NeuroRehabilitation OnLine: Description of a regional multidisciplinary group telerehabilitation innovation for stroke and neurological conditions using the Template for Intervention Description and Replication checklist.

Background: Providing recommended amounts of rehabilitation for stroke and neurological patients is challenging. Telerehabilitation is viable for delivering rehabilitation and an acceptable adjunct to in-person therapy. NeuroRehabilitation OnLine (NROL) was developed as a pilot and subsequently operationalised as a regional innovation embedded across four National Health Service (NHS) Trusts.

Biomarkers of Motor Outcomes After Stroke.

Predicting motor outcomes after stroke based on clinical judgment alone is often inaccurate and can lead to inefficient and inequitable allocation of rehabilitation resources. Prediction tools are being developed so that clinicians can make evidence-based, accurate, and reproducible prognoses for individual patients. Biomarkers of corticospinal tract structure and function can improve prediction tool performance, particularly for patients with initially moderate to severe motor impairment.

Implementation of neurological group-based telerehabilitation within existing healthcare during the COVID-19 pandemic: a mixed methods evaluation.

Background: There is a need to evaluate if and how telerehabilitation approaches might co-exist within healthcare in the long-term. Our aim was to implement and evaluate a multidisciplinary group-based telerehabilitation approach for people engaging in neurological rehabilitation.

Methods: NeuroRehabilitation OnLine (NROL) was adapted and implemented within an existing healthcare system as a programme of repeating six-week blocks.

Allied health professional research engagement and impact on healthcare performance: A systematic review protocol.

Background: Existing evidence suggests that clinician and organization engagement in research can improve healthcare processes of care and outcomes. However, current evidence has considered the relationship across all healthcare professions collectively. With the increase in allied health clinical academic and research activity, it is imperative for healthcare organizations, leaders and managers to understand engagement in research within these specific clinical fields.

Implementing the PREP2 Algorithm to Predict Upper Limb Recovery Potential After Stroke in Clinical Practice: A Qualitative Study.

Objective: Predicting motor recovery after stroke is a key factor when planning and providing rehabilitation for individual patients. The Predict REcovery Potential (PREP2) prediction tool was developed to help clinicians predict upper limb functional outcome. In parallel to further model validation, the purpose of this study was to explore how PREP2 was implemented in clinical practice within the Auckland District Health Board (ADHB) in New Zealand.

Neurochemical balance and inhibition at the subacute stage after stroke.

Stroke is a leading cause of death and disability worldwide with many people left with impaired motor function. Evidence from experimental animal models of stroke indicates that reducing motor cortex inhibition may facilitate neural plasticity and motor recovery. This study compared primary motor cortex (M1) inhibition measures over the first 12 wk after stroke with a cohort of age-similar healthy controls.

Determining the Functional Status of the Corticospinal Tract Within One Week of Stroke.

High interindividual variability in the recovery of upper limb (UL) function after stroke means it is difficult to predict an individual's potential for recovery based on clinical assessments alone. The functional integrity of the corticospinal tract is an important prognostic biomarker for recovery of UL function, particularly for those with severe initial UL impairment. This article presents a protocol for evaluating corticospinal tract function within 1 week of stroke.

PREP2 Algorithm Predictions Are Correct at 2 Years Poststroke for Most Patients.

The PREP2 algorithm combines clinical and neurophysiological measures to predict upper-limb (UL) motor outcomes 3 months poststroke, using 4 prediction categories based on Action Research Arm Test (ARAT) scores. The algorithm was accurate at 3 months for 75% of participants in a previous validation study. This study aimed to evaluate whether PREP2 predictions made at baseline are correct 2 years poststroke.

The Influence of Primary Motor Cortex Inhibition on Upper Limb Impairment and Function in Chronic Stroke: A Multimodal Study.

Background: Stroke is a leading cause of adult disability owing largely to motor impairment and loss of function. After stroke, there may be abnormalities in γ-aminobutyric acid (GABA)-mediated inhibitory function within primary motor cortex (M1), which may have implications for residual motor impairment and the potential for functional improvements at the chronic stage.

Objective: To quantify GABA neurotransmission and concentration within ipsilesional and contralesional M1 and determine if they relate to upper limb impairment and function at the chronic stage of stroke.

PREP2: A biomarker-based algorithm for predicting upper limb function after stroke.

Objective: Recovery of motor function is important for regaining independence after stroke, but difficult to predict for individual patients. Our aim was to develop an efficient, accurate, and accessible algorithm for use in clinical settings. Clinical, neurophysiological, and neuroimaging biomarkers of corticospinal integrity obtained within days of stroke were combined to predict likely upper limb motor outcomes 3 months after stroke.

Predicting Recovery Potential for Individual Stroke Patients Increases Rehabilitation Efficiency.

Background And Purpose: Several clinical measures and biomarkers are associated with motor recovery after stroke, but none are used to guide rehabilitation for individual patients. The objective of this study was to evaluate the implementation of upper limb predictions in stroke rehabilitation, by combining clinical measures and biomarkers using the Predict Recovery Potential (PREP) algorithm.

Methods: Predictions were provided for patients in the implementation group (n=110) and withheld from the comparison group (n=82).

Proportional Motor Recovery After Stroke: Implications for Trial Design.

Background And Purpose: Recovery of upper-limb motor impairment after first-ever ischemic stroke is proportional to the degree of initial impairment in patients with a functional corticospinal tract (CST). This study aimed to investigate whether proportional recovery occurs in a more clinically relevant sample including patients with intracerebral hemorrhage and previous stroke.

Methods: Patients with upper-limb weakness were assessed 3 days and 3 months poststroke with the Fugl-Meyer scale.

Kinematic measures of brain drawings are associated with illness perceptions in people with stroke.

Background: Previous research has shown that measuring the size and content of patients' drawings of their illness can reveal their perceptions and predict recovery. This study aimed to assess the usefulness of analyzing kinematic features of drawings.

Methods: A pilot observational study was conducted with 15 patients who had been hospitalized with a stroke 8 to 11 months previously.

Primed Physical Therapy Enhances Recovery of Upper Limb Function in Chronic Stroke Patients.

Background: Recovery of upper limb function is important for regaining independence after stroke.

Objective: To test the effects of priming upper limb physical therapy with intermittent theta burst stimulation (iTBS), a form of noninvasive brain stimulation.

Methods: Eighteen adults with first-ever chronic monohemispheric subcortical stroke participated in this randomized, controlled, triple-blinded trial.

Proportional recovery after stroke depends on corticomotor integrity.

Objective: For most patients, resolution of upper limb impairment during the first 6 months poststroke is 70% of the maximum possible. We sought to identify candidate mechanisms of this proportional recovery. We hypothesized that proportional resolution of upper limb impairment depends on ipsilesional corticomotor pathway function, is mirrored by proportional recovery of excitability in this pathway, and is unaffected by upper limb therapy dose.

Priming sensorimotor cortex to enhance task-specific training after subcortical stroke.

Objective: This double-blind sham-controlled crossover study investigated the interactions between primary sensory and motor cortex after stroke and their response to Theta Burst Stimulation (TBS).

Methods: Thirteen chronic subcortical stroke patients with upper limb impairment performed standardised dexterity training primed with ipsilesional M1 intermittent TBS (iTBSiM1), contralesional M1 continuous TBS (cTBScM1) or sham TBS. The effects on sensorimotor integration, corticomotor excitability, sensation and grip-lift kinetics were examined.

Promoting use-dependent plasticity with externally-paced training.

Objective: To evaluate use-dependent plasticity (UDP) before and after training under metronome-paced and self-paced conditions.

Methods: Twelve healthy adults were recruited to this cross-over, pseudo-randomized, repeated measures study. Participants performed wrist extension training that was either self-paced, or externally-paced to an auditory metronome at their preferred movement frequency or at a more demanding frequency.

Combining theta burst stimulation with training after subcortical stroke.

Background And Purpose: Repetitive transcranial magnetic stimulation of the primary motor cortex (M1) may improve outcomes after stroke. The aim of this study was to determine the effects of M1 theta burst stimulation (TBS) and standardized motor training on upper-limb function of patients with chronic stroke.

Methods: Ten patients with chronic subcortical stroke and upper-limb impairment were recruited to this double-blind, crossover, sham-controlled study.

Assessment of quality of life and participation within an outpatient rehabilitation setting.

Purpose: To evaluate the use of quality of life and participation measures in routine rehabilitation practice, determine the relationship between two scales and investigate their ability to evaluate change in a general outpatient population over a time of rehabilitation.

Methods: This cohort study consisted of 55 patients admitted consecutively to an outpatient rehabilitation centre. All participants completed the WHOQOL-BREF and the London Handicap Scale (LHS) at admission and discharge.

The effect of coordination mode on use-dependent plasticity.

Objective: To evaluate the role of coordination mode on the generation of use-dependent plasticity (UDP) within the primary motor cortex (M1).

Methods: Ten healthy volunteers performed brisk repetitive thumb movements for 30 min in the opposite direction to those evoked by transcranial magnetic stimulation (TMS) prior to training. This practice was synchronized or syncopated with a 1 Hz auditory metronome in two separate sessions.