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Post-stroke Rehabilitation: Challenges and New Perspectives
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Post-stroke Rehabilitation: Challenges and New Perspectives

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Rehabilitation".

Deadline for manuscript submissions: closed (18 December 2023) | Viewed by 23006

Special Issue Editors

Dr. Floriana Pichiorri

E-Mail Website
Guest Editor
Fondazione Santa Lucia, IRCCS Via Ardeatina, Roma, Italy
Interests: clinical neurophysiology; electroencephalography; brain-computer interfaces; stroke rehabilitation; neurorehabilitation; motor system
Special Issues, Collections and Topics in MDPI journals
Dr. Giovanni Morone

E-Mail Website
Guest Editor
Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
Interests: functional recovery; robot-sassited training; robotic training; neurorehabilitation; virtual reality; motor-cognitive recovery; stroke rehabilitation; serious game therapy
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Stroke is a leading cause of disability worldwide. Despite the advancements in the acute treatment and care, the role of rehabilitation is still pivotal to reduce the burden of patients, care-givers and society. In the last two decades, stroke rehabilitation has revealed itself as a multidisciplinary field as novel approaches have been proposed employing non-invasive brain stimulation, robotics, virtual reality, brain–machine interfaces, and other highly technology-based systems. Some of those have currently reached a sufficient level of evidence to be included in international guidelines. Moreover, the pandemic years have highlighted the need to consider home-based approaches via tele-rehabilitation. All in all, this technological invasion has promoted an improvement in the methods of outcome assessment and definition of outcome predictors, which capitalize on the technological and neuroscientific advancements derived from such a plethora of studies. Furthermore, despite these tangible advances in rehabilitation technology, there is enormous work to be done in terms of translationality to improve current clinical practice in stroke rehabilitation. The scope of this Special Issue is to provide an overview of the recent advancements, challenges, and perspectives on stroke rehabilitation (both motor and cognitive) and novel means of outcome assessment and prediction. Researchers in this field are invited to submit original articles or reviews.

Dr. Floriana Pichiorri
Dr. Giovanni Morone
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. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly 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 2600 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 sequelae
  • neurorehabilitation
  • robotics
  • virtual reality
  • non-invasive brain stimulation
  • brain–computer interface
  • tele-rehabilitation
  • motor impariment
  • cognitive impairment

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Published Papers (7 papers)

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Editorial

Jump to: Research, Review, Other

3 pages, 176 KiB  
Editorial
Post-Stroke Rehabilitation: Challenges and New Perspectives
by Giovanni Morone and Floriana Pichiorri
J. Clin. Med. 2023, 12(2), 550; https://doi.org/10.3390/jcm12020550 - 10 Jan 2023
Cited by 11 | Viewed by 2761
Abstract
A stroke is determined by insufficient blood supply to the brain due to vessel occlusion (ischemic stroke) or rupture (hemorrhagic stroke), resulting in immediate neurological impairment to differing degrees [...] Full article
(This article belongs to the Special Issue Post-stroke Rehabilitation: Challenges and New Perspectives)

Research

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20 pages, 2733 KiB  
Article
Building Bridges between People with Stroke, Families, and Health Professionals: Development of a Blended Care Program for Self-Management
by Carla Mendes Pereira, Mara Matos, Daniel Carvalho, Patricia Macedo, José M. Calheiros, Janice Alves, Luís Paulino Ferreira, Teresa L. Dias, Rui Neves Madeira and Fiona Jones
J. Clin. Med. 2024, 13(1), 300; https://doi.org/10.3390/jcm13010300 - 4 Jan 2024
Viewed by 2233
Abstract
Evidence-informed interventions for stroke self-management support can influence functional capability and social participation. People with stroke should be offered self-management support after hospital discharge. However, in Portugal, there are no known programs of this nature. This study aimed to develop a person-centered and [...] Read more.
Evidence-informed interventions for stroke self-management support can influence functional capability and social participation. People with stroke should be offered self-management support after hospital discharge. However, in Portugal, there are no known programs of this nature. This study aimed to develop a person-centered and tailored blended care program for post-stroke self-management, taking into account the existing evidence-informed interventions and the perspectives of Portuguese people with stroke, caregivers, and health professionals. An exploratory sequential mixed methods approach was used, including qualitative methods during stakeholder consultation (stage 1) and co-production (stage 2) and quantitative assessment during prototyping (stage 3). After ethical approval, recruitment occurred in three health units. Results from a literature search led to the adaptation of the Bridges Stroke Self-Management Program. In stage one, 47 participants were interviewed, with two themes emerging: (i) Personalized support and (ii) Building Bridges through small steps. In stage two, the ComVida program was developed, combining in-person and digital approaches, supported by a workbook and a mobile app. In stage three, 56 participants evaluated prototypes, demonstrating a strong level of quality. Understandability and actionability of the developed tools obtained high scores (91–100%). The app also showed good usability (A-grade) and high levels of recommendation (5 stars). Full article
(This article belongs to the Special Issue Post-stroke Rehabilitation: Challenges and New Perspectives)
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16 pages, 1418 KiB  
Article
Physical Activity, Psychological and Functional Outcomes in Non-Ambulatory Stroke Patients during Rehabilitation—A Pilot Study
by Marcin Błaszcz, Nina Prucnal, Krzysztof Wrześniewski, Szymon Pasiut, Piotr Mika, Małgorzata Kucia, Beata Stach, Marcin Woźniak and Elżbieta Mirek
J. Clin. Med. 2022, 11(24), 7260; https://doi.org/10.3390/jcm11247260 - 7 Dec 2022
Cited by 6 | Viewed by 2972
Abstract
Despite the extensive literature on stroke rehabilitation, there are few studies that comprehensively show non-ambulatory stroke patients. The aim of the study was to explore the dynamics of the change in physical activity (PA), psychological and functional outcomes, and the correlation between them [...] Read more.
Despite the extensive literature on stroke rehabilitation, there are few studies that comprehensively show non-ambulatory stroke patients. The aim of the study was to explore the dynamics of the change in physical activity (PA), psychological and functional outcomes, and the correlation between them in non-ambulatory patients during early in-patient post-stroke rehabilitation. Measurements were taken on 21 participants at the beginning of and 6 weeks post-conventional rehabilitation with the Barthel Index (BI), Berg Balance Scale (BBS), Trunk Control Test (TCT), Stroke Impact Scale (SIS), General Self-Efficacy Scale, Stroke Self-Efficacy Questionnaire (SSEQ), the original scale of belief in own impact on recovery (BiOIoR), Hospital Anxiety and Depression Scale, Acceptance of Illness Scale and when the patient could walk—Time Up & Go and 6 Minute Walk Test. Daily PA was assessed over 6 weeks using a Caltrac accelerometer. Only outcomes for BI, BBS, TCT, SIS, and SSEQ significantly improved 6 weeks post-rehabilitation. PA energy expenditure per day significantly increased over time (p < 0.001; effect size = 0.494), but PA only increased significantly up to the third week. PA change was correlated with BiOIoR post-treatment. Self-efficacy in self-management mediated improvement in SIS. The BiOIoR and confidence in self-management could be important factors in the rehabilitation process. Full article
(This article belongs to the Special Issue Post-stroke Rehabilitation: Challenges and New Perspectives)
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10 pages, 1116 KiB  
Article
Effects of Combination of Functional Electric Stimulation and Robotic Leg Movement Using Dynamic Tilt Table on Walking Characteristics in Post-Stroke Patients with Spastic Hemiplegia: A Randomized Crossover-Controlled Trial
by Koki Ueda, Yasunori Umemoto, Yoshi-ichiro Kamijo, Yuta Sakurai, Shohei Araki, Masato Ise, Izumi Yoshioka, Motohiko Banno, Satoshi Mochida, Takaya Iwahashi, Toshio Shimokawa, Yukihide Nishimura and Fumihiro Tajima
J. Clin. Med. 2022, 11(23), 6911; https://doi.org/10.3390/jcm11236911 - 23 Nov 2022
Cited by 3 | Viewed by 2095
Abstract
Background: Spastic hemiplegia causes slow and unstable walking in post-stroke patients. Dynamic tilt table with robotic leg movement (DTTRLM) is safe and effective in improving walking. Functional electric stimulation (FES) improves walking speed in post-stroke patients with spastic hemiplegia. The aim of this [...] Read more.
Background: Spastic hemiplegia causes slow and unstable walking in post-stroke patients. Dynamic tilt table with robotic leg movement (DTTRLM) is safe and effective in improving walking. Functional electric stimulation (FES) improves walking speed in post-stroke patients with spastic hemiplegia. The aim of this study was to determine the effects of combined DTTRLM + FES on walking speed compared with DTTRLM alone. Methods: Twenty post-stroke patients were randomly assigned to receive either a single session of stepping + FES treatment or a single session of stepping alone treatment. After a one-week washout period, the same two groups underwent a single session of the other treatment, and the same measurements were taken. We measured walking speed, cadence, and the number of steps in a 10 m walking test (10MWT) and assessed Modified Ashworth Scale (MAS), Fugl–Meyer Assessment (FMA), and range of motion (ROM) before and after the intervention. Results: Stepping + FES significantly improved walking speed, number of steps, and ankle inversion ROM, compared with stepping alone. Adverse events were not observed in any subject. Conclusions: Robotic stepping therapy combined with FES significantly improved 10 m walking speed (10MWS) compared with stepping only in patients with post-stroke and spastic hemiplegia. Further studies are needed to determine the long-term effects of the combination treatment. Full article
(This article belongs to the Special Issue Post-stroke Rehabilitation: Challenges and New Perspectives)
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Review

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22 pages, 862 KiB  
Review
Post-Stroke Rehabilitation of Distal Upper Limb with New Perspective Technologies: Virtual Reality and Repetitive Transcranial Magnetic Stimulation—A Mini Review
by Onika Banduni, Megha Saini, Neha Singh, Debasish Nath, S. Senthil Kumaran, Nand Kumar, M. V. Padma Srivastava and Amit Mehndiratta
J. Clin. Med. 2023, 12(8), 2944; https://doi.org/10.3390/jcm12082944 - 18 Apr 2023
Cited by 3 | Viewed by 3547
Abstract
Upper extremity motor impairment is the most common sequelae in patients with stroke. Moreover, its continual nature limits the optimal functioning of patients in the activities of daily living. Because of the intrinsic limitations in the conventional form of rehabilitation, the rehabilitation applications [...] Read more.
Upper extremity motor impairment is the most common sequelae in patients with stroke. Moreover, its continual nature limits the optimal functioning of patients in the activities of daily living. Because of the intrinsic limitations in the conventional form of rehabilitation, the rehabilitation applications have been expanded to technology-driven solutions, such as Virtual Reality and Repetitive Transcranial Magnetic Stimulation (rTMS). The motor relearning processes are influenced by variables, such as task specificity, motivation, and feedback provision, and a VR environment in the form of interactive games could provide novel and motivating customized training solutions for better post-stroke upper limb motor improvement. rTMS being a precise non-invasive brain stimulation method with good control of stimulation parameters, has the potential to facilitate neuroplasticity and hence a good recovery. Although several studies have discussed these forms of approaches and their underlying mechanisms, only a few of them have specifically summarized the synergistic applications of these paradigms. To bridge the gaps, this mini review presents recent research and focuses precisely on the applications of VR and rTMS in distal upper limb rehabilitation. It is anticipated that this article will provide a better representation of the role of VR and rTMS in distal joint upper limb rehabilitation in patients with stroke. Full article
(This article belongs to the Special Issue Post-stroke Rehabilitation: Challenges and New Perspectives)
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Other

22 pages, 3677 KiB  
Systematic Review
Effects of Immersive Virtual Reality on Upper-Extremity Stroke Rehabilitation: A Systematic Review with Meta-Analysis
by Pawel Kiper, Nathalie Godart, Manon Cavalier, Charlotte Berard, Błażej Cieślik, Sara Federico, Aleksandra Kiper, Leonardo Pellicciari and Roberto Meroni
J. Clin. Med. 2024, 13(1), 146; https://doi.org/10.3390/jcm13010146 - 27 Dec 2023
Cited by 7 | Viewed by 3717
Abstract
Virtual reality (VR) is an innovative rehabilitation tool increasingly used in stroke rehabilitation. Fully immersive VR is a type of VR that closely simulates real-life scenarios, providing a high level of immersion, and has shown promising results in improving rehabilitation functions. This study [...] Read more.
Virtual reality (VR) is an innovative rehabilitation tool increasingly used in stroke rehabilitation. Fully immersive VR is a type of VR that closely simulates real-life scenarios, providing a high level of immersion, and has shown promising results in improving rehabilitation functions. This study aimed to assess the effect of immersive VR-based therapy for stroke patients on the upper extremities, activities of daily living (ADLs), and pain reduction and its acceptability and side effects. For this review, we gathered all suitable randomized controlled trials from PubMed, EMBASE, Cochrane Library, Scopus, and Web of Science. Out of 1532, 10 articles were included, with 324 participants. The results show that immersive VR offers greater benefits in comparison with conventional rehabilitation, with significant improvements observed in ADLs (SMD 0.58, 95% CI 0.25 to 0.91, I2 = 0%, p = 0.0005), overall function as measured by the Fugl-Meyer Assessment (MD 6.33, 95% CI 4.15 to 8.50, I2 = 25%, p = 0.00001), and subscales for the shoulder (MD 4.96, 95% CI—1.90–8.03, I2 = 25%, p = 0.002), wrist (MD 2.41, 95% CI—0.56–4.26, I2 = 0%, p = 0.01), and hand (MD 2.60, 95% CI—0.70–4.5°, I2 = 0%, p = 0.007). These findings highlight the potential of immersive VR as a valuable therapeutic option for stroke survivors, enhancing their ADL performance and upper-limb function. The immersive nature of VR provides an engaging and immersive environment for rehabilitation. Full article
(This article belongs to the Special Issue Post-stroke Rehabilitation: Challenges and New Perspectives)
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12 pages, 296 KiB  
Perspective
Talking about Sexuality in Stroke Individuals: The New Era of Sexual Rehabilitation
by Marianna Contrada, Antonio Cerasa, Caterina Pucci, Irene Ciancarelli, Giovanni Pioggia, Paolo Tonin and Rocco Salvatore Calabrò
J. Clin. Med. 2023, 12(12), 3988; https://doi.org/10.3390/jcm12123988 - 12 Jun 2023
Cited by 4 | Viewed by 2704
Abstract
One of the largest causes of mortality and disability worldwide is stroke. In the last twenty years significant objectives have been achieved in the early and chronic treatment of motor and cognitive dysfunctions, increasing the quality of life in patients and their caregivers. [...] Read more.
One of the largest causes of mortality and disability worldwide is stroke. In the last twenty years significant objectives have been achieved in the early and chronic treatment of motor and cognitive dysfunctions, increasing the quality of life in patients and their caregivers. However, there is an unresolved clinical issue that remains: sexual dysfunctions. Multiple etiologies, including organic (such as lesion localization, premorbid medical problems, and drugs) and psychosocial (such as fear of recurrences, loss of self-esteem, role shifts, anxiety, and depression), are associated with sexual deficits. In this perspective review, we reported the last piece of evidence about this crucial topic which drastically affects the quality of life of these patients. Indeed, although patients may often not disclose their sexual concerns, literature demonstrates that they seek help concerning this issue. On the other side, clinicians working in the rehabilitation field are not always comfortable or prepared to deal with sexuality and sexual function in neurological patients. A new phase of the training course should be launched including different physicians, nurses, rehabilitation specialists, and social workers, to learn how to deal with topics related to sexuality. As a result, professional sexual counselors should now become a structured part of stroke settings and rehabilitation with new effective tools (i.e., PLISSIT model; TDF program) for improving quality of life. Full article
(This article belongs to the Special Issue Post-stroke Rehabilitation: Challenges and New Perspectives)
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