Correlation of Brain-Derived Neurotrophic Factor and Fugl-Meyer Score Changes after Telerehabilitation in Stroke
-
Husnul Mubarak
,
Andi Asadul Islam
,
Andi Kurnia Bintang
,
Muhammad Nasrum Massi
,
Hening Laswati Putra
,
Jumraini Tammasse
,
Susi Aulina
,
Agussalim Bukhari
,
Firdaus Hamid
,
Andi Alfian Zainuddin
,
Edwin Putra Pomada
Abstract
Background: Early post-stroke rehabilitation reduces disability and improves quality of life. However, limited access to rehabilitation facilities can be challenging. Home-based telerehabilitation emerges as a viable solution to reach distant stroke populations. Motoric recovery relies on penumbral reorganization and restructuring. Brain-Derived Neurotrophic Factor (BDNF) plays a crucial role in synaptic plasticity regulation. Yet, the impact of additional rehabilitation sessions on BDNF levels and motoric function in post-stroke patients remains unexplored.
Method: A randomized controlled trial was conducted, involving 50 stroke patients from June to September 2023. Medical history was assessed via a questionnaire, and motoric function was evaluated using the Fugl-Meyer Assessment (FMA). Blood samples were drawn to measure BDNF levels. The intervention included prescribing home-based exercises using a telerehabilitation application on cellphones for 12 weeks. BDNF levels and FMA scores were reassessed at the study's conclusion.
Result: Significant increases in BDNF and FMA scores were observed in the mobile-based telerehabilitation group. The increment of BDNF and FMA in the intervention group exceeded that of the control group.
Conclusion: Mobile-based telerehabilitation proves superior to conventional home exercise programs for delivering home-based therapeutic exercises.
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10. Sasi M, Vignoli B, Canossa M, Blum R. Neurobiology of local and intercellular BDNF signaling. Pflugers Arch. 2017 Jun 9;469(5–6):593–610.
11. Ashcroft SK, Ironside DD, Johnson L, Kuys SS, Thompson-Butel AG. Effect of Exercise on Brain-Derived Neurotrophic Factor in Stroke Survivors: A Systematic Review and Meta-Analysis. Stroke. 2022 Dec;53(12):3706–16.
12. Mitre M, Mariga A, Chao MV. Neurotrophin signalling: novel insights into mechanisms and pathophysiology. Clin Sci. 2017 Jan 1;131(1):13–23.
13. Dhingra N, Diepart M, Dziekan G, Khamassi S, Otaiza F, Wilburn S, et al. WHO Guidelines on Drawing Blood: Best Practices in phlebotomy. Cadman H, editor. Geneva: World Health Organization; 2010.
14. Vijayan M, Reddy PH. Stroke, Vascular Dementia, and Alzheimer’s Disease: Molecular Links. Journal of Alzheimer’s Disease. 2016 Sep 6;54(2):427–43.
15. Boehme AK, Esenwa C, Elkind MSV. Stroke Risk Factors, Genetics, and Prevention. Circ Res. 2017 Feb 3;120(3):472–95.
16. Metabolic mediators of the effects of body-mass index, overweight, and obesity on coronary heart disease and stroke: a pooled analysis of 97 prospective cohorts with 1·8 million participants. The Lancet. 2014 Mar;383(9921):970–83.
17. Eichler S, Salzwedel A, Rabe S, Mueller S, Mayer F, Wochatz M, et al. The Effectiveness of Telerehabilitation as a Supplement to Rehabilitation in Patients After Total Knee or Hip Replacement: Randomized Controlled Trial. JMIR Rehabil Assist Technol. 2019 Nov 7;6(2):e14236.
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20. Pratama AD, Farelin AD, Karnadipa T, Pahlawi R, Noviana M, Abdullah F. The Application of Telerehabilitation for Pain Reduction and Improving Quality of Life in Workers with Work-Related Musculoskeletal Disorders: Systematic Review. In: ICVEAST. Basel Switzerland: MDPI; 2023. p. 45.
21. Sari F, Oskay D, Tufan A. Effects of a telerehabilitation-based exercise program in patients with systemic sclerosis. Z Rheumatol. 2024 Feb 25;83(S1):167–74.
22. Pathak A, Gyanpuri V, Dev P, Dhiman N. The Bobath Concept (NDT) as rehabilitation in stroke patients: A systematic review. J Family Med Prim Care. 2021;10(11):3983.
23. Geng H, Li M, Tang J, Lv Q, Li R, Wang L. Early Rehabilitation Exercise after Stroke Improves Neurological Recovery through Enhancing Angiogenesis in Patients and Cerebral Ischemia Rat Model. Int J Mol Sci. 2022 Sep 10;23(18):10508.
24. Pumprasart T, Pramodhyakul N, Piriyaprasarth P. The effect of the Bobath therapy programme on upper limb and hand function in chronic stroke individuals with moderate to severe deficits. Int J Ther Rehabil. 2019 Oct 2;26(10):1–12.
25. Kollen BJ, Lennon S, Lyons B, Wheatley-Smith L, Scheper M, Buurke JH, et al. The Effectiveness of the Bobath Concept in Stroke Rehabilitation. Stroke. 2009 Apr;40(4).
26. Alves SS, Ocamoto GN, de Camargo PS, Santos ATS, Terra AMSV. Effects of virtual reality and motor imagery techniques using Fugl Meyer Assessment scale in post-stroke patients. Int J Ther Rehabil. 2018 Nov 2;25(11):587–96.
27. Junata M, Cheng KCC, Man HS, Lai CWK, Soo YOY, Tong RKY. Kinect-based rapid movement training to improve balance recovery for stroke fall prevention: a randomized controlled trial. J Neuroeng Rehabil. 2021 Dec 11;18(1):150.
28. Wu Z, Xu J, Yue C, Li Y, Liang Y. Collaborative Care Model Based Telerehabilitation Exercise Training Program for Acute Stroke Patients in China: A Randomized Controlled Trial. Journal of Stroke and Cerebrovascular Diseases. 2020 Dec;29(12):105328.
29. Chen J, Sun D, Zhang S, Shi Y, Qiao F, Zhou Y, et al. Effects of home-based telerehabilitation in patients with stroke. Neurology. 2020 Oct 27;95(17).
30. Federico S, Cacciante L, De Icco R, Gatti R, Jonsdottir J, Pagliari C, et al. Telerehabilitation for Stroke: A Personalized Multi-Domain Approach in a Pilot Study. J Pers Med. 2023 Dec 6;13(12):1692.
31. Pelosi AD, Roth N, Yehoshua T, Itah D, Braun Benyamin O, Dahan A. Personalized rehabilitation approach for reaching movement using reinforcement learning. Sci Rep. 2024 Jul 30;14(1):17675.
32. Scrivener K, Dorsch S, McCluskey A, Schurr K, Graham PL, Cao Z, et al. Bobath therapy is inferior to task-specific training and not superior to other interventions in improving lower limb activities after stroke: a systematic review. J Physiother. 2020 Oct;66(4):225–35.
33. Pathak A, Gyanpuri V, Dev P, Dhiman NR. The Bobath Concept (NDT) as rehabilitation in stroke patients. J Family Med Prim Care. 2021 Nov;10(11):3983–90.
34. Díaz-Arribas MJ, Martín-Casas P, Cano-de-la-Cuerda R, Plaza-Manzano G. Effectiveness of the Bobath concept in the treatment of stroke: a systematic review. Disabil Rehabil. 2020 Jun 4;42(12):1636–49.
35. Schmolesky MT, Webb DL, Hansen RA. The effects of aerobic exercise intensity and duration on levels of brain-derived neurotrophic factor in healthy men. J Sports Sci Med. 2013;12(3):502–11.
36. Ament W, Verkerke GJ. Exercise and Fatigue. Sports Medicine. 2009;39(5):389–422.
37. Upadhyaya P, Nandyala A, Ailani J. Primary Exercise Headache. Curr Neurol Neurosci Rep. 2020 May 15;20(5):9.
38. Sandoe CH, Kingston W. Exercise Headache: a Review. Curr Neurol Neurosci Rep. 2018 Jun 19;18(6):28.
39. Wilson PB. ‘I think I’m gonna hurl’: A Narrative Review of the Causes of Nausea and Vomiting in Sport. Sports. 2019 Jul 4;7(7):162.
2. Dodakian L, McKenzie AL, Le V, See J, Pearson-Fuhrhop K, Burke Quinlan E, et al. A Home-Based Telerehabilitation Program for Patients With Stroke. Neurorehabil Neural Repair. 2017;
3. Markus HS, Brainin M. COVID-19 and stroke—A global World Stroke Organization perspective. International Journal of Stroke. 2020;
4. Sarfo FS, Ulasavets U, Opare-Sem OK, Ovbiagele B. Tele-Rehabilitation after Stroke: An Updated Systematic Review of the Literature. Journal of Stroke and Cerebrovascular Diseases. 2018 Sep;27(9):2306–18.
5. Khan F, Amatya B. Medical Rehabilitation in Pandemics: Towards a New Perspective. J Rehabil Med. 2020;52(4):jrm00043.
6. Jiao Y, Liu YW, Chen WG, Liu J. Neuroregeneration and functional recovery after stroke: Advancing neural stem cell therapy toward clinical application. Neural Regeneration Research. 2021.
7. Singh AA, Katiyar S, Song M. Phytochemicals Targeting BDNF Signaling for Treating Neurological Disorders. Brain Sci. 2025 Feb 27;15(3):252.
8. Cefis M, Chaney R, Wirtz J, Méloux A, Quirié A, Leger C, et al. Molecular mechanisms underlying physical exercise-induced brain BDNF overproduction. Front Mol Neurosci. 2023 Oct 5;16.
9. Adachi N. New insight in expression, transport, and secretion of brain-derived neurotrophic factor: Implications in brain-related diseases. World J Biol Chem. 2014;5(4):409.
10. Sasi M, Vignoli B, Canossa M, Blum R. Neurobiology of local and intercellular BDNF signaling. Pflugers Arch. 2017 Jun 9;469(5–6):593–610.
11. Ashcroft SK, Ironside DD, Johnson L, Kuys SS, Thompson-Butel AG. Effect of Exercise on Brain-Derived Neurotrophic Factor in Stroke Survivors: A Systematic Review and Meta-Analysis. Stroke. 2022 Dec;53(12):3706–16.
12. Mitre M, Mariga A, Chao MV. Neurotrophin signalling: novel insights into mechanisms and pathophysiology. Clin Sci. 2017 Jan 1;131(1):13–23.
13. Dhingra N, Diepart M, Dziekan G, Khamassi S, Otaiza F, Wilburn S, et al. WHO Guidelines on Drawing Blood: Best Practices in phlebotomy. Cadman H, editor. Geneva: World Health Organization; 2010.
14. Vijayan M, Reddy PH. Stroke, Vascular Dementia, and Alzheimer’s Disease: Molecular Links. Journal of Alzheimer’s Disease. 2016 Sep 6;54(2):427–43.
15. Boehme AK, Esenwa C, Elkind MSV. Stroke Risk Factors, Genetics, and Prevention. Circ Res. 2017 Feb 3;120(3):472–95.
16. Metabolic mediators of the effects of body-mass index, overweight, and obesity on coronary heart disease and stroke: a pooled analysis of 97 prospective cohorts with 1·8 million participants. The Lancet. 2014 Mar;383(9921):970–83.
17. Eichler S, Salzwedel A, Rabe S, Mueller S, Mayer F, Wochatz M, et al. The Effectiveness of Telerehabilitation as a Supplement to Rehabilitation in Patients After Total Knee or Hip Replacement: Randomized Controlled Trial. JMIR Rehabil Assist Technol. 2019 Nov 7;6(2):e14236.
18. Amirabadi N, Hessam M, Monjezi S, Molhemi F, Mehravar M, Hosseinpour P. Effectiveness of telerehabilitation intervention to improve pain and physical function in people with patellofemoral pain syndrome: study protocol for a randomized controlled trial. Trials. 2024 Mar 19;25(1):195.
19. Dias JF, Oliveira VC, Borges PRT, Dutra FCMS, Mancini MC, Kirkwood RN, et al. Effectiveness of exercises by telerehabilitation on pain, physical function and quality of life in people with physical disabilities: a systematic review of randomised controlled trials with GRADE recommendations. Br J Sports Med. 2021 Feb;55(3):155–62.
20. Pratama AD, Farelin AD, Karnadipa T, Pahlawi R, Noviana M, Abdullah F. The Application of Telerehabilitation for Pain Reduction and Improving Quality of Life in Workers with Work-Related Musculoskeletal Disorders: Systematic Review. In: ICVEAST. Basel Switzerland: MDPI; 2023. p. 45.
21. Sari F, Oskay D, Tufan A. Effects of a telerehabilitation-based exercise program in patients with systemic sclerosis. Z Rheumatol. 2024 Feb 25;83(S1):167–74.
22. Pathak A, Gyanpuri V, Dev P, Dhiman N. The Bobath Concept (NDT) as rehabilitation in stroke patients: A systematic review. J Family Med Prim Care. 2021;10(11):3983.
23. Geng H, Li M, Tang J, Lv Q, Li R, Wang L. Early Rehabilitation Exercise after Stroke Improves Neurological Recovery through Enhancing Angiogenesis in Patients and Cerebral Ischemia Rat Model. Int J Mol Sci. 2022 Sep 10;23(18):10508.
24. Pumprasart T, Pramodhyakul N, Piriyaprasarth P. The effect of the Bobath therapy programme on upper limb and hand function in chronic stroke individuals with moderate to severe deficits. Int J Ther Rehabil. 2019 Oct 2;26(10):1–12.
25. Kollen BJ, Lennon S, Lyons B, Wheatley-Smith L, Scheper M, Buurke JH, et al. The Effectiveness of the Bobath Concept in Stroke Rehabilitation. Stroke. 2009 Apr;40(4).
26. Alves SS, Ocamoto GN, de Camargo PS, Santos ATS, Terra AMSV. Effects of virtual reality and motor imagery techniques using Fugl Meyer Assessment scale in post-stroke patients. Int J Ther Rehabil. 2018 Nov 2;25(11):587–96.
27. Junata M, Cheng KCC, Man HS, Lai CWK, Soo YOY, Tong RKY. Kinect-based rapid movement training to improve balance recovery for stroke fall prevention: a randomized controlled trial. J Neuroeng Rehabil. 2021 Dec 11;18(1):150.
28. Wu Z, Xu J, Yue C, Li Y, Liang Y. Collaborative Care Model Based Telerehabilitation Exercise Training Program for Acute Stroke Patients in China: A Randomized Controlled Trial. Journal of Stroke and Cerebrovascular Diseases. 2020 Dec;29(12):105328.
29. Chen J, Sun D, Zhang S, Shi Y, Qiao F, Zhou Y, et al. Effects of home-based telerehabilitation in patients with stroke. Neurology. 2020 Oct 27;95(17).
30. Federico S, Cacciante L, De Icco R, Gatti R, Jonsdottir J, Pagliari C, et al. Telerehabilitation for Stroke: A Personalized Multi-Domain Approach in a Pilot Study. J Pers Med. 2023 Dec 6;13(12):1692.
31. Pelosi AD, Roth N, Yehoshua T, Itah D, Braun Benyamin O, Dahan A. Personalized rehabilitation approach for reaching movement using reinforcement learning. Sci Rep. 2024 Jul 30;14(1):17675.
32. Scrivener K, Dorsch S, McCluskey A, Schurr K, Graham PL, Cao Z, et al. Bobath therapy is inferior to task-specific training and not superior to other interventions in improving lower limb activities after stroke: a systematic review. J Physiother. 2020 Oct;66(4):225–35.
33. Pathak A, Gyanpuri V, Dev P, Dhiman NR. The Bobath Concept (NDT) as rehabilitation in stroke patients. J Family Med Prim Care. 2021 Nov;10(11):3983–90.
34. Díaz-Arribas MJ, Martín-Casas P, Cano-de-la-Cuerda R, Plaza-Manzano G. Effectiveness of the Bobath concept in the treatment of stroke: a systematic review. Disabil Rehabil. 2020 Jun 4;42(12):1636–49.
35. Schmolesky MT, Webb DL, Hansen RA. The effects of aerobic exercise intensity and duration on levels of brain-derived neurotrophic factor in healthy men. J Sports Sci Med. 2013;12(3):502–11.
36. Ament W, Verkerke GJ. Exercise and Fatigue. Sports Medicine. 2009;39(5):389–422.
37. Upadhyaya P, Nandyala A, Ailani J. Primary Exercise Headache. Curr Neurol Neurosci Rep. 2020 May 15;20(5):9.
38. Sandoe CH, Kingston W. Exercise Headache: a Review. Curr Neurol Neurosci Rep. 2018 Jun 19;18(6):28.
39. Wilson PB. ‘I think I’m gonna hurl’: A Narrative Review of the Causes of Nausea and Vomiting in Sport. Sports. 2019 Jul 4;7(7):162.
| Issue | Articles in Press | |
| Section | Research Article(s) | |
| Keywords | ||
| Stroke; brain-derived neurotrophic factor; telerehabilitation; recovery of function | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Mubarak H, Islam A, Bintang A, Massi M, Putra H, Tammasse J, Aulina S, Bukhari A, Hamid F, Zainuddin A, Pomada E. Correlation of Brain-Derived Neurotrophic Factor and Fugl-Meyer Score Changes after Telerehabilitation in Stroke. jmr. 2025;(-).
