Oxidative Stress Status in Post Stroke Patients: Sex Differences

After a cerebral stroke insult, there is an overproduction of Reactive Oxygen Species (ROS), which overcome the antioxidant defenses, causing further tissues damage. The status of oxidative stress in stroke patients over time, particularly in those undergoing rehabilitation treatments, has been poorly investigated. We analyzed the oxidative stress status in 61 subacute stroke patients (33 females and 28 males) admitted to our rehabilitation center by measuring, in serum: hydroper-oxides levels (d-ROMs), antioxidant activity (BAP test), and the relative antioxidant capacity (OSI index). We also analyzed patients for glucose levels and lipid profile. In addition, we analyzed the correlation between oxidative stress status biomarkers and motor deficits, disability, and pain. Almost all patients showed high or very high levels of d-ROMs, while BAP levels were apparently in the reference range of normality. Females had lower BAP values (females: 2478 ± 379; males: 2765 ± 590; p = 0.034) and lower OSI index (females: 5.7 ± 1.9; males: 6.8 ± 1.9; p = 0.043). Moreover, in the male group, the correlation with motor impairment and disability showed a worsened motor performance when oxidative stress is higher. Female group, on the other hand, had an unexpected different trend of correlation, probably due to an unbalanced systemic oxidative stress. Further research is needed to see if sex differences in oxidative stress status in subacute stroke patients persist after rehabilitation

Effects of robotic upper limb treatment after stroke on cognitive patterns: A systematic review

BACKGROUND: Robotic therapy (RT) has been internationally recognized for the motor rehabilitation of the upper limb. Although it seems that RT can stimulate and promote neuroplasticity, the effectiveness of robotics in restoring cognitive deficits has been considered only in a few recent studies. OBJECTIVE: To verify whether, in the current state of the literature, cognitive measures are used as inclusion or exclusion criteria and/or outcomes measures in robotic upper limb rehabilitation in stroke patients. METHODS: The systematic review was conducted according to PRISMA guidelines. Studies eligible were identified through PubMed/MEDLINE and Web of Science from inception to March 2021. RESULTS: Eighty-one studies were considered in this systematic review. Seventy-three studies have at least a cognitive inclusion or exclusion criteria, while only seven studies assessed cognitive outcomes. CONCLUSION: Despite the high presence of cognitive instruments used for inclusion/exclusion criteria their heterogeneity did not allow the identification of a guideline for the evaluation of patients in different stroke stages. Therefore, although the heterogeneity and the low percentage of studies that included cognitive outcomes, seemed that the latter were positively influenced by RT in post-stroke rehabilitation. Future larger RCTs are needed to outline which cognitive scales are most suitable and their cut-off, as well as what cognitive outcome measures to use in the various stages of post-stroke rehabilitation

Healthcare practitioners and robotic-assisted rehabilitation: understanding needs and barriers

Backgrounds: In recent years, numerous robotic devices, together with allied technologies, have been developed to support rehabilitation, both in research settings and industry. Although robotic-assisted rehabilitation and related technologies hold significant promise for supporting healthcare practitioners and enhancing patient care, their use in clinical practice remains limited. One of the motivations could be that final users’ needs have not been given due consideration so far. As a matter of fact, understanding user needs and perceptions is crucial for designing these technological devices and for creating new organizational models within hospitals aiming to establish and maintain robotics-assisted rehabilitation gyms. Methods: We developed and distributed an online survey to the Italian community of healthcare practitioners working in rehabilitation, to depict the current landscape of robotic-assisted rehabilitation and to understand their opinions and demands across various domains and diseases. The questionnaire is divided into two main parts. The first section pertains to the respondents' demographics and professional experience. The second part includes questions about eight different categories of rehabilitative devices. For each category, practitioners can indicate whether they use a device in their practice, their perceptions, and any perceived barriers. Additionally, they can fill out a System Usability Scale for a specific device in that category. Results: We collected answers from 423 Italian rehabilitation professionals, including various clinical roles, that revealed significant insights into the use of robotics in rehabilitation. Gender distribution shows a high prevalence of female professionals. 40% of respondents reported being unfamiliar with any robotics devices. Advanced treadmills are the most known and used robots. Generally, usage and experience with devices are associated with positive attitudes towards robotics-assisted rehabilitation. Lack of financial resources and scientific evidence, as well as lack of opportunities and training, are the most reported barriers. Conclusions: Despite a general positivity towards technology, there is a substantial lack of awareness about rehabilitation devices among professionals. The survey highlights the need for enhanced training and education on robotics in rehabilitation programs. Additionally, the limited focus on home rehabilitation is noted. The study emphasizes the importance of verifying both the effectiveness and economic sustainability of robotic devices in clinical practice

Quantification of age-related differences in reaching and circle-drawing using a robotic rehabilitation device

BACKGROUND: Although robotic therapy is at the forefront of upper limb rehabilitation, there is limited information about the importance of selecting age-matched subjects to evaluate recovery of arm movement during rehabilitation. OBJECTIVE: This study aims to quantify differences in the arm motion of healthy children and adults when they interact with a planar robot, in order to determine whether an age-matched control group is necessary in clinical studies involving pediatric patients. METHODS: Ten children (aged 7 to 10 years) and ten adults (aged 23 to 25 years) performed, at self-selected speed and accuracy, planar-reaching and circle-drawing movements with a robotic device. We analyzed the motor performances for the two groups quantifying the participants’ dexterity in completing two chosen tasks. The measurement of the entire upper limb was obtained by merging the data provided by the robot with that of an optical tracking system. RESULTS: Children drew circles with less smoothness than adults but with the same accuracy and joint coordination. During planar reaching task, children optimized only the coordination but performed the movement with less accuracy and smoothness than adults. CONCLUSIONS: Our findings provide evidence that age-matched healthy children should be used to quantify the recovery of robot-mediated therapy in children with upper limb impairments