Breaking News
February 18, 2019 - Researchers report progress in the treatment of aggressive brain tumors
February 18, 2019 - Scientists discover trigger that turns strep infections into devastating disease
February 18, 2019 - Scanning children’s teeth may predict future mental health issues
February 18, 2019 - Health Highlights: Feb. 14, 2019
February 18, 2019 - New knowledge could help predict and prevent depression
February 18, 2019 - More primary care physicians leads to longer life spans | News Center
February 18, 2019 - Patented IU discovery to treat ARDS has been optioned to Theratome Bio
February 18, 2019 - Male Y chromosomes not ‘genetic wastelands’
February 18, 2019 - Hormone therapy during gender transition may increase risk for cardiovascular events
February 18, 2019 - NICE renews accreditation for Advanced
February 18, 2019 - FDA Grants Orphan Drug Designation to Amplyx Pharmaceuticals for APX001 for Treatment of Cryptococcosis
February 18, 2019 - Molecule effective in killing tuberculosis bacteria
February 18, 2019 - Columbia researchers unravel why some glioblastomas respond to immunotherapy
February 18, 2019 - Men who are able to do ten push-ups are less likely to have a stroke
February 18, 2019 - Blood-brain barrier disruption could lead to age-related cognitive decline
February 18, 2019 - Combination of PARP inhibitor and immunotherapy results in tumor regression in SCLC mouse models
February 18, 2019 - Heavy smoking could lead to vision loss, study finds
February 18, 2019 - New diagnostic test for malaria uses spit, not blood
February 18, 2019 - New therapeutic molecules show promise in reversing memory loss related to depression, aging
February 18, 2019 - Darla Shine joins anti-vaccination campaigners
February 18, 2019 - New study outlines sex-specific issues in ischemic heart disease
February 18, 2019 - Drug combinations could become first-line treatment for metastatic kidney cancer
February 18, 2019 - Lifetime adversity, increased neural processing during trauma combine to intensify core PTSD symptoms
February 18, 2019 - HRQoL Scores Decrease With Treatment Line in Multiple Myeloma
February 18, 2019 - Convincing evidence that type 2 diabetes is a cause of erectile dysfunction
February 18, 2019 - Study offers implications of advanced age in evaluation, management of ischemic heart disease
February 18, 2019 - Children from homes with flame-retardant sofa have high SVOC concentration in their blood
February 18, 2019 - Art Institute of Chicago announces results of research on five terracotta sculptures
February 18, 2019 - New PET/CT tracer shows high detection rate for diagnosis of acute venous thromboembolism
February 18, 2019 - Smoking may blight immune response against melanoma and reduce survival
February 18, 2019 - How Inactivity and Junk Food Can Harm Your Brain
February 18, 2019 - Diabetes tops common conditions for frequent geriatric emergency patients
February 18, 2019 - Longer-lived sperm produces offspring with healthier lifespans
February 18, 2019 - New dental adhesive prevents tooth decay around orthodontic brackets
February 18, 2019 - New eHealth tool shows potential to improve quality of asthma care
February 18, 2019 - New Australian initiative helps emergency clinicians to improve patient care
February 17, 2019 - Apellis Pharmaceuticals’ APL-2 Receives Fast Track Designation from the FDA for the Treatment of Patients with Paroxysmal Nocturnal Hemoglobinuria
February 17, 2019 - Researchers identify faulty ‘brake’ that interferes with heart muscle’s ability to contract and relax
February 17, 2019 - Support from trusted adults can reduce risk of dying in suicidal teens, finds study
February 17, 2019 - Heart attack awareness improved since 2008
February 17, 2019 - Exercise gives a better brain boost to older men than women
February 17, 2019 - New research disproves previous assumptions of how looks influence personality
February 17, 2019 - Cannabis use as a teenager linked to depression later in life
February 17, 2019 - Sinks by Toilets in ICU Patient Rooms Harbor Harmful Bacteria
February 17, 2019 - Cancer cells’ plasticity makes them harder to stop
February 17, 2019 - Young cannabis users have increased risk of depression and suicidal behavior
February 17, 2019 - Tasmanian Devils Likely to Survive Cancer Scourge
February 17, 2019 - Neoadjuvant PD-1 blockade seems effective in glioblastoma
February 17, 2019 - Personal, social factors play role in enabling sustainable return to work after ill health
February 17, 2019 - Mouse studies show ‘inhibition’ theory of autism wrong
February 17, 2019 - Study shows how neuroactive steroids inhibit activity of pro-inflammatory proteins
February 17, 2019 - Use of liver grafts from older donors decreased despite better outcomes in recipients
February 17, 2019 - MUSC researchers discover new mechanism for a class of anti-cancer drugs
February 17, 2019 - HPV misconceptions are causing women to miss smear tests
February 17, 2019 - Sanofi and Regeneron Offer Praluent (alirocumab) at a New Reduced U.S. List Price
February 17, 2019 - Researchers say auditory testing can identify children for autism screening
February 17, 2019 - New method analyzes how single biological cells react to stressful situations
February 17, 2019 - WVU gynecologic oncologist investigates novel treatment for cervical and vaginal cancers
February 17, 2019 - ADHD diagnoses poorly documented
February 17, 2019 - Majority of gender minority youth do not identify with traditional sexual identity labels
February 17, 2019 - AbbVie, Teneobio enter into strategic transaction to develop potential treatment for multiple myeloma
February 17, 2019 - Lower Birth Weight May Up Risk for Psychiatric Disorders
February 17, 2019 - Scientists identify reversible molecular defect underlying rheumatoid arthritis
February 17, 2019 - Moffitt researchers shed light on how CAR T cells function mechanistically
February 16, 2019 - Female Anatomy May Play Big Role in Sperm’s Success
February 16, 2019 - BMI may mediate inverse link between fiber intake, knee OA
February 16, 2019 - Movement impairments in autism can be reversed through behavioral training
February 16, 2019 - Studies address racial disparities in postpartum period and cardiovascular health
February 16, 2019 - Scientists implicate hidden genes in the severity of autism symptoms
February 16, 2019 - Decreased deep sleep linked to early signs of Alzheimer’s disease
February 16, 2019 - Neuroscientists show how the brain responds to texture
February 16, 2019 - Gilead Announces Topline Data From Phase 3 STELLAR-4 Study of Selonsertib in Compensated Cirrhosis (F4) Due to Nonalcoholic Steatohepatitis (NASH)
February 16, 2019 - What Can I Do About Sweating? (for Teens)
February 16, 2019 - Companies navigate dementia conversations with older workers
February 16, 2019 - Newly developed stem cell technologies show promise for treating PD patients
February 16, 2019 - Collaborative material research could advance self-assembling nanomaterials
February 16, 2019 - Researchers take major step in creating technology that mimics the human brain
February 16, 2019 - Erasing memories associated with cocaine use reduces drug seeking behavior
February 16, 2019 - Artificial intelligence can accurately predict prognosis of ovarian cancer patients
February 16, 2019 - Racial disparities in cancer deaths on the decline for America
Experts provide insight into novel concepts and approaches for stroke rehabilitation

Experts provide insight into novel concepts and approaches for stroke rehabilitation

image_pdfDownload PDFimage_print

Stroke remains a leading cause of adult disability, and the global burden of stroke continues to grow with devastating consequences for patients, families, and caregivers. In this special issue of NeuroRehabilitation leading international experts on stroke rehabilitation provide theoretical and practical insights into the steps necessary to push beyond merely compensatory training and onto a level of recovery that is satisfactory for patients.

“Stroke rehabilitation is at a crossroads,” explains Guest Editor Richard Harvey, MD, Professor, Physical Medicine and Rehabilitation and Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, and Clinical Chair, Brain Innovation Center, Wesley and Suzanne Dixon Stroke Chair, The Shirley Ryan Ability Lab, Chicago, IL, USA. “This issue of NeuroRehabilitation explores novel concepts and approaches to the rehabilitation of stroke that will help point the direction for the next wave of neurorehabilitation research.”

A promising area of research is the use of biomarkers to predict motor recovery and outcomes after stroke. Cathy M. Stinear, PhD, of the Department of Medicine, University of Auckland, Auckland, New Zealand, and colleagues, consider how algorithms to predict motor recovery and outcomes after stroke might be implemented in clinical practice.

“Since 2011 there have been eight large randomized controlled trials of motor rehabilitation that recruited all participants within 30 days of stroke. However, none were able to detect a benefit of the tested intervention,” notes Dr. Stinear. “Using biomarkers to select and stratify patients in rehabilitation trials could increase the sensitivity of trials to intervention effects, which might be particularly important for detecting these effects against the background of recovery experienced by most patients during the initial days and weeks after stroke.”

Biomarkers of the functional and structural integrity of the corticomotor system can predict recovery from motor impairment and motor function outcomes in individual patients. There are two broad categories of motor system biomarkers that have received the most research attention to date: transcranial magnetic stimulation (TMS) and magnetic resonance imaging (MRI). Dr. Stinear and colleagues describe the accumulating evidence for the use of these motor system biomarkers during the initial days and weeks after stroke and then discusses the potential challenges and benefits of implementing these biomarkers in clinical practice using the PREP2 algorithm as an example.

The PREP2 algorithm combines clinical assessment with biomarkers in an algorithm to predict upper limb functional outcomes for individual patients. It is the first algorithm to be tested in clinical practice. It is the standard of care in two Auckland hospitals and is being rolled out in several other hospitals in New Zealand, North America, Singapore, and Europe. Other biomarker-based algorithms are likely to follow. The researchers describe several potential facilitators and barriers to implementing biomarkers in clinical practice, including characteristics of the algorithm, the clinical setting, and the clinicians themselves.

The researchers conclude that active, theoretically underpinned implementation strategies are needed to ensure that biomarkers are successfully used in clinical practice for predicting motor outcomes after stroke and should be considered in parallel with biomarker development.

“Implementing biomarkers in stroke rehabilitation practice has been shown to help patients leave hospital sooner, with no negative effects on their outcomes or wellbeing,” says Dr. Stinear. “Knowing what to expect for their recovery can also help patients and families adjust more readily to life after stroke. However, principled strategies for implementing biomarkers in clinical practice are needed to produce effective and sustainable improvements in clinical practice.”

Although therapies have improved in recent years, traditional rehabilitation still fails in patients with severe paralysis. Ander Ramos-Murguialday, PhD, MSc, of the Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany, and TECNALIA Research and Innovation, San Sebastián, Spain, and colleagues, review brain-machine interfaces (BMIs) that have emerged as a promising tool to guide motor rehabilitation interventions and promote recovery because they can be applied to patients with no residual movement. A BMI is a system that records, decodes, and ultimately translates brain signals into an effector action or behavior, without necessarily involving the motor system.

The researchers reviewed a total of 13 studies. Following a pilot study in 2008, the first double-blinded controlled clinical trial using a BMI for completely paralyzed stroke patients was published in 2013. The experimental group showed significant motor learning. Subsequent studies confirmed these positive results. The duration of the interventions ranged from one to eight weeks and each session lasted between 30 and 90 minutes. Twelve out of the studies targeted the upper limb, while only one focused on the lower limb. All the studies reported improvements of motor function in the experimental group after the use of the BMI. Six studies demonstrated higher improvements in the intervention group than in the control group. Only two of the studies reported no improvements at all in the control group.

Although significant, Dr. Ramos-Murguialday and colleagues conclude that functional motor recovery achieved with novel BMI technology remains modest. “Motor rehabilitation based on BMIs is still in a preliminary stage, and further improvements are required to boost its efficacy,” comments Dr. Ramos-Murguialday. “Invasive and hybrid approaches are promising and might set the stage for the next generation of stroke rehabilitation therapies.”

“As we stand at this crossroad, the direction we need to take is becoming clearer,” concludes Dr. Harvey. “Be open to new approaches to care beyond task-oriented training. Utilize new technology to extend therapeutic approaches beyond the mat, treadmill, and hi-lo table. Critique new research based on whether it suggests just another form of compensatory training versus expansion of functional capacity. Consider the incorporation of biomarkers into clinical research and bedside care. We know where we need to go. I hope we can successfully negotiate the pathways that push beyond merely 70% recovery.”

Tagged with:

About author

Related Articles