Effects of robotic gait training after stroke : A meta-analysis / Geoffroy Moucheboeuf in Annals of physical and rehabilitation medicine, Vol. 63, n°6 (November 20)

Public ISBD [article]  inAnnals of physical and rehabilitation medicine > Vol. 63, n°6 (November 20) . - p. 518-534 Titre : Effects of robotic gait training after stroke : A meta-analysis Type de document : texte imprimé Auteurs : Geoffroy Moucheboeuf ; Romain Griffier ; David Gasq ; Bertrand Glize ; Laurent Bouyer ; Patrick Dehail ; Hélène Cassoudesalle Année de publication : 2020 Article en page(s) : p. 518-534 Note générale : doi.org/10.1016/j.rehab.2020.02.008 Langues : Anglais (eng) Mots-clés : Stroke  Robot-assisted gait training  Exoskeleton  End-effector  Gait  Walking  Rehabilitation Résumé : Background Robotic devices are often used in rehabilitation and might be efficient to improve walking capacity after stroke. Objective First to investigate the effects of robot-assisted gait training after stroke and second to explain the observed heterogeneity of results in previous meta-analyses. Methods All randomized controlled trials investigating exoskeletons or end-effector devices in adult patients with stroke were searched in databases (MEDLINE, EMBASE, CENTRAL, CINAHL, OPENGREY, OPENSIGLE, PEDRO, WEB OF SCIENCE, CLINICAL TRIALS, conference proceedings) from inception to November 2019, as were bibliographies of previous meta-analyses, independently by 2 reviewers. The following variables collected before and after the rehabilitation program were gait speed, gait endurance, Berg Balance Scale (BBS), Functional Ambulation Classification (FAC) and Timed Up and Go scores. We also extracted data on randomization method, blinding of outcome assessors, drop-outs, intention (or not) to treat, country, number of participants, disease duration, mean age, features of interventions, and date of outcomes assessment. Results We included 33 studies involving 1466 participants. On analysis by subgroups of intervention, as compared with physiotherapy alone, physiotherapy combined with body-weight support training and robot-assisted gait training conferred greater improvement in gait speed (+0.09 m/s, 95% confidence interval [CI] 0.03 to 0.15; p = 0.002), FAC scores (+0.51, 95% CI 0.07 to 0.95; p = 0.022) and BBS scores (+4.16, 95% CI 2.60 to 5.71; p = 0.000). A meta-regression analysis suggested that these results were underestimated by the attrition bias of studies. Conclusions Robot-assisted gait training combined with physiotherapy and body-weight support training seems an efficient intervention for gait recovery after stroke. Permalink : ./index.php?lvl=notice_display&id=91465 [article] Effects of robotic gait training after stroke : A meta-analysis [texte imprimé] / Geoffroy Moucheboeuf ; Romain Griffier ; David Gasq ; Bertrand Glize ; Laurent Bouyer ; Patrick Dehail ; Hélène Cassoudesalle . - 2020 . - p. 518-534. doi.org/10.1016/j.rehab.2020.02.008 Langues : Anglais (eng) in Annals of physical and rehabilitation medicine > Vol. 63, n°6 (November 20) . - p. 518-534 Mots-clés : Stroke  Robot-assisted gait training  Exoskeleton  End-effector  Gait  Walking  Rehabilitation Résumé : Background Robotic devices are often used in rehabilitation and might be efficient to improve walking capacity after stroke. Objective First to investigate the effects of robot-assisted gait training after stroke and second to explain the observed heterogeneity of results in previous meta-analyses. Methods All randomized controlled trials investigating exoskeletons or end-effector devices in adult patients with stroke were searched in databases (MEDLINE, EMBASE, CENTRAL, CINAHL, OPENGREY, OPENSIGLE, PEDRO, WEB OF SCIENCE, CLINICAL TRIALS, conference proceedings) from inception to November 2019, as were bibliographies of previous meta-analyses, independently by 2 reviewers. The following variables collected before and after the rehabilitation program were gait speed, gait endurance, Berg Balance Scale (BBS), Functional Ambulation Classification (FAC) and Timed Up and Go scores. We also extracted data on randomization method, blinding of outcome assessors, drop-outs, intention (or not) to treat, country, number of participants, disease duration, mean age, features of interventions, and date of outcomes assessment. Results We included 33 studies involving 1466 participants. On analysis by subgroups of intervention, as compared with physiotherapy alone, physiotherapy combined with body-weight support training and robot-assisted gait training conferred greater improvement in gait speed (+0.09 m/s, 95% confidence interval [CI] 0.03 to 0.15; p = 0.002), FAC scores (+0.51, 95% CI 0.07 to 0.95; p = 0.022) and BBS scores (+4.16, 95% CI 2.60 to 5.71; p = 0.000). A meta-regression analysis suggested that these results were underestimated by the attrition bias of studies. Conclusions Robot-assisted gait training combined with physiotherapy and body-weight support training seems an efficient intervention for gait recovery after stroke. Permalink : ./index.php?lvl=notice_display&id=91465

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New factors that affect quality of life in patients with aphasia / Bénédicte Bullier in Annals of physical and rehabilitation medicine, Vol. 63, n°1 (Janvier 2020)

Public ISBD [article]  inAnnals of physical and rehabilitation medicine > Vol. 63, n°1 (Janvier 2020) . - p. 33-37 Titre : New factors that affect quality of life in patients with aphasia Type de document : texte imprimé Auteurs : Bénédicte Bullier ; Hélène Cassoudesalle ; Marie Villain ; Mélanie Cogné ; Clémence Mollo ; Isabelle De Gabory ; Patrick Dehail ; Pierre-Alain Joseph ; Igor Sibon ; Bertrand Glize Année de publication : 2020 Article en page(s) : p. 33-37 Note générale : doi.org/10.1016/j.rehab.2019.06.015 Langues : Anglais (eng) Mots-clés : Aphasia  Quality of life  Stroke  Fatigue Résumé : Background Aphasia severity is known to affect quality of life (QoL) in stroke patients, as is mood disorders, functional limitations, limitations on activities of daily life, economic status and level of education. However, communication limitation or fatigue has not been explored in this specific population. Objective We aimed to investigate whether these factors were associated with QoL in patients with aphasia after stroke. Methods Patients with aphasia were included from April 2014 to November 2017 after a first stroke and were followed for 2 years post-stroke. QoL was assessed at follow-up by the French Sickness Impact Profile 65 (SIP-65). We explored predictors such as mood disorders, communication impairment, fatigue, limitations on activities of daily life, and aphasia severity in addition to socio-demographic factors. Results We included 32 individuals (22 men; mean age 60.7 [SD 16.6] years) with aphasia after a first stroke. Poor QoL as assessed by the SIP-65 was significantly associated (Pearson correlations) with increased severity of aphasia initially (P = 0.008) and at follow-up (P = 0.01); increased communication activity limitations at follow-up (P < 0.001); increased limitations on activities of daily life at baseline (P = 0.008) and follow-up (P < 0.001); increased fatigue at follow-up (P = 0.001); and increased depression symptoms at follow-up (P = 0.001). On multivariable analysis, QoL was associated with communication activity limitations, limitations on activities of daily life, fatigue and depression, explaining more than 75% of the variance (linear regression R2 = 0.756, P < 0.001). The relative importance in predicting the variance was 32% for limitations on activities of daily life, 21% fatigue, 23% depression and 24% communication activity limitations. Conclusion Aphasia severity, mood disorders and functional limitations may have a negative effect on QoL in patients with aphasia. Also, for the first time, we show that fatigue has an important impact on QoL in this population. Specific management of this symptom might be beneficial and should be explored in future studies. Permalink : ./index.php?lvl=notice_display&id=90685 [article] New factors that affect quality of life in patients with aphasia [texte imprimé] / Bénédicte Bullier ; Hélène Cassoudesalle ; Marie Villain ; Mélanie Cogné ; Clémence Mollo ; Isabelle De Gabory ; Patrick Dehail ; Pierre-Alain Joseph ; Igor Sibon ; Bertrand Glize . - 2020 . - p. 33-37. doi.org/10.1016/j.rehab.2019.06.015 Langues : Anglais (eng) in Annals of physical and rehabilitation medicine > Vol. 63, n°1 (Janvier 2020) . - p. 33-37 Mots-clés : Aphasia  Quality of life  Stroke  Fatigue Résumé : Background Aphasia severity is known to affect quality of life (QoL) in stroke patients, as is mood disorders, functional limitations, limitations on activities of daily life, economic status and level of education. However, communication limitation or fatigue has not been explored in this specific population. Objective We aimed to investigate whether these factors were associated with QoL in patients with aphasia after stroke. Methods Patients with aphasia were included from April 2014 to November 2017 after a first stroke and were followed for 2 years post-stroke. QoL was assessed at follow-up by the French Sickness Impact Profile 65 (SIP-65). We explored predictors such as mood disorders, communication impairment, fatigue, limitations on activities of daily life, and aphasia severity in addition to socio-demographic factors. Results We included 32 individuals (22 men; mean age 60.7 [SD 16.6] years) with aphasia after a first stroke. Poor QoL as assessed by the SIP-65 was significantly associated (Pearson correlations) with increased severity of aphasia initially (P = 0.008) and at follow-up (P = 0.01); increased communication activity limitations at follow-up (P < 0.001); increased limitations on activities of daily life at baseline (P = 0.008) and follow-up (P < 0.001); increased fatigue at follow-up (P = 0.001); and increased depression symptoms at follow-up (P = 0.001). On multivariable analysis, QoL was associated with communication activity limitations, limitations on activities of daily life, fatigue and depression, explaining more than 75% of the variance (linear regression R2 = 0.756, P < 0.001). The relative importance in predicting the variance was 32% for limitations on activities of daily life, 21% fatigue, 23% depression and 24% communication activity limitations. Conclusion Aphasia severity, mood disorders and functional limitations may have a negative effect on QoL in patients with aphasia. Also, for the first time, we show that fatigue has an important impact on QoL in this population. Specific management of this symptom might be beneficial and should be explored in future studies. Permalink : ./index.php?lvl=notice_display&id=90685

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Post-acute referral of stroke victims in a French urban area: Results of a specific program / Hélène Cassoudesalle in Annals of physical and rehabilitation medicine, Vol. 59, n° 4 (September 2016)

Public ISBD [article]  inAnnals of physical and rehabilitation medicine > Vol. 59, n° 4 (September 2016) . - p. 248-254 Titre : Post-acute referral of stroke victims in a French urban area: Results of a specific program Type de document : texte imprimé Auteurs : Hélène Cassoudesalle, Auteur ; Hervé Petit, Auteur ; A. Nozères, Auteur Année de publication : 2016 Article en page(s) : p. 248-254 Langues : Anglais (eng) Français (fre) Mots-clés : Accident cérébrovasculaire  Rééducation fonctionnelle  Soins  Hôpital public  Gironde  Stroke,Rehabilitation units,Care organization Résumé : Objective: The main objective of this study was to describe the distribution of referrals offered to patients assessed in the “Post-Acute Stroke program” of Bordeaux University Hospital (France). This program was developed in 2008 to organize the dispensation of care in rehabilitation units specialized in neurological diseases. Material and methods: This was a single-centre observational study. Between July 2008 and December 2012, data on the number of stroke patients hospitalized at the Bordeaux University Hospital and their post-acute referral were collected from the local hospital discharge database. Some of these patients were assessed by Physical Rehabilitation and Medicine physicians participating in the program. Proposed and actual referrals, time from admission to assessment and functional status were also collected. Results: Among 4189 stroke patients, 1465 (35%) survivors were assessed, of whom 932 (22.2%) were discharged to inpatient rehabilitation facilities. There were no patients discharged to this type of unit without an assessment. Among the 1465 patients who were assessed, 57.2% were referred to specialized rehabilitation units, 6.3% were discharged to non-specialized rehabilitation units and 26% returned home directly. The median total length of stay in acute units varied from 10 to 15days depending on referral orientation. Conclusion: Patients that were assessed were more likely to be transferred to specialized rehabilitation units than to non-specialized rehabilitation units. The Post-Acute Stroke program has the particularity of combining private and public specialized rehabilitation units in a common collaborative referral system while retaining the control and flexibility of personalised referral for each patient in the light of local care availability. Permalink : ./index.php?lvl=notice_display&id=45219 [article] Post-acute referral of stroke victims in a French urban area: Results of a specific program [texte imprimé] / Hélène Cassoudesalle, Auteur ; Hervé Petit, Auteur ; A. Nozères, Auteur . - 2016 . - p. 248-254. Langues : Anglais (eng) Français (fre) in Annals of physical and rehabilitation medicine > Vol. 59, n° 4 (September 2016) . - p. 248-254 Mots-clés : Accident cérébrovasculaire  Rééducation fonctionnelle  Soins  Hôpital public  Gironde  Stroke,Rehabilitation units,Care organization Résumé : Objective: The main objective of this study was to describe the distribution of referrals offered to patients assessed in the “Post-Acute Stroke program” of Bordeaux University Hospital (France). This program was developed in 2008 to organize the dispensation of care in rehabilitation units specialized in neurological diseases. Material and methods: This was a single-centre observational study. Between July 2008 and December 2012, data on the number of stroke patients hospitalized at the Bordeaux University Hospital and their post-acute referral were collected from the local hospital discharge database. Some of these patients were assessed by Physical Rehabilitation and Medicine physicians participating in the program. Proposed and actual referrals, time from admission to assessment and functional status were also collected. Results: Among 4189 stroke patients, 1465 (35%) survivors were assessed, of whom 932 (22.2%) were discharged to inpatient rehabilitation facilities. There were no patients discharged to this type of unit without an assessment. Among the 1465 patients who were assessed, 57.2% were referred to specialized rehabilitation units, 6.3% were discharged to non-specialized rehabilitation units and 26% returned home directly. The median total length of stay in acute units varied from 10 to 15days depending on referral orientation. Conclusion: Patients that were assessed were more likely to be transferred to specialized rehabilitation units than to non-specialized rehabilitation units. The Post-Acute Stroke program has the particularity of combining private and public specialized rehabilitation units in a common collaborative referral system while retaining the control and flexibility of personalised referral for each patient in the light of local care availability. Permalink : ./index.php?lvl=notice_display&id=45219

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Transcranial direct current stimulation in post-stroke aphasia rehabilitation: A systematic review / Elisa Biou in Annals of physical and rehabilitation medicine, Vol. 62, n°2 (Mars 2019)  

Public ISBD [article]  inAnnals of physical and rehabilitation medicine > Vol. 62, n°2 (Mars 2019) . - p. 104-121 Titre : Transcranial direct current stimulation in post-stroke aphasia rehabilitation: A systematic review Type de document : texte imprimé Auteurs : Elisa Biou ; Hélène Cassoudesalle ; Mélanie Cogné ; Igor Sibon ; Isabelle De Gabory ; Patrick Dehail ; Jérôme Aupy ; Bertrand Glize Année de publication : 2019 Article en page(s) : p. 104-121 Note générale : https://doi.org/10.1016/j.rehab.2019.01.003 Langues : Anglais (eng) Mots-clés : Aphasia  TDCS  Rehabilitation  Speech therapy Résumé : Abstract Background Transcranial direct current stimulation (tDCS) is a non-invasive tool that induces neuromodulation in the brain. Several studies have shown the effectiveness of tDCS in improving language recovery in post-stroke aphasia. However, this innovative technique is not currently used in routine speech and language therapy (SLT) practice. Objective This systematic review aimed to summarise the role of tDCS in aphasia rehabilitation. Methods We searched MEDLINE via PubMed and Scopus on October 5, 2018 for English articles published from 1996 to 2018. Eligible studies involved post-stroke aphasia rehabilitation with tDCS combined or not with SLT. Results We retained 5 meta-analyses and 48 studies. Among the 48 studies, 39 were randomised controlled trials (558 patients), 2 prospective studies (56 patients), and 5 case studies (5 patients). Two articles were sub-analyses of a randomised clinical trial. Methods used in these studies were heterogeneous. Only 6 studies did not find a significant effect of tDCS on language performance. As compared with earlier meta-analyses, the 2 latest found significant effects. Conclusion Evidence from published peer reviewed literature is effective for post-stroke aphasia rehabilitation at the chronic stages. tDCS devices are easy to use, safe and inexpensive. They can be used in routine clinical practice by speech therapists for aphasia rehabilitation. However, further studies should investigate the effectiveness in the subacute post-stroke phase and determine the effect of the lesion for precisely identifying the targeted brain areas. We discuss crucial challenges for future studies. En ligne : https://www.sciencedirect.com/science/article/pii/S1877065719300107 Permalink : ./index.php?lvl=notice_display&id=84105 [article] Transcranial direct current stimulation in post-stroke aphasia rehabilitation: A systematic review [texte imprimé] / Elisa Biou ; Hélène Cassoudesalle ; Mélanie Cogné ; Igor Sibon ; Isabelle De Gabory ; Patrick Dehail ; Jérôme Aupy ; Bertrand Glize . - 2019 . - p. 104-121. https://doi.org/10.1016/j.rehab.2019.01.003 Langues : Anglais (eng) in Annals of physical and rehabilitation medicine > Vol. 62, n°2 (Mars 2019) . - p. 104-121 Mots-clés : Aphasia  TDCS  Rehabilitation  Speech therapy Résumé : Abstract Background Transcranial direct current stimulation (tDCS) is a non-invasive tool that induces neuromodulation in the brain. Several studies have shown the effectiveness of tDCS in improving language recovery in post-stroke aphasia. However, this innovative technique is not currently used in routine speech and language therapy (SLT) practice. Objective This systematic review aimed to summarise the role of tDCS in aphasia rehabilitation. Methods We searched MEDLINE via PubMed and Scopus on October 5, 2018 for English articles published from 1996 to 2018. Eligible studies involved post-stroke aphasia rehabilitation with tDCS combined or not with SLT. Results We retained 5 meta-analyses and 48 studies. Among the 48 studies, 39 were randomised controlled trials (558 patients), 2 prospective studies (56 patients), and 5 case studies (5 patients). Two articles were sub-analyses of a randomised clinical trial. Methods used in these studies were heterogeneous. Only 6 studies did not find a significant effect of tDCS on language performance. As compared with earlier meta-analyses, the 2 latest found significant effects. Conclusion Evidence from published peer reviewed literature is effective for post-stroke aphasia rehabilitation at the chronic stages. tDCS devices are easy to use, safe and inexpensive. They can be used in routine clinical practice by speech therapists for aphasia rehabilitation. However, further studies should investigate the effectiveness in the subacute post-stroke phase and determine the effect of the lesion for precisely identifying the targeted brain areas. We discuss crucial challenges for future studies. En ligne : https://www.sciencedirect.com/science/article/pii/S1877065719300107 Permalink : ./index.php?lvl=notice_display&id=84105

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