Displaying One Session

e-Poster Discussion
Session Type
e-Poster Discussion
Room
Station 9 (E-Poster Area)
Date
07.11.2020, Saturday
Session Time
06:30 PM - 07:30 PM

RISK OF FALLING ON AN INPATIENT STROKE REHABILITATION UNIT: IS THE STROKE ASSESSMENT OF FALL RISK TOOL THE RIGHT ONE TO USE?

Session Type
e-Poster Discussion
Date
07.11.2020, Saturday
Session Time
06:30 PM - 07:30 PM
Room
Station 9 (E-Poster Area)
Lecture Time
06:30 PM - 06:35 PM

Abstract

Background And Aims

Falls in the inpatient stroke population are common, resulting in increased morbidity, and slow rehabilitation progress. Falls may result from stroke-specific neurologic deficits, however assessment of these is often lacking from fall screening tools. The aim of this study was to compare the Stroke Assessment of Fall Risk (SAFR) tool to a commonly-used Morse Fall Scale.

Methods

A prospective observational study was conducted in an inpatient stroke rehabilitation unit. Falls were captured by hospital Risk Incident Measures reports and medical records. The risk of falls was measured using both fall screening tools. We calculated sensitivity and specificity for predicting falls using a receiver operating characteristic (ROC) curve.

Results

Patients (N=220) with acute stroke were recruited. Forty-eight (21.8%) patients experienced fall with six having repeat falls. Using SAFR tool, there was a statistically significant difference in hemi-neglect between fallers and non-fallers (p=0.02). There was a trend towards more falls in hemorrhagic stroke (p=0.16) and those demonstrating impulsivity (p=0.17). Sensitivity and specificity of SAFR were 47.9% and 76.7%, vs 45.8% and 68.0% for the Morse Fall Scale, respectively. SAFR PPV and NPV were 36.5% and 84.1%, respectively, similar to the Morse Fall Scale (28.6% and 81.8%). The area under the ROC curve was 0.65 for SAFR, and 0.55 for Morse but was not statistically significant.

Conclusions

The SAFR tool predicted overall fall equally compared to the Morse Fall Scale but showed superior specificity. The SAFR neurologic-specific hemi-neglect component was an independent falls predictor, a component that is not present on the Morse Fall scale.

Trial Registration Number

Not applicable

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CONTINUOUS FUNCTIONAL IMPROVEMENT OF THE SPASTIC DROP FOOT UNDER REPETITIVE BOTULINUM TOXIN TYPE/A INJECTIONS

Session Type
e-Poster Discussion
Date
07.11.2020, Saturday
Session Time
06:30 PM - 07:30 PM
Room
Station 9 (E-Poster Area)
Lecture Time
06:35 PM - 06:40 PM

Abstract

Background And Aims

Injections of 500 to 1500 MU botulinum toxin/A (BoNT/A) into the calf muscles for the treatment of the spastic foot in hemiparetic patients effectively reduce muscle tone. The aim of the study was to analyze whether patients experience an increasing benefit with repeat injections every three months and which parameter correlates best with the patient's experience.

Methods

24 free-walking BoNT-naïve adult patients with chronic hemiparesis after stroke received 5 injections every three months of 800 U aboBoNT/A into the affected calf muscles. Patients assessed the treatment effect using a global assessment scale, physicians scored the muscle tone at the ankle joint, measured active and passive ranges of movement at the knee and ankle joint and determined the distance patients succeeded to walk during a minute.

Results

Patients reported a significantly (p<.01) increasing benefit with time. This benefit significantly correlated with all parameters measured. The best correlation (r=.927; p<.0001) was found with the sum of the active ranges of movement of knee and ankle joint. The outcome after one year of treatment was better and significantly correlated with the peak effect of the first injection. This correlation was higher for the passive (r=.855; p<.00001) compared to the active (r=.567; p<.009) ranges of movement.

Conclusions

BoNT/A treatment of the spastic foot in chronic hemiplegia should be performed regularly every three months and for at least one year, since patients experience an increasing benefit, and have to learn how to adapt to and use the new degree of freedom induced by the injections.

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THE DYNAMIC OF EXTRACELLULAR VESICLES IN SUBACUTE STROKE: RESULTS OF THE BIOMARKERS AND PERFUSION – TRAINING-INDUCED CHANGES AFTER STROKE (BAPTISE) STUDY

Session Type
e-Poster Discussion
Date
07.11.2020, Saturday
Session Time
06:30 PM - 07:30 PM
Room
Station 9 (E-Poster Area)
Lecture Time
06:40 PM - 06:45 PM

Abstract

Group Name

The abstract is presented by the Biomarkers and Perfusion - training-induced changes after stroke (BAPTISe) trial investigators.

Background And Aims

Objective: Medium-sized extracellular vesicles (MV), a subgroup of extracellular vesicles, have been shown to be associated with stroke severity and long-term cardiovascular risk after ischemic stroke. However, the dynamics of MV after stroke have not been investigated yet.

Methods

Methods: We analysed blood samples of 110 patients with subacute ischemic stroke (day 5-45 post stroke) enrolled in the BAPTISe-trial, a sub-cohort of the randomized-controlled PHYS-STROKE trial. In PHYS-STROKE, patients received a four-week aerobic physical fitness training or relaxation sessions. We assessed levels of endothelial (EMV: AnnexinV+,CD45-,CD41-,CD31+/CD144+/CD146+), leukocyte-derived (LMV: AnnexinV+,CD45+,CD41-), monocytic (MMV: AnnexinV+,CD41-,CD14+), neural (NMV: AnnexinV+,CD41-,CD45-,CD144-,CD56+/CD171+/CD271+), and platelet-derived (PMV: AnnexinV+, CD41+) MV via flow cytometry before and after intervention. Associations were analysed using multivariate linear regression analyses.

Results

Results: At baseline and at follow-up, the largest population of MV were PMV with a log-transformed absolute count/ml (LTAC) of at baseline. Other LTACs were for NMV, for MMV, for LMV, and for EMV, demonstrating a significant between-groups difference (p<0.001). Levels of MV were not significantly different after the 4-week intervention. In multivariate regression analyses, a higher Barthel-Index at baseline, indicating a higher functional status, was associated with higher NMV levels and lower MMV levels (p<0.01).

Conclusions

Conclusion: This is the first report demonstrating the sustained presence of multiple types of MV, including neural MV, in serial blood samples of subacute stroke patients. Results on the functional outcome will be presented at the conference.

Trial Registration Number

NCT01954797

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HOW AND WHAT SPEECH AND LANGUAGE THERAPY (SLT) SHOULD BE PROVIDED FOR PEOPLE WITH APHASIA AFTER STROKE; THE RELEASE INDIVIDUAL PARTICIPANT DATA (IPD) NETWORK META-ANALYSES

Session Type
e-Poster Discussion
Date
07.11.2020, Saturday
Session Time
06:30 PM - 07:30 PM
Room
Station 9 (E-Poster Area)
Lecture Time
06:45 PM - 06:50 PM

Abstract

Group Name

The RELEASE Collaborators

Background And Aims

Optimising what/who/how (essential knowledge units) is essential for effective rehabilitation services and developing comparative randomised controlled trials (RCTs). We explored the contribution SLT target, delivery (provider, context) and tailoring (functional relevance, difficulty) make to language recovery; including overall ability, naming and auditory comprehension.

Methods

In a systematic search (inception to September 2015) we identified RCTs 10 IPD) detailing aphasia, time post-stroke and language outcomes (PROSPERO CRD42018110947). Intervention and quality data were also extracted. We used a statistical inferencing approach, undertaking one-stage, random effects, network meta-analyses, filtering relevant data into a model which considered IPD clustering by dataset. Predictors of recovery (age, sex, time since onset) were controlled. Risk of bias was considered by dataset and database.

Results

Drawing from 5928 IPD across 28 countries, our network meta-analyses were based on 1766 IPD (45 RCTs). Mixed spoken-language/auditory-comprehension-SLT was associated with greatest overall language gains (15.62 [CI 95% 8.82-22.4] Western Aphasia Battery-AQ (WAB-AQ)). Word-finding-SLT was linked to best naming (10.24 [CI 95% 3.56-16.92] Boston Naming Test (BNT)) and comprehension gains (4.46 [CI 95% 0.31-8.62] Token Test). Greatest overall language gains (16.68 [CI 95% 10.01, 23.37] WAB-AQ) were also associated with reported home-practice versus none. Context (in-patient/out-patient) contributed little to change. Greatest overall language (16.47 [CI 95% 10.95-21.99] WAB-AQ) and naming gains (8.79 [CI 95% 1.95-15.63] BNT) were associated with functionally-tailored (versus non-tailored) SLT. Relative covariance was acceptable (<30%). We found no indication of meta-biases.

Conclusions

Targeted, tailored therapies incorporating home-practice are important considerations for future definitive RCT and aphasia service provision.

Trial Registration Number

PROSPERO CRD42018110947

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TMS NEUROFEEDBACK AS A NEW APPROACH TO UPREGULATE EXCITABILITY OF UPPER LIMB CORTICO-SPINAL PATHWAYS IN SUBACUTE STROKE; A FEASIBILITY STUDY

Session Type
e-Poster Discussion
Date
07.11.2020, Saturday
Session Time
06:30 PM - 07:30 PM
Room
Station 9 (E-Poster Area)
Lecture Time
06:50 PM - 06:55 PM

Abstract

Background And Aims

Upper limb weakness following stroke affects the vast majority of survivors and is a key factor in preventing them from returning to activities of daily living. Most of the current state-of-the art approaches to rehabilitation require that the patient can generate some activity in the paretic limb, which is not possible for many patients in the early period following stroke, nor for some patients even in the chronic period.

Our aim was to establish the feasibility of using a novel brain-computer interface (BCI) allowing patients to gain an insight into the effect of motor imagery on their brain-muscle pathways.

Methods

We provided neurofeedback (NF) of corticospinal excitability in paretic hand and wrist muscles, measured by the size of motor evoked potentials (MEP) in response to transcranial magnetic stimulation (TMS). Patients used the feedback to learn how to use imagery to make MEPs bigger.

Results

Six patients training finger muscles learned to elevate MEP amplitudes above their resting baseline values. By day 3, MEP amplitudes were sustained above baseline in all three NF blocks.

Conclusions

We have described the first clinical implementation of TMS NF in a population of sub-acute stroke patients, demonstrating that in the context of severe upper limb paralysis, patients are capable of using feedback to elevate corticospinal excitability in the affected muscles. This may provide a new training modality for early intervention in patients shortly after the event.

Trial Registration Number

Not applicable

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SLEEP FRAGMENTATION IS ASSOCIATED WITH POORER REHABILITATION OUTCOMES AFTER STROKE AND BRAIN INJURY

Session Type
e-Poster Discussion
Date
07.11.2020, Saturday
Session Time
06:30 PM - 07:30 PM
Room
Station 9 (E-Poster Area)
Lecture Time
06:55 PM - 07:00 PM

Abstract

Background And Aims

Sleep is important for consolidation of motor learning, but stroke and brain injury may affect sleep continuity and therefore rehabilitation outcomes. This study aims to assess the relationship between sleep quality and motor recovery in stroke and brain injury patients during inpatient rehabilitation.

Methods

59 patients with stroke (n=40) or other types of brain injury (n=19), and 55 healthy community-dwelling controls participated. Sleep quality was assessed (up to 3 times) objectively using actigraphy (7 nights) and subjectively using the Sleep Condition Indicator. Motor outcome assessments included: Action Research Arm test (upper limb function; ARAT), Fugl Meyer assessment (motor impairment; FMA) and the Rivermead Mobility Index (RMI). The functional independence measure (FIM) was assessed at admission and discharge by the clinical team.

Results

fig 1.pngInpatients with stroke/brain injury demonstrated lower subjective sleep quality (p<0.001) and more fragmented sleep (p<0.001) than controls (Fig. 1). For inpatients, sleep fragmentation explained significant variance in ARAT (R2=0.181, p=0.014), FMA (R2=0.327, p=0.003) and RMI (R2=0.303, p<0.001) at discharge, such that more disrupted sleep was associated with poorer motor outcomes. Using stepwise linear regression, sleep fragmentation was the only variable found to explain variance in rate of change in FIM (R2=0.12, p = 0.03), whereby more disrupted sleep was associated with slower recovery.

Conclusions

Inpatients with stroke/brain injury demonstrate impaired sleep quality. Sleep fragmentation consistently explains a small but statistically significant proportion of the variance in motor outcomes and functional recovery. Further investigation is needed to determine how sleep quality can be improved and whether this affects outcome.

Trial Registration Number

Not applicable

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INTENSITY, DURATION AND DOSAGE OF APHASIA THERAPY AND LANGUAGE RECOVERY AFTER STROKE; A SYSTEMATIC REVIEW INFORMED, INDIVIDUAL PARTICIPANT DATA (IPD) NETWORK META-ANALYSIS

Session Type
e-Poster Discussion
Date
07.11.2020, Saturday
Session Time
06:30 PM - 07:30 PM
Room
Station 9 (E-Poster Area)
Lecture Time
07:00 PM - 07:05 PM

Abstract

Group Name

The RELEASE Collaborators

Background And Aims

While speech and language therapy (SLT) benefits language and communication recovery following stroke-related aphasia, the optimal threshold dose remains uncertain. We explored SLT dose (weekly frequency, intensity of hours weekly, total therapy hours dosage) by language outcomes including overall language ability.

Methods

We systematically searched electronic databases (inception to September 2015, no language restrictions) identifying randomised controlled trials (RCTs) with ≥10 IPD on stroke-related aphasia, time since stroke and language outcomes (PROSPERO CRD42018110947). Intervention and RCT quality group-level data were also extracted.

We used a statistical inferencing approach and transformed language assessments to anchor outcomes (Williams-Godwin transformations). A one-stage, random effects, network meta-analysis filtered relevant IPD into a single model. Individual predictors of recovery (age, sex, time post-stroke) were controlled. We considered clustering by source dataset and risk of dataset and database bias. Dose parameters were analysed separately and were non-cumulative.

Results

Our centralised database included 5928 IPD from across 28 countries. Network meta-analyses based on 45 RCTs (1766 IPD) found greatest overall language gains (Western Aphasia Battery Aphasia Quotient) were associated with SLT 4-to-5 days weekly (484 IPD; mean 14.95 CI 95% [8.7 to 21.2]), up to 4 hours weekly (IPD 482; mean 15.9 CI 95% [8.0 to 23.6]) and dosage of 20-to-50 SLT hours (480 IPD; mean 18.37 [10.58 to 26.16]). Relative covariance was acceptable (<30%). We found no indication of meta-biases.

Conclusions

Greatest language gains were associated with daily SLT, several hours weekly, over several months – raising important questions regarding duration and intensity of clinical services.

Trial Registration Number

PROSPERO CRD42018110947

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ESD APPLICATIONS FOR RURAL POPULATIONS: IMPLEMENTING AN EARLY SUPPORTED DISCHARGE PROGRAM IN RURAL CANADA

Session Type
e-Poster Discussion
Date
07.11.2020, Saturday
Session Time
06:30 PM - 07:30 PM
Room
Station 9 (E-Poster Area)
Lecture Time
07:05 PM - 07:10 PM

Abstract

Background And Aims

To date the focus of Early Supported Discharge (ESD) research and implementation has been concentrated in urban centres.[1] This review describes the results of the pragmatic implementation of an ESD pilot in a largely rural region of Canada.

[1] Langhorne, P., Baylan, S. (2017). Early supported discharge services for people with acute stroke (Review). Cochrane Library. Accessed January 2020 at http://www.cochrane.org/CD000443/STROKE_services-reducing-duration-hospital-care-people-acute-stroke

Methods

An ESD pilot program was developed at the Huron Perth Healthcare Alliance in June 2018. Patients from acute care and inpatient rehabilitation who met eligibility criteria were identified for the ESD pathway providing up to 2 weeks of in-home care, 5 days/week and up to 3 hours/day.

Results

Over a 9-month period, 34 patients were admitted to ESD directly from inpatient rehabilitation, 24% from urban settings, and 76% from rural settings (population < 30,000). Preliminary results indicate median FIM® Efficiency improved for both urban and rural cohorts compared to historical control prior to ESD. Full results will be available by April 2020.

Conclusions

To our knowledge, this is the first demonstration of a successful ESD program in a rural setting.[1] The differences in results suggest that higher intensity care provided in-home by a multi-disciplinary team can be effective for rural patients.

[1] Askim, T., Rohweder, G., Lydersen, S., & Indredavik, B. (2004). Evaluation of an extended stroke unit service with early supported discharge for patients living in a rural community. A randomized controlled trial. Clinical Rehabilitation, 18(3), 238–248. doi: https://doi.org/10.1191/0269215504cr752oa

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ACTIVEARM (AUSTRALIAN CONSTRAINT THERAPY IMPLEMENTATION STUDY OF THE ARM): IMPLEMENTATION OF UPPER LIMB CONSTRAINT-INDUCED MOVEMENT THERAPY.

Session Type
e-Poster Discussion
Date
07.11.2020, Saturday
Session Time
06:30 PM - 07:30 PM
Room
Station 9 (E-Poster Area)
Lecture Time
07:10 PM - 07:15 PM

Abstract

Background And Aims

Constraint-induced movement therapy (CIMT) is recommended for arm recovery in multiple stroke guidelines internationally. Australian audits demonstrate only 12% of eligible stroke survivors receive CIMT.

The aim of this study was to establish if CIMT programs can be translated into practice and sustained over two years across multiple public health services in Sydney, Australia.

Methods

A before-and-after study was conducted in Australia involving 65 occupational therapists, physiotherapists and assistants across nine teams. File audits were repeated 10 times over 30 months (T1- T10). Teams received a CIMT implementation package including: quarterly audit feedback cycles; a 2-day workshop; poster reminders, and community of practice support and mentoring Medical file audits were conducted at three baseline time points (T1-T3) and three-monthly intervals up to 18 months post-delivery of IP(T4-T9). Follow-up audits (T10) were conducted 6 months after withdrawal of implementation support; evaluating practice change sustainability.

Primary outcome: Change in the proportion of eligible participants that received CIMT

Results

Baseline file audits (T1-T3, n=420) found 30% of patients were eligible for CIMT but few were provided with CIMT (n=3, <1%). File audits after delivery of the CIMT implementation package (T4, n=149; T5, n=156; T6, n=158; T7, n=164; T8, n=158; T9, n=165) showed improvements in CIMT delivery. More eligible people were offered CIMT (52%-73%, T4-T9). More people received CIMT (27%-46%, T4 -T9). File audits at follow up (T10, n=175) showed sustained practice change (56% of eligible people offered CIMT; 40% received CIMT).

Conclusions

Nine therapy teams overcame an evidence-practice gap and increased CIMT delivery.

Trial Registration Number

ACTRN12617001147370

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THE PREVALENCE AND PREDICTORS OF POST-STROKE FATIGUE AMONG JORDANIAN INDIVIDUALS WITH STROKE

Session Type
e-Poster Discussion
Date
07.11.2020, Saturday
Session Time
06:30 PM - 07:30 PM
Room
Station 9 (E-Poster Area)
Lecture Time
07:15 PM - 07:20 PM

Abstract

Background And Aims

Post-Stroke fatigue has a major impact on patients’ quality of life and may reduce abilities of conducting functional activities. This study aimed to determine the prevalence of post-stroke fatigue and to comprehensively identify its predictors in Jordan.

Methods

The study utilized a cross-sectional design. Outcome measures included modified fatigue impact scale, 12-item Short-Form Health Survey, Montreal Cognitive Assessment, Motor Assessment Log, Upper Extremity Fugl Meyer assessment, Nine Hole Peg Test, 10 Meter Walk Testing, goniometry, Hand-held dynamometry, and modified Ashworth scale. Prevalence of post-stroke fatigue was reported using descriptive analyses. Multiple variable linear regression analysis was used to identify predictors of post-stroke fatigue. Participants needed to have a confirmed stroke diagnosis, aged between 25 and 75 years, and a stroke chronicity of ≥ 4 months. Participants with aphasia, other neurological diseases, pregnant, or depression were excluded.

Results

The total number of individuals with stroke participated in the study was 153. The prevalence of fatigue in the study sample was 69.9%. Significant predictors of post-stroke fatigue included mental component of quality of life (p < 0.001), cognition (p= 0.001), weekly sport hours (p = 0.022) and shoulder abduction spasticity (p= 0.024).

Conclusions

Post-stroke fatigue is highly prevalent in Jordan. Significant post-stroke fatigue predictors included mental related quality of life, cognition status, sport participation, and spasticity. Clinicians working in neurorehabilitation should take post-stroke fatigue and its significant predictors into consideration when treating individuals with stroke.

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