Stroke ihas categorized as been one of the most concerning global health issues as it is a serious and commonleading causes of disabling factorility worldwide. Ageing and urbanization are two powerful drivers of stroke. The elderly population is at higher risk of experiencing a stroke, but stroke can be prevented to some extent by dealing with the modifiable menace factors such as and is still a social health issue. Keeping in view the importance of physical inactivity, drugs, unhealthy diet, and tobacco so that problems such as hypertension, high blood pressure, and diabetes,rehabilitation of stroke patients, an analytical review has been compiled in which are the root causes of the epidemic, may be managed. Different therapies are describeddifferent therapies have been reviewed for their effectiveness, such as functional electric stimulation (FES), noninvasive brain stimulation (NIBS) including transcranial direct current stimulation (t-DCS) and transcranial magnetic stimulation (t-MS), invasive epidural cortical stimulation, virtual reality (VR) rehabilitation, task-oriented therapy, robot-assisted training, tele rehabilitation, and cerebral plasticity for the rehabilitation of upper extremity motor impairment. New therapeutic rehabilitation techniques are also being investigated, such as VR.
Country | Per Patient Cost/Month in USD | Cost/Month in USD per Outpatient Only |
---|---|---|
Australia | 752 | Not available |
Canada | 1444 | Not available |
Modifiable Risk Factors | Non-Modifiable Risk Factors |
---|---|
40% | |
Diabetes | |
n | |
= 146 | |
27.6% | |
26.9% | |
18.5 | |
Smoking (43.0%) | --- |
Diabetes (41.3%) | --- |
Excess alcohol intake | --- |
(a) Prevalence Frequency of Different Risk Factors for Ischemic Stroke in a Study Population in Pakistan (Study included 55 subjects to analyze the prevalence of modifiable and non-modifiable risk factors |
Test Type | FES Group Mean Score | Control Group Mean Score | ||
---|---|---|---|---|
Risk Factor | Male (n = 43) |
(a) | Inpatient Stay Care | Outpatient Specialty Care |
Outpatient Primary Care |
Home Care Services | Particular Housing Days |
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Female ( | |||||||||||||||||
Pretraining | Post-Training | ||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
n | |||||||||||||||||
First year | = 12) | Month 1–3 | Total ( | No. of Daysn = 55) | |||||||||||||
Amout in Euros | No. of Visits | Amout in Euros | No. of Visits | Amout in Euros | No. of Hours | Amout in Euros | No. of Days | Amout in Euros | |||||||||
Pretraining | |||||||||||||||||
Smoking | |||||||||||||||||
32 (74.3%) | 0 | 32 (58.1%) | |||||||||||||||
Post-Training | |||||||||||||||||
2 | |||||||||||||||||
23 | 20,015 | 11 | 3123 | 13 | 1525 | 19 | 876 | 2 | 330 | ||||||||
Familystroke history | 22 (51%) | 6 (50%) | 28 (50.8%) | ||||||||||||||
3 | 37 | 31,668 | 10 | 2812 | 11 | 1310 | 235 | 10,904 | 34 | 6290 | Dyslipidemia | 15 (34.5%) | 3 (25.1%) | ||||
4 | 18 (32.5%) | ||||||||||||||||
49 | 42,295 | 12 | 3358 | 12 | 1374 | 510 | 23,684 | 82 | 15,071 | Obesity | 9 (20.8%) | 11(91.2%) | 20 (17.9%) | ||||
5 | 64 | 55,370 | 6 | 1605 | 9 | 1069 | 501 | 23,264 | 170 | 31,476 | Cardiac disease | 4 (9.3%) | 1 (8.3%) | 5 (9.2%) | |||
Deaths | 14 | 12,397 | 1 | 327 | 1 | 127 | 47 | 2177 | 26 | 4780 | Diabetes mellitus | 17 (38.8%) | 3 (24.9%) | 20 (35%) | |||
Survivals | 39 | 33,521 | 10 | 2898 | 12 | 1369 | 213 | 9873 | 51 | 9494 | Epilepsy | 7 (15.9%) | 2 (16.5%) | 9 (15.9%) | |||
Patients | 29 | 25,306 | 7 | 1898 | 7 | 886 | 146 | 6769 | 41 | 7661 | (b) Yearly Awareness, Control, and Treatment Ratio for Stroke Risk Factors in China, Japan, and Taiwan | ||||||
Second year | Month 12 | Risk Factor | Category | China | Japan | Taiwan | |||||||||||
2 | 2 | 9784 | 4 | 1033 | 5 | 626 | 25 | 1155 | 1 | Hypertension | Awareness | 44.7 in 2000–2001, 24 in 2002, and 45 in 2007–2008 |
54 in 2000 and 66 in males and 73 in females in 2000–2001 |
22.5 in males and 39.3 in females in 1993–1996 | |||
230 | |||||||||||||||||
3 | 6 | 9770 | 4 | 1032 | 6 | 667 | 698 | 32,420 | 39 | 7115 | Treatment | 28 in 2000–2001, 20 in 2002, and 36.2 in 2007–2008 |
46.1 in 2000, 16.4 in males and 33–57 in females in 2000–2001, and 54.4 in 2008 |
||||
4 | 7 | 13.4 in males and 28 in females in 1993–1996, | 9032 44 in males and 59 in females in 2002 |
||||||||||||||
3 | 954 | 6 | 674 | 1419 | 65,931 | 67 | 12,448 | Control | 8.1 in 2000–2001, 5 in 2002, and 11 in 2007–2008 |
23.4 in males and 28 in females in 2000, 27 in 2008, and 25 in 2009, |
2–2.3 in males and 5.1 in females in 1993–1996, 21 in males and 28 in females in 2002 |
||||||
5 | 3 | 6217 | 2 | 656 | 5 | 550 | 689 | 31,999 | 250 | 46,221 | High cholesterol | Awareness | 24.4 in 2003–2013 | 56 in males and 59 in females in 2000–2001 | --- | ||
Deaths | 12 | 7431 | 3 | 785 | 4 | 527 | 453 | 21,056 | 128 | 23,570 | Treatment | 9 in 2003–2013 | 52 in males and 53 in females in 2000–2001 | --- | |||
Survivals | 5 | 8159 | 3 | 862 | 5 | 588 | 429 | 19,931 | 52 | 9581 | Control | 4.2 in 2003–2013 | 72 in 2009 | ||||
Patients | 65 in 2002–2003 in 2006–2007 | ||||||||||||||||
5 | 8095 | 3 | 855 | 5 | 582 | 431 | 20,021 | 59 | 10,811 | Diabetes | |||||||
(b) | Awareness | mRs Scale Value24 in 2000–2001 and 30 in 2010 |
--- | Inpatient Stay Care | Outpatient | 70 in males and 63 in females in 1993–1996 | |||||||||||
Specialty Care | Outpatient | Primary Care | Home Care Services | Particular | Housing |
Treatment | 20 in 2000–2001 and 26 in 2010 |
--- | --- | ||||||||
First year | Month 1–3 |
No. of Days | Amout in Euros | No. of Visits | Amout in Euros | No. of Visits | Amout in Euros | No. of Hours | Amout in Euros | No. of Days | Amout in Euros | Control | 8.4 in 2000–2001 and 39.7 treated patients in 2010 |
34 from 2000–2002 and 36 from 2006–2008 | 27.00 in 1998 and 11.2 in 2006 (among patients having insulin therapy) | ||
2 | 12 | 20,015 | 9 | 3123 | 13 | 1525 | 13 | 876 | 1 | 330 | (c) Prevalence assessment of stroke risk factors in a study with 688 patients in Brazil | ||||||
3 | 25 | 31,668 | 8 | 2812 | 12 | 1310 | 243 | 10,904 | 34 | 6290 | Patients n = 688 |
Microangiopathy | Macroangiopathy n = 127 (18.5%) |
Cardio Embolism n = 195 (28.3%) |
|||
4 | 35 | 42,295 | 9 | 3358 | 75 | 15,071 | Women n = 360 (52.3%) | 49.6% | 52.3% | 53.3% | |||||||
5 | 41 | 55,370 | 5 | 1605 | 8 | 1069 | 392 | 23,264 | 213 | 31,476 | Men n = 328 (47.7%) | 50.4% | 47.5% | ||||
Deaths | 46.7% | ||||||||||||||||
23 | 12,397 | 2 | 327 | 3 | 127 | 100 | Age above 65 | 72.4% | 63.2% | 56.8% | |||||||
13 | 1374 | 547 | 23,684 | 2177 | 48 | 4780 | |||||||||||
Survivals | 22 | 33,521 | 8 | 2898 | 12 | 1369 | 171 | 9873 | 40 | 9494 | Smoking n = 164 | 29.1% | 30% | 16.9% | |||
Patients | 22 | 25,306 | 7 | 1898 | 10 | 886 | 154 | 6769 | 42 | 7661 | Hypertension n = 517 (almost in all groups) | 92.1% | 80.7% | 69.7% | |||
Dyslipidemia | |||||||||||||||||
Second year | Month 12 | n = 324 | 50.4% | 57.8% | |||||||||||||
2 | 3 | 1704 | 3 | 1033 | 5 | 626 | 26 | 1155 | 1 | 230 | |||||||
3 | 6 | 4263 | 3 | 1032 | 5 | 667 | 571 | 32,420 | 40 | 7115 | |||||||
4 | 8 | 4899 | 3 | 954 | 5 | 674 | 1325 | 65,931 | 78 | 12,448 | |||||||
5 | 4 | 2465 | 3 | 656 | 5 | 550 | 741 | 31,999 | 265 | 46,221 | |||||||
Deaths | 14 | 8736 | 3 | 785 | 5 | 527 | 505 | 21,056 | 105 | 23,570 | |||||||
Survivals | 5 | 3262 | 3 | 862 | 5 | 588 | 373 | 19,931 | 44 | 9581 | |||||||
Patients | 6 | 3744 | 3 | 855 | 5 | 582 | 384 | 20,021 | 50 | 10,811 | |||||||
Hypertension (65.8%) | Older age > 65 years | ||||||||||||||||
Transient ischemic attack (TIA) (24.9%) | Family stroke history | 48.00 ± 28.00 | |||||||||||||||
Cuba | Not available | 616 | |||||||||||||||
Cardiac Diseases (29.1%) | |||||||||||||||||
Control Group | 4.00 ± 0.50 | 25.5 ± 15.0 | Denmark | 3022 | Not available | ||||||||||||
Higher in males | |||||||||||||||||
Carotid artery stenosis | Ethnic factor | France | 1125 | Not available | |||||||||||||
2. mF-M | Atrial fibrillation | --- | |||||||||||||||
Fugl-Meyer test | 18.1 ± 7.8 | 25.8 ± 8.7 | 19.9 ± 10.00 | 22.0 ± 9.8 | |||||||||||||
Forward reaching (cm) | 12.6 ± 7.6 | 20.4 ± 9.7 | 7.7 ± 9.7 | 11.9 ± 12.4 | |||||||||||||
Grip power (kg) | 1.20 ± 1.9 | ||||||||||||||||
Germany | 996 | ||||||||||||||||
2.20 ± 2.0 | Hyperlipidemia | 559 | |||||||||||||||
1.1 ± 1.59(25.5%) | --- | Italy | 833 | ||||||||||||||
Physical inactivity | Not available | ||||||||||||||||
--- | Malaysia | Not available | 192 | ||||||||||||||
Netherland | 2016 | Not available | |||||||||||||||
Norway | 2147 | Not available | |||||||||||||||
Sweden | 768 | 389 | |||||||||||||||
Switzerland | 1505 | Not available | |||||||||||||||
UK | 868 | 883 | |||||||||||||||
USA | 4850 | 773 | |||||||||||||||
Multicentric | 2385 | Not available |
2.00 ± 2.1 |
FES group |
FTHUE |
23.0 ± 17 |
To study the effect of FES on UL rehabilitation |
Open-label block inpatient randomized control study | Fast recovery than task traditional task-oriented physiotherapy | Acute phase of stroke | |||||
FES [51] | Application of FES with bilateral training on UL | Randomized double-blinded controlled study | Test scores for FES intervention showed better improvement | 6 months after stroke onset | |||
FES therapy [52] | FES therapy on triceps and anterior deltoid | 18 sessions of 60 min. therapy with diff. functional tasks | FES therapeutic intervention improved functionality tests score by 4.5 points | Hemorrhagic stroke | |||
NMES-neuromuscular electric stimulation [53][54][55][56][57][53,54,55,56,57] | To study the effect of NMES application on hemiplegic patients | ||||||
51.0 ± 44.0 | |||||||
2.5 ± 0.8 | Cyclic stimulation in randomized control studies | Satisfactory results have been observed | Acute/subacute phase of stroke but applicable in chronic phase as well | ||||
3.7 ± 0.5 | 2.8 ± 0.6 | FES [58] | For analysing the effect of FES in patients with hemiplegia | Randomly controlled FES session of 6 weeks for 6 h everyday | UL motor functions were significantly improved | Hemiplegia with subluxation | |
FES-ET [59] | Potency check of FES therapy | Comparative controlled strategy | Obtained satisfactory results | Stroke subacute phase (UL hemiplegia) | |||
Control Group | 20.5 ± 15.5 | 39.0 ± 33.25 | NIBS [60]][60[61],61[62][63,62,63] | To test the results of tDCS and tMS | Modulation of cortical excitability | Effective and feasible | Motor disability due to Stroke |
NIBS [64] | Application of tDCS for UL rehabilitation | Placebo controlled mechanism | Encouraging outcomes in terms of recovery duration | Post ischemic stroke disability | |||
NIBS [65] | |||||||
] | |||||||
[ |
Technique | Focus | Strategy | Comparison with Conventional Therapy | Disability |
---|---|---|---|---|
FES (functional electric stimulation) [50] | ||||
3. J-T | ||||
FES group | 60.0 ± 18.0 | 5.70 ± 4.20 | ||
83 | ||||
, | ||||
84 | ||||
, | ||||
85 | ||||
] | To understand the effect of VR for stroke rehabilitation | Stroke patients were included in the study | General experience indicated positive results | Post stroke disability |
VR [86][87][88][86,87,88] | To analyse the efficacy of virtual rehabilitation | Different databases were examined in a review | Sufficient satisfactory results were observed | Functional disability |
VR [89] | ||||
Robot assisted therapy | ||||
[103]103[104][,104105][,105106][107][,106,107] | To compare the results of EULT and robotic therapy based on MIT robotic gym | Repetitive functional therapy | Not significant improvement was observed in UL functionality | UL disability |
Tele rehabilitation [108][109][108,109] | To check the feasibility of tele rehabilitation system |
Test Type | Baseline Score | 12th Week Score | |||||
---|---|---|---|---|---|---|---|
Outpatient therapy | |||||||
As effective as clinical based therapies | |||||||
Motor disability | |||||||
Tele rehabilitation | |||||||
[ | |||||||
111 | |||||||
] | |||||||
1. B&B | |||||||
[ | |||||||
FES group | 7.00 ± 0.00 | ||||||
[ | |||||||
66 | |||||||
] | |||||||
[ | |||||||
67 | |||||||
][68][69][70][71][65,66,67,68,69,70,71] | Neuromodulation using NIBS | Regulation of cortical excitability with r-tMS | safe and effective | UL disability after stroke | |||
Control Group | 60.0 ± 39.75 | 10.0 ± 7.87 | NIBS [72][73][74][72,73,74] | Application of anodal non-invasive t-DCS as motor therapy | Meta analysis of 23 studies with >500 patients in total | Positive but not-sufficient outcomes to reach any conclusion. | UL disability due to chronic stroke |
Epidural stimulation invasive [75][76][75,76] | To check the efficacy and feasibility of EECS | Single blinded and multicenter study | Better recovery rate was recorded as compared to the control group | Moderate to severe ischemic stroke patients with UL disability | |||
Cortical electric stimulation [77][78][77,78] | Rehabilitation of motor activity of UL | Stimulation of motor cortex of animal models | Satisfactory results were observed | Disability of UL | |||
Stimulation of motor cortex [79][80][81][82][79,80,81,82] | To understand the neurological characteristics through motor cortex & deep brain stimulation | stroke subjects were included in the studies | 48–50% patients showed positive results | Post stroke pain | |||
VR rehabilitation [83][84][85 | |||||||
[90][[93][8991][92],90,91,92,93] | Rehabilitation of motor activity | PC-based VR systems were designed and pilot trials were performed | Satisfactory improvements were observed in hand parameters | Chronic stroke patients | |||
Task-oriented therapy [94] | To test the functional and impairment efficacies of task-oriented therapy | 20 patients were included in a Single-blinded randomized study | Group who received task-oriented exercises showed better recovery rate | Post stroke UL disability | |||
Task-oriented therapy [95][96][97][98][99][100][101][95,96,97,98,99,100,101] | Optimization of locomotor relearning | Aerobic complex task trainings | Motor abilities of the patients improved after therapy session | Chronic stroke patients | |||
Robotic therapy [102] | To design a robot based therapeutic system | Robot based training | Positive but not satisfactory | Functional disability | |||
Tele rehabilitation | |||||||
[110] |
To examine the efficacy of tele rehabilitation | Different data bases from MADLINE, Cochrane, and Embase were collected and analyzed | No adverse events were reported, considered to be an emerging field however more trials are needed | Post stroke motor disability | |||
112][113][111,112,113] | Use of tele rehabilitation for accommodating the stroke patients on large scale | Activity based therapies | Appears to be a holistic approach | Patients of functional disability |
3.1 ± 0.6 | |||
Functional independence | |||
76.7 ± 12.0 | 80.2 ± 6.9 | 77.3 ± 12.0 | 77.6 ± 12.0 |