/brainsci11050642 - 15 May 2021

Cited by 8 | Viewed by 3322

Abstract

Post-stroke depression and cognitive impairment are common conditions affecting patients after stroke. Serotonin is a neurotransmitter involved in modulating, among others, mood, cognition, learning, and memory. Sub-optimal serotonin activity may be in part responsible for cognitive deficits seen in depression. In this pilot [...] Read more.

Post-stroke depression and cognitive impairment are common conditions affecting patients after stroke. Serotonin is a neurotransmitter involved in modulating, among others, mood, cognition, learning, and memory. Sub-optimal serotonin activity may be in part responsible for cognitive deficits seen in depression. In this pilot study serotonin levels were evaluated in 29 patients with sub-acute stroke before and after a rehabilitation treatment (consisting of a program of upper limb robotic rehabilitation in addition to conventional physical therapy treatment). We employed the Back Depression Inventory scale to evaluate symptoms of depression, and specific tools to evaluate cognitive functions. We found a significant reduction of the serotonin levels after rehabilitation in the whole group (T0: 85.9 ± 92.4 ng/mL; T1: 61.9 ± 58.4 ng/mL; p = 0.0018), as well as in the subgroup of patients untreated with Selective Serotonin Reuptake Inhibitors (SRRI), (mean serotonin at T0: 154.0 ± 102.3 ng/mL; mean serotonin at T1: 92.9. ± 68.7 ng/mL at T1; p = 0.005). We also found a correlation with cognitive assessment: in particular, the change from baseline of the serotonin (ΔSerotonin) was correlated with the changes from baseline of the Rey’s Figure (ΔROCF) (r = 0.535; p < 0.05), the Tower of London (ΔToL) (subscore point: r = 0.621; p < 0.005; subscore time: r = −0.619; p < 0.005) meaning that a serotonin levels decrease is associated with a worsening of cognitive functions. Considering patients treated and untreated with SSRIs separately, in patients treated with SSRIs (n = 16) we found only a positive correlation between ∆Serotonin and ∆ToL (subscore point: r= 0.587; p = 0.045), whereas in patients untreated with SSRIs (n = 13) we found a positive correlations between ΔSerotonin and ΔROCF (r = 0.700; p = 0.036), ∆Stroop (subscore time: r = 0.750; p = 0.020) and ∆Tol (subscore point: r = 0.740; p = 0.023) and a negative correlation between ΔSerotonin and ∆Tol (subscore time: r= −0.833; p = 0.005). These results suggest that variation of serotonin levels should be monitored in patients during a rehabilitation program, not only for their relationship with depression symptoms, but also for the correlation with cognitive performance. Full article

(This article belongs to the Special Issue Neurorehabilitation of Cerebrovascular Diseases and Related Cognitive Complications)

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9 pages, 1566 KiB

Open AccessArticle

Italian Version of the Pittsburgh Rehabilitation Participation Scale: Psychometric Analysis of Validity and Reliability

by Marco Iosa, Giovanni Galeoto, Daniela De Bartolo, Valentina Russo, Ilaria Ruotolo, Grazia Fernanda Spitoni, Irene Ciancarelli, Marco Tramontano, Gabriella Antonucci, Stefano Paolucci and Giovanni Morone

Brain Sci. 2021, 11(5), 626; https://doi.org/10.3390/brainsci11050626 - 13 May 2021

Cited by 12 | Viewed by 2800

Abstract

Patient’s active participation in therapy is a key component of successful rehabilitation. In fact, low participation has been shown to be a prognostic factor of poor outcome; however, participation is rarely assessed in clinical settings. The Pittsburgh Rehabilitation Participation Scale (PRPS) is a [...] Read more.

Patient’s active participation in therapy is a key component of successful rehabilitation. In fact, low participation has been shown to be a prognostic factor of poor outcome; however, participation is rarely assessed in clinical settings. The Pittsburgh Rehabilitation Participation Scale (PRPS) is a validated, quick, and accurate measure of participation, relying on clinicians’ observation, and not requiring any self-report by patients. The aim of this study was to validate an Italian version of the PRPS. Following forward and back-translation of PRPS into Italian, the translated version was validated in a total of 640 therapy sessions, related to a cohort of 32 patients admitted to an Italian hospital. It was tested for concurrent validity, finding significant correlations with Barthel Index (R > 0.58, p < 0.001) and SF-36 Physical and Mental Health (R > 0.4, p < 0.02), for predictive validity, finding significant correlation with the effectiveness of rehabilitation (R = 0.358, p = 0.045), and for inter-rater and intra-rater reliability, computing an Intra-class correlation coefficient (ICC = 0.926 and 0.756, respectively). These psychometric properties results were similar to those of the original version of this scale. The proposed PRPS can be helpful for Italian clinicians in the assessment of patient’s participation during rehabilitation. Full article

(This article belongs to the Special Issue Neurorehabilitation of Cerebrovascular Diseases and Related Cognitive Complications)

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10 pages, 1822 KiB

Open AccessArticle

Influence of Cognitive Impairment on the Recovery of Subjects with Subacute Stroke Undergoing Upper Limb Robotic Rehabilitation

by Irene Aprile, Giulia Guardati, Valeria Cipollini, Dionysia Papadopoulou, Serena Monteleone, Alessandra Redolfi, Romina Garattini, Gianluigi Sacella, Fulvia Noro, Silvia Galeri, Maria Chiara Carrozza and Marco Germanotta

Brain Sci. 2021, 11(5), 587; https://doi.org/10.3390/brainsci11050587 - 30 Apr 2021

Cited by 11 | Viewed by 3004

Abstract

Cognitive decline is often present in stroke survivors, with a significant impact on motor recovery. However, how specific cognitive domains could impact motor recovery after robotic rehabilitation in patients with stroke is still not well understood. In this study, we analyzed the relationship [...] Read more.

Cognitive decline is often present in stroke survivors, with a significant impact on motor recovery. However, how specific cognitive domains could impact motor recovery after robotic rehabilitation in patients with stroke is still not well understood. In this study, we analyzed the relationship between cognitive impairment and the outcome of a robot-mediated upper limb rehabilitation intervention in a sample of 51 subacute stroke patients. Participants were enrolled and treated with a set of robotic and sensor-based devices. Before the intervention, patients underwent a cognitive assessment by means of the Oxford Cognitive Screen. To assess the effect of the 30-session rehabilitation intervention, patients were assessed twice with the following outcome measures: the Fugl-Meyer Assessment for Upper Extremity (FMA-UE), to evaluate motor function; the Upper limb Motricity Index (MI), to evaluate upper limb muscle strength; the Modified Barthel Index (mBI), to evaluate activities of daily living and mobility. We found that deficits in spatial attention and executive functions impacted the mBI improvement, while language, number processing, and spatial attention deficits reduced the gains in the FMA-UE. These results suggest the importance to evaluate the cognitive functions using an adequate tool in patients with stroke undergoing a robotic rehabilitation intervention. Full article

(This article belongs to the Special Issue Neurorehabilitation of Cerebrovascular Diseases and Related Cognitive Complications)

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9 pages, 977 KiB

Open AccessArticle

Effect of Prism Adaptation Therapy on the Activities of Daily Living and Awareness for Spatial Neglect: A Secondary Analysis of the Randomized, Controlled Trial

by Katsuhiro Mizuno, Kengo Tsujimoto and Tetsuya Tsuji

Brain Sci. 2021, 11(3), 347; https://doi.org/10.3390/brainsci11030347 - 9 Mar 2021

Cited by 7 | Viewed by 3173

Abstract

Background: Rehabilitation for unilateral spatial neglect (USN) using prism adaptation (PA) is one of the most widely used methods, and the effectiveness of PA is well-evidenced. Although the effect of PA generalized various neglect symptoms, the effectiveness for some aspects of neglect is [...] Read more.

Background: Rehabilitation for unilateral spatial neglect (USN) using prism adaptation (PA) is one of the most widely used methods, and the effectiveness of PA is well-evidenced. Although the effect of PA generalized various neglect symptoms, the effectiveness for some aspects of neglect is not fully proven. The Catherine Bergego Scale (CBS) was developed to identify problems with the activities of daily living (ADL) caused by USN. The CBS is composed of 10 observation assessments and a self-assessment questionnaire. To assess the self-awareness of USN, the anosognosia score is calculated as the difference between the observational scores and the self-assessment scores. To investigate how PA affects ADL and self-awareness in subacute USN patients during rehabilitation, we analyzed each item of the CBS and self-awareness from a randomized, controlled trial (RCT) that we previously conducted (Mizuno et al., 2011). Methods: A double-masked randomized, controlled trial was conducted to evaluate the effects of a 2-week PA therapy on USN in 8 hospitals in Japan. We compared each item of the CBS, anosognosia score, and absolute value of the anosognosia score between the prism group and the control group. Results: Two of ten items (gaze orientation and exploration of personal belongings) were significantly improved in the prism group compared with those in the control group. The absolute value of the anosognosia score was significantly improved by PA. Conclusions: Improvement of oculomotor exploration by PA may generalize the behavioral level in a daily living environment. This study suggested that PA could accelerate the self-awareness of neglect during subacute rehabilitation. Full article

(This article belongs to the Special Issue Neurorehabilitation of Cerebrovascular Diseases and Related Cognitive Complications)

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18 pages, 661 KiB

Open AccessArticle

Is an Oral Health Status a Predictor of Functional Improvement in Ischemic Stroke Patients Undergoing Comprehensive Rehabilitation Treatment?

by Piotr Gerreth, Karolina Gerreth, Mateusz Maciejczyk, Anna Zalewska and Katarzyna Hojan

Brain Sci. 2021, 11(3), 338; https://doi.org/10.3390/brainsci11030338 - 7 Mar 2021

Cited by 13 | Viewed by 3496

Abstract

The study’s aim was a clinical observation concerning the influence of oral health on functional status in stroke patients undergoing neurorehabilitation. This pilot cross-sectional clinical study was performed in 60 subacute phase stroke patients during 12 weeks of treatment. The program was patient-specific [...] Read more.

The study’s aim was a clinical observation concerning the influence of oral health on functional status in stroke patients undergoing neurorehabilitation. This pilot cross-sectional clinical study was performed in 60 subacute phase stroke patients during 12 weeks of treatment. The program was patient-specific and consisted of neurodevelopmental treatment by a comprehensive rehabilitation team. The functional assessment was performed using the Barthel index (BI), Berg balance scale (BBS), functional independence measure (FIM), and Addenbrooke’s cognitive examination III (ACE III) scales. Oral health was assessed according to World Health Organization (WHO) criteria, and it was presented using DMFT, DMFS, gingival index (GI), and plaque index (PlI). Significant improvement in many functional scales was noticed. However, important differences in most dental parameters without relevant changes in GI and PlI after the study were not observed. Reverse interdependence (p < 0.05) was shown between physical functioning (BI, FIM, or BBS) with GI and PlI results, and most dental parameters correlated with ACE III. Using multivariate regression analysis, we showed that ACE III and BI are predictive variables for DMFT, just as FIM is for DS (p < 0.05). The present research revealed that poor oral health status in patients after stroke might be associated with inpatient rehabilitation results. Full article

(This article belongs to the Special Issue Neurorehabilitation of Cerebrovascular Diseases and Related Cognitive Complications)

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12 pages, 284 KiB

Open AccessArticle

Action Observation Therapy for Upper Limb Recovery in Patients with Stroke: A Randomized Controlled Pilot Study

by Mauro Mancuso, Serena Di Tondo, Enza Costantini, Alessio Damora, Patrizio Sale and Laura Abbruzzese

Brain Sci. 2021, 11(3), 290; https://doi.org/10.3390/brainsci11030290 - 26 Feb 2021

Cited by 11 | Viewed by 4790

Abstract

Due to the complexity of the interventions for upper limb recovery, at the moment there is a lack of evidence regarding innovative and effective rehabilitative interventions. Action Observation Training (AOT) constitutes a promising rehabilitative method to improve upper limb motor recovery in stroke [...] Read more.

Due to the complexity of the interventions for upper limb recovery, at the moment there is a lack of evidence regarding innovative and effective rehabilitative interventions. Action Observation Training (AOT) constitutes a promising rehabilitative method to improve upper limb motor recovery in stroke patients. The aim of the present study was to evaluate the potential efficacy of AOT, both in upper limb recovery and in functional outcomes when compared to patients treated with task oriented training (TOT). Both treatments were added to traditional rehabilitative treatment. Thirty-two acute stroke patients at 15.6 days (±8.3) from onset, with moderate to severe upper limb impairment at baseline following their first-ever stroke, were enrolled and randomized into two groups: 16 in the experimental group (EG) and 16 in the control group (CG). The EG underwent 30 min sessions of AOT, and the CG underwent 30 min sessions of TOT. All participants received 20 sessions of treatment for four consecutive weeks (five days/week). The Fugl-Meyer Assessment for Upper Extremity (FMA-UE), Box and Block Test (BBT), Functional Independence Measure (FIM) and Modified Ashworth Scale (MAS) were administered at baseline (T₀) and at the end of treatment (T₁). No statistical differences were found at T₀ for inclusion criteria between the CG and EG, whereas both groups improved significantly at T₁. After the treatment period, the rehabilitative gain was greater in the EG compared to the CG for FMA-UE and FIM (all p < 0.05). Our results suggest that AOT can contribute to increased motor recovery in subacute stroke patients with moderate to severe upper limb impairment in the early phase after stroke. The improvements presented in this article, together with the lack of adverse events, confirm that the use of AOT should be broadened out to larger pools of subacute stroke patients. Full article

(This article belongs to the Special Issue Neurorehabilitation of Cerebrovascular Diseases and Related Cognitive Complications)

14 pages, 3217 KiB

Open AccessArticle

Gait Recovery with an Overground Powered Exoskeleton: A Randomized Controlled Trial on Subacute Stroke Subjects

by Franco Molteni, Eleonora Guanziroli, Michela Goffredo, Rocco Salvatore Calabrò, Sanaz Pournajaf, Marina Gaffuri, Giulio Gasperini, Serena Filoni, Silvano Baratta, Daniele Galafate, Domenica Le Pera, Placido Bramanti, Marco Franceschini and on behalf of Italian Eksogait Study Group

Brain Sci. 2021, 11(1), 104; https://doi.org/10.3390/brainsci11010104 - 14 Jan 2021

Cited by 40 | Viewed by 5226

Abstract

Background: Overground Robot-Assisted Gait Training (o-RAGT) provides intensive gait rehabilitation. This study investigated the efficacy of o-RAGT in subacute stroke subjects, compared to conventional gait training. Methods: A multicenter randomized controlled trial was conducted on 75 subacute stroke subjects (38 in the Experimental [...] Read more.

Background: Overground Robot-Assisted Gait Training (o-RAGT) provides intensive gait rehabilitation. This study investigated the efficacy of o-RAGT in subacute stroke subjects, compared to conventional gait training. Methods: A multicenter randomized controlled trial was conducted on 75 subacute stroke subjects (38 in the Experimental Group (EG) and 37 in the Control Group (CG)). Both groups received 15 sessions of gait training (5 sessions/week for 60 min) and daily conventional rehabilitation. The subjects were assessed at the beginning (T1) and end (T2) of the training period with the primary outcome of a 6 Minutes Walking Test (6MWT), the Modified Ashworth Scale of the Affected lower Limb (MAS-AL), the Motricity Index of the Affected lower Limb (MI-AL), the Trunk Control Test (TCT), Functional Ambulation Classification (FAC), a 10 Meters Walking Test (10MWT), the modified Barthel Index (mBI), and the Walking Handicap Scale (WHS). Results: The 6MWT increased in both groups, which was confirmed by both frequentist and Bayesian analyses. Similar outcomes were registered in the MI-AL, 10MWT, mBI, and MAS-AL. The FAC and WHS showed a significant number of subjects improving in functional and community ambulation in both groups at T2. Conclusions: The clinical effects of o-RAGT were similar to conventional gait training in subacute stroke subjects. The results obtained in this study are encouraging and suggest future clinical trials on the topic. Full article

(This article belongs to the Special Issue Neurorehabilitation of Cerebrovascular Diseases and Related Cognitive Complications)

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15 pages, 2070 KiB

Open AccessSystematic Review

Vibrotactile-Based Rehabilitation on Balance and Gait in Patients with Neurological Diseases: A Systematic Review and Metanalysis

by Sara De Angelis, Alessandro Antonio Princi, Fulvio Dal Farra, Giovanni Morone, Carlo Caltagirone and Marco Tramontano

Brain Sci. 2021, 11(4), 518; https://doi.org/10.3390/brainsci11040518 - 19 Apr 2021

Cited by 10 | Viewed by 3991

Abstract

Postural instability and fear of falling represent two major causes of decreased mobility and quality of life in cerebrovascular and neurologic diseases. In recent years, rehabilitation strategies were carried out considering a combined sensorimotor intervention and an active involvement of the patients during [...] Read more.

Postural instability and fear of falling represent two major causes of decreased mobility and quality of life in cerebrovascular and neurologic diseases. In recent years, rehabilitation strategies were carried out considering a combined sensorimotor intervention and an active involvement of the patients during the rehabilitation sessions. Accordingly, new technological devices and paradigms have been developed to increase the effectiveness of rehabilitation by integrating multisensory information and augmented feedback promoting the involvement of the cognitive paradigm in neurorehabilitation. In this context, the vibrotactile feedback (VF) could represent a peripheral therapeutic input, in order to provide spatial proprioceptive information to guide the patient during task-oriented exercises. The present systematic review and metanalysis aimed to explore the effectiveness of the VF on balance and gait rehabilitation in patients with neurological and cerebrovascular diseases. A total of 18 studies met the inclusion criteria and were included. Due to the lack of high-quality studies and heterogeneity of treatments protocols, clinical practice recommendations on the efficacy of VF cannot be made. Results show that VF-based intervention could be a safe complementary sensory-motor approach for balance and gait rehabilitation in patients with neurological and cerebrovascular diseases. More high-quality randomized controlled trials are needed. Full article

(This article belongs to the Special Issue Neurorehabilitation of Cerebrovascular Diseases and Related Cognitive Complications)

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17 pages, 713 KiB

Open AccessSystematic Review

Effects of Combined Interventions with Aerobic Physical Exercise and Cognitive Training on Cognitive Function in Stroke Patients: A Systematic Review

by Laura Amorós-Aguilar, Erica Rodríguez-Quiroga, Sara Sánchez-Santolaya and Margalida Coll-Andreu

Brain Sci. 2021, 11(4), 473; https://doi.org/10.3390/brainsci11040473 - 8 Apr 2021

Cited by 18 | Viewed by 4944

Abstract

(1) Background: Stroke is a major cause of permanent disability in multiple functions, including the cognitive domain. Since both cognitive training and aerobic physical exercise may exert positive effects on cognition after stroke, one may expect synergistic benefits when combining both interventions. (2) [...] Read more.

(1) Background: Stroke is a major cause of permanent disability in multiple functions, including the cognitive domain. Since both cognitive training and aerobic physical exercise may exert positive effects on cognition after stroke, one may expect synergistic benefits when combining both interventions. (2) Methods: We carried out a systematic search of studies testing, in adult stroke patients, whether structured aerobic exercise combined with cognitive training led to higher cognitive benefits than either of these interventions when applied singly, or than interventions not including aerobic exercise or cognitive training. (3) Results: Five fair-quality randomized controlled trials fulfilled the search criteria. Exercise intensity was moderate-vigorous and cognitive training was mainly computer-based. The studies were heterogeneous regarding the cognitive tests used, and for this reason, a meta-analysis was not performed. Only three studies included follow-up assessment. The combined intervention was associated with pre-post improvement in at least one cognitive test in all the studies, and with higher positive effects compared to other conditions (although statistical significance was not always reached) in four studies. (4) Conclusions: Further trials including a long-term follow-up and comprehensive neuropsychological testing should be undertaken to determine whether combined aerobic exercise and cognitive training leads to additive cognitive benefits after stroke. Full article

(This article belongs to the Special Issue Neurorehabilitation of Cerebrovascular Diseases and Related Cognitive Complications)

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