A META-ANALYSIS AND SYSTEMATIC REVIEW OF THE EFFECTIVENESS OF PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION IN THE STROKE POPULATION
Sonali Aggarwal, PT, DPT,1 Yasser Salem, PT, MS, PhD, NCS, PCS,2 Howe Liu, PT, MD, PhD,1 Ana Mendez, PT, DPT,1 Myles Quiben, PT, PhD, DPT, NCS, GCS1
1Department of Physical Therapy, University of North Texas Health Science Center; Fort Worth, Texas; 2Physical Therapy Program, Hofstra University; Hempstead, New York
Background and Purpose: Cerebrovascular accident (CVA) is the second leading cause of mortality and third for disability worldwide. Proprioceptive neuromuscular facilitation (PNF) has been utilized in treating patients post-stroke for many decades. The purpose of this systematic review and meta-analysis was to evaluate the effectiveness of PNF treatment on individuals post-stroke.
Methods: An electronic database search (PubMed, CINAHL, PEDro, and Scopus) was completed in May 2020 with keywords "proprioceptive neuromuscular facilitation" and "stroke." Randomized control trials (RCTs) included adults 18 years and older after CVA, PNF as the main intervention, and English availability. The search was complemented with hand search of reference lists from articles for additional relevant articles. Meta-analysis eligibility depended on a minimum of 3 data sets of pre-/posttest statistics per outcome measure. Forest plots and effect sizes were chosen.
Results: Initial search produced 172 articles. Seventeen RCTs were obtained after screening. In total, 656 subjects (aged 32-82) with mean age of 52.5 to 70.6 (+/-3.0-10.5) were included. Intervention parameters were 10 to 60 minutes/session, 1 to 6 times/week for 1 to 6 weeks in duration. Meta-analysis showed, with 9 studies (n = 243), significant improvements in Functional Reach and Berg Balance Scale; but not in Timed Up and Go, Trunk Impairment Scale, Walking Speed, and Performance-Oriented Mobility Assessment (POMA).
Discussion and Conclusions: PNF intervention may be effective for addressing balance, but is not definite for physical function recovery in the stroke population. Variability was noted in study designs. The overall number of studies was low with the majority having small sample sizes, which impacts validity generalizing the results to all patients post-stroke.
INFLUENCE OF AFFECTIVE DISORDERS ON ACTIVITY LIMITATIONS, AND QUALITY OF LIFE IN CHRONIC STROKE SURVIVORS IN BENIN: A CROSS-SECTIONAL STUDY
Orthelo Leonel Gbetoho Atigossou,1,2 Fatimata Ouedrago,1 Aristide S. Honado,2 Etienne Alagnide,1,3 Toussaint Godonou Kpadonou,1,3 Charles Sebiyo Batcho4
1Universite d'Abomey Calavi, Benin, Faculte des Sciences de la Sante, Ecole Superieure de Kinesitherapie; 2Centre Hospitalier Universitaire Departemental Oueme-Plateau, Benin, Service de Reeducation; 3Centre National Hospitalier Universitaire Hubert Koutoukou MAGA, Benin, Service de Medecine Physique et Readaptation; 4Laval University-CIRRIS, Center for Interdisciplinary Research in Rehabilitation and Social Integration CIRRIS, Quebec, Canada
Background and Purpose: About two-thirds of stroke survivors continue to suffer from sensorimotor impairments affecting their daily activities, even 6 months after stroke onset. This has many consequences such as poor quality of life (QoL), activity limitations, depression, or anxiety. For efficient management of rehabilitation toward better social reintegration of stroke survivors in developing countries, it appears important to understand how affective disorders influence activity limitations and QoL. Therefore, we aimed to evaluate how depression and anxiety influence activity limitations and QoL of stroke survivors in Benin.
Methods: One hundred and seventy-six chronic stroke survivors [113 males; mean age (+/-SD): 56.47 +/- 10.46 years] were recruited. We used the Barthel Index (BI) to assess activity limitations. Participants were screened for depression and anxiety symptoms using the Hamilton Depression and Anxiety Rating Scales (HDRS and HARS). QoL was assessed by Euroqol-5 Dimensions. Multiple linear regressions were performed to determine influence of depression and anxiety on activity limitations and QoL of stroke survivors.
Results: Moderate depression (19.9%) and severe depression (11.9%) were reported; 46% of participants presented a major anxiety. Depression/anxiety ([beta] <= -0.35; P < 0.0001, R2 = 0.60) were associated with activity limitations and also with QoL ([beta] <= -0.28; P < 0.0001; R2 >= 0.40).
Discussion and Conclusions: Significant proportions of the variances in BI and QoL scores were explained by HDRS and HARS scores, suggesting that depression and anxiety influence activity and QoL in Beninese stroke survivors. Our results confirm that the poststroke psychological consequences tend to reduce the QoL and functional status of stroke survivors.
EFFECT OF BRAIN-COMPUTER INTERFACE TRAINING BASED ON NON-INVASIVE ELECTROENCEPHALOGRAPHY USING MOTOR IMAGERY ON FUNCTIONAL RECOVERY AFTER STROKE-A SYSTEMATIC REVIEW AND META-ANALYSIS
Antje Kruse, MSc,1,2 Zorica Suica, MSc,3 Jan Taeymans, PhD,1,4 Corina Schuster-Amft, PhD3,5,6
1Department of Health Professions, Bern University Applied Science, Schwarztorstrasse 48, 3007 Bern, Switzerland; 2Private Practice, Baslerstrasse 60, 4102 Binningen, Switzerland; 3Research Department, Reha Rheinfelden, Salinenstrasse 98, 4310 Rheinfelden, Switzerland; 4Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussels, Belgium; 5Department of Engineering and Information Technology, Pestalozzistrasse 20, 3401 Burgdorf, Switzerland; 6Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052 Basel, Switzerland
Background and Purpose: Training with brain-computer interface (BCI) technology in the rehabilitation of patients after a stroke (PaS) is rapidly developing. We aimed to summarize effects of BCI trainings (BCIT) on PaS recovery.
Methods: Medline, IEEE Xplore Digital Library, Cochrane library, and Embase (July 2018 to March 2019) were systematically searched. RCTs or controlled clinical trials were identified. Data were meta-analyzed (random-effects model) and key parameter calculated: (1) standardized mean difference (SMD, 95% CI), (2) 95% prediction interval (95% PI), and (3) meta-regression to evaluate the effects of covariates on the pooled effect size.
Results: Fourteen studies (362 PaS [cortical, subcortical], 121 females; age 53.0 +/- 5.8; time since stroke onset 15.7 +/- 18.2 months) were included. The Fugl-Meyer Assessment was used as main outcome measure. BCI training compared to conventional therapy alone in PaS was effective with an SMD of 0.39 (95% CI: 0.17 to 0.62; 95% PI of 0.13 to 0.66) for motor function recovery upper extremity and an SMD of 0.41 (95% CI: -0.29 to 1.12) for motor function recovery lower extremity were found. BCI training enhanced brain function recovery with an SMD of 1.11 (95% CI: 0.64 to 1.59; 95% PI of 0.33 to 1.89). Covariates (training duration, impairment level upper extremity, and combination of both) did not show significant effects.
Discussion and Conclusions: BCIT added to conventional therapy may enhance motor functioning (upper extremity, brain function recovery) in PaS. We recommend motor imagery ability evaluation of included patients and assessment of brain function recovery (neuropsychological aspects). Influencing factors on motor recovery due to BCI technology might consider age, lesion type and location, quality of motor imagery ability, and neuropsychological aspects.
UNILATERAL SPATIAL NEGLECT REHABILITATION POST-STROKE: CURRENT TREATMENT OPTIONS, PRACTICE AND KNOWLEDGE OF PHYSIOTHERAPISTS
Umeonwuka Ifeanyi Chuka, PhD,1 Ronel Roos, PhD; Veronica Ntsiea, PhD,1
1Department of Physiotherapy, Faculty of Health Sciences, University of Witwatersrand, Johannesburg
Background and Purpose: Unilateral spatial neglect (USN) is a leading cause of disability and handicap in stroke survivors. Therapists' knowledge and practice in poststroke USN are key to rehabilitation success. This study explored current treatment for patients with poststroke USN and evaluated physiotherapists' knowledge and practice of USN.
Methods: A scoping review was conducted to explore current poststroke USN treatment approaches. A 3-step search strategy using the Johanna Briggs Institute's guidelines was undertaken. PubMed, CINAHL, Cochrane, SCOPUS, PROSPERO, JBI, and Google Scholar databases were searched. An online based cross-sectional study (N = 94) was also undertaken among Nigerian physiotherapists and data were analyzed using STATA 19.
Results: Three Hundred and eleven articles were screened; 86 articles were critically appraised, with 83 articles included in the final review. Intervention for USN varied widely, with the 2 most common being combination therapy and prism adaptation therapy. Knowledge on USN was 14.23 +/- 3.61 and 7.45% of responding physiotherapists demonstrated good knowledge of USN. Significant associations between USN knowledge and physiotherapist's educational level (P = 0.009), postgraduate certification in neurology (P = 0.002) were found. Significant positive correlation was observed between duration of practice (r = 0.22; P = 0.04), age (r = 0.21; P = 0.04) with USN knowledge. Constraint-induced movement therapy (71.3%, n = 67) and Albert test (18.1%, n=17) were the most common treatment and assessment for USN respectively.
Discussion and Conclusion: This study provides insight into the current interventions for poststroke unilateral spatial neglect. A plethora of intervention studies have been explored to ameliorate neglect symptoms post-stroke. Very few physiotherapists had good knowledge of USN.