Discharge Communication and the Achievement of Lifestyle and Behavioral Changes Post-Stroke in the Transitions of Care Stroke Disparities Study.

This study identifies the association between patient perception of discharge education/resources and adequate transitions of care (ATOC) (i.e., patient achievement of at least 75% of recommended positive behaviors and activities within 30 days post-stroke hospitalization).

The association between social networks and functional recovery after stroke.

Background And Purpose: Social determinants of health (SDOH), including social networks, impact disability and quality of life post-stroke, yet the direct influence of SDOH on functional change remains undetermined. We aimed to identify which SDOH predict change on the modified Rankin Scale (mRS) within 90 days after stroke hospitalization.

Methods: Stroke patients from the Transitions of Care Stroke Disparities Study (TCSDS) were enrolled from 12 hospitals in the Florida Stroke Registry.

The effect of 30-day adequate transitions of acute stroke care on 90-day readmission or death.

Objectives: We explore patient-reported behaviors and activities within 30-days post-stroke hospitalization and their role in reducing death or readmissions within 90-days post-stroke.

Methods: We constructed the adequate transitions of care (ATOC) composite score, measuring patient-reported participation in eligible behaviors and activities (diet modification, weekly exercise, follow-up medical appointment attendance, medication adherence, therapy use, and toxic habit cessation) within 30 days post-stroke hospital discharge. We analyzed ATOC scores in ischemic and intracerebral hemorrhage stroke patients discharged from the hospital to home or rehabilitation facilities and enrolled in the NIH-funded Transitions of Care Stroke Disparities Study (TCSD-S).

A Novel, Wearable Inertial Measurement Unit for Stroke Survivors: Validity, Acceptability, and Usability.

Objective: To establish the concurrent validity, acceptability, and sensor optimization of a consumer-grade, wearable, multi-sensor system to capture quantity and quality metrics of mobility and upper limb movements in stroke survivors.

Design: Single-session, cross-sectional.

Setting: Clinical research laboratory.

Wearable Technology to Capture Arm Use of People With Stroke in Home and Community Settings: Feasibility and Early Insights on Motor Performance.

Objective: The objectives of this study were to establish the short-term feasibility and usability of wrist-worn wearable sensors for capturing the arm and hand activity of people with stroke and to explore the association between factors related to the use of the paretic arm and hand.

Methods: Thirty people with chronic stroke were monitored with wrist-worn wearable sensors for 12 hours per day for a 7-day period. Participants also completed standardized assessments to capture stroke severity, arm motor impairments, self-perceived arm use, and self-efficacy.

Validity and reliability of inertial measurement units for gait assessment within a post stroke population.

Background: The ability to objectively measure spatiotemporal metrics within individuals post-stroke is integral to plan appropriate intervention, track recovery, and ultimately improve efficacy of rehabilitation programs. Inertial measurement units (IMUs) provide a means to systematically collect gait-specific metrics that could not otherwise be obtained from clinical outcomes. However, the use of IMUs to measure spatiotemporal parameters in stroke survivors has yet to be validated.

Understanding preferences of stroke survivors for feedback provision about functional movement behavior from wearable sensors: a mixed-methods study.

Background: In stroke rehabilitation, wearable technology can be used as an intervention modality by providing timely, meaningful feedback on motor performance. Stroke survivors' preferences may offer a unique perspective on what metrics are intuitive, actionable, and meaningful to change behavior. However, few studies have identified feedback preferences from stroke survivors.

Wearable technology to capture arm use of stroke survivors in home and community settings: feasibility and early insights on motor performance.

Objective: To establish short-term feasibility and usability of wrist-worn wearable sensors to capture arm/hand activity of stroke survivors and to explore factors related to use of the paretic arm/hand.

Methods: 30 chronic stroke survivors were monitored with wrist-worn wearable sensors during 12h/day for a 7-day period. Participants also completed standardized assessments to capture stroke severity, arm motor impairments, self-perceived arm use and self-efficacy.

Quantifying intra- and interlimb use during unimanual and bimanual tasks in persons with hemiparesis post-stroke.

Background: Individuals with hemiparesis post-stroke often have difficulty with tasks requiring upper extremity (UE) intra- and interlimb use, yet methods to quantify both are limited.

Objective: To develop a quantitative yet sensitive method to identify distinct features of UE intra- and interlimb use during task performance.

Methods: Twenty adults post-stroke and 20 controls wore five inertial sensors (wrists, upper arms, sternum) during 12 seated UE tasks.

Ipsilesional arm training in severe stroke to improve functional independence (IPSI): phase II protocol.

Background: We previously characterized hemisphere-specific motor control deficits in the ipsilesional, less-impaired arm of unilaterally lesioned stroke survivors. Our preliminary data indicate these deficits are substantial and functionally limiting in patients with severe paresis.

Methods: We have designed an intervention ("IPSI") to remediate the hemisphere-specific deficits in the ipsilesional arm, using a virtual-reality platform, followed by manipulation training with a variety of real objects, designed to facilitate generalization and transfer to functional behaviors encountered in the natural environment.

mHealth technologies used to capture walking and arm use behavior in adult stroke survivors: a scoping review beyond measurement properties.

Purpose: We aimed to provide a critical review of measurement properties of mHealth technologies used for stroke survivors to measure the amount and intensity of functional skills, and to identify facilitators and barriers toward adoption in research and clinical practice.

Materials And Methods: Using Arksey and O'Malley's framework, two independent reviewers determined eligibility and performed data extraction. We conducted an online consultation survey exercise with 37 experts.

Comparing a Novel Neuroanimation Experience to Conventional Therapy for High-Dose Intensive Upper-Limb Training in Subacute Stroke: The SMARTS2 Randomized Trial.

Background: Evidence from animal studies suggests that greater reductions in poststroke motor impairment can be attained with significantly higher doses and intensities of therapy focused on movement quality. These studies also indicate a dose-timing interaction, with more pronounced effects if high-intensity therapy is delivered in the acute/subacute, rather than chronic, poststroke period.

Objective: To compare 2 approaches of delivering high-intensity, high-dose upper-limb therapy in patients with subacute stroke: a novel exploratory neuroanimation therapy (NAT) and modified conventional occupational therapy (COT).

User-Driven Functional Movement Training With a Wearable Hand Robot After Stroke.

We studied the performance of a robotic orthosis designed to assist the paretic hand after stroke. It is wearable and fully user-controlled, serving two possible roles: as a therapeutic tool that facilitates device-mediated hand exercises to recover neuromuscular function or as an assistive device for use in everyday activities to aid functional use of the hand. We present the clinical outcomes of a pilot study designed as a feasibility test for these hypotheses.

Gait Adaptation Using a Cable-Driven Active Leg Exoskeleton (C-ALEX) With Post-Stroke Participants.

Individuals with chronic hemiparesis post-stroke exhibit gait impairments that require functional rehabilitation through training. Exoskeletal robotic assistive devices can provide a user with continuous assistance but impose movement restrictions. There are currently devices that allow unrestricted movement but provide assistance only intermittently at specific points of the gait cycle.

Treadmill-Based Locomotor Training With Robotic Pelvic Assist and Visual Feedback: A Feasibility Study.

Background And Purpose: Gait asymmetries are common after stroke, and often persist despite conventional rehabilitation. Robots provide training at a greater practice frequency than conventional approaches. However, prior studies of have found the transfer of learned skills outside of the device to be inadequate.

Development of Sensor-Based Measures of Upper Extremity Interlimb Coordination.

The development of motor impairment after the onset of an injury such as stroke may result in long-term compensatory behaviors. Because compensation often evolves in ambient settings (outside the purview of monitoring clinicians), there is a need for quantitative tools capable of accurately detecting the subtleties of compensation and related reduction in interlimb coordination. Improvement in interlimb coordination may serve as a marker of recovery from stroke, and rehabilitation progress.

EMG pattern classification to control a hand orthosis for functional grasp assistance after stroke.

Wearable orthoses can function both as assistive devices, which allow the user to live independently, and as rehabilitation devices, which allow the user to regain use of an impaired limb. To be fully wearable, such devices must have intuitive controls, and to improve quality of life, the device should enable the user to perform Activities of Daily Living. In this context, we explore the feasibility of using electromyography (EMG) signals to control a wearable exotendon device to enable pick and place tasks.

Exploration of Two Training Paradigms Using Forced Induced Weight Shifting With the Tethered Pelvic Assist Device to Reduce Asymmetry in Individuals After Stroke: Case Reports.

Many robotic devices in rehabilitation incorporate an assist-as-needed haptic guidance paradigm to promote training. This error reduction model, while beneficial for skill acquisition, could be detrimental for long-term retention. Error augmentation (EA) models have been explored as alternatives.

Hand Robotic Therapy in Children with Hemiparesis: A Pilot Study.

Objective: The aim of this study was to understand the impact of training with a hand robotic device on hand paresis and function in a population of children with hemiparesis.

Methods: Twelve children with hemiparesis (mean age, 9 [SD, 3.64] years) completed participation in this prospective, experimental, pilot study.

Gait training with a robotic leg brace after stroke: a randomized controlled pilot study.

Objective: Robot-aided exercise therapy is a promising approach to enhance walking ability in stroke survivors. This study was designed to test a new robotic knee brace for restoring mobility in stroke survivors.

Design: Twenty-four ambulatory individuals with chronic hemiparesis after stroke were enrolled in this pilot study.

Three upper limb robotic devices for stroke rehabilitation: a review and clinical perspective.

Background: Stroke is a leading cause of disability worldwide. Many survivors of stroke remain with residual disabilities, even years later. Advances in technology have led to the development of a variety of robotic devices for use in rehabilitation.

Sexuality after stroke: patient counseling preferences.

Purpose: Sexual dysfunction is common after stroke, but is frequently not addressed by healthcare providers. The aim of this study was to examine patient preferences for counseling related to sexuality post-stroke.

Method: Two hundred and sixty-eight patients from a stroke registry were provided an anonymous paper or online survey.

Robot-aided gait training in an individual with chronic spinal cord injury: a case study.

Background And Purpose: Traditional physical therapy is beneficial in restoring mobility in individuals who have sustained spinal cord injury (SCI), but residual limitations often persist. Robotic technologies may offer opportunities for further gains. The purpose of this case study was to document the use and practicality of gait training for an individual with chronic, incomplete SCI with asymmetric lower limb motor deficits using a novel robotic knee orthosis (RKO).