The Burden of Clostridium Difficile Infection in Post-Stroke Rehabilitation

Nathali Plute^*
*Correspondence: Nathali Plute, Department of Medicine, Rehabilitation Teaching and Research Unit, University of Otago, Wellington, New Zealand, Email:

Introduction

The purpose of this article is to provide the first comprehensive metaanalysis and systematic review comparing the effectiveness of Virtual Reality (VR) and transcranial Direct Current Stimulation (tDCS) in the rehabilitation of upper extremity function in stroke patients. Stroke is a prevalent condition that significantly impacts quality of life, with the ability to perform activities of daily living being a key determinant of a patient's overall well-being. While the Barthel Index (BI) is a valuable measure for assessing self-care and mobility, it does not evaluate cognitive, speech, visual, or pain-related functions. Despite this, the BI remains a reliable and valid indicator of functional status. Interestingly, the results of this review showed a significant improvement in the BI scores when tDCS was combined with VR compared to VR alone, suggesting that the combined treatment improved the quality of life of stroke patients more effectively than VR by itself. To assess upper extremity impairment, the Fugl-Meyer Upper Extremity (FM-UE) scale was used, which is a commonly applied measure for evaluating motor function. However, the meta-analysis revealed that the combination of tDCS and VR did not lead to better improvements in FM-UE scores compared to VR alone. Additionally, the Box and Block Test (BBT) was used to measure upper extremity function by assessing the number of blocks an affected hand can grasp and release within one minute. This test provides valuable insight into motor recovery in various patient populations [1].

Description

Stroke patients often face motor impairments in their upper extremities, which can significantly impact their daily activities. The main goal of stroke treatment is to reduce brain damage and promote recovery. Researchers are exploring various innovative approaches to neurorehabilitation to determine which methods are most effective or suitable for different populations. One such approach, constraint-induced movement therapy, has been shown to improve upper extremity movement and function in stroke rehabilitation. A review of 45 studies found that robot-assisted upper extremity training can enhance muscle strength, function and quality of life without increasing risks. Thieme and colleagues discovered that mirror therapy, which creates the illusion that the affected limb is moving like the unaffected one, can reduce pain and improve motor function. Additionally, neuromuscular electrical stimulation was found to improve Fugl-Meyer scale and MAS scores, with these improvements lasting up to six months [2,3].

A network meta-analysis has shown that cathodal transcranial direct current stimulation (tDCS) is the most effective treatment option for improving the capacity for activities of daily living following a stroke, compared to other forms of tDCS and physical rehabilitation. Ahmed et al. found that among various types of electric neurostimulation, both tDCS and transcranial vagus nerve stimulation were particularly effective. Subramanian et al. reported that combining noninvasive brain stimulation with virtual reality holds promise for subacute stroke rehabilitation. However, the study included a wide range of stimulation methods, such as tDCS and repetitive transcranial magnetic stimulation and involved both stroke patients and healthy volunteers. Importantly, no meta-analysis has directly compared the effectiveness of virtual reality alone versus combination treatment for upper limb training in stroke patients. This raises the question: is combination treatment necessary for stroke patients? Both patients and clinicians need more evidence to guide treatment decisions [4].

In the brief period of time following the stroke, there would be varying degrees of spontaneous rehabilitation. Each patient's spontaneous rehabilitation was very different. This cycle was significant and worked with by different medications or restoration measures. We were also bothered by the delay in initiating rehabilitation measures. Kwakkel, others proposed that FM-UE scores in no less than about a month post-stroke were unequivocally connected with long haul forecast. The majority of the patients who participated in Yao et al.'s study were in the subacute phase and significantly improved in FM-UE following VR and tDCS treatment. The other study did not reach the same conclusion because it only included patients with chronic stroke. Furthermore, the cathodal terminal was set over the hand region of the unaffected engine cortex in 3 RCTs, while the anodal terminal was set over the essential engine cortex of the impacted half of the globe in another RCT [5].

Conclusion

It is identified that early recurrence (defined as a relapse within two months of CDI treatment) and delayed recurrence (defined as a relapse after two months of CDI treatment) rates of 19.2% and 19.5%, respectively. Patients who experienced an early recurrence showed a significantly higher rate of delayed recurrence at 42.1%. Furthermore, the two-year mortality rate following CDI diagnosis was notably high at 32.5%, suggesting that a CDI diagnosis may serve as an important predictor of mortality due to underlying diseases.

References

1. Ricciardi, Rocco, David A. Rothenberger, Robert D. Madoff and Nancy N. Baxter. "Increasing prevalence and severity of C. difficile colitis in hospitalized patients in the United States." Arch Surg 142 (2007): 624-631.

   Google Scholar, Crossref, Indexed at

2. Cohen, Stuart H., Dale N. Gerding, Stuart Johnson and Ciaran P. Kelly, et al. "Clinical practice guidelines for C. difficile infection in adults: 2010 update by the society for healthcare epidemiology of America (SHEA) and the infectious diseases society of America (IDSA)." Clin Infect Dis 31 (2010): 431-455.

   Google Scholar, Crossref, Indexed at