Search Results (47)

Background: Early rehabilitation is crucial for predicting post-stroke outcomes. In rural Thailand, previous works identified limited access to prompt rehabilitation services, discontinuity of home visits, and a lack of interdisciplinary management, hindering comprehensive resolution. Objective: This participatory action research-based pilot quasi-experimental study investigated the effects of personalized intermediate care (IMC) programs led by physical therapists on clinical outcomes in post-ischemic stroke older adults living in rural areas. Methods: Participatory stakeholders (two physical therapists, a physician, a nurse, and a nutritionist) convened to coordinate with relevant stakeholders (community leaders, village health volunteers (VHVs), and family caregivers (CGs)). Thirty-four acute post-stroke patients were included in the study. The interventions consisted of three action research cycles (planning, action, observation, and reflection) of home-based neurorehabilitation and comprehensive treatments by a healthcare professional network for six months and another six-month follow-up. The primary outcome was the Barthel index for activities of daily living (BI-ADL). The modified Rankin scale (mRS) was a secondary outcome for assessing disability levels. Results: Results showed that the BI-ADL gradually and significantly increased from a baseline median (IQR) of 55 (15) to 100 (20) after 6 months (p < 0.05). This improvement of the BI-ADL was maintained after 12 months (100 (15)). Furthermore, the mRS at 6 months post-discharge reduced considerably from the first month of rehabilitation (p < 0.05). Conclusions: In conclusion, the early and continuous personalized IMC rehabilitation program effectively enhanced ADL and reduced disability levels and should be disseminated to the community. Full article

Background/Objectives: Individuals with chronic stroke often experience various impairments, including poor balance, reduced mobility, limited physical activity, and difficulty performing daily tasks. In the context of the COVID-19 pandemic, telerehabilitation (TR) can overcome the barriers of geographical and physical distancing, time, costs, and travel, as well as the anxiety about contracting COVID-19. In this retrospective case-control study, we aim to evaluate the motor and cognitive effects of balance TR training carried out with a sensor-based non-immersive virtual reality system compared to conventional rehabilitation in chronic stroke patients. Methods: Twenty chronic post-stroke patients underwent evaluation for inclusion in the analysis through an electronic recovery data system. The patients included in the study were divided into two groups with similar medical characteristics and duration of rehabilitation training. However, the groups differed in the type of rehabilitation approach used. The experimental group (EG) received TR with a sensor-based VR device, called VRRS—HomeKit (n. 10). In contrast, the control group (CG) underwent conventional home-based rehabilitation (n. 10). Results: At the end of the training, we observed significant improvements in the EG in the 10-m walking test (10MWT) (p = 0.01), Timed-Up-Go Left (TUG L) (p = 0.01), and Montreal Cognitive Assessment (MoCA) (p = 0.005). Conclusions: In our study, we highlighted the potential role of sensor-based virtual reality TR in chronic stroke patients for improving lower limb function, suggesting that this approach is feasible and not inferior to conventional home-based rehabilitation. Full article

Wearable sensors are increasingly used to provide objective quantification of spatiotemporal and kinematic parameters post-stroke. This study aimed to evaluate the practical value of sensor-based gait reports in delivering augmented feedback and informing the development of home training programmes following a 2-week supervised intensive intervention after stroke. Four patients with chronic stroke were assessed on four occasions (pre- and post-intervention, 3-month, and 6-month follow-ups) using clinical gait tests, during which a portable sensor-based system recorded kinematic data. The meaningfulness of individual changes in gait parameters was interpreted based on established minimal detectable change values (MDC). Three participants improved their gait speed, joint angles, and/or cadence in the Ten-Metre Walk Test, and three participants improved their walking distance in the Six-Minute Walk Test. The improvements were most evident at the 3-month follow-up (with the most obvious changes above MDC estimates) and indicated the reappearance of normal gait patterns, adjustments of gait patterns, or a combination of both. Participants showed interest in and understanding of the information derived from the gait reports (ratings of 5–10 out of 10). In conclusion, augmented feedback derived from gait reports provides a valuable complement to traditional clinical assessments used in stroke rehabilitation to optimize treatment outcomes. Full article

(1) Background: Digital health technologies (DHTs) are increasingly being utilized to facilitate receiving rehabilitation services remotely, offering innovative solutions to enhance recovery outcomes. This scoping review examines the role of DHT in home-based stroke rehabilitation, focusing on its applications, effectiveness, and limitations. It identifies key advancements and future directions for improving stroke recovery through technological innovations. (2) Methods: Using Arksey and O’Malley’s framework, a systematic search was conducted across multiple databases to identify studies involving DHT for home-based stroke rehabilitation. Eligible studies incorporated technologies for monitoring and evaluation. Data extraction followed PRISMA-ScR guidelines, synthesizing findings across various research designs. (3) Results: Ten studies were reviewed, categorizing technologies into wearable devices, smartphones, and sensor-based solutions. These tools primarily assessed mobility, upper extremity function, cognitive function, daily living activities, and continuous physiological monitoring. High feasibility and usability were reported, though challenges included small sample sizes and user-centered design limitations. (4) Conclusions: Most DHTs used for evaluating and monitoring home-based stroke rehabilitation are wearable and sensor-based, mainly focusing on mobility and upper extremity function. Their application is effective, but limitations remain. Future research should address these gaps to enhance usability and coverage. Full article

Stroke is a leading cause of disability worldwide. The long-term effects of a stroke depend on the location and size of the affected brain area, resulting in diverse disabilities and experiences for survivors. More than 70% of people experiencing stroke suffer upper-limb dysfunction, which can significantly limit independence in daily life. The growing strain on national healthcare resources, coupled with the rising demand for personalised, home-based rehabilitation, along with increased familiarity with digital technologies, has set the stage for developing an advanced therapeutics system consisting of a wearable solution aimed at complementing current stroke rehabilitation to enhance recovery outcomes. Through a user-centred approach, supported by primary and secondary research, this study has developed an advanced prototype integrating electromyography smart sensors, functional electrical stimulation, and virtual reality technologies in a closed-loop system that is capable of supporting personalised recovery journeys. The outcome is a more engaging and accessible rehabilitation experience, designed and evaluated through the participation of stroke survivors. This paper presents the design of the therapeutic platform, feedback from stroke survivors, and considerations regarding the integration of the proposed technology across the stroke pathway, from early days in a hospital to later stage rehabilitation in the community. Full article

One emerging method in home stroke rehabilitation is digital technology. However, existing approaches typically target one domain (e.g., upper limb). Moreover, existing interventions do not cater to older adults with stroke (OAwS), especially those with high motor impairment, who require adjunct therapeutic agents to independently perform challenging exercises. We examined the feasibility of Smartphone-based Exercise Training after Stroke (SETS) with Functional Electrical Stimulation (FES). A total of 12 participants (67 ± 5 years) with stroke (onset > 6 months) exhibiting moderate-to-high motor impairment (Chedoke McMaster Leg ≤ 4/7) underwent 6 weeks of multicomponent (gait, functional strength, dynamic balance) training integrated with FES to paretic lower limb muscles. Primary measures included safety and adherence. Secondary measures included motivation, acceptability and attitude, usability, and clinical measures of gait and balance function like the 10-Meter Walk Test and Mini-BESTest. Participants reported no adverse events and moderate-to-high adherence (84.17 ± 11.24%) and improvement (up to 40%) in motivation, acceptability, and attitude and system usability. Participants also showed pre-post improvements in all measures of gait and balance function (p < 0.05). Integrating SETS and FES is feasible and yields short-term gains in gait and balance function among OAwS. Future studies could validate our findings by examining its efficacy with control groups to identify the differential effects of SETS and FES. Full article

Background: Socially Assistive Robots (SARs) represent an innovative approach in rehabilitation technology, significantly enhancing the support and motivation for individuals across diverse rehabilitation settings. Despite their growing utilization, especially in stroke recovery and pediatric rehabilitation, their potential in musculoskeletal and orthopedic rehabilitation remains largely underexplored. Although there is methodological and outcome variability across the included studies, this review aims to critically evaluate and summarize the research on SARs in rehabilitation, providing a thorough overview of the current evidence and practical applications. Methods: A comprehensive search was conducted across multiple databases, resulting in the selection of 20 studies for analysis. The reviewed papers were categorized into three main classes based on the roles of the robots in rehabilitation: Motivation, Imitation, and Feedback Providers. Results: The analysis highlights that SARs significantly improve adherence to rehabilitation programs, enhance motor function, and increase motivation across clinical and home settings. Robots such as NAO, Pepper, and ZORA demonstrated high efficacy, particularly in stroke recovery and pediatric rehabilitation. Conclusions: SARs offer transformative benefits in rehabilitation, providing scalable, personalized solutions through motivational support, guided exercises, and real-time feedback. Their integration into orthopedic rehabilitation could address critical clinical needs, enhancing precision in exercises, adherence to long-term programs, and overall patient outcomes. Future research should prioritize the development and validation of SAR-based interventions for musculoskeletal disorders to unlock their full potential in this domain. Full article

Purpose: Over the past decade, tele-neurorehabilitation (TNR) has emerged as a vital and effective tool for delivering continuous care to stroke patients, playing a key role in enhancing functional recovery and ensuring consistent access to rehabilitation services. In the field of TNR, various protocols are utilized to ensure effective cognitive stimulation at home. Recent preliminary studies highlight the employment of multidomain cognitive interventions, which would seem to induce more stable and relevant cognitive recovery in stroke patients. A randomized controlled trial (RCT) study was conducted to compare the effectiveness of a TNR multidomain cognitive approach to conventional face-to-face cognitive treatment. Methods: A total of 30 patients with stroke were equally enrolled and randomly assigned to the experimental and control groups. In the experimental group, patients received sessions of home-based cognitive virtual reality rehabilitation system (VRRS) training. The control group underwent traditional face-to-face cognitive multidomain treatment at the hospital. The therapy was given for one hour every day for four weeks in both groups. Specific cognitive domains, including memory, praxis skills, executive functions, and speech therapy, were stimulated in the procedure. Neuropsychological evaluations were performed at three timepoints: at baseline (T0), at the end of TNR (T1), and six months later (T2). Results: The TNR group demonstrated significant improvements in working memory and language abilities, as well as in depressive symptoms and caregiver burden, with an average decrease of 2.07. Most of this improvement persisted 6 months after treatment. The group that received face-to-face cognitive treatment showed improvements (not persisting at T2) after treatment in a task measuring constructive apraxia and alternating attention with the cognitive skill of set-shifting. Conclusions: According to our findings, multidomain cognitive TNR may be useful in enhancing cognitive outcomes in stroke populations (even six months after treatment concludes). TNR may also be a viable way to deliver these interventions since it boosts people’s motivation to train and, consequently, their adherence to treatment while also having a positive effect on caregivers’ distress management. Full article

Background/Objectives: Despite the increase in home-based rehabilitation, outcome measures for telerehabilitation are still underdeveloped. The Fugl-Meyer Assessment (FMA) is one of the most widely used tools for evaluating post-stroke motor deficits, with the upper extremity component (FMA-UE) recommended for assessing motor deficits of the arm. This study aims to examine the intrarater and interrater reliability of the Italian version of the FMA-UE, administered remotely via video conferencing during a robotic telerehabilitation program. Methods: Twenty stroke patients participated and underwent 20 sessions of remote upper limb rehabilitation with a robotic device. In-person evaluations were conducted before (T0) and after (T1) treatment, with additional remote assessments throughout. The study evaluated both intrarater and interrater reliability using Intraclass Correlation Coefficients (ICC) and Bland–Altman plots, classifying reliability as excellent for scores above 0.90. Results: Bland–Altman analysis showed no systematic variance for both intrarater and interrater reliability of the FMA-UE scale. Excellent reliability was found with intrarater ICC = 0.972 and interrater ICC = 0.981. Sections A and C of the FMA-UE showed excellent intrarater reliability, while sections B and D had satisfactory results. Both intrarater and interrater reliability analysis of the total score of the FMA-UE scale also showed strong agreement with Cohen’s Kappa values above 0.70. Conclusions: The findings suggest that the remote administration of the FMA-UE scale is a reliable tool for assessing upper limb motor function in stroke patients, supporting its use in telerehabilitation settings. Full article

Daily restricted environmental enrichment (REE) refers to limited, structured periods of enrichment aimed at improving both physical and cognitive well-being in animals and humans. This review explores the significance of REE, focusing on studies that investigate 2 and 3 h daily enrichment protocols. Through an analysis of 21 key studies, this paper highlights how even brief periods of REE can lead to substantial improvements in brain plasticity, cognitive function, and stress resilience. The review tracks the evolution of environmental enrichment from early research on enriched environments in animals to modern applications in human rehabilitation, particularly for stroke recovery and mental health treatment. While the traditional approach to environmental enrichment often involves continuous exposure, recent research suggests that restricted daily enrichment can yield comparable benefits, offering a practical, scalable solution for clinical settings. This review underscores the importance of adapting REE for individual needs and developing flexible, home-based programs for broader application. Full article

Background and Objectives: Neurological disorders like stroke, spinal cord injury (SCI), and Parkinson’s disease (PD) significantly affect global health, requiring accurate diagnosis and long-term neurorehabilitation. Artificial intelligence (AI), such as machine learning (ML), may enhance early diagnosis, personalize treatment, and optimize rehabilitation through predictive analytics, robotic systems, and brain-computer interfaces, improving outcomes for patients. This systematic review examines how AI and ML systems influence diagnosis and treatment in neurorehabilitation among neurological disorders. Materials and Methods: Studies were identified from an online search of PubMed, Web of Science, and Scopus databases with a search time range from 2014 to 2024. This review has been registered on Open OSF (n) EH9PT. Results: Recent advancements in AI and ML are revolutionizing motor rehabilitation and diagnosis for conditions like stroke, SCI, and PD, offering new opportunities for personalized care and improved outcomes. These technologies enhance clinical assessments, therapy personalization, and remote monitoring, providing more precise interventions and better long-term management. Conclusions: AI is revolutionizing neurorehabilitation, offering personalized, data-driven treatments that enhance recovery in neurological disorders. Future efforts should focus on large-scale validation, ethical considerations, and expanding access to advanced, home-based care. Full article

Background/Objectives: Physical rehabilitation based on neurofunctional exercises can have a positive impact on restoring functionality and enhancing the quality of life of these individuals. Therefore, the purpose of this study is to analyze the effects of rehabilitation, including neurofunctional exercises, on the functional status of stroke patients. Methods: The cohort study design included 102 male and female participants: 51 patients underwent physiotherapy rehabilitation including neurofunctional exercises (SG), while the other 51 did not follow a rehabilitation program based on neurofunctional exercises (CG). The participants were assessed twice: once during their stay in the early neurology department after the first stroke, and again six months later. The assessments were conducted using the Barthel Scale (BS), the Rankin Scale (RS), and the National Institutes of Health Stroke Scale (NIHSS). Results: Baseline comparisons revealed significantly greater BS (p = 0.001) in the CG compared to the SG. Conversely, the SG had a significantly higher NIHSS than the CG at baseline (p = 0.001), as well as higher RS (p < 0.001). Within the SG, there were significant increases in BS (p < 0.001), while no significant differences were found between baseline and post 6 months in RS (p = 0.537) and NIHSS (p = 0.475). Regarding the CG, significant increases were observed in BS (p = 0.005) and NIHSS (p < 0.001), while no significant differences were found in RS (p = 0.335). Conclusions: In conclusion, this study reveals that incorporating neurofunctional exercises does not appear to play a significant role in the patients’ progress. The controlled group, engaged in home-based activities, showed greater improvements in their condition. Full article

Stroke often causes neuromotor disabilities, impacting index finger function in daily activities. Due to the role of repetitive, even passive, finger movements in neuromuscular re-education and spasticity control, this study aims to design a rehabilitation exoskeleton based on the pulp pinch movement. The exoskeleton uses an underactuated RML topology with a single degree of mobility, customized from 3D scans of the patient’s hand. It consists of eight links, incorporating two consecutive four-bar mechanisms and the third inversion of a crank–slider. A two-stage genetic optimization was applied, first to the location of the intermediate joint between the two four-bar mechanisms and later to the remaining dimensions. A targeted genetic optimization process monitored two quality metrics: average mechanical advantage from extension to flexion, and its variability. By analyzing the relationship between these metrics and key parameters at different synthesis stages, the population evaluated is reduced by up to 96.2%, compared to previous studies for the same problem. This custom-fit exoskeleton uses a small linear actuator to deliver a stable 12.45 N force to the fingertip with near-constant mechanical advantage during flexion. It enables repetitive pulp pinch movements in a flaccid finger, improving rehabilitation consistency and facilitating home-based therapy. Full article

Background/Objectives: Finding innovative digital solutions is fundamental to ensure prompt and continuous care for patients with chronic neurological disorders, whose demand for rehabilitation also in home-based settings is steadily increasing. The aim is to verify the safety and the effectiveness of two telerehabilitation (TR) models in improving recovery from subacute upper limb (UL) disability after stroke, with and without a robotic device. Methods: One hundred nineteen subjects with subacute post-stroke UL disability were assessed for eligibility. Of them, 30 patients were enrolled in the study and randomly assigned to either the Robotic Group (RG), undergoing a 20-session TR program, using a robotic device, or the Non-Robotic Group (NRG), undergoing a 20-session TR program without robotics. Clinical evaluations were measured at baseline (T0) and post-intervention (T1, 5 weeks after baseline), and included assessments of quality of life, motor skills, and clinical/functional status. The primary outcome measure was the World Health Organization Disability Assessment Schedule 2.0, evaluating the change in perceived disability. Results: Statistical analysis shows that patients of both groups improved significantly over time in all domains analyzed (mean decrease from baseline in the WHODAS 2.0 of 6.09 ± 2.62% for the NRG, and of 0.76 ± 2.21% for the RG), with a greater improvement of patients in the NRG in motor (Fugl-Meyer Assessment Upper Extremity—motor function, Box and Block Test) and cognitive skills (Trail Making Test-A). Conclusions: This study highlights the potential of TR programs to transform stroke rehabilitation by enhancing accessibility and patient-centered care, promoting autonomy, improving adherence, and leading to better outcomes and quality of life for stroke survivors. Full article

Stroke causes disability and significantly affects patient quality of life. Post-stroke rehabilitation of upper limb function is crucial, as it affects daily activities and individual autonomy. Traditional rehabilitation methods often require frequent visits to specialized centers, which can be costly and challenging. This study investigated the effectiveness of a home-based self-training device, “Kenko Yusuri”, in improving upper limb function in patients with chronic stroke. This multicenter prospective intervention study used a quasi-randomized controlled trial design. Ninety-three outpatients from five hospitals in Japan were enrolled and assigned to either the intervention group which used the “Kenko Yusuri” device or the control group which underwent conventional rehabilitation. All patients received botulinum toxin type A (BoNT-A) injections to treat upper limb spasticity. The primary outcome measure was the Fugl–Meyer Assessment (FMA) of upper-extremity motor function. Secondary outcomes included the modified Ashworth scale (MAS) score, range of motion (ROM), and chronic pain assessments. The intervention group demonstrated significantly greater improvements in FMA total scores than the control group. Patients with moderate impairment experienced the greatest benefits from the intervention. There were no significant between-group differences in MAS scores or ROM measurements. Pain and wrist ROM showed improvement in the intervention group. Home-based training with a shaking device significantly improved upper limb function in patients with moderate chronic post-stroke paralysis. This approach aligns with the principles of use-dependent plasticity and offers a feasible and cost-effective alternative to traditional rehabilitation methods. Full article