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Sample records for central post-stroke pain

  1. Analgesic effect of transcranial direct current stimulation on central post-stroke pain.

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    Bae, Sea-Hyun; Kim, Gi-Do; Kim, Kyung-Yoon

    2014-01-01

    Pain that occurs after a stroke lowers the quality of life. Such post-stroke pain is caused in part by the brain lesion itself, called central post-stroke pain. We investigated the analgesic effects of transcranial direct current stimulation (tDCS) in stroke patients through quantitative sensory testing. Fourteen participants with central post-stroke pain (7 female and 7 male subjects) were recruited and were allocated to either tDCS (n = 7) or sham-tDCS (n = 7) group. Their ages ranged from 45 to 55 years. tDCS was administered for 20 min at a 2-mA current intensity, with anodal stimulations were performed at primary motor cortex. The sham-tDCS group was stimulated 30-second current carrying time. Both group interventions were given for 3 days per week, for a period of 3 weeks. Subjective pain was measured using the visual analogue scale (VAS) of 0 to 10. Sensations of cold and warmth, and pain from cold and heat were quantified to examine analgesic effects. The sham-tDCS group showed no statistically significant differences in time. In contrast, tDCS group showed decreased VAS scores and skin temperature (p temperatures for the sense of cold and pain from cold increased (p heat decreased (p stroke patients with central post-stroke pain. PMID:25341455

  2. Population-based study of central post-stroke pain in Rimini district, Italy

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    Raffaeli W

    2013-09-01

    Full Text Available William Raffaeli,1 Cristina E Minella,2 Francesco Magnani,3 Donatella Sarti3 1ISAL Foundation, Institute for Research on Pain, Torre Pedrera, Rimini, Italy 2Pain Therapy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy 3Department of Pain Therapy and Palliative Care, Infermi Hospital, Rimini, Italy Abstract: Central post-stroke pain (CPSP is still an underestimated complication of stroke, resulting in impaired quality of life and, in addition to the functional and cognitive consequences of stroke, the presence of CPSP may be associated with mood disorders, such as depression, anxiety, and sleep disturbances. This type of pain may also impair activities of daily living and further worsen quality of life, negatively influencing the rehabilitation process. The prevalence of CSPS in the literature is highly variable (1%–12% according to different studies, and this variability could be influenced by selection criteria and the different ethnic populations being investigated. With this scenario in mind, we performed a population-based study to assess the prevalence of CPSP and its main features in a homogeneous health district (Rimini, Italy, including five hospitals for a total population of 329,970 inhabitants. From 2008 to 2010, we selected 1,494 post-stroke patients and were able to interview 660 patients, 66 (11% of whom reported pain with related tactile and thermal hyperesthesia, accompanied by needle puncture, tingling, swelling, and pressure sensations. Patients reported motor impairment and disability, which influenced their working ability, rehabilitation, and social life. Despite this severe pain state, there was a high percentage of patients who did not receive adequate treatment for pain. Keywords: stroke, central post-stroke pain, disability

  3. Caloric Vestibular Stimulation Reduces Pain and Somatoparaphrenia in a Severe Chronic Central Post-Stroke Pain Patient: A Case Study.

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    Grazia Fernanda Spitoni

    Full Text Available Central post-stroke pain is a neuropathic syndrome characterized by intolerable contralesional pain and, in rare cases, somatic delusions. To date, there is limited evidence for the effective treatments of this disease. Here we used caloric vestibular stimulation to reduce pain and somatoparaphrenia in a 57-year-old woman suffering from central post-stroke pain. Resting-state functional magnetic resonance imaging was used to assess the neurological effects of this treatment. Following vestibular stimulation we observed impressive improvements in motor skills, pain, and somatic delusions. In the functional connectivity study before the vestibular stimulation, we observed differences in the patient's left thalamus functional connectivity, with respect to the thalamus connectivity of a control group (N = 20, in the bilateral cingulate cortex and left insula. After the caloric stimulation, the left thalamus functional connectivity with these regions, which are known to be involved in the cortical response to pain, disappeared as in the control group. The beneficial use of vestibular stimulation in the reduction of pain and somatic delusion in a CPSP patient is now documented by behavioral and imaging data. This evidence can be applied to theoretical models of pain and body delusions.

  4. The Effects of Lamotrigine on Pain, Sleep, and Mood in Refractory Form of Central Post-Stroke Pain Syndrome

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    Peyman Petramfar

    2010-12-01

    Full Text Available Background: Central post-stroke pain (CPSP is a distressingpain syndrome, sometimes become refractory to the conventionalpain managements. Anticonvulsants have been used toalleviate different central pains. Lamotrigine is a novel anticonvulsantand its proper dosage and its efficacy have notbeen well studied yet. The aim of this study was to evaluatethe effect of 100 mg lamotrigine on refractory form of CPSP.Methods: The medical files of 17 patients with CPSP who hadnot responded to the other drugs and were treated with lamotriginewere studied. Using Brief Pain Inventory, pain, sleepand mood were assessed before, and after 8 and 24 weeks oftreatment.Results: After 24 weeks, 70.5 % of the patients responded tolamotrigine, and there was an improvement of 2.41 in themean score of average pain (P=0.001.Conclusion: Lamotrigine 100 mg daily was effective in thetreatment of refractory CPSP, and might be prescribed beforeplanning for more aggressive surgical managements.Iran J Med Sci 2010; 35(4: 299-303.

  5. Efficacy of methylprednisolone versus other pharmacologic interventions for the treatment of central post-stroke pain: a retrospective analysis

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    Pellicane AJ

    2013-07-01

    Full Text Available Anthony J Pellicane, Scott R Millis Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine, Rehabilitation Institute of Michigan in the Detroit Medical Center, Detroit, MI, USA Purpose: To determine if an oral, tapered methylprednisolone regimen is superior to other commonly used pharmacologic interventions for the treatment of central post-stroke pain (CPSP. Patients and methods: In this study, the charts of 146 stroke patients admitted to acute inpatient rehabilitation were retrospectively reviewed. Patients diagnosed with CPSP underwent further chart review to assess numerical rating scale for pain scores and as-needed pain medication usage at different time points comparing CPSP patients treated with methylprednisolone to those treated with other pharmacologic interventions. Results: In the sample, 8.2% were diagnosed with CPSP during acute care or inpatient rehabilitation. Mean numerical rating scale for pain scores day of symptom onset did not differ between those patients treated with methylprednisolone versus those treated with other pharmacologic interventions (mean ± standard deviation; 6.1 ± 2.3 versus 5.7 ± 1.6, P = 0.77. However, mean numerical rating scale for pain scores differed significantly 1-day after treatment initiation (1.7 ± 2.1 versus 5.0 ± 1.9, P = 0.03 and 1-day prior to rehabilitation discharge (0.3 ± 0.9 versus 4.1 ± 3.2, P = 0.01 between the two groups. Compared to day of symptom onset, as-needed pain medication usage within the methylprednisolone group was marginally less 1-day after treatment initiation (Z = -1.73, P = 0.08 and 1-day prior to rehabilitation discharge (Z = -1.89, P = 0.06. No difference in as-needed pain medication usage existed within the non-steroid group at the same time points. Conclusion: Methylprednisolone is a potential therapeutic option for CPSP. The findings herein warrant study in prospective trials. Keywords: stroke, pain, central post-stroke

  6. The antalgic effects of non-invasive physical modalities on central post-stroke pain: a systematic review.

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    Chen, Chih-Chung; Chuang, Yu-Fen; Huang, Andrew Chih-Wei; Chen, Chih-Kuang; Chang, Ya-Ju

    2016-04-01

    [Purpose] This study systematically reviewed the antalgic effects of non-invasive physical modalities (NIPMs) on central post-stroke pain (CPSP). [Subjects and Methods] Clinical studies were sought on September 2015 in 10 electronic databases, including Medline and Scopus. The searching strings were "central pain and stroke" and "treatment, and physical or non-pharmacological". The inclusion and exclusion criteria were set for screening the clinical articles by two reviewers. Pain scores on visual analog scale in an article were used as the outcome measure for resulting judgment. The NIPMs intervention summarized from the eligible articles was rated from Levels A to C according to Evidence Classification Scheme for Therapeutic Interventions. [Results] Over 1200 articles were identified in the initial searches and 85 studies were retrieved. Sixteen studies were eligible and judged. Caloric vestibular stimulation (n=3), heterotopic noxious conditioning stimulation (n=1), and transcutaneous electrical stimulation (n=1) were rated below Level C. Transcranial direct current stimulation (TDCS; n=2) and transcranial magnetic stimulation (TMS; n=9) were rated as Level B. [Conclusion] The findings suggest that TMS and TDCS were better than other treatments for CPSP relief but the studies were of insufficient quality. PMID:27190485

  7. Brain stimulation therapy for central post-stroke pain from a perspective of interhemispheric neural network remodeling

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    Takashi eMorishita

    2016-04-01

    Full Text Available Central post-stroke pain (CPSP is a debilitating, severe disorder affecting patient quality of life. Since CPSP is refractory to medication, various treatment modalities have been tried with marginal results. Following the first report of epidural motor cortex stimulation (MCS for CPSP, many researchers have investigated the mechanisms of electrical stimulation of the motor cortex. CPSP is currently considered to be a maladapted network reorganization problem following stroke, and recent studies have revealed that the activities of the impaired hemisphere after stroke may be inhibited by the contralesional hemisphere. Even though this interhemispheric inhibition (IHI theory was originally proposed to explain the motor recovery process in stroke patients, we considered that IHI may also contribute to the CPSP mechanism. Based on the IHI theory and the fact that electrical stimulation of the motor cortex suppresses CPSP, we hypothesized that the inhibitory signals from the contralesional hemisphere may suppress the activities of the motor cortex in the ipsilesional hemisphere, and therefore pain suppression mechanisms may be malfunctioning in CPSP patients. In this context, transcranial direct current stimulation (tDCS was considered to be a reasonable procedure to address the interhemispheric imbalance, as the bilateral motor cortex can be simultaneously stimulated using an anode (excitatory and cathode (inhibitory. In this paper, we review the potential mechanisms and propose a new model of CPSP. We also report two cases where CPSP was addressed with transcranial direct current stimulation (tDCS, discuss the potential roles of tDCS in the treatment of CPSP, and make recommendations for future studies.

  8. Brain Stimulation Therapy for Central Post-Stroke Pain from a Perspective of Interhemispheric Neural Network Remodeling.

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    Morishita, Takashi; Inoue, Tooru

    2016-01-01

    Central post-stroke pain (CPSP) is a debilitating, severe disorder affecting patient quality of life. Since CPSP is refractory to medication, various treatment modalities have been tried with marginal results. Following the first report of epidural motor cortex (M1) stimulation (MCS) for CPSP, many researchers have investigated the mechanisms of electrical stimulation of the M1. CPSP is currently considered to be a maladapted network reorganization problem following stroke, and recent studies have revealed that the activities of the impaired hemisphere after stroke may be inhibited by the contralesional hemisphere. Even though this interhemispheric inhibition (IHI) theory was originally proposed to explain the motor recovery process in stroke patients, we considered that IHI may also contribute to the CPSP mechanism. Based on the IHI theory and the fact that electrical stimulation of the M1 suppresses CPSP, we hypothesized that the inhibitory signals from the contralesional hemisphere may suppress the activities of the M1 in the ipsilesional hemisphere, and therefore pain suppression mechanisms may be malfunctioning in CPSP patients. In this context, transcranial direct current stimulation (tDCS) was considered to be a reasonable procedure to address the interhemispheric imbalance, as the bilateral M1 can be simultaneously stimulated using an anode (excitatory) and cathode (inhibitory). In this article, we review the potential mechanisms and propose a new model of CPSP. We also report two cases where CPSP was addressed with tDCS, discuss the potential roles of tDCS in the treatment of CPSP, and make recommendations for future studies.

  9. Pain management of hemiplegic shoulder pain post stroke in patients from Nanjing, China*

    Institute of Scientific and Technical Information of China (English)

    Yi Zhu; Bin Su; Ning Li; Hongzhu Jin

    2013-01-01

    We selected 106 hemiplegic patients with shoulder pain hospitalized after stroke from three hospit-als in Nanjing, China between February 2007 and January 2012. Al patients had complete clinical data sets and accounted for 45.5% of the inpatients because of stroke. Results showed that the number of patients with hemiplegic shoulder pain post stroke increased yearly, attacking mainly males 50-69 years of age. Of 106 patients, there were 60 cases (56.6%) of adhesive capsulitis, 19 (17.9%) of shoulder subluxation, 14 (13.2%) of complex regional pain syndrome, and 13 (12.6%) of central pain. The main symptoms were shoulder pain (100%), limit of shoulder mobility (98.1%), and adhesion of the scapula (56.6%). MRI of the shoulder showed tendon and ligament lesions (57.1%) and rotator cuff tear (38.1%). 53.8%of central pain was related to the thalamus, in addition to the basal ganglia, brain stem, and cerebel opontine angle. Shoulder pain, upper limb motor function, and function independence were significantly improved after comprehensive rehabilitation. In par-ticular, electroacupuncture based on basic physical therapy exhibited efficacy on shoulder tion and complex regional pain syndrome. Multiple linear regression results showed a negative re-lationship of efficacy of pain management with the attack period of shoulder pain, involvement of the posterior limb of the internal capsule, and duration between onset and rehabilitation treatment, but a positive correlation with pain-related education, pain regression period, and pain diagnosis.

  10. 自拟中风疼痛汤配合曲马多治疗中枢性卒中后疼痛%Zhongfeng-Tengtong decoction combined with pregabalin for central post-stroke pain

    Institute of Scientific and Technical Information of China (English)

    佟邵刚

    2016-01-01

    目的:评价自拟中风疼痛汤配合曲马多治疗中枢性卒中后疼痛(central post-stroke pain, CPSP)的临床疗效。方法将符合纳入标准的脑卒中患者121例,按随机数字表法分为联合治疗组61例,对照组60例。患者入组后均实施脑卒中常规二级预防,对照组在此基础上口服盐酸曲马多缓释片,联合治疗组在对照组基础上加服自拟中风疼痛汤,均治疗14 d。采用疼痛数字评价量表(Numerical Rating Scale, NRS)评价患者的疼痛程度;Fugl-Meyer运动功能量表(Fugl-Meyer Assessment, FMA)评价患者的运动功能;脑卒中专用的生活质量量表(Stroke Specific Quality of Life Scale, SS-QOL)评价患者的生活质量;观察记录2组患者治疗前后血液流变学指标的变化。结果治疗后,联合治疗组NRS评分[(2.5±0.4)分比(4.6±0.7)分,t=20.303)低于对照组(P<0.01);FMA评分[(57.1±18.1)分比(44.2±12.5)分,t=4.702]、SS-QOL评分[(193.4±25.6)分比(165.4±22.8)分,t=6.536]均高于对照组(P<0.01);联合治疗组全血黏度[(4.22±0.13)mPa•s 比(4.56±0.41)mPa•s , t=14.452]、血浆黏度[(1.72±0.31)mPa•s 比(2.33±0.23)mPa•s,t=14.258]、纤维蛋白原[(3.72±0.49)g/L 比(4.98±0.41)g/L,t=17.783]、血栓形成系数[(0.76±0.30)比(1.11±0.20),t=8.178]均低于对照组(P<0.01)。结论中风疼痛汤联用曲马多可有效缓解CPSP患者疼痛症状,改善患者肢体运动功能,提高生活质量。%Objective To observe the clinical effect of Zhongfeng-Tengtong decoction combined with tramadol in the treatment of central post-stroke pain (CPSP). Methods A total of 121 patients with stroke were recruited in our hospital. The patients were randomly divided into 2 groups by the ramdom number table method, 61 patients in the treatment group and 60 in the control group. All patients received conventional treatment of stroke secondary prevention, and the control group received oral

  11. Ultrasonographic and clinical study of post-stroke painful hemiplegic shoulder

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    Rania E. Mohamed; Mohamed A. Amin; Ashraf A. Aboelsafa

    2014-01-01

    Aim of the work: To describe the structural abnormalities of the painful hemiplegic shoulder (PHS) by ultrasound (U/S) and their relationship with some clinical variables. Materials and methods: Eighty consecutive patients with post-stroke PHS were subjected to both clinical assessment and ultrasonographic examination of both shoulders. Ultrasonographic imaging data were classified into five grades. Results: The biceps tendon sheath effusion (51.25%) and the SA–SD bursitis (43.75%) were...

  12. Central poststroke pain: somatosensory abnormalities and the presence of associated myofascial pain syndrome

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    de Oliveira Rogério Adas; de Andrade Daniel; Machado André Guelman; Teixeira Manoel

    2012-01-01

    Abstract Background Central post-stroke pain (CPSP) is a neuropathic pain syndrome associated with somatosensory abnormalities due to central nervous system lesion following a cerebrovascular insult. Post-stroke pain (PSP) refers to a broader range of clinical conditions leading to pain after stroke, but not restricted to CPSP, including other types of pain such as myofascial pain syndrome (MPS), painful shoulder, lumbar and dorsal pain, complex regional pain syndrome, and spasticity-related ...

  13. Ultrasonographic and clinical study of post-stroke painful hemiplegic shoulder

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    Rania E. Mohamed

    2014-12-01

    Conclusion: Ultrasonography is an essential method in evaluation of post-stroke PHS. However, the U/S grades were not correlated with the stages of motor recovery. Avoiding overuse of the unaffected shoulder will be helpful for prevention of shoulder injuries following hemiplegic stroke.

  14. Comparative study of Acupuncture, Bee Venom Acupuncture and Bee Venom Herbal Acupuncture on the treatment of Post-stroke Hemiplegic Shoulder Pain

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    Jae Yong Eom

    2006-02-01

    Full Text Available Objective : This experiment was conducted to evaluate the effectiveness of Acupuncture, Bee Venom Acupuncture (BVA and Bee Venom Herbal Acupuncture (BVHA on post-stroke hemiplegic shoulder pain. Methods : 30 patients were randomly allocated into Acupuncture group, BVA group and BVHA group and was monitored weekly for 4 weeks; initial(T0, 1 week(T1, 2 weeks(T2, 3 weeks(T3 and 4 weeks(T4. Results : Visual analogue scale of shoulder pain showed significant decrease in BVA and BVHA groups compared to the Acupuncture group at T4 evaluation. Painless passive ROM of shoulder external rotation and Fugl-Meyer Motor Assessment of Upper Limb motor function showed significant increase in all groups. Modified Ashworth scale of the spasticity of upper limb showed no differences between the three groups. Conclusion : BVA & BVHA appears to be an effective in treating post-stroke hemiplegic shoulder pain. Further clinical studies must be done to obtain more concrete findings.

  15. Results availability for analgesic device, complex regional pain syndrome, and post-stroke pain trials: comparing the RReADS, RReACT, and RReMiT databases

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    Dufka, Faustine L.; Munch, Troels; Dworkin, Robert H.; Rowbotham, Michael C.

    2015-01-01

    Abstract Evidence-based medicine rests on the assumption that treatment recommendations are robust, free from bias, and include results of all randomized clinical trials. The Repository of Registered Analgesic Clinical Trials search and analysis methodology was applied to create databases of complex regional pain syndrome (CRPS) and central post-stroke pain (CPSP) trials and adapted to create the Repository of Registered Analgesic Device Studies databases for trials of spinal cord stimulation (SCS), repetitive transcranial magnetic stimulation (rTMS), and transcranial direct current stimulation (tDCS). We identified 34 CRPS trials, 18 CPSP trials, 72 trials of SCS, and 92 trials of rTMS/tDCS. Irrespective of time since study completion, 45% of eligible CRPS and CPSP trials and 46% of eligible SCS and rTMS/tDCS trials had available results (peer-reviewed literature, results entered on registry, or gray literature); peer-reviewed publications could be found for 38% and 39%, respectively. Examining almost 1000 trials across a spectrum of painful disorders (fibromyalgia, diabetic painful neuropathy, post-herpetic neuralgia, migraine, CRPS, CPSP) and types of treatment, no single study characteristic consistently predicts unavailability of results. Results availability is higher 12 months after study completion but remains below 60% for peer-reviewed publications. Recommendations to increase results availability include supporting organizations advocating for transparency, enforcing existing results reporting regulations, enabling all primary registries to post results, stating trial registration numbers in all publication abstracts, and reducing barriers to publishing “negative” trials. For all diseases and treatment modalities, evidence-based medicine must rigorously adjust for the sheer magnitude of missing results in formulating treatment recommendations. PMID:25599303

  16. Central Pain Syndrome

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    ... Enhancing Diversity Find People About NINDS NINDS Central Pain Syndrome Information Page Table of Contents (click to ... being done? Clinical Trials Organizations What is Central Pain Syndrome? Central pain syndrome is a neurological condition ...

  17. [Post Stroke Dementia].

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    Ihara, Masafumi

    2016-07-01

    Post-stroke dementia (PSD) is a clinical entity that encompasses all types of dementia following an index stroke. Current evidence suggests that 25-30% of ischemic stroke survivors develop immediate or delayed vascular cognitive impairment or vascular dementia. The type of stroke can be either ischemic, hemorrhagic or hypoperfusive. There are multiple risk factors for PSD including older age, family history, genetic variants, low educational status, vascular comorbidities, prior transient ischemic attack or recurrent stroke and depressive illness. Pre-stroke dementia refers to the occurrence of cognitive impairment before the index stroke, which may be caused by a vascular burden as well as insidious neurodegenerative changes. Neuroimaging determinants of dementia after stroke include silent brain infarcts, white matter changes, lacunar infarcts and medial temporal lobe atrophy. Published clinical trials have not been promising and there is little information on whether PSD can be prevented using pharmacological agents. Control of vascular disease risk and prevention of recurrent strokes are key to reducing the burden of cognitive decline and post-stroke dementia. Modern imaging and analysis techniques will help to elucidate the mechanism of PSD and establish better treatment. PMID:27395459

  18. 卒中后肩痛周围神经电生理学研究%Peripheral Nerve Electrophysiological Studies of Post Stroke Shoulder Pain

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    王青青; 李铁山; 阎文静; 王琳; 高正玉

    2012-01-01

    The motor nerve conduction velocity in axillaris nerve, musculocutaneous nerve, medianus nerve of shoulder-pain group were evaluated, we found that the compound muscle action potential(CMAP) amplitudes were significantly decreased compared with the without shoulder-pain group(P=0.000, 0.001, 0.000). The CMAP amplitude of ulnaris nerve was significantly lower on the affected side than that on the unaffected side in without shoulder-pain group(P=0.000). The sensory nerve action potential(SNAP) amplitude of ulnaris nerve was significantly smaller on the hemiplegic side in shoulder-pain group than that in without shoulder-pain group(P=0.000). The incidence of spontaneous electrical potential of the deltoid and biceps in shoulder-pain group were significantly higher than those in without shoulder-pain group(P=0.044,0.044). Conclusion Peripheral nerve damage was found in post stroke shoulder pain, injury to motor neuro may be important for development of neuropathic pain.%目的 通过对卒中后肩痛患者上肢进行神经传导速度检查及针极肌电图检查,观察卒中后肩痛患者周围神经电生理指标的变化.方法 选择符合入选标准的卒中住院患者40例,根据数字疼痛评分法(Numerical Pain Rating Scale,NPRS)分为肩痛组(26例)与无肩痛组(14例).分别进行双侧上肢神经传导速度检查和针极肌电图(electromyography,EMG)检查.结果 肩痛组惠侧腋神经、肌皮神经、正中神经复合肌肉动作电位(compound muscle action potentlal,CMAP)波幅较无肩痛组惠侧降低,差异有显著性(P=0.000,0.001,0.000);无肩痛组惠侧尺神经CMAP波幅较同组健侧降低,差异有显著性(P=0.00 0);肩痛组惠侧尺神经感觉神经动作电位(sensory nerve action potential,SNAP)波幅较无肩痛组患侧降低,差异有显著性(P=0.000).三角肌、肱二头肌自发电位出现率,肩痛组较无肩痛组增高,差异具有显著性(P=0.044,0.044).结论 卒中后肩痛患者伴有上肢周围

  19. Imaging central pain syndromes.

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    Veldhuijzen, Dieuwke S; Greenspan, Joel D; Kim, Jong H; Coghill, Robert C; Treede, Rolf-Detlef; Ohara, Shinji; Lenz, Frederick A

    2007-06-01

    Anatomic, functional, and neurochemical imaging studies have provided new investigative tools in the study of central pain. High-resolution imaging studies allow for precise determination of lesion location, whereas functional neuroimaging studies measure pathophysiologic consequences of injury to the central nervous system. Additionally, magnetic resonance spectroscopy evaluates lesion-induced neurochemical changes in specific brain regions that may be related to central pain. The small number of studies to date precludes definitive conclusions, but the recent findings provide information that either supports or refutes current hypotheses and can serve to generate new ideas.

  20. Central poststroke pain: somatosensory abnormalities and the presence of associated myofascial pain syndrome

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    de Oliveira Rogério Adas

    2012-09-01

    Full Text Available Abstract Background Central post-stroke pain (CPSP is a neuropathic pain syndrome associated with somatosensory abnormalities due to central nervous system lesion following a cerebrovascular insult. Post-stroke pain (PSP refers to a broader range of clinical conditions leading to pain after stroke, but not restricted to CPSP, including other types of pain such as myofascial pain syndrome (MPS, painful shoulder, lumbar and dorsal pain, complex regional pain syndrome, and spasticity-related pain. Despite its recognition as part of the general PSP diagnostic possibilities, the prevalence of MPS has never been characterized in patients with CPSP patients. We performed a cross-sectional standardized clinical and radiological evaluation of patients with definite CPSP in order to assess the presence of other non-neuropathic pain syndromes, and in particular, the role of myofascial pain syndrome in these patients. Methods CPSP patients underwent a standardized sensory and motor neurological evaluation, and were classified according to stroke mechanism, neurological deficits, presence and profile of MPS. The Visual Analogic Scale (VAS, McGill Pain Questionnaire (MPQ, and Beck Depression Scale (BDS were filled out by all participants. Results Forty CPSP patients were included. Thirty-six (90.0% had one single ischemic stroke. Pain presented during the first three months after stroke in 75.0%. Median pain intensity was 10 (5 to 10. There was no difference in pain intensity among the different lesion site groups. Neuropathic pain was continuous-ongoing in 34 (85.0% patients and intermittent in the remainder. Burning was the most common descriptor (70%. Main aggravating factors were contact to cold (62.5%. Thermo-sensory abnormalities were universal. MPS was diagnosed in 27 (67.5% patients and was more common in the supratentorial extra-thalamic group (P Conclusions The presence of MPS is not an exception after stroke and may present in association with CPSP

  1. The effect of Monkey Chair and Band exercise system on shoulder range of motion and pain in post-stroke patients with hemiplegia

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    Jeon, Hyun-Ju; An, Sangjoon; Yoo, Jinwoo; Park, No-Hyun; Lee, Kyu Hoon

    2016-01-01

    [Purpose] A simple rehabilitation device system for strengthening upper limb muscles in hemiplegic patients was developed. This system, which stimulates active exercise while accounting for intensity, time, and frequency, was examined in the present pilot study. [Subjects and Methods] Patients had shoulder pain and limited shoulder movement. Changes in range of motion (ROM) and scores of a visual analog scale (VAS) for pain were evaluated in the experimental and control groups every four weeks for twelve weeks. The modified motor assessment scale (MMAS) was used before and after experiments. [Results] Significant differences between experimental times in ROM for shoulder flexion, abduction, and adduction on the paralyzed side were observed in the experimental group at every time point. Pain VAS scores in the experimental group improved progressively and significantly with time, indicating a consistently increasing effect of exercise. There were significant differences between the MMAS scores before and after completion of the program in the experimental group. [Conclusion] Muscle strengthening is important in hemiplegic patients, and active exercise was more efficient than passive exercise in this regard. Rehabilitation with the Monkey Chair and Band system may represent an efficient and important tool in upper limb training and comprehensive modern rehabilitation therapy. PMID:27630403

  2. Hypernatremia secondary to post-stroke hypodipsia: just add water!

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    Ramthun, Maikel; Mocelin, Altair Jacob; Alvares Delfino, Vinicius Daher

    2011-01-01

    Disorders in water metabolism may occur in stroke patients. When hypernatremia arises in this setting, it is usually secondary to the development of central diabetes insipidus or it is the result of neurologic lesions that prevent patients from having free access to water. Much rarer are the cases of post-stroke hypernatremia caused by hypodipsia secondary to lesions of the thirst center. We report the case of a patient with severe hypernatremia, probably secondary to post-hemorrhagic stroke ...

  3. Effectiveness of strength training in post stroke

    International Nuclear Information System (INIS)

    The study was done to evaluate the effectiveness of strength training in post stroke. This was an experimental randomized study, conducted at various Physical Therapy OPD setting areas. Sample n = 30; 3 females and 12 males as experimental group and 3 females and 12 males as control group were selected through probability sampling. Mean age of 57 with middle recovery stage of post stroke were included. Different selected strength training exercises were applied on experimental group to assess spasticity, cadence and manual muscle testing. Result was taken by using Mann - Whiteny U test for outcome measures as in cadence, spasticity and manual muscle testing. The result of two outcome measure shows significant result which means the strength training is more effective than the conventional treatment for post stroke of middle recovery stage. (author)

  4. Early Detection of Post-Stroke Depression

    OpenAIRE

    de Man - van Ginkel, J.M.

    2012-01-01

    In the first two years after stroke approximately one-third of the patients suffer from depression, also referred to as post-stroke depression (PSD). Patients with PSD suffer from symptoms, such as a diminished interest or pleasure (anhedonia), depressed mood, sleep disturbances, loss of energy, changes in appetite, feelings of inappropriate guilt, concentration difficulties, psychomotor retardation or agitation, and suicidal thoughts. PSD aggravates the burden of physical, psychological and ...

  5. Oral care post stroke: a scoping review.

    Science.gov (United States)

    Kwok, C; McIntyre, A; Janzen, S; Mays, R; Teasell, R

    2015-01-01

    Health concerns post stroke may be the result of, or exacerbated by, neglected oral health care (OHC). However, OHC may be challenging post stroke due to hemiparesis, hemiplegia, a lack of coordination, and/or cognitive deficits. The objective of this study was to conduct a scoping review and summarise the current state of knowledge pertaining to OHC post stroke. A literature search was conducted using the multiple databases (MEDLINE, CINAHL, EMBASE, etc.). Combinations of multiple keywords were searched: oral, dental, health, care, hygiene, teeth, dentures, tooth brushing, stroke, cardiovascular health and cardiovascular disease. A grey literature search was also conducted. Articles included were those published in English between 1970 and July 2013, which focused on at least one aspect of OHC among a stroke population. For clinical trials, ≥50% of the sample must have sustained a stroke. In total, 60 articles met inclusion and focused on three primary area: (i) OHC Importance/Stroke Implications; (ii) Current Research; and (iii) Current Practice. It was found that OHC concerns are mainly related to mastication, dysphagia/nutrition, hygiene, prostheses and quality of life. Research indicates that there is limited specialised and individual care provided, and there are few assessment tools, guidelines and established protocols for oral health that are specific to the stroke population. Further, dental professionals' and nurses' knowledge of OHC is generally inadequate; hence, proper education for health professionals in acute and rehabilitation settings, patients, and caregivers has been discussed. PMID:25244419

  6. Central hypersensitivity in chronic musculoskeletal pain

    DEFF Research Database (Denmark)

    Curatolo, Michele; Arendt-Nielsen, Lars

    2015-01-01

    Clinical research has consistently detected alteration in central pain processing leading to hypersensitivity. Most methods used in humans are reliable and have face validity to detect widespread central hypersensitivity. However, construct validity is difficult to investigate due to lack of gold...... standards. Reference values in the pain-free population have been generated, but need replication. Research on pain biomarkers that reflect specific central hypersensitivity processes is warranted. Few studies have analyzed the prognostic value of central hypersensitivity. Most medications acting at central...

  7. Post-stroke depression therapy: where are we now?

    Science.gov (United States)

    Nabavi, Seyed Fazel; Turner, Alyna; Dean, Olivia; Sureda, Antoni; Mohammad, Seyed

    2014-01-01

    Post-stroke depression is an important psychological consequence of ischemic stroke, and affects around one third of stroke patients at any time post-stroke. It has a negative impact on patient morbidity and mortality, and as such development of effective post-stroke recognition and treatment strategies are very important. There are several therapeutic strategies for post-stroke depression, including both pharmacological and non-pharmacological approaches. In this review, we present evidence regarding the underlying biology of post-stroke depression, commonalities between post-stroke depression and Major Depressive Disorder and explore several treatment approaches, including antidepressant therapy, psychotherapy, surgical therapy, electroconvulsive therapy, acupuncture, music therapy and natural products. Further experimental and clinical studies are required, particularly in emerging fields such as the role of nutraceuticals in the treatment of stroke. PMID:24852795

  8. Pain Mechanisms and Centralized Pain in Temporomandibular Disorders.

    Science.gov (United States)

    Harper, D E; Schrepf, A; Clauw, D J

    2016-09-01

    Until recently, most clinicians and scientists believed that the experience of pain is perceptually proportional to the amount of incoming peripheral nociceptive drive due to injury or inflammation in the area perceived to be painful. However, many cases of chronic pain have defied this logic, leaving clinicians perplexed as to how patients are experiencing pain with no obvious signs of injury in the periphery. Conversely, there are patients who have a peripheral injury and/or inflammation but little or no pain. What makes some individuals experience intense pain with minimal peripheral nociceptive stimulation and others experience minimal pain with serious injury? It is increasingly well accepted in the scientific community that pain can be generated and maintained or, through other mechanisms, suppressed by changes in the central nervous system, creating a complete mismatch between peripheral nociceptive drive and perceived pain. In fact, there is no known chronic pain condition where the observed extent of peripheral damage reproducibly engenders the same level of pain across individuals. Temporomandibular disorders (TMDs) are no exception. This review focuses on the idea that TMD patients range on a continuum-from those whose pain is generated peripherally to those whose pain is centralized (i.e., generated, exacerbated, and/or maintained by central nervous system mechanisms). This article uses other centralized chronic pain conditions as a guide, and it suggests that the mechanistic variability in TMD pain etiology has prevented us from adequately treating many individuals who are diagnosed with the condition. As the field moves forward, it will be imperative to understand each person's pain from its own mechanistic standpoint, which will enable clinicians to deliver personalized medicine to TMD patients and eventually provide relief in even the most recalcitrant cases. PMID:27422858

  9. Cinesioterapia previne ombro doloroso em pacientes hemiplégicos/paréticos na fase sub-aguda do acidente vascular encefálico Kinesiotherapy prevents shoulder pain in hemiplegic/paretic patients on sub-acute stage post-stroke

    Directory of Open Access Journals (Sweden)

    Agnes Irna Horn

    2003-09-01

    Full Text Available CONTEXTO: Ombro doloroso é freqüente em pacientes com hemiplegia/hemiparesia (H/P por acidente vascular encefálico (AVE, dificultando a recuperação neuromotora gerando incapacidade funcional. OBJETIVO: Estudar tratamento fisioterapêutico para a prevenção da dor no ombro com H/P em pacientes com AVE na fase sub-aguda, e analisar desfechos secundários (força muscular do ombro acometido e movimentos funcionais ativos básicos. MÉTODO: Estudaram-se 21 pacientes (12 homens, 9 mulheres; idades 26 a 87 anos com H/P. O tratamento fisioterapêutico consistiu de 30 minutos diários de cinesioterapia, desde as 48 horas após o AVE até a alta hospitalar. Os pacientes foram avaliados antes e após o tratamento em relação à presença ou ausência de dor no ombro H/P, à força dos diversos grupos musculares do ombro e quanto aos movimentos funcionais de transferência e manutenção postural básica. RESULTADOS: Nenhum paciente apresentava dor no ombro H/P na alta (pBACKGROUND: Painful shoulder is considered the most common complication of hemiplegic/parethic (H/P stroke patients. It is a negative factor for neuromotor recovery. PURPOSE: To study the effects of kinesiotherapy treatment on shoulder pain prevention, and as a secondary endpoints, to analyze muscle strength of H/P shoulder looking at basic functional active mobility. METHOD: Twenty one inpatients (12 men, 9 women aged 26 to 87 years, with post-stroke H/P were submitted to thirty minutes daily program kinesiotherapy, started at 48 hours post-stroke up to their hospital discharge. Patients were evaluated pre and post treatment according to the presence or absence of shoulder pain, movements and shoulder strength, and for presence or absence of basic functional movements. RESULTS: No patient complaining of shoulder pain at the hospital discharge (p<0.001. The muscle strength improved signifcantly for elevation, protusion, abduction and flexion of the shoulder (p<0.001. There was

  10. Life satisfaction post stroke : The role of illness cognitions

    NARCIS (Netherlands)

    van Mierlo, M. L.; van Heugten, C. M.; Post, M. W M; de Kort, P. L M; Visser-Meily, J.M.A.

    2015-01-01

    OBJECTIVE: To describe illness cognitions two months and two years post stroke and to investigate changes in illness cognitions over time. We also examined the associations between illness cognitions and life satisfaction at two months and two years post stroke and investigated if changes in illness

  11. Life satisfaction post stroke : The role of illness cognitions

    NARCIS (Netherlands)

    van Mierlo, M. L.; van Heugten, C. M.; Post, M. W. M.; de Kort, P. L. M.; Visser-Meily, J. M. A.

    2015-01-01

    Objective: To describe illness cognitions two months and two years post stroke and to investigate changes in illness cognitions over time. We also examined the associations between illness cognitions and life satisfaction at two months and two years post stroke and investigated if changes in illness

  12. Treatment of Post-Stroke Ankylosis by Warm-Needling

    Institute of Scientific and Technical Information of China (English)

    刘傲霜

    2004-01-01

    @@ Ankylosis is one of the post-stroke sequelae that hampers seriously the daily activities of the patients.Since 1996, the author has adopted warm needling for treatment of post-stroke ankylosis and obtained excellent therapeutic results. The statistical findings have shown that this therapeutic method can exert an important action in improving the joint spasm for patients with post-stroke sequelae. Especially, a better effect can be expected when it is used at the points of yin channels. A report follows.

  13. A Review of Select Centralized Pain Syndromes

    Directory of Open Access Journals (Sweden)

    David R. Spiegel

    2015-01-01

    Full Text Available Pain can be broadly divided into 3 classes, including nociceptive or inflammatory pain (protective, neuropathic (pathological, occurring after damage to the nervous system, or centralized (pathological, due to abnormal function but with no damage or inflammation to the nervous system. The latter has been posited to occur when descending analgesic pathways are attenuated and/or glutamatergic transmission is facilitated. Additionally, this “pain prone phenotype” can be associated with early life trauma and a suboptimal response to opiates. This article will review the relationships between centralized pain syndromes (ie, fibromyalgia, chronic low back pain, childhood sexual abuse, and opiate misuse. Finally, treatment implications, potentially effecting primary care physicians, will be discussed.

  14. Impaired Hyperemic Response to Exercise Post Stroke.

    Directory of Open Access Journals (Sweden)

    Matthew J Durand

    Full Text Available Individuals with chronic stroke have reduced perfusion of the paretic lower limb at rest; however, the hyperemic response to graded muscle contractions in this patient population has not been examined. This study quantified blood flow to the paretic and non-paretic lower limbs of subjects with chronic stroke after submaximal contractions of the knee extensor muscles and correlated those measures with limb function and activity. Ten subjects with chronic stroke and ten controls had blood flow through the superficial femoral artery quantified with ultrasonography before and immediately after 10 second contractions of the knee extensor muscles at 20, 40, 60, and 80% of the maximal voluntary contraction (MVC of the test limb. Blood flow to the paretic and non-paretic limb of stroke subjects was significantly reduced at all load levels compared to control subjects even after normalization to lean muscle mass. Of variables measured, increased blood flow after an 80% MVC was the single best predictor of paretic limb strength, the symmetry of strength between the paretic and non-paretic limbs, coordination of the paretic limb, and physical activity. The impaired hemodynamic response to high intensity contractions was a better predictor of lower limb function than resting perfusion measures. Stroke-dependent weakness and atrophy of the paretic limb do not explain the reduced hyperemic response to muscle contraction alone as the response is similarly reduced in the non-paretic limb when compared to controls. These data may suggest a role for perfusion therapies to optimize rehabilitation post stroke.

  15. Clinical analysis and treatment of central pain due to headinjury

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    @@Central pain is induced by the involvement of the abnormal pain pathway due to diseases of the central nervous system. Central pain after brain trauma is common clinically, but it is often misdiagnosed and neglected because of lack of objective disturbances. We treated 20 cases of central pain after head injury by invigorating blood circulation and satisfactory result was obtained.

  16. Impact and risk factors of post-stroke bone fracture.

    Science.gov (United States)

    Huo, Kang; Hashim, Syed I; Yong, Kimberley L Y; Su, Hua; Qu, Qiu-Min

    2016-02-20

    Bone fracture occurs in stroke patients at different times during the recovery phase, prolonging recovery time and increasing medical costs. In this review, we discuss the potential risk factors for post-stroke bone fracture and preventive methods. Most post-stroke bone fractures occur in the lower extremities, indicating fragile bones are a risk factor. Motor changes, including posture, mobility, and balance post-stroke contribute to bone loss and thus increase risk of bone fracture. Bone mineral density is a useful indicator for bone resorption, useful to identify patients at risk of post-stroke bone fracture. Calcium supplementation was previously regarded as a useful treatment during physical rehabilitation. However, recent data suggests calcium supplementation has a negative impact on atherosclerotic conditions. Vitamin D intake may prevent osteoporosis and fractures in patients with stroke. Although drugs such as teriparatide show some benefits in preventing osteoporosis, additional clinical trials are needed to determine the most effective conditions for post-stroke applications. PMID:26929915

  17. Alterations in the corticotropin-releasing hormone (CRH) neurocircuitry: Insights into post stroke functional impairments.

    Science.gov (United States)

    Barra de la Tremblaye, P; Plamondon, H

    2016-07-01

    Although it is well accepted that changes in the regulation of the hypothalamic-pituitary adrenal (HPA) axis may increase susceptibility to affective disorders in the general population, this link has been less examined in stroke patients. Yet, the bidirectional association between depression and cardiovascular disease is strong, and stress increases vulnerability to stroke. Corticotropin-releasing hormone (CRH) is the central stress hormone of the HPA axis pathway and acts by binding to CRH receptors (CRHR) 1 and 2, which are located in several stress-related brain regions. Evidence from clinical and animal studies suggests a role for CRH in the neurobiological basis of depression and ischemic brain injury. Given its importance in the regulation of the neuroendocrine, autonomic, and behavioral correlates of adaptation and maladaptation to stress, CRH is likely associated in the pathophysiology of post stroke emotional impairments. The goals of this review article are to examine the clinical and experimental data describing (1) that CRH regulates the molecular signaling brain circuit underlying anxiety- and depression-like behaviors, (2) the influence of CRH and other stress markers in the pathophysiology of post stroke emotional and cognitive impairments, and (3) context and site specific interactions of CRH and BDNF as a basis for the development of novel therapeutic targets. This review addresses how the production and release of the neuropeptide CRH within the various regions of the mesocorticolimbic system influences emotional and cognitive behaviors with a look into its role in psychiatric disorders post stroke. PMID:27455847

  18. 电针配合推拿治疗脑卒中后肩痛:双中心随机对照试验%Double-center randomized controlled trial on post-stroke shoulder pain treated by electroacupuncture combined with Tuina

    Institute of Scientific and Technical Information of China (English)

    李宁; 田丰玮; 王成伟; 喻鹏铭; 周熙; 文谦; 乔秀兰; 黄露

    2012-01-01

    Objective To evaluate clinical therapeutic effect of post-stroke shoulder pain treated by acupuncture combined with Tuina. Methods Three hundred cases of post-stroke shoulder pain were randomly divided into an acupuncture and Tuina group and a rehabilitation group by double-center randomized controlled clinical trial method. In acupuncture and Tuina group, normalized electroacupuncture and Tuina therapy were applied, that was electroacupuncture at main points, such as Chize (LU 5), Quze (PC 3), Shaohai (HT 3), Jianyu (LI 15), Jianliao (TE 14) and Jianjing (GB 21) ,etc. , combined with traditional Tuina manipulations; in rehabilitation group, the rehabilitation methods such as the electrostimulation through nervus cutaneus and the squeezing and stabilizing manipulations of Proprioceptive Neuromuscular Facilitation (PNF) , etc. Were applied. The treatment courses of both groups were 6 weeks. The main therapeutic effect indices were the Assessment Face Scale (AFS) for pain when shoulder was in passive motion and the Fugl- Meyer Motor Assessment for upper limbs active function; the secondary indices were the modified Rankin Scale (mRS) and the clinical incidences of shoulder-hand syndrome of hemiplegia and shoulder joint subluxation of hemiplegia. Results After 6 weeks treatment and 12 weeks follow-up, AFS score, Fugl-Meyer motor assessment of upper limbs active function and mRS evaluation in acupuncture and Tuina group were more obviously improved than those in rehabilitation group (P0.05], the data indicated that there was a superiority tendency in acupuncture and Tuina group. Conclusion The combined therapy of electroacupuncture and Tuina is a normative manipulation, and the therapeutic effect is satisfying for post-stroke shoulder pain, superior to that of comprehensive rehabilitation treatment.%目的:评价“针推双通治疗方案”治疗偏瘫肩痛的临床疗效.方法:采用双中心随机对照临床试验研究方法,将符合脑卒中后肩痛的300

  19. Facilities of Early Rehabilitation post Stroke in Poland 2010

    DEFF Research Database (Denmark)

    Opara, Jozef; Langhorne, Peter; Larsen, Torben

    2012-01-01

    ? Aims - Growing costs of health care are encouraging healthcare planners to look for new organizational solutions of services which could enable rehabilitation as early as possible after disease onset. Early post-stroke rehabilitation consists of many elements that provide for early onset rehabilitation......-stroke, i.e. within 3 months of stroke. Comment - Taking into account that about half of stroke survivors will need rehabilitation (30 days after stroke onset), the current facilities of early post-stroke rehabilitation in Poland cannot meet this need. We should do our best to introduce rehabilitation...

  20. The characteristics of chronic central pain after traumatic brain injury.

    Science.gov (United States)

    Ofek, Hadas; Defrin, Ruth

    2007-10-01

    Central pain following traumatic brain injury (TBI) has not been studied in depth. Our purpose was to conduct a systematic study of patients with TBI suffering from chronic central pain, and to describe the characteristics of the central pain. Groups were TBI patients with (TBIP) and without central pain (TBINP) and healthy controls. TBI patients with other pain mechanisms were excluded from the study. Participants underwent quantitative somatosensory testing in the painful and pain-free body regions. Thresholds for warmth, cold, heat-pain, touch and graphesthesia were measured and pathologically evoked pain (allodynia, hyperpathia and wind-up pain) evaluated. Chronic pain was mapped and characterized. Chronic pain developed at a relatively late onset (6.6+/-9 months) was almost exclusively unilateral and reported as pricking, throbbing and burning. Although both TBIP and TBINP exhibited a significant reduction in thermal and tactile sensations compared to controls, thermal sensations in the painful regions of TBIP were significantly more impaired than pain-free regions in the same patients (p<0.01) and in TBINP (p<0.01). Painful regions also exhibited very high rates of allodynia, hyperpathia and exaggerated wind-up. The characteristics of the chronic pain resembled those of other central pain patients although TBIP displayed several unique features. The sensory profile indicated that damage to the pain and temperature systems is a necessary but not sufficient condition for the development of chronic central pain following TBI. Neuronal hyperexcitability may be a contributing factor to the chronic pain.

  1. Central pain: definition, phisiopathology and therapy

    Directory of Open Access Journals (Sweden)

    Vincenzo Moschini

    2012-12-01

    Full Text Available Central pain is the expression of an injury and/or a primary or secondary dysfunction of the central nervous system.1 It is based on total or partial damage along the spinal-thalamic-cortical pathways and it may have cerebral or spinal origin. It has variable incidence according to its etiology: 8-10% in stroke patients, 30% in multiple sclerosis patients, 30-60% in paraplegic patients.2-3 At the spinal level, the most frequent causes are: traumatic injuries, cancer, plaques from multiple sclerosis, syringomyelia. In this review, we examine the main symptoms that contribute to confirm the diagnosis of central pain, neuropathic or thalamic. The presence of nerve injury, evaluated by neuroimaging and neurophysiological tests, allows us to complete the diagnostic picture.

  2. Determining Optimal Post-Stroke Exercise (DOSE)

    Science.gov (United States)

    2016-10-04

    Cerebrovascular Accident; Stroke; Cerebral Infarction; Brain Infarction; Brain Ischemia; Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Vascular Diseases

  3. Botulinum-A toxin in the treatment of painful post-stroke nocturnal paroxysmal dystonia triggered by periodic limb movements of sleep: case report Toxina botulínica tipo A no tratamento da distonia paroxística noturna dolorosa pós-isquemia cerebral desencadeada por movimentos periódicos do sono: relato de caso

    Directory of Open Access Journals (Sweden)

    Pedro A. Kowacs

    2006-12-01

    Full Text Available INTRODUCTION: Sleep disorders presenting involuntary movements may be very annoying to patients, apart from their negative influence on sleep. OBJECTIVE: To report the use of botulinum type-A toxin (BoNT-A to manage the case of a patient whose sleep was severely disrupted by episodes of dystonic posturing of the right lower limb triggered by periodic limb movements of sleep (PLMS. METHOD: A 79-year-old woman with mild post-stroke right hemiparesis presented with recurrent painful episodes of dystonia of the right lower limb, which disrupted her sleep. The dystonic episodes could also be voluntarily triggered by extension of the right hallux. Polysomnography confirmed that the dystonic episodes were triggered by PLMS. Twenty units of BoNT-A (20U/500U vial were injected into her right extensor hallucis longus. RESULTS: Shortly after BoNT-A was injected, the dystonic symptoms abated, and the patient achieved better sleep efficiency. CONCLUSION: The PLMS-related involuntary extension of the hallux was probably triggering the nocturnal post-stroke lower limb dystonic paroxysms. BoNT-A injection into the right extensor hallucis longus was effective in managing this condition and thus resolved the associated disruption of sleep.INTRODUÇÃO: Desordens do sono apresentando movimentos involuntários podem ser bastante perturbadoras aos pacientes, além de sua influência negativa no sono. OBJETIVO: Descrever o uso da toxina botulínica tipo-A (BoNT-A no manejo do caso de um paciente cujo sono estava gravemente fragmentado por episódios de distonia do membro inferior direito, desencadeados por movimentos periódicos do sono (MPS. MÉTODO: Uma paciente com 79 anos portadora de hemiparesia direita leve seqüelar a isquemia cerebral (AVCI procurou-nos por episódios dolorosos recorrentes de distonia noturna de seu membro inferior direito, os quais fragmentavam seu sono. Os episódios de distonia também podiam ser desencadeados voluntariamente, por extens

  4. Research Progression on Biological Mechanism of Post-stroke Depression

    Institute of Scientific and Technical Information of China (English)

    Lin Facai; Huang Dehong

    2014-01-01

    The biological mechanism of post-stroke depression (PSD) is still unclear. However, there are two hypothesises including primary endogenous mechanism and reactive mechanism. This study mainly reviewed the biological mechanism of PSD from the aspects of neuroanatomy, neurotransmitter, neuroendocrinology, inlfammatory response, neurtrophin and neuropeptide.

  5. Chromium supplementation improved post-stroke brain infarction and hyperglycemia.

    Science.gov (United States)

    Chen, Wen-Ying; Mao, Frank Chiahung; Liu, Chia-Hsin; Kuan, Yu-Hsiang; Lai, Nai-Wei; Wu, Chih-Cheng; Chen, Chun-Jung

    2016-04-01

    Hyperglycemia is common after acute stroke and is associated with a worse outcome of stroke. Thus, a better understanding of stress hyperglycemia is helpful to the prevention and therapeutic treatment of stroke. Chromium is an essential nutrient required for optimal insulin activity and normal carbohydrate and lipid metabolism. Beyond its nutritional effects, dietary supplement of chromium causes beneficial outcomes against several diseases, in particular diabetes-associated complications. In this study, we investigated whether post-stroke hyperglycemia involved chromium dynamic mobilization in a rat model of permanent focal cerebral ischemia and whether dietary supplement of chromium improved post-stroke injury and alterations. Stroke rats developed brain infarction, hyperglycemia, hyperinsulinemia, glucose intolerance, and insulin resistance. Post-stroke hyperglycemia was accompanied by elevated secretion of counter-regulatory hormones including glucagon, corticosterone, and norepinephrine, decreased insulin signaling in skeletal muscles, and increased hepatic gluconeogenesis. Correlation studies revealed that counter-regulatory hormone secretion showed a positive correlation with chromium loss and blood glucose increased together with chromium loss. Daily chromium supplementation increased tissue chromium levels, attenuated brain infarction, improved hyperglycemia, and decreased plasma levels of glucagon and corticosterone in stroke rats. Our findings suggest that stroke rats show disturbance of tissue chromium homeostasis with a net loss through urinary excretion and chromium mobilization and loss might be an alternative mechanism responsible for post-stroke hyperglycemia. PMID:26477944

  6. Effectiveness of bee venom acupuncture in alleviating post-stroke shoulder pain:a systematic review and meta-analysis

    Institute of Scientific and Technical Information of China (English)

    Sung Min Lim; Sook-Hyun Lee

    2015-01-01

    BACKGROUND:Shoulder pain is a common complication of stroke. Bee venom acupuncture (BVA) is increasingly used in the treatment of post-stroke shoulder pain. OBJECTIVE: To summarize and evaluate evidence on the effectiveness of BVA in relieving shoulder pain after stroke. SEARCH STRATEGY: Nine databases, namely MEDLINE, EMBASE, the Cochrane Library, the China National Knowledge Infrastructure (CNKI), the Japan Science and Technology Information Aggregator, Electronic (J-STAGE), and four Korean medical databases, namely, the National Assembly Library, the Research Information Service System, the National Discovery for Science Leaders, and OASIS, were searched from their inception through August 2014 without language restrictions. INCLUSION CRITERIA: Randomized controled trials (RCTs) were included if BVA was used at acupoints as the sole treatment, or as an adjunct to other treatments, for shoulder pain after stroke. DATA EXTRACTION AND ANALYSIS:Two review authors independently selected trials for inclusion, assessed methodological quality and extracted data. RESULTS: A total of 138 potentialy relevant articles were identiifed, 4 of which were RCTs that met our inclusion criteria. The quality of studies included was generaly low, and a preponderance of positive results was demonstrated. Al four trials reported favorable effects of BVA on shoulder pain after stroke. Two RCTs assessing the effects of BVA on post-stroke shoulder pain, as opposed to saline injections, were included in the meta-analysis. Pain was signiifcantly lower for BVA than for saline injections (standardized mean difference on 10-cm visual analog scale: 1.46 cm, 95% CI = 0.30–2.62,P = 0.02, n = 86) CONCLUSION: This review provided evidence suggesting that BVA is effective in relieving shoulder pain after stroke. However, further studies are needed to conifrm the role of BVA in aleviating post-stroke shoulder pain. Future studies should be conducted with large samples and rigorous study designs.

  7. Central adaptation of pain perception in response to rehabilitation of musculoskeletal pain

    DEFF Research Database (Denmark)

    Andersen, Lars L; Andersen, Christoffer H; Sundstrup, Emil;

    2012-01-01

    Understanding the mechanisms of long-standing musculoskeletal pain and adaptations in response to physical rehabilitation is important for developing optimal treatment strategies. The influence of central adaptations of pain perception in response to rehabilitation of musculoskeletal pain remains...

  8. Difficulties in post-stroke gait improvement caused by post-stroke depression

    Institute of Scientific and Technical Information of China (English)

    Stanislaw Kijowski

    2014-01-01

    Background Depression is a common problem impeding post-stroke rehabilitation.Up to 70% of patients show depression symptoms during the first twelve months after stroke onset.However,the depression and its effect on functional recovery can be difficult to diagnose.The purpose of this study was to use gait analysis as a tool to compare the recovery after stroke in patients with and without depression and to assess the impact of the initiation time of rehabilitation after stroke onset.Methods One hundred and forty five consecutive patients after first ever stroke admitted for designed rehabilitation program within 2 to 31 months after stroke onset participated.All patients received 4 weeks treatment program included comprehensive rehabilitation consisted of multipurpose activities 5 days a week.These included individual and group exercises,physiotherapy,occupational therapy and gait training.Gait analysis with Kistler force plates was employed to assess gait pattern symmetry before and after the treatment.Gait symmetry was evaluated based on seven gait parameters.Regaining of gait pattern symmetry was assumed as a measure of rehabilitation outcome.Results After rehabilitation program gait symmetry w()ined in patients without depression.Gait asymmetry remained unchanged in patients diagnosed with depression.No major differences in outcome from rehabilitation were noted in regards to the initiation time of rehabilitation after the stroke onset.Conclusions Depression limits gait recovery after stroke.The time of initiation of rehabilitation after stroke onset does not limit the motor recovery after rehabilitation program.

  9. 早期康复治疗对脑卒中后抑郁的影响%Impact of early rehabilitation therapy on post stroke depression

    Institute of Scientific and Technical Information of China (English)

    胡祝英; 胡云南; 卢青英

    2003-01-01

    @@ INTRODUCTION Post stroke depression (PSD), the commonly observed complication of cerebrovascular diseases, seriously affectspatients' function, re-covery and life, leading to self injury or suicide. Early rehabilitation therapy is beneficial for functional recovery, reduction of disability rate, improvement of quality of life and relief of pain, thus reducing incidence of depression.

  10. Soleus H-reflex excitability during pedaling post-stroke

    DEFF Research Database (Denmark)

    Schindler-Ivens, Sheila; Brown, David A.; Lewis, Gwyn N.;

    2008-01-01

    A major contributor to impaired locomotion post-stroke is abnormal phasing of paretic muscle activity, but the mechanisms remain unclear. Previous studies have shown that, in the paretic limb of people post-stroke, Group Ia reflexes are abnormally elevated and fail to decrease in amplitude during...... locomotion. Hence, we hypothesized that inappropriate muscle phasing may be associated with enhanced transmission in the monosynaptic Group Ia afferent pathway. Soleus (SO) H-reflexes were used to examine transmission in the Group Ia afferent pathway to SO motor neurons during pedaling, a locomotor task...... in the pedaling cycle and during tonic plantar flexion at comparable limb positions and levels of SO EMG. In both groups, SO H-reflexes were smaller during pedaling as compared to matched tonic plantar flexion. In the NI group, but not the paretic group, SO H-reflex amplitude was significantly modulated across...

  11. Post stroke rehabilitation based on SMART goals: a case study

    Directory of Open Access Journals (Sweden)

    Amir-ur Rehman

    2014-02-01

    Full Text Available Post stroke rehabilitation has been consistently reported in physiotherapy as being difficult to manage and limiting to rehabilitation outcome. It is reported that the first few months post stroke are crucial for rehabilitation to reach a maximum potential. However, after this period further recovery is unlikely. Specific, measurable, achievable, realistic, and time-framed (SMART goals are used for goal setting for rehabilitation. They can provide coordination between a multidisciplinary team to develop a plan for the individual needs of patients. This case study explored the use of SMART goals, which are often not used in a rehabilitation setting due to being time-consuming and difficult to create. This case report provides the first evidence that SMART goals may serve as a powerful tool for rehabilitation following stroke. The case study illustrates the clinical role of physiotherapists in the management of a patient with stroke. [J Exp Integr Med 2014; 4(1.000: 71-73

  12. Post-stroke cognitive dysfunctions: A clinical and neuroimaging study

    Directory of Open Access Journals (Sweden)

    Andrei Yuryevich Emelin

    2013-01-01

    Full Text Available Clinical, neuropsychological, and neuroimaging examinations were made in 65 patients (52 men and 13 women aged 65.6±10.1 years who had experienced ischemic stroke. Cognitive impairments (CI were heterogeneous; regulatory functions, attention, and counting were most significantly affected in moderate CI. In mild dementia, mainly poor attention and regulatory dysfunctions were added by clearly-cut impairments of memory, orientation, and visual-spatial function. Brain atrophy, white matter changes, and small focal gray matter damages along with focal post-stroke changes were revealed by neuroimaging in most patients. It was found that besides the volume and location of a damage focus, the signs of impaired integrated mental activity of the brain, regulatory dysfunctions in particular, should be a necessary condition for the verification of post-stroke CI.

  13. Gait post-stroke: Pathophysiology and rehabilitation strategies.

    Science.gov (United States)

    Beyaert, C; Vasa, R; Frykberg, G E

    2015-11-01

    We reviewed neural control and biomechanical description of gait in both non-disabled and post-stroke subjects. In addition, we reviewed most of the gait rehabilitation strategies currently in use or in development and observed their principles in relation to recent pathophysiology of post-stroke gait. In both non-disabled and post-stroke subjects, motor control is organized on a task-oriented basis using a common set of a few muscle modules to simultaneously achieve body support, balance control, and forward progression during gait. Hemiparesis following stroke is due to disruption of descending neural pathways, usually with no direct lesion of the brainstem and cerebellar structures involved in motor automatic processes. Post-stroke, improvements of motor activities including standing and locomotion are variable but are typically characterized by a common postural behaviour which involves the unaffected side more for body support and balance control, likely in response to initial muscle weakness of the affected side. Various rehabilitation strategies are regularly used or in development, targeting muscle activity, postural and gait tasks, using more or less high-technology equipment. Reduced walking speed often improves with time and with various rehabilitation strategies, but asymmetric postural behaviour during standing and walking is often reinforced, maintained, or only transitorily decreased. This asymmetric compensatory postural behaviour appears to be robust, driven by support and balance tasks maintaining the predominant use of the unaffected side over the initially impaired affected side. Based on these elements, stroke rehabilitation including affected muscle strengthening and often stretching would first need to correct the postural asymmetric pattern by exploiting postural automatic processes in various particular motor tasks secondarily beneficial to gait. PMID:26547547

  14. Gait post-stroke: Pathophysiology and rehabilitation strategies.

    Science.gov (United States)

    Beyaert, C; Vasa, R; Frykberg, G E

    2015-11-01

    We reviewed neural control and biomechanical description of gait in both non-disabled and post-stroke subjects. In addition, we reviewed most of the gait rehabilitation strategies currently in use or in development and observed their principles in relation to recent pathophysiology of post-stroke gait. In both non-disabled and post-stroke subjects, motor control is organized on a task-oriented basis using a common set of a few muscle modules to simultaneously achieve body support, balance control, and forward progression during gait. Hemiparesis following stroke is due to disruption of descending neural pathways, usually with no direct lesion of the brainstem and cerebellar structures involved in motor automatic processes. Post-stroke, improvements of motor activities including standing and locomotion are variable but are typically characterized by a common postural behaviour which involves the unaffected side more for body support and balance control, likely in response to initial muscle weakness of the affected side. Various rehabilitation strategies are regularly used or in development, targeting muscle activity, postural and gait tasks, using more or less high-technology equipment. Reduced walking speed often improves with time and with various rehabilitation strategies, but asymmetric postural behaviour during standing and walking is often reinforced, maintained, or only transitorily decreased. This asymmetric compensatory postural behaviour appears to be robust, driven by support and balance tasks maintaining the predominant use of the unaffected side over the initially impaired affected side. Based on these elements, stroke rehabilitation including affected muscle strengthening and often stretching would first need to correct the postural asymmetric pattern by exploiting postural automatic processes in various particular motor tasks secondarily beneficial to gait.

  15. Clinical Observation on Electroacupuncture for Post-stroke Flaccid Paralysis

    Institute of Scientific and Technical Information of China (English)

    Zhu Xian-min; Hou Jing-yue

    2013-01-01

    Objective:To observe the clinical efficacy of electroacupuncture (EA) in treating post-stroke flaccid paralysis.Methods:Forty patients with post-stroke flaccid paralysis were randomized by the random number table into a treatment group and a control group,20 cases in each.The treatment group was intervened by acupuncture at Jiquan (HT 1),Tianquan (PC 2),Ququan (LR 8),Yinlingquan (SP 9),and Yongquan (KI 1),and the control group was treated by acupuncture with conventional acupoint selection.Barthel index (BI) was adopted for evaluating the activities of daily living (ADL),and therapeutic efficacy was analyzed.Results:The two groups both had marked increases of BI score after treatment.Compared to the control group after 1 treatment course and 2treatment courses respectively,the treatment group had significant differences in BI score (P<0.01).The total effective rate was 100.0% in the treatment group versus 90.0% in the control group,and the difference was statistically significant (P<0.01).Conclusion:EA at Jiquan (HT 1),Tianquan (PC 2),Ququan (LR 8),Yinlingquan (SP 9),Yongquan (KI 1) is an effective approach in treating post-stroke flaccid paralysis.

  16. 卒中后疲劳%Post-stroke fatigue

    Institute of Scientific and Technical Information of China (English)

    梁金凤; 岳莹莹; 袁勇贵

    2015-01-01

    卒中后疲劳是独立于抑郁的一种常见卒中后症状。卒中后疲劳可影响患者的躯体和心理康复以及生存质量,与死亡率增高存在关联性。识别卒中后疲劳的危险因素及明确诊断并对其进行有效干预有助于患者的早日康复。文章就卒中后疲劳的发生率、危险因素、发生机制、诊断和治疗方面的研究进展进行了综述。%Post-stroke fatigue is a common symptom after stroke independent of depression. It impacts functional recovery of limbs, psychological rehabilitation and quality of life, and has been linked w ith a higher mortality rate. Identifing the risk factors of post -stroke fatigue and clarifying the diagnosis and conducting effective intervention may contribute to the early rehabilitation. This article review s the advances in research on the incidence, risk factors, mechanisms, diagnosis and treatment of post -stroke fatigue.

  17. Pair housing reverses post-stroke depressive behavior in mice.

    Science.gov (United States)

    Verma, Rajkumar; Friedler, Brett D; Harris, Nia M; McCullough, Louise D

    2014-08-01

    Social isolation (SI) has been linked epidemiologically to high rates of morbidity and mortality following stroke. In contrast, strong social support enhances recovery and lowers stroke recurrence. However, the mechanism by which social support influences stroke recovery has not been adequately explored. The goal of this study was to examine the effect of post-stroke pair housing and SI on behavioral phenotypes and chronic functional recovery in mice. Young male mice were paired for 14 days before a 60 min transient middle cerebral artery occlusion (MCAO) or sham surgery and assigned to various housing environments immediately after stroke. Post-stroke mice paired with either a sham or stroke partner showed significantly higher (Preduced immobility in the tail suspension test compared to isolated cohorts. Pair-housed stroked mice demonstrated significantly reduced cerebral atrophy after 6 weeks (17.5 ± 1.5% in PH versus 40.8 ± 1.3% in SI; Preduces avolitional and anhedonic behavior. Pair housing reduced serum IL-6 and enhanced peri-infarct microglia arginase-1 expression. Social interaction reduces post-stroke depression and improves functional recovery.

  18. Post-stroke cognitive impairments: diagnosis and therapeutic approaches

    Directory of Open Access Journals (Sweden)

    Natalia Vyacheslavovna Pizova

    2013-01-01

    Full Text Available Stroke is a leading cause of disability not only due to its impact on motor or sensory functions, but also to post-stroke cognitive impairments (CI. Within the first year after stroke, the rate of CI may be as high as 80-90% and 7-23% of patients develop dementia. The most important risk factors for CI are strokes, their extent, site, and number. Old age, low education level, severe previous pathological changes in the brain parenchyma, diabetes mellitus, atrial fibrillations, and recurrent strokes in particular, are associated with an increased risk of CI. Examining cognitive functions, monitoring the evolution of cognitive deficit, and post-stroke rehabilitation are indicated in patients who have had stroke. The main treatments in patients with CI are secondary stroke prevention, including lifestyle modification and symptomatic therapy. Sermion is one of the promising agents for the prevention and treatment of CI in these patients.

  19. Factors affecting return to driving post-stroke.

    LENUS (Irish Health Repository)

    Tan, K M

    2012-02-01

    BACKGROUND: Stroke can affect a person\\'s ability to drive, an important means of transportation in the developed world. AIMS: To determine percentage of patients and factors associated with return to driving post-stroke in a service with emphasis on driver assessment. METHODS: Retrospective study of patients discharged from the Stroke Service of our 470-bed teaching hospital from 1998 to 2002. RESULTS: Of 72 drivers pre-stroke, 54% recalled a driving assessment and 68% returned to driving. Younger patients (58.6 +\\/- 12.0 vs. 66.5 +\\/- 10.5, p = 0.008) with lower Modified Rankin Score (median 1 vs. 2, p = 0.0001) and normal cognition (55 vs. 43%, p = 0.45) were more likely to resume driving. More patients who were assessed returned to driving than those who were not (74 vs. 61%, p = 0.31). CONCLUSIONS: A relatively high level of return to driving can be achieved post-stroke with a pro-active approach to driver assessment and rehabilitation. A structured assessment and referral programme should be offered where appropriate.

  20. New insights into the pathophysiology of post-stroke spasticity

    Directory of Open Access Journals (Sweden)

    Sheng eLi

    2015-04-01

    Full Text Available Spasticity is one of many consequences after stroke. It is characterized by a velocity-dependent increase in resistance during passive stretch, resulting from hyperexcitability of the stretch reflex. The underlying mechanism of the hyperexcitable stretch reflex, however, remains poorly understood. Accumulated experimental evidence has supported supraspinal origins of spasticity, likely from an imbalance between descending inhibitory and facilitatory regulation of spinal stretch reflexes secondary to cortical disinhibition after stroke. The excitability of reticulospinal and vestibulospinal tracts has been assessed in stroke survivors with spasticity using non-invasive indirect measures. There are strong experimental findings that support the reticulospinal hyperexcitability as a prominent underlying mechanism of post-stroke spasticity. This mechanism can at least partly account for clinical features associated with spasticity and provide insightful guidance for clinical assessment and management of spasticity. However, the possible role of VST hyperexcitability can not be ruled out from indirect measures. In vivo measure of individual brainstem nuclei in stroke survivors with spasticity using advanced fMRI techniques in the future is probably able to provide direct evidence of pathogenesis of post-stroke spasticity.

  1. The impact of patient's weight on post-stroke rehabilitation.

    Science.gov (United States)

    Kalichman, Leonid; Alperovitch-Najenson, Deborah; Treger, Iuly

    2016-08-01

    Purpose To evaluate the influence of patient's weight on rehabilitation outcomes in first-event stroke patients. Design Retrospective, observational comparative study. 102 first-time stroke male and female patients admitted to the 52-bed neurology rehabilitation department in a rehabilitation hospital were included in the study. Body mass index (BMI), Functional Independence Measure (FIM) on admission and at discharge, as well as the delta-FIM (FIM on admission - FIM at discharge) were evaluated. The Kruskal-Wallis test was used to compare the FIM and the NIHSS scores between BMI groups (normal, overweight, moderate and severe obesity). Results A statistically significant negative correlation (rho = -0.20, p = 0.049) was found between FIM change and BMI, that remained significant after adjustments for age, sex and hospitalisation days. No difference was found between groups in FIM or NIHSS change between BMI groups. Conclusions In sub-acute post-stroke patients undergoing rehabilitation in rehabilitation hospital, BMI was negatively associated with the improvement of functional parameters. Patients' BMI should be taken into consideration when predicting rehabilitation outcome for stroke patients. Further investigations are needed to identify the functional parameters affected by the patients' BMI. Implications for Rehabilitation In sub-acute post-stroke patients undergoing rehabilitation in rehabilitation hospital, BMI was negatively associated with the improvement of functional parameters. Patients' BMI should be taken into consideration when predicting rehabilitation outcome for stroke patients. New rehabilitation strategies should be designed to improve the functional outcomes of rehabilitation of obese patients. PMID:27248186

  2. Pain sensitivity and headache: an examination of the central theory.

    Science.gov (United States)

    Marlowe, N I

    1992-01-01

    The central theory of headache was investigated by examining pain sensitivity in headache sufferers and headache-free controls. Headache subjects had lower pain threshold and tolerance levels than controls for electrical stimulation of the finger. Headache subjects also had a lesser tolerance for pain induced by the application of ice to the temporal region, but there was no significant difference between groups on temporal ice pain threshold. Sensitivity to finger pain was not affected by the presence or absence of headache at the time of testing. No significant differences between tension and migraine subjects were observed; neither were headache subjects, reporting unilateral headaches, significantly more sensitive to temporal ice pain on the side affected by headache. It was concluded that headache sufferers may be more sensitive to pain than headache-free persons but, that this heightened sensitivity is not specific to the head, and in itself, seems unable to account for the locus of headache. PMID:1538347

  3. Rapid relief of thalamic pain syndrome induced by vestibular caloric stimulation.

    Science.gov (United States)

    Ramachandran, Vilayanur S; McGeoch, Paul D; Williams, Lisa; Arcilla, Gerard

    2007-06-01

    Central post-stroke pain syndrome develops in a minority of patients following a stroke. The most usual causative lesion involves the lateral thalamus. The classic presentation is of severe, unrelenting pain that involves the entire contralateral half of the body. It is largely refractory to current treatments. We found that in two patients with this condition their pain was substantially improved by vestibular caloric stimulation, whereas placebo procedures had no effect. We proposed that this is because vestibular stimulation activates the posterior insula, which in turn inhibits the generation of pain in the anterior cingulate.

  4. miR-137, a new target for post-stroke depression?

    Institute of Scientific and Technical Information of China (English)

    Lixia Zhao; Huazi Li; Ruiyou Guo; Teng Ma; Rongyao Hou; Xiaowei Ma; Yifeng Du

    2013-01-01

    Expression of miR-137 is downregulated in brain tissue from patients with depression and suicidal behavior, and is also downregulated in peripheral blood from stroke patients. However, it is not yet known if miR-137 acts as a bridge between stroke and depression. To test this, we used middle cerebral artery occlusion and chronic mild stress to establish a post-stroke depression model in rats. Compared with controls, we found significantly lower miR-137 levels in the brain and peripheral blood from post-stroke depression rats. Injection of a miR-137 antagonist into the brain ventricles upregulated miR-137 levels, and improved behavioral changes in post-stroke depression rats. Lu-ciferase assays showed miR-137 bound to the 3′UTR of Grin2A, regulating Grin2A expression in a neuronal cel line. Grin2A gene overexpression in the brain of post-stroke depression rats, noticea-bly suppressed the inhibitory effect of miR-137 on post-stroke depression. Overal , our results show that miR-137 suppresses Grin2A protein expression through binding to Grin2A mRNA, thereby ex-erting an inhibitory effect on post-stroke depression. Our results offer a new therapeutic direction for post-stroke depression.

  5. Habituation to pain: further support for a central component.

    Science.gov (United States)

    Rennefeld, C; Wiech, K; Schoell, E D; Lorenz, J; Bingel, U

    2010-03-01

    Habituation to repetitive painful stimulation may represent an important protection mechanism against the development of chronic pain states. However, the exact neurobiological mechanisms of this phenomenon remain unclear. In this study we (i) explore the somatotopic specificity of pain attenuation over time and (ii) investigate the role of the endogenous opioid system in its development. We investigated 24 healthy volunteers with a paradigm of daily painful stimulation of the left volar forearm for 1 week. Habituation was assessed by comparing pain-related responses (ratings and thresholds) between days 1 and 8. To test whether a repetition-dependent attenuation of pain is restricted to the site of stimulus application or induces additional systemic effects indicative of a central mechanism, we also measured pain-related responses at the contralateral arm and the left leg. To assess the role of the endogenous opioid system in this mechanism, we used the opioid-receptor antagonist naloxone in a double-blind design. Repetitive painful stimulation over several days resulted in a significant habituation to pain at the site of daily stimulation. In addition, we also observed significant pain attenuation at the non-stimulated limbs. This effect was less pronounced at the untreated arm compared to the treated arm and even weaker in the leg, displaying a significant Stimulation-Site x Time interaction. The development of pain habituation was unaffected by the opioid antagonist naloxone. Taken together, these results strongly support the role of central components in the mechanism of pain habituation that do not directly involve the endogenous opioid system. PMID:20097005

  6. Post-stroke seizures in consecutive elderly stroke patients

    Institute of Scientific and Technical Information of China (English)

    Yue Chen; Lufang Chen; Yiqing Tao; Maomao Han; Chunlan Cui; Shichao Liu

    2011-01-01

    This prospective study sought to investigate the clinical, radiological and electroencephalographic (EEG) characteristics of seizures in elderly stroke patients, and their outcomes. Over a 2-year study period, 158 consecutive eldedy patients with stroke were examined and followed up. Of these patients, 32 (20%) developed seizures, primarily related to stroke, within a follow up period between 5 months and 2 years. Of these 32 cases, 20 experienced infarctions, and 12 experienced hemorrhages. Involvement of cortical regions was detected in most of the patients exhibiting seizures. In these patients, 44% of the lesions involved cortical areas exclusively or in addition to subcortical areas observed on computed tomography (CT) images. Twenty-five patients (78%)developed early seizures (within 2 weeks after stroke), and half exhibited immediate post-stroke seizures. None of the patients exhibiting early onset seizures developed recurrent seizures or epilepsy, while 57% of late onset seizures (four cases) developed epilepsy. No specific EEG patterns were apparent in those who later developed epilepsy. Overall, early onset seizures after stroke were found to be relatively common, and did not affect outcome. Late onset seizures were less common, but were associated with chronic epilepsy.

  7. Post-stroke epilepsy in Burkina Faso (West Africa).

    Science.gov (United States)

    Napon, Christian; Dabilgou, Anselme; Kyelem, Julie; Kaboré, Jean

    2016-09-15

    Post-stroke epilepsy (PSE) is defined as "recurrent seizures following stroke with confirmed diagnosis of epilepsy". Our objective was to describe the epidemiological, clinical and therapeutic PSE aspects at the Yalgado Ouedraogo Teaching Hospital, the main reference centre for neurological conditions in Burkina Faso. We conducted a retrospective study from January 2006 to December 2014. The data on thirty-two (32) cases of PSE was collected from a total of 1616 patients hospitalized for stroke, representing a rate of 1.98%. The patients' ages ranged from 25 to 77years old with a mean age of 58±10.39. There were 21 men and 11 women, with a gender ratio of 1.9. The time of occurrence of PSE ranged between 10 and 3600days (10years). The brain CT scan helped distinguish the different subtypes of stroke. Sixty-four percent (64%) of the cases experienced ischemic stroke and 36% of the cases cerebral hemorrhage. With regard to medical treatment, 23 patients received monotherapy, and 4 patients dual therapy. Exactly 96.87% of seizures were stabilized during the hospitalization period. PSE is a symptomatic type of epilepsy occurring during stroke sequelae. It is important not to lose sight of this before the occurrence of any focal or generalized seizure after a stroke. PMID:27538600

  8. Literature and art therapy in post-stroke psychological disorders.

    Science.gov (United States)

    Eum, Yeongcheol; Yim, Jongeun

    2015-01-01

    Stroke is one of the leading causes of morbidity and long-term disability worldwide, and post-stroke depression (PSD) is a common and serious psychiatric complication of stroke. PSD makes patients have more severe deficits in activities of daily living, a worse functional outcome, more severe cognitive deficits and increased mortality as compared to stroke patients without depression. Therefore, to reduce or prevent mental problems of stroke patients, psychological treatment should be recommended. Literature and art therapy are highly effective psychological treatment for stroke patients. Literature therapy divided into poetry and story therapy is an assistive tool that treats neurosis as well as emotional or behavioral disorders. Poetry can add impression to the lethargic life of a patient with PSD, thereby acting as a natural treatment. Story therapy can change the gloomy psychological state of patients into a bright and healthy story, and therefore can help stroke patients to overcome their emotional disabilities. Art therapy is one form of psychological therapy that can treat depression and anxiety in stroke patients. Stroke patients can express their internal conflicts, emotions, and psychological status through art works or processes and it would be a healing process of mental problems. Music therapy can relieve the suppressed emotions of patients and add vitality to the body, while giving them the energy to share their feelings with others. In conclusion, literature and art therapy can identify the emotional status of patients and serve as a useful auxiliary tool to help stroke patients in their rehabilitation process. PMID:25744067

  9. Literature and art therapy in post-stroke psychological disorders.

    Science.gov (United States)

    Eum, Yeongcheol; Yim, Jongeun

    2015-01-01

    Stroke is one of the leading causes of morbidity and long-term disability worldwide, and post-stroke depression (PSD) is a common and serious psychiatric complication of stroke. PSD makes patients have more severe deficits in activities of daily living, a worse functional outcome, more severe cognitive deficits and increased mortality as compared to stroke patients without depression. Therefore, to reduce or prevent mental problems of stroke patients, psychological treatment should be recommended. Literature and art therapy are highly effective psychological treatment for stroke patients. Literature therapy divided into poetry and story therapy is an assistive tool that treats neurosis as well as emotional or behavioral disorders. Poetry can add impression to the lethargic life of a patient with PSD, thereby acting as a natural treatment. Story therapy can change the gloomy psychological state of patients into a bright and healthy story, and therefore can help stroke patients to overcome their emotional disabilities. Art therapy is one form of psychological therapy that can treat depression and anxiety in stroke patients. Stroke patients can express their internal conflicts, emotions, and psychological status through art works or processes and it would be a healing process of mental problems. Music therapy can relieve the suppressed emotions of patients and add vitality to the body, while giving them the energy to share their feelings with others. In conclusion, literature and art therapy can identify the emotional status of patients and serve as a useful auxiliary tool to help stroke patients in their rehabilitation process.

  10. Motor cortex stimulation therapy for post-stroke weakness

    International Nuclear Information System (INIS)

    Motor cortex stimulation (MCS) delivered concurrently with rehabilitation therapy may enhance motor recovery following stroke. We investigated the effects of MCS on the recovery from upper extremity paresis in patients with chronic stroke. In 12 patients who had moderate arm and finger paresis at more than 4 months after stroke, an electrode was placed through a small craniotomy on the epidural space of the motor cortex that was identified using functional MRI. MCS during occupational therapy for one hour was performed 3 times a day for at least 4 weeks. The mean scores for Fugl-Meyer assessments of the arm improved, from 37 preoperatively to 46 postoperatively. The mean grip strength improved from 3.25 to 9.0 kg. All patients appeared satisfactory in their results because they recognized an improvement of arm function. Although the mechanism of the beneficial effects of MCS on recovery after stroke has not been well known, the neuroplasticity might play a important role. In a few cases of the present series, it was observed that the hand motor cortex area detected on functional MRI had been enlarged after MCS therapy. MCS could become a novel neurosurgical treatment modality for the chronic post-stroke weakness. (author)

  11. The sensory side of post-stroke motor rehabilitation.

    Science.gov (United States)

    Bolognini, Nadia; Russo, Cristina; Edwards, Dylan J

    2016-04-11

    Contemporary strategies to promote motor recovery following stroke focus on repetitive voluntary movements. Although successful movement relies on efficient sensorimotor integration, functional outcomes often bias motor therapy toward motor-related impairments such as weakness, spasticity and synergies; sensory therapy and reintegration is implied, but seldom targeted. However, the planning and execution of voluntary movement requires that the brain extracts sensory information regarding body position and predicts future positions, by integrating a variety of sensory inputs with ongoing and planned motor activity. Neurological patients who have lost one or more of their senses may show profoundly affected motor functions, even if muscle strength remains unaffected. Following stroke, motor recovery can be dictated by the degree of sensory disruption. Consequently, a thorough account of sensory function might be both prognostic and prescriptive in neurorehabilitation. This review outlines the key sensory components of human voluntary movement, describes how sensory disruption can influence prognosis and expected outcomes in stroke patients, reports on current sensory-based approaches in post-stroke motor rehabilitation, and makes recommendations for optimizing rehabilitation programs based on sensory stimulation. PMID:27080070

  12. Central Pain Processing in Early-Stage Parkinson's Disease: A Laser Pain fMRI Study

    Science.gov (United States)

    Petschow, Christine; Scheef, Lukas; Paus, Sebastian; Zimmermann, Nadine; Schild, Hans H.; Klockgether, Thomas; Boecker, Henning

    2016-01-01

    Background & Objective Pain is a common non-motor symptom in Parkinson’s disease. As dopaminergic dysfunction is suggested to affect intrinsic nociceptive processing, this study was designed to characterize laser-induced pain processing in early-stage Parkinson’s disease patients in the dopaminergic OFF state, using a multimodal experimental approach at behavioral, autonomic, imaging levels. Methods 13 right-handed early-stage Parkinson’s disease patients without cognitive or sensory impairment were investigated OFF medication, along with 13 age-matched healthy control subjects. Measurements included warmth perception thresholds, heat pain thresholds, and central pain processing with event-related functional magnetic resonance imaging (erfMRI) during laser-induced pain stimulation at lower (E = 440 mJ) and higher (E = 640 mJ) target energies. Additionally, electrodermal activity was characterized during delivery of 60 randomized pain stimuli ranging from 440 mJ to 640 mJ, along with evaluation of subjective pain ratings on a visual analogue scale. Results No significant differences in warmth perception thresholds, heat pain thresholds, electrodermal activity and subjective pain ratings were found between Parkinson’s disease patients and controls, and erfMRI revealed a generally comparable activation pattern induced by laser-pain stimuli in brain areas belonging to the central pain matrix. However, relatively reduced deactivation was found in Parkinson’s disease patients in posterior regions of the default mode network, notably the precuneus and the posterior cingulate cortex. Conclusion Our data during pain processing extend previous findings suggesting default mode network dysfunction in Parkinson’s disease. On the other hand, they argue against a genuine pain-specific processing abnormality in early-stage Parkinson’s disease. Future studies are now required using similar multimodal experimental designs to examine pain processing in more advanced

  13. Pain and efficacy of local anesthetics for central venous access

    Directory of Open Access Journals (Sweden)

    William C Culp Jr

    2008-11-01

    Full Text Available William C Culp Jr1, Mohammed Yousaf2, Benjamin Lowry1, Timothy C McCowan3, William C Culp21Division of Cardiothoracic Anesthesiology, Scott and White Hospital, The Texas A&M University College of Medicine, Temple, TX, USA; 2Division of Interventional Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA; 3Department of Radiology, University of Mississippi Medical Center, Jackson, MS, USAPurpose: To compare pain during injection and efficacy of analgesia of local anesthetics during central venous line placement.Methods: Sixty-two patients were studied in a randomized, double-blinded prospective fashion. Patients received 1% lidocaine (L, buffered 1% lidocaine (LB, or 2% chloroprocaine (CP injected around the internal jugular vein for procedural analgesia for central venous access. Patients reported pain via a standard linear visual analog scale, with 0 representing no pain and 10 being the worst pain imaginable.Results: Overall patient perception of pain was better with CP and L than LB with mean scores of CP 2.4, L 2.6, LB 4.2. Pain with injection mean scores were CP 2.1, L 2.5, LB 3.2. Pain with catheter placement scores were CP 2.5, L 1.7, LB 3.4. Operator assessment of overall pain values were CP 1.9, L 2.2, LB 3.4. LB consistently scored the worst, though compared with CP, this only reached statistical significance in overall patient pain and pain at catheter insertion compared with L.Conclusion: Though chloroprocaine scored better than lidocaine in 3 of 4 parameters, this trend did not achieve statistical significance. Adding sodium bicarbonate to lidocaine isn’t justified in routine practice, nor is routine replacement of lidocaine with chloroprocaine.Keywords: local anesthesia, analgesia, central venous access, lidocaine, chloroprocaine

  14. The pain of RSI. The central issue.

    Science.gov (United States)

    Quintner, J L

    1989-12-01

    In this paper RSI (repetition strain injury) is used to refer to those diffuse neck and arm pain syndromes that appear to be directly related to occupational factors; for example, occupational overuse syndrome (OOS) and occupational cervicobrachial disorder (OCD). The author examines the clinical evidence that suggests the involvement of neural tissues in the pathogenesis of these conditions. He also speculates on the possible underlying pathophysiological mechanisms that may explain their development and persistence. PMID:2696462

  15. Delayed-Onset Post-Stroke Delusional Disorder: A Case Report

    Directory of Open Access Journals (Sweden)

    Raíssa B. Barboza

    2013-01-01

    Full Text Available Although the prevalence of neuropsychiatric disorders among patients with cerebrovascular illness is relatively high, there are only few case reports describing post-stroke psychotic symptoms. In general, post-stroke psychoses have been reported to emerge few days after the vascular event and to vanish soon afterwards. In this report, we describe delayed-onset post-stroke delusional disorder, persecutory type. A middle-aged female patient developed a persistent delusional disorder with homicidal behavior about one year after a cerebrovascular accident affecting the right fronto-temporo-parietal region and a long period of chronic post-stroke mixed anxiety and depressive symptoms. Our case suggests that there might be long intervals between stroke and the appearance of psychotic symptoms.

  16. Problems with balance and binocular visual dysfunction are associated with post-stroke fatigue

    DEFF Research Database (Denmark)

    Schow, Trine; Teasdale, Thomas William; Jensen Quas, Kirsten;

    2016-01-01

    Trine Schow, Thomas William Teasdale, Kirsten Jensen Quas& Morten Arendt Rasmussen (2016): Problems with balance and binocular visual dysfunction are associated with post-stroke fatigue, Topics in Stroke Rehabilitation, DOI: 10.1080/10749357.2016.1188475......Trine Schow, Thomas William Teasdale, Kirsten Jensen Quas& Morten Arendt Rasmussen (2016): Problems with balance and binocular visual dysfunction are associated with post-stroke fatigue, Topics in Stroke Rehabilitation, DOI: 10.1080/10749357.2016.1188475...

  17. 4-CLASS MOTOR IMAGERY CLASSIFICATION FOR POST STROKE REHABILITATION USING BRAIN-COMPUTER INTERFACE

    OpenAIRE

    Aarathi Kumar*, Nisha. P. V

    2016-01-01

    Brain-Computer Interface (BCI) is a mechanism that helps in the control/communication of one’s environment through the brain signals obtained directly from the brain via an EEG signal acquisition unit. A BCI incorporating Motor Imagery for post-stroke rehabilitation of upper limbs and knee in fully disabled patients is designed. It helps in restoring some of the activities of the daily living. It aids post-stroke sufferers to carry out functionalities like movement of right an...

  18. Powered robotic exoskeletons in post-stroke rehabilitation of gait: a scoping review.

    Science.gov (United States)

    Louie, Dennis R; Eng, Janice J

    2016-01-01

    Powered robotic exoskeletons are a potential intervention for gait rehabilitation in stroke to enable repetitive walking practice to maximize neural recovery. As this is a relatively new technology for stroke, a scoping review can help guide current research and propose recommendations for advancing the research development. The aim of this scoping review was to map the current literature surrounding the use of robotic exoskeletons for gait rehabilitation in adults post-stroke. Five databases (Pubmed, OVID MEDLINE, CINAHL, Embase, Cochrane Central Register of Clinical Trials) were searched for articles from inception to October 2015. Reference lists of included articles were reviewed to identify additional studies. Articles were included if they utilized a robotic exoskeleton as a gait training intervention for adult stroke survivors and reported walking outcome measures. Of 441 records identified, 11 studies, all published within the last five years, involving 216 participants met the inclusion criteria. The study designs ranged from pre-post clinical studies (n = 7) to controlled trials (n = 4); five of the studies utilized a robotic exoskeleton device unilaterally, while six used a bilateral design. Participants ranged from sub-acute (6 months) stroke. Training periods ranged from single-session to 8-week interventions. Main walking outcome measures were gait speed, Timed Up and Go, 6-min Walk Test, and the Functional Ambulation Category. Meaningful improvement with exoskeleton-based gait training was more apparent in sub-acute stroke compared to chronic stroke. Two of the four controlled trials showed no greater improvement in any walking outcomes compared to a control group in chronic stroke. In conclusion, clinical trials demonstrate that powered robotic exoskeletons can be used safely as a gait training intervention for stroke. Preliminary findings suggest that exoskeletal gait training is equivalent to traditional therapy for chronic stroke

  19. Completing the Pain Circuit: Recent Advances in Imaging Pain and Inflammation beyond the Central Nervous System.

    Science.gov (United States)

    Linnman, Clas; Borsook, David

    2013-01-01

    This review describes some of the recent developments in imaging aspects of pain in the periphery. It is now possible to image nerves in the cornea non-invasively, to image receptor level expression and inflammatory processes in injured tissue, to image nerves and alterations in nerve properties, to image astrocyte and glial roles in neuroinflammatory processes, and to image pain conduction functionally in the trigeminal ganglion. These advances will ultimately allow us to describe the pain pathway, from injury site to behavioral consequence, in a quantitative manner. Such a development could lead to diagnostics determining the source of pain (peripheral or central), objective monitoring of treatment progression, and, hopefully, objective biomarkers of pain. PMID:24228169

  20. Completing the Pain Circuit: Recent Advances in Imaging Pain and Inflammation beyond the Central Nervous System

    Directory of Open Access Journals (Sweden)

    Clas Linnman

    2013-10-01

    Full Text Available This review describes some of the recent developments in imaging aspects of pain in the periphery. It is now possible to image nerves in the cornea non-invasively, to image receptor level expression and inflammatory processes in injured tissue, to image nerves and alterations in nerve properties, to image astrocyte and glial roles in neuroinflammatory processes, and to image pain conduction functionally in the trigeminal ganglion. These advances will ultimately allow us to describe the pain pathway, from injury site to behavioral consequence, in a quantitative manner. Such a development could lead to diagnostics determining the source of pain (peripheral or central, objective monitoring of treatment progression, and, hopefully, objective biomarkers of pain.

  1. Central Hyperexcitability in Chronic Musculoskeletal Pain: A Conceptual Breakthrough with Multiple Clinical Implications

    Directory of Open Access Journals (Sweden)

    Jan Lidbeck

    2002-01-01

    Full Text Available Recent investigations of dysfunctional pain processing in the central nervous system have contributed much knowledge about the development of chronic musculoskeletal pain. Many common chronic musculoskeletal pain syndromes - including regional myofascial pain syndromes, whiplash pain syndromes, refractory work-related neck-shoulder pain, certain types of chronic low back pain, fibromyalgia and others - may essentially be explained by abnormalities in central pain modulation. The growing awareness of dysfunctional central pain modulation may be a conceptual breakthrough leading to a better understanding of common chronic pain disorders. A new paradigm will have multiple clinical implications, including re-evaluation of clinical practice routines and rehabilitation methods, and will focus on controversial issues of medicolegal concern. The concept of dysfunctional central pain processing will also necessitate a mechanism-based classification of pain for the selection of individual treatment and rehabilitation programs for subgroups of patients with chronic musculoskeletal pain due to different pathophysiological mechanisms.

  2. Slow temporal summation of pain for assessment of central pain sensitivity and clinical pain of fibromyalgia patients.

    Directory of Open Access Journals (Sweden)

    Roland Staud

    Full Text Available BACKGROUND: In healthy individuals slow temporal summation of pain or wind-up (WU can be evoked by repetitive heat-pulses at frequencies of ≥.33 Hz. Previous WU studies have used various stimulus frequencies and intensities to characterize central sensitization of human subjects including fibromyalgia (FM patients. However, many trials demonstrated considerable WU-variability including zero WU or even wind-down (WD at stimulus intensities sufficient for activating C-nociceptors. Additionally, few WU-protocols have controlled for contributions of individual pain sensitivity to WU-magnitude, which is critical for WU-comparisons. We hypothesized that integration of 3 different WU-trains into a single WU-response function (WU-RF would not only control for individuals' pain sensitivity but also better characterize their central pain responding including WU and WD. METHODS: 33 normal controls (NC and 38 FM patients participated in a study of heat-WU. We systematically varied stimulus intensities of.4 Hz heat-pulse trains applied to the hands. Pain summation was calculated as difference scores of 1st and 5th heat-pulse ratings. WU-difference (WU-Δ scores related to 3 heat-pulse trains (44°C, 46°C, 48°C were integrated into WU-response functions whose slopes were used to assess group differences in central pain sensitivity. WU-aftersensations (WU-AS at 15 s and 30 s were used to predict clinical FM pain intensity. RESULTS: WU-Δ scores linearly accelerated with increasing stimulus intensity (pNC from WD to WU. Slope of WU-RF, which is representative of central pain sensitivity, was significantly steeper in FM patients than NC (p<.003. WU-AS predicted clinical FM pain intensity (Pearson's r = .4; p<.04. CONCLUSIONS: Compared to single WU series, WU-RFs integrate individuals' pain sensitivity as well as WU and WD. Slope of WU-RFs was significantly different between FM patients and NC. Therefore WU-RF may be useful for assessing central

  3. Frontal white matter hyperintensities, clasmatodendrosis and gliovascular abnormalities in ageing and post-stroke dementia.

    Science.gov (United States)

    Chen, Aiqing; Akinyemi, Rufus O; Hase, Yoshiki; Firbank, Michael J; Ndung'u, Michael N; Foster, Vincent; Craggs, Lucy J L; Washida, Kazuo; Okamoto, Yoko; Thomas, Alan J; Polvikoski, Tuomo M; Allan, Louise M; Oakley, Arthur E; O'Brien, John T; Horsburgh, Karen; Ihara, Masafumi; Kalaria, Raj N

    2016-01-01

    White matter hyperintensities as seen on brain T2-weighted magnetic resonance imaging are associated with varying degrees of cognitive dysfunction in stroke, cerebral small vessel disease and dementia. The pathophysiological mechanisms within the white matter accounting for cognitive dysfunction remain unclear. With the hypothesis that gliovascular interactions are impaired in subjects with high burdens of white matter hyperintensities, we performed clinicopathological studies in post-stroke survivors, who had exhibited greater frontal white matter hyperintensities volumes that predicted shorter time to dementia onset. Histopathological methods were used to identify substrates in the white matter that would distinguish post-stroke demented from post-stroke non-demented subjects. We focused on the reactive cell marker glial fibrillary acidic protein (GFAP) to study the incidence and location of clasmatodendrosis, a morphological attribute of irreversibly injured astrocytes. In contrast to normal appearing GFAP+ astrocytes, clasmatodendrocytes were swollen and had vacuolated cell bodies. Other markers such as aldehyde dehydrogenase 1 family, member L1 (ALDH1L1) showed cytoplasmic disintegration of the astrocytes. Total GFAP+ cells in both the frontal and temporal white matter were not greater in post-stroke demented versus post-stroke non-demented subjects. However, the percentage of clasmatodendrocytes was increased by >2-fold in subjects with post-stroke demented compared to post-stroke non-demented subjects (P = 0.026) and by 11-fold in older controls versus young controls (P stroke demented subjects. Double immunofluorescent staining showed aberrant co-localization of aquaporin 4 (AQP4) in retracted GFAP+ astrocytes with disrupted end-feet juxtaposed to microvessels. To explore whether this was associated with the disrupted gliovascular interactions or blood-brain barrier damage, we assessed the co-localization of GFAP and AQP4 immunoreactivities in post

  4. Fractal dynamics of body motion in post-stroke hemiplegic patients during walking

    Science.gov (United States)

    Akay, M.; Sekine, M.; Tamura, T.; Higashi, Y.; Fujimoto, T.

    2004-06-01

    In this paper, we quantify the complexity of body motion during walking in post-stroke hemiplegic patients. The body motion of patients and healthy elderly subjects was measured by using the accelerometry technique. The complexity of body motion was quantified using the maximum likelihood estimator (MLE-) based fractal analysis methods. Our results suggest that the fractal dimensions of the body motion in post-stroke hemiplegic patients at several Brunnstrom stages were significantly higher than those of healthy elderly subjects (p hemiplegic patients, the fractal dimensions were more related to Brunnstrom stages.

  5. Recognition of central sensitization in patients with musculoskeletal pain: Application of pain neurophysiology in manual therapy practice.

    NARCIS (Netherlands)

    Nijs, J.; Houdenhove, B. Van; Oostendorp, R.A.B.

    2010-01-01

    Central sensitization plays an important role in the pathophysiology of numerous musculoskeletal pain disorders, yet it remains unclear how manual therapists can recognize this condition. Therefore, mechanism based clinical guidelines for the recognition of central sensitization in patients with mus

  6. Effects of Physical Exercise on Working Memory and Prefrontal Cortex Function in Post-Stroke Patients.

    Science.gov (United States)

    Moriya, M; Aoki, C; Sakatani, K

    2016-01-01

    Physical exercise enhances prefrontal cortex activity and improves working memory performance in healthy older adults, but it is not clear whether this remains the case in post-stroke patients. Therefore, the aim of this study was to examine the acute effect of physical exercise on prefrontal cortex activity in post-stroke patients using near-infrared spectroscopy (NIRS). We studied 11 post-stroke patients. The patients performed Sternberg-type working memory tasks before and after moderate intensity aerobic exercise (40 % of maximal oxygen uptake) with a cycling ergometer for 15 min. We measured the NIRS response at the prefrontal cortex during the working memory task. We evaluated behavioral performance (response time and accuracy) of the working memory task. It was found that physical exercise improved behavioral performance of the working memory task compared with the control condition (p physical exercise enhanced prefrontal cortex activation, particularly in the right prefrontal cortex (p exercise enhances prefrontal cortex activity and improves working memory performance in post-stroke patients. PMID:27526144

  7. Graph analytic characterization of resting state networks in post-stroke aphasia

    Directory of Open Access Journals (Sweden)

    Swathi Kiran

    2014-04-01

    Relative to controls, these results indicate inefficiencies in the post-stroke resting-state network, with greater shifts in network hubs in PWA dependent on the site and size of lesion. Such graph analytic results may prove informative in advancing individual-specific therapies.

  8. Diagnostic value of the Rotterdam-CAMCOG in post-stroke dementia

    NARCIS (Netherlands)

    I. de Koning (Inge); F. van Kooten (Fop); P.J. Koudstaal (Peter Jan); D.W.J. Dippel (Diederik)

    2005-01-01

    textabstractBACKGROUND AND OBJECTIVE: Specific screening tests to detect post-stroke dementia are lacking. We recently reported that an adaptation of the Cambridge Cognitive Examination (CAMCOG), the Rotterdam-CAMCOG, had excellent sensitivity and specificity for detecting post-str

  9. Overexpression of brain-derived neurotrophic factor in the hippocampus protects against post-stroke depression

    Institute of Scientific and Technical Information of China (English)

    Hao-hao Chen; Ning Zhang; Wei-yun Li; Ma-rong Fang; Hui Zhang; Yuan-shu Fang; Ming-xing Ding; Xiao-yan Fu

    2015-01-01

    Post-stroke depression is associated with reduced expression of brain-derived neurotrophic factor (BDNF). In this study, we evaluated whether BDNF overexpression affects depression-like behavior in a rat model of post-stroke depression. The middle cerebral artery was occluded to produce a model of focal cerebral ischemia. These rats were then subjected to isolation-housing combined with chronic unpredictable mild stress to generate a model of post-stroke depression. ABDNF gene lentiviral vector was injected into the hippocampus. At 7 days after injection, western blot assay and real-time quantitative PCR revealed that BDNF expression in the hippo-campus was increased in depressive rats injected with BDNF lentivirus compared with depressive rats injected with control vector. Furthermore, sucrose solution consumption was higher, and horizontal and vertical movement scores were increased in the open ifeld test in these rats as well. These ifndings suggest that BDNF overexpression in the hippocampus of post-stroke depressive rats alleviates depression-like behaviors.

  10. Post-stroke depression treated with acupuncture and moxibustion: an evaluation of therapeutic effect and safety

    Institute of Scientific and Technical Information of China (English)

    聂容荣

    2013-01-01

    Objective To evaluate the efficacy and safety of acupuncture and moxibustion in the treatment of post-stroke depression (PSD) by regulating the liver and strengthening the root prescription.Methods In light of the random controlled trial principle,123 cases were

  11. Frontal white matter hyperintensities, clasmatodendrosis and gliovascular abnormalities in ageing and post-stroke dementia

    Science.gov (United States)

    Chen, Aiqing; Akinyemi, Rufus O.; Hase, Yoshiki; Firbank, Michael J.; Ndung’u, Michael N.; Foster, Vincent; Craggs, Lucy J. L.; Washida, Kazuo; Okamoto, Yoko; Thomas, Alan J.; Polvikoski, Tuomo M.; Allan, Louise M.; Oakley, Arthur E.; O’Brien, John T.; Horsburgh, Karen; Ihara, Masafumi

    2016-01-01

    White matter hyperintensities as seen on brain T2-weighted magnetic resonance imaging are associated with varying degrees of cognitive dysfunction in stroke, cerebral small vessel disease and dementia. The pathophysiological mechanisms within the white matter accounting for cognitive dysfunction remain unclear. With the hypothesis that gliovascular interactions are impaired in subjects with high burdens of white matter hyperintensities, we performed clinicopathological studies in post-stroke survivors, who had exhibited greater frontal white matter hyperintensities volumes that predicted shorter time to dementia onset. Histopathological methods were used to identify substrates in the white matter that would distinguish post-stroke demented from post-stroke non-demented subjects. We focused on the reactive cell marker glial fibrillary acidic protein (GFAP) to study the incidence and location of clasmatodendrosis, a morphological attribute of irreversibly injured astrocytes. In contrast to normal appearing GFAP+ astrocytes, clasmatodendrocytes were swollen and had vacuolated cell bodies. Other markers such as aldehyde dehydrogenase 1 family, member L1 (ALDH1L1) showed cytoplasmic disintegration of the astrocytes. Total GFAP+ cells in both the frontal and temporal white matter were not greater in post-stroke demented versus post-stroke non-demented subjects. However, the percentage of clasmatodendrocytes was increased by >2-fold in subjects with post-stroke demented compared to post-stroke non-demented subjects (P = 0.026) and by 11-fold in older controls versus young controls (P < 0.023) in the frontal white matter. High ratios of clasmotodendrocytes to total astrocytes in the frontal white matter were consistent with lower Mini-Mental State Examination and the revised Cambridge Cognition Examination scores in post-stroke demented subjects. Double immunofluorescent staining showed aberrant co-localization of aquaporin 4 (AQP4) in retracted GFAP+ astrocytes with

  12. Opportunities for guided multichannel non-invasive transcranial current stimulation in post-stroke rehabilitation

    Directory of Open Access Journals (Sweden)

    Begonya eOtal

    2016-02-01

    Full Text Available Stroke is a leading cause of serious long-term disability worldwide. Functional outcome depends on stroke location, severity and early intervention. Conventional rehabilitation strategies have limited effectiveness, and new treatments still fail to keep pace, in part due to a lack of understanding of the different stages in brain recovery and the vast heterogeneity in the post-stroke population. Innovative methodologies for restorative neurorehabilitation are required to reduce long-term disability and socioeconomic burden. Neuroplasticity is involved in post-stroke functional disturbances, and also during rehabilitation. Tackling post-stroke neuroplasticity by non-invasive brain stimulation is regarded as promising, but efficacy might be limited because of rather uniform application across patients despite individual heterogeneity of lesions, symptoms and other factors. Transcranial direct current stimulation (tDCS induces and modulates neuroplasticity, and has been shown to be able to improve motor and cognitive functions. tDCS is suited to improve post-stroke rehabilitation outcomes, but effect sizes are often moderate and suffer from variability. Indeed, the location, extent and pattern of functional network connectivity disruption should be considered when determining the optimal location sites for tDCS therapies. Here, we present potential opportunities for neuroimaging-guided tDCS-based rehabilitation strategies after stroke that could be personalized. We introduce innovative multimodal intervention protocols based on multichannel tDCS montages, neuroimaging methods and real-time closed-loop systems to guide therapy. This might help to overcome current treatment limitations in post-stroke rehabilitation and increase our general understanding of adaptive neuroplasticity leading to neural reorganization after stroke.

  13. Clinical use of pregabalin in the management of central neuropathic pain

    Directory of Open Access Journals (Sweden)

    Nanna B Finnerup

    2007-01-01

    Full Text Available Nanna B Finnerup, Troels S JensenDanish Pain Research Center, Department of Neurology, Aarhus University Hospital, Aarhus, DenmarkAbstract: Central neuropathic pain (central pain is treated with antidepressants, various anticonvulsants, opioids, and cannabinoids, but in many cases treatment is insufficient and associated with a range of side-effects. This review addresses a new treatment for neuropathic pain, the anticonvulsant pregabalin. We review the pharmacology, mode of action, pharmacokinetics, and safety of pregabalin as well as two randomized efficacy studies in central pain and a brief overview of efficacy in peripheral neuropathic pain. Pregabalin appears to have efficacy in treating central pain comparable to that in peripheral neuropathic pain as well as efficacy of other recommended drugs for central pain. Pregabalin also improves disturbed sleep and anxiety. Pregabalin is well tolerated; the most common side-effects are somnolence, dizziness, ataxia, and weight gain. Pregabalin is suitable for patients on multiple drugs although there may be additive CNS-related side-effects. Thus, pregabalin has a primary role in central pain patients.Keywords: central pain, neuropathic pain, pregabalin, pharmacology

  14. Reaction to topical capsaicin in spinal cord injury patients with and without central pain

    DEFF Research Database (Denmark)

    Finnerup, Nanna Brix; Pedersen, Louise H.; Terkelsen, Astrid J.;

    2007-01-01

    Central neuropathic pain is a debilitating and frequent complication to spinal cord injury (SCI). Excitatory input from hyperexcitable cells around the injured grey matter zone is suggested to play a role for central neuropathic pain felt below the level of a spinal cord injury. Direct evidence...... of a spinal cord injury which already is hyperexcitable, would cause enhanced responses in patients with central pain at the level of injury compared to patients without neuropathic pain and healthy controls. Touch, punctuate stimuli, cold stimuli and topical capsaicin was applied above, at, and below injury...... at the level of injury. Keywords: Spinal cord injury; Neuropathic pain; Capsaicin; Neuronal hyperexcitability; Hyperalgesia; Blood flow...

  15. Virtual reality environments for post-stroke arm rehabilitation

    Directory of Open Access Journals (Sweden)

    Beaudoin Christian

    2007-06-01

    Full Text Available Abstract Introduction Optimal practice and feedback elements are essential requirements for maximal motor recovery in patients with motor deficits due to central nervous system lesions. Methods A virtual environment (VE was created that incorporates practice and feedback elements necessary for maximal motor recovery. It permits varied and challenging practice in a motivating environment that provides salient feedback. Results The VE gives the user knowledge of results feedback about motor behavior and knowledge of performance feedback about the quality of pointing movements made in a virtual elevator. Movement distances are related to length of body segments. Conclusion We describe an immersive and interactive experimental protocol developed in a virtual reality environment using the CAREN system. The VE can be used as a training environment for the upper limb in patients with motor impairments.

  16. Post-stroke epilepsy in young adults: a long-term follow-up study

    OpenAIRE

    Arntz, R.M.; Rutten-Jacobs, L.C.A.; Maaijwee, N.A.M.M.; Schoonderwaldt, H.C.; Dorresteijn, L.D.A.; Dijk, E.J. van; de Leeuw, F E

    2013-01-01

    BACKGROUND: Little is known about the incidence and risk of seizures after stroke in young adults. Especially in the young seizures might dramatically influence prognosis and quality of life. We therefore investigated the long-term incidence and risk of post-stroke epilepsy in young adults with a transient ischemic attack (TIA), ischemic stroke (IS) or intracerebral hemorrhage (ICH). METHODS AND FINDINGS: We performed a prospective cohort study among 697 consecutive patients with a first-ever...

  17. Plantar Pressure Distribution During Robotic-Assisted Gait in Post-stroke Hemiplegic Patients

    OpenAIRE

    Yang, Jin Kyu; Ahn, Na El; Kim, Dae Hyun; Kim, Deog Young

    2014-01-01

    Objective To assess the plantar pressure distribution during the robotic-assisted walking, guided through normal symmetrical hip and knee physiological kinematic trajectories, with unassisted walking in post-stroke hemiplegic patients. Methods Fifteen hemiplegic stroke patients, who were able to walk a minimum of ten meters independently but with asymmetric gait patterns, were enrolled in this study. All the patients performed both the robotic-assisted walking (Lokomat) and the unassisted wal...

  18. Effect of Auditory Constraints on Motor Learning Depends on Stage of Recovery Post Stroke

    Directory of Open Access Journals (Sweden)

    Viswanath eAluru

    2014-06-01

    Full Text Available In order to develop evidence-based rehabilitation protocols post stroke, one must first reconcile the vast heterogeneity in the post-stroke population and develop protocols to facilitate motor learning in the various subgroups. The main purpose of this study is to show that auditory constraints interact with the stage of recovery post stroke to influence motor learning. We characterized the stages of upper limb recovery using task-based kinematic measures in twenty subjects with chronic hemiparesis, and used a bimanual wrist extension task using a custom-made wrist trainer to facilitate learning of wrist extension in the paretic hand under four auditory conditions: 1 without auditory cueing; 2 to non-musical happy sounds; 3 to self-selected music; and 4 to a metronome beat set at a comfortable tempo. Two bimanual trials (15 s each were followed by one unimanual trial with the paretic hand over six cycles under each condition. Clinical metrics, wrist and arm kinematics and electromyographic activity were recorded. Hierarchical cluster analysis with the Mahalanobis metric based on baseline speed and extent of wrist movement stratified subjects into three distinct groups which reflected their stage of recovery: spastic paresis, spastic co-contraction, and minimal paresis. In spastic paresis, the metronome beat increased wrist extension, but also increased muscle co-activation across the wrist. In contrast, in spastic co-contraction, no auditory stimulation increased wrist extension and reduced co-activation. In minimal paresis, wrist extension did not improve under any condition. The results suggest that auditory task constraints interact with stage of recovery during motor learning after stroke, perhaps due to recruitment of distinct neural substrates over the course of recovery. The findings advance our understanding of the mechanisms of progression of motor recovery and lay the foundation for personalized treatment algorithms post stroke.

  19. Relationship between plasma glutamate levels and post-stroke depression in patients with acute ischemic stroke

    Institute of Scientific and Technical Information of China (English)

    钱方媛

    2014-01-01

    Objective To test the association between the plasma glutamate levels during acute ischemic stroke andpost-stroke depression(PSD)initially.Methods Seventy-four ischemic stroke patients admitted to the hospital within the first day of stroke onset were evaluated at a follow-up of 2 weeks.The Beck Depression Inventory(BDI,21-item)and DSM-Ⅳcriteria was used to diagnose post-stroke depression(PSD)at 2 weeks after stroke.

  20. Concurrent deficits of soleus and gastrocnemius muscle fascicles and Achilles tendon post stroke

    OpenAIRE

    Zhao, Heng; Ren, Yupeng; Roth, Elliot J.; Harvey, Richard L.; Zhang, Li-Qun

    2015-01-01

    Calf muscles and Achilles tendon play important roles in functional activities. However, it is not clear how biomechanical properties of the uniarticular soleus (SOL) and biarticular gastrocnemius muscle and Achilles tendon, including the fascicle length, pennation angle, and stiffness, change concurrently post stroke. Biomechanical properties of the medial gastrocnemius (GM) and soleus muscles were evaluated bilaterally in 10 hemiparetic stroke survivors using combined ultrasonography-biomec...

  1. Effect of auditory constraints on motor performance depends on stage of recovery post-stroke.

    Science.gov (United States)

    Aluru, Viswanath; Lu, Ying; Leung, Alan; Verghese, Joe; Raghavan, Preeti

    2014-01-01

    In order to develop evidence-based rehabilitation protocols post-stroke, one must first reconcile the vast heterogeneity in the post-stroke population and develop protocols to facilitate motor learning in the various subgroups. The main purpose of this study is to show that auditory constraints interact with the stage of recovery post-stroke to influence motor learning. We characterized the stages of upper limb recovery using task-based kinematic measures in 20 subjects with chronic hemiparesis. We used a bimanual wrist extension task, performed with a custom-made wrist trainer, to facilitate learning of wrist extension in the paretic hand under four auditory conditions: (1) without auditory cueing; (2) to non-musical happy sounds; (3) to self-selected music; and (4) to a metronome beat set at a comfortable tempo. Two bimanual trials (15 s each) were followed by one unimanual trial with the paretic hand over six cycles under each condition. Clinical metrics, wrist and arm kinematics, and electromyographic activity were recorded. Hierarchical cluster analysis with the Mahalanobis metric based on baseline speed and extent of wrist movement stratified subjects into three distinct groups, which reflected their stage of recovery: spastic paresis, spastic co-contraction, and minimal paresis. In spastic paresis, the metronome beat increased wrist extension, but also increased muscle co-activation across the wrist. In contrast, in spastic co-contraction, no auditory stimulation increased wrist extension and reduced co-activation. In minimal paresis, wrist extension did not improve under any condition. The results suggest that auditory task constraints interact with stage of recovery during motor learning after stroke, perhaps due to recruitment of distinct neural substrates over the course of recovery. The findings advance our understanding of the mechanisms of progression of motor recovery and lay the foundation for personalized treatment algorithms post-stroke. PMID

  2. The influence of demographic, environmental and physical factors on functional independence post stroke

    Directory of Open Access Journals (Sweden)

    M.V. Mamabolo

    2008-02-01

    Full Text Available Purpose: The magnitude of disability observed in strokesurvivors is believed to be dependent in part, on the severity of neurological deficits incurred. A s important but less well understood, is thecontribution of demographic, physical and environmental factors. The objective of this study was to establish what demographic, environmentaland physical factors influence functional independence post stroke. Method: Convenience sampling was used in the selection of subjects from four stroke outpatient public health facilities in the Gauteng Province of South Africa. The data were collected using a structured questionnaire. The analytical tools used included descriptive statistics to measure percentages and cross tabulations to measure the level of associations between functional independence and some of the demographic factors. The Barthel Index was computed to establish the degree of functional independence. Finally the influence of factors on functional independence was investigated using bivariate logistic regressions.Results: The results showed that younger patients (18 - 34 yrs may have a higher likelihood of functional independence compared to older patients at the time of discharge from hospital (18 - 34 years: Odds Ratio = 1. Patients without helpers were more likely to be functionally independent than those with a helper (p = 0.03. Involvement in household activities (p = 0.01, participation in community activities (p = 0.02 and bowel and bladder continence (p = 0.003 and p = 0.04 improved the likelihood of functional independence.Conclusion and im plications: Factors that influence functional independence post stroke are: age, bowel and bladder continence, the presence of a caregiver, participation in household and community activities. It is also of value to encourage patients to participate in household and community activities post stroke as well as being less dependent on helpers in an effort to attain functional independence post

  3. The influence of demographic, environmental and physical factors on functional independence post stroke

    OpenAIRE

    M.V. Mamabolo; W. Mudzi; A.S. Stewart; N. P. Mbambo; S. Olorunju

    2008-01-01

    Purpose: The magnitude of disability observed in strokesurvivors is believed to be dependent in part, on the severity of neurological deficits incurred. A s important but less well understood, is thecontribution of demographic, physical and environmental factors. The objective of this study was to establish what demographic, environmentaland physical factors influence functional independence post stroke. Method: Convenience sampling was used in the selection of subjects from four stroke outpa...

  4. Virtual reality therapy for adults post-stroke: a systematic review and meta-analysis exploring virtual environments and commercial games in therapy.

    Directory of Open Access Journals (Sweden)

    Keith R Lohse

    Full Text Available BACKGROUND: The objective of this analysis was to systematically review the evidence for virtual reality (VR therapy in an adult post-stroke population in both custom built virtual environments (VE and commercially available gaming systems (CG. METHODS: MEDLINE, CINAHL, EMBASE, ERIC, PSYCInfo, DARE, PEDro, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews were systematically searched from the earliest available date until April 4, 2013. Controlled trials that compared VR to conventional therapy were included. Population criteria included adults (>18 post-stroke, excluding children, cerebral palsy, and other neurological disorders. Included studies were reported in English. Quality of studies was assessed with the Physiotherapy Evidence Database Scale (PEDro. RESULTS: Twenty-six studies met the inclusion criteria. For body function outcomes, there was a significant benefit of VR therapy compared to conventional therapy controls, G = 0.48, 95% CI = [0.27, 0.70], and no significant difference between VE and CG interventions (P = 0.38. For activity outcomes, there was a significant benefit of VR therapy, G = 0.58, 95% CI = [0.32, 0.85], and no significant difference between VE and CG interventions (P = 0.66. For participation outcomes, the overall effect size was G = 0.56, 95% CI = [0.02, 1.10]. All participation outcomes came from VE studies. DISCUSSION: VR rehabilitation moderately improves outcomes compared to conventional therapy in adults post-stroke. Current CG interventions have been too few and too small to assess potential benefits of CG. Future research in this area should aim to clearly define conventional therapy, report on participation measures, consider motivational components of therapy, and investigate commercially available systems in larger RCTs. TRIAL REGISTRATION: Prospero CRD42013004338.

  5. Clinical Observation on Acupuncture Treatment for Post-stroke Spastic Hemiplegia

    Institute of Scientific and Technical Information of China (English)

    Zhang Yan; Liu Guo-cheng; Wang Jin-yu; Sun Yun-guang; Yang Liu-jiang

    2013-01-01

    Objective:To observe the clinical effect of contralateral needling plus rehabilitation for post-stroke spastic hemiplegia.Methods:Thirty-six patients with post-stroke spastic hemiplegia were randomly divided into a treatment group and a control group,18 cases in each group.The two groups were all given rehabilitation training.The contralateral needling was adopted in the treatment group on the acupoints group of brain-refreshing and orifice-opening needling method.The routine acupuncture was applied in the control group on the same acupoints.Respectively before and after the treatment,the modified Ashworth scale (MAS) and clinical spasticity index (CSI) were used to assess the therapeutic effects.Results:The total effective rate was 94.4% in the treatment group and 67.7% in the control group,with a statistical difference in comparison of the two groups (P<0.05).In comparison of MAS and CSl scores after the treatment between the treatment group and control group,the differences were statistically significant (P<0.05).Conclusion:The contralateral needling plus rehabilitation training is an effective method for the treatment of post-stroke spastic hemiplegia.

  6. Effortful swallowing training combined with electrical stimulation in post-stroke dysphagia: a randomized controlled study.

    Science.gov (United States)

    Park, Jin-Woo; Kim, Youngsun; Oh, Jong-Chi; Lee, Ho-Jun

    2012-12-01

    We tested the effect of effortful swallow combined with surface electrical stimulation used as a form of resistance training in post-stroke patients with dysphagia. Twenty post-stroke dysphagic patients were randomly divided into two groups: those who underwent effortful swallow with infrahyoid motor electrical stimulation (experimental group, n = 10) and effortful swallow with infrahyoid sensory electrical stimulation (control group, n = 10). In the experimental group, electrical stimulation was applied to the skin above the infrahyoid muscle with the current was adjusted until muscle contraction occurred and the hyoid bone was depressed. In the control group, the stimulation intensity was applied just above the sensory threshold. The patients in both groups were then asked to swallow effortfully in order to elevate their hyolaryngeal complex when the stimulation began. A total of 12 sessions of 20 min of training for 4 weeks were performed. Blinded biomechanical measurements of the extent of hyolaryngeal excursion, the maximal width of the upper esophageal sphincter (UES) opening, and the penetration-aspiration scale before and after training were performed. In the experimental group, the maximal vertical displacement of the larynx was increased significantly after the intervention (p method in post-stroke patients with dysphagia. PMID:22447240

  7. Factors associated with post-stroke depression and fatigue: lesion location and coping styles.

    Science.gov (United States)

    Wei, Changjuan; Zhang, Fang; Chen, Li; Ma, Xiaofeng; Zhang, Nan; Hao, Junwei

    2016-02-01

    Post-stroke depression (PSD) and post-stroke fatigue (PSF) are frequent and persistent problems among stroke survivors. Therefore, awareness of signs and symptoms of PSD and PSF is important for their treatment and recovery from stroke. Additionally, since sudden serious illness can result in disequilibrium, early institution of a coping process is essential to restoring stability. The brain damage of stroke leaves patients with unique physical and mental dysfunctions for which coping maybe a key resource while rebuilding lives. We evaluated 368 consecutive patients with acute ischemic stroke for post-stroke emotional disorders at admission and 3 months later. PSD was evaluated by using the Beck Depression Inventory, and PSF was scored with the Fatigue Severity Scale. The Social Support Rating Scale and Medical Coping Modes Questionnaire were also used as measurement tools. Locations of lesions were based on MRI. Those scans revealed infarcts located in the basal ganglia, corona radiate and internal capsule and constituted the independent factors associated with PSF 3 months after stroke occurrence. Conversely, PSD was not related to lesion location. Acceptance-resignation related to PSD and PSF both at admission and 3 months after stroke. Avoidance was the independent factor most closely related to PSD, whereas confrontation was the independent factor best related to PSF at 3 months after stroke onset. PMID:26568559

  8. Regulatory T Cells in Post-stroke Immune Homeostasis.

    Science.gov (United States)

    Liesz, Arthur; Kleinschnitz, Christoph

    2016-08-01

    The secondary neuroinflammatory response has come into focus of experimental stroke research. Immunological mechanisms after acute stroke are being investigated in the hope to identify novel and druggable pathways that contribute to secondary infarct growth after stroke. Among a variety of neuroimmunological events after acute brain ischemia, including microglial activation, brain leukocyte invasion, and secretion of pro-inflammatory factors, lymphocytes have been identified as the key leukocyte subpopulation driving the neuroinflammatory response and contributing to stroke outcome. Several studies have shown that pro-inflammatory lymphocyte subpopulations worsen stroke outcome and that inhibiting their invasion to the injured brain is neuroprotective. In contrast to the effector functions of pro-inflammatory lymphocytes, regulatory T cells (Treg) are critically involved in maintaining immune homeostasis and have been characterized as disease-limiting protective cells in several inflammatory conditions, particularly in primary inflammatory diseases of the central nervous system (CNS). However, due to the complex function of regulatory cells in immune homeostasis and disease, divergent findings have been described for the role of Treg in stroke models. Emerging evidence suggests that this discrepancy arises from potentially differing functions of Treg depending on the predominant site of action within the neurovascular unit and the surrounding inflammatory milieu. This article will provide a comprehensive review of current findings on Treg in brain ischemia models and discuss potential reasons for the observed discrepancies. PMID:27030356

  9. Post-Stroke Mortality, Stroke Severity, and Preadmission Antipsychotic Medicine Use – A Population-Based Cohort Study

    DEFF Research Database (Denmark)

    Prior, Anders; Laursen, Thomas Munk; Larsen, Karen Kjær;

    2014-01-01

    severity, length of hospital stay, and 30-day post-stroke mortality using logistic regression analysis, survival analysis, and propensity score matching. Results: Current users of antipsychotics had a higher risk of severe or very severe stroke on The Scandinavian Stroke Scale than never users...... of antipsychotics (adjusted odds ratios, 1.43; 95% CI, 1.29–1.58). Current users were less likely to be discharged from hospital within 30 days of admission than never users (probability of non-discharge, 27.0% vs. 21.9%). Antipsychotics was associated with an increased 30-day post-stroke mortality among current......Background and Purpose: It has been suggested that antipsychotic medication may be neuroprotective and may reduce post-stroke mortality, but studies are few and ambiguous. We aimed to investigate the post-stroke effects of preadmission antipsychotic use. Methods: We conducted a nationwide...

  10. Design and Development of a Low Cost Platform to Facilitate Post-Stroke Rehabilitation of the Elbow/Shoulder Region

    OpenAIRE

    Curran, Stephen

    2013-01-01

    For post-stroke rehabilitation of the upper limbs, increased amounts of therapy are directly related to improved rehabilitation outcomes. As such, a low cost therapy platform is proposed suitable for facilitating active therapy and administering activeassist therapy to the shoulder/elbow region of the upper limbs of individuals post-stroke in a local clinic or domestic setting. Enabling a person to undergo intensive rehabilitation therapy outside of a rehabilitation hospital setting permits t...

  11. Carpus-ankle Acupuncture Combined with Physical Therapy for Patients with Post-stroke Shoulder Pain: a Randomized Controlled Trial%腕踝针配合康复疗法治疗脑卒中后肩痛的临床研究

    Institute of Scientific and Technical Information of China (English)

    石敦康; 唐小山

    2011-01-01

    Objectives: to clarify the efficacy of carpus-ankle acupuncture in the management of shoulder pain after stroke, in order to provide a new therapy. Methods: 90 participants were included in this trial They were randomly assigned to carpus-ankle acupuncture group and physical therapy group using computer generated random table. The main outcome measurement was VAS score.The secondary outcome measurements were Fugl-Meyer and ADL score. The treatment was given once every two days, 10 times a course, 20 times in total Participants were assessed right after treatment and 1 month after treatment. Results: VAS score of two groups was decreased significantly after treatment ( P < 0.05 ) . Carpus-ankle acupuncture group is superior to physical therapy group (P < 0.05). Fugl-Meyer and ADL score were significant increase after treatment (P < 0.05 ), and Carpus-ankle acupuncture group is superior to physical therapy group (P < 0.05) . Conclusion: Carpus-ankle acupuncture combined with physical therapy is better than physical therapy alone.%目的:观察腕踝针配合康复疗法对脑卒中后肩痛的疗效,为临床治疗此病提供新证据和新手段.方法:本研究选取90例中风患者,采用计算机产生随机数字表,将病人随机分为腕踝针配合康复治疗组及康复治疗组.主要结局指标为视觉模拟评分(VAS),次要结局指标包括Fugl-Meyer关节活动及疼痛评分和ADL日常生活能力评分.两组均采取常规神经内科治疗,腕踝针配合康复治疗组在此基础上再行腕踝针刺.隔天治疗1次,10次1疗程,共治疗2疗程.治疗结束时及治疗后1月各评价1次.结果:治疗结束时,腕踝针结合康复治疗组VAS评分显著低于康复治疗组(P=0.02),而Fugl-Meyer运动功能评分和ADL评分均显著高于康复治疗组.治疗结束后1月时,腕踝针结合康复纽的VAS评分、Fugl-Meyer运动功能评分和ADL评分与与治疗结束时相近,而康复组的相关评分有向基线值

  12. Detection of central circuits implicated in the formation of novel pain memories

    Directory of Open Access Journals (Sweden)

    Upadhyay J

    2016-09-01

    Full Text Available Jaymin Upadhyay,1 Julia Granitzka,1 Thomas Bauermann,2 Ulf Baumgärtner,3 Markus Breimhorst,1 Rolf-Detlef Treede,3 Frank Birklein1 1Department of Neurology, 2Department of Neuroradiology, University Medical Centre, Johannes Gutenberg University Mainz, Mainz, 3Department of Neurophysiology, Center for Biomedicine and Medical Technology Mannheim (CBTM, Heidelberg University, Mannheim, Germany Abstract: Being able to remember physically and emotionally painful events in one’s own past may shape behavior, and can create an aversion to a variety of situations. Pain imagination is a related process that may include recall of past experiences, in addition to production of sensory and emotional percepts without external stimuli. This study aimed to understand 1 the central nervous system processes that underlie pain imagination, 2 the retrieval of pain memories, and 3 to compare the latter with visual object memory. These goals were achieved by longitudinally investigating brain function with functional magnetic resonance imaging in a unique group of healthy volunteers who had never experienced tooth pain. In these subjects, we compared brain responses elicited during three experimental conditions in the following order: imagination of tooth pain (pain imagination, remembering one’s own house (object memory, and remembrance of tooth pain following an episode of induced acute tooth pain (pain memory. Key observations stemming from group-level conjunction analyses revealed common activation in the posterior parietal cortex for both pain imagination and pain memory, while object and pain memory each had strong activation predominantly within the middle frontal gyrus. When contrasting pain imagination and memory, significant activation differences were observed in subcortical structures (ie, parahippocampus – pain imagination > pain memory; midbrain – pain memory > pain imagination. Importantly, these findings were observed in the presence of

  13. Altered central sensitization and pain modulation in the CNS in chronic joint pain

    DEFF Research Database (Denmark)

    Arendt-Nielsen, Lars; Skou, Søren Thorgaard; Nielsen, Thomas Arendt;

    2015-01-01

    Musculoskeletal pain disorders are the second largest contributor to global disability underlining the significance of effective treatments. However, treating chronic musculoskeletal pain, and chronic joint pain (osteoarthritis (OA)) in particular, is challenging as the underlying peripheral and ...... mechanisms, available tools are important for patent profiling and providing the basic knowledge for development of new drugs and for developing pain management regimes....... of human quantitative pain assessment tools (quantitative sensory testing (QST)) have been developed providing new opportunities for profiling patients and reaching a greater understanding of the mechanisms involved in chronic joint pain. As joint pain is a complex interaction between many different pain...

  14. Immediate effects of acupuncture on biceps brachii muscle function in healthy and post-stroke subjects

    Directory of Open Access Journals (Sweden)

    Fragoso Ana

    2012-03-01

    Full Text Available Abstract Background The effects of acupuncture on muscle function in healthy subjects are contradictory and cannot be extrapolated to post-stroke patients. This study evaluated the immediate effects of manual acupuncture on myoelectric activity and isometric force in healthy and post-stroke patients. Methods A randomized clinical trial, with parallel groups, single-blinded study design, was conducted with 32 healthy subjects and 15 post-stroke patients with chronic hemiparesis. Surface electromyography from biceps brachii during maximal isometric voluntary tests was performed before and after 20-min intermittent, and manual stimulation of acupoints Quchi (LI11 or Tianquan (PC2. Pattern differentiation was performed by an automated method based on logistic regression equations. Results Healthy subjects showed a decrease in the root mean-squared (RMS values after the stimulation of LI11 (pre: 1.392 ± 0.826 V; post: 0.612 ± 0.0.320 V; P = 0.002 and PC2 (pre: 1.494 ± 0.826 V; post: 0.623 ± 0.320 V; P = 0.001. Elbow flexion maximal isometric voluntary contraction (MIVC was not significantly different after acupuncture stimulation of LI11 (pre: 22.2 ± 10.7 kg; post: 21.7 ± 9.5 kg; P = 0.288 or PC2 (pre: 18.8 ± 4.6 kg; post: 18.7 ± 6.0 kg; P = 0.468. Post-stroke patients did not exhibit any significant decrease in the RMS values after the stimulation of LI11 (pre: 0.627 ± 0.335 V; post: 0.530 ± 0.272 V; P = 0.187 and PC2 (pre: 0.601 ± 0.258 V; post: 0.591 ± 0.326 V; P = 0.398. Also, no significant decrease in the MIVC value was observed after the stimulation of LI11 (pre: 9.6 ± 3.9 kg; post: 9.6 ± 4.7 kg; P = 0.499 or PC2 (pre: 10.7 ± 5.6 kg; post: 10.2 ± 5.3 kg; P = 0.251. Different frequency of patterns was observed among healthy subjects and post-stroke patients groups (χ2 = 9.759; P = 0.021. Conclusion Manual acupuncture provides sufficient neuromuscular stimuli to promote immediate changes in motor unit gross recruitment without

  15. Voxel-based analysis of fractional anisotropy in post-stroke apathy.

    Directory of Open Access Journals (Sweden)

    Song-ran Yang

    Full Text Available To explore the structural basis of post-stroke apathy by using voxel-based analysis (VBA of fractional anisotropy (FA maps.We enrolled 54 consecutive patients with ischemic stroke during convalescence, and divided them into apathy (n = 31 and non-apathy (n = 23 groups. We obtained magnetic resonance images of their brains, including T1, T2 and DTI sequences. Age, sex, education level, Hamilton Depression Scale (HAMD scores, Mini-Mental State Examination (MMSE scores, National Institutes of Health Stroke Scale (NIHSS scores, and infarct locations for the two groups were compared. Finally, to investigate the structural basis of post-stroke apathy, VBA of FA maps was performed in which we included the variables that a univariate analysis determined had P-values less than 0.20 as covariates.HAMD (P = 0.01 and MMSE (P<0.01 scores differed significantly between the apathy and non-apathy groups. After controlling for age, education level, HAMD scores, and MMSE scores, significant FA reduction was detected in four clusters with peak voxels at the genu of the corpus callosum (X = -16, Y = 30, Z = 8, left anterior corona radiata (-22, 30, 10, splenium of the corpus callosum (-24, -56, 18, and right inferior frontal gyrus white matter (52, 24, 18, after family-wise error correction for multiple comparisons.Post-stroke apathy is related to depression and cognitive decline. Damage to the genu of the corpus callosum, left anterior corona radiata, splenium of the corpus callosum, and white matter in the right inferior frontal gyrus may lead to apathy after ischemic stroke.

  16. Functional recovery of post stroke patients with hemiparesis after stroke of different aetiology

    Directory of Open Access Journals (Sweden)

    Mandić Milan

    2012-01-01

    Full Text Available Introduction. Medical rehabilitation focuses on improvement of functional recovery in post stroke patients. The aim of the work was to analyze functional recovery in a cohort of post stroke patients with hemiparesis three months after stroke. Material and Methods. A prospective, cohort study included 30 patients from the city of Niš aged 40 to 69. The study was conducted at the Department of Physical Medicine and Rehabilitation in Niš from March 1 to June 30, 2009. The aetiology of stroke was determined by the nuclear magnetic resonance. The average values, standard deviation, and t-test were calculated. Results. Of the total sample of 30 patients, 23 (77%, 16 men and 7 women had left hemiparesis and 7 (23%, 4 men and 3 women had right hemiparesis. The average age of the patients was 58.93± 6.86. Fourteen (47% patients were not able to move, 10 (33% patients could move when they were assisted by someone and only 6 (20% patients could move independently. Twenty-six (88% patients were not able to take care of themselves without assistance and 4 (13% patients could take care of themselves. The average Barthel Index score on admission to the Department of Physical Medicine and Rehabilitation was 57 and 3 months after discharge it was 79; the determined difference was statistically significant (p<0.01. At the end of the study, 57% of all the patients could walk without assistance. Conclusion. These results suggest that disabled post stroke patients may attain significant functional improvements in response to early rehabilitation as well as to prolonged rehabilitation therapy.

  17. Post-stroke depression: Prevalence and relationship with disability in chronic stroke survivors

    Directory of Open Access Journals (Sweden)

    Srivastava Abhishek

    2010-01-01

    Full Text Available Objectives: To evaluate (1 the prevalence of operationally defined depressive disorder (ICD-10 in chronic stroke subjects and (2 the relationship of post-stroke depression (PSD with disability. Design: Cross-sectional, descriptive study. Setting: Neurological rehabilitation unit of a tertiary care university research center. Materials and Methods: Participants were those with first episode of supratentorial stroke of more than 3 months′ duration with impaired balance and gait who had been referred for rehabilitation. Data were collected on demographic data, stroke data (side and type of lesion and post-stroke duration, cognition (mini mental state examination, depressive ideation (Hamilton Depression Rating Scale - HRDS, impairment (Scandinavian Stroke Scale, balance (Berg Balance Scale, ambulatory status (Functional Ambulation Category, walking ability (speed, and independence in activities of daily living (Barthel Index. Statistical analysis was done using SPSS 13.0. We carried out the chi-square test for ordinal variables and the independent t test for continuous variables. Results: Fifty-one patients (M:F: 41:10 of mean age 46.06 ± 11.19 years and mean post-stroke duration of 467.33 ± 436.39 days were included in the study. Eighteen of the 51 participants (35.29% met the criteria for depression. Demographic variables like male gender, being married, living in a nuclear family, urban background, and higher HRDS score were significantly correlated with PSD (P < 0.05. Depression was related to functional disability after stroke but to a statistically insignificant level (P > 0.05 and was unrelated to lesion-related parameters. Conclusion: Depression occurs in one-third of chronic stroke survivors and is prevalent in subjects referred for rehabilitation. PSD is related primarily to demographic variables and only to a lesser extent to functional disability following stroke.

  18. BDNF genotype interacts with motor-function to influence rehabilitation responsiveness post-stroke

    Directory of Open Access Journals (Sweden)

    Christine T Shiner

    2016-05-01

    Full Text Available Background. Persistent motor impairment is common but highly heterogeneous post-stroke. Genetic polymorphisms, including those identified on the brain derived neurotrophic factor (BDNF and apolipoprotein E (APOE genes, may contribute to this variability by limiting the capacity for use-dependent neuroplasticity, and hence rehabilitation responsiveness.Objective. To determine whether BDNF and APOE genotypes influence motor improvement facilitated by post-stroke upper-limb rehabilitation. Methods. BDNF Val66Met and APOE isoform genotypes were determined using leukocyte DNA for 55 community-dwelling patients 2-123 months post-stroke. All patients completed a dose-matched upper-limb rehabilitation program of either Wii-based Movement Therapy or Constraint-induced Movement Therapy. Upper-limb motor-function was assessed pre- and post-therapy using a suite of functional measures. Results. Motor-function improved for all patients post-therapy, with no difference between therapy groups. In the pooled data, there was no significant effect of BDNF or APOE genotype on motor-function at baseline, or following the intervention. However, a significant interaction between the level of residual motor-function and BDNF genotype was identified (p=0.029, whereby post-therapy improvement was significantly less for Met allele carriers with moderate and high, but not low motor-function. There was no significant association between APOE genotype and therapy outcomes. Conclusions. This study identified a novel interaction between the BDNF Val66Met polymorphism, motor-function status and the magnitude of improvement with rehabilitation in chronic stroke. This polymorphism does not preclude, but may reduce, the magnitude of motor improvement with therapy, particularly for patients with higher but not lower residual motor-function. BDNF genotype should be considered in the design and interpretation of clinical trials.

  19. Persistent post-stroke depression in mice following unilateral medial prefrontal cortical stroke.

    Science.gov (United States)

    Vahid-Ansari, F; Lagace, D C; Albert, P R

    2016-01-01

    Post-stroke depression (PSD) is a common outcome following stroke that is associated with poor recovery. To develop a preclinical model of PSD, we targeted a key node of the depression-anxiety circuitry by inducing a unilateral ischemic lesion to the medial prefrontal cortex (mPFC) stroke. Microinjection of male C57/BL6 mice with endothelin-1 (ET-1, 1600 pmol) induced a small (1 mm(3)) stroke consistently localized within the left mPFC. Compared with sham control mice, the stroke mice displayed a robust behavioral phenotype in four validated tests of anxiety including the elevated plus maze, light-dark, open-field and novelty-suppressed feeding tests. In addition, the stroke mice displayed depression-like behaviors in both the forced swim and tail suspension test. In contrast, there was no effect on locomotor activity or sensorimotor function in the horizontal ladder, or cylinder and home cage activity tests, indicating a silent stroke due to the absence of motor abnormalities. When re-tested at 6 weeks post stroke, the stroke mice retained both anxiety and depression phenotypes. Surprisingly, at 6 weeks post stroke the lesion site was infiltrated by neurons, suggesting that the ET-1-induced neuronal loss in the mPFC was reversible over time, but was insufficient to promote behavioral recovery. In summary, unilateral ischemic lesion of the mPFC results in a pronounced and persistent anxiety and depression phenotype with no evident sensorimotor deficits. This precise lesion of the depression circuitry provides a reproducible model to study adaptive cellular changes and preclinical efficacy of novel interventions to alleviate PSD symptoms. PMID:27483381

  20. A Comparative Study Between Modified Starch and Xanthan Gum Thickeners in Post-Stroke Oropharyngeal Dysphagia.

    Science.gov (United States)

    Vilardell, N; Rofes, L; Arreola, V; Speyer, R; Clavé, P

    2016-04-01

    Thickeners are used in post-stroke oropharyngeal dysphagia (OD) as a compensatory therapeutic strategy against aspirations. To compare the therapeutic effects of modified starch (MS) and xanthan gum (XG) thickeners on swallow safety and efficacy in chronic post-stroke OD patients using clinical and videofluoroscopic (VFS) assessment. Patients were studied by clinical assessment (volume-viscosity swallow test, V-VST) and VFS using 3 volumes (5, 10, 20 mL) and 3 viscosities (liquid, nectar and spoon thick), comparing MS and XG. We studied 122 patients (46MS, 76XG). (A) V-VST showed that both thickeners similarly improved safety of swallow. Prevalence of safe swallowing significantly increased with enhanced viscosity (P < 0.001 vs liquid), MS: 47.83 % at liquid, 84.93 % at nectar and 92.96 % at spoon thick; XG: 55.31 % at liquid, 77.78 % at nectar and 97.84 % at spoon thick. Patients on MS reported higher prevalence of pharyngeal residue at spoon-thick viscosities. (B) VFS: increasing bolus viscosity with either thickener increased prevalence of safe swallows (P < 0.001 vs liquid), MS: 30.25 % liquid, 61.07 % nectar and 92.64 % spoon thick; XG: 29.12 % liquid, 71.30 % nectar and 89.91 % spoon thick. Penetration-aspiration scale score was significantly reduced with increased viscosity with both thickeners. MS increased oral and pharyngeal residues at nectar and spoon-thick viscosities but XG did not. Timing of airway protection mechanisms and bolus velocity were not affected by either thickener. Increasing bolus viscosity with MS and XG thickeners strongly and similarly improved safety of swallow in chronic post-stroke OD by a compensatory mechanism; in contrast only MS thickeners increased oropharyngeal residue. PMID:26607158

  1. Exercise Strengthens Central Nervous System Modulation of Pain in Fibromyalgia

    Science.gov (United States)

    Ellingson, Laura D.; Stegner, Aaron J.; Schwabacher, Isaac J.; Koltyn, Kelli F.; Cook, Dane B.

    2016-01-01

    To begin to elucidate the mechanisms underlying the benefits of exercise for chronic pain, we assessed the influence of exercise on brain responses to pain in fibromyalgia (FM). Complete data were collected for nine female FM patients and nine pain-free controls (CO) who underwent two functional neuroimaging scans, following exercise (EX) and following quiet rest (QR). Brain responses and pain ratings to noxious heat stimuli were compared within and between groups. For pain ratings, there was a significant (p < 0.05) Condition by Run interaction characterized by moderately lower pain ratings post EX compared to QR (d = 0.39–0.41) for FM but similar to ratings in CO (d = 0.10–0.26), thereby demonstrating that exercise decreased pain sensitivity in FM patients to a level that was analogous to pain-free controls. Brain responses demonstrated a significant within-group difference in FM patients, characterized by less brain activity bilaterally in the anterior insula following QR as compared to EX. There was also a significant Group by Condition interaction with FM patients showing less activity in the left dorsolateral prefrontal cortex following QR as compared to post-EX and CO following both conditions. These results suggest that exercise appeared to stimulate brain regions involved in descending pain inhibition in FM patients, decreasing their sensitivity to pain. Thus, exercise may benefit patients with FM via improving the functional capacity of the pain modulatory system. PMID:26927193

  2. The effect of optokinetic and galvanic vestibular stimulations in reducing post-stroke postural asymmetry

    OpenAIRE

    Bonan, I. V.; Leblong, E.; Leplaideur, S.; Laviolle, B; Tasseel Tonche, Sophie; Yelnik, A. P.

    2015-01-01

    Objective: To investigate the postural effect of 2 types of sensory stimulation in patients with a left hemispheric lesion (LHL) or right hemispheric lesion (RHL) compared with controls. Methods: 35 patients (18 LHL, 17 RHL) and 27 controls (Mean age 54.1 years), with a mean delay post-stroke of 3.0 months were enrolled. Subjects stood on a force platform and were stimulated on the left and right side by optokinetic (Okn) and galvanic vestibular (Gv) stimulation. Lateral displacement followin...

  3. Post-stroke disposition from a geriatric-rehabilitative stroke care area: an Italian experience

    Directory of Open Access Journals (Sweden)

    Marco Masina

    2014-02-01

    Full Text Available A large number of stroke patients cannot be discharged at home. Studies on post stroke disposition have low validity outside the country in which they are carried out because healthcare systems offer different rehabilitative and long-term facilities. Moreover absolute selection criteria for admission to rehabilitation are not available yet. Few studies on post-stroke disposition from Italian stroke units are available. Authors evaluated data of a 18-month period from a geriatric managed stroke care area where comprehensive multi-professional assessment and discharge planning are routinely carried out. Only patients discharged with diagnosis related to acute stroke were considered. Baseline characteristics, clinical, neurological and functional conditions according to the structured multidimensional assessment were prospectively collected in the stroke unit registry. Univariate and multinomial logistic regression were performed to identify independent variables associated with three discharge settings: home, rehabilitation and skilled long-term ward. Out of 188 patients evaluated, 56.4% were discharged home, 18.6% to rehabilitation and 25.0% to long-term ward. Data showed an efficient disposition to intermediate settings with a shorter length of stay compared to other international studies. Factors associated with post-stroke disposition were age, dysphagia, neurological impairment on admission (NIH-SS≥6, after stroke functional status (mRankin≥3, poor pre-stroke functional level (mRankin≥3 and hemorrhagic stroke. Dysphagia, severe neurological impairment and post-stroke disability were associated with discharge to rehabilitation and long term ward. These two settings differed in age and pre-stroke functional condition. Patients discharged to long-term wards were about 10 years older than those admitted to rehabilitative ward. Only 5% of patients discharged to rehabilitation had a pre-stroke mRankin score ≥3. Disposition to a skilled

  4. Virtual Reality for Sensorimotor Rehabilitation Post-Stroke: The Promise and Current State of the Field.

    Science.gov (United States)

    Fluet, Gerard G; Deutsch, Judith E

    2013-03-01

    Developments over the past 2 years in virtual reality (VR) augmented sensorimotor rehabilitation of upper limb use and gait post-stroke were reviewed. Studies were included if they evaluated comparative efficacy between VR and standard of care, and or differences in VR delivery methods; and were CEBM (center for evidence based medicine) level 2 or higher. Eight upper limb and two gait studies were included and described using the following categories hardware (input and output), software (virtual task and feedback and presentation) intervention (progression and dose), and outcomes. Trends in the field were commented on, gaps in knowledge identified, and areas of future research and translation of VR to practice were suggested.

  5. Central adaptation of pain perception in response to rehabilitation of musculoskeletal pain

    DEFF Research Database (Denmark)

    Andersen, Lars L; Andersen, Christoffer H; Sundstrup, Emil;

    2012-01-01

    pain remains unclear. OBJECTIVE: To investigate the effect of neck/shoulder resistance training on pressure pain threshold (PPT) of the painful neck/shoulder muscles (upper trapezius) and a non-painful reference muscle of the leg (tibialis anterior) in adults with neck/shoulder pain. STUDY DESIGN...... of pain 186 days during the previous year, computer use 93% of work time) were randomly allocated to 10 weeks of specific resistance training for the neck/shoulder muscles for 2 or 12 minutes per day 5 times a week, or weekly information on general health (control group). Primary outcomes were changes...... in PPT of the painful neck/shoulder muscles (upper trapezius) and a distant non-painful reference muscle (tibialis anterior) at 10 weeks. RESULTS: PPT of both the trained painful trapezius and the non-trained reference muscle of the leg increased more in the training groups compared with the control...

  6. Detection of central circuits implicated in the formation of novel pain memories

    Science.gov (United States)

    Upadhyay, Jaymin; Granitzka, Julia; Bauermann, Thomas; Baumgärtner, Ulf; Breimhorst, Markus; Treede, Rolf-Detlef; Birklein, Frank

    2016-01-01

    Being able to remember physically and emotionally painful events in one’s own past may shape behavior, and can create an aversion to a variety of situations. Pain imagination is a related process that may include recall of past experiences, in addition to production of sensory and emotional percepts without external stimuli. This study aimed to understand 1) the central nervous system processes that underlie pain imagination, 2) the retrieval of pain memories, and 3) to compare the latter with visual object memory. These goals were achieved by longitudinally investigating brain function with functional magnetic resonance imaging in a unique group of healthy volunteers who had never experienced tooth pain. In these subjects, we compared brain responses elicited during three experimental conditions in the following order: imagination of tooth pain (pain imagination), remembering one’s own house (object memory), and remembrance of tooth pain following an episode of induced acute tooth pain (pain memory). Key observations stemming from group-level conjunction analyses revealed common activation in the posterior parietal cortex for both pain imagination and pain memory, while object and pain memory each had strong activation predominantly within the middle frontal gyrus. When contrasting pain imagination and memory, significant activation differences were observed in subcortical structures (ie, parahippocampus − pain imagination > pain memory; midbrain − pain memory > pain imagination). Importantly, these findings were observed in the presence of consistent and reproducible psychophysical and behavioral measures that informed on the subjects’ ability to imagine novel and familiar thoughts, as well as the subjects’ pain perception.

  7. Quantitative videofluoroscopic analysis of penetration-aspiration in post-stroke patients

    Directory of Open Access Journals (Sweden)

    Bingjie Li

    2010-01-01

    Full Text Available Background : Dysphagia is a common complication of stroke and is a potential cause for aspiration and malnutrition and is also associated with poor outcome. Videofluoroscopic Swallowing Study (VFSS is the most objective method for evaluation of swallowing disorders. Aim : To investigate the incidence and characteristics of penetration-aspiration in post-stroke patients, and to study the relationship between penetration-aspiration and kinematic parameters of swallow. Materials and Methods : We prospectively studied swallowing function in 105 consecutive post-stroke patients and 100 normal adults by videofluoroscopic swallowing studies. The severity of airway invasion, penetration-aspiration, was studied quantitatively and kinematic parameters of swallow i.e. oral transit time, pharyngeal transit time (PTT, pharyngeal delay timem (PDT, maximal extent of vertical and anterior movement of larynx and hyoid bone for four kinds of boluses were also studied. Logistic regression was used to analyze the association between aspiration and kinematic parameters of swallow. Results : Stroke patients scored significantly higher scores on penetration-aspiration scale than the normal subjects (P < 0.001 during four bolus swallows. Logistic regression analysis showed that PTT, PDT, maximal extent of vertical laryngeal and hyoid movement were statistically associated with the prevalence of aspiration (P < 0.05. Conclusion : Penetration-aspiration is common in stroke patients. Several kinematic parameters of swallow are associated with the presence of aspiration on fluoroscopy. These data demonstrate that VFSS may be helpful for objective identification of dysphagia in stroke patients.

  8. Reliability of isokinetic normalized peak torque assessments for knee muscles in post-stroke hemiparesis.

    Science.gov (United States)

    Noorizadeh Dehkordi, Shohreh; Talebian, Saeed; Olyaei, Gholamreza; Montazeri, Ali

    2008-05-01

    The purpose of this study was to establish test-retest reliability of measurement procedures for quantifying isokinetic concentric peak torque (PT) at the knee using normalization methods post-stroke. A second aim was to estimate the change required to show clinically significant improvements in knee muscles strength. The isokinetic normalized PT (NPT) values for the knee extensors and flexors were measured in each participant at two different angular velocities during two sessions 1 day apart. Thirty participants with mild to moderate hemiparesis after stroke who were able to walk were tested. The normalized PT measures for the knee muscles of the affected lower extremity were highly reliable (intraclass correlation coefficients ranged from 0.85 to 0.98; pknee flexors had more random variation than the knee extensors. This study supports the use of isokinetic dynamometers for the assessment of knee muscle strength in participants with chronic mild to moderate post-stroke hemiparesis and to measure clinical improvements. Established measurement error and smallest real differences in normalized PT will aid interpretation of real changes in muscle strength in this clinical population.

  9. Moving Forward by Stimulating the Brain: Transcranial Direct Current Stimulation in Post-Stroke Hemiparesis.

    Science.gov (United States)

    Peters, Heather T; Edwards, Dylan J; Wortman-Jutt, Susan; Page, Stephen J

    2016-01-01

    Stroke remains a leading cause of disability worldwide, with a majority of survivors experiencing long term decrements in motor function that severely undermine quality of life. While many treatment approaches and adjunctive strategies exist to remediate motor impairment, many are only efficacious or feasible for survivors with active hand and wrist function, a population who constitute only a minority of stroke survivors. Transcranial direct current stimulation (tDCS), a type of non-invasive brain stimulation, has been increasingly utilized to increase motor function following stroke as it is able to be used with stroke survivors of varying impairment levels, is portable, is relatively inexpensive and has few side effects and contraindications. Accordingly, in recent years the number of studies investigating its efficacy when utilized as an adjunct to motor rehabilitation regimens has drastically increased. While many of these trials have reported positive and promising efficacy, methodologies vary greatly between studies, including differences in stimulation parameters, outcome measures and the nature of physical practice. As such, an urgent need remains, centering on the need to investigate these methodological differences and synthesize the most current evidence surrounding the application of tDCS for post-stroke motor rehabilitation. Accordingly, the purpose of this paper is to provide a detailed overview of the most recent tDCS literature (published 2014-2015), while highlighting these variations in methodological approach, as well to elucidate the mechanisms associated with tDCS and post-stroke motor re-learning and neuroplasticity. PMID:27555811

  10. Moving Forward by Stimulating the Brain: Transcranial Direct Current Stimulation in Post-Stroke Hemiparesis

    Science.gov (United States)

    Peters, Heather T.; Edwards, Dylan J.; Wortman-Jutt, Susan; Page, Stephen J.

    2016-01-01

    Stroke remains a leading cause of disability worldwide, with a majority of survivors experiencing long term decrements in motor function that severely undermine quality of life. While many treatment approaches and adjunctive strategies exist to remediate motor impairment, many are only efficacious or feasible for survivors with active hand and wrist function, a population who constitute only a minority of stroke survivors. Transcranial direct current stimulation (tDCS), a type of non-invasive brain stimulation, has been increasingly utilized to increase motor function following stroke as it is able to be used with stroke survivors of varying impairment levels, is portable, is relatively inexpensive and has few side effects and contraindications. Accordingly, in recent years the number of studies investigating its efficacy when utilized as an adjunct to motor rehabilitation regimens has drastically increased. While many of these trials have reported positive and promising efficacy, methodologies vary greatly between studies, including differences in stimulation parameters, outcome measures and the nature of physical practice. As such, an urgent need remains, centering on the need to investigate these methodological differences and synthesize the most current evidence surrounding the application of tDCS for post-stroke motor rehabilitation. Accordingly, the purpose of this paper is to provide a detailed overview of the most recent tDCS literature (published 2014-2015), while highlighting these variations in methodological approach, as well to elucidate the mechanisms associated with tDCS and post-stroke motor re-learning and neuroplasticity. PMID:27555811

  11. 卒中后尿失禁%Post-stroke urinary incontinence

    Institute of Scientific and Technical Information of China (English)

    李彦丽; 武如冰

    2014-01-01

    Urinary incontinence is a common complication of stroke,40% to 60% of inpatients with stroke have urinary incontinence.Post-stroke urinary incontinence is a strong predictor of death,functional disability,and admission of rehabilitation institutions.Recovery of urinary incontinence is associated with a better stroke outcome.This article reviews the epidemiology,causes and classification,effects on stroke outcome,and treatment strategies of post-stroke urinary incontinence.%尿失禁是卒中的一种常见并发症,40%~60%的卒中住院患者存在尿失禁.卒中后尿失禁是患者死亡、功能残疾和入住康复机构的强烈预测因素.尿失禁的恢复与卒中转归更好相关.文章对卒中后尿失禁的流行病学、原因和分类、对卒中转归的影响以及治疗策略进行了综述.

  12. Factors associated with post-stroke depression and emotional incontinence: lesion location and coping styles.

    Science.gov (United States)

    Wei, Changjuan; Gao, Juan; Chen, Li; Zhang, Fang; Ma, Xiaofeng; Zhang, Nan; Zhang, Wei; Xue, Rong; Luo, Lanlan; Hao, Junwei

    2016-07-01

    Post-stroke depression (PSD) and post-stroke emotional incontinence (PSEI) have attracted worldwide interest in recent years. These emotional disturbances have a negative impact on the rehabilitation process and the associated worse outcome. Consequently, defining the risk factors for development of PSD and PSEI is important. In this study, we evaluated 368 consecutive patients with acute ischemic stroke at admission and at three months later. PSD was evaluated by using the Beck Depression Inventory, and PSEI was evaluated using Kim's criteria. The Social Support Rating Scale and Medical Coping Modes Questionnaire were also used as measurement tools. Multivariate analyses showed that anterior cortex infarction was associated with PSEI three months after stroke occurrence. The appearance of PSD was not related to lesion location. Both motor and sensory dysfunctions was independently associated with PSD at admission, whereas low degree of social utilization was the independent factor associated with PSD 3 months after stroke. Acceptance-resignation is related to PSD and PSEI both at admission and 3 months after stroke. Avoidance was the independent factor related to PSD at 3 months after stroke onset. PMID:26005045

  13. Use of virtual reality to promote hand therapy post-stroke

    Science.gov (United States)

    Tsoupikova, Daria; Stoykov, Nikolay; Vick, Randy; Li, Yu; Kamper, Derek; Listenberger, Molly

    2013-03-01

    A novel artistic virtual reality (VR) environment was developed and tested for use as a rehabilitation protocol for post-stroke hand rehabilitation therapy. The system was developed by an interdisciplinary team of engineers, art therapists, occupational therapists, and VR artists to improve patients' motivation and engagement. Specific exercises were developed to explicitly promote the practice of therapeutic tasks requiring hand and arm coordination for upper extremity rehabilitation. Here we describe system design, development, and user testing for efficiency, subject's satisfaction and clinical feasibility. We report results of the completed qualitative, pre-clinical pilot study of the system effectiveness for therapy. Fourteen stroke survivors with chronic hemiparesis participated in a single training session within the environment to gauge user response to the protocol through a custom survey. Results indicate that users found the system comfortable, enjoyable, tiring; instructions clear, and reported a high level of satisfaction with the VR environment and rehabilitation task variety and difficulty. Most patients reported very positive impressions of the VR environment and rated it highly, appreciating its engagement and motivation. We are currently conducting a longitudinal intervention study over 6 weeks in stroke survivors with chronic hemiparesis. Initial results following use of the system on the first subjects demonstrate that the system is operational and can facilitate therapy for post stroke patients with upper extremity impairment.

  14. Induction of neuroplasticity and recovery in post-stroke aphasia by non-invasive brain stimulation

    Directory of Open Access Journals (Sweden)

    Priyanka eShah

    2013-12-01

    Full Text Available Stroke victims tend to prioritize speaking, writing and walking as the three most important rehabilitation goals. Of note is that two of these goals involve communication. This underscores the significance of developing successful approaches to aphasia treatment for the several hundred thousand new aphasia patients each year and over 1 million stroke survivors with chronic aphasia in the U.S. alone. After several years of growth as a research tool, noninvasive brain stimulation (NBS is gradually entering the arena of clinical aphasiology. In this review, we first examine the current state of knowledge of post-stroke language recovery including the contributions from the dominant and non-dominant hemispheres. Next, we briefly discuss the methods and the physiologic basis of the use of inhibitory and excitatory repetitive transcranial magnetic stimulation (rTMS and transcranial direct current stimulation (tDCS as research tools in patients who experience post-stroke aphasia. Finally, we provide a critical review of the most influential evidence behind the potential use of these two brain stimulation methods as clinical rehabilitative tools.

  15. Central Sensitization in Functional Chronic Pain Syndromes: Overview and Clinical Application.

    Science.gov (United States)

    Bettini, Liz; Moore, Ki

    2016-10-01

    The purpose of this review and clinical application article is to offer nurses up-to-date knowledge on peripheral and central sensitization in chronic functional pain syndromes, and to discuss therapies that have shown efficacy in treating various aspects of these disorders. Central sensitization is a result of changes in the peripheral and central nervous system due to noxious stimuli, such as illness or trauma. Once these changes occur, treatment for the associated syndromes requires a multimodal approach that includes behavioral pain psychology, physical therapy, and pharmacological agents that specifically target neuroinflammation, pain modulation, and amplification of pain pathways. More research needs to be conducted on the basis and patient perception of functional pain syndromes to reduce the morbidity and significant disability associated with these illnesses. Nurses have the opportunity to be at the forefront of this research because of their holistic and multidimensional approach to patient care, assessment, and symptom management. PMID:27553129

  16. Post-stroke mortality, stroke severity, and preadmission antipsychotic medicine use--a population-based cohort study.

    Directory of Open Access Journals (Sweden)

    Anders Prior

    Full Text Available BACKGROUND AND PURPOSE: It has been suggested that antipsychotic medication may be neuroprotective and may reduce post-stroke mortality, but studies are few and ambiguous. We aimed to investigate the post-stroke effects of preadmission antipsychotic use. METHODS: We conducted a nationwide, population-based cohort study of 81,143 persons admitted with stroke in Denmark from 2003-2010. Using Danish health care databases, we extracted data on preadmission use of antipsychotics and confounding factors. We examined the association between current, former, and never use of antipsychotics and stroke severity, length of hospital stay, and 30-day post-stroke mortality using logistic regression analysis, survival analysis, and propensity score matching. RESULTS: Current users of antipsychotics had a higher risk of severe or very severe stroke on The Scandinavian Stroke Scale than never users of antipsychotics (adjusted odds ratios, 1.43; 95% CI, 1.29-1.58. Current users were less likely to be discharged from hospital within 30 days of admission than never users (probability of non-discharge, 27.0% vs. 21.9%. Antipsychotics was associated with an increased 30-day post-stroke mortality among current users (adjusted mortality rate ratios, 1.42; 95% CI, 1.29-1.55, but not among former users (adjusted mortality rate ratios, 1.05; 95% CI, 0.98-1.14. CONCLUSIONS: Preadmission use of antipsychotics was associated with a higher risk of severe stroke, a longer duration of hospital stay, and a higher post-stroke mortality, even after adjustment for known confounders. Antipsychotics play an important role in the treatment of many psychiatric conditions, but our findings do not support the hypothesis that they reduce stroke severity or post-stroke mortality.

  17. Axial Diffusivity of the Corona Radiata at 24 Hours Post-Stroke: A New Biomarker for Motor and Global Outcome

    OpenAIRE

    Eric Moulton; Mélika Amor-Sahli; Vincent Perlbarg; Christine Pires; Sophie Crozier; Damien Galanaud; Romain Valabregue; Marion Yger; Flore Baronnet-Chauvet; Yves Samson; Didier Dormont; Charlotte Rosso

    2015-01-01

    International audience Fractional anisotropy (FA) is an effective marker of motor outcome at the chronic stage of stroke yet proves to be less efficient at early time points. This study aims to determine which diffusion metric in which location is the best marker of long-term stroke outcome after throm-bolysis with diffusion tensor imaging (DTI) at 24 hours post-stroke. Twenty-eight thrombo-lyzed patients underwent DTI at 24 hours post-stroke onset. Ipsilesional and contralesional FA, mean...

  18. Musculoskeletal pain among postmenopausal women in Nigeria: Association with overall and central obesity

    Directory of Open Access Journals (Sweden)

    Omoyemi O. Ogwumike, PhD

    2016-06-01

    Conclusion: Lower extremity and back pain symptoms were the most prevalent. For overall and central obesity directly associated with MSP, WHtR seemed the best obesity screening tool for MSP in postmenopausal women.

  19. Central pain processing in chronic tension-type headache

    DEFF Research Database (Denmark)

    Lindelof, Kim; Ellrich, Jens; Jensen, Rigmor;

    2009-01-01

    ) reflects neuronal excitability due to nociceptive input in the brainstem. The aim of this study was to investigate nociceptive processing at the level of the brainstem in an experimental pain model of CTTH symptoms. METHODS: The effect of conditioning pain, 5 min infusion of hypertonic saline into the neck......: A combined homotopic and heterotopic effect of the conditioning pain onto the blink reflex could account for this finding....... muscles, was investigated in 20 patients with CTTH and 20 healthy controls. In addition, a pilot study with isotonic saline was performed with 5 subjects in each group. The BR was elicited by electrical stimuli with an intensity of four times the pain threshold, with a superficial concentric electrode. We...

  20. Completing the Pain Circuit: Recent Advances in Imaging Pain and Inflammation beyond the Central Nervous System

    OpenAIRE

    Clas Linnman; David Borsook

    2013-01-01

    This review describes some of the recent developments in imaging aspects of pain in the periphery. It is now possible to image nerves in the cornea non-invasively, to image receptor level expression and inflammatory processes in injured tissue, to image nerves and alterations in nerve properties, to image astrocyte and glial roles in neuroinflammatory processes, and to image pain conduction functionally in the trigeminal ganglion. These advances will ultimately allow us to describe the pain p...

  1. Meta-analysis of transcranial magnetic stimulation to treat post-stroke dysfunction

    Institute of Scientific and Technical Information of China (English)

    Yang Tian; Lianguo Kang; Hongying Wang; Zhenyi Liu

    2011-01-01

    OBJECTIVE: To evaluate the effects of transcranial magnetic stimulation (TMS) on post-stroke dysfunction.DATA SOURCES: A computer-based online search of the VIP and PubMed databases was performed to identify TMS studies published between January 1989 and December 2010 using the Key Words "transcranial magnetic stimulation, stroke" in Chinese and English.A total of 61 articles were collected.STUDY SELECTION: Repetitive articles were excluded.Articles published recently in the authoritative journals of the same domain were selected.The full-text of selected articles was searched.A total of seven articles were randomized controlled experiments regarding the application of TMS in the treatment of post-stroke dysfunction.The methodology quality of included articles was evaluated according to standards of Cochrane Reviewer's Handbook system and analyzed using RevMand4.2 software.MAIN OUTCOME MEASURES: Therapeutic effects and difference evaluation indices were represented by odds ratios, weighted mean difference (WMD) and 95% confidence interval (CI).Potential publication bias was described using a funnel plot.RESULTS: A total of seven randomized, controlled studies were included involving 281 patients.Following TMS treatment, meta-analysis results revealed that scores in the Mini-Mental State Examination were higher in the TMS group compared with the control group [WMD = 3.96, 95% CI (2.44, 5.49), P = 0.08]; scores in the Hamilton Rating Scale for Depression were significantly lower in the TMS group compared with the control group [WMD = -6.21, 95% CI (-7.55, -4.87), P = 0.92]; scores in National Institutes of Health Stroke Scale were lower following TMS treatment compared with the control group [WMD = -0.89, 95% CI (-1.98, 0.19), P = 0.04].Performance of patients undergoing TMS treatment was better than the controls in the line bisection test [WMD = -0.78, 95% CI (-1.43, -0.12), P = 0.005] and line cancellation test [WMD = -0.47, 95% CI (-0.78, -0.15), P < 0.000 01

  2. Caregiver burden and emotional problems in partners of stroke patients at two months and one year post-stroke : Determinants and prediction

    NARCIS (Netherlands)

    Kruithof, Willeke J; Post, Marcel W M; van Mierlo, Maria L; van den Bos, Geertrudis A M; de Man-van Ginkel, Janneke M; Visser-Meily, Johanna M A

    2016-01-01

    OBJECTIVES: (a) To determine levels of and factors explaining partners' burden, anxiety and depressive symptoms at two months post-stroke, (b) to predict partners' burden, anxiety and depressive symptoms at one year post-stroke based on patient and partner characteristics available at two months pos

  3. Assessment of pressure-pain thresholds and central sensitization of pain in lateral epicondylalgia

    DEFF Research Database (Denmark)

    Jespersen, Anders; Amris, Kirstine; Graven-Nielsen, Thomas;

    2013-01-01

    OBJECTIVE.: To assess pain sensitivity and spreading hyperalgesia in lateral epicondylalgia (LE). SUBJECTS.: Twenty-two women with LE, and 38 controls were included. OUTCOME MEASURES.: Computerized cuff pressure algometry was used for assessment of pressure-pain threshold and tolerance. The stimu...

  4. Dimensions of post-stroke fatigue: a two-year follow-up study

    DEFF Research Database (Denmark)

    Christensen, Doris; Johnsen, Soeren Paaske; Watt, Torquil;

    2008-01-01

    , was reported by 59% (95% CI: 51-66%), 44% (95% CI: 36-51%), 38% (95% CI: 31-46%), and 40% (95% CI: 32-48%) of stroke patients 10 days, 3 months, 1 year, and 2 years following hospitalization for stroke, respectively. Post-stroke fatigue levels decreased after three months and remained stable throughout......-time stroke admitted to acute stroke units at the Aarhus University Hospital, Denmark. A reference group of 1,069 persons was sampled from the general population. Fatigue was assessed using the Multidimensional Fatigue Inventory (MFI-20) covering five scales of fatigue (General Fatigue, Physical Fatigue......, Reduced Activity, Reduced Motivation, and Mental Fatigue). RESULTS: Compared to the general population, stroke patients reported higher levels of Physical Fatigue. Minor or no differences were found for the other fatigue scales. Pathological fatigue, defined as a score >or=12 on the General Fatigue scale...

  5. Prevention of post-stroke generalized anxiety disorder, using escitalopram or problem-solving therapy.

    Science.gov (United States)

    Mikami, Katsunaka; Jorge, Ricardo E; Moser, David J; Arndt, Stephan; Jang, Mijin; Solodkin, Ana; Small, Steven L; Fonzetti, Pasquale; Hegel, Mark T; Robinson, Robert G

    2014-01-01

    This study examined the efficacy of antidepressant treatment for preventing the onset of generalized anxiety disorder (GAD) among patients with recent stroke. Of 799 patients assessed, 176 were randomized, and 149 patients without evidence of GAD at the initial visit were included in this double-blind treatment with escitalopram (N=47) or placebo (N=49) or non-blinded problem-solving therapy (PST; 12 total sessions; N=53). Participants given placebo over 12 months were 4.95 times more likely to develop GAD than patients given escitalopram and 4.00 times more likely to develop GAD than patients given PST. Although these results should be considered preliminary, the authors found that both escitalopram and PST were effective in preventing new onset of post-stroke GAD.

  6. Virtual Reality for Sensorimotor Rehabilitation Post-Stroke: The Promise and Current State of the Field.

    Science.gov (United States)

    Fluet, Gerard G; Deutsch, Judith E

    2013-03-01

    Developments over the past 2 years in virtual reality (VR) augmented sensorimotor rehabilitation of upper limb use and gait post-stroke were reviewed. Studies were included if they evaluated comparative efficacy between VR and standard of care, and or differences in VR delivery methods; and were CEBM (center for evidence based medicine) level 2 or higher. Eight upper limb and two gait studies were included and described using the following categories hardware (input and output), software (virtual task and feedback and presentation) intervention (progression and dose), and outcomes. Trends in the field were commented on, gaps in knowledge identified, and areas of future research and translation of VR to practice were suggested. PMID:24579058

  7. Eclectic/mixed approach to physiotherapy in post-stroke patients – case study

    Directory of Open Access Journals (Sweden)

    Emilia Mikołajewska

    2015-07-01

    Full Text Available The prevalence of stroke, and its associated costs, are going to rise with the aging population and changes in lifestyle in developing countries. Further research should better identify modifiable and non-modifiable determinants of poor outcomes in stroke survivors. Complex rehabilitation of post-stroke survivors still needs novel solutions. An eclectic/mixed approach to intervention, regarded as synthesis of the classical intervention methods, techniques, and tools, may be regarded as one of them, but it still needs more research. The aim of the article is to familiarise the aforementioned approach based on the presented case report and to investigate the extent to which available opportunities of an eclectic/mixed approach to physiotherapy is being exploited.

  8. Community participation of patients 12 months post-stroke in Johannesburg, South Africa

    Directory of Open Access Journals (Sweden)

    Witness Mudzi

    2013-01-01

    Full Text Available Background: Improvement in health-related quality of life (HRQL is the main goal of rehabilitation. The ability of the stroke-patient to participate in various situations signifies successful rehabilitation. The aim of the study was to establish the extent of communityparticipation and the barriers and facilitators to the participation for stroke patients after their discharge.Method: This study formed part of a larger study focusing on the impact of caregiver education on stroke survivors and their careers. This was a longitudinal study comprising 200 patients with first-time ischaemic stroke. Although the patients were followed up at home at 3 months, 6 months and 12 months post-stroke, this paper focuses on the 12-months follow-up participation results. Patient functional ability was measured by using the Barthel Index (BI and the Rivermead Mobility Index (RMI, whereas participation was measured by using the International Classification of Functioning, Disability and Health (ICF checklist. Descriptive statistics were used to analyse the data.Results: Patients experienced severe to complete difficulty when undertaking single and multiple tasks without help 12-months post-discharge. They struggled with the preparation of meals, household work and interpersonal interactions, and they had difficulties withcommunity life and partaking in recreation and leisure activities. Immediate family and societal attitudes were viewed as facilitators to community participation whereas friends, transportation services and social security services were viewed as barriers to communityparticipation.Conclusion: The patient-ability to socialise and participate in community issues is currently poor. The identified barriers to community participation need to be addressed in order toimprove patient-participation in the community post-stroke.

  9. Post-stroke balance rehabilitation under multi-level electrotherapy: a conceptual review

    Directory of Open Access Journals (Sweden)

    Anirban eDutta

    2014-12-01

    Full Text Available Stroke is caused when an artery carrying blood from heart to an area in the brain bursts or a clot obstructs the blood flow thereby preventing delivery of oxygen and nutrients. About half of the stroke survivors are left with some degree of disability. Innovative methodologies for restorative neurorehabilitation are urgently required to reduce long-term disability. The ability of the nervous system to respond to intrinsic or extrinsic stimuli by reorganizing its structure, function and connections is called neuroplasticity. Neuroplasticity is involved in post-stroke functional disturbances, but also in rehabilitation. It has been shown that active cortical participation in a closed-loop brain machine interface (BMI can induce neuroplasticity in cortical networks where the brain acts as a controller, e.g., during a visuomotor task. Here, the motor task can be assisted with neuromuscular electrical stimulation (NMES where the BMI will act as a real-time decoder. However, the cortical control and induction of neuroplasticity in a closed-loop brain machine interface is also dependent on the state of brain, e.g., visuospatial attention during visuomotor task performance. In fact, spatial neglect is a hidden disability that is a common complication of stroke and is associated with prolonged hospital stays, accidents, falls, safety problems and chronic functional disability. This hypothesis and theory article presents a multi-level electrotherapy paradigm towards motor rehabilitation in virtual reality that postulates that while the brain acts as a controller in a closed-loop BMI to drive NMES, the state of brain can be can be altered towards improvement of visuomotor task performance with non-invasive brain stimulation. This leads to a multi-level electrotherapy paradigm where a virtual reality-based adaptive response technology is proposed for post-stroke balance rehabilitation. In this article, we present a conceptual review of the related

  10. Treatment of post-stroke depression%卒中后抑郁的治疗

    Institute of Scientific and Technical Information of China (English)

    黄巧; 李长清

    2015-01-01

    卒中后抑郁是指卒中患者在发病后2~3年内发生的一种情感障碍性疾病,以情感低落、兴趣减低、烦躁、悲观、思维迟缓等为主要特征,通常症状持续2周以上,是卒中的常见并发症之一,可严重影响患者的康复和生活质量,部分患者甚至出现自杀倾向.早期干预治疗对卒中患者的后期神经功能恢复非常重要,不但可改善认知功能,而且能降低致残率和病死率.文章对卒中后抑郁的治疗进展进行了综述.%The post-stroke depression refers to a affective disorders within 2 to 3 years after stroke in patients with stroke.Its main features are depressed mood,decreased interest,irritability,pessimism,and slow thinking,etc.Usually the symptoms will last for more than 2 weeks.It is one of the most common complications of stroke and may seriously affect the rehabilitation and quality of life of patients.Some patients even have suicidal tendency.Early intervention is very important for late neurological recovery in patients with stroke.It can not only improve cognitive function,but also reduce the morbidity and mortality.This article reviews the treatment of post-stroke depression.

  11. Muscle weakness and lack of reflex gain adaptation predominate during post-stroke posture control of the wrist

    NARCIS (Netherlands)

    Meskers, C.G.M.; Schouten, A.C.; De Groot, J.; De Vlugt, E.; Van Hilten, B.J.J.; Van der Helm, F.C.T.; Arendzen, H.J.H.

    2009-01-01

    Instead of hyper-reflexia as sole paradigm, post-stroke movement disorders are currently considered the result of a complex interplay between neuronal and muscular properties, modified by level of activity. We used a closed loop system identification technique to quantify individual contributors to

  12. Muscle weakness and lack of reflex gain adaptation predominate during post-stroke posture control of the wrist

    NARCIS (Netherlands)

    Meskers, C.G.M.; Schouten, A.C.; De Groot J.H.; De Vlugt, E.; Van Hilten, B.J.J.; Van der Helm, F.C.T.; Arendzen, H.J.H.

    2009-01-01

    Background Instead of hyper-reflexia as sole paradigm, post-stroke movement disorders are currently considered the result of a complex interplay between neuronal and muscular properties, modified by level of activity. We used a closed loop system identification technique to quantify individual contr

  13. The effects of Xingnao Jieyu capsules on post-stroke depression are similar to those of fluoxetine*

    Institute of Scientific and Technical Information of China (English)

    Yongmei Yan; Wentao Fan; Li Liu; Ru Yang; Wenjia Yang

    2013-01-01

    The Xingnao Jieyu capsule has been shown to effectively relieve neurologic impairments and lessen depression. It remains poorly understood whether this capsule can be used to treat post-stroke depression. Thus, in the present study, we established a rat model of post-stroke de-pression using left middle cerebral artery occlusions in combination of chronic unpredictable stress and solitary housing during development. Experimental rats received intragastric perfusion with 0.82, 0.41, and 0.20 g/kg Xingnao Jieyu capsules separately dissolved in 2 mL distil ed water. Fluoxetine served as a positive control. The treatment was conducted over 28 days. Sugar water consumption test, open-field test, real-time fluorescent quantitative PCR and immunohistochemical staining re-sults demonstrated that intragastric perfusion with various doses of Xingnao Jieyu capsules in-creased sugar water consumption, voluntary behaviors and synaptotagmin mRNA and protein ex-pression in rats with post-stroke depression. These therapeutic effects were similar to those of fluoxetine. These results indicate that Xingnao Jieyu capsules upregulate synaptotagmin expres-sion in hippocampi of rats with post-stroke depression, and exert antidepressant effects.

  14. Sustained inflammation 1.5 years post-stroke is not associated with depression in elderly stroke survivors

    Directory of Open Access Journals (Sweden)

    Noonan K

    2013-01-01

    Full Text Available Kate Noonan,1,2 Sheila G Crewther,1,2 Leeanne M Carey,2,4 Michaela C Pascoe,5 Thomas Linden2,31School of Psychological Science, La Trobe University, Bundoora, Victoria, Australia; 2Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Heidelberg, Victoria, Australia; 3Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden; 4Department of Occupational Therapy, School of Allied Health, La Trobe University, Bundoora, Victoria, Australia; 5Brain Sciences Institute, Swinburne University, Melbourne, AustraliaBackground: Depression is common in elderly stroke survivors and has been associated with systemic inflammation. We aimed to investigate an elderly population of Swedish stroke patients for evidence of sustained peripheral inflammation 18 months post-stroke and to identify if inflammation is associated with post-stroke depression at 18 months post-stroke.Methods: The Barthel Index was used to measure the level of impairment in activities of daily living at 3 days post-stroke. Serum concentrations of inflammation markers, ie, C-reactive protein and white cell count, were measured in 149 stroke patients (mean age 81 ± 5.33 years, 35% male at 18 months post-stroke, and a comparison was made with an age-matched sample of elderly Swedish individuals who had not suffered a stroke. At the same visit, clinical depression was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Third Edition-Revised criteria. Severity of depression was assessed using the Montgomery-Asberg Depression Rating Scale (MADRS.Results: Mean C-reactive protein and white cell count levels in stroke patients were significantly elevated at 18 months post-stroke compared with population probands. Disability scores were associated with MADRS depression scores, but C-reactive protein and white cell count were not.Conclusion: We found evidence for a sustained peripheral inflammatory response at 18 months

  15. The role of sleep problems in central pain processing in rheumatoid arthritis

    Science.gov (United States)

    Lee, Yvonne C.; Lu, Bing; Edwards, Robert R.; Wasan, Ajay D.; Nassikas, Nicholas J.; Clauw, Daniel J.; Solomon, Daniel H.; Karlson, Elizabeth W.

    2012-01-01

    Objective Among rheumatoid arthritis (RA) patients, pain may exist out of proportion to peripheral inflammation. This observation suggests that central nervous system pain amplification mechanisms, such as diminished conditioned pain modulation (CPM), may play a role in enhancing pain perception among some RA patients. We examined CPM, pressure pain threshold and pressure pain tolerance among RA patients compared to controls. Methods Fifty-eight female RA patients and 54 age-matched controls without chronic pain underwent quantitative sensory testing (QST) to assess CPM, pressure pain threshold and pressure pain tolerance. CPM was induced using a cold water bath, and pain threshold (when patients first felt pain) and tolerance (when pain was too much to bear) were assessed with an algometer. Associations between RA and QST measures were analyzed using linear regression. Sleep problems, mental health and inflammation were assessed as mediators of the relationship between RA and QST measures. Results Median CPM levels were 0.5 kg/cm2 (interquartile range (IQR) −0.1, 1.6) among RA patients compared to 1.5 kg/cm2 (IQR −0.1, 2.5) among controls (P = 0.04). Relative to controls, RA patients had lower pain threshold and tolerance at the wrists (P ≤ 0.05). Compared to controls, RA patients had greater problems with sleep, catastrophizing, depression and anxiety (P < 0.0001). Mediation analyses suggested that low CPM levels may be partially attributable to sleep disturbance (P = 0.04). Conclusion RA patients have impaired CPM relative to pain-free controls. Sleep problems may mediate the association between RA and attenuated CPM. PMID:23124650

  16. Laparoscopic Cholecystectomy for Gallbladder Calculosis in Fibromyalgia Patients: Impact on Musculoskeletal Pain, Somatic Hyperalgesia and Central Sensitization

    OpenAIRE

    Costantini, Raffaele; Affaitati, Giannapia; Massimini, Francesca; Tana, Claudio; Innocenti, Paolo; Giamberardino, Maria Adele

    2016-01-01

    Fibromyalgia, a chronic syndrome of diffuse musculoskeletal pain and somatic hyperalgesia from central sensitization, is very often comorbid with visceral pain conditions. In fibromyalgia patients with gallbladder calculosis, this study assessed the short and long-term impact of laparoscopic cholecystectomy on fibromyalgia pain symptoms. Fibromyalgia pain (VAS scale) and pain thresholds in tender points and control areas (skin, subcutis and muscle) were evaluated 1week before (basis) and 1wee...

  17. Transcranial magnetic resonance imaging-guided focused ultrasound: noninvasive central lateral thalamotomy for chronic neuropathic pain

    OpenAIRE

    Jeanmonod, D.; Werner, B.; Morel, A.; Michels, L; Zadicario, E; Schiff, G.; Martin, E.

    2012-01-01

    Object Recent technological developments open the field of therapeutic application of focused ultrasound to the brain through the intact cranium. The goal of this study was to apply the new transcranial magnetic resonance imaging-guided focused ultrasound (tcMRgFUS) technology to perform noninvasive central lateral thalamotomies (CLTs) as a treatment for chronic neuropathic pain. Methods In 12 patients suffering from chronic therapy-resistant neuropathic pain, tcMRgFUS CLT was propos...

  18. Effectiveness of technologies in the treatment of post-stroke anomia: A systematic review

    Directory of Open Access Journals (Sweden)

    Monica Lavoie

    2015-04-01

    Procedures and analyses: The PRISMA statement(1 for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions was used as a guideline to conduct the present review. A systematic search of publications on PubMed and PsycInfo was conducted. Experimental studies designed to assess the effectiveness of an intervention delivered by a technology, namely computer, smart tablet or teletreatment, to specifically improve anomia in post-stroke participants were selected, without limitations as to the dates of publication. The main outcomes studied were improvement in naming skills and generalization to untreated items and daily communication. The Downs and Black checklist for randomised and non-randomised studies of health care interventions(2 was used by two reviewers (ML and JM to conduct the methodological quality assessment. Results: A total of 20 studies were included in this review. Up to now, computer is by far the most popular technology, whereas only a few studies aimed at exploring the effectiveness of smart tablet or teletreatment. In some studies, technology was used as a therapy tool in a clinical setting, in the presence of the clinician, while in others, therapy with technology was self-administered at home, without the clinician. All studies confirmed the effectiveness of therapy provided by technology to improve naming of trained items. However, generalization to untrained items is unclear and assessment of generalization to daily communication is scarce. Conclusions: The results of this systematic review confirm that technology is a promising avenue in the management of post-stroke anomia. Self-administered therapies are particularly interesting since they allow increasing significantly the intensity and frequency of therapeutic activities, a factor that has been explicitly recognized as a positive determinant of the efficacy of language treatment(3. In future studies, ecological tasks aiming to evaluate therapy

  19. Innate Immunity and Inflammation Post-Stroke: An α7-Nicotinic Agonist Perspective

    Directory of Open Access Journals (Sweden)

    Silke Neumann

    2015-12-01

    Full Text Available Stroke is one of the leading causes of death and long-term disability, with limited treatment options available. Inflammation contributes to damage tissue in the central nervous system across a broad range of neuropathologies, including Alzheimer’s disease, pain, Schizophrenia, and stroke. While the immune system plays an important role in contributing to brain damage produced by ischemia, the damaged brain, in turn, can exert a powerful immune-suppressive effect that promotes infections and threatens the survival of stroke patients. Recently the cholinergic anti-inflammatory pathway, in particular its modulation using α7-nicotinic acetylcholine receptor (α7-nAChR ligands, has shown potential as a strategy to dampen the inflammatory response and facilitate functional recovery in stroke patients. Here we discuss the current literature on stroke-induced inflammation and the effects of α7-nAChR modulators on innate immune cells.

  20. Innate Immunity and Inflammation Post-Stroke: An α7-Nicotinic Agonist Perspective.

    Science.gov (United States)

    Neumann, Silke; Shields, Nicholas J; Balle, Thomas; Chebib, Mary; Clarkson, Andrew N

    2015-12-04

    Stroke is one of the leading causes of death and long-term disability, with limited treatment options available. Inflammation contributes to damage tissue in the central nervous system across a broad range of neuropathologies, including Alzheimer's disease, pain, Schizophrenia, and stroke. While the immune system plays an important role in contributing to brain damage produced by ischemia, the damaged brain, in turn, can exert a powerful immune-suppressive effect that promotes infections and threatens the survival of stroke patients. Recently the cholinergic anti-inflammatory pathway, in particular its modulation using α7-nicotinic acetylcholine receptor (α7-nAChR) ligands, has shown potential as a strategy to dampen the inflammatory response and facilitate functional recovery in stroke patients. Here we discuss the current literature on stroke-induced inflammation and the effects of α7-nAChR modulators on innate immune cells.

  1. Use of hippotherapy in gait training for hemiparetic post-stroke

    Directory of Open Access Journals (Sweden)

    Fernanda Beinotti

    2010-12-01

    Full Text Available OBJECTIVE: To evaluate the hippotherapy influence on gait training in post-stroke hemiparetic individuals. METHOD: The study was constituted of 20 individuals divided into two groups. Group A performed the conventional treatment while group B the conventional treatment along with hippotherapy during 16 weeks. The patients were evaluated by using the Functional Ambulation Category Scale, Fugl-Meyer Scale, only the lower limbs and balance sub items, Berg Balance Scale, and functional assessment of gait (cadence in the beginning and end of the treatment. RESULTS: Significant improvements were observed in the experimental group including motor impairment in lower limbs (p=0.004, balance, over time (p=0.007 but a significant trend between groups (p=0.056. The gait independence, cadence and speed were not significantly in both groups (p=0.93, 0.69 and 0.44. CONCLUSION: Hippotherapy associated with conventional physical therapy demonstrates a positive influence in gait training, besides bringing the patients' gait standard closer to normality than the control group.

  2. Professional Competences of Music Therapists Working in Post-stroke Rehabilitation

    Directory of Open Access Journals (Sweden)

    Esa Ala-Ruona

    2012-11-01

    Full Text Available The aim of this qualitative study is to gain more insight into the skills and knowledge that music therapists feel they need in order to work successfully with people who have had an acute stroke. For this purpose, 6 music therapists were interviewed about their own particular specialist education. Another interview topic for them was to recount their subjective experiences of post-stroke rehabilitation work in hospitals and health care units, during the course of two projects: the Music Listening Project (=MUKU, which specifically used music listening during acute stroke rehabilitation; and the Active Music Therapy Project (=MT-STROKE, which used more active music therapy techniques. The interviews pointed to three key categories regarding the factors that are seen to affect clinical thinking: the first hinges on knowledge concerning the neurological basis of strokes; the second on patient interaction itself; and the third on the physiological and emotional aspects of music therapy. The results provide a better understanding of the tacit knowledge possessed by music therapists who work within Stroke Rehabilitation.

  3. Therapeutic Efficacy Analysis of Balancing Yin-yang Manipulation for Post-stroke Upper Limb Spasticity

    Institute of Scientific and Technical Information of China (English)

    Cui Hua-feng; Gao Guo-qiang; Wang Yan-li; Yu Xiao-hua; Guo Li; Ren Shuo

    2014-01-01

    Objective: To observe the effect of balancing yin-yang needling manipulation on post-stroke upper limb spasticity and changes of electromyography (EMG) after treatment. Methods: A total of 60 eligible cases were randomly allocated into an observation group and a control group, 30 in each group. Based on routine medication, cases in the control group were treated with conventional needling manipulation, whereas cases in the observation group were treated with balancing yin-yang manipulation. After the courses of treatment were completed, the therapeutic efficacies were evaluated using modified Ashworth scale and clinical spasticity index (CSI), coupled with the integrated electromyography (IEMG) and root mean square (RMS) value of biceps in passive flexion of the elbow joint during isokinetic testing recorded with the surface EMG. Results: The total effective rate in the observation group was 86.7%, versus 53.3% in the control group, showing a statistical significance (P Conclusion:Balancing yin-yang and conventional needling manipulations can both improve upper limb spasm and reduce CSI as well as IEMG and RMS values in stroke patients;however, balancing yin-yang manipulation is better than conventional manipulation in clinical effect.

  4. Prediction of responders for outcome measures of Locomotor Experience Applied Post Stroke trial

    Directory of Open Access Journals (Sweden)

    Bruce H. K. Dobkin, MD

    2014-03-01

    Full Text Available The Locomotor Experience Applied Post Stroke rehabilitation trial found equivalent walking outcomes for body weight-supported treadmill plus overground walking practice versus home-based exercise that did not emphasize walking. From this large database, we examined several clinically important questions that provide insights into recovery of walking that may affect future trial designs. Using logistic regression analyses, we examined predictors of response based on a variety of walking speed-related outcomes and measures that captured disability, physical impairment, and quality of life. The most robust predictor was being closer at baseline to the primary outcome measure, which was the functional walking speed thresholds of 0.4 m/s (household walking and 0.8 m/s (community walking. Regardless of baseline walking speed, a younger age and higher Berg Balance Scale score were relative predictors of responding, whether operationally defined by transitioning beyond each speed boundary or by a continuous change or a greater than median increase in walking speed. Of note, the cutoff values of 0.4 and 0.8 m/s had no particular significance compared with other walking speed changes despite their general use as descriptors of functional levels of walking. No evidence was found for any difference in predictors based on treatment group.

  5. Risk factors for post-stroke depression%卒中后抑郁的危险因素

    Institute of Scientific and Technical Information of China (English)

    曹春艳; 黄朝云

    2010-01-01

    Post-stroke depression (PSD) is a common complication of stroke. Its prevalence range was from 23% to 60%. This article reviews the risk factors for PSD,including gender, age, premorbid personality, education, history of stroke and depression, stroke type, stroke location, neurological dysfunction, cognitive impairment, aphasia, and social support.%卒中后抑郁(post-stroke depression,PSD)是卒中的一种常见并发症,患病率在23%~60%之间.文章对PSD的危险因素,包括性别、年龄、病前个性、文化程度、卒中和抑郁病史、卒中类型、卒中部位、神经功能障碍、认知障碍、失语以及社会支持等进行了综述.

  6. Mental Practice Combined with Motor Rehabilitation to Treat Upper Limb Hemiparesis of Post-Stroke Patients: Clinical and Experimental Evidence.

    Science.gov (United States)

    Machado, Sergio; Lattari, Eduardo; Paes, Flávia; Rocha, Nuno B F; Nardi, Antonio E; Arias-Carrión, Oscar; Mura, Gioia; Yuan, Ti-Fei; Carta, Mauro G; Campos, Carlos

    2016-01-01

    Stroke is one of the major causes of disability in the world. Due to the extended lifetime of the world's population, the number of people affected by stroke has increased substantially over the last years. Stroke may lead to sensorimotor deficits, usually causing hemiplegia or hemiparesia. In order to reduce motor deficits and accelerate functional recovery, MP combined with motor rehabilitation was introduced to the rehabilitation process of post-stroke patients. Evidence has shown that MP combining with motor rehabilitation based on activities of daily living was more effective than conventional motor rehabilitation used per se. This combination proved very useful and effective, with significant results in improvement of motor deficits in post-stroke patients. However, further studies must be conducted to determine specific parameters, such as type of imagery, frequency or duration.

  7. Evidence for a central mode of action for etoricoxib (COX-2 inhibitor) in patients with painful knee osteoarthritis.

    Science.gov (United States)

    Arendt-Nielsen, Lars; Egsgaard, Line Lindhardt; Petersen, Kristian Kjær

    2016-08-01

    The COX-2 inhibitor etoricoxib modulates the peripheral and central nociceptive mechanisms in animals. This interaction has not been studied in patients with pain. This randomized, double-blind, placebo-controlled, 2-way crossover, 4-week treatment study investigated the pain mechanisms modulated by etoricoxib in patients with painful knee osteoarthritis. Patients were randomized to group A (60 mg/d etoricoxib followed by placebo) or B (placebo followed by 60 mg/d etoricoxib). The quantitative, mechanistic pain biomarkers were pressure pain thresholds, temporal summation (TS), and conditioning pain modulation. Clinical readouts were Brief Pain Inventory, WOMAC, painDETECT questionnaire (PD-Q), and time and pain intensity during walking and stair climbing. Etoricoxib as compared with placebo significantly modulated the pressure pain thresholds (P = 0.012, localized sensitization) at the knee and leg (control site) (P = 0.025, spreading sensitization) and TS assessed from the knee (P = 0.038) and leg (P = 0.045). Conditioning pain modulation was not modulated. The Brief Pain Inventory (pain scores), PD-Q, WOMAC, and walking and stair climbing tests were all significantly improved by etoricoxib. Based on a minimum of 30% or 50% pain alleviation (day 0-day 28), responders and nonresponders were defined. The nonresponders showed a significant association between increased facilitation of TS and increased pain alleviation. None of the other parameters predicted the degree of pain alleviation. Generally, a responder to etoricoxib has the most facilitated TS. In conclusion, etoricoxib (1) modulated central pain modulatory mechanisms and (2) improved pain and function in painful osteoarthritis. Stronger facilitation of TS may indicate a better response to etoricoxib, supporting the central mode-of-action of the drug. PMID:27007068

  8. Impact of trichostatin A and sodium valproate treatment on post-stroke neurogenesis and behavioral outcomes in immature mice

    OpenAIRE

    Kadam, Shilpa D.; Charles Rohde; Smith, Dani R.; Anne Marie Comi

    2013-01-01

    Stroke in the neonatal brain frequently results in neurologic impairments including cognitive disability. We investigated the effect of long-term sodium valproate (valproate) and trichostatin A (TSA) treatment upon post-stroke neurogenesis in the dentate gyrus (DG) of stroke-injured immature mice. Decreased or abnormal integration of newborn DG neurons into hippocampal circuits can result in impaired visual-spatial function, abnormal modulation of mood-related behaviors, and the development o...

  9. Changes in patterns of EMG activity in post-stroke subjects following robot-assisted hand rehabilitation.

    OpenAIRE

    Salman, Berna

    2009-01-01

    A feasibility study of robot-assisted hand rehabilitation post-stroke was conducted to investigate changes in activation patterns of forearm and hand muscles. Four stroke survivors received robot-assisted hand rehabilitation twice a week for two months. Eight healthy age-matched control subjects performed the same exercises as stroke subjects in a single training session. The pattern of activation of forearm and hand muscles was analyzed by performing Principal Component Analysis on the root-...

  10. Functional connectivity in post-stroke aphasia: innovative tools at the service of evidence-based practice

    Directory of Open Access Journals (Sweden)

    Edith Durand

    2014-05-01

    This study presents an innovative approach to clinical management in post-stroke aphasia. Specifically, the evidence shows that specific anomia therapy for verbs normalizes DMN integration, thus reflecting the large scope impact of speech therapy. Also, the correlation between DMN integration values and reactivity to SFA/V shows that DMN status before therapy can be predictive of response to specific therapy. Altogether, these results show that functional integration measures of the DMN can highlight prognosis and therapy efficiency in aphasia rehabilitation.

  11. Muscle weakness and lack of reflex gain adaptation predominate during post-stroke posture control of the wrist

    Directory of Open Access Journals (Sweden)

    van der Helm Frans CT

    2009-07-01

    Full Text Available Abstract Background Instead of hyper-reflexia as sole paradigm, post-stroke movement disorders are currently considered the result of a complex interplay between neuronal and muscular properties, modified by level of activity. We used a closed loop system identification technique to quantify individual contributors to wrist joint stiffness during an active posture task. Methods Continuous random torque perturbations applied to the wrist joint by a haptic manipulator had to be resisted maximally. Reflex provoking conditions were applied i.e. additional viscous loads and reduced perturbation signal bandwidth. Linear system identification and neuromuscular modeling were used to separate joint stiffness into the intrinsic resistance of the muscles including co-contraction and the reflex mediated contribution. Results Compared to an age and sex matched control group, patients showed an overall 50% drop in intrinsic elasticity while their reflexive contribution did not respond to provoking conditions. Patients showed an increased mechanical stability compared to control subjects. Conclusion Post stroke, we found active posture tasking to be dominated by: 1 muscle weakness and 2 lack of reflex adaptation. This adds to existing doubts on reflex blocking therapy as the sole paradigm to improve active task performance and draws attention to muscle strength and power recovery and the role of the inability to modulate reflexes in post stroke movement disorders.

  12. [Remote intelligent Brunnstrom assessment system for upper limb rehabilitation for post-stroke based on extreme learning machine].

    Science.gov (United States)

    Wang, Yue; Yu, Lei; Fu, Jianming; Fang, Qiang

    2014-04-01

    In order to realize an individualized and specialized rehabilitation assessment of remoteness and intelligence, we set up a remote intelligent assessment system of upper limb movement function of post-stroke patients during rehabilitation. By using the remote rehabilitation training sensors and client data sampling software, we collected and uploaded the gesture data from a patient's forearm and upper arm during rehabilitation training to database of the server. Then a remote intelligent assessment system, which had been developed based on the extreme learning machine (ELM) algorithm and Brunnstrom stage assessment standard, was used to evaluate the gesture data. To evaluate the reliability of the proposed method, a group of 23 stroke patients, whose upper limb movement functions were in different recovery stages, and 4 healthy people, whose upper limb movement functions were normal, were recruited to finish the same training task. The results showed that, compared to that of the experienced rehabilitation expert who used the Brunnstrom stage standard table, the accuracy of the proposed remote Brunnstrom intelligent assessment system can reach a higher level, as 92.1%. The practical effects of surgery have proved that the proposed system could realize the intelligent assessment of upper limb movement function of post-stroke patients remotely, and it could also make the rehabilitation of the post-stroke patients at home or in a community care center possible.

  13. Can pelvic floor muscle training improve quality of life in men with mild to moderate post-stroke and lower urinary tract symptoms?

    DEFF Research Database (Denmark)

    Tibaek, Sigrid; Gard, Gunvor; Dehlendorff, Christian;

    2016-01-01

    . CONCLUSIONS: PFMT may improve the emotional health and vitality domains of QoL in men with mild to moderate post-stroke and LUTS; however the improvements in the treatment group were not significantly better than for the control group. PFMT did not improve nocturia-related QoL. CLINICAL REHABILITATION IMPACT......BACKGROUND: Lower urinary tract symptoms (LUTS) have a significant impact on quality of life (QoL) in post-stroke patients. AIM: To evaluate the effect of pelvic floor muscle training (PFMT) on QoL parameters in men with post-stroke LUTS. DESIGN: Randomised, controlled and single-blinded trial....... SETTING: Outpatients, University Hospital. POPULATION: Thirty-one men, median age 68 (interquartile range 60 - 74) years, with post-stroke LUTS were included. Thirty participants completed the study. METHODS: The participants randomised to the treatment group were treated in a systematic, controlled...

  14. A novel use for testosterone to treat central sensitization of chronic pain in fibromyalgia patients.

    Science.gov (United States)

    White, Hillary D; Robinson, Thomas D

    2015-08-01

    Fibromyalgia is a diffuse chronic pain condition that occurs predominantly in women and may be under-reported in men. Symptoms include a loss of feeling of well-being and generalized widespread flu-like muscle aches and pain that fail to resolve due to central sensitization of nociceptive neurons. It has commonalities with a myriad of other chronic pain conditions which include PTSD, "Gulf War Syndrome", and various stress-induced conditions caused, for example, by viral infection, emotional or physical stress, trauma, combat, accident or surgery. It is not understood why some individuals are susceptible to this condition and others are not. White et al., elsewhere in this issue, present a clinical feasibility study designed to test the hypothesis that 1) low or deficient testosterone serum levels are linked to a high risk for an inflamed nociceptive nervous system and resultant chronic pain states, and 2) a testosterone transdermal gel applied once a day by fibromyalgia patients can be an effective therapeutic against chronic pain. Here, a short profile of fibromyalgia is provided along with a brief summary of best practices currently recommended by clinical specialists. The link between testosterone and pain is then discussed, with an overview of scientific studies that lay the foundation for testosterone as a possible important additional therapeutic that has the potential to be safely administered and effective but also avoid the adverse effects of other therapeutics. Finally, novel mechanisms by which testosterone therapy is likely to down-modulate pain signaling are proposed.

  15. Does Acupuncture Alter Pain-related Functional Connectivity of the Central Nervous System? A Systematic Review.

    Science.gov (United States)

    Villarreal Santiago, María; Tumilty, Steve; Mącznik, Aleksandra; Mani, Ramakrishnan

    2016-08-01

    Acupuncture has been studied for several decades to establish evidence-based clinical practice. This systematic review aims to evaluate evidence for the effectiveness of acupuncture in influencing the functional connectivity of the central nervous system in patients with musculoskeletal pain. A systematic search of the literature was conducted to identify studies in which the central response of acupuncture in patients with musculoskeletal pain was evaluated by neuroimaging techniques. Databases searched were AMED, CINAHL, Cochrane Library, EMBASE, MEDLINE, PEDro, Pubmed, SCOPUS, SPORTDiscuss, and Web of Science. Included studies were assessed by two independent reviewers for their methodological quality by using the Downs and Black questionnaire and for their levels of completeness and transparency in reporting acupuncture interventions by using Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA) criteria. Seven studies met the inclusion criteria. Three studies were randomized controlled trials (RCTs) and four studies were nonrandomized controlled trials (NRCTs). The neuroimaging techniques used were functional magnetic resonance imaging (fMRI) and positron emission tomography (PET). Positive effects on the functional connectivity of the central nervous system more consistently occurred during long-term acupuncture treatment. The results were heterogeneous from a descriptive perspective; however, the key findings support acupuncture's ability to alter pain-related functional connectivity in the central nervous system in patients with musculoskeletal pain. PMID:27555221

  16. Does Acupuncture Alter Pain-related Functional Connectivity of the Central Nervous System? A Systematic Review.

    Science.gov (United States)

    Villarreal Santiago, María; Tumilty, Steve; Mącznik, Aleksandra; Mani, Ramakrishnan

    2016-08-01

    Acupuncture has been studied for several decades to establish evidence-based clinical practice. This systematic review aims to evaluate evidence for the effectiveness of acupuncture in influencing the functional connectivity of the central nervous system in patients with musculoskeletal pain. A systematic search of the literature was conducted to identify studies in which the central response of acupuncture in patients with musculoskeletal pain was evaluated by neuroimaging techniques. Databases searched were AMED, CINAHL, Cochrane Library, EMBASE, MEDLINE, PEDro, Pubmed, SCOPUS, SPORTDiscuss, and Web of Science. Included studies were assessed by two independent reviewers for their methodological quality by using the Downs and Black questionnaire and for their levels of completeness and transparency in reporting acupuncture interventions by using Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA) criteria. Seven studies met the inclusion criteria. Three studies were randomized controlled trials (RCTs) and four studies were nonrandomized controlled trials (NRCTs). The neuroimaging techniques used were functional magnetic resonance imaging (fMRI) and positron emission tomography (PET). Positive effects on the functional connectivity of the central nervous system more consistently occurred during long-term acupuncture treatment. The results were heterogeneous from a descriptive perspective; however, the key findings support acupuncture's ability to alter pain-related functional connectivity in the central nervous system in patients with musculoskeletal pain.

  17. Methods to measure peripheral and central sensitization using quantitative sensory testing: A focus on individuals with low back pain.

    Science.gov (United States)

    Starkweather, Angela R; Heineman, Amy; Storey, Shannon; Rubia, Gil; Lyon, Debra E; Greenspan, Joel; Dorsey, Susan G

    2016-02-01

    Quantitative sensory testing can be used to assess peripheral and central sensitization; important factors that contribute to the individual's experience of pain and disability. Many studies use quantitative sensory testing in patients with low back pain to detect alterations in pain sensitivity, however, because investigators employ different protocols, interpretation of findings across studies can become problematic. The purpose of this article is to propose a standardized method of testing peripheral and central pain sensitization in patients with low back pain. Video clips are provided to demonstrate correct procedures for measuring the response to experimental pain using mechanical, thermal and pressure modalities. As nurse researchers and clinicians increase utilization of quantitative sensory testing to examine pain phenotypes, it is anticipated that more personalized methods for monitoring the trajectory of low back pain and response to treatment will improve outcomes for this patient population.

  18. Bihemispheric Motor Cortex Transcranial Direct Current Stimulation Improves Force Steadiness in Post-Stroke Hemiparetic Patients: A Randomized Crossover Controlled Trial

    Science.gov (United States)

    Montenegro, Rafael A.; Midgley, Adrian; Massaferri, Renato; Bernardes, Wendell; Okano, Alexandre H.; Farinatti, Paulo

    2016-01-01

    Post-stroke patients usually exhibit reduced peak muscular torque (PT) and/or force steadiness during submaximal exercise. Brain stimulation techniques have been proposed to improve neural plasticity and help to restore motor performance in post-stroke patients. The present study compared the effects of bihemispheric motor cortex transcranial direct current stimulation (tDCS) on PT and force steadiness during maximal and submaximal resistance exercise performed by post-stroke patients vs. healthy controls. A double-blind randomized crossover controlled trial (identification number: TCTR20151112001; URL: http://www.clinicaltrials.in.th/) was conducted involving nine healthy and 10 post-stroke hemiparetic individuals who received either tDCS (2 mA) or sham stimulus upon the motor cortex for 20 min. PT and force steadiness (reflected by the coefficient of variation (CV) of muscular torque) were assessed during unilateral knee extension and flexion at maximal and submaximal workloads (1 set of 3 repetitions at 100% PT and 2 sets of 10 repetitions at 50% PT, respectively). No significant change in PT was observed in post-stroke and healthy subjects. Force steadiness during knee extension (~25–35%, P knee extension (~13–27%, P < 0.001) in healthy controls. These results suggest that tDCS may improve force steadiness, but not PT in post-stroke hemiparetic patients, which might be relevant in the context of motor rehabilitation programs. PMID:27601988

  19. Association of post stroke depression with social factors, insomnia, and neurological status in Chinese elderly population.

    Science.gov (United States)

    Wang, Lingru; Tao, Yong; Chen, Yang; Wang, Hua; Zhou, Huadong; Fu, Xiaoyan

    2016-08-01

    The purpose of this study was to investigate the association of post stroke depression (PSD) with social factors, insomnia, and neurological status among elderly Chinese patients with ischemic stroke. Six hundred and eight patients over 60 years of age, who had suffered from a first episode of ischemic stroke within 7 days, were enrolled into the study. They were divided into PSD and non-PSD groups according to the Self-rating Depression Scale (SDS) scores. The association of PSD with social factors, insomnia, and neurological status was analyzed using multivariable logistic regression analysis. Compared with the patients who did not develop PSD, those with PSD reported adverse life events more frequently, and more subjects with PSD lived alone, had left carotid artery infarction and cortical infarction (P < 0.05), history of insomnia, and high National Institute of Health Stroke Scale (NIHSS) scores and low Barthel Index (BI) scores (P < 0.01). The multivariable logistic regression analysis showed that the occurrence of PSD was associated with a history of insomnia (HR = 1.59, 95 % CI 1.12-2.36, P < 0.01), NIHSS scores (HR = 2.45, 95 % CI 1.42-3.91, P < 0.01) and BI scores (HR = 2.56, 95 % CI 1.39-4.25, P < 0.01). Insomnia and the degree of neurological deficit were associated with PSD in an elderly population of Chinese people. PMID:27120072

  20. [A complex study of the movement biomechanics in patients with post-stroke hemiparesis].

    Science.gov (United States)

    Skvortsov, D V; Bulatova, M A; Kovrazhkina, E A; Suvorov, A Iu; Ivanova, G E; Skvortsova, V I

    2012-01-01

    The authors present results of a pilot study on biomechanics of non-cyclic movements of the human consequent verticalization in the ontogenesis of patients with post-stroke hemiparesis (10 patients in the acute stage of cerebral stroke) and 10 healthy volunteers without neurologic and orthopedic pathology. Some movements of therapeutic exercises Balance (a model of ontogenetic kinesitherapy) have been selected for the study. Cinematic parameters have been recorded using a system of motion 3D video analysis, a kinematic model was build in accordance to standard protocols. The skin (native and straightened) electromyogram (EMG) was recorded synchronously with kinematic data using 16-channel electromyography from the following pairs of muscles: mm. sternocleido-mastoideus, trapezius (горизонтальная порция), biceps brachii, triceps brachii, rectus femoris, adductor magnus. Major differences in the EMG picture between patients and controls were: 1) the EMG "monotony" with the involvement of multiple additional muscles in locomotions with the prevalence of the peculiar "tonic" muscle activity (low amplitudes without distinct peaks), stretching along the whole cycle of movement. In controls, EMG demonstrated variability and had mostly "phasic" character with distinct 1 or 2 peaks; 2) the asymmetry of EMG profile in symmetric movements. i.e. when performed simultaneously from the right and from the left sides. The latter feature may be considered as predictive because it was never found in healthy people. It allows to identify objectively weak muscles even in the absence of visible parethis during the routine neurological examination.

  1. Pregabalin and placebo responders show different effects on central pain processing in chronic pancreatitis patients

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    Bouwense SA

    2015-07-01

    -generating study provides the first evidence that pain relief with pregabalin is associated with anti-hyperalgesic effects and increased endogenous inhibitory modulation. No such effects were observed in patients experiencing pain relief with the placebo treatment. The mechanisms underlying analgesic response to placebo vs drug treatments are different and, together with their interactions, deserve further study.Keywords: chronic pancreatitis, pregabalin, placebo, chronic pain treatment, quantitative sensory testing, central sensitization

  2. Reduction of central neuropathic pain with ketamine infusion in a patient with Ehlers–Danlos syndrome: a case report

    Science.gov (United States)

    Lo, Tony Chung Tung; Yeung, Stephen Tung; Lee, Sujin; Skavinski, Kira; Liao, Solomon

    2016-01-01

    Objective Ehlers–Danlos syndrome frequently causes acute and chronic pain because of joint subluxations and dislocations secondary to hypermobility. Current treatments for pain related to Ehlers–Danlos syndrome and central pain syndrome are inadequate. This case report discusses the therapeutic use of ketamine intravenous infusion as an alternative. Case report A 27-year-old Caucasian female with a history of Ehlers–Danlos syndrome and spinal cord ischemic myelopathy resulting in central pain syndrome, presented with severe generalized body pain refractory to multiple pharmacological interventions. After a 7-day course of ketamine intravenous infusion under controlled generalized sedation in the intensive care unit, the patient reported a dramatic reduction in pain levels from 7–8 out of 10 to 0–3 out of 10 on a numeric rating scale and had a significant functional improvement. The patient tolerated a reduction in her pain medication regimen, which originally included opioids, gabapentin, pregabalin, tricyclic antidepressants, and nonsteroidal anti-inflammatory drugs. Conclusion Ketamine infusion treatment has been used in various pain syndromes, including central neuropathic pain, ischemic pain, and regional pain syndrome. Reports have suggested that ketamine modulates pain by the regression of N-methyl-D-aspartate receptor to a resting state. As such, propagation of nociceptive signal to brain is interrupted allowing for the restoration of physiological balance between pain inhibition and facilitation. The present report shows that this treatment option can be used in patients with refractory central pain syndrome in the setting of spinal cord myelopathy secondary to Ehlers–Danlos syndrome. In addition, as seen in this case, this protocol can potentially decrease the chronic use of pain medication, such as opioids.

  3. Evidence-based pharmacological management of chronic neuropathic pain

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    Zarrin Ansari

    2013-06-01

    Full Text Available Neuropathic pain (NP is a chronic, debilitating symptomatology of lesions/injuries of the central and peripheral nervous system. As per pooled estimates, the prevalence is 7-8% in the general population; however, the prevalence varies with different neuropathic conditions. The aetiology can range from peripheral neuropathic conditions viz. peripheral diabetic neuropathic pain (PDNP, post-herpetic neuralgia (PHN, trigeminal neuralgia, HIV- associated polyneuropathy, cervical radiculopathy to central neuropathic conditions, viz. central post-stroke pain, spinal cord injury and the neuropathic pain associated with multiple sclerosis. Apart from the symptomatic perception of pain, neuropathic pain affects the cognitive and emotional aspects of the affected individual. The pain, being debilitating and resistant to over-the-counter analgesics, diminishes the quality of life, disrupts sleep and leads to psychiatric complications such as comorbid anxiety and depression. The management is palliative and involves drugs, psychological intervention, stimulations and nerve-blocking techniques. This review concentrates on the pharmacological therapeutic options available and focuses on the selection of the agent/s in accordance with the evidence. The first-line treatment includes the tricyclic antidepressants ([TCAs]; amitriptyline, nortriptyline, selective serotonin norepinephrine inhibitors ([SNRIs]; duloxetine, venlafaxine, calcium channel alpha 2 - delta ligands (pregabalin, gabapentin, carbamazepine and oxcarbazepine. Lidocaine plasters are first-line options for specific focal conditions such as post-herpetic neuralgia. The second-line therapy includes the opioid analgesics and tramadol. The choice of drug selection should complement the patient’s age, type of neuropathic condition, tolerability to an agent, comorbid condition and cost-effectiveness. Management must be individualized with a realistic and composite goal of making the pain tolerable and

  4. Evidence-based careflow management systems: the case of post-stroke rehabilitation.

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    Panzarasa, S; Maddè, S; Quaglini, S; Pistarini, C; Stefanelli, M

    2002-04-01

    The activities of a care providers' team need to be coordinated within a process properly designed on the basis of available best practice medical knowledge. It requires a rethinking of the management of care processes within health care organizations. The current workflow technology seems to offer the most convenient solution to build such cooperative systems. However, some of its present weaknesses still require an intense research effort to find solutions allowing its exploitation in real medical practice. This paper presents an approach to design and build evidence-based careflow management systems, which can be viewed as components of a knowledge management infrastructure each health care organization should be provided with to increase its performance in delivering high quality care by efficiently exploiting the available knowledge resources. The post-stroke rehabilitation process has been taken as a challenging care problem to assess our methodology for designing and developing careflow management systems. Then a system was co-developed with a team of rehabilitation professionals who will be committed to use it in their daily work. The system's main goal is to deliver a full array of rehabilitation services provided by an interdisciplinary team. They are related to identify which patients are most likely to benefit from rehabilitation, manage a rehabilitation treatment plan, and monitor progress both during rehabilitation and after return to a community residence. A model of the rehabilitation process was derived from an international guideline and adapted to the local organization of work. It involves different organizational units, such as wards, rehabilitation units, clinical laboratories, and imaging services. Several organizational agents work within them and play one or more roles. Each role is defined by the goals' set that she/he must fulfill. Special effort has been given to the design and development of a knowledge-based system for managing

  5. Concurrent neuromechanical and functional gains following upper-extremity power training post-stroke

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    Patten Carolynn

    2013-01-01

    Full Text Available Abstract Background Repetitive task practice is argued to drive neural plasticity following stroke. However, current evidence reveals that hemiparetic weakness impairs the capacity to perform, and practice, movements appropriately. Here we investigated how power training (i.e., high-intensity, dynamic resistance training affects recovery of upper-extremity motor function post-stroke. We hypothesized that power training, as a component of upper-extremity rehabilitation, would promote greater functional gains than functional task practice without deleterious consequences. Method Nineteen chronic hemiparetic individuals were studied using a crossover design. All participants received both functional task practice (FTP and HYBRID (combined FTP and power training in random order. Blinded evaluations performed at baseline, following each intervention block and 6-months post-intervention included: Wolf Motor Function Test (WMFT-FAS, Primary Outcome, upper-extremity Fugl-Meyer Motor Assessment, Ashworth Scale, and Functional Independence Measure. Neuromechanical function was evaluated using isometric and dynamic joint torques and concurrent agonist EMG. Biceps stretch reflex responses were evaluated using passive elbow stretches ranging from 60 to 180º/s and determining: EMG onset position threshold, burst duration, burst intensity and passive torque at each speed. Results Primary outcome: Improvements in WMFT-FAS were significantly greater following HYBRID vs. FTP (p = .049, regardless of treatment order. These functional improvements were retained 6-months post-intervention (p = .03. Secondary outcomes: A greater proportion of participants achieved minimally important differences (MID following HYBRID vs. FTP (p = .03. MIDs were retained 6-months post-intervention. Ashworth scores were unchanged (p > .05. Increased maximal isometric joint torque, agonist EMG and peak power were significantly greater following HYBRID vs. FTP (p p

  6. Bihemispheric Motor Cortex Transcranial Direct Current Stimulation Improves Force Steadiness in Post-Stroke Hemiparetic Patients: A Randomized Crossover Controlled Trial.

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    Montenegro, Rafael A; Midgley, Adrian; Massaferri, Renato; Bernardes, Wendell; Okano, Alexandre H; Farinatti, Paulo

    2016-01-01

    Post-stroke patients usually exhibit reduced peak muscular torque (PT) and/or force steadiness during submaximal exercise. Brain stimulation techniques have been proposed to improve neural plasticity and help to restore motor performance in post-stroke patients. The present study compared the effects of bihemispheric motor cortex transcranial direct current stimulation (tDCS) on PT and force steadiness during maximal and submaximal resistance exercise performed by post-stroke patients vs. healthy controls. A double-blind randomized crossover controlled trial (identification number: TCTR20151112001; URL: http://www.clinicaltrials.in.th/) was conducted involving nine healthy and 10 post-stroke hemiparetic individuals who received either tDCS (2 mA) or sham stimulus upon the motor cortex for 20 min. PT and force steadiness (reflected by the coefficient of variation (CV) of muscular torque) were assessed during unilateral knee extension and flexion at maximal and submaximal workloads (1 set of 3 repetitions at 100% PT and 2 sets of 10 repetitions at 50% PT, respectively). No significant change in PT was observed in post-stroke and healthy subjects. Force steadiness during knee extension (~25-35%, P < 0.001) and flexion (~22-33%, P < 0.001) improved after tDCS compared to the sham condition in post-stroke patients, but improved only during knee extension (~13-27%, P < 0.001) in healthy controls. These results suggest that tDCS may improve force steadiness, but not PT in post-stroke hemiparetic patients, which might be relevant in the context of motor rehabilitation programs. PMID:27601988

  7. Factors Influencing Goal Attainment in Patients with Post-Stroke Upper Limb Spasticity Following Treatment with Botulinum Toxin A in Real-Life Clinical Practice: Sub-Analyses from the Upper Limb International Spasticity (ULIS-II Study

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    Klemens Fheodoroff

    2015-04-01

    Full Text Available In this post-hoc analysis of the ULIS-II study, we investigated factors influencing person-centred goal setting and achievement following botulinum toxin-A (BoNT-A treatment in 456 adults with post-stroke upper limb spasticity (ULS. Patients with primary goals categorised as passive function had greater motor impairment (p < 0.001, contractures (soft tissue shortening [STS] (p = 0.006 and spasticity (p = 0.02 than those setting other goal types. Patients with goals categorised as active function had less motor impairment (0.0001, contracture (p < 0.0001, spasticity (p < 0.001 and shorter time since stroke (p = 0.001. Patients setting goals for pain were older (p = 0.01 with more contractures (p = 0.008. The proportion of patients achieving their primary goal was not impacted by timing of first-ever BoNT-A injection (medium-term (≤1 year vs. longer-term (>1 year post-stroke (80.0% vs. 79.2% or presence or absence of severe contractures (76.7% vs. 80.6%, although goal types differed. Earlier BoNT-A intervention was associated with greater achievement of active function goals. Severe contractures impacted negatively on goal achievement except in pain and passive function. Goal setting by patients with ULS is influenced by impairment severity, age and time since stroke. Our findings resonate with clinical experience and may assist patients and clinicians in selecting realistic, achievable goals for treatment.

  8. Studying post-stroke functional impairment after treatment with neural progenitor cells – an analysis of behavioral tests

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    Thorsten R. Doeppner

    2014-10-01

    Full Text Available Systemic transplantation of neural progenitor cells (NPCs in rodents reduces functional impairment after cerebral ischemia. In light of upcoming stroke trials regarding safety and feasibility of NPC transplantation, experimental studies have to successfully analyze the extent of NPC-induced neurorestoration on the functional level. However, appropriate behavioral tests for analysis of post-stroke motor coordination deficits and cognitive impairment after NPC grafting are not fully established. We therefore exposed male C57BL6 mice to either 45 min (mild or 90 min (severe of cerebral ischemia, using the thread occlusion model followed by intravenous injection of PBS or NPCs 6 h post-stroke with an observation period of three months. Post-stroke motor coordination was assessed by means of the rota rod, tight rope, corner turn, inclined plane, grip strength, foot fault, adhesive removal, pole test and balance beam test, whereas cognitive impairment was analyzed using the water maze, the open field and the passive avoidance test. Significant motor coordination differences after both mild and severe cerebral ischemia in favor of NPC-treated mice were observed for each motor coordination test except for the inclined plane and the grip strength test, which only showed significant differences after severe cerebral ischemia. Cognitive impairment after mild cerebral ischemia was successfully assessed using the water maze test, the open field and the passive avoidance test. On the contrary, the water maze test was not suitable in the severe cerebral ischemia paradigm, as it too much depends on motor coordination capabilities of test mice. In terms of both reliability and cost-effectiveness considerations, we thus recommend the corner turn, foot fault, balance beam, and open field test, which do not depend on durations of cerebral ischemia.

  9. Markedly impaired bilateral coordination of gait in post-stroke patients: Is this deficit distinct from asymmetry? A cohort study

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    van Lummel Rob C

    2011-05-01

    Full Text Available Abstract Background Multiple aspects of gait are typically impaired post-stroke. Asymmetric gait is common as a consequence of unilateral brain lesions. The relationship between the resulting asymmetric gait and impairments in the ability to properly coordinate the reciprocal stepping activation of the legs is not clear. The objective of this exploratory study is to quantify the effects of hemiparesis on two putatively independent aspects of the bilateral coordination of gait to gain insight into mechanisms and their relationship and to assess their potential as clinical markers. Methods Twelve ambulatory stroke patients and age-matched healthy adults wore a tri-axial piezo-resistive accelerometer and walked back and forth along a straight path in a hall at a comfortable walking speed during 2 minutes. Gait speed, gait asymmetry (GA, and aspects of the bilateral coordination of gait (BCG were determined. Bilateral coordination measures included the left-right stepping phase for each stride φi, consistency in the phase generation φ_CV, accuracy in the phase generation φ_ABS, and Phase Coordination Index (PCI, a combination of accuracy and consistency of the phase generation. Results Group differences (p Conclusions In ambulatory post-stroke patients, two gait coordination properties, GA and PCI, are markedly impaired. Although these features are not related to each other in healthy controls, they are strongly related in stroke patients, which is a novel finding. A measurement approach based on body-fixed sensors apparently may provide sensitive markers that can be used for clinical assessment and for enhancing rehabilitation targeting in post-stroke patients.

  10. Post-stroke depression, obstructive sleep apnea, and cognitive impairment: Rationale for, and barriers to, routine screening.

    Science.gov (United States)

    Swartz, Richard H; Bayley, Mark; Lanctôt, Krista L; Murray, Brian J; Cayley, Megan L; Lien, Karen; Sicard, Michelle N; Thorpe, Kevin E; Dowlatshahi, Dar; Mandzia, Jennifer L; Casaubon, Leanne K; Saposnik, Gustavo; Perez, Yael; Sahlas, Demetrios J; Herrmann, Nathan

    2016-07-01

    Stroke can cause neurological impairment ranging from mild to severe, but the impact of stroke extends beyond the initial brain injury to include a complex interplay of devastating comorbidities including: post-stroke depression, obstructive sleep apnea, and cognitive impairment ("DOC"). We reviewed the frequency, impact, and treatment options for each DOC condition. We then used the Ottawa Model of Research Use to examine gaps in care, understand the barriers to knowledge translation, identification, and addressing these important post-stroke comorbidities. Each of the DOC conditions is common and result in poorer recovery, greater functional impairment, increased stroke recurrence and mortality, even after accounting for traditional vascular risk factors. Despite the strong relationships between DOC comorbidities and these negative outcomes as well as recommendations for screening based on best practice recommendations from several countries, they are frequently not assessed. Barriers related to the nature of the screening tools (e.g., time consuming in high-volume clinics), practice environment (e.g., lack of human resources or space), as well as potential adopters (e.g., equipoise surrounding the benefits of treatment for these conditions) pose challenges to routine screening implementation. Simple, feasible approaches to routine screening coupled with appropriate, evidence-based treatment protocols are required to better identify and manage depression, obstructive sleep apnea, and cognitive impairment symptoms in stroke prevention clinic patients to reduce the impact of these important post-stroke comorbidities. These tools may in turn facilitate large-scale randomized controlled treatment trials of interventions for DOC conditions that may help to improve cardiovascular outcomes after stroke or TIA. PMID:27073189

  11. Axial Diffusivity of the Corona Radiata at 24 Hours Post-Stroke: A New Biomarker for Motor and Global Outcome.

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    Eric Moulton

    Full Text Available Fractional anisotropy (FA is an effective marker of motor outcome at the chronic stage of stroke yet proves to be less efficient at early time points. This study aims to determine which diffusion metric in which location is the best marker of long-term stroke outcome after thrombolysis with diffusion tensor imaging (DTI at 24 hours post-stroke. Twenty-eight thrombolyzed patients underwent DTI at 24 hours post-stroke onset. Ipsilesional and contralesional FA, mean (MD, axial (AD, and radial (RD diffusivities values were calculated in different Regions-of-Interest (ROIs: (1 the white matter underlying the precentral gyrus (M1, (2 the corona radiata (CoRad, (3 the posterior limb of the internal capsule (PLIC and (4 the cerebral peduncles (CP. NIHSS scores were acquired at admission, day 1, and day 7; modified Rankin Scores (mRS at 3 months. Significant decreases were found in FA, MD, and AD of the ipsilesional CoRad and M1. MD and AD were also significantly lower in the PLIC. The ratio of ipsi and contralesional AD of the CoRad (CoRad-rAD was the strongest diffusion parameter correlated with motor NIHSS scores on day 7 and with the mRS at 3 months. A Receiver-Operator Curve analysis yielded a model for the CoRad-rAD to predict good outcome based on upper limb NIHSS motor scores and mRS with high specificity and sensitivity. FA values were not correlated with clinical outcome. In conclusion, axial diffusivity of the CoRad from clinical DTI at 24 hours post-stroke is the most appropriate diffusion metric for quantifying stroke damage to predict outcome, suggesting the importance of early axonal damage.

  12. Axial Diffusivity of the Corona Radiata at 24 Hours Post-Stroke: A New Biomarker for Motor and Global Outcome.

    Science.gov (United States)

    Moulton, Eric; Amor-Sahli, Mélika; Perlbarg, Vincent; Pires, Christine; Crozier, Sophie; Galanaud, Damien; Valabregue, Romain; Yger, Marion; Baronnet-Chauvet, Flore; Samson, Yves; Dormont, Didier; Rosso, Charlotte

    2015-01-01

    Fractional anisotropy (FA) is an effective marker of motor outcome at the chronic stage of stroke yet proves to be less efficient at early time points. This study aims to determine which diffusion metric in which location is the best marker of long-term stroke outcome after thrombolysis with diffusion tensor imaging (DTI) at 24 hours post-stroke. Twenty-eight thrombolyzed patients underwent DTI at 24 hours post-stroke onset. Ipsilesional and contralesional FA, mean (MD), axial (AD), and radial (RD) diffusivities values were calculated in different Regions-of-Interest (ROIs): (1) the white matter underlying the precentral gyrus (M1), (2) the corona radiata (CoRad), (3) the posterior limb of the internal capsule (PLIC) and (4) the cerebral peduncles (CP). NIHSS scores were acquired at admission, day 1, and day 7; modified Rankin Scores (mRS) at 3 months. Significant decreases were found in FA, MD, and AD of the ipsilesional CoRad and M1. MD and AD were also significantly lower in the PLIC. The ratio of ipsi and contralesional AD of the CoRad (CoRad-rAD) was the strongest diffusion parameter correlated with motor NIHSS scores on day 7 and with the mRS at 3 months. A Receiver-Operator Curve analysis yielded a model for the CoRad-rAD to predict good outcome based on upper limb NIHSS motor scores and mRS with high specificity and sensitivity. FA values were not correlated with clinical outcome. In conclusion, axial diffusivity of the CoRad from clinical DTI at 24 hours post-stroke is the most appropriate diffusion metric for quantifying stroke damage to predict outcome, suggesting the importance of early axonal damage. PMID:26562509

  13. Effects of dexmedetomidine on procedural pain and discomfort associated with central venous catheter insertion

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    Aloka Samantaray

    2014-01-01

    Full Text Available Background and Aim: Central venous catheter (CVC insertion induces pain and discomfort to a conscious patient despite application of a local anaesthetic (LA field block and this pain can be greatly lessened by using additional analgesics. The aim of this study was to evaluate the efficacy of dexmedetomidine along with LA field infiltration in controlling pain and discomfort associated with CVC insertion. Methods: A prospective, randomised, double-blind, placebo-controlled trial of 54 patients scheduled for planned CVC insertion was undertaken. Patients were randomly assigned into two groups of 27 each, to receive either dexmedetomidine (1 μg/kg or 0.9% normal saline, along with LA field infiltration. Pain and discomfort score was measured at 5 time points. Results: The median pain score was worst for placebo group at local anaesthetic injection (6 [4-7] and at the end of procedure (5 [4-5], which was significantly attenuated in the dexmedetomidine group (4 [4-5] and 4 [3-5]; P = 0.007 and 0.040 respectively. The lower procedure related discomfort score in the immediate post-procedural period was statistically significant in dexmedetomidine group compared to placebo (4 [4-5] vs. 5 [4-6]; P = 0.008. Conclusions: Pre-procedural bolus dexmedetomidine infusion provides adequate analgesia and patient comfort for CVC insertion along LA field block. However, the tendency for excessive sedation and bradycardia associated with dexmedetomidine render it less desirable for this purpose.

  14. Post-Stroke Infections Exacerbate Ischemic Brain Injury in Middle-Aged Rats: Immunomodulation and Neuroprotection by Progesterone

    OpenAIRE

    Yousuf, Seema; Atif, Fahim; Sayeed, Iqbal; Wang, Jun; Stein, Donald G.

    2012-01-01

    We investigated the effect of delayed, prolonged systemic inflammation on stroke outcomes and progesterone (P4) neuroprotection in middle-aged rats. After transient middle cerebral artery occlusion/reperfusion (MCAO) surgery, rats received P4 (8 or 16 mg/kg) or vehicle injections at 2h, 6h and every 24h until day 7 post-occlusion. At 24h post-injury systemic inflammation was induced by giving 3 doses of lipopolysaccharide (LPS; 50 mg/kg, at 4h intervals) to model post-stroke infections. We me...

  15. Post stroke hyperglycemia and Ischemic stroke%卒中后高血糖与缺血性脑卒中

    Institute of Scientific and Technical Information of China (English)

    杨赟; 吴晓牧

    2010-01-01

    20~40%的脑卒中患者,无论其此前是否诊断为糖尿病,均可在卒中发生后出现高血糖,称为卒中后高血糖(post stroke hyperglycemia, PSH).PSH是脑卒中预后的一个重要预测因子,PSH能预测脑卒中患者的死亡风险及神经功能恢复情况.

  16. Reduction of central neuropathic pain with ketamine infusion in a patient with Ehlers–Danlos syndrome: a case report

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    Lo TC

    2016-09-01

    Full Text Available Tony Chung Tung Lo,1,* Stephen Tung Yeung,2,* Sujin Lee,1 Kira Skavinski,3 Solomon Liao,4 1Department of Physical Medicine and Rehabilitation, University of California Irvine, Orange, CA, 2Department of Immunology, University of Connecticut School of Medicine, Farmington, CT, 3Department of Palliative Medicine, University of California San Diego, La Jolla, 4Department of Palliative Medicine, University of California Irvine, Orange, CA, USA *These authors contributed equally to this work Objective: Ehlers–Danlos syndrome frequently causes acute and chronic pain because of joint subluxations and dislocations secondary to hypermobility. Current treatments for pain related to Ehlers–Danlos syndrome and central pain syndrome are inadequate. This case report discusses the therapeutic use of ketamine intravenous infusion as an alternative. Case report: A 27-year-old Caucasian female with a history of Ehlers–Danlos syndrome and spinal cord ischemic myelopathy resulting in central pain syndrome, presented with severe generalized body pain refractory to multiple pharmacological interventions. After a 7-day course of ketamine intravenous infusion under controlled generalized sedation in the intensive care unit, the patient reported a dramatic reduction in pain levels from 7–8 out of 10 to 0–3 out of 10 on a numeric rating scale and had a significant functional improvement. The patient tolerated a reduction in her pain medication regimen, which originally included opioids, gabapentin, pregabalin, tricyclic antidepressants, and nonsteroidal anti-inflammatory drugs. Conclusion: Ketamine infusion treatment has been used in various pain syndromes, including central neuropathic pain, ischemic pain, and regional pain syndrome. Reports have suggested that ketamine modulates pain by the regression of N-methyl-D-aspartate receptor to a resting state. As such, propagation of nociceptive signal to brain is interrupted allowing for the restoration of

  17. Perturbed connectivity of the amygdala and its subregions with the central executive and default mode networks in chronic pain.

    Science.gov (United States)

    Jiang, Ying; Oathes, Desmond; Hush, Julia; Darnall, Beth; Charvat, Mylea; Mackey, Sean; Etkin, Amit

    2016-09-01

    Maladaptive responses to pain-related distress, such as pain catastrophizing, amplify the impairments associated with chronic pain. Many of these aspects of chronic pain are similar to affective distress in clinical anxiety disorders. In light of the role of the amygdala in pain and affective distress, disruption of amygdalar functional connectivity in anxiety states, and its implication in the response to noxious stimuli, we investigated amygdala functional connectivity in 17 patients with chronic low back pain and 17 healthy comparison subjects, with respect to normal targets of amygdala subregions (basolateral vs centromedial nuclei), and connectivity to large-scale cognitive-emotional networks, including the default mode network, central executive network, and salience network. We found that patients with chronic pain had exaggerated and abnormal amygdala connectivity with central executive network, which was most exaggerated in patients with the greatest pain catastrophizing. We also found that the normally basolateral-predominant amygdala connectivity to the default mode network was blunted in patients with chronic pain. Our results therefore highlight the importance of the amygdala and its network-level interaction with large-scale cognitive/affective cortical networks in chronic pain, and help link the neurobiological mechanisms of cognitive theories for pain with other clinical states of affective distress.

  18. Perturbed connectivity of the amygdala and its subregions with the central executive and default mode networks in chronic pain.

    Science.gov (United States)

    Jiang, Ying; Oathes, Desmond; Hush, Julia; Darnall, Beth; Charvat, Mylea; Mackey, Sean; Etkin, Amit

    2016-09-01

    Maladaptive responses to pain-related distress, such as pain catastrophizing, amplify the impairments associated with chronic pain. Many of these aspects of chronic pain are similar to affective distress in clinical anxiety disorders. In light of the role of the amygdala in pain and affective distress, disruption of amygdalar functional connectivity in anxiety states, and its implication in the response to noxious stimuli, we investigated amygdala functional connectivity in 17 patients with chronic low back pain and 17 healthy comparison subjects, with respect to normal targets of amygdala subregions (basolateral vs centromedial nuclei), and connectivity to large-scale cognitive-emotional networks, including the default mode network, central executive network, and salience network. We found that patients with chronic pain had exaggerated and abnormal amygdala connectivity with central executive network, which was most exaggerated in patients with the greatest pain catastrophizing. We also found that the normally basolateral-predominant amygdala connectivity to the default mode network was blunted in patients with chronic pain. Our results therefore highlight the importance of the amygdala and its network-level interaction with large-scale cognitive/affective cortical networks in chronic pain, and help link the neurobiological mechanisms of cognitive theories for pain with other clinical states of affective distress. PMID:27168362

  19. Cannabinoid CB2 receptors regulate central sensitization and pain responses associated with osteoarthritis of the knee joint.

    Science.gov (United States)

    Burston, James J; Sagar, Devi Rani; Shao, Pin; Bai, Mingfeng; King, Emma; Brailsford, Louis; Turner, Jenna M; Hathway, Gareth J; Bennett, Andrew J; Walsh, David A; Kendall, David A; Lichtman, Aron; Chapman, Victoria

    2013-01-01

    Osteoarthritis (OA) of the joint is a prevalent disease accompanied by chronic, debilitating pain. Recent clinical evidence has demonstrated that central sensitization contributes to OA pain. An improved understanding of how OA joint pathology impacts upon the central processing of pain is crucial for the identification of novel analgesic targets/new therapeutic strategies. Inhibitory cannabinoid 2 (CB2) receptors attenuate peripheral immune cell function and modulate central neuro-immune responses in models of neurodegeneration. Systemic administration of the CB2 receptor agonist JWH133 attenuated OA-induced pain behaviour, and the changes in circulating pro- and anti-inflammatory cytokines exhibited in this model. Electrophysiological studies revealed that spinal administration of JWH133 inhibited noxious-evoked responses of spinal neurones in the model of OA pain, but not in control rats, indicating a novel spinal role of this target. We further demonstrate dynamic changes in spinal CB2 receptor mRNA and protein expression in an OA pain model. The expression of CB2 receptor protein by both neurones and microglia in the spinal cord was significantly increased in the model of OA. Hallmarks of central sensitization, significant spinal astrogliosis and increases in activity of metalloproteases MMP-2 and MMP-9 in the spinal cord were evident in the model of OA pain. Systemic administration of JWH133 attenuated these markers of central sensitization, providing a neurobiological basis for analgesic effects of the CB2 receptor in this model of OA pain. Analysis of human spinal cord revealed a negative correlation between spinal cord CB2 receptor mRNA and macroscopic knee chondropathy. These data provide new clinically relevant evidence that joint damage and spinal CB2 receptor expression are correlated combined with converging pre-clinical evidence that activation of CB2 receptors inhibits central sensitization and its contribution to the manifestation of chronic OA

  20. Cannabinoid CB2 receptors regulate central sensitization and pain responses associated with osteoarthritis of the knee joint.

    Directory of Open Access Journals (Sweden)

    James J Burston

    Full Text Available Osteoarthritis (OA of the joint is a prevalent disease accompanied by chronic, debilitating pain. Recent clinical evidence has demonstrated that central sensitization contributes to OA pain. An improved understanding of how OA joint pathology impacts upon the central processing of pain is crucial for the identification of novel analgesic targets/new therapeutic strategies. Inhibitory cannabinoid 2 (CB2 receptors attenuate peripheral immune cell function and modulate central neuro-immune responses in models of neurodegeneration. Systemic administration of the CB2 receptor agonist JWH133 attenuated OA-induced pain behaviour, and the changes in circulating pro- and anti-inflammatory cytokines exhibited in this model. Electrophysiological studies revealed that spinal administration of JWH133 inhibited noxious-evoked responses of spinal neurones in the model of OA pain, but not in control rats, indicating a novel spinal role of this target. We further demonstrate dynamic changes in spinal CB2 receptor mRNA and protein expression in an OA pain model. The expression of CB2 receptor protein by both neurones and microglia in the spinal cord was significantly increased in the model of OA. Hallmarks of central sensitization, significant spinal astrogliosis and increases in activity of metalloproteases MMP-2 and MMP-9 in the spinal cord were evident in the model of OA pain. Systemic administration of JWH133 attenuated these markers of central sensitization, providing a neurobiological basis for analgesic effects of the CB2 receptor in this model of OA pain. Analysis of human spinal cord revealed a negative correlation between spinal cord CB2 receptor mRNA and macroscopic knee chondropathy. These data provide new clinically relevant evidence that joint damage and spinal CB2 receptor expression are correlated combined with converging pre-clinical evidence that activation of CB2 receptors inhibits central sensitization and its contribution to the manifestation

  1. Gabapentin reverses central pain sensitization following a collagenase-induced intrathalamic hemorrhage in rats

    Directory of Open Access Journals (Sweden)

    Castel A

    2013-12-01

    Full Text Available Aude Castel, Pascal VachonFaculty of Veterinary Medicine, Department of Veterinary Biomedicine, University of Montreal, Saint-Hyacinthe, QC, CanadaPurpose: The treatment of central neuropathic pain remains amongst the biggest challenges for pain specialists. The main objective of this study was to assess gabapentin (GBP, amitriptyline (AMI, and carbamazepine (CARBA for the treatment of a rodent central neuropathic pain model.Methods: Male Sprague Dawley rats were trained on the rotarod, Hargreaves, Von Frey and acetone behavioral tests, and baseline values were obtained prior to surgery. A stereotaxic injection of either a collagenase solution or saline was made in the right ventral posterolateral thalamic nucleus. The rats were tested on days 2, 4, 8, and 11 postsurgery. They were retested at regular intervals from day 15 to day 25 postsurgery, after oral administration of either the vehicle (n=7 and n=8 rats with intracerebral injections of collagenase and saline, respectively or the different drugs (GBP [60 mg/kg], AMI [10 mg/kg], CARBA [100 mg/kg]; n=8 rats/drug.Results: A significant decrease in the mechanical thresholds and no change in heat threshold were observed in both hind limbs in the collagenase group, as we had previously shown elsewhere. Reversal of the mechanical hypersensitivity was achieved only with GBP (P<0.05. AMI and CARBA, at the dosages used, failed to show any effect on mechanical thresholds. Transient cold allodynia was observed in some collagenase-injected rats but failed to be statistically significant.Conclusion: Intrathalamic hemorrhaging in the ventrolateral thalamic nucleus induced a bilateral mechanical allodynia, which was reversed by GBP but not AMI or CARBA.Keywords: central pain, thalamus, amitriptyline, carbamazepine

  2. Transcranial direct current stimulation facilitates motor learning post-stroke: a systematic review and meta-analysis.

    Science.gov (United States)

    Kang, Nyeonju; Summers, Jeffery J; Cauraugh, James H

    2016-04-01

    Transcranial direct current stimulation (tDCS) is an attractive protocol for stroke motor recovery. The current systematic review and meta-analysis investigated the effects of tDCS on motor learning post-stroke. Specifically, we determined long-term learning effects by examining motor improvements from baseline to at least 5 days after tDCS intervention and motor practise. 17 studies reported long-term retention testing (mean retention interval=43.8 days; SD=56.6 days) and qualified for inclusion in our meta-analysis. Assessing primary outcome measures for groups that received tDCS and motor practise versus sham control groups created 21 valid comparisons: (1) 16 clinical assessments and (2) 5 motor skill acquisition tests. A random effects model meta-analysis showed a significant overall effect size=0.59 (plearning: (1) stimulation protocols: anodal on the ipsilesional hemisphere, cathodal on the contralesional hemisphere, or bilateral; (2) recovery stage: subacute or chronic stroke; (3) stimulation timing: tDCS before or during motor practise; and (4) task-specific training or conventional rehabilitation protocols. This robust meta-analysis identified novel long-term motor learning effects with tDCS and motor practise post-stroke.

  3. Moving Forward By Stimulating the Brain: Transcranial Direct Current Stimulation in Post-Stroke Hemiparesis: A Mini Review

    Directory of Open Access Journals (Sweden)

    Heather T. Peters

    2016-08-01

    Full Text Available Stroke remains a leading cause of disability worldwide, with a majority of survivors experiencing long term decrements in motor function that severely undermine quality of life. While many treatment approaches and adjunctive strategies exist to remediate motor impairment, many are only efficacious or feasible for survivors with active hand and wrist function, a population who constitute only a minority of stroke survivors. Transcranial direct current stimulation (tDCS, a type of noninvasive brain stimulation, has been increasingly utilized to increase motor function following stroke as it is able to be used with stroke survivors of varying impairment levels, is portable, is relatively inexpensive and has few side effects and contraindications. Accordingly, in recent years the number of studies investigating its efficacy when utilized as an adjunct to motor rehabilitation regimens has drastically increased. While many of these trials have reported positive and promising efficacy, methodologies vary greatly between studies, including differences in stimulation parameters, outcome measures and the nature of physical practice. As such, an urgent need remains, centering on the need to investigate these methodological differences and synthesize the most current evidence surrounding the application of tDCS for post-stroke motor rehabilitation. Accordingly, the purpose of this paper is to provide a detailed overview of the most recent tDCS literature (published 2014-2015, while highlighting these variations in methodological approach, as well to elucidate the mechanisms associated with tDCS and post-stroke motor re-learning and neuroplasticity.

  4. Efficacy of virtual reality-based intervention on balance and mobility disorders post-stroke: a scoping review.

    Science.gov (United States)

    Darekar, Anuja; McFadyen, Bradford J; Lamontagne, Anouk; Fung, Joyce

    2015-05-10

    Rehabilitation interventions involving virtual reality (VR) technology have been developed for the promotion of functional independence post stroke. A scoping review was performed to examine the efficacy of VR-based interventions on balance and mobility disorders post stroke. Twenty-four articles in the English language examining VR game-based interventions and outcomes directed at balance and mobility disorders were included. Various VR systems (customized and commercially available) were used as rehabilitation tools. Outcome measures included laboratory and clinical measures of balance and gait. Outcome measures of dynamic balance showed significant improvements following VR-based interventions as compared to other interventions. Further, it was observed that VR-based intervention may have favorable effects in improving walking speed and the ability to deal with environmental challenges, which may also facilitate independent community ambulation. VR-based therapy thus has the potential to be a useful tool for balance and gait training for stroke rehabilitation. Utilization of motor learning principles related to task-related training may have been an important factor leading to positive results. Other principles such as repetition, feedback etc. were used in studies but were not explored explicitly and may need to be investigated to further improve the strength of results. Lastly, robust study designs with appropriate attention towards the intensity and dose-response aspects of VR training, clear study objectives and suitable outcomes would further aid in determining evidence-based efficacy for VR game-based interventions in the future.

  5. MRI findings in the painful hemiplegic shoulder

    Energy Technology Data Exchange (ETDEWEB)

    Tavora, D.G.F., E-mail: danielgurgel@sarah.b [Department of Radiology, Sarah Network of Hospitals for Rehabilitation, Fortaleza (Brazil); Gama, R.L.; Bomfim, R.C. [Department of Radiology, Sarah Network of Hospitals for Rehabilitation, Fortaleza (Brazil); Nakayama, M. [Department of Radiology, Federal University of Grande Dourados, Dourados (Brazil); Silva, C.E.P. [Department of Statistics, Sarah Network of Hospitals for Rehabilitation, Fortaleza (Brazil)

    2010-10-15

    Aim: To evaluate the magnetic resonance imaging (MRI) findings in painful hemiplegic shoulder (PHS) in hemiplegic post-stroke patients. Materials and methods: Patients with hemiplegia following their first cerebrovascular accident who were admitted to the Sarah Network of Hospitals for Rehabilitation were studied. Forty-five patients with pain in the hemiplegic shoulder and 23 post-stroke patients without shoulder pain were investigated. MRI and radiographic findings of the hemiplegic and contralateral asymptomatic shoulders were evaluated. Results: Some MRI findings were more frequent in PHS group, including synovial capsule thickening, synovial capsule enhancement, and enhancement in the rotator cuff interval. Conclusions: Adhesive capsulitis was found to be a possible cause of PHS.

  6. MRI findings in the painful hemiplegic shoulder

    International Nuclear Information System (INIS)

    Aim: To evaluate the magnetic resonance imaging (MRI) findings in painful hemiplegic shoulder (PHS) in hemiplegic post-stroke patients. Materials and methods: Patients with hemiplegia following their first cerebrovascular accident who were admitted to the Sarah Network of Hospitals for Rehabilitation were studied. Forty-five patients with pain in the hemiplegic shoulder and 23 post-stroke patients without shoulder pain were investigated. MRI and radiographic findings of the hemiplegic and contralateral asymptomatic shoulders were evaluated. Results: Some MRI findings were more frequent in PHS group, including synovial capsule thickening, synovial capsule enhancement, and enhancement in the rotator cuff interval. Conclusions: Adhesive capsulitis was found to be a possible cause of PHS.

  7. Electroacupuncture in conscious free-moving mice reduces pain by ameliorating peripheral and central nociceptive mechanisms

    Science.gov (United States)

    Wang, Ying; Lei, Jianxun; Gupta, Mihir; Peng, Fei; Lam, Sarah; Jha, Ritu; Raduenz, Ellis; Beitz, Al J.; Gupta, Kalpna

    2016-01-01

    Integrative approaches such as electroacupuncture, devoid of drug effects are gaining prominence for treating pain. Understanding the mechanisms of electroacupuncture induced analgesia would benefit chronic pain conditions such as sickle cell disease (SCD), for which patients may require opioid analgesics throughout life. Mouse models are instructive in developing a mechanistic understanding of pain, but the anesthesia/restraint required to administer electroacupuncture may alter the underlying mechanisms. To overcome these limitations, we developed a method to perform electroacupuncture in conscious, freely moving, unrestrained mice. Using this technique we demonstrate a significant analgesic effect in transgenic mouse models of SCD and cancer as well as complete Freund’s adjuvant-induced pain. We demonstrate a comprehensive antinociceptive effect on mechanical, cold and deep tissue hyperalagesia in both genders. Interestingly, individual mice showed a variable response to electroacupuncture, categorized into high-, moderate-, and non-responders. Mechanistically, electroacupuncture significantly ameliorated inflammatory and nociceptive mediators both peripherally and centrally in sickle mice correlative to the antinociceptive response. Application of sub-optimal doses of morphine in electroacupuncture-treated moderate-responders produced equivalent antinociception as obtained in high-responders. Electroacupuncture in conscious freely moving mice offers an effective approach to develop a mechanism-based understanding of analgesia devoid of the influence of anesthetics or restraints. PMID:27687125

  8. Mechanisms-based classifications of musculoskeletal pain: part 1 of 3: symptoms and signs of central sensitisation in patients with low back (± leg) pain.

    LENUS (Irish Health Repository)

    Smart, Keith M

    2012-08-01

    As a mechanisms-based classification of pain \\'central sensitisation pain\\' (CSP) refers to pain arising from a dominance of neurophysiological dysfunction within the central nervous system. Symptoms and signs associated with an assumed dominance of CSP in patients attending for physiotherapy have not been extensively studied. The purpose of this study was to identify symptoms and signs associated with a clinical classification of CSP in patients with low back (± leg) pain. Using a cross-sectional, between-subjects design; four hundred and sixty-four patients with low back (± leg) pain were assessed using a standardised assessment protocol. Patients\\' pain was assigned a mechanisms-based classification based on experienced clinical judgement. Clinicians then completed a clinical criteria checklist specifying the presence or absence of various clinical criteria. A binary logistic regression analysis with Bayesian model averaging identified a cluster of three symptoms and one sign predictive of CSP, including: \\'Disproportionate, non-mechanical, unpredictable pattern of pain provocation in response to multiple\\/non-specific aggravating\\/easing factors\\

  9. Influence of Xingnao Jieyu capsule on hippocampal and frontal lobe neuronal growth in a rat model of post-stroke depression

    Institute of Scientific and Technical Information of China (English)

    Wentao Fan; Qian Wang; Yongmei Yan

    2012-01-01

    The present study established a rat model of post-stroke depression using incomplete ischemia induced by unilateral carotid artery ligation in combination with solitary raising and subcutaneous injection of a small dose of reserpine. After intragastric perfusion with 45 mg/100 g, 15 mg/100 g, and 7.5 mg/100 g of Xingnao Jieyu for 7, 14 and 21 days, neuronal morphology in the frontal lobe and hippocampus was improved, depression state and voluntary behaviors were also effectively improved in rats with post-stroke depression. Moreover, the effects of Xingnao Jieyu at a dose of 45 and 15 mg/100 g were similar to the traditional antidepressant Prozac.

  10. Traditional Chinese Medicine Treatment Progress of Post-stroke Dysphagia%卒中后吞咽障碍中医临床治疗进展

    Institute of Scientific and Technical Information of China (English)

    刘强; 薛伟伟

    2016-01-01

    In this paper,Chinese medicine treatment of post-stroke dysphagia literature analysis,the traditional Chinese medicine,acupuncture,Chinese medicine rehabilitation plays an important role in post-stroke dysphagia,and worthy of clinical application.%本文通过对卒中后吞咽障碍中医治疗文献分析,认为中药、针灸、中医康复训练在卒中后吞咽障碍中起着重要作用,值得临床应用.

  11. The Central Analgesic Mechanism of YM-58483 in Attenuating Neuropathic Pain in Rats.

    Science.gov (United States)

    Qi, Zeyou; Wang, Yaping; Zhou, Haocheng; Liang, Na; Yang, Lin; Liu, Lei; Zhang, Wei

    2016-10-01

    Calcium channel antagonists are commonly used to treat neuropathic pain. Their analgesic effects rely on inhibiting long-term potentiation, and neurotransmitters release in the spinal cord. Store-operated Ca(2+)channels (SOCCs) are highly Ca(2+)-selective cation channels broadly expressed in non-excitable cells and some excitable cells. Recent studies have shown that the potent inhibitor of SOCCs, YM-58483, has analgesic effects on neuropathic pain, but its mechanism is unclear. This experiment performed on spinal nerve ligation (SNL)-induced neuropathic pain model in rats tries to explore the mechanism, whereby YM-58483 attenuates neuropathic pain. The left L5 was ligated to produce the SNL neuropathic pain model in male Sprague-Dawley rats. The withdrawal threshold of rats was measured by the up-down method and Hargreaves' method before and after intrathecal administration of YM-58483 and vehicle. The SOCCs in the spinal dorsal horn were located by immunofluorescence. The expression of phosphorylated ERK and phosphorylated CREB, CD11b, and GFAP proteins in spinal level was tested by Western blot, while the release of proinflammatory cytokines (IL-1β, TNF-α, PGE2) was measured by enzyme-linked immunosorbent assay (ELISA). Intrathecal YM-58483 at the concentration of 300 μM (1.5 nmol) and 1000 μM (10 nmol) produced a significant central analgesic effect on the SNL rats, compared with control + vehicle (n = 7, P  0.05). YM-58483 also inhibited the release of spinal cord IL-1β, TNF-α, and PGE2, compared with control + vehicle (n = 5, #P < 0.001). The analgesic mechanism of YM-58483 may be via inhibiting central ERK/CREB signaling in the neurons and decreasing central IL-1β, TNF-α, and PGE2 release to reduce neuronal excitability in the spinal dorsal horn of the SNL rats. PMID:26514127

  12. Chronic whiplash and central sensitization; an evaluation of the role of a myofascial trigger points in pain modulation

    Directory of Open Access Journals (Sweden)

    Freeman Michael D

    2009-04-01

    Full Text Available Abstract Objective it has been established that chronic neck pain following whiplash is associated with the phenomenon of central sensitization, in which injured and uninjured parts of the body exhibit lowered pain thresholds due to an alteration in central pain processing. it has furthermore been hypothesized that peripheral sources of nociception in the muscles may perpetuate central sensitization in chronic whiplash. the hypothesis explored in the present study was whether myofascial trigger points serve as a modulator of central sensitization in subjects with chronic neck pain. Design controlled case series. Setting outpatient chronic pain clinic. Subjects seventeen patients with chronic and intractable neck pain and 10 healthy controls without complaints of neck pain. Intervention symptomatic subjects received anesthetic infiltration of myofascial trigger points in the upper trapezius muscles and controls received the anesthetic in the thigh. Outcome measures: pre and post injection cervical range of motion, pressure pain thresholds (ppt over the infraspinatus, wrist extensor, and tibialis anterior muscles. sensitivity to light (photophobia and subjects' perception of pain using a visual analog scale (vas were also evaluated before and after injections. only the ppt was evaluated in the asymptomatic controls. Results immediate (within 1 minute alterations in cervical range of motion and pressure pain thresholds were observed following an average of 3.8 injections with 1–2 cc of 1% lidocaine into carefully identified trigger points. cervical range of motion increased by an average of 49% (p = 0.000 in flexion and 44% (p = 0.001 in extension, 47% (p = 0.000 and 28% (p Conclusion the present data suggest that myofascial trigger points serve to perpetuate lowered pain thresholds in uninjured tissues. additionally, it appears that lowered pain thresholds associated with central sensitization can be immediately reversed, even when associated

  13. Mobility training using a bionic knee orthosis in patients in a post-stroke chronic state: a case series

    Directory of Open Access Journals (Sweden)

    Byl Nancy N

    2012-07-01

    Full Text Available Abstract Introduction An emerging area of neurorehabilitation is the use of robotic devices to enhance the efficiency and effectiveness of lower extremity physical therapy post-stroke. Many of the robotic devices currently available rely on computer-driven locomotive algorithms combined with partial bodyweight-supported treadmill training that drive reflex stepping with minimal patient intention during therapy. In this case series, we examined the effect of task-oriented mobility training in patients in a post-stroke chronic state using a novel, wearable, mobile, intention-based robotic leg orthosis. Case presentation Three individuals, all of whom had reached a plateau with conventional bodyweight-supported treadmill training, participated in task-oriented mobility therapy (1.5 hours, two to four times per week for four weeks with a robotic leg orthosis under supervision by a physical therapist. Participant 1 was a 59-year-old Caucasian man, who had an ischemic left stroke six years previously with resultant right hemiparesis. Participant 2 was a 42-year-old Caucasian woman with left hemiparesis after a right stroke 15 months previously. Participant 3 was a 62-year-old Caucasian woman with a history of a right middle cerebral artery aneurysm with third degree sub-arachnoid hemorrhage 10 years ago. Immediately after training, all participants demonstrated improved gait speed (10 meter walk, stride length and walking endurance (6 minute walk compared with baseline measurements. Improvements were maintained one month after training. Timed up and go and five times sit-to-stand were maintained for all three participants, with only one individual remaining outside the safety performance norm. Conclusions Lower extremity training integrating an intention-based robotic leg orthosis may improve gait speed, endurance and community levels of participation in select patients in a post-stroke chronic state after plateauing within a bodyweight

  14. Cannabinoids and centrak neuropathic pain. A review (Cannabinoidi e dolore neuropatico centrale. Una rassegna

    Directory of Open Access Journals (Sweden)

    Francesco Crestani

    2014-03-01

    Full Text Available Only recently, the medical community highlighted the pharmacological scientific bases of the effects of Cannabis. The most important active principle, Delta-9-tetrahydrocannabinol was identified in the second half of the last century, and receptors were subsequently identified and endogenous ligands, called endocannabinoids, were characterized. The effectiveness of the cannabinoids in the treatment of nausea and vomit due to anti-neoplastic chemotherapy and in the wasting-syndrome during AIDS is recognized. Moreover, the cannabinoids have shown analgesic properties, particularly interesting with regard to the central neuropathic pain. This article will review the current knowledge and will give practical guidance on how to proceed in prescribing cannabinoids.

  15. Development of a fuzzy logic based intelligent system for autonomous guidance of post-stroke rehabilitation exercise.

    Science.gov (United States)

    Huq, Rajibul; Wang, Rosalie; Lu, Elaine; Hebert, Debbie; Lacheray, Hervé; Mihailidis, Alex

    2013-06-01

    This paper presents preliminary studies in developing a fuzzy logic based intelligent system for autonomous post-stroke upper-limb rehabilitation exercise. The intelligent system autonomously varies control parameters to generate different haptic effects on the robotic device. The robotic device is able to apply both resistive and assistive forces for guiding the patient during the exercise. The fuzzy logic based decision-making system estimates muscle fatigue of the patient using exercise performance and generates a combination of resistive and assistive forces so that the stroke survivor can exercise for longer durations with increasing control. The fuzzy logic based system is initially developed using a study with healthy subjects and preliminary results are also presented to validate the developed system with healthy subjects. The next stage of this work will collect data from stroke survivors for further development of the system.

  16. The effects of post-stroke upper-limb training with an electromyography (EMG)-driven hand robot.

    Science.gov (United States)

    Hu, X L; Tong, K Y; Wei, X J; Rong, W; Susanto, E A; Ho, S K

    2013-10-01

    Loss of hand function and finger dexterity are main disabilities in the upper limb after stroke. An electromyography (EMG)-driven hand robot had been developed for post-stroke rehabilitation training. The effectiveness of the hand robot assisted whole upper limb training was investigated on persons with chronic stroke (n=10) in this work. All subjects attended a 20-session training (3-5times/week) by using the hand robot to practice object grasp/release and arm transportation tasks. Significant motor improvements were observed in the Fugl-Meyer hand/wrist and shoulder/elbow scores (pEMG level (p<0.05) and a significant decrease of ED and FD co-contraction during the training (p<0.05); the excessive muscle activities in the biceps brachii were also reduced significantly after the training (p<0.05).

  17. Sex-related time-dependent variations in post-stroke survival-evidence of a female stroke survival advantage

    DEFF Research Database (Denmark)

    Olsen, Tom Skyhøj; Dehlendorff, Christian; Andersen, Klaus Kaae

    2007-01-01

    of death were identified by means of a survival model based on 22,222 individuals with a complete data set. Results: Females were older and had severer stroke. Interestingly, the risk of death between genders was time dependent. The female/male stroke mortality rate favoured women from the first day......Background: Women live longer than men, yet most studies show that gender has no influence on survival after stroke. Methods: A registry was started in 2001, with the aim of registering all hospitalized stroke patients in Denmark, and it now holds 39,484 patients of which 48% are female. We studied...... the influence of gender on post-stroke mortality, from the time of admission through the subsequent years until death or censoring ( mean follow-up time: 538 days). All patients underwent an evaluation including stroke severity, computed tomography and cardiovascular risk factors. Independent predictors...

  18. Using of virtual reality technology in acute cerebral stroke and their influense on post-stroke affective disorders

    Directory of Open Access Journals (Sweden)

    Maslyuk О.А.

    2014-12-01

    Full Text Available Aim. The study of virtual reality technology in the rehabilitation of patients with cerebral stroke and influence on post stroke affective disorder. Materials and methods. The study included 88 patients with ischemic stroke: 59 men (67% and 29 women (33%. The average age of the patients was 62,05 ± 11,74 years. In the study group included 46 patients, 44 patients in the control group. The groups were matched by age, time from the begin of disease, severity of disease, the severity of motor, affective and cognitive impairments. In addition, in the study group to the program of early rehabilitation to use individual training with virtual reality technology (BTS NIRVANA. The duration of the training was 21 days, 3 times a week for 40 minutes. Results. On the background of rehabilitation in the study group patients had a significant reduced of neurological deficit (p <0,05. Significantly improved neurodynamic and executive cognitive function (p <0,01. In the study group was a statistically significant decrease symptoms of depression on a scale of BDI was 31,7% vs. 20.9% in the control group, anxiety on a scale of HADS was 18,46% (p <0,05 vs. 12,23% (p <0,05 in the control group. Increase motivation and decrease symptoms of apathy in the study group of patients on a scale of AES-C was 13,78% (p <0,05 vs. 1,01 % in the control group. On the background of rehabilitation patients in the study group was no difference between the rates of pathological muscle and mental fatigue. On the background there is rehabilitation of the quality of life due to mobility and activities of daily living. Conclusion. The study showed the positive effect of virtual reality technology for the correction of post-stroke mood disorders.

  19. Prevalence of post-stroke cognitive impairment in china: a community-based, cross-sectional study.

    Directory of Open Access Journals (Sweden)

    Yanji Qu

    Full Text Available International hospital-based studies have indicated a high risk of cognitive impairment after stroke, evidence from community-based studies in China is scarce. To determine the prevalence of post-stroke cognitive impairment (PSCI and its subtypes in stroke survivors residing in selected rural and urban Chinese communities, we conducted a community-based, cross-sectional study in 599 patients accounting for 48% of all stroke survivors registered in the 4 communities, who had suffered confirmed strokes and had undergone cognitive assessments via the Montreal Cognitive Assessment (MoCA, Mini-Mental State Examination (MMSE, and Hachinski Ischemia Scale (HIS. Detection of PSCI was based on scores in these neuropsychological scales. Factors potentially impacting on occurrence of PSCI were explored by comparing demographic characteristics, stroke features, and cardiovascular risk factors between patients with and without PSCI. The overall prevalence of PSCI was 80.97% (95%CI: 77.82%-84.11%, while that of non-dementia PSCI (PSCI-ND and post-stroke vascular dementia (PSD was 48.91% (95%CI: 44.91%-52.92% and 32.05% (95%CI: 28.32%-35.79%, respectively. Prior stroke and complications during the acute phase were independent risk factors for PSCI. The risk of recurrent stroke survivors having PSCI was 2.7 times higher than for first-episode survivors, and it was 3 times higher for those with complications during the acute phase than for those without. The higher prevalence of PSCI in this study compared with previous Chinese studies was possibly due to the combined effects of including rural stroke survivors, a longer period from stroke onset, and different assessment methods. There is an urgent need to recognize and prevent PSCI in stroke patients, especially those with recurrent stroke and complications during the acute phase.

  20. Changes in EMG Activities of Upper Arm Muscles and in Shoulder Joint Angles in Post-stroke Patients

    Directory of Open Access Journals (Sweden)

    Rositsa Raikova

    2016-09-01

    Full Text Available The aim of the paper is to compare the electromyographic signals (EMGs and the joint angles of the affected upper limb muscles of stroke survivors to those of their non-affected limb as well as to those of the dominant and the non-dominant limbs of healthy volunteers. Twenty five volunteers, ten post-stroke survivors and fifteen healthy subjects as control group, participated in the experiments. EMGs of muscles of the upper limbs and two angles in the shoulder joint were registered and processed during three static and two dynamic tasks. The results showed a big variability of all investigated parameters (mean and median frequencies, ranges of motions, maximal normalized EMGs both for the patients and for the healthy subjects, for right and for left hand. This makes difficult a deduction of definitive conclusions about the changes in motor control of the upper limbs due to stroke. Moreover, natural differences in motor control exist for dominant and non-dominant limb. On the whole, the power-frequency analysis and the relevant statistical analysis indicated that the muscles of the affected limb had lower median frequencies than those of the healthy limb. Examination of full elbow flexions in the sagittal plane showed that the range of the motion in the shoulder joint of both limbs of the patients increased when compared to the healthy subjects and that this increase was larger for the affected limb. The post-stroke survivors used more of their muscle power although no increased co-contraction was observed.

  1. 脑卒中后抑郁症治疗进展%Treatment Progress in Post-stroke Depression

    Institute of Scientific and Technical Information of China (English)

    夏俊博; 李宁宁

    2015-01-01

    脑卒中后抑郁(PSD)是指脑卒中后引发的抑郁症,属于继发性抑郁症,表现为情绪抑郁、言语减少、睡眠障碍、食欲不佳、兴趣缺乏、精力不足、主动性差、不配合康复治疗等。PSD不仅给患者带来生理上和心理上障碍,还会延缓受损神经功能的恢复,影响生活质量,甚至增加致残率、病死率。因此,为PSD患者研发安全、有效的治疗药物是十分必要的。本文将对西医西药、中医中药及中西医结合治疗PSD的研究进展进行综述。%Post-stroke depression (PSD) referred to the onset of depression after being diagnosed with post-stroke. It was a secondary disease, mainly including depression, little words, sleep disorders, anorexia, absence of interest, undynamic, passiveness, misfitting rehabilitation and so on. It was not only a psychological and physiological disease, but also delay the function recovery of damaged nerves, influence the patient’s quality of life, and increase the rate of disability and mortality. It was essential to research and develop effective and safe treatment medication. This paper reviewed the current situation and developing prospects of western medicine, Chinese medicinal, treatment of integrated traditional Chinese medicine and western medicine in PSD treatment.

  2. LONG-TERM EFFECTS OF TRANSCRANIAL DIRECT CURRENT STIMULATION IN CHRONIC POST-STROKE APHASIA: A PILOT STUDY

    Directory of Open Access Journals (Sweden)

    Lucilla eVestito

    2014-10-01

    Full Text Available Transcranial direct current stimulation (tDCS has been suggested to improve language function in patients with post-stroke aphasia. Most studies on aphasic patients, however, were conducted with a very limited follow-up period, if any. In this pilot, single-blind study on chronic post-stroke aphasic patients, we aimed to verify whether or not tDCS is able to extend its beneficial effects for a longer period of time (21 weeks after the end of stimulation. Three aphasic patients underwent anodal tDCS (A-tDCS, 20 min, 1.5 mA and sham stimulation (S-tDCS over the left frontal (perilesional region, coupled with a simultaneous naming training (on-line tDCS. Ten consecutive sessions (five days per week for two weeks were implemented. In the first five sessions we used a list of 40 figures, while in the subsequent five sessions we utilized a second set of 40 figures differing in word difficulty. At the end of the stimulation period we found a significant beneficial effect of A-tDCS (as compared to baseline and S-tDCS in all our subjects, regardless of word difficulty, although with some inter-individual differences. In the follow-up period, the percentage of correct responses persisted significantly better until the 16th week, when an initial decline in naming performance was observed. Up to the 21st week, the number of correct responses, though no longer significant, was still above the baseline level. These results in a small group of aphasic patients suggest a long-term beneficial effect of on-line A-tDCS.

  3. The Discriminative validity of "nociceptive," "peripheral neuropathic," and "central sensitization" as mechanisms-based classifications of musculoskeletal pain.

    LENUS (Irish Health Repository)

    Smart, Keith M

    2012-02-01

    OBJECTIVES: Empirical evidence of discriminative validity is required to justify the use of mechanisms-based classifications of musculoskeletal pain in clinical practice. The purpose of this study was to evaluate the discriminative validity of mechanisms-based classifications of pain by identifying discriminatory clusters of clinical criteria predictive of "nociceptive," "peripheral neuropathic," and "central sensitization" pain in patients with low back (+\\/- leg) pain disorders. METHODS: This study was a cross-sectional, between-patients design using the extreme-groups method. Four hundred sixty-four patients with low back (+\\/- leg) pain were assessed using a standardized assessment protocol. After each assessment, patients\\' pain was assigned a mechanisms-based classification. Clinicians then completed a clinical criteria checklist indicating the presence\\/absence of various clinical criteria. RESULTS: Multivariate analyses using binary logistic regression with Bayesian model averaging identified a discriminative cluster of 7, 3, and 4 symptoms and signs predictive of a dominance of "nociceptive," "peripheral neuropathic," and "central sensitization" pain, respectively. Each cluster was found to have high levels of classification accuracy (sensitivity, specificity, positive\\/negative predictive values, positive\\/negative likelihood ratios). DISCUSSION: By identifying a discriminatory cluster of symptoms and signs predictive of "nociceptive," "peripheral neuropathic," and "central" pain, this study provides some preliminary discriminative validity evidence for mechanisms-based classifications of musculoskeletal pain. Classification system validation requires the accumulation of validity evidence before their use in clinical practice can be recommended. Further studies are required to evaluate the construct and criterion validity of mechanisms-based classifications of musculoskeletal pain.

  4. Tetrahydrocannabinol (Delta 9-THC Treatment in Chronic Central Neuropathic Pain and Fibromyalgia Patients: Results of a Multicenter Survey

    Directory of Open Access Journals (Sweden)

    Janet Weber

    2009-01-01

    Full Text Available Central neuropathic pain is difficult to treat, but delta 9-Tetrahydrocannabinol (delta 9-THC may be a promising therapeutic agent. We administered in 172 patients on average 7.5 mg delta 9-THC over 7 months. Of these, 48 patients prematurely withdrew due to side effects, insufficient analgesia, or expense of therapy. Thus, 124 patients were assessed retrospectively in a multicenter telephone survey. Reported changes in pain intensity, recorded on a numeric rating scale (NRS, Pain Disability Index (PDI, Medical Outcomes Short-Form (SF-12, Quality of Life Impairment by Pain (QLIP, Hospital Anxiety Depression Scale (HADS, and amount of concomitant pain medication were recorded. Psychometric parameters (PDI, SF-12, QLIP, HADS and pain intensity improved significantly during delta 9-THC treatment. Opioid doses were reduced and patients perceived THC therapy as effective with tolerable side effects. About 25% of the patients, however, did not tolerate the treatment. Therapy success and tolerance can be assessed by a transient delta 9-THC titration and its maintained administration for several weeks. The present survey demonstrates its ameliorating potential for the treatment of chronic pain in central neuropathy and fibromyalgia. A supplemental delta 9-THC treatment as part of a broader pain management plan therefore may represent a promising coanalgesic therapeutic option.

  5. Laparoscopic Cholecystectomy for Gallbladder Calculosis in Fibromyalgia Patients: Impact on Musculoskeletal Pain, Somatic Hyperalgesia and Central Sensitization.

    Science.gov (United States)

    Costantini, Raffaele; Affaitati, Giannapia; Massimini, Francesca; Tana, Claudio; Innocenti, Paolo; Giamberardino, Maria Adele

    2016-01-01

    Fibromyalgia, a chronic syndrome of diffuse musculoskeletal pain and somatic hyperalgesia from central sensitization, is very often comorbid with visceral pain conditions. In fibromyalgia patients with gallbladder calculosis, this study assessed the short and long-term impact of laparoscopic cholecystectomy on fibromyalgia pain symptoms. Fibromyalgia pain (VAS scale) and pain thresholds in tender points and control areas (skin, subcutis and muscle) were evaluated 1week before (basis) and 1week, 1,3,6 and 12months after laparoscopic cholecystectomy in fibromyalgia patients with symptomatic calculosis (n = 31) vs calculosis patients without fibromyalgia (n. 26) and at comparable time points in fibromyalgia patients not undergoing cholecystectomy, with symptomatic (n = 27) and asymptomatic (n = 28) calculosis, and no calculosis (n = 30). At basis, fibromyalgia+symptomatic calculosis patients presented a significant linear correlation between the number of previously experienced biliary colics and fibromyalgia pain (direct) and muscle thresholds (inverse)(pfibromyalgia pain significantly increased and all thresholds significantly decreased at 1week and 1month (1-way ANOVA, pFibromyalgia pain and thresholds returned to preoperative values at 3months, then pain significantly decreased and thresholds significantly increased at 6 and 12months (pfibromyalgia patients undergoing cholecystectomy thresholds did not change; in all other fibromyalgia groups not undergoing cholecystectomy fibromyalgia pain and thresholds remained stable, except in fibromyalgia+symptomatic calculosis at 12months when pain significantly increased and muscle thresholds significantly decreased (pfibromyalgia symptoms and that laparoscopic cholecystectomy produces only a transitory worsening of these symptoms, largely compensated by the long-term improvement/desensitization due to gallbladder removal. This study provides new insights into the role of visceral pain comorbidities and the effects of

  6. Self-reported pain severity, quality of life, disability, anxiety and depression in patients classified with 'nociceptive', 'peripheral neuropathic' and 'central sensitisation' pain. The discriminant validity of mechanisms-based classifications of low back (±leg) pain.

    LENUS (Irish Health Repository)

    Smart, Keith M

    2012-04-01

    Evidence of validity is required to support the use of mechanisms-based classifications of pain clinically. The purpose of this study was to evaluate the discriminant validity of \\'nociceptive\\' (NP), \\'peripheral neuropathic\\' (PNP) and \\'central sensitisation\\' (CSP) as mechanisms-based classifications of pain in patients with low back (±leg) pain by evaluating the extent to which patients classified in this way differ from one another according to health measures associated with various dimensions of pain. This study employed a cross-sectional, between-subjects design. Four hundred and sixty-four patients with low back (±leg) pain were assessed using a standardised assessment protocol. Clinicians classified each patient\\'s pain using a mechanisms-based classification approach. Patients completed a number of self-report measures associated with pain severity, health-related quality of life, functional disability, anxiety and depression. Discriminant validity was evaluated using a multivariate analysis of variance. There was a statistically significant difference between pain classifications on the combined self-report measures, (p = .001; Pillai\\'s Trace = .33; partial eta squared = .16). Patients classified with CSP (n = 106) reported significantly more severe pain, poorer general health-related quality of life, and greater levels of back pain-related disability, depression and anxiety compared to those classified with PNP (n = 102) and NP (n = 256). A similar pattern was found in patients with PNP compared to NP. Mechanisms-based pain classifications may reflect meaningful differences in attributes underlying the multidimensionality of pain. Further studies are required to evaluate the construct and criterion validity of mechanisms-based classifications of musculoskeletal pain.

  7. Transcutaneous Electrical Nerve Stimulation (TENS) reduces pain, fatigue, and hyperalgesia while restoring central inhibition in primary fibromyalgia

    OpenAIRE

    Dailey, Dana L.; Rakel, Barbara A.; Vance, Carol GT; Liebano, Richard E.; Anand, Amrit S; Bush, Heather M.; Lee, Kyoung S; Lee, Jennifer E.; Sluka, Kathleen A.

    2013-01-01

    Because TENS works by reducing central excitability and activating central inhibition pathways, we tested the hypothesis that TENS would reduce pain and fatigue and improve function and hyperalgesia in people with fibromyalgia who have enhanced central excitability and reduced inhibition. The current study used a double-blinded randomized, placebo controlled cross-over design to test effects of a single treatment of TENS in people with fibromyalgia. Three treatments were assessed in random or...

  8. Insufficient pain relief after surgical neuroma treatment : Prognostic factors and central sensitisation

    NARCIS (Netherlands)

    Stokvis, Annemieke; Coert, J. Henk; van Neck, Johan W.

    2010-01-01

    Background: Treatment of patients with neuromatous pain is difficult. Numerous treatment methods have been described, but none has been completely effective in providing sufficient pain relief. Patient-specific prognostic factors, predicting pain after surgical neuroma treatment, can help clinicians

  9. Incidence estimate and guideline-oriented treatment for post-stroke spasticity: an analysis based on German statutory health insurance data

    Directory of Open Access Journals (Sweden)

    Egen-Lappe V

    2013-03-01

    %, ambulatory care 48%. Oral muscle relaxants were prescribed to 13% of the patients. No patient received intrathecal baclofen or botulinum toxin.Conclusion: Claims data enabled analysis of the occurrence of stroke and post-stroke spasticity. These data provide insight into real-life treatment for spasticity in Germany. The proportion of patients who receive physiotherapy, which is the international guideline-recommended basic therapy after transition into ambulatory care, can be improved on. Botulinum toxin as an international guideline-based treatment option for focal spasticity has not been implemented in practice in Germany as yet.Keywords: health care utilization, physiotherapy, drug therapy, claims data

  10. Relationship between linguistic functions and cognitive functions in a clinical study of Chinese patients with post-stroke aphasia

    Institute of Scientific and Technical Information of China (English)

    YU Zeng-zhi; JIANG Shu-jun; BI Sheng; LI Jun; LEI Di; SUN Li-ling

    2013-01-01

    Background There has been a long debate among scholars surrounding the relationship between language and cognition.The worldwide study of aphasia is actively exploring the function of language from cognitive point of view.This study aimed to investigate the relationship between linguistic functions and cognitive functions in a clinical study of Chinese patients with post-stroke aphasia.Methods Cognitive functions of 63 Chinese patients with aphasia following a stroke were assessed with the Chinese version of the second edition of Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) battery and their linguistic functions were tested with the Western Aphasia Battery (WAB) Scale,respectively.The correlation between the results observed on the LOTCA battery and those on the WAB was analyzed.Aphasia quotient,performance quotient,cortical quotient,and linguistic function of the patients were compared.Then,each language function was analyzed by way of dependent adopt multiple regression analysis.Results The total score of 63 patients as shown on the LOTCA battery was significantly correlated with the aphasia quotient,performance quotient,and cortical quotient observed on the WAB Scale (P <0.05,P <0.01).However,the correlation between visuomotor organization under LOTCA and repeat under WAB was not significant (P >0.05).The attention of LOTCA and WAB's spontaneous speech,repeat,naming,and aphasia quotient was not relevant either (P>0.05).In addition,correlations between the results observed on the LOTCA battery and the WAB were significant (P<0.05,P <0.01).Among the significant variables finally entered into the standardized canonical discriminant functions,main factors affected the aphasia.Multiple regression analysis showed that orientation,spatial perception,and visual perception had a notable influence on aphasia quotient and naming.Orientation and thinking operation was found to have a notable influence on spontaneous speech.Spatial perception and

  11. From rehabilitation to recovery: protocol for a randomised controlled trial evaluating a goal-based intervention to reduce depression and facilitate participation post-stroke

    Directory of Open Access Journals (Sweden)

    Hill Keith

    2011-06-01

    Full Text Available Abstract Background There is much discourse in healthcare about the importance of client-centred rehabilitation, however in the realm of community-based therapy post-stroke there has been little investigation into the efficacy of goal-directed practice that reflects patients' valued activities. In addition, the effect of active involvement of carers in such a rehabilitation process and their subsequent contribution to functional and emotional recovery post-stroke is unclear. In community based rehabilitation, interventions based on patients' perceived needs may be more likely to alter such outcomes. In this paper, we describe the methodology of a randomised controlled trial of an integrated approach to facilitating patient goal achievement in the first year post-stroke. The effectiveness of this intervention in reducing the severity of post-stroke depression, improving participation status and health-related quality of life is examined. The impact on carers is also examined. Methods/Design Patients (and their primary carers, if available are randomly allocated to an intervention or control arm of the study. The intervention is multimodal and aims to screen for adverse stroke sequelae and address ways to enhance participation in patient-valued activities. Intervention methods include: telephone contacts, written information provision, home visitation, and contact with treating health professionals, with further relevant health service referrals as required. The control involves treatment as usual, as determined by inpatient and community rehabilitation treating teams. Formal blinded assessments are conducted at discharge from inpatient rehabilitation, and at six and twelve months post-stroke. The primary outcome is depression. Secondary outcome measures include participation and activity status, health-related quality of life, and self-efficacy. Discussion The results of this trial will assist with the development of a model for community

  12. Assessment of Effectiveness of Percutaneous Adhesiolysis in Managing Chronic Low Back Pain Secondary to Lumbar Central Spinal Canal Stenosis

    OpenAIRE

    Laxmaiah Manchikanti, Kimberly A. Cash, Vidyasagar Pampati, Bradley W. Wargo, Yogesh Malla

    2013-01-01

    Background: Chronic persistent low back and lower extremity pain secondary to central spinal stenosis is common and disabling. Lumbar surgical interventions with decompression or fusion are most commonly performed to manage severe spinal stenosis. However, epidural injections are also frequently performed in managing central spinal stenosis. After failure of epidural steroid injections, the next sequential step is percutaneous adhesiolysis and hypertonic saline neurolysis with a targeted deli...

  13. Efficacy of early intervention of motor relearning program on post-stroke hemiplemia:A randomized controlled observation

    Institute of Scientific and Technical Information of China (English)

    Jia Xue; Liang Bai; Qingrong Guo; Chengrong Yang; Jie Lu

    2006-01-01

    BACKGROUND: Previous studies believed that the effect of rehabilitation training within 6 months after stroke (early rehabilitation training) is usually unsatisfactory. The rehabilitation training when acute stroke is stabilized may be better for the recovery of limb function.OBJECTIVE: To observe the effects of the rehabilitation training of motor relearning program plus Bobath technique on the motor function of limbs, nerve function and activities of daily life (ADL) in patients with acute stroke hemiplegia.DESIGN: A randomized controlled observation.SETTING: Department of Neurology, Yaan People's Hospital.PARTICrPANTS: A total of 150 patients with acute post-stroke hemiplegia were selected from the Department of Neurology, Yaan People's Hospital from March 2000 to October 2002. The patients were all accorded with the diagnostic standards about stroke set by the Fifth National Academic Meeting for Cerebrovascular Disease (1996), confirmed by CT and MRI, and they were all informed with the interventions and the items of evaluation. The enrolled patients were randomly divided into training group (n=78) and control group (n=72) at admission. METHODS: ① Interventions: All the patients were given routine treatments for stroke, including managin blood pressure, maintaining the balance of hydrolyte and electrolure, reducing intracranial pressure by dehydration,and venous injection of citicoline, besides those in the training group received rehabilitation training by motor relearning program and Bobath technique. The rehabilitation training began after the vital signs became stable within 24 hours to 3 days after attack for the patients with cerebral infarction and 48 hours to 5 days after attack for those with cerebral hemorrhage respectively, three times a day in the morning, at noon and in the evening respectively, 30 minutes for each time, they were trained for 1 month. Lying position: The patients should keep the anti-spasm posture in the supine position

  14. Thinking on Post-stroke Depression%关于卒中后抑郁的思考

    Institute of Scientific and Technical Information of China (English)

    袁勇贵

    2012-01-01

    Post-stroke depression(PSD) is the most common form of complications after stroke, which holds a high morbidity and brings downfall to the patients' quality of life. The mechanismfor PSD is far from clear, in which biological factors and social-psychological factors are believed to be involved. Drugtreatment is now arranged as the first class choice, while physical therapy and psycho -therapy can add to the treatmentoutcome.%卒中后抑郁是脑卒中后常见的并发症,其发病率高,明显降低患者生活质量.卒中后抑郁症的发病机制非常复杂.目前认为社会、心理、生物学因素等均在其中扮演一定的角色.卒中后抑郁的治疗应首选药物治疗,在单一药物疗效欠佳时可加用物理治疗和心理治疗.

  15. Bilateral brain reorganization with memantine and constraint-induced aphasia therapy in chronic post-stroke aphasia: An ERP study.

    Science.gov (United States)

    Barbancho, Miguel A; Berthier, Marcelo L; Navas-Sánchez, Patricia; Dávila, Guadalupe; Green-Heredia, Cristina; García-Alberca, José M; Ruiz-Cruces, Rafael; López-González, Manuel V; Dawid-Milner, Marc S; Pulvermüller, Friedemann; Lara, J Pablo

    2015-01-01

    Changes in ERP (P100 and N400) and root mean square (RMS) were obtained during a silent reading task in 28 patients with chronic post-stroke aphasia in a randomized, double-blind, placebo-controlled trial of both memantine and constraint-induced aphasia therapy (CIAT). Participants received memantine/placebo alone (weeks 0-16), followed by drug treatment combined with CIAT (weeks 16-18), and then memantine/placebo alone (weeks 18-20). ERP/RMS values (week 16) decreased more in the memantine group than in the placebo group. During CIAT application (weeks 16-18), improvements in aphasia severity and ERP/RMS values were amplified by memantine and changes remained stable thereafter (weeks 18-20). Changes in ERP/RMS occurred in left and right hemispheres and correlated with gains in language performance. No changes in ERP/RMS were found in a healthy group in two separated evaluations. Our results show that aphasia recovery induced by both memantine alone and in combination with CIAT is indexed by bilateral cortical potentials.

  16. Use it and improve it or lose it: interactions between arm function and use in humans post-stroke.

    Directory of Open Access Journals (Sweden)

    Yukikazu Hidaka

    2012-02-01

    Full Text Available "Use it and improve it, or lose it" is one of the axioms of motor therapy after stroke. There is, however, little understanding of the interactions between arm function and use in humans post-stroke. Here, we explored putative non-linear interactions between upper extremity function and use by developing a first-order dynamical model of stroke recovery with longitudinal data from participants receiving constraint induced movement therapy (CIMT in the EXCITE clinical trial. Using a Bayesian regression framework, we systematically compared this model with competitive models that included, or not, interactions between function and use. Model comparisons showed that the model with the predicted interactions between arm function and use was the best fitting model. Furthermore, by comparing the model parameters before and after CIMT intervention in participants receiving the intervention one year after randomization, we found that therapy increased the parameter that controls the effect of arm function on arm use. Increase in this parameter, which can be thought of as the confidence to use the arm for a given level of function, lead to increase in spontaneous use after therapy compared to before therapy.

  17. Effect of Fluoxetine on Expression of Brain-derived Neurotrophic Factor in Patients with Post-stroke Depression

    Institute of Scientific and Technical Information of China (English)

    LI Hong-liang; WANG Shou-yong; SHI Xiang-song; PAN He-yue; HUANG Wen-zhong; GAO Xuan

    2014-01-01

    Objective:To observe the effect of lfuoxetine on the expression brain-derived neurotrophic factor (BDNF) in patients with post-stroke depression (PSD). Methods:A total of 62 patients with ischemic stroke and post depression were divided into PSD group (32 cases) given fluoxetine combined with rehabilitation and Non-PSD group (30 cases) given rehabilitation treatment according to the presence of depression after stroke. The degree of depression, activities of daily living and the motor function were evaluated by Hamilton Depression Scale 17 (HAMD-17), Modified Barthel Index (MBI) and Fugl-Meyer Assessment (FMA) before and after treatment, respectively. And the levels of BDNF were examined using enzyme-linked immunosorbent assay (ELISA). Results: Before treatment, HAMD-17 score and MBI scores were markedly higher in PSD group than in Non-PSD group (P0.05). After 3, 6 and 12-month treatment, BDNF concentrations in PSD group were signiifcantly higher than in Non-PSD group (P<0.01). Relevant analysis showed that BDNF in patients with PSD was in negative relationship with HAMD-17 (r=-0.784,P=0.000) and in positive association with BMI and FMA (r=0.761,P=0.000;r=0.789,P=0.000). Conclusion: Fluoxetine combined with rehabilitation can regulate depression, improve motor function and activities of daily living through increasing the concentration of BNDF in treating PSD patients.

  18. A randomized, placebo-controlled trial of levetiracetam in central pain in multiple sclerosis

    DEFF Research Database (Denmark)

    Falah, M; Madsen, C; Holbech, J V;

    2012-01-01

    as pain intensity of more than 4 on a 0 to 10-point numeric rating scale were included in the study. The primary outcome measure was pain relief at the end of each treatment period as measured on a 6-point verbal scale. Eighty-nine patients were screened for participation and 30 patients entered the study...... of patients. However, there was significant reduction of pain, increased pain relief and/or more favourable pain relief with levetiracetam than with placebo in patients with lancinating or without touch-evoked pain (p = 0.025-0.046). This study found no effect of the anticonvulsant levetiracetam in non...

  19. 脑卒中后头晕与心理因素的相关性%Post- stroke dizziness and psychological disturbance

    Institute of Scientific and Technical Information of China (English)

    何晓军; 张沙丽; 马敏敏; 张传文

    2003-01-01

    AIM:To study the relationship between post- stroke dizziness and psychological factors.METHODS:To choose 82 cases with dizziness after stroke. The patients whose medical treatment were invalid were divided into two groups randomly.The experimental group of 43 cases was treated with antipsychotic and the controls group of 39 cases was treated with consolation.RESULTS:The total effective rate in experimental group was significantly higher than that in the control group(P< 0.001).CONCLUSION:It is suggested that though the mental scales scores might be normal, post- stroke dizziness should be treated for a long- term helplessly be just a sign of psychological matter.It ought to be discerned and given pertinent treatments.

  20. 脑卒中后偏瘫患者中医康复现状%Present Situation of Post-stroke Patients with Hemiplegia TCM Rehabilitation

    Institute of Scientific and Technical Information of China (English)

    石蕾

    2012-01-01

    This paper overview of post-stroke patients with hemiplegia rehabilitation treatment and care-related measures, from the hospital stage and family or community self-rehabilitation stage compare two aspects are summarized and explore, to provide advice to promote the rehabilitation of post-stroke patients with hemiplegia.%文章综述了脑卒中后偏瘫患者康复治疗和护理的有关措施,从住院阶段和家庭或社区自行康复阶段两个方面进行对比归纳与探讨,为促进脑卒中后偏瘫患者的康复提供意见。

  1. 脑卒中后抑郁状态的心理护理干预%The Effect of Psychologic Nursing on Post - stroke Depression

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Objective To investigate the effect of psychologic nursing on the rehabilitation for post-stroke depression(PSD) patients. Method 62 patients of 98 PSD patients were divided into 31couples. According to age, sex, course of illness and statge of illness, the patients were divided into rehabilitation nursing ( interference group) and routine nursing ( control group) with CES - D ( Center of epidemi ological survey - depression Scale ) and CNFD ( Criterion of nervous function defect). Every couple was compared with each other. Result The score of two groups before treatment was not obviously different(p> 0. 05). Two scores in two groups after treatment were obviously better than those of before treatment. Two scores of interference group were significantly higher compared with control group ( p < 0. 05). Conclusion Interference of psychologic nursing is effective in treating post - stroke depression.

  2. Efficacy Observation of Stellate Ganglion Block in the Treatment of Post-stroke Shoulder-hand Syndrome in Early Stage%星状神经阻滞治疗脑卒中后早期肩手综合征疗效观察

    Institute of Scientific and Technical Information of China (English)

    孙建兵

    2013-01-01

    Objective: To observe clinical curative effect of stellate ganglion block ,treating post-stroke shoulder-hand syndrome in early stage. Methods: 60 cases of post-stroke shoulder-hand syndrome in early stage were in treatment of stellate ganglion block. Re-sults: 20 cases were powerfully effective, 37 were valid, and 3 were invalid, the total efficiency was 95%. Conclusion: Stellate gan-glion block in the treatment of early shoulder hand syndrome of edema and pain is clearly effective.%  目的:观察星状神经阻滞治疗脑卒中后早期肩手综合征的临床疗效。方法:60例脑卒中后肩手综合征患者均进行星状神经阻滞治疗。结果:显效20例,有效37例,无效3例,总有效率95%。结论:星状神经阻滞治疗早期肩手综合征疼痛水肿效果明显。

  3. Combined use of spatial restraint stress and middle cerebral artery occlusion is a novel model of post-stroke depression in mice

    OpenAIRE

    Gaocai Zhang; Li Chen; Lingli Yang; Xiaodong Hua; Beiqun Zhou; Zhigang Miao; Jizhen Li; Hua Hu; Michael Namaka; Jiming Kong; Xingshun Xu

    2015-01-01

    Post stroke depression (PSD) is one of the most common complications of ischemic stroke. At present, the underlying mechanisms are unclear, largely because there are no reliable, valid and reproducible animal models of PSD. Here we report a novel animal model of PSD that displays consistent and reliable clinical features of hemiplegic stroke. The animal model encompasses a combination of the middle cerebral artery occlusion (MCAO) and spatial restraint stress. We found that a 60-minute MCAO f...

  4. Serum leptin, neuron specific enolase and S-100B in relation to post-stroke depression in a prospective nested case-control study

    Directory of Open Access Journals (Sweden)

    Mei-ying ZHAO

    2015-04-01

    Full Text Available Objective To investigate the relationship between the serum levels of leptin, neuron-specific enolase (NSE and S-100B in patients of stroke and the incidence of post-stroke depression (PSD. Methods The clinical data of 121 cases of acute ischemic stroke, admitted to Zhengzhou Central Hospital affiliated to Zhengzhou University from Jun. 2010 to Dec. 2012, were retrospectively analyzed. After six months of follow-up 42 patients were diagnosed as suffering from PSD (Hamilton Depression Scale score ≥8. Another 42 participants with available matching data on onset time, age, gender and lesions of brain were selected. The serum samples were collected from all patients at time of discharge, and the concentrations of serum leptin, NSE and S-100B were analyzed by enzyme-linked immunosorbent assay (ELISA kit. Correlation and efficiency of diagnosing PSD among them was validated by receptor operator curve (ROC. Results The concentration of serum leptin, NSE, and S-100B in PSD group (25.84±13.80, 2.59±1.48 and 25.03±8.24μg/L, respectively was higher than that in the control group (8.67±6.17, 2.27±1.84 and 22.40±6.84μg/L, respectively. No obvious correlation was found between serum leptin and the NSE and S-100B in PSD patients. Based on the ROC curve, the area under the curve of serum leptin in PSD patients was 0.935 (95%CI 0.885-0.984, and the optimal cutoff value of serum leptin level was 16.17μg/L, which was an indicator for predicting of PSD with 81.0% sensitivity and 90.1% specificity. Conclusion Elevation of serum leptin level at admission was found to be associated with PSD, and it may act as a new marker for predicting the occurrence of PSD. DOI: 10.11855/j.issn.0577-7402.2015.03.11

  5. Regular physical activity prevents development of chronic pain and activation of central neurons

    OpenAIRE

    Sluka, Kathleen A; O'Donnell, James M.; DANIELSON, JESSICA; Rasmussen, Lynn A.

    2012-01-01

    Chronic musculoskeletal pain is a significant health problem and is associated with increases in pain during acute physical activity. Regular physical activity is protective against many chronic diseases; however, it is unknown if it plays a role in development of chronic pain. The current study induced physical activity by placing running wheels in home cages of mice for 5 days or 8 wk and compared these to sedentary mice without running wheels in their home cages. Chronic muscle pain was in...

  6. 针刺治疗卒中后抑郁的研究进展%Research Progress of Acupuncture Treatment for Post-stroke Depression

    Institute of Scientific and Technical Information of China (English)

    崔倩倩; 蔡圣朝; 曹云燕; 袁卫华

    2013-01-01

    卒中后抑郁的发生率在脑卒中患者中占有较大比例,它严重影响脑卒中患者的康复.因长期口服抗抑郁药物有较大的副作用,而针刺对于治疗本病具有疗效好和副作用少的特点.所以,近年来针刺治疗卒中后抑郁越来越被人们所重视.本研究综述脑卒中后抑郁的相关中西医病因和不同针刺疗法对该病的治疗,并提出相关的问题和展望.%The occurrence of post stroke depression accounts for a large proportion of stroke patients,which seriously affects the rehabilitation of stroke patients.In recent years,acupuncture treatment for post stroke depression is increasingly important,because of good efficacy and few side reactions by acupuncture for the treatment of this disease and great side reaction comes from long-term oral anti melancholic.This paper is mainly engaged in post stroke depression etiology of Chinese and Western medicine and acupuncture treatment for the disease,and proposes the related problems and prospects.

  7. 中风后抑郁的早期预防现状%Present Situation of Early Prevention of Post-Stroke Depression

    Institute of Scientific and Technical Information of China (English)

    蔡金亚; 孙建华; 徐修竹

    2016-01-01

    中风后抑郁(PSD)是脑血管疾病常见的并发症之一,发生率、致残率和病死率高. 从发病机制、中西医早期预防方面将有关中风后抑郁的早期预防的研究及文献进行综述,并对目前西药治疗PSD存在的问题以及中医药疗法治疗本病的优势进行讨论,为寻求有效的预防中风后抑郁的方案提供新思路、新方法. 参考文献26篇.%Post-stroke depression(PSD) is one of the common complications of cerebrovascular disease,which has high incidence,morbidity and mortality. This article reviews the study of early prevention of post-stroke depression from the aspects of pathogenesis ,early prevention of Chinese and western medicine in recent years,and discusses the current problems of western medicine treatment of PSD and the advantages of the traditional Chinese medicine therapy for this disease ,to provide a new idea and new method for the effective prevention of post-stroke depression.

  8. 脑卒中后抑郁的影响因素分析%Analysis is on the Related Risk Factors of Post-stroke Depression

    Institute of Scientific and Technical Information of China (English)

    周瑾; 韩毅; 王冰; 孙玉华

    2011-01-01

    探讨脑卒中后抑郁的影响因素,找出预防脑卒中后抑郁的有效措施.采用汉密尔顿抑郁量表(HAMD)及神经功能缺损量表(SSS)时患者分别进行抑郁状态及疾病严重程度的评分,同时针时可能的影响因素制定问卷并进行问卷调查.卒中后抑郁的发生与神经功能的缺损程度、病程、负性生活事件及脑损害是否为部位优势半球有关.卒中后抑郁的发生可能是神经生物学因紊及社会心理因素综合作用的结果.%This paper is to analysis on the related risk factors of post-stroke depression and the measure to prevent it. The depressive stares were assessed by Hamilton Depression Scale(HAMD) , Scandinavian Stroke Scale(SSS) and a questionnaire. The related risk factors of post-stroke depression were the degree of neurofunctional coloboma, course of disease,negativity events and the position of brain damage. The development of post-stroke depression complex was the complex action of neurobiology factor and social psychic factor.

  9. Dopamine and 5-HT supersensitivity in nonorganic central pain and in morphine abstinence: fortuitous or renal analogy?

    Science.gov (United States)

    Sicuteri, F; Anselmi, B; Del Bianco, P L

    1980-01-01

    Unexplained pain, such as central panalgesia, might be the most common clinical expression of a deficiency, central in nature, of the endorphin system. Acute natural opioid deficiency is comparable to morphine withdrawal in addicts characterized by vegetative, psychic disorder and the appearance of pain. An impressive supersensitivity (up to 1000 fold) to dopamine and 5-HT of the smooth muscle (hand dorsal vein: venotest) is detected both in central panalgesia sufferers and in addicts during spontaneous (withdrawal) or pharmacological (naloxone) abstinence. A 5-HT and dopamine supersensitivity, of less intensity, however, (10-30 fold), is found during migraine attacks: on these occasions, morphine-like factors in CSF appear reduced or undetectable, reinforcing the chemical analogy between morphine abstinence and migraine attacks. In the present study, evidence of opiate receptors in the human vein is also provided: 5-HT venospasms, inhibited by morphine, promptly emerge when naloxone is inoculated locally. PMID:7395606

  10. Ischemia, Immunosuppression and Infection—Tackling the Predicaments of Post-Stroke Complications

    Directory of Open Access Journals (Sweden)

    Raymond Shim

    2016-01-01

    Full Text Available The incidence of stroke has risen over the past decade and will continue to be one of the leading causes of death and disability worldwide. While a large portion of immediate death following stroke is due to cerebral infarction and neurological complications, the most common medical complication in stroke patients is infection. In fact, infections, such as pneumonia and urinary tract infections, greatly worsen the clinical outcome of stroke patients. Recent evidence suggests that the disrupted interplay between the central nervous system and immune system contributes to the development of infection after stroke. The suppression of systemic immunity by the nervous system is thought to protect the brain from further inflammatory insult, yet this comes at the cost of increased susceptibility to infection after stroke. To improve patient outcome, there have been attempts to lessen the stroke-associated bacterial burden through the prophylactic use of broad-spectrum antibiotics. However, preventative antibiotic treatments have been unsuccessful, and therefore have been discouraged. Additionally, with the ever-rising obstacle of antibiotic-resistance, future therapeutic options to reverse immune impairment after stroke by augmentation of host immunity may be a viable alternative option. However, cautionary steps are required to ensure that collateral ischemic damage caused by cerebral inflammation remains minimal.

  11. Feasibility of the adaptive and automatic presentation of tasks (ADAPT system for rehabilitation of upper extremity function post-stroke

    Directory of Open Access Journals (Sweden)

    Choi Younggeun

    2011-08-01

    Full Text Available Abstract Background Current guidelines for rehabilitation of arm and hand function after stroke recommend that motor training focus on realistic tasks that require reaching and manipulation and engage the patient intensively, actively, and adaptively. Here, we investigated the feasibility of a novel robotic task-practice system, ADAPT, designed in accordance with such guidelines. At each trial, ADAPT selects a functional task according to a training schedule and with difficulty based on previous performance. Once the task is selected, the robot picks up and presents the corresponding tool, simulates the dynamics of the tasks, and the patient interacts with the tool to perform the task. Methods Five participants with chronic stroke with mild to moderate impairments (> 9 months post-stroke; Fugl-Meyer arm score 49.2 ± 5.6 practiced four functional tasks (selected out of six in a pre-test with ADAPT for about one and half hour and 144 trials in a pseudo-random schedule of 3-trial blocks per task. Results No adverse events occurred and ADAPT successfully presented the six functional tasks without human intervention for a total of 900 trials. Qualitative analysis of trajectories showed that ADAPT simulated the desired task dynamics adequately, and participants reported good, although not excellent, task fidelity. During training, the adaptive difficulty algorithm progressively increased task difficulty leading towards an optimal challenge point based on performance; difficulty was then continuously adjusted to keep performance around the challenge point. Furthermore, the time to complete all trained tasks decreased significantly from pretest to one-hour post-test. Finally, post-training questionnaires demonstrated positive patient acceptance of ADAPT. Conclusions ADAPT successfully provided adaptive progressive training for multiple functional tasks based on participant's performance. Our encouraging results establish the feasibility of ADAPT; its

  12. Rehabilitation evaluation on post-stroke abnormal movement pattern prevented and treated with acupuncture and rehabilitation%针刺加康复防治脑卒中异常运动模式的康复学评定

    Institute of Scientific and Technical Information of China (English)

    张慧敏; 唐强

    2011-01-01

    Objective To explore the impacts of acupuncture and rehabilitation on post-stroke abnormal patterns of limb movement and evaluate them via rehabilitation method. Methods Ninety cases of post-stroke movement disorder were randomly divided into an acupuncture-rehabilitation group, a body acupuncture group and a medication group, 30 cases in each group. In medication group, the conventional medication in neurological department was administered. In acupuncture-rehabilitation group and body acupuncture group, on the basis of the therapy as medication group, scalp acupuncture (such as parietal area and anterior parietal area, etc. ), rehabilitation training and traditional body acupuncture [such as J ianyu (LI 15) and Fengshi (GB 31),etc. ] were supplemented.The continuous electric stimulation was applied in body acupuncture group. The treatment lasted for 8 weeks. The assessment of clinical efficacy, Fugl-Meyer score, Modified Ashworth scale (MAS), range of motion (ROM) and shoulder pain score were taken as observation indices for rehabilitation evaluation before and after treatment in each group. Results The effective rate was 93.1% (27/29) in acupuncture-rehabilitation group, which was superior to 66. 7% (20/30) in body acupuncture group and 57.1% (16/28) in control group (both P<0.01) separately. After treatment, Fugl-Meyer score, MAS, ROM of the lower limbs and shoulder joint and shoulder pain score (except medication group) were all remarkably improved as compared with those before treatment in each group (all P<0. 01). The improvements in Fugl-Meyer score, MAS, ROM of the upper limbs and shoulder pain score in acupuncture-rehabilitation group were significantly superior to those in body acupuncture group and medication group (P<0. 05, P< 0. 01 ). Conclusion Acupuncture and rehabilitation therapy and traditional body acupuncture remarkably improve in post-stroke movement disorder. But acupuncture and rehabilitation therapy is apparently superior to

  13. Double-Cone Coil TMS Stimulation of the Medial Cortex Inhibits Central Pain Habituation.

    Directory of Open Access Journals (Sweden)

    Federico D'Agata

    Full Text Available The aim of this study was to investigate whether Transcranial Magnetic Stimulation (TMS applied over the medial line of the scalp affects the subjective perception of continuous pain induced by means of electric stimulation. In addition, we wanted to identify the point of stimulation where this effect was maximum.Superficial electrical stimulation was used to induce continuous pain on the dominant hand. At the beginning of the experiment we reached a pain rating of 5 on an 11-point numeric rating scale (NRS; 0 = no pain and 10 = maximum tolerable pain for each subject by setting individually the current intensity. The TMS (five pulses at increasing intensities was applied on 5 equidistant points (one per session over the medial line of the scalp in 13 healthy volunteers using a double-cone coil to stimulate underlying parts of the brain cortex. In every experimental session the painful stimulation lasted 45 minutes, during which pain and distress intensities NRS were recorded continuously. We calculated the effect of adaptation and the immediate effect of the TMS stimulation for all locations. Additionally, an ALE (Activation Likelihood Estimation meta-analysis was performed to compare our results with the neuroimaging literature on subjective pain rating.TMS stimulation temporarily decreased the pain ratings, and pain adaptation was suppressed when applying the TMS over the FCz site on the scalp. No effect was found for distress ratings.The present data suggest that the medial cortex in proximity of the cingulated gyrus has a causal role in adaptation mechanisms and in processing ongoing pain and subjective sensation of pain intensity.

  14. Assessment of Effectiveness of Percutaneous Adhesiolysis in Managing Chronic Low Back Pain Secondary to Lumbar Central Spinal Canal Stenosis

    Directory of Open Access Journals (Sweden)

    Laxmaiah Manchikanti, Kimberly A. Cash, Carla D. McManus, Vidyasagar Pampati

    2013-01-01

    Full Text Available Background: Chronic persistent low back and lower extremity pain secondary to central spinal stenosis is common and disabling. Lumbar surgical interventions with decompression or fusion are most commonly performed to manage severe spinal stenosis. However, epidural injections are also frequently performed in managing central spinal stenosis. After failure of epidural steroid injections, the next sequential step is percutaneous adhesiolysis and hypertonic saline neurolysis with a targeted delivery. The literature on the effectiveness of percutaneous adhesiolysis in managing central spinal stenosis after failure of epidural injections has not been widely studied.Study Design: A prospective evaluation.Setting: An interventional pain management practice, a specialty referral center, a private practice setting in the United States.Objective: To evaluate the effectiveness of percutaneous epidural adhesiolysis in patients with chronic low back and lower extremity pain with lumbar central spinal stenosis.Methods: Seventy patients were recruited. The initial phase of the study was randomized, double-blind with a comparison of percutaneous adhesiolysis with caudal epidural injections. The 25 patients from the adhesiolysis group continued with follow-up, along with 45 additional patients, leading to a total of 70 patients. All patients received percutaneous adhesiolysis and appropriate placement of the Racz catheter, followed by an injection of 5 mL of 2% preservative-free lidocaine with subsequent monitoring in the recovery room. In the recovery room, each patient also received 6 mL of 10% hypertonic sodium chloride solution, and 6 mg of non-particulate betamethasone, followed by an injection of 1 mL of sodium chloride solution and removal of the catheter.Outcomes Assessment: Multiple outcome measures were utilized including the Numeric Rating Scale (NRS, the Oswestry Disability Index 2.0 (ODI, employment status, and opioid intake with assessment at 3, 6

  15. Effect of TENS on pain in relation to central sensitization in patients with osteoarthritis of the knee: study protocol of a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Beckwée David

    2012-02-01

    Full Text Available Abstract Background Central sensitization has recently been documented in patients with knee osteoarthritis (OAk. So far, the presence of central sensitization has not been considered as a confounding factor in studies assessing the pain inhibitory effect of tens on osteoarthritis of the knee. The purpose of this study is to explore the pain inhibitory effect of burst tens in OAk patients and to explore the prognostic value of central sensitization on the pain inhibitory effect of tens in OAk patients. Methods Patients with knee pain due to OAk will be recruited through advertisements in local media. Temporal summation, before and after a heterotopic noxious conditioning stimulation, will be measured. In addition, pain on a numeric rating score, WOMAC subscores for pain and function and global perceived effect will be assessed. Patients will be randomly allocated to one of two treatment groups (tens, sham tens. Follow-up measurements will be scheduled after a period of 6 and 12 weeks. Discussion Tens influences pain through the electrical stimulation of low-threshold A-beta cutaneous fibers. The responsiveness of central pain-signaling neurons of centrally sensitized OAk patients may be augmented to the input of these electrical stimuli. This would encompass an adverse therapy effect of tens. To increase treatment effectiveness it might be interesting to identify a subgroup of symptomatic OAk patients, i.e., non-sensitized patients, who are likely to benefit from burst tens. Trial Registration ClinicalTrials.gov: NCT01390285

  16. 加巴喷丁在神经性疼痛中的应用%Application of gabapentin in the treatment of neuropathic pain

    Institute of Scientific and Technical Information of China (English)

    朱珠; 王毅

    2015-01-01

    作为一种抗癫痫药物,加巴喷丁可通过中枢和外周的多种机制,在神经性疼痛的治疗中发挥着重要作用.研究表明,加巴喷丁对于卒中和脊髓损伤相关疼痛、带状疱疹后神经痛以及糖尿病周围神经病所致疼痛等均有较好的疗效.加巴喷丁的不良反应轻、耐受性好、药物相互作用少,是治疗神经性疼痛的理想药物.%As an anti-epilepsy drug,gabapentin plays an important role in the treatment of neuropathic pain through a variety of central and peripheral mechanisms.Studies have shown that gabapentin has better efficacy for post-stroke pain,spinal cord injury-related pain,postherpetic neuralgia,and pain in diabetic peripheral neuropathy.For mild adverse effects,good tolerance and lack of interactions,gabapentin is an ideal drug for the treatment of neuropathic pain.

  17. [Post-stroke apathy].

    Science.gov (United States)

    López-Dóriga Bonnardeaux, Pedro; Andrino Díaz, Nuria

    2016-01-01

    Apathy is a motivational disturbance that can be defined as a quantitative reduction of goal-directed behaviour. Patients present with loss of motivation, concern, interest, and emotional response, resulting in a loss of initiative, decreased interaction with their environment, and a reduced interest in social life. Apathy not only appears to be common in stroke patients, but it has also been related to a wide range of negative consequences for the patients and their caregivers, including poor functional recovery, loss of social independence, and caregiver distress. Clear definition and consensus diagnostic criteria for apathy are needed to accomplish an accurate assessment and an individualised treatment plan. Although there have been reports of successful behavioural therapy treatment of apathetic states, there is a paucity of controlled clinical trials on the efficacy of apathetic behaviours using pharmacotherapy. PMID:26522489

  18. Pregabalin and placebo responders show different effects on central pain processing in chronic pancreatitis patients

    NARCIS (Netherlands)

    Bouwense, S.A.; Olesen, S.S.; Drewes, A.M.; Goor, H. van; Wilder-Smith, O.H.G.

    2015-01-01

    BACKGROUND: Pain control in chronic pancreatitis is a major challenge; the mechanisms behind analgesic treatment are poorly understood. This study aims to investigate the differences in pain sensitivity and modulation in chronic pancreatitis patients, based on their clinical response (responders vs

  19. 心理干预对脑卒中后抑郁患者的影响%Effect of psychotherapy on the patients with post - stroke depression

    Institute of Scientific and Technical Information of China (English)

    李丽平; 居丽晶; 周玉珍

    2009-01-01

    Objective To study the effect of psychotherapy on the patients with post - stroke depression. Methods 86 patients with post - stroke depression were randomly divided into psychotherapy and non psychotherapy groups. The scores of SDS, SF - 36 and clinical outcome were evaluated between the two groups. Results The score of SDS of psychotherapy group was significantly lower than that of control group, and the evaluation of clinical outcome was significantly better than that of control group ( P < 0. 05) . While the scores of SF - 36 of psychotherapy group were significantly better than those of control group except physiological function ( P < 0.01) . Conclusions Psychotherapy could obviously decrease the degree of depression and improve clinical outcome, physical function and quality of life in patients with post - stroke depression.%目的 探讨心理治疗对脑卒中后抑郁患者的干预效果及其对生活质量的影响.方法 将86例脑卒中后抑郁患者随机分为心理治疗组和对照组,评定并比较两组SDS,SF-36生活质量得分及其临床疗效.结果 心理治疗组SDS评分显著低于对照组,其临床疗效评定显著高于对照组(P<0.05);生活质量除生理机能外,其它指标心理治疗组均优于对照组(P<0.0).结论 心理治疗能显著降低脑卒中后抑郁患者的严重程度,并可提高临床疗效、躯体功能及生活质量.

  20. Association of the Single Nucleotide Polymorphisms in microRNAs 130b, 200b, and 495 with Ischemic Stroke Susceptibility and Post-Stroke Mortality

    Science.gov (United States)

    Choi, Gun Ho; Ko, Ki Han; Kim, Jung Oh; Oh, Seung Hun; Park, Young Seok

    2016-01-01

    The microRNA (miRNA) is a small non-coding RNA molecule that modulates gene expression at the posttranscriptional level. Platelets have a crucial role in both hemostasis and thrombosis, a condition that can occlude a cerebral artery and cause ischemic stroke. miR-130b, miR-200b, and miR-495 are potential genetic modulators involving platelet production and activation. We hypothesized that single nucleotide polymorphisms (SNPs) in these miRNAs might potentially contribute to the susceptibility to ischemic stroke and post-stroke mortality. This study included 523 ischemic stroke patients and 400 control subjects. We investigated the association of three miRNA SNPs (miR-130bT>C, miR-200bT>C, and miR-495A>C) with ischemic stroke prevalence and post-stroke mortality. In the multivariate logistic regression, there was no statistically significant difference in the distribution of miR-130bT>C, miR-200bT>C, or miR-495A>C between the ischemic stroke and control groups. In the subgroup analysis based on ischemic stroke subtype, the miR-200b CC genotype was less frequently found in the large-artery atherosclerosis stroke subtype compared with controls (TT+CT vs CC; adjusted odds ratio for CC, 0.506; 95% confidence interval, 0.265–0.965). During a mean follow-up period of 4.80 ± 2.11 years after stroke onset, there were 106 all-cause deaths among the 523 stroke patients. Multivariate Cox regression analysis did not find a significant association between post-stroke mortality and three miRNA SNPs. Our findings suggest that the functional SNP of miR-200b might be responsible for the susceptibility to large-artery atherosclerotic stroke. PMID:27603512

  1. Outcome After Pituitary Radiosurgery for Thalamic Pain Syndrome

    International Nuclear Information System (INIS)

    Purpose: To evaluate outcomes after pituitary radiosurgery in patients with post-stroke thalamic pain syndrome. Methods and Materials: From 2002 to 2006, 24 patients with thalamic pain syndrome underwent pituitary radiosurgery at Tokyo Women's Medical University and were followed at least 12 months thereafter. The radiosurgical target was defined as the pituitary gland and its connection with the pituitary stalk. The maximum dose varied from 140 to 180 Gy. Mean follow-up after treatment was 35 months (range, 12-48 months). Results: Initial pain reduction, usually within 48 h after radiosurgery, was marked in 17 patients (71%). However, in the majority of cases the pain recurred within 6 months after treatment, and at the time of the last follow-up examination durable pain control was marked in only 5 patients (21%). Ten patients (42%) had treatment-associated side effects. Anterior pituitary abnormalities were marked in 8 cases and required hormonal replacement therapy in 3; transient diabetes insipidus was observed in 2 cases, transient hyponatremia in 1, and clinical deterioration due to increase of the numbness severity despite significant reduction of pain was seen once. Conclusions: Pituitary radiosurgery for thalamic pain results in a high rate of initial efficacy and is accompanied by acceptable morbidity. It can be used as a primary minimally invasive management option for patients with post-stroke thalamic pain resistant to medical therapy. However, in the majority of cases pain recurrence occurs within 1 year after treatment

  2. A Comparative Analysis of 2D and 3D Tasks for Virtual Reality Therapies Based on Robotic-Assisted Neurorehabilitation for Post-stroke Patients.

    Science.gov (United States)

    Lledó, Luis D; Díez, Jorge A; Bertomeu-Motos, Arturo; Ezquerro, Santiago; Badesa, Francisco J; Sabater-Navarro, José M; García-Aracil, Nicolás

    2016-01-01

    Post-stroke neurorehabilitation based on virtual therapies are performed completing repetitive exercises shown in visual electronic devices, whose content represents imaginary or daily life tasks. Currently, there are two ways of visualization of these task. 3D virtual environments are used to get a three dimensional space that represents the real world with a high level of detail, whose realism is determinated by the resolucion and fidelity of the objects of the task. Furthermore, 2D virtual environments are used to represent the tasks with a low degree of realism using techniques of bidimensional graphics. However, the type of visualization can influence the quality of perception of the task, affecting the patient's sensorimotor performance. The purpose of this paper was to evaluate if there were differences in patterns of kinematic movements when post-stroke patients performed a reach task viewing a virtual therapeutic game with two different type of visualization of virtual environment: 2D and 3D. Nine post-stroke patients have participated in the study receiving a virtual therapy assisted by PUPArm rehabilitation robot. Horizontal movements of the upper limb were performed to complete the aim of the tasks, which consist in reaching peripheral or perspective targets depending on the virtual environment shown. Various parameter types such as the maximum speed, reaction time, path length, or initial movement are analyzed from the data acquired objectively by the robotic device to evaluate the influence of the task visualization. At the end of the study, a usability survey was provided to each patient to analysis his/her satisfaction level. For all patients, the movement trajectories were enhanced when they completed the therapy. This fact suggests that patient's motor recovery was increased. Despite of the similarity in majority of the kinematic parameters, differences in reaction time and path length were higher using the 3D task. Regarding the success rates

  3. The Calculation of Language Lateralization Indices in Post-stroke Aphasia: A Comparison of a Standard and a Lesion-Adjusted Formula

    Science.gov (United States)

    Dietz, Aimee; Vannest, Jennifer; Maloney, Thomas; Altaye, Mekibib; Szaflarski, Jerzy P.; Holland, Scott K.

    2016-01-01

    Background: The language lateralization index (LI) is a valuable tool in functional magnetic resonance imaging (fMRI) research, especially in people with post-stroke aphasia. However, there is inconsistent consideration for the overlap of lesions with regions of interest (ROIs). The purpose of this study was to determine whether standard LI (SLI) and lesion-adjusted LI (LALI) formulae generate different LI values and language lateralization classification for people with post-stroke chronic aphasia. Methods: SLI and LALI were calculated for an event-related (overt) verb generation task in an anterior and a posterior language ROI. Twelve people with aphasia due to a single left-hemispheric infarct (11 right-handed; 1 left-handed; 77.2 ± 41.7 months post-stroke) were included (eight females; 57 ± 8.88 years). Spearman correlation coefficients and intraclass correlation coefficients were calculated to determine the relationship of the LI values generated by the SLI and the LALI formulas. Fischer’s exact test and a weighted Cohen’s Kappa determined the difference in language lateralization classification and agreement in the classification. Spearman correlation was used to examine the relationship between the difference in lateralization values produced by the LALI and SLI calculations with (1) lesion size, (2) the percentage of lesion overlap in each ROI, and (3) aphasia severity. Results: The two calculation methods were highly correlated and produced similar LI Values, yet yielded significantly different classification for language lateralization. Further, a more leftward LI resulted from application of the LALI formula in 10 participants, in either the anterior ROI (n = 3) or the posterior ROI (n = 7). Finally, for the posterior ROI only, significant correlations were revealed between the two calculation methods and the (1) lesion size and (2) percent of overlap with the ROI. Discussion: While both approaches produce highly correlated LI values, differences

  4. 脑卒中后情感障碍的研究进展%Research Progress of Post-stroke Emotional Disorder

    Institute of Scientific and Technical Information of China (English)

    张艳芳; 乾栋梁; 王力群; 雒扬

    2013-01-01

    脑卒中后情感障碍是脑卒中常见的并发症之一,主要包括脑卒中后抑郁、焦虑或焦虑抑郁共病,严重影响脑卒中患者的功能康复,增加脑卒中后患者的病死率和致残率.关于脑卒中后情感障碍的发病机制,一种理论认为与心理社会因素(如残疾和社会支持)有关,而其他理论则强调与生物学机制,如生物胺、神经递质的紊乱和免疫炎性因子的释放有关.分析脑卒中的病变位置是为了试图建立病变部位和情感障碍之间的某种关系,但观察结果仍存在争议.该文就脑卒中后情感障碍的临床表现、流行病学、发病机制、病灶部位、药物治疗作一综述.%Stroke emotional problems, which contains post stroke depression, post stroke anxietyor, post-stroke anxiety combined with depression, is one of the common complications of stroke. STEP adversely affects rehabilitation and significantly increase risk of death and disability in the post-stroke period. One of the theoretical views on the determinants of STEP focuses on psychosocial factors like disability and social support. Others emphasize biologic mechanisms such as disruption of biogenic amine neurotransmission and release of proinflammatory cytokines. The " lesion location" perspective attempts to establish a relationship between localization of stroke and occurrence of depression,but empirical results remain contradictory. Here is to make a review on the clinical manifestations, epidemiology,pathogenesis, lesion location and pharmacotherapy of the stroke emotional problems.

  5. A Comparative Analysis of 2D and 3D Tasks for Virtual Reality Therapies Based on Robotic-Assisted Neurorehabilitation for Post-stroke Patients.

    Science.gov (United States)

    Lledó, Luis D; Díez, Jorge A; Bertomeu-Motos, Arturo; Ezquerro, Santiago; Badesa, Francisco J; Sabater-Navarro, José M; García-Aracil, Nicolás

    2016-01-01

    Post-stroke neurorehabilitation based on virtual therapies are performed completing repetitive exercises shown in visual electronic devices, whose content represents imaginary or daily life tasks. Currently, there are two ways of visualization of these task. 3D virtual environments are used to get a three dimensional space that represents the real world with a high level of detail, whose realism is determinated by the resolucion and fidelity of the objects of the task. Furthermore, 2D virtual environments are used to represent the tasks with a low degree of realism using techniques of bidimensional graphics. However, the type of visualization can influence the quality of perception of the task, affecting the patient's sensorimotor performance. The purpose of this paper was to evaluate if there were differences in patterns of kinematic movements when post-stroke patients performed a reach task viewing a virtual therapeutic game with two different type of visualization of virtual environment: 2D and 3D. Nine post-stroke patients have participated in the study receiving a virtual therapy assisted by PUPArm rehabilitation robot. Horizontal movements of the upper limb were performed to complete the aim of the tasks, which consist in reaching peripheral or perspective targets depending on the virtual environment shown. Various parameter types such as the maximum speed, reaction time, path length, or initial movement are analyzed from the data acquired objectively by the robotic device to evaluate the influence of the task visualization. At the end of the study, a usability survey was provided to each patient to analysis his/her satisfaction level. For all patients, the movement trajectories were enhanced when they completed the therapy. This fact suggests that patient's motor recovery was increased. Despite of the similarity in majority of the kinematic parameters, differences in reaction time and path length were higher using the 3D task. Regarding the success rates

  6. 卒中后认知损害的危险因素分析%Analysis of risk factors for post -stroke cognitive impairment

    Institute of Scientific and Technical Information of China (English)

    牛晓波

    2015-01-01

    目的:研究卒中后认知损害的危险因素。方法入组152例急性脑卒中住院患者,于卒中3个月后进行认知功能评测,运用 Logistic 回归法分析卒中后认知损害的危险因素。结果卒中后认知损害的发生率为51.3%,年龄、低教育程度、体力劳动为主、糖尿病、长期饮酒、卒中复发、关键部位病变、神经功能缺损严重及日常生活能力低下是卒中后认知损害的独立危险因素。结论年龄、低教育程度、体力劳动为主、糖尿病、长期饮酒、卒中复发、关键部位病变、神经功能缺损严重及日常生活能力低下是卒中后认知损害的独立危险因素。%Objective To study the risk factors of post -stroke cognitive impairment.Methods A total of 152 patients with acute stroke were enrolled in this study.The cognitive status were evaluated using MoCA at 3 months after stroke.Logistic regres-sion analysis was used to find the risk factors of cognitive impairment after stroke.Results The incidence of post -stroke cogni-tive impairment was 51.3%.Logsitc regression showed that age,low educational level,manual workers,diabetes mellitus, long -standing drinking habits,recurrent stroke,lesion of strategic location,high NIHSS scores and high MRS scores were inde-pendent risk factors for post -stroke cognitive impairment.Conclusion Independent risk factors for post -stroke cognitive im-pairment are age,low educational level,manual workers,diabetes mellitus,long -standing drinking habits,recurrent stroke, lesion of strategic location,high NIHSS scores and high MRS scores.

  7. A comparative analysis of 2D and 3D tasks for virtual reality therapies based on robotic-assisted neurorehabilitation for post-stroke patients

    Directory of Open Access Journals (Sweden)

    Luis Daniel Lledó

    2016-08-01

    Full Text Available Post-stroke neurorehabilitation based on virtual therapies are performed completing repetitive exercises shown in visual electronic devices, whose content represents imaginary or daily life tasks. Currently, there are two ways of visualization of these task. 3D virtual environments are used to get a three dimensional space that represents the real world with a high level of detail, whose realism is determinated by the resolucion and fidelity of the objects of the task. Furthermore, 2D virtual environments are used to represent the tasks with a low degree of realism using techniques of bidimensional graphics. However, the type of visualization can influence the quality of perception of the task, affecting the patient's sensorimotor performance. The purpose of this paper was to evaluate if there were differences in patterns of kinematic movements when post-stroke patients performed a reach task viewing a virtual therapeutic game with two different type of visualization of virtual environment: 2D and 3D. Nine post-stroke patients have participated in the study receiving a virtual therapy assisted by PUPArm rehabilitation robot. Horizontal movements of the upper limb were performed to complete the aim of the tasks, which consist in reaching peripheral or perspective targets depending on the virtual environment shown. Various parameter types such as the maximum speed, reaction time, path length or initial movement are analyzed from the data acquired objectively by the robotic device to evaluate the influence of the task visualization. At the end of the study, a usability survey was provided to each patient to analysis his/her satisfaction level. For all patients, the movement trajectories were enhanced when they completed the therapy. This fact suggests that patient's motor recovery was increased. Despite of the similarity in majority of the kinematic parameters, differences in reaction time and path length were higher using the 3D task. Regarding

  8. The association of post-stroke anhedonia with salivary cortisol levels and stroke lesion in hippocampal/parahippocampal region

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    Terroni L

    2015-02-01

    Full Text Available Luisa Terroni,1 Edson Amaro Jr,2 Dan V Iosifescu,3 Patricia Mattos,4 Fabio I Yamamoto,5 Gisela Tinone,5 Adriana B Conforto,5 Matildes FM Sobreiro,1 Valeri D Guajardo,1 Mara Cristina S De Lucia,7 Ayrton C Moreira,6 Milberto Scaff,5 Claudia C Leite,2 Renerio Fraguas1 1Consultation-Liaison Psychiatry Group, Department and Institute of Psychiatry, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil; 2Department of Radiology, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil; 3Mood and Anxiety Disorders Program, Icahn School of Medicine at Mount Sinai, New York, NY, USA; 4Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil; 5Department of Neurology, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil; 6Department of Medicine, University of São Paulo, School of Medicine, Ribeirão Preto, Brazil; 7Division of Psychology, Central Institute, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil Background: Anhedonia constitutes a coherent construct, with neural correlates and negative clinical impact, independent of depression. However, little is known about the neural correlates of anhedonia in stroke patients. In this study, we investigated the association of post-stroke anhedonia with salivary cortisol levels and stroke location and volume.Patients and methods: A psychiatrist administered the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition to identify anhedonia in 36 inpatients, without previous depression, consecutively admitted in a neurology clinic in the first month after a first-ever ischemic stroke. Salivary cortisol levels were assessed in the morning, evening, and after a dexamethasone suppression test. We used magnetic resonance imaging and a semi-automated brain morphometry method to assess stroke location, and the MRIcro program

  9. Theories of inter-hemispheric interactions in aphasia: the role of tDCS in rehabilitation of post-stroke aphasia

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    Roy H Hamilton

    2014-04-01

    Full Text Available Mounting data from behavioral and neuroimaging studies have shown that the process of recovery from aphasia is largely driven by the reorganization of brain networks related to language. Evidence implicates a variety of potential mechanisms in this reorganization, some of which involve substantive changes in brain functional activity within and between cerebral hemispheres. These changes include intrahemispheric recruitment of perilesional left-hemisphere regions and transcallosal interhemispheric interactions between lesioned left-hemisphere language areas and homologous regions in the right hemisphere. With respect to the role of the right hemisphere, it is debated whether interhemispheric interactions are beneficial or deleterious to recovering language networks. Recent years have also seen the emergence of noninvasive brain stimulation techniques such as transcranial magnetic stimulation (TMS and transcranial direct current stimulation (tDCS as potential novel treatments for post-stroke aphasia. Because these techniques are predicated on either focal excitation or inhibition of brain areas, characterization of the functional roles of the left and right hemispheres and transcallosal interactions in aphasia recovery is of central importance to the development and refinement of stimulation-based therapies. However, most treatment studies involving noninvasive brain stimulation in aphasia have tacitly accepted the interhemispheric inhibition model, in which right hemisphere activity interferes with language recovery that is mediated by left hemisphere perisylvian regions. Based on this account, many studies in aphasia involving TMS and tDCS have adopted one of two approaches consistent with the model: left hemisphere excitation or right hemisphere inhibition. In this presentation, we will review both clinical and cognitive neuroscience evidence that elucidates different hemispheric mechanisms that influence recovery from aphasia after stroke

  10. Botulinum Toxin Type A for the Treatment of Neuropathic Pain in Neuro-Rehabilitation

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    Domenico Intiso

    2015-06-01

    Full Text Available Pain is a natural protective mechanism and has a warning function signaling imminent or actual tissue damage. Neuropathic pain (NP results from a dysfunction and derangement in the transmission and signal processing along the nervous system and it is a recognized disease in itself. The prevalence of NP is estimated to be between 6.9% and 10% in the general population. This condition can complicate the recovery from stroke, multiple sclerosis, spinal cord lesions, and several neuropathies promoting persistent disability and poor quality of life. Subjects suffering from NP describe it as burning, itching, lancing, and numbness, but hyperalgesia and allodynia represent the most bothersome symptoms. The management of NP is a clinical challenge and several non-pharmacological and pharmacological interventions have been proposed with variable benefits. Botulinum toxin (BTX as an adjunct to other interventions can be a useful therapeutic tool for the treatment of disabled people. Although BTX-A is predominantly used to reduce spasticity in a neuro-rehabilitation setting, it has been used in several painful conditions including disorders characterized by NP. The underlying pharmacological mechanisms that operate in reducing pain are still unclear and include blocking nociceptor transduction, the reduction of neurogenic inflammation by inhibiting neural substances and neurotransmitters, and the prevention of peripheral and central sensitization. Some neurological disorders requiring rehabilitative intervention can show neuropathic pain resistant to common analgesic treatment. This paper addresses the effect of BTX-A in treating NP that complicates frequent disorders of the central and peripheral nervous system such as spinal cord injury, post-stroke shoulder pain, and painful diabetic neuropathy, which are commonly managed in a rehabilitation setting. Furthermore, BTX-A has an effect in relief pain that may characterize less common neurological disorders

  11. Combined use of spatial restraint stress and middle cerebral artery occlusion is a novel model of post-stroke depression in mice.

    Science.gov (United States)

    Zhang, Gaocai; Chen, Li; Yang, Lingli; Hua, Xiaodong; Zhou, Beiqun; Miao, Zhigang; Li, Jizhen; Hu, Hua; Namaka, Michael; Kong, Jiming; Xu, Xingshun

    2015-01-01

    Post stroke depression (PSD) is one of the most common complications of ischemic stroke. At present, the underlying mechanisms are unclear, largely because there are no reliable, valid and reproducible animal models of PSD. Here we report a novel animal model of PSD that displays consistent and reliable clinical features of hemiplegic stroke. The animal model encompasses a combination of the middle cerebral artery occlusion (MCAO) and spatial restraint stress. We found that a 60-minute MCAO followed by spatial restraint stress for 2 h daily for 2 to 4 weeks from the fourth day after MCAO induced PSD-like depressive phenotypes in mice. Importantly, the mice showed exacerbated deficits of neurological functions and decreased body weights, which were accompanied with reduced levels of brain derived neurotrophic factor and neurotransmitters including serotonin and dopamine. In addition, we identified increased levels of serum cortisol in our PSD mice. Finally, we found that mice with PSD were responsive to the tri-cyclic antidepressant imipramine as evidenced by their attenuated depressive behaviors, increased body weights, recovered brain serotonin levels, and decreased serum cortisol levels. This mouse model replicates multiple features of human post-stroke depression and thus provides a new model for the investigation of PSD. PMID:26572587

  12. 卒中后抑郁新的病因假说--谷氨酸能障碍%Glutamate Dysfunctional Etiology Hypothesis of Post-stroke Depression

    Institute of Scientific and Technical Information of China (English)

    岳莹莹; 袁勇贵; 张志

    2014-01-01

    卒中后抑郁(post-stroke depression,PSD)是卒中后常见的神经精神症状之一,以心境低落、兴趣下降为主要特征,不仅影响患者神经功能的康复,而且显著增加卒中病死率。其发病机制尚未明确,伴随离子型谷氨酸受体拮抗剂氯胺酮的快速抗抑郁作用的出现,谷氨酸(glutamate,Glu)能神经系统在抑郁症及PSD中的作用日益突出,也为抗抑郁治疗带来新的契机。%Post-stroke depression (PSD) is one of the most common neuropsychiatric complications after stroke that is characterized by depressed mood and loss interest. It can not only affect the neurological rehabilitation, but also signiifcantly increase the mortality of patients. However, the pathogenesis is not clear. Glutamate system plays an important role in depression and PSD and brings new opportunities for treatment along with the appearance of rapid antidepressant ketamine which is the antagonist of an ionotropic glutamate receptor.

  13. 中风后恢复与康复研究的进展%Recent advances in post-stroke recovery and rehabilitation

    Institute of Scientific and Technical Information of China (English)

    倪国新

    2014-01-01

    Stroke is a leading cause of death and disability .With improvement in acute stroke care ,many stroke victims sur-vive.However,substantial dysfunctions also left at the same time .In the last decade,great advances have been made in stroke recovery and rehabilitation.In this review,the author introduces major determinants of post-stroke recovery,some key issues in post-stroke reha-bilitation,as well as several emerging rehabilitation modalities .Potential future directions in research are also addressed .%中风是一种严重危害生命与功能的常见疾病,临床处理技术的进步使得很多的中风患者得以存活,但同时也遗留了大量的功能障碍。最近十年在中风后恢复与康复方面取得了巨大的进展,本文从影响中风后恢复的主要因素、中风后康复的几个关键问题以及新的康复治疗技术等方面进行了介绍,并对今后的研究进行了展望。

  14. Effect of Buzhongyiqi Decoction on Post Stroke Fatigue%补中益气汤对卒中后疲劳的疗效观察

    Institute of Scientific and Technical Information of China (English)

    冯玲; 何玲燕; 茹文亚; 许小峰; 陶小英

    2011-01-01

    目的探讨补中益气汤加减治疗卒中后疲劳的疗效.方法对60例卒中后疲劳患者给予补中益气汤加减连续治疗4周,参照制定疗效评定标准,根据症状改善情况对其进行疗效评价.结果 60例患者中,显效47例(78.33%),有效10例(16.67%),无效3例(5%),总有效率95%,全身乏力、纳差、肌肉酸痛等症状均有明显改善.结论补中益气汤加减治疗卒中后疲劳疗效显著,有利于康复治疗的顺利进行.%Objective To observe the effect of Buzhongyiqi decoction on post stroke fatigue. Methods 60 stroke patients with fatigue were given Buzhongyiqi decoction for 4 weeks continuously. Chinese New Drug Clinical Guidelines was to evaluate the effect for patients according to improvement of symptoms. Results In 60 cases, markedly effective in 47 cases (78. 33 %), effective in 10 patients (16. 67 % ), invalid in 3 cases (5 % ). Symptoms of malaise, anorexia, muscle soreness were significantly improved. Conclusion Buzhongyiqi decoction can improve post stroke fatigue of stroke patients.

  15. A multi-center study on low-frequency rTMS combined with intensive occupational therapy for upper limb hemiparesis in post-stroke patients

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    Kakuda Wataru

    2012-01-01

    Full Text Available Abstract Background Both low-frequency repetitive transcranial magnetic stimulation (rTMS and intensive occupational therapy (OT have been recently reported to be clinically beneficial for post-stroke patients with upper limb hemiparesis. Based on these reports, we developed an inpatient combination protocol of these two modalities for the treatment of such patients. The aims of this pilot study were to confirm the safety and feasibility of the protocol in a large number of patients from different institutions, and identify predictors of the clinical response to the treatment. Methods The study subjects were 204 post-stroke patients with upper limb hemiparesis (mean age at admission 58.5 ± 13.4 years, mean time after stroke 5.0 ± 4.5 years, ± SD from five institutions in Japan. During 15-day hospitalization, each patient received 22 treatment sessions of 20-min low-frequency rTMS and 120-min intensive OT daily. Low-frequency rTMS of 1 Hz was applied to the contralesional hemisphere over the primary motor area. The intensive OT, consisting of 60-min one-to-one training and 60-min self-exercise, was provided after the application of low-frequency rTMS. Fugl-Meyer Assessment (FMA and Wolf Motor Function Test (WMFT were performed serially. The physiatrists and occupational therapists involved in this study received training prior to the study to standardize the therapeutic protocol. Results All patients completed the protocol without any adverse effects. The FMA score increased and WMFT log performance time decreased significantly at discharge, relative to the respective values at admission (change in FMA score: median at admission, 47 points; median at discharge, 51 points; p Conclusions The 15-day inpatient rTMS plus OT protocol is a safe, feasible, and clinically useful neurorehabilitative intervention for post-stroke patients with upper limb hemiparesis. The response to the treatment was not influenced by age or time after stroke onset. The

  16. 男性卒中后焦虑/抑郁症患者血清性激素水平变化研究%Altered serum sexual hormone in male post-stroke anxiety/depression patients

    Institute of Scientific and Technical Information of China (English)

    姚恺; 邬军锋; 张剑峰

    2011-01-01

    Objective To explore the relationship between male sexual hormone (estradiol, testosterone, progesterone) and post-stroke anxiety or post-stroke depression. Methods The serum estradiol, testosterone, progesterone levels were measured in 30 post-stroke anxiety or post-stroke depressive patients and 30 post-stroke patients without anxiety or depression. The degree of anxiety and depression was clinically assessed with Hamilton Anxiety Scale(HAMA) and Hamilton Rating Scale for depression(HAMD). Correlation analysis was conducted. Results The estradiol level of male poststroke anxiety or post- stroke depressive patients was significantly lower than that of controls (P < 0.05), and showed negative correlation with the scores of HAMA (r =-0. 540,P < 0.05) and HAMD (r =-0. 503, P < 0.05 ). The testosterone level of male post-stroke anxiety and male post-stoke depressive patients was significantly lower than that of controls (P < 0. 05), and showed negative correlation with the scores of HAMA (r=-0. 535,P<0. 05) and HAMD (r=-0. 602,P<0.05). The levels of progesterone between two groups were not significantly different (P > 0. 05). Conclusions The sexual hormone disturbance was found significantly in post-stroke anxiety and post-stroke depressive patients, which has close relationship with morbidity and development of stroke. The measurement of estradiol and testosterone level may be used as a biomarker for post-stroke anxiety and post-stroke depression.%目的 探讨男性性激素水平(雌二醇、睾酮、孕酮)与卒中后焦虑、抑郁症的关系.方法 检测和比较30例男性卒中后焦虑、抑郁症患者和30例非卒中后焦虑、抑郁症患者的血清雌二醇、睾酮、孕酮的水平,并应用汉密尔顿焦虑量表(HAMA)和汉密尔顿抑郁量表(HAMD)对卒中后焦虑、抑郁症患者进行临床评分,同时作相关分析.结果 男性卒中后焦虑、抑郁症患者血清雌二醇水平均显著低于对照组(P0.05).结论

  17. Influence factors of post-stroke cognitive impairment%脑卒中后认知功能障碍的影响因素

    Institute of Scientific and Technical Information of China (English)

    秦晓明; 张新卿; 方向华

    2009-01-01

    脑卒中是危害人类健康的最主要的疾病之一,而脑卒中后的认知功能障碍(post-stroke cognitive impairment, PSCI)是其常见的并发症,发病率为11.6%~56.3%。PSCI按照严重程度可以分为非痴呆的认知功能障碍( cognitive impairment with no dementia, CIND)和脑卒中后痴呆(poststroke dementia, PSD).前者属于血管性轻度认知功能障碍的范畴(vascular mild cognitive impairment, VMCI),

  18. A Machine Learning Framework for Gait Classification Using Inertial Sensors: Application to Elderly, Post-Stroke and Huntington’s Disease Patients

    Directory of Open Access Journals (Sweden)

    Andrea Mannini

    2016-01-01

    Full Text Available Machine learning methods have been widely used for gait assessment through the estimation of spatio-temporal parameters. As a further step, the objective of this work is to propose and validate a general probabilistic modeling approach for the classification of different pathological gaits. Specifically, the presented methodology was tested on gait data recorded on two pathological populations (Huntington’s disease and post-stroke subjects and healthy elderly controls using data from inertial measurement units placed at shank and waist. By extracting features from group-specific Hidden Markov Models (HMMs and signal information in time and frequency domain, a Support Vector Machines classifier (SVM was designed and validated. The 90.5% of subjects was assigned to the right group after leave-one-subject–out cross validation and majority voting. The long-term goal we point to is the gait assessment in everyday life to early detect gait alterations.

  19. 脑卒中后吞咽障碍的康复护理进展%Progress on rehabilitation hursing of post-stroke patients with dysphagia

    Institute of Scientific and Technical Information of China (English)

    赵明利; 叶文琴

    2011-01-01

    It introduced neural pathomechanism and rehabilitation assessment methods of dysphagia and evaluation tools of swallowing function. It reviewed nursing progress on rehabilitation of post - stroke patients with dysphagia from aspects of time window of rehabilitation training, exercise therapy, physical therapy, and traditional Chinese medicine rehabilitation treatment.%介绍了吞咽障碍的神经病理机制及吞咽障碍的康复评估法和吞咽功能评估工具,从康复训练的时间窗、运动疗法、物理治疗、中医康复治疗等方面综述了脑卒中后吞咽障碍的康复护理进展.

  20. The influence of μ-opioid and noradrenaline reuptake inhibition in the modulation of pain responsive neurones in the central amygdala by tapentadol in rats with neuropathy

    OpenAIRE

    L. Gonçalves; Friend, L. V.; Dickenson, A. H.

    2015-01-01

    Treatments for neuropathic pain are either not fully effective or have problematic side effects. Combinations of drugs are often used. Tapentadol is a newer molecule that produces analgesia in various pain models through two inhibitory mechanisms, namely central μ-opioid receptor (MOR) agonism and noradrenaline reuptake inhibition. These two components interact synergistically, resulting in levels of analgesia similar to opioid analgesics such as oxycodone and morphine, but with more tolerabl...

  1. On the G-Protein-Coupled Receptor Heteromers and Their Allosteric Receptor-Receptor Interactions in the Central Nervous System: Focus on Their Role in Pain Modulation

    OpenAIRE

    Kjell Fuxe; Tarakanov, Alexander O.; Luigi F. Agnati; Alicia Rivera; Kathleen Van Craenenbroeck; Wilber Romero-Fernandez; Dasiel O. Borroto-Escuela

    2013-01-01

    The modulatory role of allosteric receptor-receptor interactions in the pain pathways of the Central Nervous System and the peripheral nociceptors has become of increasing interest. As integrators of nociceptive and antinociceptive wiring and volume transmission signals, with a major role for the opioid receptor heteromers, they likely have an important role in the pain circuits and may be involved in acupuncture. The delta opioid receptor (DOR) exerts an antagonistic allosteric influence on ...

  2. Methylphenidate modulates activity within cognitive neural networks of patients with post-stroke major depression: A placebo-controlled fMRI study

    Directory of Open Access Journals (Sweden)

    Rajamannar Ramasubbu

    2008-10-01

    Full Text Available Rajamannar Ramasubbu1, Bradley G Goodyear21Departments of Psychiatry and Clinical Neurosciences; 2Department of Radiology and Clinical Neurosciences, University of Calgary, Hotchkiss Brain Institute, Calgary, AB, CanadaBackground: Methylphenidate (MP is a dopamine- and noradrenaline-enhancing agent beneficial for post-stroke depression (PSD and stroke recovery due to its therapeutic effects on cognition, motivation, and mood; however, the neural mechanisms underlying its clinical effects remain unknown. This study used functional magnetic resonance imaging (fMRI to investigate the effect of MP on brain activity in response to cognitive tasks in patients with PSD.Methods: Nine stroke outpatients with DSM IV defined major depression underwent fMRI during two cognitive tasks (2-back and serial subtraction on four occasions, on the first and third day of a three-day treatment of MP and placebo. Nine healthy control (HC subjects matched for age and sex scanned during a single session served as normative data for comparison. The main outcome measure was cognitive task-dependent brain activity.Results: For the 2-back task, left prefrontal, right parietal, posterior cingulate, and temporal and bilateral cerebellar regions exhibited significantly greater activity during the MP condition relative to placebo. Less activity was detected in rostral prefrontal and left parietal regions. For serial subtraction, greater activity was detected in medial prefrontal, biparietal, bitemporal, posterior cingulate, and bilateral cerebellar regions, as well as thalamus, putamen, and insula. Further, underactivation observed during the placebo condition relative to HC improved or reversed during MP treatment. No significant differences in behavioral measures were found between MP and placebo conditions or between patients and HC.Conclusions: Short-term MP treatment may improve and normalize activity in cognitive neuronal networks in patients with PSD

  3. Effects of interleukin-6, interleukin-18, and statin use, evaluated at acute stroke, on post-stroke depression during 1-year follow-up.

    Science.gov (United States)

    Kang, Hee-Ju; Bae, Kyung-Yeol; Kim, Sung-Wan; Kim, Joon-Tae; Park, Man-Seok; Cho, Ki-Hyun; Kim, Jae-Min

    2016-10-01

    Proinflammatory cytokines are associated with the development of post-stroke depression (PSD). Statins are thought to possess anti-inflammatory properties but their interactions with cytokines regarding the risk of PSD have yet to be investigated. Thus, the present study aimed to determine whether interleukin (IL)-6 and IL-18 were associated with the development of depression at 2 weeks and 1year after stroke using a longitudinal post-stroke cohort. Furthermore, this study examined the potential interactions between statin use and cytokines on PSD. For this study, 286 patients were evaluated 2 weeks after stroke and 222 patients were followed-up 1year later. Depression was diagnosed using criteria from the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) and then categorized into no PSD or any PSD, which included diagnoses of both major and minor depression. The effects of IL-6 and IL-18 on PSD as well as their interaction with a statin at both examination time-points were investigated using a multivariate logistic regression model. Higher IL-6 and IL-18 levels were independently associated with depressive disorders within 2 weeks and at 1year after stroke. When stratified by statin use, these significant associations were more evident in patients who did not use a statin. Furthermore, there was a significant interaction between statin use and IL-6 on the presence of a depressive disorder at 1year. The present findings support the cytokine hypothesis of PSD and indicate that the preventive effects of statin use against PSD may be mediated by its interactions with IL-6. PMID:27428088

  4. Clinical Application of Loewenstein Occupational Therapy Cognitive Assessment Battery-Second Edition in Evaluating of Cognitive Function of Chinese Patients with Post-stroke Aphasia

    Institute of Scientific and Technical Information of China (English)

    Zeng-zhi Yu; Shu-jun Jiang; Jun Li; Sheng Bi; Fei Li; Tao Xie; Rui Wang; Xiao-tan Zhang

    2013-01-01

    Objective To investigate the clinical application value of Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) battery in Chinese patients with post-stroke aphasia. Methods Cognitive functions of 59 Chinese patients with aphasia following a stroke were assessed with the Chinese version of the second edition of LOTCA battery and their linguistic functions were tested with the Western Aphasia Battery (WAB) Scale, respectively. The results of LOTCA were analyzed and compared across different groups, in the light of gender, age, educational background, the length of illness, and the degree of aphasia. Results Neither the score of subtests of the LOTCA nor the overall scores of LOTCA of aphasia patients with different gender and educational background differed (all P>0.05). In different age groups, apart from thinking operation (F=3.373, P=0.016), visuomotor organization (F=3.124, P=0.022), attention (F=3.729, P=0.009) and the total score (F=2.683, P=0.041), there was no difference in terms of the other subtest scores of LOTCA (all P>0.05). In the groups of different length of time with illness, apart from orientation (F=2.982, P=0.039) and attention (F=3.485, P=0.022), the score of other subtests and the total score of LOTCA were not different (all P>0.05). In the groups of different degree of aphasia, apart from attention (F=2.061, P=0.074), both the score of other subtests and the total score of LOTCA differed (all P Conclusion LOTCA might be suitable to assessing the cognitive ability of post-stroke Chinese patients with aphasia.

  5. Deanxit for Treating Patients with Post-Stroke Depression in 40 Cases%黛力新治疗脑卒中后抑郁40例

    Institute of Scientific and Technical Information of China (English)

    顾亚兰

    2016-01-01

    Objective To study the efficacy of Deanxit treatment for patients with post-stroke depression. Methods 80 patients with post-stroke depression were randomized into the control group ( routine treatment ) and the observation group ( based on the routine treatment, addition to the Deanxit ) according to the random number method, 40 patients per group. The changes of Hamilton Depression Scale ( HAMD ) , National Institute of Health Stroke Scale ( NIHSS ) , Barthel index ( BI ) , and the plasma levels of norepinephrine ( NE ) , Dobaamine ( DA ) , 5-hydroxytryptamine ( 5-HT ) on pre- and post-treatment, and clinical efficacy and adverse reactions in the two groups were compared. Results Compared with the control group, the scores of HAMD and NIHSS were significantly decreased and the BI scores were obviously increased on post-treatment in the observation group ( P ﹤ 0. 05 );the plasma levels of NE, DA, 5-HT were significantly increased on post-treatment in the observation group ( P ﹤ 0. 05 ); the total effective rate was significant improved in the observation group ( P ﹤ 0. 05 ); there were no serious adverse reactions in the two groups during the treatment period. Conclusion Deanxit can significantly improve the neurological function and depression symptoms for patients with post-stroke depression, and im-prove the daily life ability.%目的:观察黛力新治疗脑卒中后抑郁的临床疗效。方法将80例脑卒中后抑郁患者按随机数字表法分为对照组(常规治疗)和观察组(常规治疗基础上加用黛力新),各40例。比较两组治疗前后汉密尔顿抑郁量表评分(HAMD)、美国国立卫生研究院卒中量表评分(NIHSS)、Barthel指数(BI)变化情况,血浆去甲肾上腺素(NE)、多巴胺(DA)、5-羟色胺(5-HT)含量变化情况,以及临床疗效、不良反应发生情况。结果与对照组相比,观察组治疗后HAMD及NIHSS均明显降低,BI评分显著增高( P

  6. Polysomnography in diagnosis of post-stroke depression%多道睡眠图指标评估脑卒中后抑郁的价值

    Institute of Scientific and Technical Information of China (English)

    吴东宇; 袁光固

    2004-01-01

    AIM:To investigate the value of the polysomnograpy(PSG) in diagnosis of post-stroke depression(PSD). METHODS:PSG analysis was performed on 3 groups of 30 subjects, with 10 PSD patients diagnosed according to DSM-IV criteria in the experimental group,10 post-stroke patients without depression in the control group,and 10 age and gender matched healthy subjects. RESULTS:In comparison with healthy and control subjects,there was significant difference in the sleep schedule in PSD patients,represented by prolonged sleep latency,increased number of cycles of REM-NREM,deceased latency of REM stage,more active and frequent REM,and increased S1 stage but decreased S2 and S3+ 4 stages of sleep.In PSD patients,the total sleeping time and slow wave sleeping time were shorter than that in the healthy subjects,but did not differ from that in control subjects.There was no significant difference in duration of wakefulness and sleep efficiency among three groups. CONCLUSION:Changes in PSG have been shown in PSD patients.These changes may be helpful references for the diagnosis of PSD.%目的:探讨多道睡眠图 ( polysomnograph,PSG)指标对脑卒中后抑郁 (post-stroke depression,PSD)的诊断价值. 方法: 30例研究对象分为 3组进行多道睡眠图检查并分析其结果:病例组为 10例 PSD患者,根据 DSM-Ⅳ诊断标准确诊;对照组为 10例脑卒中后无抑郁的患者;正常组为年龄、性别匹配的健康者. 结果:与对照组、正常组比较,病例组睡眠结构发生明显变化,表现为睡眠潜伏期延长,快速动眼睡眠与非快速动眼睡眠( REM-NREM)周期次数增加;快速动眼睡眠( rapid eye movements,REM)潜伏期缩短; REM活动度、强度、密度增加; S1阶段睡眠增加, S2和 S3+ 4阶段睡眠减少.总睡眠时间、慢波睡眠时间比正常组少,但与对照组之间无差异. 3组之间觉醒时间、睡眠效率无明显差异. 结论: PSD患者存在 PSG指标变化,这些改变可能有助于 PSD的诊断参考.

  7. The effectiveness of an augmented cognitive behavioural intervention for post-stroke depression with or without anxiety (PSDA: the Restore4Stroke-PSDA trial

    Directory of Open Access Journals (Sweden)

    Kootker Joyce A

    2012-07-01

    Full Text Available Abstract Background Post-Stroke Depression with or without Anxiety (PSDA is a common disorder in the chronic phase of stroke. Neuropsychiatric problems, such as PSDA, have a negative impact on social reintegration and quality of life. Currently, there is no evidence-based treatment available for reducing PSDA symptoms. In the recent literature on depression in the general population it has been shown that depression complaints can diminish by cognitive behavioural therapy (CBT. In the current study, the effectiveness of augmented, activation-based and individually tailored CBT on the reduction of depression and anxiety will be investigated in patients with PSDA. Additionally, the effects on various secondary outcome measures, such as quality of life, goal attainment and societal participation will be evaluated. This study is embedded in a consortium of 4 interrelated studies on quality of life after stroke (Restore4Stroke. Methods/design A multi-centre, assessor-blind, randomized controlled trial is conducted. A sample of 106 PSDA patients, as assessed with the Hospital Anxiety and Depression Scale (HADS depression subscale >7, will be recruited and randomly allocated to either an experimental or a control group. The experimental intervention consists of an augmented CBT intervention. The intervention is based on CBT principles of recognizing, registering, and altering negative thoughts and cognitions so that mood, and emotional symptoms are improved. CBT is augmented with direct in-vivo activation offered by occupational or movement therapists. Patients in the control group will receive a computerized cognitive training intervention. Outcomes will be assessed at baseline, immediately post intervention, and at 6 and 12 months follow up. Discussion This study is the first randomized clinical trial that evaluates the (maintenance of effects of augmented CBT on post-stroke depression with or without anxiety symptoms. Together with three other

  8. Spatial localization and distribution of the TMS-related 'hotspot' of the tibialis anterior muscle representation in the healthy and post-stroke motor cortex.

    Science.gov (United States)

    Sivaramakrishnan, Anjali; Tahara-Eckl, Lenore; Madhavan, Sangeetha

    2016-08-01

    Transcranial magnetic stimulation (TMS) is a type of noninvasive brain stimulation used to study corticomotor excitability of the intact and injured brain. Identification of muscle representations in the motor cortex is typically done using a procedure called 'hotspotting', which involves establishing the optimal location on the scalp that evokes a maximum TMS response with minimum stimulator intensity. The purpose of this study was to report the hotspot locations for the tibialis anterior (TA) muscle representation in the motor cortex of healthy and post stroke individuals. A retrospective data analyses from 42 stroke participants and 32 healthy participants was conducted for reporting TMS hotspot locations and their spatial patterns. Single pulse TMS, using a 110mm double cone coil, was used to identify the motor representation of the TA. The hotspot locations were represented as x and y-distances from the vertex for each participant. The mediolateral extent of the loci from the vertex (x-coordinate) and anteroposterior extent of the loci from the vertex (y-coordinate) was reported for each hemisphere: non-lesioned (XNLes, YNLes), lesioned (XLes, YLes) and healthy (XH, YH). We found that the mean hotspot loci for TA muscle from the vertex were approximately: 1.29cm lateral and 0.55cm posterior in the non-lesioned hemisphere, 1.25cm lateral and 0.5cm posterior in the lesioned hemisphere and 1.6cm lateral and 0.8cm posterior in the healthy brain. There was no significant difference in the x- and y-coordinates between the lesioned and non-lesioned hemispheres. However, the locations of the XNLes (p=0.01) and XLes (p=0.004) were significantly different from XH. The YNLes and YLes showed no significant differences from YH loci. Analyses of spatial clustering patterns using the Moran's I index showed a negative autocorrelation in stroke participants (NLes: Moran's I=-0.09, p<0.001; Les: Moran's I=-0.14, p=0.002), and a positive autocorrelation in healthy participants

  9. Pain Assessment

    Science.gov (United States)

    Introduction Types of Pain Pain Assessment Pain Treatments Integrative Pain Therapy Pain Management Recommendations References September 04, 2016 Pain Assessment Effective pain management begins with a comprehensive ...

  10. Imaging Pain.

    Science.gov (United States)

    Martucci, Katherine T; Mackey, Sean C

    2016-06-01

    The challenges and understanding of acute and chronic pain have been illuminated through the advancement of central neuroimaging. Through neuroimaging research, new technology and findings have allowed us to identify and understand the neural mechanisms contributing to chronic pain. Several regions of the brain are known to be of particular importance for the maintenance and amplification of chronic pain, and this knowledge provides novel targets for future research and treatment. This article reviews neuroimaging for the study of chronic pain, and in particular, the rapidly advancing and popular research tools of structural and functional MRI. PMID:27208709

  11. Spinal pain

    International Nuclear Information System (INIS)

    Highlights: • Purpose of this review is to address the current concepts on the pathophysiology of discogenic, radicular, facet and dysfunctional spinal pain, focusing on the role of the imaging in the diagnostic setting, to potentially address a correct approach also to minimally invasive interventional techniques. • Special attention will be given to the discogenic pain, actually considered as the most frequent cause of chronic low back pain. • The correct distinction between referred pain and radicular pain contributes to give a more correct approach to spinal pain. • The pathogenesis of chronic pain renders this pain a true pathology requiring a specific management. - Abstract: The spinal pain, and expecially the low back pain (LBP), represents the second cause for a medical consultation in primary care setting and a leading cause of disability worldwide [1]. LBP is more often idiopathic. It has as most frequent cause the internal disc disruption (IDD) and is referred to as discogenic pain. IDD refers to annular fissures, disc collapse and mechanical failure, with no significant modification of external disc shape, with or without endplates changes. IDD is described as a separate clinical entity in respect to disc herniation, segmental instability and degenerative disc desease (DDD). The radicular pain has as most frequent causes a disc herniation and a canal stenosis. Both discogenic and radicular pain also have either a mechanical and an inflammatory genesis. For to be richly innervated, facet joints can be a direct source of pain, while for their degenerative changes cause compression of nerve roots in lateral recesses and in the neural foramina. Degenerative instability is a common and often misdiagnosed cause of axial and radicular pain, being also a frequent indication for surgery. Acute pain tends to extinguish along with its cause, but the setting of complex processes of peripheral and central sensitization may influence its evolution in chronic

  12. Spinal pain

    Energy Technology Data Exchange (ETDEWEB)

    Izzo, R., E-mail: roberto1766@interfree.it [Neuroradiology Department, A. Cardarelli Hospital, Naples (Italy); Popolizio, T., E-mail: t.popolizio1@gmail.com [Radiology Department, Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo (Fg) (Italy); D’Aprile, P., E-mail: paoladaprile@yahoo.it [Neuroradiology Department, San Paolo Hospital, Bari (Italy); Muto, M., E-mail: mutomar@tiscali.it [Neuroradiology Department, A. Cardarelli Hospital, Napoli (Italy)

    2015-05-15

    Highlights: • Purpose of this review is to address the current concepts on the pathophysiology of discogenic, radicular, facet and dysfunctional spinal pain, focusing on the role of the imaging in the diagnostic setting, to potentially address a correct approach also to minimally invasive interventional techniques. • Special attention will be given to the discogenic pain, actually considered as the most frequent cause of chronic low back pain. • The correct distinction between referred pain and radicular pain contributes to give a more correct approach to spinal pain. • The pathogenesis of chronic pain renders this pain a true pathology requiring a specific management. - Abstract: The spinal pain, and expecially the low back pain (LBP), represents the second cause for a medical consultation in primary care setting and a leading cause of disability worldwide [1]. LBP is more often idiopathic. It has as most frequent cause the internal disc disruption (IDD) and is referred to as discogenic pain. IDD refers to annular fissures, disc collapse and mechanical failure, with no significant modification of external disc shape, with or without endplates changes. IDD is described as a separate clinical entity in respect to disc herniation, segmental instability and degenerative disc desease (DDD). The radicular pain has as most frequent causes a disc herniation and a canal stenosis. Both discogenic and radicular pain also have either a mechanical and an inflammatory genesis. For to be richly innervated, facet joints can be a direct source of pain, while for their degenerative changes cause compression of nerve roots in lateral recesses and in the neural foramina. Degenerative instability is a common and often misdiagnosed cause of axial and radicular pain, being also a frequent indication for surgery. Acute pain tends to extinguish along with its cause, but the setting of complex processes of peripheral and central sensitization may influence its evolution in chronic

  13. Poststroke Pain – but Multiple Pain Mechanisms

    OpenAIRE

    Vinjamuri Chari; Eldon Tunks

    2010-01-01

    A 42-year-old man presented with acute left hemiplegia due to a right frontotemporal hemorrhagic stroke and left-sided pain. While the initial presentation suggested central poststroke pain, subsequent investigations also implicated heterotopic ossification of the left hip and amplification of previous low back pain by the new central pain. While heterotopic ossification has been commonly associated with brain injury, spinal cord injury or osseous injury, it is only rarely associated with str...

  14. The influence of μ-opioid and noradrenaline reuptake inhibition in the modulation of pain responsive neurones in the central amygdala by tapentadol in rats with neuropathy.

    Science.gov (United States)

    Gonçalves, Leonor; Friend, Lauren V; Dickenson, Anthony H

    2015-02-15

    Treatments for neuropathic pain are either not fully effective or have problematic side effects. Combinations of drugs are often used. Tapentadol is a newer molecule that produces analgesia in various pain models through two inhibitory mechanisms, namely central μ-opioid receptor (MOR) agonism and noradrenaline reuptake inhibition. These two components interact synergistically, resulting in levels of analgesia similar to opioid analgesics such as oxycodone and morphine, but with more tolerable side effects. The right central nucleus of the amygdala (CeA) is critical for the lateral spinal ascending pain pathway, regulates descending pain pathways and is key in the emotional-affective components of pain. Few studies have investigated the pharmacology of limbic brain areas in pain models. Here we determined the actions of systemic tapentadol on right CeA neurones of animals with neuropathy and which component of tapentadol contributes to its effect. Neuronal responses to multimodal peripheral stimulation of animals with spinal nerve ligation or sham surgery were recorded before and after two doses of tapentadol. After the higher dose of tapentadol either naloxone or yohimbine were administered. Systemic tapentadol resulted in dose-dependent decrease in right CeA neuronal activity only in neuropathy. Both naloxone and yohimbine reversed this effect to an extent that was modality selective. The interactions of the components of tapentadol are not limited to the synergy between the MOR and α2-adrenoceptors seen at spinal levels, but are seen at this supraspinal site where suppression of responses may relate to the ability of the drug to alter affective components of pain. PMID:25576174

  15. Relationship between the Modified Modified Ashworth Scale and the Biomechanical Measure in Assessing Knee Extensor Muscle Spasticity in Patients with Post-Stroke Hemiparesia:A Pilot Study

    Directory of Open Access Journals (Sweden)

    N. Nakhostin Ansari

    2014-07-01

    Full Text Available Introduction & Objective: The Modified Modified Ashworth Scale (MMAS is a clinical meas-ure that has been recently developed for the assessment of muscle spasticity. There is a dearth of research on the validity of the MMAS. The aim of the present study was to investi-gate the relationship between the MMAS and the biomechanical measure of work-velocity slope in assessing knee extensor muscle spasticity in patients with hemiparesia. Materials & Methods: Fourteen patients with post-stroke hemiparesia were included in this cross sectional study. Knee extensor spasticity was assessed with MMAS. An isokinetic dy-namometer was used to impose knee passive flexion with the angular velocity of 10, 30, 60, and 90 °/Sec to measure Torque-angle data. Work (Joule was calculated at each velocity to determine the slope of the work-velocity curves as the biomechanical measure of muscle spasticity. Results: The mean work decreased as the velocity increased but was not statistically signifi-cant (P = 0.07. The mean slope was – 0.35 [J /(°/Sec]. There was no significant correlation between the MMAS and the work-velocity slope (r =0.31, P = 0.28. Conclusion: There was no significant relationship between the MMAS and the biomechanical measure of work-velocity slope. Further studies with larger sample size are suggested. (Sci J Hamadan Univ Med Sci 2014; 21 (2: 131-136

  16. [Changes in the Functional Connectivity of Motor Zones in the Use of Multimodal Exoskeleton Complex "Regent" in the Neurorehabilitation of Post-Stroke Patients].

    Science.gov (United States)

    Saenko, I V; Morozova, S N; Zmeykina, E A; Konovalov, R N; Chervyakov, A V; Poydasheva, A G; Chernikova, L A; Suponeva, N A; Piradov, M A; Kozlovskaya, I B

    2016-01-01

    The article discusses the effect of a course of treatment with the use of multimodal complex exoskeleton (MCE) "Regent" on the reorganization of cortical locomotor zones in 14 patients with post-stroke hemiparesis, mainly atthe chronic stage of the disease. Before the course of treatment, we identified specific areas of activation in the primary sensorimotor and supplementary motor areas and the inferior parietal lobules in both affected and healthy hemispheres by means of functional MRI (fMRI) with the use of special passive sensorimotor paradigms. After the course of treatment with MCE, we observed an improvement of temporal characteristics of walking; it was accompanied by a decrease in the activation zones of inferior parietal lobules, especially in the healthy hemisphere, and by a significant increase in the activation zone of primary sensorimotor and supplementary motor areas. The analysis of the functional connectivity of studied zones before and after the course of treatment with MCE showed significant changes in intra- and interhemispheric interactions. PMID:27188148

  17. Improvement of language functions in a chronic non-fluent post-stroke aphasic patient following bilateral sequential theta burst magnetic stimulation.

    Science.gov (United States)

    Vuksanović, Jasmina; Jelić, Milan B; Milanović, Sladjan D; Kačar, Katarina; Konstantinović, Ljubica; Filipović, Saša R

    2015-01-01

    In chronic non-fluent aphasia patients, inhibition of the intact right hemisphere (RH), by transcranial magnetic stimulation (TMS) or similar methods, can induce improvement in language functions. The supposed mechanism behind this improvement is a release of preserved left hemisphere (LH) language networks from RH transcallosal inhibition. Direct stimulation of the damaged LH can sometimes bring similar results too. Therefore, we developed a novel treatment approach that combined direct LH (Broca's area (BA)) stimulation, by intermittent theta burst stimulation (TBS), with homologue RH area's inhibition, by continuous TBS. We present the results of application of 15 daily sessions of the described treatment approach in a right-handed patient with chronic post-stroke non-fluent aphasia. The intervention appeared to improve several language functions, but most notably propositional speech, semantic fluency, short-term verbal memory, and verbal learning. Bilateral TBS modulation of activation of the language-related areas of both hemispheres seems to be a feasible and promising way to induce recovery in chronic aphasic patients. Due to potentially cumulative physiological effects of bilateral stimulation, the improvements may be even greater than following unilateral interventions.

  18. Risk factors and prediction of very short term versus short/intermediate term post-stroke mortality: a data mining approach.

    Science.gov (United States)

    Easton, Jonathan F; Stephens, Christopher R; Angelova, Maia

    2014-11-01

    Data mining and knowledge discovery as an approach to examining medical data can limit some of the inherent bias in the hypothesis assumptions that can be found in traditional clinical data analysis. In this paper we illustrate the benefits of a data mining inspired approach to statistically analysing a bespoke data set, the academic multicentre randomised control trial, U.K Glucose Insulin in Stroke Trial (GIST-UK), with a view to discovering new insights distinct from the original hypotheses of the trial. We consider post-stroke mortality prediction as a function of days since stroke onset, showing that the time scales that best characterise changes in mortality risk are most naturally defined by examination of the mortality curve. We show that certain risk factors differentiate between very short term and intermediate term mortality. In particular, we show that age is highly relevant for intermediate term risk but not for very short or short term mortality. We suggest that this is due to the concept of frailty. Other risk factors are highlighted across a range of variable types including socio-demographics, past medical histories and admission medication. Using the most statistically significant risk factors we build predictive classification models for very short term and short/intermediate term mortality.

  19. Effect of Laryngopharyngeal Neuromuscular Electrical Stimulation on Dysphonia Accompanied by Dysphagia in Post-stroke and Traumatic Brain Injury Patients: A Pilot Study

    Science.gov (United States)

    2016-01-01

    Objective To investigate the effect of laryngopharyngeal neuromuscular electrical stimulation (NMES) on dysphonia in patients with dysphagia caused by stroke or traumatic brain injury (TBI). Methods Eighteen patients participated in this study. The subjects were divided into NMES (n=12) and conventional swallowing training only (CST, n=6) groups. The NMES group received NMES combined with CST for 2 weeks, followed by CST without NMES for the next 2 weeks. The CST group received only CST for 4 weeks. All of the patients were evaluated before and at 2 and 4 weeks into the study. The outcome measurements included perceptual, acoustic and aerodynamic analyses. The correlation between dysphonia and swallowing function was also investigated. Results There were significant differences in the GRBAS (grade, roughness, breathiness, asthenia and strain scale) total score and sound pressure level (SPL) between the two groups over time. The NMES relative to the CST group showed significant improvements in total GRBAS score and SPL at 2 weeks, though no inter-group differences were evident at 4 weeks. The improvement of the total GRBAS scores at 2 weeks was positively correlated with the improved pharyngeal phase scores on the functional dysphagia scale at 2 weeks. Conclusion The results demonstrate that laryngopharyngeal NMES in post-stroke or TBI patients with dysphonia can have promising effects on phonation. Therefore, laryngopharyngeal NMES may be considered as an additional treatment option for dysphonia accompanied by dysphagia after stroke or TBI. PMID:27606266

  20. CLINICAL STUDY ON ACUPUNCTURE IN THE TREATMENT OF POST-STROKE DEPRESSION WITH THE METHOD OF ACTIVATING THE DU MERIDIAN AND CLEARING THE MIND

    Institute of Scientific and Technical Information of China (English)

    HE Xi-jun; LAI Xin-sheng; TAN Ji-lin; WANG Ben-guo

    2006-01-01

    Objective: To observe the therapeutic effect of acupuncture in the treatment of post-stroke depression (PSD) with the method of activating the Du Meridian and clearing the mind. Methods: Two hundred and thirty one cases of PSD were randomly divided into two groups, acupuncture and control groups. In acupuncture group, Baihui (百会 GV 20), Dazhui (大椎 GV 14), Neiguan (内关 PC 6), Taichong (太冲 LR 3) and Shenmen (神门 HT 7) were selected as the main points to invigorate flow of qi in the Du Meridian and clear the mind. Patients in the control group received Fluoxetine orally, 20 rng once per-day. In addition, the same routine treatments were given to both groups, strengthened with rehabilitation exercises as early as possible; 8 weeks constituted one therapeutic course. HAMD and severity of neuro-functional defect of each case were evaluated before and 8-week after the treatment. Results: The total effective rate of acupuncture group was 92.37%, the control group, 72.88%. According to x2 test, the difference between the two groups was remarkably significant (P<0.05). Conclusion: Acupuncture therapy of activating the Du Meridian and clearing the mind in the treatment of PSD was safe and effective.

  1. Research progress on rehabilitation nursing of post- stroke patients with dysphagia%脑卒中后吞咽障碍康复护理研究进展

    Institute of Scientific and Technical Information of China (English)

    阎蕾; 关风光; 周宁; 林朝芹

    2012-01-01

    Dysphagia is the independent risk factor causing death and poor prognosis of stroke patients,so taking the targeted nursing strategies earlier can promote the recovery of patients' swallowing function. It reviewed the rehabilitation nursing strategies for post - stroke patients with dysphagia from aspects of mechanism, functional evaluation tools, Chinese and Western medicine rehabilitation care strategy,so as to provide evidences for related research of rehabilitation nursing.%吞咽障碍是导致脑卒中病人死亡和预后不良的独立危险因素,早期采取针对性的康复护理策略,可促进病人吞咽功能的恢复.现从脑卒中后吞咽障碍的发生机制、功能评估工具、中西医康复护理策略方面进行综述,为康复护理相关研究提供参考.

  2. Poststroke Pain – but Multiple Pain Mechanisms

    Directory of Open Access Journals (Sweden)

    Vinjamuri Chari

    2010-01-01

    Full Text Available A 42-year-old man presented with acute left hemiplegia due to a right frontotemporal hemorrhagic stroke and left-sided pain. While the initial presentation suggested central poststroke pain, subsequent investigations also implicated heterotopic ossification of the left hip and amplification of previous low back pain by the new central pain. While heterotopic ossification has been commonly associated with brain injury, spinal cord injury or osseous injury, it is only rarely associated with stroke. Poststroke pain may be multifactorial, and discovering the pain mechanisms has important implications for treatment.

  3. Central or peripheral delivery of an adenosine A1 receptor agonist improves mechanical allodynia in a mouse model of painful diabetic neuropathy.

    Science.gov (United States)

    Katz, N K; Ryals, J M; Wright, D E

    2015-01-29

    Diabetic peripheral neuropathy is a common complication of diabetes mellitus, and a significant proportion of individuals suffer debilitating pain that significantly affects their quality of life. Unfortunately, symptomatic treatment options have limited efficacy, and often carry significant risk of systemic adverse effects. Activation of the adenosine A1 receptor (A1R) by the analgesic small molecule adenosine has been shown to have antinociceptive benefits in models of inflammatory and neuropathic pain. The current study used a mouse model of painful diabetic neuropathy to determine the effect of diabetes on endogenous adenosine production, and if central or peripheral delivery of adenosine receptor agonists could alleviate signs of mechanical allodynia in diabetic mice. Diabetes was induced using streptozocin in male A/J mice. Mechanical withdrawal thresholds were measured weekly to characterize neuropathy phenotype. Hydrolysis of AMP into adenosine by ectonucleotidases was determined in the dorsal root ganglia (DRG) and spinal cord at 8 weeks post-induction of diabetes. AMP, adenosine and the specific A1R agonist, N(6)-cyclopentyladenosine (CPA), were administered both centrally (intrathecal) and peripherally (intraplantar) to determine the effect of activation of adenosine receptors on mechanical allodynia in diabetic mice. Eight weeks post-induction, diabetic mice displayed significantly decreased hydrolysis of extracellular AMP in the DRG; at this same time, diabetic mice displayed significantly decreased mechanical withdrawal thresholds compared to nondiabetic controls. Central delivery AMP, adenosine and CPA significantly improved mechanical withdrawal thresholds in diabetic mice. Surprisingly, peripheral delivery of CPA also improved mechanical allodynia in diabetic mice. This study provides new evidence that diabetes significantly affects endogenous AMP hydrolysis, suggesting that altered adenosine production could contribute to the development of

  4. 西酞普兰通过免疫调节机制治疗脑卒中后抑郁状态%Citalopram in treatment of post stroke depression through its immunoregulatory mechanism

    Institute of Scientific and Technical Information of China (English)

    王姗姗; 姜磊

    2013-01-01

    Objective To study the expression of TNFα in hypothalamus of rats by observing post stroke depression and its pathogenesis after citalopram treatment .Methods Eighteen rats that underwent open field test were randomly divided into the control group (n=6) and experimental group (n= 12 ). The rats in experimental group were further divided into post stroke depression group (n=6) and citalopram treatment group (n= 6) after left middle cerebral artery occlusion . Behaviors in these two groups were observed by open field test and sugar-water test ,respectively . Expression of TNF-α mRNA in hypothalamus of rats was detected by quantitative polymerase dhain reaction .Results The levels of horizontal and vertical activities and the preference for sug -ar-water were significantly lower in post stroke depression group than in control group (P<0 .01) and significantly higher in citalopram treatment group than in post stroke depression group (P< 0.05). The TNF-α mRNA expression level in hypothalamus was significantly higher in post stroke depression group than in control group (P<0 .05) and significantly lower in post stroke depression group than in citalopram treatment group (P<0 .05 ) .Conclusion Citalopram exerts its therapeutic effect on post stroke depression by down-regulating the expression of TNF-α in hypothalamus of rats .%目的 本研究通过观察脑卒中后抑郁(post stroke depression,PSD)大鼠给予抗抑郁药物西酞普兰干预后,观察下丘脑TNF-α的表达变化,并探讨PSD发病机制和潜在的药物治疗机制.方法 经旷场实验筛选出18只大鼠,随机分为对照组6只,另12只大鼠经过单侧大脑中动脉线栓法后,又随机分为PSD组6只和西酞普兰组6只,经慢性不可预见性应激后,通过旷场实验和糖水实验观察各组大鼠的行为学改变,定量PCR检测各组大鼠下丘脑TNF-α mRNA的表达改变.结果 与对照组比较,PSD组的水平活动、直立探索和糖水喜好明显下

  5. The risk factors for malnutrition in post-stroke patients%影响卒中后患者营养不良相关因素的研究

    Institute of Scientific and Technical Information of China (English)

    杨江胜; 王少石; 周晓宇; 陈真理; 刘春风; 沈月平; 郝俊杰

    2009-01-01

    目的 调查社区医院住院的卒中后患者营养不良的检出率以探讨影响恢复期卒中患者营养不良的相关因素.方法 采用横断面研究,以438例社区医院住院的卒中后患者为研究对象,记录营养学评定指标及可能导致营养不良的相关因素.结果 438例卒中后患者营养不良的检出率达52.7%;多因素logistic回归分析显示:卒中次数越多、美国国立卫生研究院卒中评分及Rankin残障量表评分分值越高,检出营养不良的风险越大(趋势检验P<0.0001),营养不良的风险还与卒中后抑郁、家庭照料差、未进行早期康复及大量饮酒史相关.结论 社区医院卒中后患者营养不良检出率高、影响因素多,关注卒中后患者营养状况的可控因素有利于卒中预后.%Objective To investigate the detection rate of malnutrition among post-stroke patients in community hospitals and unravel the relevant factors that precipitate malnutrition after stroke. Methods Based on 438 post-stroke patients who were admitted in community hospitals, we examined the demographic characteristics, the nutritional indices and the possible malnutrition related factors through a cross-sectional study.Results The detection rate of malnutrition among post-stroke patients was 52.7%. Group comparison through multivariate logistic regression analysis showed that there was a higher malnutrition detection rate in the post-stroke patients with multiple stroke attacks (three stroke attackes and above, OR = 11.00,95%CI 1. 14-106.34), higher NIHSS scores (group with NIHSS≥15, OR=7.09, 95% CI 2.90-17.36) , higher modified Rankin scales (group mRS 4-5, OR = 15. 77,95% CI 6.61-37.59) (trend test P<0.0001) .The risk of malnutrition was also correlated with the post-stroke depression, poorer family care, no early-stage rehabilitation, history of malignant tumors and severe alcoholism. Conclusions There is a high detection rate of malnutrition among post-stroke patients in

  6. Are There Abnormalities in Peripheral and Central Components of Somatosensory Evoked Potentials in Non-Specific Chronic Low Back Pain?

    Science.gov (United States)

    Puta, Christian; Franz, Marcel; Blume, Kathrin R.; Gabriel, Holger H. W.; Miltner, Wolfgang H. R.; Weiss, Thomas

    2016-01-01

    Chronic low back pain (CLBP) was shown to be associated with longer reflex response latencies of trunk muscles during external upper limb perturbations. One theoretical, but rarely investigated possibility for longer reflex latencies might be related to modulated somatosensory information processing. Therefore, the present study investigated somatosensory evoked potentials (SEPs) to median nerve stimulation in CLBP patients and healthy controls (HC). Latencies of the peripheral N9 SEP component were used as the primary outcome. In addition, latencies and amplitudes of the central N20 SEP component, sensory thresholds, motor thresholds and nerve conduction velocity were also analyzed in CLBP patients and HC. There is a trend for the CLBP patients to exhibit longer N9 latencies at the ipsilateral Erb’s point compared to HC. This trend is substantiated by significantly longer N9 latencies in CLBP patients compared to normative data. None of the other parameters showed any significant difference between CLBP patients and HC. Overall, our data indicate small differences of the peripheral N9 SEP component; however, these differences cannot explain the reflex delay observed in CLBP patients. While it was important to rule out the contribution of early somatosensory processing and to elucidate its contribution to the delayed reflex responses in CLBP patients, further research is needed to find the primary source(s) of time-delayed reflexes in CLBP. PMID:27799904

  7. Pain genes.

    Directory of Open Access Journals (Sweden)

    Tom Foulkes

    2008-07-01

    Full Text Available Pain, which afflicts up to 20% of the population at any time, provides both a massive therapeutic challenge and a route to understanding mechanisms in the nervous system. Specialised sensory neurons (nociceptors signal the existence of tissue damage to the central nervous system (CNS, where pain is represented in a complex matrix involving many CNS structures. Genetic approaches to investigating pain pathways using model organisms have identified the molecular nature of the transducers, regulatory mechanisms involved in changing neuronal activity, as well as the critical role of immune system cells in driving pain pathways. In man, mapping of human pain mutants as well as twin studies and association studies of altered pain behaviour have identified important regulators of the pain system. In turn, new drug targets for chronic pain treatment have been validated in transgenic mouse studies. Thus, genetic studies of pain pathways have complemented the traditional neuroscience approaches of electrophysiology and pharmacology to give us fresh insights into the molecular basis of pain perception.

  8. 首发脑卒中后抑郁与脑卒中部位的关系%The relationship between the first onset post-stroke depression and stroke position

    Institute of Scientific and Technical Information of China (English)

    何春艳; 杨平生; 伍苏方

    2014-01-01

    目的:探讨首发脑卒中患者卒中部位与卒中后抑郁的关系。方法选择78例首发脑卒中患者,按照是否发生抑郁症分为脑卒中后抑郁组(观察组)及脑卒中后无抑郁组(对照组),观察脑卒中后抑郁患病率及卒中部位与发生卒中后抑郁的关系。结果脑卒中后抑郁患病率为12.82%,与对照组比较,观察组发生在左侧、皮质部位的发生率明显增加,差异有统计学意义(P<0.05)。结论脑卒中患者卒中部位与卒中后抑郁具有相关性。%Objective To study the correlation between the first onset post-stroke depression and stroke position. Methods Selected 78 cases with the first onset stroke,according to whether depression onset or not,they were divided into post-stroke depression group (observe group),and post-stroke non depression group (control group),the correlation of prevalence of depression after stroke,parts of the stroke with poststroke depression were observed. Results Incidence rate of depression after stroke was 12.82%,compared with control group,observation group patients’ onset at left and cortex position obviously increased,the differences had statistical significance (P<0.05). Conclusion Among stroke pa-tients stroke position have correlation with post-stroke depression onset.

  9. 中医康复治疗脑卒中后抑郁的研究近况%Research Status of Applying Traditional Chinese Medicine Rehabilitation to Treat Post-stroke Depression

    Institute of Scientific and Technical Information of China (English)

    蒋成志; 苏海林; 林红旭; 黄正超; 冯玉芝

    2014-01-01

    Post-stroke depression is one of the common complications of stroke.It affects the quality and level of life of the patients,especially affects the rehabilitation after the stroke,and even the stroke may occur again.The Traditional Chinese Medicine rehabilitation therapy in improving post-stroke depression has its characteristics.The author may outline the Traditional Chinese Medicine rehabilitation therapy of post-stroke depression in recent years.%脑卒中后抑郁是脑卒中常见的并发症之一,影响患者生活质量和水平,尤其严重影响了患者脑卒中后的康复,甚至导致脑卒中的再次发生可能,中医康复治疗在改善脑卒中后抑郁方面有其特色,笔者也从近年来中医康复治疗脑卒中后抑郁方面进行了概述.

  10. 舌三针合金津玉液治疗脑卒中后吞咽障碍临床观察%Clinical observation on treating post-stroke dysphagia by tongue Three-needle and Jinjin Yuye point

    Institute of Scientific and Technical Information of China (English)

    刘麒麟; 邱厚道

    2014-01-01

    Objective:To observe curative effects of tongue Three-needle and Jinjin Yuye point on treating post-stroke dysphagia. Methods:64 patients with post-stroke dysphagia were randomly divided into control group of 31cases and experimental group of 33cases. All the patients received regular medication, and experimental group receiving acupuncture with tongue Three-needle and prick bloodletting with Jinjinyuye point in addition. Result:Compared with control group,experimental group was better in cured rate and total efficacy rate. Conclusion:Tongue Three-needle and Jinjin Yuye point has good curative effect on treating post-stroke dysphagia.%目的:观察舌三针合金津玉液治疗脑卒中后吞咽障碍的临床疗效。方法:将64例患者随机分为治疗组33例,对照组31例,两组均予常规药物治疗,治疗组加用针刺舌三针及点刺金津玉液放血。结果:治疗组的治愈率及总有效率优于对照组。结论:舌三针合金津玉液对于治疗脑卒中后吞咽障碍有良好的疗效。

  11. Effects of Electroacupuncture on Pain Threshold of Laboring Rats and the Expression of Norepinephrine Transporter and α2 Adrenergic Receptor in the Central Nervous System

    Directory of Open Access Journals (Sweden)

    Qianli Tang

    2016-01-01

    Full Text Available To observe the effects of electroacupuncture on pain threshold of laboring rats and the expression of norepinephrine transporter and α2 adrenergic receptor in the central nervous system to determine the mechanism of the analgesic effect of labor. 120 pregnant rats were divided into 6 groups: a control group, 4 electroacupuncture groups, and a meperidine group. After interventions, the warm water tail-flick test was used to observe pain threshold. NE levels in serum, NET, and α2AR mRNA and protein expression levels in the central nervous system were measured. No difference in pain threshold was observed between the 6 groups before intervention. After intervention, increased pain thresholds were observed in all groups except the control group with a higher threshold seen in the electroacupuncture groups. Serum NE levels decreased in the electroacupuncture and MP groups. Increases in NET and α2AR expression in the cerebral cortex and decreases in enlarged segments of the spinal cord were seen. Acupuncture increases uptake of NE via cerebral NET and decreases its uptake by spinal NET. The levels of α2AR are also increased and decreased, respectively, in both tissues. This results in a decrease in systemic NE levels and may be the mechanism for its analgesic effects.

  12. Efficacy of two cannabis based medicinal extracts for relief of central neuropathic pain from brachial plexus avulsion: results of a randomised controlled trial.

    Science.gov (United States)

    Berman, Jonathan S; Symonds, Catherine; Birch, Rolfe

    2004-12-01

    The objective was to investigate the effectiveness of cannabis-based medicines for treatment of chronic pain associated with brachial plexus root avulsion. This condition is an excellent human model of central neuropathic pain as it represents an unusually homogenous group in terms of anatomical location of injury, pain descriptions and patient demographics. Forty-eight patients with at least one avulsed root and baseline pain score of four or more on an 11-point ordinate scale participated in a randomised, double-blind, placebo-controlled, three period crossover study. All patients had intractable symptoms regardless of current analgesic therapy. Patients entered a baseline period of 2 weeks, followed by three, 2-week treatment periods during each of which they received one of three oromucosal spray preparations. These were placebo and two whole plant extracts of Cannabis sativa L.: GW-1000-02 (Sativex), containing Delta(9)tetrahydrocannabinol (THC):cannabidiol (CBD) in an approximate 1:1 ratio and GW-2000-02, containing primarily THC. The primary outcome measure was the mean pain severity score during the last 7 days of treatment. Secondary outcome measures included pain related quality of life assessments. The primary outcome measure failed to fall by the two points defined in our hypothesis. However, both this measure and measures of sleep showed statistically significant improvements. The study medications were generally well tolerated with the majority of adverse events, including intoxication type reactions, being mild to moderate in severity and resolving spontaneously. Studies of longer duration in neuropathic pain are required to confirm a clinically relevant, improvement in the treatment of this condition. PMID:15561385

  13. Clinical analysis of post-stroke depression disorder%脑卒中后抑郁障碍的临床分析

    Institute of Scientific and Technical Information of China (English)

    周玉颖; 王艳; 王景华; 宁宪嘉

    2012-01-01

    Objective To analyze the relative pathiogenetic factors for post-stroke depression disor-der(PSDD). Methods Six hundred and ninety-seven cerebral stroke patients were enrolled in this study. Their gender, age .cerebral stroke type and foci,NIHSS score,Barthel index(BI) and Hamilton rating scale score were recorded. The incidence of different PSDD types was compared. Results The incidence of cerebral hemorrhage was significantly higher in PSDD patients than in cerebral infarction patients at admission(26. 6% vs 16. 3% , f = 6. 48, P = 0. 01). The NIHSS score was significantly higher while the BI was significantly lower in PSDD patients than in non-PSDD patients at admission(6. 00 +4. 60 vs 4. 52 + 3. 74,57. 40?6. 50 vs 68. 16 + 25. 76,P< 0. 01). The NIHSS score was positively related while the BI was negatively related with the occurrence of PSDD. Logistic regression analysis showed that the BI was a protective factor for PSDD(Oi? = 0. 98,95%C7:0. 98-0. 99,P<0. 01). Conclusion PSDD is related with the stroke type,NIHSS score and BI.%目的 分析脑卒中后抑郁障碍(post-stroke depression disorder,PSDD)的发病相关因素.方法 对入选的697例脑率中患者的性别、年龄、脑卒中类型、脑卒中病灶部位、美国国立卫生研究院脑卒中量表( National Institutes of Health Stroke Scale,NIHSS)神经功能缺损程度评分、Barthel指数(BI)、汉密尔顿抑郁量表评分(Hamilton Rating Scale for Depression,HAMD)进行记录,并对不同分类中PSDD发生率进行比较.结果 脑出血PSDD发生率明显高于脑梗死PSDD发生率(26.6% vs 16.3%,x2=6.48,P=0.01).PSDD患者入院时NIHSS评分明显高于无PSDD患者[(6.00±4.60)分vs (4.52±3.74)分],BI评分明显低于无PSDD患者[(57.40±26.54)分vs (68.16±25.76)分],差异有统计学意义(P<0.01).PSDD患者入院时NIHSS评分HAMD呈正相关(r=0.21,P<0.01),入院时BI评分与HAMD呈负相关(r=-0.18,P<0.01).logistic回归分析显示,入院时BI评分是抑郁

  14. 脑卒中后抑郁症的危险因素分析%The risk factors of post-stroke depression

    Institute of Scientific and Technical Information of China (English)

    陈光军; 鲁世华

    2011-01-01

    目的 探讨脑卒中后抑郁症(PSD)的危险因素.方法 对196例脑卒中患者行头颅MRI或头颅CT检查以明确诊断,发病后6周内多次对患者进行汉密尔顿抑郁量表(HAMD)评分,共有65人确诊为PSD,分析PSD的发生与性别、年龄、文化程度、卒中性质、日常生活能力、独立行走和发病部位的关系.结果 日常生活能力明显障碍或不能独立行走的脑卒中患者PSD的发病率明显高于日常生活能力无明显障碍或能独立行走的患者(P<0.05).左侧额叶卒中患者PSD的发病率高于其他部位脑卒中患者(P<0.05).性别、年龄、文化程度、卒中性质不同的脑卒中患者PSD发生率差异无统计学意义.结论 急性期脑卒中患者PSD的发生与日常生活能力明显障碍、不能独立行走、左侧额叶卒中有关.%Objective To explore risk factors of post-stroke depression (PSD). Methods 196 stroke patients were diagnosed by MRI or CT. All patients were tested many times by the Hamilton Depression Scale ( HAMD) in six week after stroke and 65 patients with post-stroke depression were diagnosed. To analyze the relationship between PSD and the stroke patients with gender, age, culture level, stroke type, activity of dailing living, independent ambulation and lesion location. Results Patients with dependent ambulation or obviously disorder in activity of dailing living had higher incidence of PSD than that with independent ambulation or without obviously disorder in activity of dailing living (P < 0.05 ). Left frontal lobe lesion has higher incidence of PSD than the other location lesion in the brain (P<0.05). There was no difference in the incidence of PSD in stroke patients with different gender,age,culture level or stroke type (P≥0.05). Conclusion PSD is related to dependent ambulation,obviously disorder in activity and left frontal lobe lesion.

  15. Investigation and analysis of post-stroke depression%卒中后患者抑郁情绪调查及相关因素分析

    Institute of Scientific and Technical Information of China (English)

    叶海霞; 李世林

    2014-01-01

    目的:调查卒中后患者抑郁发病情况并分析其影响因素。方法选择188例脑卒中后患者,采用自制一般情况调查表、艾森克人格问卷(EPQ )、社会支持量表、美国国立卫生研究院神经系统疾病与卒中研究所卒中量表(NIHSS )及HAMILTON抑郁量表(HAMD)评价脑卒中后患者的人格特征、社会支持情况、神经功能缺损情况、抑郁状态,并分析其影响因素。结果188例脑卒中后抑郁患者,合并卒中后抑郁112例,发生率59.57%,其中轻度抑郁62例(55.36%),中度抑郁46例(41.07%);重度抑郁4例(3.57%)。卒中后抑郁组与非抑郁组比较,在性别、年龄、经济收入、合并脑卒中危险因素、人格特征、社会支持分、社会支持利用度及神经功能缺损情况等方面差异有统计学意义,而在文化程度、脑卒中性质等方面无统计学差异,表明性别、年龄、经济收入、合并脑卒中危险因素、人格特征、社会支持利用度及神经功能缺损情况与卒中后抑郁的发生可能有关。结论医护人员应高度重视卒中后患者的抑郁情绪对疾病康复和疗效的影响,从多维度进行干预来改善患者的抑郁情绪,以促进其早日康复。%Objective To investigate the incidence of post-stroke depression(PSD) and to analyze the related factors .Meth-ods 188 patients with stroke were assessed by self-designed general questionnaire ,Eysenck Personality Questionnaire (EPQ) , Social Support Scale ,the NIH Institute of neurological diseases and Stroke Stroke Scale (NIHSS) and HAMILTON depression Scale (HAMD) to evaluate the personality characteristics ,social support ,neurological deficit ,the depression of patients after stroke ,and the related factors were analyzed .Results The incidence of PSD was 59 .57% ,including 32 .98% of mild patients , 24 .47% of moderate patients and 2 .13% of severe patients .Compared post-stroke

  16. Exploring the impact of laterality and polarity of tDCS on therapy for post-stroke anomia: A case study

    Directory of Open Access Journals (Sweden)

    Anna M. Woollams

    2015-05-01

    Full Text Available Anomia is a frequent and persistent symptom of post-stroke aphasia. Cortical neuroplasticity plays a significant role in language recovery following stroke and can be facilitated by behavioural speech and language therapy (e.g. Fridriksson et al., 2012. Existing research suggests that complementing therapy for anomia with neurostimulation techniques (such as transcranial Direct Current Stimulation, or tDCS can lead to greater therapeutic gains, with studies suggesting that applying anodal (excitatory tDCS to the left hemisphere and/or cathodal (inhibitory tDCS to the right hemisphere may be particularly beneficial (e.g. Baker et al., 2010; Rosso et al., 2014. However, the effects of varying both polarity and laterality of tDCS have yet to be systematically investigated. The primary aim of the current study was to determine the optimal tDCS parameters to increase naming ability in an 81 year old right-handed male (JS with chronic non-fluent post stroke anomia. Results of a pre-therapy screening assessment were used to create 12, 20-item therapy sets (6 treated and 6 untreated, matched across a range of psycholinguistic variables. JS completed two therapy runs over 7 months. The three therapy conditions within each run involved either anodal, cathodal or sham stimulation. Stimulation sites were determined on the basis of a previous MRI structural scan. In the first run, stimulation targeted the perilesional left inferior frontal gyrus (IFG and in the second run, stimulation targeted its right homologue. In all six cycles, JS received 20 minutes of 1mA tDCS (electrodes 5cm x 7cm on three consecutive days alongside computerised naming therapy. In the sham conditions, anodal stimulation was applied for one minute before being slowly turned off. The percentage of correctly named treated items increased in all conditions immediately following therapy. As shown in the Figure, for items consistently incorrect over both of the screening sessions, only the

  17. Comparing the production of complex sentences in Persian patients with ‎post-stroke aphasia and non-damaged people with normal speaking

    Directory of Open Access Journals (Sweden)

    Azar Mehri

    2016-01-01

    Full Text Available Background: Cerebrovascular disease leading to stroke is the most common cause of aphasia. Speakers with agrammatic non-fluent aphasia have difficulties in production of movement-derived sentences such as passive sentences, topicalized constituents, and Wh-questions. To assess the production of complex sentences, some passive, topicalized and focused sentences were designed for patients with non-fluent Persian aphasic. Afterwards, patients’ performance in sentence production was tested and compared with healthy non-damaged subjects.Methods: In this cross sectional study, a task was designed to assess the different types of sentences (active, passive, topicalized and focused adapted to Persian structures. Seven Persian patients with post-stroke non-fluent agrammatic aphasia (5 men and 2 women and seven healthy non-damaged subjects participated in this study. The computed tomography (CT scan or magnetic resonance imaging (MRI showed that all the patients had a single left hemisphere lesion involved middle cerebral artery (MCA, Broca`s area and in its white matter. In addition, based on Bedside version of Persian Western Aphasia Battery (P-WAB-1, all of them were diagnosed with moderate Broca aphasia. Then, the production task of Persian complex sentences was administered.Results: There was a significant difference between four types of sentences in patients with aphasia [Degree of freedom (df = 3, P < 0.001]. All the patients showed worse performance than the healthy participants in all the four types of sentence production (P < 0.050.Conclusion: In general, it is concluded that topicalized and focused sentences as non-canonical complex sentences in Persian are very difficult to produce for patients with agrammatic non-fluent aphasia. It seems that sentences with A-movement are simpler for the patients than sentences involving A`-movement; since they include shorter movements in compare to topicalized and focused sentences.

  18. A Human-machine-interface Integrating Low-cost Sensors with a Neuromuscular Electrical Stimulation System for Post-stroke Balance Rehabilitation.

    Science.gov (United States)

    Kumar, Deepesh; Das, Abhijit; Lahiri, Uttama; Dutta, Anirban

    2016-04-12

    A stroke is caused when an artery carrying blood from heart to an area in the brain bursts or a clot obstructs the blood flow to brain thereby preventing delivery of oxygen and nutrients. About half of the stroke survivors are left with some degree of disability. Innovative methodologies for restorative neurorehabilitation are urgently required to reduce long-term disability. The ability of the nervous system to reorganize its structure, function and connections as a response to intrinsic or extrinsic stimuli is called neuroplasticity. Neuroplasticity is involved in post-stroke functional disturbances, but also in rehabilitation. Beneficial neuroplastic changes may be facilitated with non-invasive electrotherapy, such as neuromuscular electrical stimulation (NMES) and sensory electrical stimulation (SES). NMES involves coordinated electrical stimulation of motor nerves and muscles to activate them with continuous short pulses of electrical current while SES involves stimulation of sensory nerves with electrical current resulting in sensations that vary from barely perceivable to highly unpleasant. Here, active cortical participation in rehabilitation procedures may be facilitated by driving the non-invasive electrotherapy with biosignals (electromyogram (EMG), electroencephalogram (EEG), electrooculogram (EOG)) that represent simultaneous active perception and volitional effort. To achieve this in a resource-poor setting, e.g., in low- and middle-income countries, we present a low-cost human-machine-interface (HMI) by leveraging recent advances in off-the-shelf video game sensor technology. In this paper, we discuss the open-source software interface that integrates low-cost off-the-shelf sensors for visual-auditory biofeedback with non-invasive electrotherapy to assist postural control during balance rehabilitation. We demonstrate the proof-of-concept on healthy volunteers.

  19. Post-Stroke Depression Modulation and in Vivo Antioxidant Activity of Gallic Acid and Its Synthetic Derivatives in a Murine Model System

    Directory of Open Access Journals (Sweden)

    Seyed Fazel Nabavi

    2016-04-01

    Full Text Available Gallic acid (3,4,5-trihydroxybenzoic acid, GA is a plant secondary metabolite, which shows antioxidant activity and is commonly found in many plant-based foods and beverages. Recent evidence suggests that oxidative stress contributes to the development of many human chronic diseases, including cardiovascular and neurodegenerative pathologies, metabolic syndrome, type 2 diabetes and cancer. GA and its derivative, methyl-3-O-methyl gallate (M3OMG, possess physiological and pharmacological activities closely related to their antioxidant properties. This paper describes the antidepressive-like effects of intraperitoneal administration of GA and two synthetic analogues, M3OMG and P3OMG (propyl-3-O-methylgallate, in balb/c mice with post-stroke depression, a secondary form of depression that could be due to oxidative stress occurring during cerebral ischemia and the following reperfusion. Moreover, this study determined the in vivo antioxidant activity of these compounds through the evaluation of superoxide dismutase (SOD and catalase (Cat activity, thiobarbituric acid-reactive substances (TBARS and reduced glutathione (GSH levels in mouse brain. GA and its synthetic analogues were found to be active (at doses of 25 and 50 mg/kg in the modulation of depressive symptoms and the reduction of oxidative stress, restoring normal behavior and, at least in part, antioxidant endogenous defenses, with M3OMG being the most active of these compounds. SOD, TBARS, and GSH all showed strong correlation with behavioral parameters, suggesting that oxidative stress is tightly linked to the pathological processes involved in stroke and PSD. As a whole, the obtained results show that the administration of GA, M3OMG and P3OMG induce a reduction in depressive symptoms and oxidative stress.

  20. Dor: aspectos atuais da sensibilização periférica e central Dolor: aspectos actuales de la sensibilización periférica y central Pain: current aspects on peripheral and central sensitization

    Directory of Open Access Journals (Sweden)

    Anita Perpétua Carvalho Rocha

    2007-02-01

    conducción nerviosa central y periférica.BACKGROUND AND OBJECTIVES: Current research has focused on the biochemical and structural plasticity of the nervous system secondary to tissue injury. The mechanisms involved in the transition from acute to chronic pain are complex and involve the interaction of receptor systems and the flow of intracellular ions, second messenger systems, and new synaptic connections. The aim of this article was to discuss the new mechanisms concerning peripheral and central sensitization. CONTENTS: Tissue injury increases the response of nociceptors, known as sensitization or facilitation. These phenomena begin after the local release of inflammatory mediators and the activation of the cells of the immune system or specific receptors in the peripheral and central nervous system. CONCLUSIONS: Tissue and neuronal lesions result in sensitization of the nociceptors and facilitation of the central and peripheral nervous conduction.

  1. Neurofeedback therapy in patients with acute and chronic pain syndromes--literature review and own experience.

    Science.gov (United States)

    Kubik, Alicja; Biedroń, Agnieszka

    2013-01-01

    Pain management is based mainly on pharmacotherapy which has many limitations. Non-pharmacological techniques, like neurofeedback (EEG-biofeedback) are alternative methods of pain treatment. Data from literature confirm high efficacy of neurofeedback in pain syndromes treatment, chronic and acute as well. Neurofeedback plays an important role in management of post stroke, post traumatic headaches and in primary headaches like tension type headaches or migraine. Literature review and own experience indicate importance of number and frequency of performed neurofeedback trainings on treatment effectiveness. Satisfactory results have already been observed after 30 trainings however usually 40-60 training have to be performed. Effectiveness of such therapy in pain syndromes is usually good or less often acceptable (50% reduction of headaches). Children with tension type headaches (differently than adults) need reminder therapy every 6-12 months, otherwise recurrence of headaches is observed. Based on our own experience neurofeedback therapy seems to play role in neuropathic pain and cancer pain management.

  2. Neuropathic pain

    Directory of Open Access Journals (Sweden)

    Giuseppe Re

    2009-02-01

    Full Text Available Neuropathic pain is the expression of a dysfunction or primary lesion of a nerve in the peripheral or central nervous system, or both, rather than the biological signal transmitted by the nerve following peripheral nociceptor activation. It represents about 20% of all painful syndromes, with an estimated prevalence of 1.5%, however is actual incidence is hard to pinpoint due to the difficulties encountered in distinguishing it from chronic pain, of which it represents a significant percentage, on account of the not infrequent concurrence of conditions. It is crucial to recognise the variety of symptoms with which it can present: these can be negative and positive and, in turn, motor, sensitive and autonomic. In public health terms, it is important to emphasise that the diagnosis of neuropathic pain does not in most cases require sophisticated procedures and does not therefore weigh on health expenditure. In clinical practice, a validated scale (the LANSS is mentioned is useful for identifying patients presenting neuropathic pain symptoms. Therapy is based on three categories of medication: tricyclic antidepressants, anti-epileptics and opioids at high doses: neuropathic pain has a bad reputation for often resisting common therapeutic approaches and responding less well that nociceptor pain to monotherapy. Therapeutic strategies are all the more adequate the more they are based on symptoms and therefore on the pain generation mechanisms, although the recommendations are dictated more by expert opinions that double-blind randomised trials.

  3. Peripheral Pain Mechanisms in Chronic Widespread Pain

    OpenAIRE

    Staud, Roland

    2011-01-01

    Clinical symptoms of chronic widespread pain (CWP) conditions including fibromyalgia (FM), include pain, stiffness, subjective weakness, and muscle fatigue. Muscle pain in CWP is usually described as fluctuating and often associated with local or generalized tenderness (hyperalgesia and/or allodynia). This tenderness related to muscle pain depends on increased peripheral and/or central nervous system responsiveness to peripheral stimuli which can be either noxious (hyperalgesia) or non-noxiou...

  4. Altered pain perception in children with chronic tension-type headache: Is this a sign of central sensitisation?

    DEFF Research Database (Denmark)

    Soee, AL; Thomsen, LL; Kreiner, S;

    2013-01-01

    The aim of this article is to investigate if children (7-17 years) with frequent episodic tension-type headache (FETTH) or chronic TTH (CTTH) have an altered pain perception compared to healthy controls....

  5. Pain and modulation processes

    Directory of Open Access Journals (Sweden)

    Ghaffarpoor M

    1997-08-01

    Full Text Available Pain is one of the most important and sometimes difficult problems, that patients and physicians are encountered. It may be clinically acute or chronic, acute pain has usually definite cause and favourable response to treatment. On the other hand there are difficulties in diagnosis and management of chronic pain. Peripheral and cranial nerves convey pain impulses toward central nervous system, and modulations take place at several levels. Diagnosis of different pains, including nociceptive, nerve trunk pain and deafferentation types is essential to acceptable management. In this article we review pain pathway, neurotransmitters and modulation.

  6. Effect of Occupational Therapy on Post Stroke Depression%作业疗法对卒中后抑郁的疗效①

    Institute of Scientific and Technical Information of China (English)

    由丽; 赵鹏; 刘莉; 饶江; 邵伟波

    2013-01-01

      目的探讨作业疗法对卒中后抑郁患者抑郁情绪及日常生活活动能力(ADL)的作用。方法42例卒中后抑郁患者分为作业组和对照组,各21例。在常规治疗基础上,作业组强化ADL训练,并针对性地进行文体活动和音乐欣赏。治疗前后采用改良Bathel指数(MBI)及汉密尔顿抑郁量表(HAMD)进行效果评价。结果4周后两组MBI评分显著提高,HAMD评分显著下降(P<0.001),且作业组改善明显优于对照组(P<0.01)。结论作业疗法不仅能提高卒中后抑郁患者的ADL,且有利于抑郁情绪的改善。%Objective To explore the effect of occupational therapy (OT) on the depressive mood and activity of daily living (ADL) in patients with post stroke depression (PSD). Methods 42 patients with PSD were divided into OT group (n=21) and control group (n=21). Both 2 groups received routine therapy, and OT group received ADL training, selective recreation and sport and appreciation of music in ad-dition. They were evaluated by modified Bathel index (MBI) and Hamilton Self-rating Scale for Depression (HAMD) before and after treat-ment. Results The scores of MBI increased and the scores of HAMD decreased significantly after 4 weeks in both 2 groups (P<0.001), espe-cially in the OT group (P<0.01). Conclusion OT can improve not only ADL, but also the depressive mood in patients with PSD.

  7. The effect of social support on the post-stroke depression patients%社会支持对脑卒中后抑郁患者的影响

    Institute of Scientific and Technical Information of China (English)

    靳玲; 陈鹏莉; 马晓华

    2010-01-01

    目的 了解脑卒中患者社会支持情况,探讨社会支持对脑卒中后抑郁(PSD)患者的影响.方法 采用一般资料调查表、抑郁自评量表(SDS)、社会支持评定量表对205例脑卒中患者进行调查,并对资料进行统计学分析.结果 脑卒中后抑郁的发生率为61.4%,统计学分析显示,脑卒中后抑郁与患者年龄、患病种数有关.年龄在60岁及以下的患者,其抑郁发生率高于年龄在60岁以上的患者.不伴有高血压、糖尿病、心脏病、高脂血症的脑卒中患者,其抑郁发生率高于患病种数为一种及以上的患者.脑卒中后抑郁组与非抑郁组在客观支持分、主观支持分、支持利用度和总分之间无统计学差异(P>0.05).社会支持各维度与脑卒中后抑郁未见明显相关性.结论 未见社会支持与脑卒中后抑郁存在相关性.%Objective To investigate the social support condition of post-stroke patients and to explore the influence of social support to the patients with post-stroke depression.Methods The data from 205 post-stroke patients who were evaluated by SDS,SSRS were analyzed statistically.Results The incidence rate ofpost-stroke depression was 61.4%.The incidence rate of post-stroke depression in younger people(younger than 60 years include 60)was higher than those of the older people(older than 60 years).The incidence rate of people who had no disease(hypertention,diabets meIlitus,heart disease)was higher than those the people who had disease There was no statistical difference in every part of social support between depression group and non-depression group.There wa8 no significant correlation every part of social support and post-stroke depression.Conclusions There was no significant correlation between every part of social support and post-stroke depression.

  8. Disfunción sexual asociada al uso de gabapentina en el tratamiento del dolor central Associated sexual dysfunction to the use of gabapentin in the treatment of the central pain

    Directory of Open Access Journals (Sweden)

    E. Calderón

    2006-06-01

    Full Text Available El dolor neuropático de origen central es uno de los síndromes dolorosos más complejos, su tratamiento es difícil y, en general, poco satisfactorio. Gabapentina (GBP es un anticonvulsivante usado en el tratamiento de la epilepsia, dolor neuropático, desórdenes bipolares, y es generalmente bien tolerado. Los anticonvulsivantes de segunda generación cuentan entre sus ventajas con una menor incidencia de efectos secundarios. No obstante, estamos hablando de fármacos relativamente nuevos, sobre todo para su utilización al margen de los trastornos no epilépticos, como es el caso del dolor neuropático, por lo que es necesario un estudio y seguimiento más completo de sus posibles efectos secundarios. Presentamos 2 casos de disfunción sexual en hombre y mujer en relación con la administración de gabapentina para control del dolor de origen central. El aumento de la concentración de serotonina podría ser la causa de las alteraciones sexuales relacionadas con el tratamiento con GBP a las dosis utilizadas en nuestros pacientes, superiores a 1.800 mg/día. Este efecto es dosis-dependiente y el tratamiento consiste en disminuir o ajustar la dosis para maximizar el intervalo de tiempo entre la toma previa y el acto sexual.The neuropathic central pain, is one of the more complex painful syndromes, its treatment is difficult and, in general, little satisfactory. Gabapentin (GBP, it is a anticon-vulsant used in the treatment of the epilepsy, neuropathic pain, disorder bipolar, and it is generally well tolerated The anticonvulsants of second generation count between their advantages with a smaller incidence of secondary effects. However, we are considering of relatively new drugs, mainly for its use to the margin of epilepsy, as it is the case of the neuropathic pain. For this reason it is necessary a study and more complete pursuit of its possible secondary effects. We presented 2 cases of sexual dysfunction in a man and a woman in relation to

  9. 综合康复对中风后肩手综合征的疗效观察%The Curative Effect of comprehensive rehabilitation in post-stroke shoulder-hand syndrome

    Institute of Scientific and Technical Information of China (English)

    姜贺; 刘阳; 王伟祥

    2013-01-01

    目的:观察综合康复对中风后肩手综合征的疗效。方法选择60例中风后肩手综合征后的患者,随机分为治疗组和对照组,各30例。对照组采用常规现代康复技术。治疗组在对照组基础上加用针灸、推拿。观察两组治疗后的效果疗效。结果治疗组疗效优于对照组,差异有统计学意义(p<0.05)。结论综合康复治疗中风后肩手综合征的疗效显著。%ABSTRACT:Objective to observe the curative effect of comprehensive rehabilitation in post-stroke shoulder-hand syndrome.Methods60 patients of post-stroke shoulder-hand syndrome were randomly divided into two groups averagely: the control group and the treatment group. every group has30 patients. the control group was treated with common practice modern rehabilitation technology. the treatment group was additionally given acupuncture and massage based on the control group. the curative effect of the two groups were observed after treatment. results the treatment group was better than the control group. The difference was statistical signiifcance (P<0.05). Conclusion the comprehensive rehabilitation in post-stroke shoulder-hand syndrome has signiifcant curative effect.

  10. 卒中后抑郁病人影像学分析及发病机制初步探讨%POST STROKE DEPRFSSION: ICONOGRAPHIC ANALYSIS AND PRELIMINARY APPROACH TO ITS MECHANISM

    Institute of Scientific and Technical Information of China (English)

    王彩霞; 李彬; 郭瑞友

    2011-01-01

    目的 了解卒中后抑郁病人的影像学特点,初步探讨脑卒中后抑郁的发病机制.方法 96例脑卒中病人采用汉密顿抑郁量表评分进行抑郁评定,依据卒中24 h后首次颅脑CT扫描结果进行影像学评估.结果 卒中后抑郁的发生率为61.46%.病灶多发、体积大、位于脑前部、有脑萎缩者易发生抑郁(x2=5.56~14.11,P<0.05).结论 卒中后抑郁影像学特点突出.病灶数量、体积及部位与脑卒中后抑郁的发生有密切关系.%Objective To understand the iconographic features of patients with post-stroke depression, and explore the pathogenesis of this condition. Methods Ninety-six post-stroke patients were assessed for depression by using Hamilton Depression Scale, and evaluation of ieonography was made based on the findings of the first CT scanning 24 hours after the attack of stroke. Results The incidence of depression in patients after the attack of stoke was 61.46%, which was easily occurred in those with multiple focus, big volume, located on anterior part of the brain, or cerebral atrophy (x2= 5.55-14. 11, P<0. 05).Conclusion The imaging characteristics of the post-stroke depression are outstanding. The number of focus, volume and location are closely related with the development of the condition.

  11. 对脑卒中后抑郁患者实施人文关怀的方法与效果%The methods and effects of humanistic care in patients with post - stroke depression

    Institute of Scientific and Technical Information of China (English)

    乔艳

    2012-01-01

    目的 探讨对脑卒中后抑郁患者实施人文关怀的方法与效果.方法 组织护理人员进行人文关怀知识培训,对40例脑卒中后抑郁患者实施人文关怀,采取提供人文的住院环境、建立患者个人档案、建立“护士-患者-家属”支持系统、制订人文关怀计划、丰富患者住院生活等方法.结果 实施人文关怀后患者抑郁指数降低(P<0.01),对护理工作满意度提高(P<0.01).结论 对脑卒中后抑郁患者实施人文关怀,可降低患者抑郁状态,提高患者对护理工作的满意度.%Objective To discuss the methods and effects of humanistic care in patients with post - stroke depression. Methods The muses were organized to learn the knowledge of humanistic care, and provided the 40 patients with post - stroke depression humanistic care, such as establishing humanistic environment , establishing individual documentation for the patients, setting up supporting system of " Nurse - Patient - Family", making plan of humanistic care and enriching the patient's life in hospital. Results After the implementation of the humanistic care,the depression index decreased (P<0.0l) and the satisfaction degree to nursing work increased (P <0.01). Conclusion Humanistic care to the patients with post - stroke depression can reduce the level of depression and enhance the satisfaction of nursing work.

  12. Clinical Observation on Post Stroke Fatigue Treated by Recuperate Gan and Pi Therapy%调肝理脾法治疗腔隙性脑卒中后疲劳的临床观察

    Institute of Scientific and Technical Information of China (English)

    王明红; 杨爱明; 艾清龙; 胡璘媛

    2015-01-01

    目的:探讨调肝理脾法治疗腔隙性脑卒中后疲劳的有效性。方法纳入50例腔隙性脑卒中患者,随机分为治疗组和对照组。治疗组25例患者在卒中二级预防基础上予调肝理脾之中药逍遥散加味内服,对照组25例患者单纯行卒中二级预防。结果治疗组总有效率为68.0%,对照组总有效率为40.0%,两组比较有统计学意义(P<0.01)。结论调肝理脾法治疗腔隙性脑卒中后疲劳可提高疗效,改善患者生活质量。%Objective To observe the effect of post stroke fatigue treated by recuperate liver and spleen therapy.Methods Fifty patients with post stroke fatigue were randomly divided into two groups:The control group(n=25)treated with secondary prevention of stroke, and the treatment group(n=25)treated with Xiaoyaosan decoction and secondary prevention of stroke.Results The total effective rate in the treated group was 68.0%,which was higher than that in control group(40.0%,P<0.05).Conclusion The recuperate liver and spleen therapy can improve the therapeutic and quality of life in patients with post stroke fatigue.

  13. 西酞普兰与氟西汀治疗脑卒中后抑郁临床对照研究%Citalopram and fluoxetine in t he treatment of post-stroke depression clinical control study

    Institute of Scientific and Technical Information of China (English)

    段媛卿; 王文泽; 王继禹

    2010-01-01

    Objective Discussion of citalopram and fluoxetine in the treatment of post-stroke depression efficacy and safety of. Methods 82 cases of post-stroke depression were randomly divided into groups of citalopram and fluoxetine groups, treatment of 6 weeks, Hamilton Depression Rating Scale (HAMD) and Emergent Symptom Scale(TESS) in pre-treatment and treatment of 1,2,4,6 weekend separately assessed the efficacy and adverse reactions. Results Citalopram and fluoxetine group the overall effect of a considerable, citalopram group effect faster than the fluoxetine group of adverse reactions due to limited light. Conclusion Citalopram in the treatment of post-stroke depression are both effective and safe.%目的 探讨西酞普兰与氟西汀治疗脑卒中后抑郁的疗效和安全性.方法 82例脑卒中后抑郁患者,随机分为西酞普兰组和氟西汀组,治疗6周,采用汉密尔顿抑郁量表(HAMD)和副反应量表(TESS)于治疗前和治疗1、2、4、6周末分别评定疗效和不良反应.结果 西酞普兰组和氟西汀组总体疗效相当,西酞普兰组起效较快,不良反应较氟西汀组少而轻.结论 西酞普兰治疗脑卒中后抑郁既有效又安全.

  14. 护理干预在治疗脑卒中后抑郁中的应用%Nursing intervention in the treatment of post stroke depression the application

    Institute of Scientific and Technical Information of China (English)

    丁瑛瑛

    2014-01-01

    目的:观察护理干预在治疗脑卒中后抑郁中的效果。方法:回顾性分析我院2010年1月至2012年1月收治的脑卒中后抑郁患者的护理措施及效果。结果:40例脑卒中后抑郁患者经全面护理后,治愈25例,有效6例,明显好转9例,无效0例。结论:脑卒中后抑郁的护理重点是心理护理、用药护理、基础护理、康复指导,能提高脑卒中后抑郁患者的治愈率和生存质量。%Objective:To observe the nursing intervention in the treatment of post stroke depression effect.Methods:Retrospectively analyze the nursing measures and effect in January 2010 to January 2012 for depressed patients after stroke.Result:Cases of patients with post stroke depression by comprehensive care,cure 25 cases,6 caG ses improved significantly effective,9 cases,invalid zero cases.Conclusion:Post stroke depression care focuses on psychological nursing,nursing,medicine basic nursing care and rehabilitation guidance,can improve after the cure rate and quality of life stroke in patients with depression.

  15. 护理干预在治疗脑卒中后抑郁中的应用%Nursing intervention in the treatment of post stroke depression the application

    Institute of Scientific and Technical Information of China (English)

    丁瑛瑛

    2014-01-01

    Objective:To observe the nursing intervention in the treatment of post stroke depression ef ect.Methods:Retrospectively analyze the nursing measures and ef ect in January 2010 to January 2012 for depressed patients after stroke.Result:Cases of patients with post stroke depression by comprehensive care,cure 25 cases,6 cases improved significantly ef ective,9 cases,invalid zero cases.ConcluG sion:Post stroke depression care focuses on psychological nursing,nursing,medicine basic nursing care and rehabilitation guidance,can improve after the cure rate and quality of life stroke in patients with deG pression.%目的:观察护理干预在治疗脑卒中后抑郁中的效果。方法:回顾性分析我院2010年1月至2012年1月收治的脑卒中后抑郁患者的护理措施及效果。结果:40例脑卒中后抑郁患者经全面护理后,治愈25例,有效6例,明显好转9例,无效0例。结论:脑卒中后抑郁的护理重点是心理护理、用药护理、基础护理、康复指导,能提高脑卒中后抑郁患者的治愈率和生存质量。

  16. 高血压患者脑卒中后并发抑郁症的影响因素分析%The Influence Factors Analysis of Post-stroke Depression for Hypertensive Patients

    Institute of Scientific and Technical Information of China (English)

    宋德宽

    2016-01-01

    Objective:To study the influence factors of post-stroke depression for hypertensive patients. Method:A total of 113 cases of hypertension combined cerebral stroke were selected by convenient sampling method from our hospital,the clinical data were investigated by the questionnaire survey,the influence factors of post-stroke depression for hypertensive patients were analyzed by single factor and multi-factor Logistic regression analysis.Result:Post-stroke depression for hypertensive patients were 43 cases,accounted for 38.05%,mild depression were 29 cases(25.66%),moderate depression were 10 cases(8.85%),severe depressive were 4 cases(3.54%).The single factor analysis showed,post-stroke depression rate of female,hyperlipidemia, coronary heart disease,diabetes,high blood pressure duration>15 years,self-paying medical expense,no spouse,monthly income≤2000 yuan/month,education above high school level were significantly higher,the comparative differences were statistically significant(P15年、自费医疗、无配偶、人均月收入≤2000元、高中或以上文化程度的患者抑郁症发生率明显增高,比较差异均有统计学意义(P<0.05)。经多因素Logistic回归分析显示,自费医疗、无配偶、人均月收入≤2000元是高血压患者脑卒中后并发抑郁症的独立危险因素(OR=10.698、4.215、7.245,P<0.05)。结论:高血压患者脑卒中后并发抑郁症是性别、合并症、病程、医疗费用支付方式、婚姻状况、经济收入、文化程度等多种因素共同作用的结果。

  17. 音乐疗法对脑卒中后抑郁患者的干预研究%The Efficacy of Music Therapy on Patients with Post Stroke Depression

    Institute of Scientific and Technical Information of China (English)

    翁赛峥

    2012-01-01

    目的 探讨音乐疗法对脑卒中后抑郁患者的康复疗效.方法 60例脑卒中后抑郁患者随机分为对照组(30例)和试验组(30例),两组均进行常规治疗,试验组同时配合音乐疗法.治疗1个月前后,分别对患者进行汉密尔顿抑郁量表评分(HAMD)和神经功能缺损评分(CSS).结果 治疗1个月后,两组患者HAMD、CSS评分与治疗前比较均明显下降(t=3.75,P<0.01);两组间比较,试验组治疗1个月后HAMD、CSS评分均低于对照组(t=3.16,P<0.05;t=3.21,P<0.01).结论 音乐疗法干预脑卒中后抑郁患者可改善患者抑郁状态,为脑卒中患者的康复治疗提供了良好的条件.%Objective To explore the rehabilitated effect on patients of post stroke depression with music therapy. Methods A total of 60 cases of post stroke depression were divided into control group(30cases)and experimental group(30cases) ,all of the two groups accepted conventional treatment, and the experimental group accepted music therapy simultaneously. We made HAMD and CSS score before and after one month of therapy. Results Compared to pre-therapy ,HAMD and CSS scores of all the two groups reduced significantly(t= 3. 75,P<0. 01) (after therapy of one month,the HAMD and CSS scores of experimental group were less than control group(i=3. 16,P<0. 05 or t = 3. 21,P<0. 01). Conclusion Music therapy can improve the depression state of patients with post stroke depression, and provide favorable conditions for rehabilitated therapy of patients with post stroke depression.

  18. 卒中后抑郁细胞因子蛋白组学初探%Cytokines Proteomic Study in Post-Stroke Depression:A Preliminary Study

    Institute of Scientific and Technical Information of China (English)

    耿磊钰; 唐浩; 李文平; 钱方媛; 钱俊峰; 李凌江; 张志珺

    2014-01-01

    目的初步探讨急性缺血性卒中患者血浆120种细胞因子蛋白水平与卒中后抑郁(post-stroke depression,PSD)发生的关系。方法入组PSD及非PSD患者各12例,均为卒中发生后3 d内入院的急性缺血性卒中患者,随访至卒中后2周,对患者进行神经功能,认知功能及抑郁、焦虑严重程度评估。患者入院后1d[卒中后(1.5±0.9) d]清晨6∶30留取空腹时静脉血浆标本,利用人类细胞因子蛋白表达微阵列芯片进行120种细胞因子蛋白组学检测。结果与非PSD组相比,PSD组4个细胞因子血浆中点信号强度(spot signal intensity,SIs)显示降低,差异有显著性,分别为胰岛素样生长因子1受体(insulin-like growth factor 1 receptor, IGF-I SR)(P=0.021),巨噬细胞炎症蛋白-3β(macrophage inflammatory protein-3 beta,MIP-3 beta)(P=0.033),胎盘生长因子(placental growth factor,PIGF)(P=0.021),血管内皮生长因子(vascular endothelial growth factor,VEGF)(P=0.015),但均未通过错误发现率多重校正,多因素Logistic回归分析无阳性发现。血浆胰岛素样生长因子1受体蛋白SIs与患者入院时Barthel指数呈负相关(r=-0.641, P=0.025),与2周后PSD患者汉密尔顿抑郁量表评分(r=0.478,P=0.005)及汉密尔顿焦虑量表评分(r=0.674,P=0.016)呈正相关。结论本研究的数据尚未发现能独立预测卒中急性期PSD风险的血浆细胞因子,但3种生长因子水平的异常提示PSD可能存在突触可塑及神经再生障碍。%Objective To investigate the association between post-stroke depression (PSD) and the level of cytokines in plasma. Methods Plasma spot signal intensity (SIs) of 120 cytokines were measured by Human Cytokine Antibody Array G-Series 1000 in 12 patients with PSD and 12 non-PSD controls who admitted to the hospital within the ifrst 3 days after stroke onset. The diagnoses of PSD were made in

  19. How effective is tetracaine 4% gel, before a peripherally inserted central catheter, in reducing procedural pain in infants: a randomized double-blind placebo controlled trial [ISRCTN75884221

    Directory of Open Access Journals (Sweden)

    Blanchard Colline

    2006-05-01

    Full Text Available Abstract Background Procedural pain relief is sub-optimal in infants, especially small and vulnerable ones. Tetracaine gel 4% (Ametop®, Smith-Nephew provides pain relief in children and larger infants, but its efficacy in smaller infants and for peripherally inserted central catheters (PICC remains uncertain. The objective of this trial was to assess the safety and efficacy of tetracaine gel on the pain response of very low birth weight (VLBW infants during insertion of a PICC. Methods Medically stable infants greater than or equal to 24 weeks gestation, requiring a non-urgent PICC, were included. Following randomization and double blinding, 1.1 g of tetracaine or placebo was applied to the skin for 30 minutes. The PICC was inserted according to a standard protocol. Pain was assessed using the Premature Infant Pain Profile (PIPP. A 3-point change in the pain score was considered clinically significant, leading to a sample size of 54 infants, with 90% statistical power. Local skin reactions and immediate adverse cardiorespiratory events were noted. The primary outcome, PIPP score at 1 minute, was analysed using an independent Student's t-test. Results Fifty-four infants were included, 27 +/- 2 weeks gestation, 916 +/- 292 grams and 6.5 +/- 3.2 days of age. Baseline characteristics were similar between groups. The mean PIPP score in the first minute was 10.88 in the treatment group as compared to 11.74 in the placebo group (difference 0.86, 95% CI -1.86, 3.58. Median duration of crying in non-intubated infants was 181 seconds in the tetracaine group compared to 68 seconds in the placebo group (difference -78, 95% CI -539, 117. Local skin erythema was observed transiently in 4 infants (3 in the treatment and 1 in the placebo group. No serious harms were observed. Conclusion Tetracaine 4% when applied for 30 minutes was not beneficial in decreasing procedural pain associated with a PICC in very small infants.

  20. Effect of electroacupuncture on P2X3 receptor regulation in the peripheral and central nervous systems of rats with visceral pain caused by irritable bowel syndrome

    OpenAIRE

    Weng, Z. J.; L. Y. Wu; Zhou, C. L.; Dou, C. Z.; Shi, Y; H. R. Liu; Wu, H. G.

    2015-01-01

    The aim of this study is to investigate the role of the purinergic receptor P2X3 in the peripheral and central nervous systems during acupuncture treatment for the visceral pain of irritable bowel syndrome (IBS). A total of 24 8-day-old Sprague–Dawley (SD) neonatal male rats (SPF grade) were stimulated using colorectal distention (CRD) when the rats were awake. The modeling lasted for 2 weeks with one stimulation per day. After 6 weeks, the rats were randomly divided into three groups of eigh...

  1. 中医药治疗中风后抑郁症临床研究进展%Clinical Research Progress of Chinese Medicine Treatment on Post-stroke Depression

    Institute of Scientific and Technical Information of China (English)

    楚彩云; 张元兴

    2012-01-01

    Post-stroke depression ( PSD )is considered as the most frequent and important neuropsyehiatry consequence of stroke, this condition can have an adverse effection on cognitive function, functional recovery and survival. Acupuncture coordinated with Chinese herbal medicine therapy has certain advantages of PSD. This article gives a systematic review on the prevalence and the epidemiology of PSD, outlines the merit of acupuncture coordinated with Chinese herbal medicine therapy on this disorder and debates on some issues of the current understanding of diagnosis and clinical management of Post-stroke depression. It is proposed that Chinese medicine treatment of PSD has obvious advantages, but there are still problems to be solved.%中风后抑郁是常见的脑中风后并发症,可以严重影响中风患者主动康复训练的积极性从而延缓恢复过程,中医药在治疗中风后抑郁症方面有一定优势.文章从病因病机、中医药及针灸治疗等方面将近年来有关中风后抑郁研究及文献进行综述,并对中医药治疗本病的优势及目前存在的一些问题进行讨论,提出今后研究思路与建议.

  2. Combination Protocol of Low-Frequency rTMS and Intensive Occupational Therapy for Post-stroke Upper Limb Hemiparesis: a 6-year Experience of More Than 1700 Japanese Patients.

    Science.gov (United States)

    Kakuda, Wataru; Abo, Masahiro; Sasanuma, Jinichi; Shimizu, Masato; Okamoto, Takatsugu; Kimura, Chikou; Kakita, Kiyohito; Hara, Hiroyoshi

    2016-06-01

    Several years ago, we proposed a combination protocol of repetitive transcranial magnetic stimulation (rTMS) and intensive occupational therapy (OT) for upper limb hemiparesis after stroke. Subsequently, the number of patients treated with the protocol has increased in Japan. We aimed to present the latest data on our proposed combination protocol for post-stroke upper limb hemiparesis as a result of a multi-institutional study. After confirming that a patient met the inclusion criteria for the protocol, they were scheduled to receive the 15-day inpatient protocol. In the protocol, two sessions of 20-min rTMS and 120-min occupational therapy were provided daily, except for Sundays and the days of admission/discharge. Motor function of the affected upper limb was evaluated by the Fugl-Meyer assessment (FMA) and Wolf motor function test (WMFT) at admission/discharge and at 4 weeks after discharge if possible. A total of 1725 post-stroke patients were studied (mean age at admission 61.4 ± 13.0 years). The scheduled 15-day protocol was completed by all patients. At discharge, the increase in FMA score, shortening in performance time of WMFT, and increase in functional ability scale (FAS) score of WMFT were significant (FMA score 46.8 ± 12.2 to 50.9 ± 11.4 points, p stroke, although its efficacy should be confirmed in a randomized controlled study.

  3. 中风后吞咽困难康复护理临床观察%Clinical Observation on Rehabilitation Nursing for 60 Cases of Post-stroke Dysphagia

    Institute of Scientific and Technical Information of China (English)

    唐波

    2013-01-01

    目的:观察传统护理疗法与针刺结合药物护理疗法对中风后遗症吞咽困难的疗效差异.方法:把中风后遗症吞咽困难60例患者分两组,治疗组和对照组,用洼田饮水试验法评定,对比两组疗效差异.结果和结论:治疗组的有效率明显高于对照组,经检验两组差异有统计学意义(P<0.05),说明治疗组疗效优于对照组.%Objective:To observe the different effects of traditional nursing and acupuncture combined with drug nursing for post-stroke dysphagia.Methods:60 cases of post-stroke dysphagia were divided into two groups:treatment group and control group.The effects of two groups were compared by Kubota drinking water test.Results and Conclusions:The effect in treatment group was obviously higher than that in control group with significant difference (P<0.05),indicating the treatment is superior to the control group.

  4. 针刺与康复训练治疗脑卒中后吞咽功能障碍的研究进展%Research progress on acupuncture and rehabilitation in the treatment of post-stroke dysphagia

    Institute of Scientific and Technical Information of China (English)

    陈启波(综述); 谭毅(审校)

    2013-01-01

    Recent literatures of acupuncture and rehabilitation in the treatment of post-stroke dysphagia were reviewed.Acupuncture combining with rehabilitation is the best treatment of dysphagia induced by post -stroke pseudobulbar paralysis ,which plays an important role in reducing disability and improving the quality of life for pa -tients with dysphagia .%  针刺与康复结合治疗法是目前治疗卒中后假性球麻痹的吞咽功能障碍的最佳方案,对降低疾病致残率、提高患者生存质量具有较好的作用。该文经检索收集相关文献,对脑卒中后吞咽功能障碍针刺与康复的治疗方法、机制和效果的研究进展进行综述。

  5. Medication of post-stroke depression——the past,present and future%卒中后抑郁的药物治疗——过去、现在与未来

    Institute of Scientific and Technical Information of China (English)

    张琦祺; 高俊鹏

    2011-01-01

    Post-stroke depression (PSD) is one of the common complications of stroke, which has an obvious effect on the recovery of the body function. Epidemiologic researches showed that about 30 %stroke patients exist PSD, which hinders their recovery procedure, and prolongs their hospitalization time. This article summarized the clinical researches on treating PSD so as to probe into the curative effect,mechanism and further development of medication on PSD.%卒中后抑郁(post-stroke depression,PSD)是卒中的常见并发症之一.根据流行病学研究,近30%的卒中患者存在抑郁.卒中后抑郁可阻碍患者康复进程,延长患者住院时间,对患者的功能恢复可产生显著影响.本文综述了近年来药物治疗PSD的临床研究进展,旨在探讨其疗效、机制并展望未来发展方向.

  6. 卒中后抑郁的相关因素分析%Related factors analysis of post-stroke depression

    Institute of Scientific and Technical Information of China (English)

    单小英; 石秋艳; 孙惠芳; 林述凯; 张国志

    2012-01-01

    目的 探讨卒中后抑郁(PSD)的相关因素.方法 采用汉密尔顿抑郁量表(HAMD)在卒中后14 d及90 d对300例脑卒中患者进行评分,并据此分为PSD组及非PSD组,对两组间的卒中部位、美国国立卫生研究院卒中量表(NIHSS)评分、改良Rankin量表评分(mRS)及简易精神状态检查表(MMSE)评分进行比较.结果 140例(46.7%)患者发生PSD;卒中灶多发或位于左侧半球、额颞叶及基底节的患者PSD发生率明显高于卒中灶单发、位于右侧半球、顶枕叶及皮质的患者(均P <0.05);PSD组发病14 d时NIHSS评分、发病14 d及90 d时mRS评分明显高于非PSD组(P<0.05~0.01).结论 PSD发生与多灶性卒中及卒中灶位于左侧半球、额颞叶、基底节区有关;且与卒中后神经功能缺损程度及残疾程度有关.%Objective To explore the related factors of post-stroke depression (PSD). Methods According to the scores of Hamilton Depression Scale (HAMD) assessed at 14 d and 90 d after stroke, the 300 stroke patients were divided into PSD group and non-PSD group. The lesion location, the scores of National Institute of Health stroke scale (NHSS) , modified rainkin Scale (mRS) and minimental status examination (MMSE) were compared between the two groups. Results There were 140 cases (46. 7% ) with PSD. The incidences of PSD in patients with multiple infarct lesions and the lesions located at left hemisphere, fronto-temporal lobe and basal ganglia were significant higher than the patients with single infarct lesion, and the lesion located at right hemisphere, parietal-occipital lobe and cortex (all P < 0. 05). The NIHSS score at 14 d after onset, and mRS scores at 14 d, 90 d after onset in PSD group were significant higher than thos in non-PSD group (P <0. 05 -0. 01 ). Conclusion The PSD occurrence is correlated with the multifocal stroke and stroke located at left hemisphere, fronto-temporal lobe and basal ganglia; also with degrees of neurological function

  7. 卒中后失语患者抑郁情绪特征比较%The characteristics of post-stroke depression in patients with aphasia

    Institute of Scientific and Technical Information of China (English)

    许璇; 王维清; 刘晓加; 陈东; 王心宇

    2011-01-01

    目的 比较卒中后失语患者与非失语患者抑郁情绪的特征.方法 纳入70例卒中后失语患者和70例卒中后非失语患者.对失语组采用标准化汉语失语检查量表(Aphasia Battery of Chinese,ABC)进行失语评估,并用卒中后失语患者抑郁问卷(医院版)(Stroke Aphasic Depression Questionnaire Hospital Version,SADQ-H)比较卒中后失语患者和非失语患者的抑郁情绪.结果 失语组的SADQ-H总分[(22.03±9.55)分]显著高于非失语组[(16.81±10.47)分],差异有显著性(P<0.01);卒中后失语患者在兴趣缺乏、乐趣丧失、社交回避、易怒、情绪低落、注意力下降等方面较卒中后非失语患者严重.失语组抑郁发生率[64.28%]高于非失语组[50.00%];失语组中完全性失语抑郁发生率最高[78.26%];经皮质混合性失语[62.5%]、Broca[61.53%]、Werincke[62.50%]发生率相近为[62.00%]左右;抑郁严重程度与失语严重程度相关,卡方分析差异有统计学意义(P<0.01).结论 卒中后失语患者较非失语患者抑郁情绪的发生率高,尤其是完全性失语、经皮质混合性失语、Broca、Werincke等类型的失语患者,并且抑郁发生率与失语严重程度相关.%Objective To compare the characteristics of post-stroke depression in patients with and without aphasia.Methods Seventy patients on the first infarction with aphasia and 70 stroke patients without aphasia were recruited.The aphasia deficits in patients were evaluated by using the Aphasia Battery of Chinese ( Aphasia Battery of Chinese, ABC) .The Stroke Aphasic Depression Questionnaire Hospital Version ( Stroke Aphasic Depression Questionnaire Hospital Version, SADQ-H) was applied to analyze the depression in the two groups.Results The sore in SADQ-H of the aphasia group was significantly higher than the control group( (22.03 ±9.55 )vs ( 16.81 ± 10.47 ), P < 0.01 ) .Loss interest, anhedonia, social avoidance, irritability, depression, decreased attention were

  8. Observation and psychological intervention of 68 patients with post-stroke depression%68位脑卒中后抑郁患者的心理干预

    Institute of Scientific and Technical Information of China (English)

    王静; 杨玲

    2012-01-01

    [ Objective]To study the effect of psychological intervention on recovery of patients with post-stroke depression (PSD). [Methods]68 PSD patients were randomly divided into the observation group and the control group. Two groups were treated with routine treatment (including drug therapy, antidepressant treatment and rehabilitation) and routine nursing, while the observation group was given the psychological intervention. Self Rating Depressive Scale ( SDS) , NIH Stroke Scale ( NIHSS) and Activity of Daily Living (ADL) were applied to evaluation before intervention and 4th, 8th week after intervention. [ Results] Before interven-tion, there was no significant difference in SDS score between the observation group and the control group (P >0.05). At the 4th week after intervention, SDS score of the observation group (39.2 ± 12. 8) was lower than that of control group (47.3 ± 12.7) sig-nificantly (P 0. 05) , but it had shown significant differences since 8th week after intervention. [ Conclusion] Improving the understanding of PSD, carrying out the psychological intervention and implementing the psychological nursing according to patients'psychological characteristics can significantly improve the depressive state and nerve function of PSD patients, and effectively promote patients'recovery.%目的 探讨以心理干预为主的护理措施对脑卒中后抑郁(PSD)患者康复的影响.方法 将符合PSD的68例患者随机分为观察组和对照组,均给予脑卒中药物、抗抑郁、康复等常规治疗以及脑卒中常规护理,观察组同时实施以心理干预为主的护理措施.采用抑郁自评量表(SDS)、美国国立卫生研究院卒中量表(NIHSS)、日常生活能力(ADL)评分分别于干预前及干预后第4周及第8周后进行评定.结果 观察组与对照组在干预前SDS评分无明显差异(P>0.05),在接受干预后4周SDS评分为(39.2±12.8)分,与对照组[(47.3±12.7)台]比较,差异有统计学意义(P<0.05).观察

  9. Metabolic changes of prefrontal cerebral lobe ,white matter and cerebellum in patients with post-stroke depression A proton magnetic resonance spectroscopy study

    Institute of Scientific and Technical Information of China (English)

    Qinggang Xu; Hong Cao; Qingwei Song; Jianlin Wu

    2008-01-01

    BACKGROUND:Proton magnetic resonance spectroscopy(1H-MRS)non-invasively detects changes in chemical substances in the brain,which reflects the pathological metabolism.OBJECTIVE:To investigate changes in N-acetyl-aspartate(NAA),choline(Cho),creatine(Cr),and myoinositol(MI)in the gray and white matter of cerebral prefrontal lobe and cerebellum of patients with differential degrees of post-stroke depression(PSD)using 1H-MRS.DESIGN:A case control study.SETTING:The First Affiliated Hospital of the Dalian Medical University.PARTICIPANTS:A total of 38 patients with stroke(28 male and 10 female patients,aged 40 to 79 years)were selected from the Department of Neurology,1st Atfiliated Hospital,Dalian Medical University,from February to October in 2004.All subjects met the DSM-IV criteria for cerebrovascular disease and depression.The degree of depression was defined according to Hamilton criteria.38 patients with PSD were divided into two groups according to the time after ischemia,20 patients in the acute group with less than 10 days after ischemic attack(mild:16 patients,moderate/severe:4 patients)and 18 patients in the chronic group with more than 11 days after ischemic attack(mild:15 patients,moderate/severe:3 patients).Seventeen healthy volunteers with matching age from 41 to 80 years were examined as a control group.The study was approved by the Medical Ethics Committee of the University Medical Center Utrecht,and each participant signed an informed consent form.METHODS:Spectra were acquired by multi-voxel point-resolved spectroscopy(PRESS)sequence with GE signal.ST MP-di,localized in prefrontal cerebral lobe and cerebellum.Values of NAA,Cho,MI,and Cr ere compared between different graded PSD patients and control subjects with one-way analysis of variance in software SPSS11.5.MAIN OUTCOME MEASURES:Metabolite concentration in different brain regions of interest.Difference in metabolites between distinctly graded PSD patients and control subjects.Exclusion of age

  10. Investigation on mood disorder and its influencing factors in post-stroke patients%卒中后患者情绪障碍及其影响因素调查

    Institute of Scientific and Technical Information of China (English)

    张树山; 朱陶; 熊健; 余巨明; 李健

    2015-01-01

    Objective To survey and analyze the mood disorder in post-stroke patients and to investigate its influencing factors. Methods The stratified sampling method was adopted to randomly extract 183 cases of stroke definitely diagnosed by the class 3A hospital in the Nanchong municipal administered communities and performed the questionnaire survey. The obtained data were analyzed by using the Hamilton depression scale and Hamilton anxiety scale. Results (1)The incidence rate of anxiety and depression in community post-stroke patients were 88.5%and 94.0%respectively;(2)the analysis results found that the factors of age,marital status and comorbidities significantly influenced the scores of anxiety and depression (P0.05);(3)Excluding the mutual influence of various factors by the further multivariate linear regression analysis found that the main factors influencing anxiety in community post-stroke patients were age and comorbidities,while which influencing depression were the marital status,age and comorbidities. Conclusion The incidence of anxiety and depression in community post-stroke patients are higher;the main factors of anxiety and depression occurrence in community post-stroke patients are advanced age and complicating multiple chronic diseases.%目的:调查分析卒中后患者情绪障碍并探索其影响因素。方法采用整群抽样法随机抽取南充市市辖社区由三甲医院确诊为卒中的患者183例,用调查问卷及汉密尔顿焦虑、抑郁量表进行分析。结果(1)南充市市辖社区卒中患者焦虑的发病率为88.5%,抑郁的发病率为94.0%;(2)经分析发现,年龄、婚姻状况和合并疾病因素对焦虑、抑郁得分影响显著(P<0.05);性别、学历、职业、病程、家庭月收入和是否接受健康教育等因素对焦虑、抑郁得分影响不明显(P>0.05);(3)进一步经多元线性回归分析,排除各因素间的相互影响后发现,影响社区卒中患

  11. [Physiological Basis of Pain Mechanisms for Pain Management].

    Science.gov (United States)

    Kawamata, Mikito

    2016-05-01

    Physician anesthesiologists should ensure a future leadership position in perioperative medicine and pain medicine. In order to establish the missions, anesthesiologists need to know how to relieve pain in surgical patients, critically ill patients and patients with cancer and non-cancer chronic pain. Thus, anesthesiologists should realize physiology of pain representation from pain management I will review physiological basis of pain mechanisms in this manuscript which includes 1) evolutional aspect of pain perception, 2) transduction of noxious stimuli, 3) the types of nociceptors and conduction of noxious stimuli, 4) the ascending pathway of pain and central modulation of pain, 5) the descending inhibitory pain system, and 6) various types of pain. Finally, anesthesiologists should manage pain from physiological basis of pain mechanisms. PMID:27319092

  12. Effect of electroacupuncture on P2X3 receptor regulation in the peripheral and central nervous systems of rats with visceral pain caused by irritable bowel syndrome.

    Science.gov (United States)

    Weng, Z J; Wu, L Y; Zhou, C L; Dou, C Z; Shi, Y; Liu, H R; Wu, H G

    2015-09-01

    The aim of this study is to investigate the role of the purinergic receptor P2X3 in the peripheral and central nervous systems during acupuncture treatment for the visceral pain of irritable bowel syndrome (IBS). A total of 24 8-day-old Sprague-Dawley (SD) neonatal male rats (SPF grade) were stimulated using colorectal distention (CRD) when the rats were awake. The modeling lasted for 2 weeks with one stimulation per day. After 6 weeks, the rats were randomly divided into three groups of eight each: (1) the normal group (NG, n = 8); (2) the model group (MG, n = 8); and (3) the model + electroacupuncture group (EA, n = 8) that received electroacupuncture at a needling depth of 5 mm at the Shangjuxu (ST37, bilateral) and Tianshu (ST25, bilateral) acupoints. The parameters of the Han's acupoint nerve stimulator (HANS) were as follows: sparse-dense wave with a frequency of 2/100 Hz, current of 2 mA, 20 min/stimulation, and one stimulation per day; the treatment was provided for seven consecutive days. At the sixth week after the treatment, the abdominal withdrawal reflex (AWR) score was determined; immunofluorescence and immunohistochemistry were used to measure the expression of the P2X3 receptor in myenteric plexus neurons, prefrontal cortex, and anterior cingulate cortex; and, a real-time PCR assay was performed to measure the expression of P2X3 messenger RNA (mRNA) in the dorsal root ganglion (DRG) and spinal cord. After stimulation with CRD, the expression levels of the P2X3 receptor in the inter-colonic myenteric plexus, DRG, spinal cord, prefrontal cortex, and anterior cingulate cortex were upregulated, and the sensitivity of the rats to IBS visceral pain was increased. Electroacupuncture (EA) could downregulate the expression of the P2X3 receptor and ease the sensitivity to visceral pain. The P2X3 receptor plays an important role in IBS visceral pain. The different levels of P2X3 in the peripheral enteric nervous system and central nervous system mediate the

  13. Pain-related increase of excitatory transmission and decrease of inhibitory transmission in the central nucleus of the amygdala are mediated by mGluR1

    Directory of Open Access Journals (Sweden)

    Neugebauer Volker

    2010-12-01

    Full Text Available Abstract Neuroplasticity in the central nucleus of the amygdala (CeA, particularly its latero-capsular division (CeLC, is an important contributor to the emotional-affective aspects of pain. Previous studies showed synaptic plasticity of excitatory transmission to the CeLC in different pain models, but pain-related changes of inhibitory transmission remain to be determined. The CeLC receives convergent excitatory inputs from the parabrachial nucleus in the brainstem and from the basolateral amygdala (BLA. In addition, feedforward inhibition of CeA neurons is driven by glutamatergic projections from the BLA area to a cluster of GABAergic neurons in the intercalated cell masses (ITC. Using patch-clamp in rat brain slices we measured monosynaptic excitatory postsynaptic currents (EPSCs and polysynaptic inhibitory currents (IPSCs that were evoked by electrical stimulation in the BLA. In brain slices from arthritic rats, input-output functions of excitatory synaptic transmission were enhanced whereas inhibitory synaptic transmission was decreased compared to control slices from normal untreated rats. A non-NMDA receptor antagonist (NBQX blocked the EPSCs and reduced the IPSCs, suggesting that non-NMDA receptors mediate excitatory transmission and also contribute to glutamate-driven feed-forward inhibition of CeLC neurons. IPSCs were blocked by a GABAA receptor antagonist (bicuculline. Bicuculline increased EPSCs under normal conditions but not in slices from arthritic rats, which indicates a loss of GABAergic control of excitatory transmission. A metabotropic glutamate receptor subtype 1 (mGluR1 antagonist (LY367385 reversed both the increase of excitatory transmission and the decrease of inhibitory transmission in the arthritis pain model but had no effect on basal synaptic transmission in control slices from normal rats. The inhibitory effect of LY367385 on excitatory transmission was blocked by bicuculline suggesting the involvement of a GABAergic

  14. Comparative study of effects of three treatment methods for post-stroke depression%三种治疗方法对患者脑卒中后抑郁疗效的比较

    Institute of Scientific and Technical Information of China (English)

    胡雪峰; 潘信明; 张愉

    2015-01-01

    Objective:To compare effects of conventional therapy, Escitalopram and Escitalopram combined with cognitive be-havioral therapy on depression symptoms and nerve functional rehabilitation in post-stroke depression. Methods:A total of 90 patients with post-stroke depression were randomly divided into control group, Escitalopram group and Escitalopram combined with cognitive behavioral therapy group. These groups were evaluated with Hamilton depression scale ( HAMD) and activity of daily living ( ADL) ( BI) before and8 weeks after the treatment. Results:8 weeks after the treatment, the degree of depression was reduced and the daily living ability was improved in Escitalopram group and Escitalopram combined with cognitive behavioral therapy group. The escitalopram combined with cognitive-behavioral therapy group was more effective. Conclusions: Escitalopram and Escitalopram combined with cognitive behavioral therapy are in favor of not only controlling the post-stroke depression effectively, but also improving the daily living ability. The Escitalopram combined with cognitive behavioral therapy is more effective.%目的::比较常规治疗、艾司西酞普兰及艾司西酞普兰联合认知行为治疗三种不同治疗方法对脑卒中后抑郁的抑郁症状及神经功能康复的疗效。方法:90例脑卒中后抑郁患者随机分为三组,分别为对照组、抗抑郁药组(艾司西酞普兰治疗组)及联合治疗组(艾司西酞普兰联合认知行为治疗组),分别于治疗前及治疗后8周用汉密尔顿抑郁量表( HAMA)和日常生活能力Barthel指数( BI)进行评定。结果:抗抑郁药组及联合治疗组在8周后的抑郁程度及日常生活能力均有所改善,其中以联合治疗组改善更明显。结论:艾司西酞普兰及艾司西酞普兰联合认知行为治疗均能改善脑卒中后抑郁的抑郁症状及日常生活能力,尤以艾司西酞普兰联合认知行为治疗效果更佳。

  15. 心理干预对急性脑卒中后抑郁患者康复疗效的影响%The effect of psychological intervention on the patients with acute post -stroke depression

    Institute of Scientific and Technical Information of China (English)

    逯传玲

    2009-01-01

    目的 探讨心理干预对脑卒中后抑郁患者康复疗效的影响.方法 采用随机对照的方法,选择住院的脑卒中后抑郁患者,对照组50例,入院后给予常规的药物及相应的物理康复治疗,治疗组50例,在对照组治疗的基础上,给予针对性的心理干预.对比两组患者的HAMD评分,Fugl-mey-er值及Barthd指数.结果 发病第5天两组HAMD评分,Fugl-meyer值及Barthel指数差异无统计学意义(P>0.05);发病30 d和60 d后,治疗组Fugl-meyer值、Barthel指数积分均明显高于对照组,且HAMD评分低于对照组,均具有显著性差异(P<0.01).结论 心理干预可明显改善或消除脑卒中患者的抑郁情绪,有利于患者在健康的心理状态下接受治疗,且操作方便.为治疗脑卒中后抑郁的较好方法.%Objective To investigate the effect of psychological intervention on rehabilitation of acute post-stroke depression patients. Methods 100 post-stroke depression were randomly divided into control and treatment groups, each group 50 cases. All the patients were treated with routine medicine and physical rehabilita-tion, and treatment group was received psychological intervention besides routine therapy. Hamilton depression scale, Fugl -Meyer and Barthel index of two groups were analyzed. Results Hamilton depression scale, Fugl -Meyer and Barthel index of two groups were different after treatment. Conclusions Psychological intervenetion were benefit to rehabilitation of post -stroke depression.

  16. 全身振动训练及其对脑卒中患者运动功能康复价值%Effect of whole-body vibration on post-stroke patients

    Institute of Scientific and Technical Information of China (English)

    张丽; 瓮长水

    2013-01-01

    脑卒中后运动功能障碍是康复治疗中难以解决的问题之一.文章对新型全身振动(WBV)训练在脑卒中后运动功能康复中的应用进行阐述.目前WBV训练已在运动热身、肌肉放松、力量训练,特别是在骨关节损伤康复、肌肉骨骼功能改善以及老年人健康预防等多个领域发挥着独特的优势,在帕金森病、多发性硬化、脑瘫等神经系统疾病的康复亦有报道.然而,WBV训练用于脑卒中偏瘫患者的基础和临床研究仍十分有限.目前还没有WBV训练的临床指南,对该疗法的作用机制和临床干预效果尚缺乏全面、系统的认识,进一步开展针对WBV训练的基础和临床研究可以作为今后脑卒中康复研究的方向之一.%There has been an increasing interest in the usage of whole-body vibration(WBV) as a therapeutic modality.The WBV exercise has been postulated to be effective in improving functional performance by enhancing flexibility,body balance,postural control,muscle strength and bone mineral density,and increasing the muscle blood flow to the lower extremity and serum levels of testosterone and growth hormone.And WBV exercise is safe and well tolerated in older or frail patients.Earlier studies proved that WBV has beneficial effects on neuromuscular performance in older adults and may be a viable treatment option for post-stroke patients.This review was aimed at determining whether WBV improves mobility performance,activities of daily living(ADL) and general health in patients with subacute or chronic stroke.The results showed that there was preliminary evidence to have proven the effectiveness of WBV in enhancing the mobility,balance and postural control ability,and quality of life (QOL) in post-stroke patients.However,more good-quality trials are needed to establish the clinical efficacy of WBV in improving mobility function and general health status in post-stroke patients.

  17. Therapeutic effect of donepezil on the post-stroke aphasia%多奈哌齐对脑卒中后失语的治疗效果评价

    Institute of Scientific and Technical Information of China (English)

    罗红波; 杨金升; 石向群; 于伟玲

    2011-01-01

    目的 探讨多奈哌齐治疗脑卒中后失语的疗效和安全性.方法 脑卒中后失语患者随机分为对照组(38例)及治疗组(38例).对照组给予常规治疗,治疗组在常规治疗的基础上给予多奈哌齐5mg,1次/d,共4周.采用西方成套测验( WAB)并计算失语商(AQ)评定患者语言功能.结果 治疗后,两组的WAB、AQ评分均有所提高,但治疗组WAB中的口语表达、听理解、复述等方面评分与对照组相比明显增高,差异有统计学意义(P<0.05).多奈哌齐对运动性失语、感觉性及传导性失语中的复述言语障碍改善作用明显,但对命名性失语无明显疗效.未见明显药物不良反应.结论多奈哌齐治疗脑卒中后失语有效且较安全.%Objective To study the efficacy and safety of donepezil in the treatment of post-stroke aphasia. Methods Patients with post-stroke aphasia were randomly divided into twogroups; donepezil treated and control (n = 38, each). The control group received a conventional treatment. Beside the conventional treatment, the patients in treated group were given 5 mg donepezil once a day for 4 weeks. The language function of patients was evaluated by western aphasia battery (WAB) and aphasia quotient (AQ). Results The WAB and AQ scores in the two groups increased after treatment. The WAB scores ( oral expression, auditory comprehension and retelling) in the donepezil treated group were significantly higher than those in the control group (P <0. 05) 4 weeks after treatment. Donepezil had obvious effects on retelling in speech disorders of anandia, sensoryaphasia and conduction aphasia, but anomicaphasia. No significant adverse effects of donepezil were observed. Conclusions Donepezil is effective and safety in the treatment of post-stroke aphasia.

  18. 患者及病变相关因素对卒中后失语症恢复的影响%Effects of patient-related and stroke-related factors on post-stroke aphasia recovery

    Institute of Scientific and Technical Information of China (English)

    赵燕龙; 闫中瑞; 张作记; 梅峰; 孙树印

    2016-01-01

    Post-stroke aphasia is an acquired language disorder caused by stroke.It impaired the quality of life of patients and brought a heavy burden to family and the society.Unfortunately,the highly variable predictive factors make the prognosis of aphasia recovery difficult.Much of the researches indicated that the post-stroke aphasia recovery is associated with the patient-related and stroke-related factors.We searched the recent advances on the influence of patient-related factors and stroke-related factors on aphasia recovery.It showed that patient-related factors have no obvious effect on predicting aphasia recovery while the lesion (stroke)-related factors appeared close correlation with post-stroke aphasia recovery.The clinicians should pay more attention on lesion (stroke)-related factors when evaluate the outcome and give the intervention measures.%卒中后失语症是由于卒中导致的获得性语言障碍,对卒中患者的生活质量造成严重影响,给社会和家庭带来很大负担.因预后因素高度多变,使得预测卒中后失语症恢复变得困难.研究显示,卒中后失语症恢复与患者及病变相关的因素有关.本研究从患者相关的因素和病变(卒中)相关因素进行文献检索,分析二者对卒中后失语症恢复的影响.结果发现与患者相关的因素对失语症恢复的影响并不明显,与病变(卒中)相关的因素与失语症恢复之间有较强的相关性.提示临床医生在评估卒中后失语症患者的干预措施和预后时,应更多的考虑与病变相关的因素.

  19. Effects of sertraline combined with quetiapine on post-stroke depression%舍曲林单用与合并奎硫平治疗脑卒中后抑郁障碍患者的疗效

    Institute of Scientific and Technical Information of China (English)

    徐玉英; 钱菊芬

    2012-01-01

    Objective: To explore the effect of sertraline combined with quetiapine on post-stroke depression. Method:76 post-stroke depression patients were randomized into groups observation (re =39) and control ( n = 37). Observation group were given treatment of sertraline and quetiapine, control only sertraline for eight weeks. Hamilton depression rating scale (HAMD) and treatment emergent symptoms scale (TESS) were used to evaluate the efficacy before and after treatment. Results;The was no statistics difference in the effectiveness in two group (x2=0.69 ,P >0. 05). The scores of HAMD at the end of treatment were lower than the before treating( P 0.05). Conclusion; Sertraline with quetiapine were effective early and safe to treat post-stroke depression compared with sertraline.%目的:探讨舍曲林联合奎硫平治疗脑卒中后抑郁的疗效. 方法:将76例脑卒中后抑郁患者随机分为研究组(舍曲林合并奎硫平治疗)39例和对照组(单用舍曲林治疗)37例.疗程8周.于治疗前和治疗后采用汉密尔顿抑郁量表(HAMD)及治疗中出现的症状量表(TESS)评定疗效及不良反应.结果:两组疗效差异无统计学意义(x2=0.69,P>0.05).两组HAMD评分治疗后均显著降低(P均<0.05);以研究组在治疗1周和治疗2周时HAMD评分降分显著(t=2.89,2.73;P均<0.05),治疗4周和治疗8周,两组差异无统计学意义(t=1.22,1.07;P均>0.05). 结论:舍曲林联合奎硫平治疗脑卒中后抑郁障碍与单用舍曲林疗效相当,但起效更快.

  20. Observation on Therapeutic Effects of Olanzapine on Patients with Post Stroke Insommia%奥氮平在脑卒中后睡眠障碍中的应用

    Institute of Scientific and Technical Information of China (English)

    吕双喜; 李莉

    2014-01-01

    Objective:To observe the therapeutic effects of Olanzapine on patients with post stroke insommia.Method:Fifty-eight cases with post stroke insommia were randomized into treatment group(treated with Olanzapine)and control group,before and after four weeks’ treatment,the SPIEGEL,Modified Edinburgh-Scandinavia stroke scale(MESSS)and Modified Barthel Index(MBI)were evaluated and used for assessing treatment effects Result:The total effective rate in the group treated with Olanzapine were higher than that in control group,reached 83.3%,the different was statistical significant,also the scales of MESSS in treatment group were higher than those in control group(P<0.05).Conclusion:Olanzapine can effectively treat the patients with post stroke insommia,and also is helpful for recovery of patients’ neurological function.%目的:观察奥氮平在脑卒中后睡眠障碍中的治疗作用。方法:将58例脑卒中后睡眠障碍的患者随机分为奥氮平治疗组和对照组,观察治疗4周后的临床效果,并于治疗前后评估MESSS和MBI。结果:奥氮平治疗组可显著改善卒中后睡眠障碍,有效率达83.3%,而且对神经功能的康复有积极影响,与对照组比较差异有统计学意义(P<0.05)。结论:奥氮平对脑卒中后睡眠障碍有较好的临床疗效,并对患者神经功能的康复有积极意义。

  1. Clinical Study on Acupuncture plus Rehabilitation Training for Post-stroke Depression%针刺配合康复训练治疗卒中后抑郁的临床研究

    Institute of Scientific and Technical Information of China (English)

    占道伟; 罗开涛; 茅利玉; 高峰; 钱立锋; 沈来华; 方剑乔

    2016-01-01

    目的:观察针刺配合康复训练治疗卒中后抑郁的临床疗效。方法将41例卒中后抑郁患者随机分为治疗组22例和对照组19例。两组均采用内科基础治疗,治疗组在此基础上采用针刺配合康复训练治疗,对照组采用单纯康复训练治疗。观察并比较两组治疗前后汉密尔顿抑郁量表(HDRS)和美国国立卫生研究院卒中量表(NIHSS)评分的变化情况。结果两组治疗4、8星期后HDRS评分和NIHSS评分与同组治疗前比较,差异均具有统计学意义(P<0.05,P<0.01)。治疗组治疗4、8星期后HDRS评分和NIHSS评分与对照组比较,差异具有统计学意义(P<0.05,P<0.01)。结论针刺配合康复训练是一种治疗卒中后抑郁的有效方法。%Objective To observe the clinical efficacy of acupuncture plus rehabilitation training in treating post-stroke depression.Method Forty-one patients with post-stroke depression were randomized into a treatment group of 22 cases and a control group of 19 cases. In addition to the basic internal medicine treatment, the treatment group received acupuncture plus rehabilitation training, while the control group was intervened by rehabilitation training alone. The Hamilton Depression Scale (HAMD) and National Institutes of Health Stroke Scale (NIHSS) were observed and compared before and after treatment.Result The HAMD and NIHSS scores in the two groups were significantly changed respectively after 4-week and 8-week treatment (P<0.05,P<0.01). Respectively after 4-week and 8-week treatment, the HAMD and NIHSS scores in the treatment group were significantly different from that in the control group (P<0.05,P<0.01).Conclusion Acupuncture plus rehabilitation training is an effective approach in treating post-stroke depression.

  2. Survey of constipation symptom score in post-stroke patients with cerebrocardiac syndrome%卒中后合并脑心综合征患者的便秘症状评分的调查

    Institute of Scientific and Technical Information of China (English)

    李晓瑛; 高连波

    2012-01-01

    Objective: To inquire constipation symptom score in post - stroke patients with cerebrocardiac syndrome (CCS). Methods: A total of 39 post-stroke patients with CCS (stroke + CCS group) received evaluation of "constipation symptom and therapeutic effect evaluation questionnaire", and they were compared with 54 stroke patients without CCS (stroke control group) admitted in the same period. Results: Compared with stroke control group, there were significant increase in incidence rate of chronic idiopathic constipation (CIC, 24. 07% vs. 64.10%) , and total score and score of each item of constipation symptom [total score: (10. 25 ± 3. 17) scores vs. (14. 47 ± 4. 61) scores] in stroke + CCS group, P<0. 01 both. Conclusion: Chronic idiopathic constipation often occurs in post-stroke patients with cerebrocardiac syndrome and it possesses higher constipation symptom score, which may be one of causes of cerebrocardiac syndrome.%目的:调查卒中后合并脑心综合征(CCS)患者的便秘症状评分现况.方法:39例卒中后合并CCS患者(卒中+CCS组)接受了“便秘症状及疗效评估问卷”评估,并与54例同期住院未合并CCS脑卒中患者(卒中对照组)比较.结果:卒中+CCS组住院期间功能性便秘(CIC)发生率明显高于卒中对照组(64.10%比24.07%,P<0.01),同时卒中+CCS组的便秘症状总分及各分项评分均明显高于卒中对照组[总分:(14.47±4.61)分比(10.25±3.17)分,P<0.01)].结论:卒中后合并脑心综合征患者常常患有功能性便秘,且便秘症状评分严重,后者也可能是脑心综合征发病诱因之一.

  3. Clinical Observation of Acupuncture plus Hyperbaric Oxygen for Post-stroke Depression%针刺配合高压氧治疗脑卒中后抑郁症临床观察

    Institute of Scientific and Technical Information of China (English)

    林妙君; 关浩峰

    2015-01-01

    目的:观察针刺配合高压氧治疗脑卒中后抑郁症的疗效。方法将60例脑卒中后抑郁症患者随机分为治疗组30例和对照组30例,治疗组予针刺配合高压氧治疗,对照组予氟西汀胶囊(百优解)治疗。治疗前后采用汉密尔顿抑郁量表(HAMD)对患者进行评定,比较两组的疗效。结果治疗组总有效率明显高于对照组(P<0.01),治疗组治疗后 HAMD 评分明显低于对照组(P<0.01)。结论针刺配合高压氧治疗脑卒中后抑郁症能明显改善患者的抑郁症状,而且能促进神经功能的康复。%Objective To observe the therapeutic efficacy of acupuncture plus hyperbaric oxygen in treating post-stroke depression. Method Sixty patients with post-stroke depression were randomized into a treatment group of 30 cases and a control group of 30 cases. The treatment group was intervened by acupuncture plus hyperbaric oxygen, while the control group was by Fluoxetine. Before and after intervention, the Hamilton Depression scale (HAMD) was adopted for evaluation, and the efficacies were compared. Result The total effective rate of the treatment group was significantly higher than that of the control (P<0.01);after intervention, the HAMD score of the treatment group was markedly lower than that of the control (P<0.01). Conclusion Acupuncture plus hyperbaric oxygen can obviously improve the depression symptom and promote the recovery of neurologic function in patients with post-stroke depression.

  4. Nervous function and manifestations of mental psychology in patients with post-stroke depression of different syndrome types of traditional Chinese medicine

    Institute of Scientific and Technical Information of China (English)

    Yan Dong; Bo Yang; Jingling Song; Lihua Yu

    2007-01-01

    BACKGROUND: Poly-criteria pathogenesis of patients with stroke causes diversity of syndrome types of traditional Chinese medicine (TCM); meanwhile, complexity and diversity of pathological mechanism also play a key role in determining severity so as to induce effects on nervous function and manifestation of mental psychology in patients with post-stroke depression (PSD).OBJECTIVE: To analyze the syndrome types of TCM with nervous function and manifestations of mental psychology in PSD patients so as to provide evidence for the treatment based on the syndrome differentiation.DESIGN: Contrast observation.SETTING: Departments of Neurology and Traditional Chinese Medicine, General Hospital of Fuxin Mining Industry Group.PARTICIPANTS: A total of 469 outpatients or inpatients with stroke were selected from the Department of Neurology, General Hospital of Fuxin Mining Industry Group from April 2002 to July 2005. All subjects met the diagnostic criteria of stroke established by the Fourth National Cerebrovascular Disease Academic Meeting in 1995 and were finally diagnosed with CT and MRI. Totally, 177 PSD patients were involved in the final analysis and provided the confirmed consent. There were 121 males and 56 females aged from 46 to 79 years.physicians within 1 week before discharge based on Diagnostics of Traditional Chinese Medicine, which was classified into 5 types, including sputum-stasis stagnation syndrome, qi stagnation and blood stasis,kidney-essence deficiency, deficiency of the spleen and stomach and phlegm-fire disturbing the heart. In addition, they were also assessed by neurologic deficit scale (NDS; 45 points in total; the higher the scores were, the severer the deficit was), Fugl-Meyer assessment, (FMA; 100 points in total, including 66 points of upper limbs and 34 points of lower limbs; the higher the scores were, the stronger the motor function was),modified Barthel index [BI; 100 points in total; the higher the scores were, the better the activity of

  5. Reabilitação de déficits comunicativos pós-acidente vascular cerebral Rehabilitation of post-stroke communication impairments

    Directory of Open Access Journals (Sweden)

    Gigiane Gindri

    2012-01-01

    do tratamento. Sugere-se que propostas de intervenção dos processamentos comunicativos sejam delineadas com bases teóricas e que sejam conduzidos e publicados estudos com este enfoque para verificação de efeito terapêutico.Discursive, lexical-semantic, pragmatic-inferential and/or prosodic communication processing may be impaired following a cerebrovascular accident. These deficits require intervention methods and programmes for effective communication rehabilitation. Within this context, the aim of this systematic review was to identify and describe methods used for neuropsychological rehabilitation of the communication of adults after a stroke, more specifically, systematic intervention approaches for each communication processing. Abstracts published in the last ten years were selected in PubMed, using keywords related to rehabilitation, stroke and communication. For the communication topic, we also used specific keywords related to the four communication processing components. Initially, 914 abstracts were found; after exclusion of the repeated studies, 460 were analyzed. Full texts were examined if the abstract evidenced that the study was empirical, included at least one post-stroke patient, focused in communication rehabilitation, presented pre- and post-intervention assessments, and if it was published in English, French or Portuguese within the last ten years. Only four empirical studies accomplished such criteria, being conducted mainly with aphasic or aprosodic patients. These findings might be considered surprising and alarming, since there is a lack of systematic studies about rehabilitation of communication components. It is important to highlight the need to search for a detailed description of intervention procedures with specific goals, allowing studies to be replicated and also contributing for monitoring the effects of treatment. Communicative processing intervention programmes should be developed based on theoretical approaches, and studies

  6. Central activation by histamine-induced itch: analogies to pain processing: a correlational analysis of O-15 H2O positron emission tomography studies.

    Science.gov (United States)

    Drzezga, A; Darsow, U; Treede, R D; Siebner, H; Frisch, M; Munz, F; Weilke, F; Ring, J; Schwaiger, M; Bartenstein, P

    2001-05-01

    The aim of this study was to identify the functional cerebral network involved in the central processing of itch and to detect analogies and differences to previously identified cerebral activation patterns triggered by painful noxious stimuli. Repeated positron emission tomography regional cerebral blood flow (rCBF) measurements using O15-labeled water were performed in six healthy right-handed male subjects (mean age 32 +/- 2 years). Each subject underwent 12 sequential rCBF measurements. In all subjects a standardized skin prick test was performed on the right forearm 2 min before each rCBF measurement. For activation, histamine was applied in nine tests in logarithmically increasing concentrations from 0.03 to 8%. Three tests were performed with isotonic saline solution serving as a control condition. Itch intensity and unpleasantness were registered with a visual analogue scale during each test. Subtraction analysis between activation and control conditions as well as correlation analysis with covariates were performed. Itch induced a significant activation in the predominantly contralateral somatosensory cortex and in the ipsilateral and contralateral motor areas (supplementary motor area (SMA), premotor cortex, primary motor cortex). Additional significant activations were found in the prefrontal cortex and the cingulate gyrus, but not in subcortical structures nor in the secondary somatosensory cortex. In correlation analyses, several cortical areas showed a graded increase in rCBF with the logarithm of the histamine concentration (bilateral sensorimotor areas and cingulate cortex; contralateral insula, superior temporal cortex and prefrontal cortex) and with itch unpleasantness (contralateral sensorimotor cortex, prefrontal cortex and posterior insula; ipsilateral SMA). Induction of itch results in the activation of a distributed cerebral network. Itch and pain seem to share common pathways (a medial and a lateral processing pathway and a strong projection

  7. [The pain from burns].

    Science.gov (United States)

    Latarjet, J

    2002-03-01

    The painful events associated with the treatment of a severe burn can, because of their long-lasting and repetitive characteristics, be one of the most excruciating experiences in clinical practice. Moreover, burn pain has been shown to be detrimental to burn patients. Although nociception and peripheral hyperalgesia are considered the major causes of burn pain, the study of more hypothetical mechanisms like central hyperalgesia and neuropathic pain may lead to a better understanding of burn pain symptoms and to new therapeutic approaches. Continuous pain and intermittent pain due to therapeutic procedures are two distinct components of burn pain. They have to be evaluated and managed separately. Although continuous pain is by far less severe than intermittent pain, the treatment is, in both cases, essentially pharmacological relying basically on opioids. Because of wide intra- and inter-individual variations, protocols will have to leave large possibilities of adaptation for each case, systematic pain evaluation being mandatory to achieve the best risk/benefit ratio. Surprisingly, the dose of medication decreases only slowly with time, a burn often remaining painful for long periods after healing. Non pharmacological treatments are often useful and sometimes indispensable adjuncts; but their rationale and their feasibility depends entirely on previous optimal pharmacological control of burn pain. Several recent studies show that burn pain management is inadequate in most burn centres.

  8. Phospholipase D-mediated hypersensitivity at central synapses is associated with abnormal behaviours and pain sensitivity in rats exposed to prenatal stress.

    Science.gov (United States)

    Sun, Liting; Gooding, Hayley L; Brunton, Paula J; Russell, John A; Mitchell, Rory; Fleetwood-Walker, Sue

    2013-11-01

    Adverse events at critical stages of development can lead to lasting dysfunction in the central nervous system (CNS). To seek potential underlying changes in synaptic function, we used a newly developed protocol to measure alterations in receptor-mediated Ca(2+) fluorescence responses of synaptoneurosomes, freshly isolated from selected regions of the CNS concerned with emotionality and pain processing. We compared adult male controls and offspring of rats exposed to social stress in late pregnancy (prenatal stress, PS), which showed programmed behavioural changes indicating anxiety, anhedonia and pain hypersensitivity. We found corresponding increases, in PS rats compared with normal controls, in responsiveness of synaptoneurosomes from frontal cortex to a glutamate receptor (GluR) agonist, and from spinal cord to activators of nociceptive afferents. Through a combined pharmacological and biochemical strategy, we found evidence for a role of phospholipase D1 (PLD1)-mediated signalling, that may involve 5-HT2A receptor (5-HT2AR) activation, at both levels of the nervous system. These changes might participate in underpinning the enduring alterations in behaviour induced by PS. PMID:23932932

  9. An epidemiologic survey on nutritional status among post-stroke patients at community hospitals%社区脑卒中后患者营养现状的流行病学调查

    Institute of Scientific and Technical Information of China (English)

    杨江胜; 王少石; 郑天衡; 周晓宇; 沈月平

    2011-01-01

    目的 调查上海市虹口区社区医院住院的卒中后患者吞咽障碍、低白蛋白血症和营养不良的检出率以及进食情况.方法 采用横断面研究,以438例在社区医院住院的卒中后患者为研究对象,记录其人口学特征、洼田饮水试验评估结果、营养学指标(包括人体测量学指标和生化指标)和进食情况.结果 438例卒中后患者吞咽障碍、低白蛋白血症和营养不良的检出率分别为18.6%、42.7%和52.7%;376例患者经口进食,61例鼻饲肠内喂养,1例经皮内窥镜胃造瘘术.其中376例经口进食患者中32%进食量恢复正常,60%进食量为正常状态的一半以上,8%为正常状态的一半以下;62例肠内营养患者中46例能量需要量未按照"肠内肠外营养临床指南(2006版)"推荐的标准实施.结论 社区医院住院的卒中后患者中仍有相当大比例的患者存在吞咽障碍,低白蛋白血症及营养不良的检出率高;患者进食缺乏统一管理,饮食内容随意无序,进食缺乏监控;临床医生应关注卒中后患者的营养现状.%Objective To investigate the detection rate of dysphagia, hypoalbuminemia, malnutrition, and eating condition among post-stroke patients at community hospitals in Hongkou District of Shanghai. Methods A cross sectional study was carried out on 438 post- stroke patients who were admitted at community hospitals, information was gathered including demographic characteristics, the results of the assessment about water swallow test , nutrition assessment indices(anthropometry indices and nutritional biochemical indices) and eating situation. Results The detection rate of dysphagia, hypoalbuminemia and malnutrition were 18. 6%、42.7%and 52.7% respectively. There were 376 patients with oral feeding, 61 patients with nasal feeding and 1 patient with percutaneous endoscopic gastrostomy. The 32% of 376 patients with oral feeding returned to normal food intaking, 60% to more than half of

  10. 脑卒中执行功能障碍康复技术的研究进展①%Advance in Rehabilitation for Post-stroke Executive Dysfunction (review)

    Institute of Scientific and Technical Information of China (English)

    2013-01-01

    Executive dysfunction is one of the cognitive impairment in patients with stroke. This paper reviewed the assessment tools and rehabilitation approaches for post-stroke executive dysfunction, and the interactive game such as Xbox Kinect may be prospective reha-bilitation for executive dysfunction.%  执行功能障碍是脑卒中患者常见的认知功能障碍之一。本文综述脑卒中执行功能障碍的常见评测工具及康复技术,指出体感游戏Xbox360 Kinect可能成为执行功能障碍康复技术有希望的方法。

  11. 探讨早期干预对卒中后抑郁康复的效果%To explore early intervention on the effectiveness of rehabilitation post-stroke depression

    Institute of Scientific and Technical Information of China (English)

    刘中华; 白佩军; 王奎

    2010-01-01

    目的 研究早期干预对脑卒中后抑郁(post-stroke depression,PSD)康复的效果.方法 30例急性PSD患者随机分成2组:2组均采用神经内科常规药物治疗及康复训练,治疗组加用抗抑郁药物及心理行为治疗.结果 治疗组各项功能评分、临床疗效明显优于对照组.结论 PSD的干预治疗,可促进脑卒中患者运动功能的康复.

  12. Observation on clinical effect of auricular acupoint sticking plus music therapy for post-stroke insomnia%耳穴贴压结合音乐疗法对脑卒中后失眠的疗效观察

    Institute of Scientific and Technical Information of China (English)

    蔡晓敏; 章旭萍; 唐杏

    2015-01-01

    目的:观察耳穴贴压结合音乐疗法对脑卒中失眠的疗效。方法:将154例脑卒中后失眠患者按照随机数表法分为对照组及观察组,每组各77例。对照组接受耳穴贴压治疗,观察组在耳穴贴压的基础上结合音乐移情护理。比较两组患者疗程结束时及治疗结束3个月后的临床疗效。结果:治疗结束时,观察组总有效率为98.7%,显著高于对照组的89.6%,两组差异具有统计学意义(P<0.05);治疗结束3个月后,观察组总有效率为90.9%,显著高于对照组的80.5%,两组差异具有统计学意义(P<0.05)。结论:耳穴贴压结合音乐疗法治疗脑卒中后失眠临床疗效肯定,为制定脑卒中后失眠患者最佳护理康复干预方案提供了新思路。%Objective:To observe the clinical effect of auricular acupoint sticking plus music therapy for post-stroke insomnia. Methods:A total of 154 cases with post-stroke insomnia were randomly divided into a control group and an observation group by the random digital table, 77 cases in each group. The control group was treated by auricular acupoint sticking, while the observation group was treated by auricular acupoint sticking plus music therapy, to compare the clinical effects at the end of the treatment and three months after the treatment between the two groups. Results:At the end of treatment, the total effective rate was 98.7% in the observation group, remarkably higher than 89.6% in the control group, with a statistically significant difference between the two groups (P Conclusion:Auricular acupoint sticking plus music therapy was affirmative in the clinical effects for post-stroke insomnia, providing a new idea to design a best nursing and rehabilitative plan for the patients with post-stroke insomnia.

  13. Concentration Change and Clinical Significance of Plasma Cortisol in Patients with Post - stroke Depression%脑卒中后抑郁症患者血浆皮质醇的含量变化及临床意义

    Institute of Scientific and Technical Information of China (English)

    刘永强; 段晓峰; 尹娟

    2012-01-01

    Objective To explore the concentration variation and clinical value of plasma cortisol in patients with post -stroke depression. Methods Fifty- nine patients with post - stroke depression admitted to Cerebrovascular Disease Hospital of Baoding from September 2010 to August 2011 were selected as observation group. According to the scores of Hamilton rating scale for depression (HAMD), they were divided into depression group (n = 21) and non- depression group (n = 38), and the concentration change of plasma cortisol of all the patients was determined. 32 cases with normal plasma cortisol levels detected in our hospital were served as control group. The features of concentration change of plasma cortisol of patients with post - stroke depression were analyzed. Results The plasma cortisol concentrations at 8:00 am, 16:00 and 0:00 pm in patients of observation group were significantly higher than those of control group, and the difference was statistically significant between the two groups ( P < 0.05 ). The plasma cortisol concentrations at 8:00 am, 16:00 and 0:00 pm in patients of depression group were significantly higher than those of non - depression group, and the difference was statistically significant between the two groups (P <0.05). Conclusions The concentration change of plasma cortisol of patients with post - stroke depression is more significantly, which should be taken seriously by clinicians. And the corresponding therapeutic measures should be adopted actively.%目的 探讨脑卒中后抑郁症患者血浆皮质醇的含量变化及临床意义. 方法 选择本院2010年9月-2011年8月收治的脑卒中患者59例作为观察组,采用汉密顿抑郁量表(HAMD)测定后分为抑郁组21例和非抑郁组38例,均测定血浆皮质醇的含量变化,以在本院检测血浆皮质醇含量正常的32例作为对照组,分析脑卒中后抑郁症患者血浆皮质醇的含量变化特点. 结果 观察组患者清晨8时、下午4时、夜间12时的

  14. The observation about the effect of cognitive behavioral therapy in post stroke depression and nervous dysfunction%认知行为疗法对脑卒中后抑郁及神经功能康复的影响

    Institute of Scientific and Technical Information of China (English)

    梁翠萍; 孙素娟; 张卫红; 孙军雪; 刘夕霞

    2011-01-01

    Objective : To explore the effect of cognitive behavioral therapy on patients with post - stroke depression and nervous dysfunction. Methods : The 178 patients of post - stroke depression were randomly divided into treatment group and control group,89patients in each group. Treatment group accepted cognitive behavioral therapy on the hase of conventional therapy and control group accepted conventional therapy. The Self - Rating Depress Scale and Neurological Function Deficit Scale were used in the two groups before and after the treatment. Results : After 5 weeks. the scores of Self - Rating Depression and Neurological Function Deficit in the therapy group were lower than in the control group( P < 0. 01 ). Conclusion : Cognitive behavioral therapy can significantly improve the depression and promote nervous dysfunction in stroke.%目的:探讨认知行为疗法对脑卒中后抑郁及神经功能康复的临床疗效.方法:以178例脑卒中后抑郁患者为研究对象,依随机的形式分为治疗组和对照组,各89例,两组患者均采用常规治疗,治疗组则在此基础之上给予认知行为疗法.治疗前、后分别采用抑郁量表和神经功能缺损程度量表进行测评.结果:治疗组治疗5周后抑郁量表评分和神经功能缺损评分明显低于对照组,有显著性差异(P<0.01).结论:认知行为疗法对改善脑卒中后抑郁、促进神经功能康复效果显著.

  15. 不同时期脑卒中后抑郁的心理分析治疗及护理对策%Psychoanalysis treatment on post-stroke depression in different periods and the nursing strategies

    Institute of Scientific and Technical Information of China (English)

    邓华; 段勇

    2013-01-01

    Objective To study the psychoanalysis treatment on post-stroke depression in different periodsand the nursing strategies. Methods36 cases of patients with post-stroke depression were treated and nursed with the method of psychoanalysis, and prescribed with appropriate antidepressant treatment. To compare the changes of pre and post treatment with the scores of Hamilton Depression Rating Scale (HAMD). Results23 cases were cured (63.89%), 11 cases were getting better (30.56%), and 2 cases were ineffective (5.55%). The total effective rate is 94.44%. ConclusionThe method of proper psychoanalysis treatment and nursing, accompanying with appropriate antidepressant treatment , can notably relieve the depressive symptoms and improve the patients’ activities of daily living.%目的:探讨不同时期脑卒中后抑郁的心理分析治疗及护理对策方法。方法对36例脑卒中后抑郁的病人进行心理分析治疗和护理,并且适当给予抗抑郁药物治疗,治疗前后用汉密尔顿抑郁量表(HAMD)评分对比变化。结果治愈23例(63.89%),好转11例(30.56%),无效2例(5.55%),总有效率94.44%。结论对脑卒中后抑郁的病人进行正确的心理分析治疗及护理,并适当抗抑郁药物治疗,能明显改善患者的抑郁症状,提高患者日常生活活动能力。

  16. Effect of sertraline on the rehabilitation effect of patients with ischemic post-stroke depression%舍曲林对缺血性脑卒中后抑郁患者康复效果的影响

    Institute of Scientific and Technical Information of China (English)

    郝金海

    2015-01-01

    Objective:To explore the clinical effect of sertraline in the treatment of ischemic post-stroke depression.Methods:The patients in two groups were given conventional stroke treatment and appropriate psychological counseling.The observation group was treated with sertraline on the basis of stroke conventional treatment.Results:After 8 weeks treatment,the total effective rate(93.8%) of the observation group was significantly higher than 48.4% of the control group;the decreased degree of NIHSS score in the observation group was significantly higher than that of the control group.Conclusion:Sertraline in the treatment of ischemic post-stroke depression can effectively improve the depression symptoms and neurologic impairment symptoms.%目的:探讨舍曲林治疗缺血性脑卒中后抑郁的临床效果.方法:两组患者均给予常规脑卒中治疗及适当给予心理疏导.观察组在脑卒中常规治疗基础上给予舍曲林治疗.结果:治疗8周后,观察组总有效率93.8%明显优于对照组的48.4%;观察组NIHSS评分下降程度明显大于对照组.结论:舍曲林治疗缺血性脑卒中后抑郁,可有效改善抑郁症状及神经功能缺损症状.

  17. 肌电触发电刺激疗法对脑卒中患者手功能的影响①%Effects of Electromyography-triggered Stimulation on Hand Function Post Stroke

    Institute of Scientific and Technical Information of China (English)

    2013-01-01

    Objective To investigate the effectiveness of electromyography-triggered stimulation on the hand function post stroke. Methods 40 stroke patients were divided into electromyography-triggered stimulation group and neuromuscular electric stimulation group. They were assessed with Fugl-Meyer Assessment (FMA), active range of motion of wrist extension (WE-AROM) and modified Barthel in-dex (MBI) before and 6 weeks after treatment. Results The scores of all the assessments improved in both groups after treatment (P<0.001), and improved more in the electromyography-triggered stimulation group than in the neuromuscular electric stimulation group (P<0.05). Conclusion Compared with neuromuscular electrical stimulation, electromyography-triggered stimulation may further improve the hand function post stroke.%  目的研究肌电触发电刺激疗法对脑卒中患者手功能的影响。方法脑卒中患者40例分为肌电触发电刺激疗法组(肌电触发组)19例,神经肌肉电刺激疗法组21例(NMES组),比较两组治疗前后Fugl-Meyer上肢功能评分、改良Barthel指数、腕背伸主动关节活动度。结果两组患者治疗后各项评分均有显著提高(P<0.001);与NMES组比较,肌电触发组各项评分均有提高(P<0.05)。结论肌电触发电刺激疗法可有效改善偏瘫患者手功能障碍,疗效优于神经肌肉电刺激疗法。

  18. 中医药协同治疗卒中后抑郁症的研究近况%The recent clinical research of Chinese-western therapy on post-stroke depression

    Institute of Scientific and Technical Information of China (English)

    万媛

    2014-01-01

    脑卒中后抑郁症(post-stroke depression,PSD)是脑卒中后常见的并发症之一,主要表现为情绪情感、行为障碍及躯体不适等心理疾病。卒中后引起的神经损害和认知、功能障碍,一定程度会影响脑卒中后肢体、语言功能的恢复,治疗脑卒中后抑郁也成为促进患者康复的关键环节。随着中医药的迅速发展,中西医结合治疗PSD近年来发展较快,临床证明中医药结合西药治疗PSD更能增强患者的治疗信心,更能促进患者肢体、语言功能的恢复,更能提高患者的生活质量。%The post stroke depression is one of the complications of stroke,which is a mental disease mainly characterized with the emotional disorder, behavior disorder and somatic syndromes.Cognitive dysfunction and nervous impairment after stroke will to a certain extent affect the motor and language functional recover,and PSD is the key link of the rehabilitation of nervous function. Along with the development of traditional medicine,and integrated Chinese-western therapy of PSD are developing rapidly.There is clinical evidence that Chinese-western therapy of PSD could strengthen the confidence of patients, promote the rehabilitation of the function of motor and language and improve the patients' life quality.

  19. 分级康复治疗对脑卒中患者吞咽功能的影响%Effect of graded rehabilitation treatment on dysphagia in post-stroke patients

    Institute of Scientific and Technical Information of China (English)

    李飞燕; 沈军; 冯丽华

    2013-01-01

    目的:探讨分级康复治疗对脑卒中吞咽困难患者吞咽功能的影响.方法:将108例脑卒中吞咽困难患者随机分成两组,实验组和对照组各54例,实验组根据吞咽困难不同分级采取分级康复治疗,对照组采用神经内科常规治疗,治疗4周后对比两组患者吞咽功能改善情况.结果:康复治疗4周后,实验组吞咽功能有显著改善,两组患者疗效间差异有统计学意义(P<0.05).结论:分级康复治疗可以改善卒中后患者的吞咽功能.%Objective:To evaluate the effect of graded rehabilitation treatmentinpost-stroke patients with different levels of dysphagia.Methods:Totallyy 108 post-stroke patients with dysphagia were randomly divided as trial group (n =54) receiving graded rehabilitation treatment,and control group (n =54) receiving routine medical therapy.Results:After four weeks treatment,the swallowing function in the trial group was improved dramatically (p < 0.05).Conclusion:The graded rehabilitation treatment could improve the swallowing function of the post-stroke patients with dysphagia.

  20. Spatial and temporal activation of spinal glial cells: role of gliopathy in central neuropathic pain following spinal cord injury in rats.

    Science.gov (United States)

    Gwak, Young S; Kang, Jonghoon; Unabia, Geda C; Hulsebosch, Claire E

    2012-04-01

    In the spinal cord, neuron and glial cells actively interact and contribute to neurofunction. Surprisingly, both cell types have similar receptors, transporters and ion channels and also produce similar neurotransmitters and cytokines. The neuroanatomical and neurochemical similarities work synergistically to maintain physiological homeostasis in the normal spinal cord. However, in trauma or disease states, spinal glia become activated, dorsal horn neurons become hyperexcitable contributing to sensitized neuronal-glial circuits. The maladaptive spinal circuits directly affect synaptic excitability, including activation of intracellular downstream cascades that result in enhanced evoked and spontaneous activity in dorsal horn neurons with the result that abnormal pain syndromes develop. Recent literature reported that spinal cord injury produces glial activation in the dorsal horn; however, the majority of glial activation studies after SCI have focused on transient and/or acute time points, from a few hours to 1 month, and peri-lesion sites, a few millimeters rostral and caudal to the lesion site. In addition, thoracic spinal cord injury produces activation of astrocytes and microglia that contributes to dorsal horn neuronal hyperexcitability and central neuropathic pain in above-level, at-level and below-level segments remote from the lesion in the spinal cord. The cellular and molecular events of glial activation are not simple events, rather they are the consequence of a combination of several neurochemical and neurophysiological changes following SCI. The ionic imbalances, neuroinflammation and alterations of cell cycle proteins after SCI are predominant components for neuroanatomical and neurochemical changes that result in glial activation. More importantly, SCI induced release of glutamate, proinflammatory cytokines, ATP, reactive oxygen species (ROS) and neurotrophic factors trigger activation of postsynaptic neuron and glial cells via their own receptors

  1. Effect of different therapies of Chinese medicine on the expressions of c-Fos and c-Jun proteins in hippocampus of rats with post-stroke depression

    Institute of Scientific and Technical Information of China (English)

    Hongyan Wang; Mei Chen; Binhui Zhang

    2006-01-01

    BACKGROUND: c-fos and c-jun, the important immediate early genes (IEG), are regarded as the markers for the location and function of neuronal activity, as well as the third signal messengers, they couple the stress stimulation and the gene expression in neuron, and hippocampus is involved in the process of signal transmission after stress stimulation induced depression.OBJECTIVE: To observe the therapeutic effects of Bushen Yiqi (tonifying kidney to benefit qi), Huoxue Huayu (promoting blood circulation to dissipate blood stasis) and Ditan Kaiqiao (eliminating phlegm for resuscitation) on the expressions of c-Fos and c-Jun proteins in hippocampus and spontaneous behaviors of rats with post-stroke depression (PSD), and compare the results with those of fluoxetine, which is known to have definite effect on depression.DESIGN: A randomized controlled trial.SETrING: Zhejiang College of Traditional Chinese Medicine.MATERIALS: The trial was completed in Zhejiang College of Traditional Chinese Medicine from January to July in 2003. Fifty-six healthy adult Wistar male rats of clean grade, weighing (250±50) g, were randomly divided into 7 groups with 8 rats in each group: control group, model group, forced swimming group,Bushen Yiqi group; Huoxue Huayu, Ditan Kaiqiao group and fluoxetine group. The Bushen Yiqi Tang con tained Renshen, Huangqi, Heshouwu, Gouqi, Shudi, etc., crude drugs 1 800 g/L. The Huoxue Huayu Tang contained Danshen, Chuanxiong, Chishao, Yujin, etc., crude drugs 3 600 g/L. The Dian Kaiqiao Tang contained Banxia, Danxing, Changpu, Yuanzhi, etc., crude drug 1 000 g/L.METHODS: ① Except the control group and forced swimming group, rats in the other groups were made into PSD models by deligating the bilateral common carotid arteries permanently. ② Rats in the control group, model group and forced swimming group were intragastrically perfused by saline (3 mL for each time); those in the Bushen Yiqi group, Huoxue Huayu, Ditan Kaiqiao group and fluoxetine

  2. The measurement of pain.

    Science.gov (United States)

    Frampton, C L; Hughes-Webb, P

    2011-08-01

    Pain has been studied in depth for decades, yet the pain associated with cancer is still frequently under treated. The measurement of pain in patients with terminal cancer is imperative, because failure to carry it out is recognised as an important reason for inadequate treatment. Although pain is characterised as a symptom, it is a subjective personal experience or a perception. This perception is influenced by both nociceptive transmission and central nervous system modulation; and psychological, social and other environmental factors. It is a complex issue most simply described by the phrase 'Pain is whatever the experiencing person says it is, existing whenever he says it does'. With such complex interplays between pathophysiological and biopsychosocial factors, it is unsurprising that an objective assessment of pain remains elusive. Despite this, many subjective measures of pain have been developed that produce consistent and reliable results when used properly and appropriately. PMID:21571514

  3. Chemical Interventions for Pain.

    Science.gov (United States)

    Aronoff, Gerald M.; And Others

    1986-01-01

    Reviews properties and pharmacological effects of medications for pain, including peripherally acting analgesics, centrally acting narcotics, and adjuvant analgesics including antidepressants. Discusses the role of the endogenous opioid system in pain and depression. Explores clinical management issues in both inpatient and outpatient settings,…

  4. Persistent facial pain conditions

    DEFF Research Database (Denmark)

    Forssell, Heli; Alstergren, Per; Bakke, Merete;

    2016-01-01

    , clinical features, consequences, central and peripheral mechanisms, diagnostic criteria (DC/TMD), and principles of management. For each of the neuropathic facial pain entities, the definitions, prevalence, clinical features, and diagnostics are described. The current understanding of the pathophysiology...

  5. Pain in Down's Syndrome

    Directory of Open Access Journals (Sweden)

    Federica Mafrica

    2006-01-01

    Full Text Available Pain is a homeostatic mechanism that intervenes to protect the organism from harmful stimuli that could damage its integrity. It is made up of two components: the sensory-discriminative component, which identifies the provenance and characteristics of the type of pain; and the affective-motivational component, on which emotional reflexes, following the painful sensation, depend.There is a system for pain control at an encephalic and spinal level, principally made up of the periaqueductal grey matter, the periventricular area, the nucleus raphe magnus, and the pain-inhibition complex situated in the posterior horns of the spinal cord. Through the activation of these pain-control systems, the nervous system suppresses the afference of pain signals. Endogenous opioids represent another analgesic system.In the course of various studies on pain transmission in Down patients, the reduced tolerance of pain and the incapacity to give a qualitative and quantitative description emerged in a powerful way. All of these aspects cause difficulty in evaluating pain. This is linked to several learning difficulties. However, it cannot be excluded that in these anomalies of pain perception, both the anatomical and the neurotransmitter alteration, typical of this syndrome, may hold a certain importance.This fact may have important clinical repercussions that could affect the choice of therapeutic and rehabilitative schemes for treatment of pathologies in which pain is the dominant symptom, such as postoperative pain. It could influence research on analgesics that are more suitable for these patients, the evaluation of the depth of analgesia during surgical operation, and ultimately, absence of obvious pain manifestations. In conclusion, alterations of the central nervous system, neurotransmitters, pain transmission, and all related problems should be considered in the management of pain in patients with Down's syndrome, especially by algologists and

  6. La estimulación eléctrica de la corteza motora para el tratamiento del dolor central y dolor periférico por desaferentización Electrical stimulation of the motor cortex for the management of central pain and peripheral pain caused by desafferentiation

    Directory of Open Access Journals (Sweden)

    J. V. Pesudo

    2004-09-01

    Full Text Available El dolor central y el dolor periférico por desaferentización son de difícil tratamiento incluso con fármacos de última generación. La estimulación eléctrica sobre diversas estructuras ha demostrado en general ser poco efectiva. La estimulación sobre la corteza motora es una técnica relativamente nueva que parece ofrecer resultados prometedores en estos cuadros. Aunque desde el punto de vista quirúrgico es una técnica sencilla, no lo es tanto la localización adecuada de la corteza motora, lo cual es una condición importante para su efectividad. En este trabajo ofrecemos una revisión bibliográfica sobre ella. Sus indicaciones fundamentales actualmente son el dolor central fundamentalmente talámico, y el dolor trigeminal por desaferentización. La respuesta a barbitúricos sin respuesta a opioides, la conservación relativa de las vías motoras y sensitivas, y la respuesta a la estimulación magnética transcraneal predicen un buen resultado. Diversos métodos son utilizados para determinar la zona a estimular: PESS, estimulación intraoperatoria, neuronavegación, RNM funcional. Los parámetros de estimulación recomendados varían de unos autores a otros. Su mecanismo de actuación no es en la actualidad bien conocido aunque las teorías más aceptadas son la activación de zonas que modulan el dolor y la inhibición de la transmisión de los estímulos nociceptivos a nivel medular.Central pain and peripheral pain caused by desafferentation are difficult to treat even with last generation drugs. Electric stimulation of several structures has shown to be scarcely effective in general. Stimulation of motor cortex is a relatively new technique that seems to offer promising results in these disorders. While it is a simple technique from the surgical point of view, the adequate location of the motor cortex is not so easy, this being a significant condition for its effectiveness. In this paper we review the literature that has been

  7. Patellofemoral pain.

    Science.gov (United States)

    Crossley, Kay M; Callaghan, Michael J; van Linschoten, Robbart

    2016-02-01

    Patellofemoral pain refers to pain behind or around the patella (also known as patellofemoral pain syndrome, anterior knee pain, runner's knee, and, formerly, chondromalacia patellae). Patellofemoral pain is common, accounting for 11-17% of all knee pain presentations to general practice.(1 2) While it typically occurs in physically active people aged Patellofemoral pain can be diagnosed in the clinic, and evidence based treatments can reduce pain and improve function, allowing patients to maintain a physically active lifestyle. PMID:26834209

  8. Pain following stroke: a population-based follow-up study.

    Directory of Open Access Journals (Sweden)

    Henriette Klit

    Full Text Available BACKGROUND AND PURPOSE: Chronic pain is increasingly recognized as a consequence of stroke. This study aimed to describe the prevalence and pain types of new onset chronic pain ("novel pain" in patients with stroke compared with a randomly selected reference group from the general population and to identify factors associated with pain development in stroke patients. METHODS: In a population-based follow-up design, development of chronic pain after stroke was assessed by a questionnaire sent to consecutive stroke patients, registered in a Danish national stroke database, two years after their stroke. A randomly selected sex- and age-matched reference group from the same catchment area received a similar questionnaire about development of new types of chronic pain in the same time period. A total of 608 stroke patients and 519 reference subjects were included in the study. RESULTS: Development of novel pain was reported by 39.0% of stroke patients and 28.9% of reference subjects (OR 1.57, CI 1.21-2.04, and was associated with low age and depression in a multivariate model. Daily intake of pain medication for novel pain was reported by 15.3% and 9.4% of the stroke and reference population, respectively. Novel headache, shoulder pain, pain from increased muscle stiffness, and other types of novel pain were more common in stroke patients, whereas joint pain was equally common in the two groups. CONCLUSIONS: Development of chronic pain is more common in stroke patients compared with sex- and age-matched reference subjects. Evaluation of post-stroke pain should be part of stroke follow-up.

  9. 生物反馈训练联合米氮平治疗脑卒中后抑郁%Biofeedback training combined with mirtazapine for post-stroke depression

    Institute of Scientific and Technical Information of China (English)

    朱建中; 王百灵; 王瑛; 俞皎

    2012-01-01

    目的:探讨辅助生物反馈训练联合米氮平治疗脑卒中后抑郁(PSD)的康复效果.方法:脑卒中后抑郁患者66例,分为生物反馈联合米氮平组(联合组)及单用米氮平组(米氮平组).2组均服用米氮平,联合组加用生物反馈治疗.采用汉密顿抑郁量表(HAMD)和抑郁自评量表(SDS)评定临床疗效.结果:治疗第1周末联合组HAMD及SDS评分较治疗前显著下降(P<0.05),且显著低于米氮平组(P<0.05),米氮平组在治疗第2周末HAMD及SDS评分较治疗前显著下降(P<0.01).治疗第6周末,2组HAMD及SDS评分较治疗前均显著下降(均P<0.01).联合组显效率较米氮平组差异无统计学意义(85.29%,84.37%).结论:辅助生物反馈训练可加快改善脑卒中抑郁患者的抑郁状态,值得在临床上推广使用.%Objective: To explore the rehabilitation effect of biofeedback training combined with mirtazapine on the post-stroke depression. Methods: Sixty-six cases of post-stroke depression were randomly divided into biofeedback training combined mirtazapine group (combined group) and mirtazapine group. Both groups were given mirtazapine, and combined group was given biofeedback training additionally. Hamilton depressive scale (HAMD) and depression self rating scale (SDS) were used to assess the curative effectiveness at 1st, 2nd, 4th, and 6th week after treatment. Results: At 1st week after treatment, HAMD and SDS scores in combined group was decreased obviously as as compared with those before treatment (P<0. 05) and in mirtazapine group (P<0. 05). At 2nd week after treatment, HAMD and SDS scores in mirtazapine group were decreased obviously as compared with those before treatment (P<0. 01). At 6th week after treatment, HAMD and SDS scores in both groups were decreased obviously (P <0. 01). There was no significant difference in the efficiency between combined group and mirtazapine group (85. 29% vs. 84. 37%). Conclusion: Auxiliary biofeedback training can improve

  10. 黄连冰刺激对脑卒中后吞咽障碍的护理干预观察%Observation of Iced Rhizoma Coptidis Decoction Stimulation for Intervention of Post-stroke Swallowing Disorder

    Institute of Scientific and Technical Information of China (English)

    谢梦姣

    2015-01-01

    【目的】观察黄连冰刺激对脑卒中后吞咽障碍的临床疗效。【方法】选择2012年6月至2014年6月在本院接受治疗的脑卒中后吞咽障碍患者62例,随机分为干预组和对照组各31例。对照组给予常规治疗,并进行冰刺激护理干预;干预组在常规治疗的基础上,给予黄连冰刺激护理干预。2组均每周治疗7 d,共治疗4周。观察2组改善吞咽能力的疗效和治疗前后吞咽障碍评分的变化情况。【结果】(1)干预组总有效率为87.09%,对照组为67.74%,干预组在改善吞咽能力方面的疗效优于对照组,2组比较差异有统计学意义(P<0.05)。(2)治疗后,2组患者的吞咽障碍评分均较治疗前提高,差异均有统计学意义(P<0.05),且干预组较对照组提高更明显,差异有统计学意义(P<0.05)。【结论】黄连冰刺激疗法对脑卒中后吞咽障碍进行干预治疗,能明显改善患者的吞咽功能。%Objective To observe the therapeutic effect of iced Rhizoma Coptidis decoction stimulation for post-stroke swallowing disorder. Methods Sixty-two post-stroke swallowing disorder patients admitted from June of 2012 to June of 2014 in Sanya Hospital of Traditional Chinese Medicine were enrolled into the study. The patients were evenly randomized into intervention group and control group. The control group was given conventional intervention and stomatological nursing with ice, and the intervention group was given conventional intervention and stomatological nursing with iced Rhizoma Coptidis decoction, once a day for 4 continuous weeks. After treatment, the therapeutic effect on swallowing disorder was evaluated, and the changes of scores of swallowing disorder before and after treatment were compared in the two groups. Results (1) The total effective rate of intervention group was 87.09%, and that of the control group was 67.74%, the difference being significant (P<0.05) . (2) After

  11. Therapeutic Effect of Citalopram Combined with Shenshuaining Pill in Treatment of Post-stroke Depression%西酞普兰合并神衰宁丸治疗脑卒中后抑郁症

    Institute of Scientific and Technical Information of China (English)

    程素满; 陈金峰; 李志榕

    2011-01-01

    目的:探讨西酞普兰合并神衰宁丸治疗脑卒中后抑郁的临床疗效.方法:将80例脑卒中后抑郁患者随机分为西酞普兰合并神衰宁丸的治疗组和西酞普兰对照组各40例,观察治疗6周.于治疗前及治疗1,2,4,6周末采用汉密顿抑郁量表(HAMD)进行抗抑郁疗效评定,用改良的爱丁堡-斯堪的纳维亚卒中量表(MESSS)进行神经功能康复评定,用治疗中出现的症状量表(TESS)评定药物不良反应.结果:HAMD和TESS评分显示,在第1和2周末治疗组和对照组区别显著(P <0.05);MESSS评分显示:在治疗6周末,治疗组(14.22 ± 4.53)比对照组(17.38±5.10)下降显著(P<0.05).结论:在治疗脑卒中后抑郁中,酞普兰合并神衰宁丸抗抑郁的起效更快,对神经功能的康复效果和患者的耐受性都较好.%Objective: To study the therapeutic effect of citalopram combined with Shenshuaining pill (SSNP) in the treatment of post-stroke depression. Method: Eighty post-stroke depression patients were randomly assigned into treated (citalopram combined with SSNP) and control (citalopram) groups (each n = 40 ) for 6 weeks. Anti-depression therapeutic effect, neural functional impairment and adverse reactions were assessed with the hamilton depression scale (HAMD), the modified Edinburgh-Scandinavia stroke scale (MESSS), and the Treatment Emergent Symptom Scale(TESS) respectively. Result: In the treatment group, the scores of the HAMD and TESS distinguished markedly at the end of the 1st and 2st weeks, and the total scores of the MESSS were 14. 22 ±4. 53 in treatment groups at the end of the 6th were, compared with control group( 17.38 ±5. 10), they decreased significantly distinguished ( P < 0. 05 ). Conclusion: Citalopram combined with SSNP had superior therapeutic effect for neural function recovery, and was a kind of rapid and safe drug in the treatment of post-stroke depression.

  12. Post-stroke hand dysfunction treated with acupuncture at Zhongzhu(TE 3) and Waiguan(TE 5)%针刺中渚、外关治疗脑卒中后手功能障碍

    Institute of Scientific and Technical Information of China (English)

    程先宽; 王征美; 孙岚; 李玉华

    2011-01-01

    目的:观察针刺中渚、外关改善脑卒中后手功能障碍的临床疗效.方法:将60例脑卒中后手功能障碍患者随机分为观察组和对照组,每组30例,两组均给予常规药物治疗及物理治疗、作业治疗等康复训练.观察组加针刺患手中渚、外关.两组治疗前后分别进行神经功能缺损评分、手功能、步行能力、日常生活活动能力(ADL)改良巴氏指数量表等评定.结果:两组患者治疗后,手功能、步行能力、ADL、NIHSS评分较治疗前均有明显改善(均P<0.01).观察组手功能、步行能力、ADL改善较对照组更为明显(均P<0.05).结论:脑卒中后手功能障碍患者常规药物治疗及康复训练配合针刺中渚、外关治疗,能明显改善脑卒中后手功能障碍,提高步行能力.提高日常生活活动能力,提高康复疗效.%Objective To observe the curative effects of post-stroke hand dysfunction treated with acupuncture at Zhongzhu(TE 3) and Waiguan(TE 5).Methods Sixty cases of post-stroke hand dysfunction were randomly divided into an observation group(30 cases) and a control group(30 cases).Routine medicine, physical therapy, occupational therapy and other rehabilitation trainings were applied in both groups; Zhongzhu(TE 3) and Waiguan(TE 5) were punctured in observation group.Scores of nervous functions deficit by the National Institutes of Health Stroke Scale (NIHSS), hand function, walking ability, activities of daily living (ADL) by Modified Barthel Index Scale were evaluated in both groups before and after treatment.Results After treatment, the scores of hand function, walking ability, ADL and NIHSS were improved in both groups(all P<0.01), and the hand function, walking ability and ADL in observation group were superior to those in control group (all P<0.05).Conclusion Routine medicine and rehabilitation trainings combined with acupuncture at Zhongzhu (TE 3) and Waiguan (TE 5) to treat post-stroke hand dysfunction can obviously

  13. Research on Post-stroke Depression and the Impact on Neurological Rehabilitation%脑卒中后抑郁对神经功能康复的影响研究

    Institute of Scientific and Technical Information of China (English)

    廖玲

    2013-01-01

    Objective: To explore the post-stroke depression ( Post-stroke Depression PSD ) and its impact on neurological rehabilitation. Method: Using the retrospective analysis of clinical data, 122 cases of a-cute stroke patients admitted to hospital psychiatric clinical data was given a retrospective analysis during Dec. 2008 to Dec. 2011. And then PSD diagnostic tests were provided at the month of 1,3 ,5 respectively. Mainly neurological deficit score ( SSS ), the Hamilton depression scale ( HAMD ), as well as activities of daily living score ( ADL ) were provided during the periods. Result: The incidence of PSD and severity of neurological deficits has a obvious relationship with activities of daily living decreased ( P 0. 05 ). Conclusion: The PSD is a relatively common complication of acute cerebrovascular disease, but also affect the rate of recovery of neurological function in patients with the degree of rehabilitation, it should be active in the treatment and improvement of depressive symptoms in patients with acute stroke, then be able to ensure that acute stroke patients with neurological function and to rehabilitate and daily living skills to restore.%目的:探讨脑卒中后抑郁(Post-stroke Depression,PSD)及其对神经功能康复的影响.方法:采用临床资料回顾性分析的方法,将于2008年12月至2011年12月入住我院神经科的122例急性脑卒中患者的临床资料进行回顾性分析,分别在本组患者1、3、5个月进行PSD诊断检查,行神经功能缺损评分(SSS)、汉密尔顿抑郁量表(HAMD)以及日常生活能力评分(ADL).结果:PSD的发生率以及严重程度与神经功能缺损与日常生活能力下降程度有着较为明显的关系,具有显著的统计学意义,P<0.01;PSD发生率与发生的严重程度与病变所发生的具体部位以及病灶规格没有直接的关联性,其不存在统计学差异,P>0.05.结论:PSD是急性脑血管疾病较为常见的一种并发症,而且还会影响到

  14. Clinical Efficacy Observation of Zoloft Combined with Danzhixiaoyao Pills for the Treatment of Post-stroke Depression%左洛复联合丹栀逍遥丸治疗卒中后抑郁的临床疗效

    Institute of Scientific and Technical Information of China (English)

    张毓茂; 郭玉花; 陈晓燕; 黄河

    2014-01-01

    Objective To observe the efficacy and safety of Zoloft combined with Danzhixiaoyao pills for the treatment of post-stroke depression. Methods 80 cases of patients with post-stroke depression received in our hospital were randomly divided into observation group and control group, with 40 cases in each group. Control group was given Zoloft, and the observation group was given Danzhixiaoyao pills based on the control group. Efficacy and adverse reactions in the two groups of patients were observed and recorded after 8 weeks of treatment. Results Reduced rate of HAMD scale scores in the observation group 2, 4, 6, 8 weeks after the treatment were significantly higher than the control group, the difference was statistically significant (t=4.571, 3.317, 3.971, 3.348,P<0.05);The total effective rate in observation group was 97.5%after 8 weeks of treatment, significantly better than the control group (82.5%), the difference was statistically significant (χ2=5.00,P<0.05);Adverse reactions rate in observation was 7.5%, significantly lower than the control group (30%), the difference was statistically significant (χ2=6.65,P<0.05). Conclusions Zoloft combined Danzhixiaoyao pills for the treatment of post-stroke depression had significant effect and less adverse reactions, worthy of clinical promotion.%目的:观察左洛复联合丹栀逍遥丸治疗卒中后抑郁的疗效与安全性。方法将本院收治的80例卒中后抑郁的患者根据随机原则分为观察组与对照组,每组40例。对照组给予左洛复治疗,观察组在对照组的基础上加用丹栀逍遥丸,治疗8周后,对两组患者的疗效与不良反应进行观察和记录。结果在治疗2、4、6、8周后,观察组的HAMD抑郁量表评分减分率均显著大于对照组,差异有统计学意义(t=4.571、3.317、3.971、3.348,P<0.05);治疗8周后,观察组的总有效率为97.5%,显著优于对照组(82.5%),差异具有统计学意义(χ2=5.00, P

  15. 黛力新对青年卒中后抑郁的干预作用%The intervention effect of Dailixin in post-stroke depression of youth

    Institute of Scientific and Technical Information of China (English)

    朱浩猛; 程哲; 张伟东; 杜会山

    2012-01-01

    Objective To explore the curative effect and recovery of neural function of Dailixin to post-stroke depression of youth. Methods 78 cases of youth with post-stroke depression were randomly divided into the treatment group and control group, all patients were given neurological conventional treatments, neural function recovery and psychological treatment, at the same time, the treatment group was given Dailixin antidepressant treatment. The Hamilton depression rating scale (HAMD), improvement of Edinburgh-in Scandinavia rating scale (MESSS) to depression degree, neural function defect were assessed before treatment and after treatment. Results After four weeks of therapy, the treatment group in patients with depression, neural function defect of improved range was better than that in the control group. Conclusion Dailixin treatment after stroke has a good young depression effect, and can promote the nerve functional recoveryof patients.%目的 探讨黛力新对青年卒中后抑郁患者的疗效及其对神经功能康复的影响.方法 将78例青年卒中后抑郁患者随机分为对照组和治疗组,均给予神经内科常规药物治疗、神经功能康复及心理治疗,治疗组同时给予黛力新抗抑郁治疗.分别于治疗前、后采用汉密尔顿抑郁量表(HAMD)、改良爱丁堡-斯堪的那维亚评分量表(MESSS)对患者抑郁程度、神经功能缺损程度进行评定.结果 经4周的治疗后,治疗组患者在抑郁、神经功能缺损程度改善幅度均优于对照组.结论 黛力新治疗青年卒中后抑郁具有良好的效果,同时也能促进患者神经功能恢复.

  16. Effect of post stroke depression on the nerve function rehabilitation%脑卒中后抑郁及其对神经功能康复的影响

    Institute of Scientific and Technical Information of China (English)

    李丽

    2009-01-01

    目的 探讨脑卒中后抑郁(post-stroke deppression,PSD)时神经功能康复的影响.方法 选取急性脑卒中患者80例,分别在病程1、3、6个月行PSD诊断,行神经功能缺损评分(SSS)、日常生活能力评分(ADL)、汉密尔顿抑郁量表评分(HAMD).结果 脑卒中后抑郁的发生率和严重程度与神经功能缺损和日常生活能力下降程度有关,与病变部位、病灶大小无相关性.结论 卒中后抑郁是急性脑血管病患者常见并发症,并可影响患者神经功能康复的速度和程度,抗抑郁治疗能在抑郁症状明显改善的同时,促进患者神经功能和日常生活能力的恢复.%Objective To investigate the effect of post-stroke depression on the nerve function rehabilitation. Methods Eighty acute stroke patients were included in the study. After inclusion,we did three times of assessments at the end of 1 month,3 months,6 months respectively using HAMD assessment to determine whether there had depression or not, as well as SSS(modified edingburgh-seoring scale)for neurological function, ADL(activity of daily living). Results The morbidity and severity of PSD were related to the degrees of neurological impairment and daily living ability decline. PSD was not correlated with stroke location, size. Conclusions PSD is a frequent and longterm complication in acute cerebro-vascular disease, which influences speed of rehabilitation of neurological impairment in stroke patients. Anti-Depressive therapy could ameliorate the symptom of depression and improve the ability of daily living and neurologic function notably

  17. The McKenzie method compared with manipulation when used adjunctive to information and advice in low back pain patients presenting with centralization or peripheralization. A randomized controlled trial

    DEFF Research Database (Denmark)

    Petersen, Tom; Larsen, Kristian; Nordsteen, Jan;

    2011-01-01

    a structured exercise programme tailored to the individual patient as well as manual therapy for the treatment of persistent low back pain. There is presently insufficient evidence to recommend the use of specific decision methods tailoring specific therapies to clinical subgroups of patients in primary care.......Methods. A total of 350 patients suffering from low back pain with a duration of more than 6 weeks who presented with centralization or peripheralization of symptoms with or without signs of nerve root involvement, were enrolled in the trial. Main outcome was number of patients with treatment success defined...... 0.2 to 2.9, P = 0.030 respectively). There was also a significant difference of 13% in number of patients reporting global perceived effect at end of treatment (P = 0.016). None of the other secondary outcomes showed statically significant differences.Conclusion. In patients with low back pain...

  18. Neonatal pain management

    Directory of Open Access Journals (Sweden)

    Tarun Bhalla

    2014-01-01

    Full Text Available The past 2-3 decades have seen dramatic changes in the approach to pain management in the neonate. These practices started with refuting previously held misconceptions regarding nociception in preterm infants. Although neonates were initially thought to have limited response to painful stimuli, it was demonstrated that the developmental immaturity of the central nervous system makes the neonate more likely to feel pain. It was further demonstrated that untreated pain can have long-lasting physiologic and neurodevelopmental consequences. These concerns have resulted in a significant emphasis on improving and optimizing the techniques of analgesia for neonates and infants. The following article will review techniques for pain assessment, prevention, and treatment in this population with a specific focus on acute pain related to medical and surgical conditions.

  19. Dor neuropática central após lesão medular traumática: capacidade funcional e aspectos sociais Dolor neuropático central después de lesión medular traumática: capacidad funcional y aspectos sociales Central neuropathic pain after traumatic spinal cord injury: functional capacity and social aspects

    Directory of Open Access Journals (Sweden)

    Janaina Vall

    2005-12-01

    Full Text Available Estudo de caso comparativo com o objetivo de avaliar a capacidade funcional e os aspectos sociais de dois pacientes, ambos com lesão medular traumática, sem e com dor neuropática central associada, respectivamente. Para avaliar a capacidade funcional, foi utilizado como instrumento o Functional Independence Measure ou Escala de Independência Funcional. E para avaliar os aspectos sociais foi construído o ecomapa de cada paciente, preconizado pelo modelo Calgary de avaliação de famílias. Ambos foram aplicados no domicílio do paciente. Os resultados mostraram que o paciente com dor neuropática central secundária à lesão medular possui baixa capacidade funcional e precária rede social de apoio, quando comparado com o paciente com as mesmas condições, porém sem dor associada.Estudio de caso comparativo con el objetivo de evaluar la capacidad funcional y los aspectos sociales de dos paciente, ambos con lesión medular traumática, sin y con el dolor neuropático central, respectivamente. Para evaluar la capacidad funcional, se usó como instrumento la Escala de Independencia Funcional. Y para evaluar los aspectos sociales, el ecomapa de cada paciente fue construido, preconizado por el modelo Calgary de evaluación de familias. Los dos furon aplicados en la casa del paciente. Los resultados mostraron que el paciente con dolor neuropatico central secundario a la lesión medular posee capacidad funcional baja y precaria red social de apoyo, cuando comparado con el paciente con las mismas condiciones, pero sin el dolor asociado.Comparative study of case with the aim of evaluating the functional capacity and social aspects of two patients, both with traumatic spinal cord injury, without and with central neuropathic pain associated, respectively. To evaluate the functional capacity it was used as instrument Functional Independence Measure. And to evaluate the social aspects the ecomap of each patient one it was built, extolled by the model

  20. Successful use of stellate ganglion block and a new centrally acting analgesic with dual mode of action in a resistant temporomandibular joint pain

    OpenAIRE

    Jones, Gareth Peter; Tripathi, Shiva Shankar

    2014-01-01

    Stellate ganglion blocks have been shown to provide effective pain relief in a number of different conditions involving the upper body. This was demonstrated in a 65-year-old woman who had experienced severe debilitating pain in her left temporomandibular joint (TMJ) and the surrounding area of her face for over 10 years. The pain was unresponsive to indomethacin, carbamazepine, sodium valproate, gabapentin, lithium, melatonin and amitriptyline. She had also had four surgical procedures to th...

  1. 认知行为疗法在脑卒中抑郁症患者康复过程中的作用%Cognitive behavioral therapy for patients with post-stroke depression in the restoration process

    Institute of Scientific and Technical Information of China (English)

    李丽; 赵明芳

    2009-01-01

    目的:研究认知行为疗法(cognitive behavioral therapy,CBT)在脑卒中抑郁症(post-stroke depression,PSD)患者康复过程中的作用.方法:将40例PSD患者随机均分为观察组和对照组,对照组口服阿米替林,观察组在口服阿米替林同时加用CBT,采用汉密顿抑郁量表(Hamilton depression scale,HAMD)对患者进行测查,检测时间为脑卒中发病后1~11个月,2个月检测1次. 结果:在加用CBT后,观察组在6个月后评分均明显低于对照组(P<0.05). 结论:CBT在PSD患者康复过程中有明显的效果.

  2. Xuefuzhuyutang Combined Treatment of Acupuncture Baihui for 72 Cases of Post-stroke Depression%血府逐瘀汤合针刺百会治疗脑卒中后抑郁72例

    Institute of Scientific and Technical Information of China (English)

    潘文明

    2013-01-01

    Objective: To observe the curative ef ect of depression of Xuefu Zhuyu Decoction Combined with acupuncture in treatment of post stroke. Methods: 72 cases of patients with depression after stroke were selected, Xuefuzhuyu Decoction Combined with acupuncture at Baihui acupoint therapy. Results: of the 72 patients, 24 cases were cured, 29 cases markedly ef ective, 14 cases, 5 cases inef ective, the total ef iciency of 93.1%. Conclusion: this method has obvious curative ef ect, is worth the clinical promotion.%目的:观察血府逐瘀汤合针刺百会治疗脑卒中后抑郁的疗效。方法选择脑卒中后抑郁症患者72例,进行血府逐瘀汤加减结合针刺百会穴治疗。结果72例患者,痊愈24例,显效29例,有效14例,无效5例,总有效率93.1%。结论此法疗效显著,值得临床推广。

  3. The characteristic appearance and analysis of H reflex in lower extremity of hemiplegic patients with post-stroke%脑卒中后偏瘫患者下肢H反射的特征表现

    Institute of Scientific and Technical Information of China (English)

    李红玲; 徐凌娇; 潘拴珍; 王淑英

    2011-01-01

    目的:通过研究脑卒中后偏瘫患者下肢H反射的特征表现及其与偏瘫下肢肢体功能评定的关系,探讨H反射在脑卒中后偏瘫患者神经电生理评定中的应用价值.方法:选择脑卒中恢复期偏瘫患者40例,分别对患者双侧胫神经和腓总神经所支配的腓肠肌和胫骨前肌进行H反射检查,并对患侧下肢给予临床痉挛指数(CSI)评定.计算胫神经和腓总神经H反射的引出率,并对其所引出的H反射结果以及与CSI的相关性进行比较和分析.结果:患者双侧胫神经所支配的腓肠肌H反射引出率100%,胫骨前肌H反射引出率为10%.患侧胫神经H反射潜伏期平均为(30.09±1.87 )ms;非患侧胫神经H反射潜伏期平均为(31.99±2.31 )ms.患侧胫神经Hmax/Mmax比值均数中位数平均为0.476;非患侧胫神经Hmax/Mmax比值平均为0.189.患侧与非患侧相比,患侧H反射潜伏期缩短,Hmax/Mmax比值增大,且差异有显著性意义(P<0.05).将患侧下肢胫神经H反射潜伏期分别与CSI进行Spearman 秩相关检验,结果显示患侧下肢胫神经H反射潜伏期与CSI不相关,而患侧下肢胫神经Hmax/Mmax比值与CSI存在秩相关关系.结论:用H反射来评价脑卒中后偏瘫患者患侧痉挛的存在和严重程度,比CSI量表更客观、量化.其中Hmax/Mmax 比值是评估下运动神经元兴奋性的较好指标.%Objective: To investigate the value of application of H reflex in electrophysiological evaluation by studying relationship between the characteristic appearance of H reflex and functional assessment of affected lower extremity of hemiplegic patients post-stroke.Method: Forty hemiplegic inpatients in post-stroke convalescence stage were in various severities of limb dysfunction. The H reflex examination was administered on gastrocnemius (GS) innervated by tibial nerve and tibialis anterior (TA) innervated by common peroneal nerve of patients' extremities of both sides. At the same time, affected

  4. 针刺配合言语康复对脑卒中后失语症的治疗效果%Treatment With Acupuncture and Speech Rehabilitation for Post-stroke Aphasia

    Institute of Scientific and Technical Information of China (English)

    杨晓伟

    2015-01-01

    目的:探究针刺配合言语康复对脑卒中后失语症的治疗效果。方法将我院70例脑卒中后失语症患者随机分为对照组与研究组各35例,对照组给予单纯语言康复训练,研究组加针刺治疗,对比两组语言功能评分与临床疗效。结果研究组语言功能评分、治疗总有效率明显高于对照组。结论针刺配合言语康复治疗脑卒中后失语症效果显著。%Objective To explore the effect of acupuncture therapy combined with speech rehabilitation after stroke aphasia.Methods70 cases in our hospital after stroke aphasia patients were randomly divided into the control group and the study group, 35 patients in the control group only were treated by language rehabilitation training, study group received acupuncture treatment, compared two groups of language function scores and clinical efficacy.Results The study group language score, the total efficiency were significantly higher.Conclusion The Treatment with acupuncture and speech rehabilitation for Post-stroke aphasia is very signiifcant.

  5. 神经康复介入对脑卒中后抑郁发生率的影响%The effect of neural rehabilitation on post stroke depression

    Institute of Scientific and Technical Information of China (English)

    张智博; 谭红

    2001-01-01

    目的探讨神经康复对卒中后抑郁(Post Stroke Depression,PSD)的影响。方法选择 120例首次发病的急性脑卒中患者,随机分为康复组和对照组各 60 例,康复组在药物治疗的同时给予正规的康复训练,对照组仅给药物治疗。分别在康复治疗前中后(1~ 6个月)对患者采用汉密尔顿量表(HAMD),ADL量表采用 Barthel指数(BI),评定抑郁症和 ADL 的变化。结果经过神经康复训练,患者 ADL和抑郁症状较未进行神经康复训练组有较大改善,其抑郁的发生率和程度都有明显的降低(P <0。05)。结论神经康复训练对PSD有积极的疗效。

  6. On the mutual effects of pain and emotion: facial pain expressions enhance pain perception and vice versa are perceived as more arousing when feeling pain.

    Science.gov (United States)

    Reicherts, Philipp; Gerdes, Antje B M; Pauli, Paul; Wieser, Matthias J

    2013-06-01

    Perception of emotional stimuli alters the perception of pain. Although facial expressions are powerful emotional cues - the expression of pain especially plays a crucial role for the experience and communication of pain - research on their influence on pain perception is scarce. In addition, the opposite effect of pain on the processing of emotion has been elucidated even less. To further scrutinize mutual influences of emotion and pain, 22 participants were administered painful and nonpainful thermal stimuli while watching dynamic facial expressions depicting joy, fear, pain, and a neutral expression. As a control condition of low visual complexity, a central fixation cross was presented. Participants rated the intensity of the thermal stimuli and evaluated valence and arousal of the facial expressions. In addition, facial electromyography was recorded as an index of emotion and pain perception. Results show that faces per se, compared to the low-level control condition, decreased pain, suggesting a general attention modulation of pain by complex (social) stimuli. The facial response to painful stimulation revealed a significant correlation with pain intensity ratings. Most important, painful thermal stimuli increased the arousal of simultaneously presented pain expressions, and in turn, pain expressions resulted in higher pain ratings compared to all other facial expressions. These findings demonstrate that the modulation of pain and emotion is bidirectional with pain faces being mostly prone to having mutual influences, and support the view of interconnections between pain and emotion. Furthermore, the special relevance of pain faces for the processing of pain was demonstrated.

  7. On the mutual effects of pain and emotion: facial pain expressions enhance pain perception and vice versa are perceived as more arousing when feeling pain.

    Science.gov (United States)

    Reicherts, Philipp; Gerdes, Antje B M; Pauli, Paul; Wieser, Matthias J

    2013-06-01

    Perception of emotional stimuli alters the perception of pain. Although facial expressions are powerful emotional cues - the expression of pain especially plays a crucial role for the experience and communication of pain - research on their influence on pain perception is scarce. In addition, the opposite effect of pain on the processing of emotion has been elucidated even less. To further scrutinize mutual influences of emotion and pain, 22 participants were administered painful and nonpainful thermal stimuli while watching dynamic facial expressions depicting joy, fear, pain, and a neutral expression. As a control condition of low visual complexity, a central fixation cross was presented. Participants rated the intensity of the thermal stimuli and evaluated valence and arousal of the facial expressions. In addition, facial electromyography was recorded as an index of emotion and pain perception. Results show that faces per se, compared to the low-level control condition, decreased pain, suggesting a general attention modulation of pain by complex (social) stimuli. The facial response to painful stimulation revealed a significant correlation with pain intensity ratings. Most important, painful thermal stimuli increased the arousal of simultaneously presented pain expressions, and in turn, pain expressions resulted in higher pain ratings compared to all other facial expressions. These findings demonstrate that the modulation of pain and emotion is bidirectional with pain faces being mostly prone to having mutual influences, and support the view of interconnections between pain and emotion. Furthermore, the special relevance of pain faces for the processing of pain was demonstrated. PMID:23541426

  8. Remifentanilo vs. bloqueo central epidural para control del dolor postoperatorio en cirugía vascular de urgencias Remifentanyl versus epidural central blockade for the management of postoperative pain in emergency vascular surgery

    Directory of Open Access Journals (Sweden)

    A. Quirante

    2004-12-01

    Full Text Available El correcto tratamiento del dolor postoperatorio constituye una prioridad dentro de los objetivos del anestesiólogo. En pacientes con patología vascular severa quirúrgica, el tratamiento analgésico efectivo se suele realizar mediante bloqueo continuo epidural. Sin embargo, la administración de analgésicos, tanto opiáceos como no opiáceos, por vía intravenosa, es una alternativa a la vía epidural cuando esta es desestimada. Caso clínico: Presentamos el caso de un paciente varón de 63 años portador de un bypass fémoro-poplíteo a primera porción en miembro inferior izquierdo, el cual es intervenido quirúrgicamente y con carácter urgente tras el diagnóstico de falso aneurisma séptico de arteria iliaca izquierda con rotura de anastomosis fémoro-poplítea. Se optó por una anestesia general basada en la analgesia con remifentanilo frente a bloqueo central epidural dado el carácter urgente de la cirugía y la ingesta habitual de antiagregantes plaquetarios. Se planificó como estrategia analgésica postoperatoria la administración de remifentanilo a dosis sedoanalgésicas (Introduction: The appropriate management of postoperative pain is a priority among the objectives of the anesthesiologist. In patients with severe surgical vascular pathology, an effective analgesic treatment is usually provided with epidural continuous blockade. However, the intravenous administration of analgesics, either opiates or non opiates, is an alternative to the epidural route when this has to be dismissed. Clinical case: We present the case of a 63-years old male patient carrying a femoro-popliteus bypass in the first portion of the left lower limb that underwent emergency surgery after being diagnosed of a false septic aneurysm in the left iliac artery with breakage of the femoro-popliteus anastomosis. General anesthesia based on remifentanyl was decided instead of epidural central blockade due to the urgent nature of the surgery and the regular

  9. Groin pain

    Science.gov (United States)

    ... groin pain in men. The terms "groin" and "testicle" are sometimes used interchangeably. But what causes pain ... hernia. It may also involve pain in the testicles. Hernia : This problem occurs when there is a ...

  10. Eye pain

    Science.gov (United States)

    Ophthalmalgia; Pain - eye ... Pain in the eye can be an important symptom of a health problem. Make sure you tell your health care provider if you have eye pain that does not go away. Tired eyes or ...

  11. Wrist pain

    Science.gov (United States)

    Pain - wrist; Pain - carpal tunnel; Injury - wrist; Arthritis - wrist; Gout - wrist; Pseudogout - wrist ... Carpal tunnel syndrome: A common cause of wrist pain is carpal tunnel syndrome . You may feel aching, ...

  12. Elbow pain

    Science.gov (United States)

    Pain - elbow ... Elbow pain can be caused by many problems. A common cause in adults is tendinitis . This is inflammation and ... a partial dislocation ). Other common causes of elbow pain are: Bursitis -- inflammation of a fluid-filled cushion ...

  13. Heel pain

    Science.gov (United States)

    Pain - heel ... Heel pain is most often the result of overuse. Rarely, it may be caused by an injury. Your heel ... on the heel Conditions that may cause heel pain include: When the tendon that connects the back ...

  14. Depression, Pain, and Pain Behavior.

    Science.gov (United States)

    Keefe, Francis J.; And Others

    1986-01-01

    Examined the degree to which depression predicted pain and pain behavior. The Beck Depression Inventory was administered to 207 low back pain patients. Depression and physical findings were the most important predictors of pain and pain behavior. Depression proved significant even after controlling for important demographic and medical status…

  15. Postoperative pain

    DEFF Research Database (Denmark)

    Kehlet, H; Dahl, J B

    1993-01-01

    also modify various aspects of the surgical stress response, and nociceptive blockade by regional anesthetic techniques has been demonstrated to improve various parameters of postoperative outcome. It is therefore stressed that effective control of postoperative pain, combined with a high degree......Treatment of postoperative pain has not received sufficient attention by the surgical profession. Recent developments concerned with acute pain physiology and improved techniques for postoperative pain relief should result in more satisfactory treatment of postoperative pain. Such pain relief may...

  16. Does intermittent pneumatic compression reduce the risk of post stroke deep vein thrombosis? The CLOTS 3 trial: study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Dennis Martin

    2012-03-01

    Full Text Available Abstract Background Approximately 80,000 patients each year are admitted to UK hospitals with an acute stroke and are immobile. At least 10% will develop a proximal Deep Vein Thrombosis in the first month and 1.5% a pulmonary embolus. Although hydration, antiplatelet treatment and early mobilisation may reduce the risk of deep vein thrombosis, there are currently no preventive strategies which have been clearly shown to be both effective and safe. Anticoagulation increases the risks of bleeding and compression stockings are ineffective. Systematic reviews of small randomized trials of intermittent pneumatic compression have shown that this reduces the risk of deep vein thrombosis in patients undergoing surgery, but that there are few data concerning its use after stroke. The CLOTS trial 3 aims to determine whether, compared with best medical care, best medical care plus intermittent pneumatic compression in immobile stroke patients reduces the risk of proximal deep vein thrombosis. Methods/Design CLOTS Trial 3 is a parallel group multicentre trial; with centralized randomisation (minimisation to ensure allocation concealment. Over 80 centres in the UK will recruit 2800 immobile stroke patients within the first 3 days of their hospital admission. Patients will be allocated to best medical care or best medical care plus intermittent pneumatic compression. Ultrasonographers will perform a Compression Duplex Ultrasound Scan to detect deep vein thrombosis in each treatment group at about 7-10 days and 25-30 days. The primary outcome cluster includes symptomatic or asymptomatic deep vein thrombosis in the popliteal or femoral veins detected on either scan. Patients are then followed up by postal or telephone questionnaire at 6 months from randomisation to detect later symptomatic deep vein thrombosis and pulmonary emboli and to establish their functional outcome (Oxford handicap scale and quality of life (EQ5D-3 L. The ultrasonographers performing the

  17. Observation on Therapeutic Effect of Acupuncture Combined with Medicine on Post-stroke Anxiety Disorders%针药联合治疗卒中后焦虑症30例临床疗效观察

    Institute of Scientific and Technical Information of China (English)

    张丽文

    2016-01-01

    Objective To observe therapeutic effect of acupuncture on post-stroke anxiety disorders (PSAD). Methods According to the diagnosis criteria ICD.10F0.64 organic anxiety disorders and 60 cases of post-stroke anxiety disorder patient selection and divided for 2 groups, an acupuncture plus medication group and a medication group, 30 cases in each group. The acupuncture plus medication group were treated with acupuncture, and oral administration of paroxetine, and the medication group only with paroxetine. The anxiety level and quality of life before and after treatment in two groups were evaluated by the internationally recognized Hamilton Anxiety Scale (HAMA), the Zung's self rating Anxiety Scale (SAS) and the life self-care ability assessment Barthel index (BI). Results In the acupuncture plus medication group, 6 cases were clinically controlled, 14 cases were markedly effective, 7 cases were effective, 3 cases were ineffective, the total improvement rate of 90% in the acupuncture plus medication group was significantly higher than 70% in the medication group (P<0.05), the score of HAMA,SAS, BI in acupuncture plus medication group improved significantly better than that in the medication group. Conclusion Acupuncture has a certain therapeutic effect on PSAD.%目的:观察使用电针治疗卒中后焦虑症的临床疗效。方法按现行 ICD.10F0.64器质性焦虑障碍的诊断标准,选择临床上60例卒中后焦虑症患者随机分成两组,针药组30例,针刺电针治疗并配合口服帕罗西汀;药物组30例,仅单纯口服帕罗西汀。应用 Zung 氏焦虑自评量表(SAS)、汉密尔顿焦虑量表(HAMA)及生活自理能力评定Barthel 指数(BI)评价上述两组患者治疗前后的焦虑程度及生活质量的改善状况。结果针药组临床控制6例,显效14例,有效7例,无效3例,总有效率为90%,明显高于药物组的70%(P <0.05)。针药组 HAMA、SAS、BI 评分改善程度均显著优

  18. 卒中后抑郁患者社会心理因素的纵向研究%A longitudinal study of psychosocial factors in patients with post-stroke depression

    Institute of Scientific and Technical Information of China (English)

    余政; 张梅英

    2014-01-01

    Objective To investigate the psychosocial factors in the stroke patients with Post-stroke Depression. Methods A longitudinal study was conducted to collect data at two time points:T1,2 weeks after stroke; T2,6 months after stroke. At T1,120 stroke patients were assessed with General investigate Scale,Hamilton Depression Scale (HAMD),Trait Coping Style Questionnaire (TCSQ),Social Support Rating Scale (SSRS),Eysenck Personality Inventory (EPI),Barthel Index (BI).At T2,All patients were as-sessed with Hamilton Depression Scale(HAMD),Barthel Index(BI). Results Incidences of PSD was 42.5%at T1,while it 56.6%at T2. Regression analysis revealed complex relationships between the psychosocial factors with the level of depressive symptoms at T2. Four variables were found to explain 62%of the variance in depressive symptoms at T2. The variables with significant standard-ized regression coefficients were:the level of depressive symptoms,passive coping,social support using at T1,and the level of Barthel Index at T2. Conclusion Patients with early depression after stroke,resorting to passive coping,lack of social support us-ing and low level of Barthel Index at 6 month after stroke may be more susceptible to Post-Stroke Depression at 6 month after stroke.%目的:研究脑卒中患者发生卒中后抑郁的相关社会心理因素。方法采用6个月纵向研究设计,共选定2个观察时间点:T1,发生脑卒中后的第2周;T2,发生脑卒中后的第6个月。在T1时间点对120例脑卒中患者分别应用一般情况调查表(自制)、汉密尔顿抑郁量表、特质应对方式问卷、社会支持评定量表、艾森克人格问卷、Barthel指数(BI)6个量表进行调查。T2时间点对患者应用汉密尔顿抑郁量表、Barthel指数(BI)量表进行追踪调查。结果 T1和T2时卒中后抑郁的发生率分别为42.5%和56.6%。通过多元线性回归分析发现,共有4个变量可解释T2时卒中后抑郁62%的差异

  19. 社会心理因素对卒中后抑郁发病的影响%Effect of Psychosocial Factors on Onset of Post-Stroke Depression

    Institute of Scientific and Technical Information of China (English)

    余政; 张梅英; 李梦倩; 袁也丰

    2012-01-01

    目的 研究卒中后抑郁的发生与生活事件、应对方式、社会支持及人格的关系.方法 对120例脑卒中患者进行汉密尔顿抑郁量表评定,HAMD≥8分者为抑郁组,HAMD<8分者为疾病对照组.所有患者应用生活事件量表、特质应对方式问卷、社会支持评定量表,艾森克个性问卷(成年)4个量表进行调查.结果 抑郁组的负性事件应激量和生活事件总应激量均较对照组高(P<0.01),消极应对得分高于对照组(P<0.01),主观支持度及对支持利用度评分都低于对照组(P<0.01).艾森克人格测验(成人)N值较对照组大,而E值较对照组小,差异均有统计学意义(P<0.01).结论 病前的负性生活事件量多、消极的应对方式、主观社会支持和对支持的利用度低、以及内向神经质的人格特质可能是影响卒中后抑郁发生的社会心理因素.%Objective To investigate the relationship of onset of post-stroke depression (PSD) to life events, coping style, social support and personality. Methods According to the Hamilton depression scale, 120 patients with stroke were divided into depression group (score≥8) and control group(score<8). All patients were accessed with life event scale(LES), trait coping style questionnaire ( TCSQ), social support rating scale (SSRS) and Eysenck personality inventory (EPQ). Results Compared with control group,the amount of negative life events,total amount of life events and passive coping score obviously increased,and subjective support and support using score significantly decreased in depression group(P<0. 01). The results of EPI showed an increase in N value and a decrease in E value in depression group compared with control group (P< 0. 01). Conclusion A large number of negative life events, passive coping style, low subjective support and social support,and introverted and neurotic personality may be the psychosocial risk factors for post-stroke depression.

  20. 卒中后抑郁模型大鼠杏仁核神经元凋亡增加%Apoptosis increased in amygdala neurons of post-stroke depression model rats

    Institute of Scientific and Technical Information of China (English)

    刘昊; 王海涛; 徐爱军; 李世英; 张晋霞; 张蕊

    2011-01-01

    目的:探讨卒中后抑郁(post-stroke depression,PSD)模型大鼠杏仁核神经元凋亡现象。方法:将成年健康雄性SD大鼠随机分为对照组(15只)和模型组(15只)。采用颈总动脉线栓再灌注法制备局灶性脑缺血大鼠模型,结合孤养和慢性不可预见的温和性应激方法制备PSD大鼠模型。采用糖水实验、开场实验和Morris水迷宫检测行为学改变,TUNEL和流式细胞术检测杏仁核神经元凋亡和凋亡率。结果:模型组大鼠行为学发生明显改变。对照组和模型组凋亡细胞阳性率分别为3.91%±0.49%和25.04%±6.32%,凋亡率分别为3.50%±0.5%和18.75%±2.95%,差异均有统计学意义(P<0.01)。结论:PSD模型大鼠杏仁核存在明显的神经元凋亡,这可能是PSD患者杏仁核体积异常的原因之一。%Objective To observe the neuronal apoptosis in amygdala of post-stroke depression (PSD) model rats. Methods Male Wistar rats were randomly divided into control group and model group. The model of focal cerebral ischemia was set up by thread occlusion through arteria carotis interna and reperfusion. Then the rats were raised alone and given chronic unpredictable modest stress to establish the PSD model. The behavior was examined using sucrose preference test,open-filed test and Morris water maze. TUNEL-staining and double-labeled flow cytometry (FCM) were employed for the detection and quantification of the apoptotic cells in the amygdala. Results The consumption of sucrose and erect quantity of model group were lower than those of control group (P <0.05). The percentage of TUNEL-positive cell and the apoptotic cell rate of model group were higher than those of control group respectively ( P < 0.01). Conclusion Apoptosis is increased in amygdala neurons of PSD model rats,and might be one of reasons that induced the amygdala become smaller in PSD.

  1. Observation of clinical efficacy of music therapy in treatment of post-stroke depression%音乐治疗应用于卒中后抑郁临床疗效观察

    Institute of Scientific and Technical Information of China (English)

    陈先德; 王朔

    2013-01-01

    目的 调查研究音乐治疗应用于卒中后抑郁患者的临床疗效及其在患者社会功能恢复中的作用.方法 选取符合ICD-10卒中后抑郁诊断标准的患者98例,随机分为音乐治疗组(音乐治疗+抗抑郁药物治疗)和对照组(常规抗抑郁药物治疗),治疗前及治疗8周后采用汉密尔顿抑郁量表(HAMD)评定临床疗效、席汉残疾量表(SDS)评定社会功能恢复情况.结果 共95例完成研究,治疗8周末,两组汉密尔顿抑郁量表(HAMD)总分较治疗前显著下降(P < 0.05),音乐治疗组较对照组显著下降(P < 0.05);两组席汉残疾量表(SDS)均较治疗前显著降低(P < 0.05),音乐治疗组较对照组显著降低(P < 0.05).结论 音乐治疗联合抗抑郁剂治疗卒中后抑郁较单用抗抑郁剂治疗效果更显著,能有效改善患者的社会功能.%Objective To investigate the clinical efficacy of music therapy in the treatment of patients with pos-stroke depression and its role in the patients' social function recovery. Methods 98 patients meeting the diagnostic criteria of ICD-10 post-stroke depression were selected and randomly divided into the music therapy group (music therapy + an-tidepressant drug therapy) and the control group (conventional antidepressant drug therapy). Before the treatment and 8 weeks after the treatment, the clinical efficacy was evaluated by using the Hamilton Depression Rating Scale (HAMD) and the social function recovery was evaluated by using the Sheehan Disability Scale (SDS). Results A total of 95 patients finished the study, at the end of 8 weeks after the treatment, the total HAMD scores of both groups significantly decreased compared to those before the treatment (P < 0.05), and the music therapy group decreased more significantly than the control group (P < 0.05). The SDS scores of both groups significantly decreased compared to those before the treatment (P < 0.05), and the music therapy group decreased more significantly

  2. 自我效能理论在脑卒中后抑郁患者康复护理中的应用%Application of Self-efficacy Theory in Rehabilitative Nursing of Patients with Post-stroke Depression

    Institute of Scientific and Technical Information of China (English)

    陆雪琴; 严斌泓

    2015-01-01

    目的:探讨自我效能理论在脑卒中后抑郁(post-stroke depression,PSD)患者康复护理中的应用方法及效果.方法便利抽样法选择2014年1-10月上海第七人民医院康复科收治的 PSD患者60例,按入院先后将其分为观察组和对照组各30例,对照组患者予以常规康复护理,观察组患者在对照组的基础上应用自我效能理论对其进行干预.评价并比较干预前后两组患者的汉密顿抑郁量表(Hamilton depression scale,HAMD)评分及神经功能损害评分(national institute of health stroke scale,NIHSS).结果干预前,两组患者的 HAMD及NIHSS评分差异均无统计学意义(均P>0.05);干预后,观察组患者的HAMD及 NIHSS评分均低于干预前,且观察组的评分均低于对照组,差异均有统计学意义(均P<0.05).结论将自我效能理论应用于PSD患者的康复护理中有利于改善患者的抑郁状况,促进患者康复.%Objective To study application method and effect of self-efficacy theory in rehabilitative nursing of patients with post-stroke depression(PSD).Methods By convenience sampling,60 PSD cases were selected and equally divided into observation group and control group.Observation group was given self-efficacy intervention combined with rehabilitative training,while the control group was only received routine rehabilitative nursing.The Hamilton depression scale (HAMD)and NIHSS score was observed before and after treatment.Results There was no statistical significance of HAMD score and NIHSS score showed before intervention between two groups (all P>0.05).The HAMD score and NIHSS score after intervention were reduced compared with before intervention,and the scores in observation group were lower than which in control group (all P<0.05 ).Conclusion The application of self-efficacy theory combined with rehabilitative training can effectively improve the depression status of patients,and can also promote the recovery.

  3. Effect of Psychological rehabilitation post-stroke depression in elderly patients%心理康复治疗对老年脑卒中后抑郁病人的影响

    Institute of Scientific and Technical Information of China (English)

    钟秋园

    2012-01-01

    OBJECTIVE To investigate the psychological rehabilitation of patients with ischemic strokes depression effect METHODS Random number table was used in our study. From September 2009 - September 2011. 78 cases of ischemic stroke patients were selected from department of Neurology in the general hospital were divided into control group and treatment group. The control group were treated with conventional therapy and exercise rehabilitation training, while the treatment group in the treatment of patients were used psychological rehabilitation and conventional therapy. The cases were evaluated by using self-compiled questionnaire, Hamilton depression Rating Scale (HAMD), exercise capacity (Fugl-Meye scale) and life skills (Bathel index) after 4 weeks of treatment. RESULTS After 4-week treatment, the psychological rehabilitation in patients treated with HAMD score were significantly lower than the control group, while the FMA score and MBI score was significantly higher (P < 0.01). CONCLUSION In the post-stroke depression in elderly patients with clinical treatment, physical therapy and psychological treatment were complementary and mutually reinforcing to make post-stroke depression in elderly rehabilitation pa-tienls to receive good results and shorten the treatment of patients time, and improve patient quality of life.%目的 探讨心理康复治疗对缺血性脑卒中后抑郁病人的作用.方法 运用随机数字表法对2009年9月~2011年9月在某市综合性医院神经内科78例缺血性脑卒中患者分为对照组和治疗组,对照组患者给予常规药物治疗加运动康复训练,治疗组患者则在上述治疗的基础上加用心理康复治疗,分别于入组时及治疗4周后使用自编问卷、汉密尔顿抑郁量表(HAMD)、运动能力(Fugl-Meye量表)及生活能力(Bathel指数)进行测评,评价2组患者的临床治疗效果.结果 经过为期4周的治疗后,心理康复治疗组患者的HAMD评分低于对照组,而其FMA

  4. The effect of music therapy on patients with post-stroke depression%音乐疗法对脑卒中后抑郁患者的疗效观察

    Institute of Scientific and Technical Information of China (English)

    徐建忠; 彭辰; 马建强; 沈亚平

    2015-01-01

    Objective To observe the effect of music therapy on stroke patients with depression.Methods 70 post-stroke depression patients were divided into the observation group and the control group according to the hospitalized number,the control group received conventional therapy neurology without giving antidepressants;the observation group were given music therapy group basis.Both groups were at the time of enrollment and after treatment using the Hamilton Depression Rating Scale (HAMD),Self-rating Depression Scale (SDS) for the two groups of patients assessed the degree of depression.Results After the treatment,the HAMD score of the observation group was (23.57 ± 10.33)points,compared with the control group[(28.20 ± 8.83)points],the difference was statistically significant (t =2.02,P < 0.05);the SDS score of the observation group was (61.00 ± 10.67) points,compared with the control group [] (66.11 ± 10.38) points],the difference was statistically significant (t =-2.03,P < 0.05).Conclusion Music therapy for depression in patients with post-stroke recovery has a positive meaning.%目的 观察音乐疗法对脑卒中后抑郁患者的疗效.方法 将70例符合要求的卒中后抑郁患者按住院号随机分为观察组和对照组,各35例,对照组给予神经内科常规药物治疗但不给与抗抑郁药物;观察组在对照组基础上给予音乐疗法.两组均于入选时和疗程结束后采用汉密尔顿抑郁量表(HAMD)、抑郁自评量表(SDS)对两组患者抑郁程度进行评定.结果 治疗后观察组HAMD评分(23.57±10.33)分,低于对照组的(28.20±8.83)分,差异有统计学意义(t=2.02,P<0.05);观察组SDS评分(61.00±10.67)分,低于对照组的(66.11±10.38)分,差异有统计学意义(t=-2.03,P<0.05).结论 音乐疗法对脑卒中后抑郁患者的恢复有积极意义.

  5. 个案管理模式护理对脑卒中后抑郁患者主要照顾者的影响%Effect of case management on primary caregivers for patients with post-stroke depression

    Institute of Scientific and Technical Information of China (English)

    朱敏; 赵巧红; 李秀雄; 吴定芳

    2015-01-01

    目的:探讨个案管理护理对脑卒中后抑郁患者主要照顾者的影响。方法选择2012年6月~2014年10月佛山市第一人民医院特需医疗中心96例脑卒中后抑郁患者的主要照顾者为研究对象,按患者的入院时间顺序将其主要照顾者分为对照组(52名)和实验组(44名)。对照组接受常规护理,实验组实施个案管理护理。两组均接受出院后6个月随访。分别收集入院时、出院时及出院后3、6个月两组主要照顾者的自我效能感(GSES)和生活满意度(LSIA),比较两组护理效果。结果入院时、出院时两组GSES、LSIA比较,差异无统计学意义(P跃0.05)。出院后3、6个月的GSES、LSIA实验组均优于对照组,差异均有统计学意义(P0.05), but 3 month and 6 month after discharge, the comparative results of study group were all superior to the control group with significant difference (P<0.05 or P<0.01). Conclusion Case management can improve self-efficacy and life satisfaction of the primary caretakers of patients with post-stroke depression.

  6. Analysis of Pre-morbid Personality and Correlative Factors in Patient with Post-stroke Depression%卒中后抑郁病人的病前人格及相关因素分析

    Institute of Scientific and Technical Information of China (English)

    程宗新; 涂江龙; 熊友生

    2009-01-01

    目的 探讨卒中病人的病前人格及相关因素与卒中后抑郁(PSD)发生的相关性.方法 对PSD病人(病例组)29例和脑卒中病人(对照组)32例进行艾森克人格问卷(EPQ)调查,并记录每位病例的相关资料.结果 男、女性病例组N值均较对照组大(均P0和优势比为1.504;而E值均较对照组小(均P0.05).结论 PSD病人的病前人格中有更多的情绪不稳定和性格内向,情绪不稳定和性格内向与PSD有相关性,是其危险因素.%Objective To explore the occurrenced correlation between pre-morbid personality and correlative factors in patient with post-stroke depression (PSD) and stoke.Methods Twenty-nine patients with PSD (case group) and 32 patients with subacute stroke (control group) investigated of eysenck personality questionnaire(EPQ).The recording information of each case was correlative.Results N value of male and female case group was higher than those in control group(P0 and odds ratio was 1.504;while E value was reversed(P0.05,respectively).Conclusion Unstable emotion and introverted personality show more frequently in patient with PSD,which maybe correlative in the occurrence of depression in patient with stroke.They are risk factors of PSD.

  7. 5-羟色胺运载体基因多态性与脑卒中后抑郁的相关性%Association between 5-serotonin transporter gene polymorphism and post stroke depression

    Institute of Scientific and Technical Information of China (English)

    崔超巍; 王萱

    2011-01-01

    Objective To determine whether the 5-HTTLPR, rs25531 polymorphisms of SERT were associated with post-stroke depression(PSD) in stroke survivors. Methods Seventy-five stroke survivors with PSD and 75 non-depressed stroke survivors,blood or saliva samples were collected from each participant for DNA extraction and genotyping. Results Subjects with the 5-HTTLPR s/s genotype had three-fold higher odds for PSD compared to l/l or l/Xl genotype carriers(OR 3.1, 95%CI 1.2~8.3). An association of rs25531 with PSD could not be shown. Conclusions The 5-HTTLPR but not the rs25531, polymorphisms of SERT are associated with PSD in stroke survivors. This gives further evidence for a role of SERT polymorphisms in mediating resilience to biopsychosocial stress.%目的 检测脑卒中存活者5-羟色胺运载体(SERT)中5-羟色胺转运体基因启动子区多态性(5-HTTLPR)、rs25531多态性是否与卒中后抑郁(PSD)相关.方法 选取70例脑卒中后抑郁患者为实验组,70例脑卒中后无抑郁患者为对照组,收集两组患者唾液与血液样本提取DNA进行基因分析.结果 5-HTTLPR s/s基因携带者发生PSD几率比l/l 或 l/Xl高2倍,rs25531基因与PSD无相关性.结论 5-HTTLPR多态性与PSD发生相关,进一步证实SERT基因多态性在生物心理社会学应激中的作用.

  8. Management of chronic visceral pain

    DEFF Research Database (Denmark)

    Olesen, Anne E; Farmer, Adam D; Olesen, Søren S;

    2016-01-01

    Despite marked differences in underlying pathophysiology, the current management of visceral pain largely follows the guidelines derived from the somatic pain literature. The effective management of patients with chronic visceral pain should be multifaceted, including both pharmacological......' symptoms, adopting an empathic approach and taking time to educate patients. To optimize treatment and outcomes in chronic visceral pain we need to move away from approaches exclusively based on dealing with peripheral nociceptive input toward more holistic strategies, taking into account alterations...... in central pain processing....

  9. Pelvic Pain

    Science.gov (United States)

    Pelvic pain occurs mostly in the lower abdomen area. The pain might be steady, or it might come and go. If the pain is severe, it might get in the way ... re a woman, you might feel a dull pain during your period. It could also happen during ...

  10. Shoulder pain

    Science.gov (United States)

    Pain - shoulder ... changes around the rotator cuff can cause shoulder pain. You may have pain when lifting the arm above your head or ... The most common cause of shoulder pain occurs when rotator cuff tendons ... The tendons become inflamed or damaged. This condition ...

  11. Pain Sensitisation in Women with Active Rheumatoid Arthritis

    DEFF Research Database (Denmark)

    Vladimirova, Nora; Jespersen, Anders; Bartels, Else Marie;

    2015-01-01

    Objectives. In some rheumatoid arthritis (RA) patients, joint pain persists without signs of inflammation. This indicates that central pain sensitisation may play a role in the generation of chronic pain in a subgroup of RA. Our aim was to assess the degree of peripheral and central pain...

  12. Segmental hypersensitivity and spinothalamic function in spinal cord injury pain

    DEFF Research Database (Denmark)

    Finnerup, Nanna Brix; Sørensen, Leif Hougaard; Biering-Sørensen, Fin;

    2007-01-01

    The mechanisms underlying central pain following spinal cord injury (SCI) are unsettled. The purpose of the present study was to examine differences in spinothalamic tract function below injury level and evoked pain in incomplete SCI patients with neuropathic pain below injury level (central pain...... in central SCI pain and furthermore - in contrast to previous findings - that loss of spinothalamic functions does not appear to be a predictor for central neuropathic pain in spinal cord injury....... and thermal detection thresholds below injury level. SCI patients with central pain had sensory hypersensitivity in dermatomes corresponding to the lesion level more frequently than SCI patients without pain, but this may in part be explained by the exclusion of at-level spontaneous pain in the pain...

  13. Spinal cord injury pain: mechanisms and management.

    Science.gov (United States)

    Finnerup, Nanna Brix; Baastrup, Cathrine

    2012-06-01

    Patients with spinal cord injury (SCI) may experience several types of chronic pain, including peripheral and central neuropathic pain, pain secondary to overuse, painful muscle spasms, and visceral pain. An accurate classification of the patient's pain is important for choosing the optimal treatment strategy. In particular, neuropathic pain appears to be persistent despite various treatment attempts. In recent years, we have gained increasing knowledge of SCI pain mechanisms from experimental models and clinical studies. Nevertheless, treatment remains difficult and inadequate. In line with the recommendations for peripheral neuropathic pain, evidence from randomized controlled treatment trials suggests that tricyclic antidepressants and pregabalin are first-line treatments. This review highlights the diagnosis and classification of SCI pain and recent improvements in the understanding of underlying mechanisms, and provides an update on treatment of SCI pain. PMID:22392531

  14. POST-STROKE WRITING AND READING DISORDERS

    Directory of Open Access Journals (Sweden)

    Sinanović Osman

    2013-01-01

    Full Text Available The writing and reading disorders in stroke patients (alexias, agraphias and acalculias are more frequent than verified in routine exam, not only in the less developed but also in large neurological departments. Alexia is an acquired type of sensory aphasia where damage to the brain causes a patient to lose the ability to read. It is also called word blindness, text blindness orvisual aphasia. Alexia refers to an acquired inability to read caused by brain damage and must be distinguished from dyslexia, a developmental abnormality in which the individual is unable to learn to read, and from illiteracy, which reflects a poor educational back-ground. Most aphasics are also alexic, but alexia may occur in the absence of aphasia and may occasionally be the soledisability resulting from specific brain lesions. There are different classifications of alexias. Traditionally, the alexias are divided into three categories: pure alexia with agraphia, pure alexia without agraphia, and alexia associated with aphasia (“aphasic alexia”. Agraphia is defined as the disruption of previously intact writing skills by brain damage. Writing involves several elements—language processing, spelling, visual perception, visual-spatial orientation for graphic symbols, motor planning, and motor control of writing. A disturbance of any of these processes can impair writing. Agraphia may occur by itself or as association with aphasias, alexia, agnosia and apraxia. Agraphia can also result from “peripheral” involvement of the motor act of writing. Like alexia, agraphia must be distinguished from illiteracy, where writing skills were never developed. Acalculia is a clinical syndrome of acquired deficits in mathematical calculation, either mentally or with paper and pencil. This language disturbances can be classified differently, but there are three principal types of acalculia: acalculia associated with language disturbances, including number paraphasia, number agraphia, or number alexia; acalculia secondary to visual-spatial dysfunction with malalignment of numbers and columns, and a primary anarithmetria entailing disruption of the computation process.

  15. POST-STROKE WRITING AND READING DISORDERS

    OpenAIRE

    Sinanović Osman; Mrkonjić Zamir

    2013-01-01

    The writing and reading disorders in stroke patients (alexias, agraphias and acalculias) are more frequent than verified in routine exam, not only in the less developed but also in large neurological departments. Alexia is an acquired type of sensory aphasia where damage to the brain causes a patient to lose the ability to read. It is also called word blindness, text blindness orvisual aphasia. Alexia refers to an acquired inability to read caused by brain damage and must be distinguished fro...

  16. Impaired Hyperemic Response to Exercise Post Stroke

    OpenAIRE

    Durand, Matthew J.; Murphy, Spencer A.; Schaefer, Kathleen K.; HUNTER, SANDRA K.; Schmit, Brian D.; Gutterman, David D.; Hyngstrom, Allison S.

    2015-01-01

    Individuals with chronic stroke have reduced perfusion of the paretic lower limb at rest; however, the hyperemic response to graded muscle contractions in this patient population has not been examined. This study quantified blood flow to the paretic and non-paretic lower limbs of subjects with chronic stroke after submaximal contractions of the knee extensor muscles and correlated those measures with limb function and activity. Ten subjects with chronic stroke and ten controls had blood flow ...

  17. The characteristic appearance and analysis of H reflex in hemiplegic upper extremity patients with post-stroke%H反射在脑卒中后上肢偏瘫患者中的特征表现及分析

    Institute of Scientific and Technical Information of China (English)

    李红玲; 徐凌娇; 岳崴; 刘春辉; 潘拴针; 王淑英

    2012-01-01

    Objective: To investigate the valuable application of H reflex in electrophysiological evaluation by study of the relationship between the characteristic appearance of H reflex and muscular tone of affected side in upper extremity of hemiplegic patients post-stroke.Method: Forty-two hemiplegic inpatients with post-stroke in convalescence stage who fulfilled the study entry criteria were in various levels of upper extremity dysfunction. The H reflex examination was given to abductor polli- cis brevis (APB) dominanted by median nerve, abductor digiti minimi (ADM) dominanted by ulnar nerve, extensor digitorum communis dominanted by radial nerve of the patients' both affected and unaffected sides. At the same time, affected upper extremity was assessed by modified Ashworth scale (MAS), to determine whether H reflex could be easily obtained from all the nerves above mentioned. Then the changes in H reflex latencies and ratios of Hmax/Mmax of both sides were compared; the correlation between MAS and H reflex latency and Hmax/Mmax ratio in affected upper extremities were analysed.Result: H reflex was easily obtained from APB dominanted by median nerve, ADM dominanted by ulnar nerve of both sides, and the elicitation rates were 100%. But elicitation rate of extensor digitorum communis dominanted by radial nerve was only 7.14%. The mean (SD) H reflex latencies for medium nerve and ulnar nerve of affected sides were (25.89 ± 3.66)ms and (25.71 ± 3.26)ms respectirely, and those of unaffected sides were (26.60 ± 3.1 l)ms and (26.44 ± 2.87)ms recpectively. The medians of Hmax/Mmax ratio value for the median nerve and ulnar nerve of affected sides were 0.185 and 0.217 respectively, and those of unaffected sides were 0.126 and 0.112 respectively. The H reflex latency reduced and the Hmax/Mmax ratio increased in affected side comparing with unaffected side for median nerve and ulnar nerve, and the differences of both sides were statistically significant(P<0.05). By using

  18. Evaluation of analgesic effect of tapentadol, a central novel analgesic versus tramadol, a widely used opioid analgesic in treatment of low back pain: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Zaki Anwar Zaman

    2013-08-01

    Full Text Available Background: The objective of the study was to compare efficacy and tolerability (safety of tapentadol with tramadol in the treatment of low back pain. Methods: The study was a prospective, randomized, single blinded, total 102 patients are recruited for study in which 44 patients are prescribed (50mgtwice daily tapentadol and 58 patients prescribed (50mg twice daily tramadol for 4 weeks. Follow-up was done on days 7, 14, 28 and 4 week after stoppage of treatment. Assessment of improvement were performed by Indian Health Assessment Questionnaire Disability Index (Indian HAQDI, Visual Analogue Scale (VAS, Numerical Rating Scale (NRS and measurement of Pain Relief Rate (PRR. Adverse events were recorded. Results: Scores in Indian HAQDI, VAS and NRS improved significantly in both groups in the last visit but more so with tapentadol. PRR was reasonably higher with tapentadol [27(n=4461.36%] patients experiencing significant to complete pain relief at the end of the study, compared to tramadol [25(n=58 43.10%]. Adverse effects was less in tapentadol group [15(n=4434.09%] versus 33(n=5856.89%], p<0.05]. Conclusion: Tapentadol has better sustained efficacy and tolerability than tramadol in low back pain. [Int J Basic Clin Pharmacol 2013; 2(4.000: 392-396

  19. Research on related factors of post-stroke depression and their relationship with prognosis%脑卒中后抑郁相关因素与患者预后分析研究

    Institute of Scientific and Technical Information of China (English)

    张国利; 曾湘良; 刘芳; 朱勇

    2012-01-01

    目的 探讨脑卒中后抑郁的相关因素及患者预后分析.方法选择2008年2月~2011年2月本院住院治疗的280例脑卒中患者,采用抑郁自评量表、汉密尔顿抑郁量表对患者进行评估.280例患者中确诊为卒中后抑郁者62例,将32例接受早期干预治疗的卒中后抑郁者为观察组,30例未接受早期干预者为对照组.对可能引起脑中后抑郁的相关因素进行分析,并采用改良Barthel指数评估患者日常生活能力(ADL),采用FMA运动功能评定肢体运动功能.结果统计学分析显示文化程度、家庭关系、病变部位、偏瘫严重程度与患者脑卒中后抑郁显著相关(P 0.05);治疗后1、3及6个月进行评估,结果显示观察组MBI评分及FMA评分显著优于对照组(P 0.05); MBI scores and FMA scores in experience group were much better than that in control group on 1, 3 and 6 months of post-treatment (P < 0.05). Conclusion Culture degree, family relationship, lesion site, the hemiplegic degree are the risk factors for post-stroke depression. The patients who receive early treatment have better prognosis. Early treatment should be performed in order to promote the recovery and improve the prognosis of patients.

  20. 脑卒中后认知功能障碍与糖化血红蛋白相关性临床研究%Study of relationship between post-stroke cognitive impairment and glycosylated hemoglobin

    Institute of Scientific and Technical Information of China (English)

    陆悠; 刘学源; 赵延欣; 陈玉娟; 殷少军

    2013-01-01

    Objective To evaluate the relationship between glycosylated hemoglobin and post-stroke cognitive impairment. Methods 105 cases of patients with ischemic stroke who had elevated glycosylated hemoglobin level ( hyper group) and 94 cases of ischemic stroke patients with normal glycosylated hemoglobin level ( control group) were enrolled in this study. Mini-mental status examination ( MMSE) , Hamilton depression scale score ( HAMD) were evaluated during the acute phase of stroke and follow-up of 30 days. Results In the acute phase after stroke the glycosylated hemoglobin patients had more impaired cognitive function than patients with normal glycosylated hemoglobin (P 0. 05 ). While after follow-up for 30 days, the patients of hyper group showed more severe depression than those of control group. At this time point the cognitive dysfunction was still distinguishable between these two groups(P<0. 05). Conclusions Elevated glycosylated hemoglobin influences cognitive function after stroke.%目的 分析脑卒中后认知功能障碍与糖化血红蛋白(HbA1c)的关系. 方法 对105例HbA1c 升高的缺血性脑卒中患者(增高组),在脑卒中急性期和随访30 d行简易精神状态检查量表(MMSE)、汉密尔顿抑郁量表(HAMD)评分,并与94例同期收治的同龄HbA1c正常缺血性脑卒中患者(对照组)对比,分析HbA1c升高对脑卒中后认知功能障碍发生的影响. 结果 脑卒中急性期,HbA1c增高组患者认知功能较对照组患者有明显损伤(P<0.05),2组的抑郁状态无明显差别(P>0.05).而随访30 d后,HbA1c增高组患者的认知功能仍低于对照组(P<0.05),并且此时HbA1c增高组患者的抑郁程度较对照组患者明显加重(P<0.05). 结论 HbA1c升高影响脑卒中后认知功能障碍的发生和发展.

  1. Youth post-stroke depression of patients with clinical observation of early psychological intervention%青年脑卒中后抑郁患者早期心理干预的临床观察

    Institute of Scientific and Technical Information of China (English)

    王建; 王俊; 李运明; 房妮妮; 王庆松

    2013-01-01

    Objective To investigate the rehabilitation outcome of early psychotherapy to young post-stroke depression of the youngelderly patients.Methods After aged young patients with stroke are hospitalized,they are filtered and graded by hamiliton depression rating scale (HRSD) in a week,for 67 patients with depression were divided into psychotherapy group (subject to normal rehabilitation therapy and psychotherapy)and normal group (only subject to normal rehabilitation) randomly.Both two group s are contrasted by spitzer quality of life inventory(QLI) and H RSD after 8-weeks.Results Through the early psychotherapy,the psychotherapy group is obviously superior to normal group in health,support of family and social support,and the understanding to prospect.OtherwiseFurthermore,the patients of in psychotherapy group are imp roved in with depress situation of depression (P < 0.01).Conclusion The early systemic psychotherapy is effective in cureing depression,fastening the comebackrecovering of everyneuronal function early,and improving the quality of life.%目的 探讨早期心理干预对青年脑卒中后抑郁(PSD)的治疗效果.方法 青年脑卒中患者在住院1w内采用汉密顿抑郁量表(HRSD)进行筛选评分,对符合抑郁状态诊断的患者67例随机分为干预组和常规组,常规组采用常规的药物治疗和护理,干预组同时给予早期心理干预,8w后采用Spitzer生存质量指数量表(QLI)和HRSD对两组进行评定.结果 经过早期心理干预后,干预组在健康感觉、家庭和社会的支持以及对前景的认识方面明显优于常规组,干预组患者的抑郁情况与常规组比较明显改善(P<0.01).结论 对青年脑卒中后抑郁患者早期系统的心理干预可明显改善抑郁,加快神经缺失功能恢复,提高生活质量.

  2. 迷迭香精油吸嗅对PSD大鼠的神经行为学影响%Effects of rosemary on behavioral models related to post-stroke depression in rats

    Institute of Scientific and Technical Information of China (English)

    李键; 高晓平; 李光武; 陈和木; 窦云龙

    2012-01-01

    目的 探讨迷迭香吸入对脑卒中后抑郁(PSD)大鼠行为学的影响.方法 采用线栓法制备局灶性脑缺血大鼠模型后予以孤养、应激处理复合制备PSD大鼠模型,随机分为迷迭香组、文拉法辛组和对照组,观察PSD大鼠蔗糖水消耗量、旷野试验等行为学指标.结果 与对照组相比,迷迭香组和文拉法辛组PSD大鼠蔗糖水消耗量、旷野实验水平和垂直运动次数均有所增加(P<0.01);而两组效果亦有差异(P<0.01),文拉法辛组更为明显.结论 迷迭香吸入对PSD大鼠神经行为学变化有一定的改善.%Aim To observe the effect of rosemary on the changes of behaviors in post-stroke depression( PSD) rats. Methods The focal cerebral ischemia model was set up by blocking the middle cerebral artery ( MCAO). Then the model rats were separately raised and put into chronic unpredictable mild stress ( CUMS) to induce the PSD model. The rats were divided into control group, Rosemary group and venlafaxine group. The rats were examined dynamically at the 7th, 14th, 28th days by open-field test (OFT) and sucrose consumption test. Results There were no obvious differences of the baseline level in the three groups. In Rosemary group as well as venlafaxine group the behavior ability significantly improved compared with control group (P 〈0. 01) . The behavior scores of venlafaxine group were higher than those of Rosemary group (P 〈0. 01). Conclusions Rosemary can improve the behavior abnormality in PSD rats.

  3. The effect of duloxetine combined with zopiclone in the treatment of post-stroke depression%度洛西汀联合右佐匹克隆治疗老年脑卒中后抑郁的疗效

    Institute of Scientific and Technical Information of China (English)

    尹丽丽; 张美增

    2015-01-01

    目的 分析度洛西汀联合右佐匹克隆治疗老年脑卒中后抑郁疗效.方法 回顾性分析2013年12月~2014年12月本院72例老年脑卒中患者临床资料,按数字表法分成两组,研究组予度洛西汀并右佐匹克隆治疗,对照组予度洛西汀并劳拉西泮片治疗,比较两组患者治疗前后抑郁症状和不良反应情况.结果 研究组治疗1、2、4周后HAMD评分均比对照组低;研究组TESS评分低于对照组,比较差异均有具统计学意义(P<0.05).结论 度洛西汀联合右佐匹克隆治疗老年脑卒中后抑郁的疗效显著.%Objective Analysis of duloxetine combined with zopiclone in the treatment of senile cerebral depression patients after stroke.Methods A retrospective analysis of 2013December -2014 year in December in our hospital 72 cases of elderly stroke patients with clinical data, divided into two groups randomly, the study group were treated with duloxetine and zopiclone in the treatment, control group were treated with duloxetine and Lorazepam tablets treatment, depression symptoms and adverse reactions were compared between the two groups patients before and after treatment.Results The treatment group 1, 2, 4 weeks after the HAMD scores were lower than the control group; the TESS scores of the study group than in the control group, the differences were statistically significant (P<0.05).Conclusion The efficacy of duloxetine combined with zopiclone in the treatment of post-stroke depression in the elderly was significantly.

  4. 音乐治疗对脑卒中后抑郁患者情绪影响的研究%Effect of music therapy on mood in post-stroke depression patients

    Institute of Scientific and Technical Information of China (English)

    潘田华

    2015-01-01

    Objective To investigate the effect of music therapy on depression and anxiety in patients with post-stroke depression (PSD).Methods 192 cases of PSD were randomly divided into music therapy group and control group.Patients in control group received routine physical and drug therapy,and patients in music therapy group received systematical music therapy on the basis of control group.Psychological status of all patients was evaluated with Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) before and after treatment.Results After treatment,BDI score and BAI score in music therapy group decreased more significantly compared with control group.BDI score in music therapy group before treatment was (16.7±6.4),that after treatment was (14.3±4.6),with statistically significant difference (P<0.05).Conclusion Music therapy has a positive effect on mood in PSD patients,which can be applied in clinical work to improve PSD patients' mood.%目的 研究音乐治疗对卒中后抑郁患者焦虑抑郁情绪的作用.方法 192名卒中后抑郁患者随机分至音乐治疗及对照组.给予音乐治疗组患者常规物理、药物治疗,及计划性音乐治疗,仅给予对照组患者常规物理及药物治疗.两组患者入组前后均采用贝克抑郁量表(BDI)和贝克焦虑量表(BAI)进行情绪评估.结果 音乐治疗后音乐治疗组患者BDI和BAI评分较对照组下降更为明显,但仅有音乐治疗组患者治疗前后BDI显著下降,治疗前BDI均分(16.7±6.4),治疗后BDI均分(14.3±4.6)(P<0.05).结论 音乐治疗对于卒中后抑郁患者情绪有改善作用,可用于卒中后抑郁患者临床治疗.

  5. 三级康复系统对于脑卒中后康复治疗的效果探讨%The effect of three stage rehabilitation system to explore rehabilitation treatment on post-stroke

    Institute of Scientific and Technical Information of China (English)

    韩建

    2015-01-01

    Objective To explore the effect of three stage rehabilitation system to explore rehabilitation treatment on post-stroke. Methods 80 cases were selected and divided into two groups, 40 cases each, the observation group were used three stage rehabilitation intervention, the control group were received the routine rehabilitation treatment, then patients quality of life score and complications were compared in the two group follow-up in 1 and 3 month. Results Followed up in 1 and 3 month, the observation group with quality of life score was better than control group (P < 0.05),the observation group occurred with lung, urinary tract infection,venous thrombosis with lower limbs, joint contracture and bedsore ratio were lower than control group (P<0.05). Conclusion Three stage rehabilitation can effectively extend the patient's family rehabilitation treatment, it can improve the life quality and reduce complications.%目的:探讨三级康复系统对于脑卒中后康复治疗的临床效果。方法选择患者80例,分为两组,各40例,观察组实施三级康复干预,对照组实施常规康复治疗,比较两组出院时和随访1个月、3个月患者生活质量得分及发生并发症情况。结果随访1个月和3个月,观察组生活质量得分显著优于对照组(P<0.05),观察组发生肺部、泌尿系感染,下肢静脉血栓,关节挛缩和褥疮的比例显著低于对照组(P<0.05)。结论三级康复能有效延续患者家庭康复治疗,提高生活质量,减少并发症。

  6. Relativity study between serum cortisol level and post-stroke depression in old patients with stroke%老年脑卒中患者血清皮质醇水平与卒中后抑郁的相关性研究

    Institute of Scientific and Technical Information of China (English)

    孟宪栋; 罗晓红; 樊红艳

    2009-01-01

    Objective To explore relativity between serum cortisol and post-stroke depression in old patients with stroke. Methods Serum cortisols of 41 stroke patients were examined two weeks after stroke, and they were all assessed through Hamilton Depression Scale and then happening rates of post-stroke depression observed in both normal cortisol group and enhanced cortisol group were tested through χ2 test. Meanwhile relativity between serum cortisol level and post-stroke depression were analysised. Results Happening rates of post-stroke depression had an evidently difference between both normal cortisol group and enhanced cortisol group(χ2=4.11;P <0.05). Mark of normal cortisol group was 15.29±7.28, enhanced cortisol group was 25.85±10.81, both groups had an evidently difference( P <0.01). Serum cortisols were not obviously relative to depression degree in normal cortisol group( r =0.295;P =0.194) while they were obviously relative in enhanced cortisol group( r =0.702;P =0.001). Conclusion Enhanced cortisol could forecast higher possibility of depression after the old post-stroke, and detecting cortisol could offer theory foundation for prevention and cure of post-stroke depression.%目的 探讨老年脑卒中患者血清皮质醇水平与卒中后抑郁(PSD)是否具有相关性.方法 对41例老年卒中患者在发病后2周进行血清皮质醇检测,并在发病后3月对患者进行抑郁量表评定,观察皮质醇正常组以及皮质醇增高组卒中后抑郁发生率,并进行卡方检验,同时对各组内皮质醇水平和抑郁程度进行相关性分析.结果 皮质醇正常组和皮质醇增高组PSD发生率差异有显著性(χ2=4.11;P <0.05),皮质醇正常组平均汉密尔顿分值为(15.29±7.28)分,皮质醇增高组为(25.85±10.81)分,2组差异有显著性( P <0.01).皮质醇正常组皮质醇水平与抑郁程度无明显相关( r =0.295;P =0.194),皮质醇增高组皮质醇水平与抑郁程度明显相关( r =0.702;P =0.001).结论 老

  7. Pain Management

    Science.gov (United States)

    ... opiates such as morphine could relieve pain and chemist Felix Hoffmann developed aspirin from a substance in ... sensory and emotional experience associated with actual or potential tissue damage.” TODAY Pain affects more Americans than ...

  8. [Oral pain].

    Science.gov (United States)

    Benslama, Lotfi

    2002-02-15

    Pain, a major symptom of stomatological disease, usually leads to a specialist consultation. Most commonly it is caused by dental caries and differs in nature and in intensity according to the stage of disease: dentinitis, pulpitis, desmodontitis and dental abscess. Added to this is peridental pain and the pre- and post-operative pains related to these diseases. Almost all oral-maxillary pathology is painful, be it boney such as in osteomyelitis and fractures, mucosal in gingivo-stomatitis and aphthous ulcers, or tumourous. However, besides the "multidisciplinary" facial pains such as facial neuralgia and vascular pain, two pain syndromes are specific to stomatology: pain of the tempero-mandibular joint associated with problems of the bite and glossodynia, a very common somatic expression of psychological problems.

  9. Habituating pain

    DEFF Research Database (Denmark)

    Ajslev, Jeppe Zielinski Nguyen; Lund, Henrik Lambrecht; Møller, Jeppe Lykke;

    2013-01-01

    the industry reproduce physical strain and the habituation of pain as unquestioned conditions in construction work. The understanding of this mutual reinforcement of the necessity of physically straining, painful, high-paced construction work provides fruitful perspectives on the overrepresentation...

  10. Testicle pain

    Science.gov (United States)

    ... pain include: Injury Infection or swelling of the sperm ducts ( epididymitis ) or testicles ( orchitis ) Twisting of the ... Cyst in the epididymis that often contains dead sperm cells ( spermatocele ) Fluid surrounding the testicle ( hydrocele ) Pain ...

  11. Breast pain

    Science.gov (United States)

    Pain - breast; Mastalgia; Mastodynia; Breast tenderness ... There are many possible causes for breast pain. For example, hormone level changes from menstruation or pregnancy often cause breast tenderness. Some swelling and tenderness just before your period ...

  12. Centralized cancer pain cognition situation in basic medical staff from China%我国西南地区基层医务人员癌痛认知现状调查

    Institute of Scientific and Technical Information of China (English)

    刘婧; 王静; 贾钰铭; 雷开键; 张瑶; 江健; 郭菁菁; 贾凤琴

    2013-01-01

    目的:了解我国西南地区基层医务人员的癌痛认知状况,为提高基层癌痛控制水平提供依据。方法:选择我国西南地区四川省宜宾市宜宾县横江镇及所辖部分村级医务人员,进行集中式癌痛问卷调查并进行癌痛知识宣教。结果:横江镇医务人员认为仅有17%(8/46)的癌痛患者得到治疗;70%(32/46)医务人员不注重对患者进行癌痛治疗宣教;64%(40/46)医务人员对规范癌痛控制知识不了解;87%(40/46)医务人员认为麻醉止痛药不能满足患者需要;70%(32/46)的医务人员要求增加癌痛培训次数。结论:横江镇医务人员癌痛认知状况较差,需要更多适应基层的癌痛知识培训,建议将癌痛控制纳入社区慢性病肿瘤的具体管理之中。%Objective:To understand the recognition status of cancer pain in basic medical staff from small towns to provide the basis for the improvement of cancer pain management in these areas. Methods:The medical staff of Hengjiang Town and subordinate villages was selected. The study area is situated in southwest China. Centralized questionnaires regarding cancer pain were collected and analyzed. A program and education of cancer pain were provided for these medical workers. Results: The medical staff from Hengjiang asserted that only 17%of cancer pain patients receive treatments. Approximately 70%of the medical staff did not consider the popularization and explanation of cancer pain treatment in their patients. Approximately 64%of the medical staff was not familiar with standardized cancer pain control, 87%did not believe that narcotics could suffice the need of patients, and 44%did not participate in the training for cancer pain control. Conclusion: The medical staff in Hengjiang possesses less knowledge on the importance of cancer pain. Hence, further training is necessary. The specific management of cancer pain as a part of community chronic diseases is

  13. Urination Pain

    Science.gov (United States)

    ... more often bad-smelling, bloody, or discolored urine (pee) fever or chills decreased appetite or activity irritability nausea or vomiting lower back pain or abdominal (belly) pain wetting accidents (in potty-trained kids) What to Do Call the doctor if your child has pain while urinating or can't ...

  14. Abdominal Pain

    Science.gov (United States)

    ... relaxation. Guided imagery for abdominal pain About self-hypnosis and kids See YourChild : Pain and Your Child or Teen for more detail ... how to help your baby cope with the pain of medical procedures, circumcision, and teething. ... Helping Kids YourChild : A Look at Biofeedback YourChild : ...

  15. Does suprascapular nerve block reduce shoulder pain following stroke: a double-blind randomised controlled trial with masked outcome assessment

    Directory of Open Access Journals (Sweden)

    Crotty Maria

    2010-09-01

    Full Text Available Abstract Background Shoulder pain is a common complication of a stroke which can impede participation in rehabilitation programs and has been associated with poorer outcomes. The evidence base for current medical and therapeutic management options of hemiplegic shoulder pain is limited. This study will evaluate the use of suprascapular nerve block injection as part of an interdisciplinary approach to the treatment of shoulder pain following stroke. The technique has previously been proven safe and effective in the treatment of shoulder pain associated with rheumatoid arthritis and degenerative shoulder conditions but its usefulness in a stroke population is unclear. Methods/Design A double blind randomised placebo controlled trial will assess the effect of a suprascapular nerve block compared with placebo in a population of 66 stroke patients. The trial will measure effect of injection on the primary outcome of pain, and secondary outcomes of function and quality of life. Measurements will take place at baseline, and 1, 4 and 12 weeks post intervention. Both groups will continue to receive routine physiotherapy and standard ward care. Discussion The results of this study could reduce pain symptoms in persons with mechanical shoulder pain post stroke and provide improvement in upper limb function. Trial Registration This trial is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR - ACTRN12609000621213.

  16. Altered pain modulation in patients with persistent postendodontic pain.

    Science.gov (United States)

    Nasri-Heir, Cibele; Khan, Junad; Benoliel, Rafael; Feng, Changyong; Yarnitsky, David; Kuo, Fengshen; Hirschberg, Craig; Hartwell, Gary; Huang, Ching-Yu; Heir, Gary; Korczeniewska, Olga; Diehl, Scott R; Eliav, Eli

    2015-10-01

    Persistent pain may follow nerve injuries associated with invasive therapeutic interventions. About 3% to 7% of the patients remain with chronic pain after endodontic treatment, and these are described as suffering from painful posttraumatic trigeminal neuropathy (PTTN). Unfortunately, we are unable to identify which patients undergoing such procedures are at increased risk of developing PTTN. Recent findings suggest that impaired endogenous analgesia may be associated with the development of postsurgical chronic pain. We hypothesized that patients with PTTN display pronociceptive pain modulation, in line with other chronic pain disorders. Dynamic (conditioned pain modulation, temporal summation) and static (response to mechanical and cold stimulation) psychophysical tests were performed intraorally and in the forearm of 27 patients with PTTN and 27 sex- and age-matched controls. The dynamic sensory testing demonstrated less efficient conditioned pain modulation, suggesting reduced function of the inhibitory endogenous pain-modulatory system, in patients with PTTN, mainly in those suffering from the condition for more than a year. The static sensory testing of patients with PTTN demonstrated forearm hyperalgesia to mechanical stimulation mainly in patients suffering from the condition for less than a year and prolonged painful sensation after intraoral cold stimulus mainly in patients suffering from the condition for more than a year. These findings suggest that PTTN is associated more with the inhibitory rather than the facilitatory arm of pain modulation and that the central nervous system has a role in PTTN pathophysiology, possibly in a time-dependent fashion. PMID:26098442

  17. 针刺结合康复训练治疗脑卒中后运动功能障碍临床疗效的Meta分析%Meta analysis on the Therapeutic Effct of Acupuncture Plus Rehabilition Exercise on Post-stroke Hemiplegic Patients

    Institute of Scientific and Technical Information of China (English)

    吴宗蔚; 李铁浪; 唐雄

    2013-01-01

    Objective: To explore the therapeutic effct of acupuncture plus rehabilition exercise on post-stroke hemiplegic patients. Methods: literature reviews on the clinical trials (RCTs) that use acupuncture and rehabilition exercise as the main intervention to treat post-stroke hemiplegia before 2012 were captured extensive,and 980 reports were collected for the study. After screening, 13 reports were eventually selected. Assess the quality of reports of RCTs was assessed according to Jadad quality scoring method,and was meta analysised using RevMan 4.2.7. Results: The findings disclosed that there were highly significant statistical difference between two groups in excellence and total effective rates,and the therapeutic effect of acupuncture with rehabilition exercise to treat post-stroke hemiplegia was better than that of single acupuncture, rehabilition exercise or western medicine. Conclusion; According to statistic analysis of literature,acupuncture with rehabilition exercise treatment of post-stroke hemiplegia is effective. Nevertheless,because of the lack of enough more high quality literatures to prove the curative effect,more well-designed randomized clinical trials are needed to confirm the clinical efficacy of this method.%目的 评价针刺结合康复治疗脑卒中后运动功能障碍的临床疗效.方法 全面检索截止2012年针刺结合康复治疗脑卒中后运动功能障碍的临床研究文献共980篇,经过筛选,最终纳入13篇文献.采用Jadad 量表评价文献质量,使用RevMan4.2.7进行Meta分析.结果 通过Meta分析不分级的文献,发现对脑卒中后运动功能障碍的针刺合并康复治疗有效率高于针刺、康复、西医等治疗,提示针刺合并康复功能训练的治疗方案较优胜.结论 针刺结合康复训练对脑卒中后运动功能的恢复有利,但鉴于目前缺乏相关高质量临床研究文献,尚需要更多设计良好的临床随机对照试验来进一步证实其效果.

  18. The controlled study on psychosocial factors for post-stroke depression%卒中后抑郁患者心理社会影响因素的对照研究

    Institute of Scientific and Technical Information of China (English)

    康岚; 王希林; 刘粹; 廖金敏; 黄成兵; 黄悦勤; 孙丽君; 谷朝霞

    2014-01-01

    Objective To investigate psychosocial factors for post-stroke depression (PSD). Methods 405 in-pa-tients with stroke were first screened for depression using Comprehensive International Diagnostic Interview-3.0. 22 pa-tients with depression were recruited as the depression group. From 383 patients without depression, 44 patients were se-lected and served as the non depression controlled group according to the sex and age paired with 1:2. Both groups were measured by using questionnaires including Life Event Scale, Simplified Coping Style Questionnaire, Social Support Rat-ing Scale, Activities of Daily Living Scale and Quality of Life Enjoyment and Satisfaction Questionnaire, Short Form. Re-sults The score of passive coping was significantly higher in depression group than in non depression group [(1.2 ± 0.5) vs. (0.8±0.7), P<0.05]. The score of subjective support was significantly lower in depression group than in non depression group [(17.5±4.0) vs. (20.7±4.6), P<0.05]. Logistic regression analysis showed, minority nationality (OR=2.564, 95%CI:1.039~6.327) and passive coping style (OR=2.223, 95%CI:1.052~5.192) were risk factors for PSD, while subjective sup-port was protective factor for PSD (OR=0.884, 95%CI:0.793~0.986). Conclusions Passive coping style and low subjec-tive support may be the important psychosocial factors of PSD.%目的:探讨卒中后抑郁(post-stroke depression,PSD)的主要心理社会影响因素。方法应用复合性国际诊断问卷-3.0中文版对405例住院脑卒中患者进行筛查与诊断,其中符合抑郁障碍诊断标准的22例患者为抑郁组,在383例无抑郁障碍的患者中按性别、年龄匹配原则以1:2比例抽取44例作为非抑郁组。采用生活事件量表、简易应对方式问卷、社会支持评定量表、日常生活活动能力量表和简明幸福与生活质量满意度问卷对两组进行测评。结果抑郁组的简易应对方式问卷中消极应

  19. Donepezil in the treatment of early post-stroke aphasia:a randomized controlled trial%多奈哌齐治疗早期卒中后失语:随机对照研究

    Institute of Scientific and Technical Information of China (English)

    吴小琴; 刘晓加; 邢一兰; 王心宇

    2013-01-01

    Objective To investigate the effectiveness of donepezil in the treatment of early post-stroke aphasia (PSA).Methods PSA patients within one month after onset were randomly assigned into either a donepezil group or a control group.On the basis of conventional medication,the donepezil group was given hydrochloride donepezil 5 mg/d.The patients were followed-up after 4 week.The efficacy was evaluated by the Aphasia Battery of Chinese (ABC),the National Institute of Health Stroke Scale (NIHSS),the Stroke Aphasic Depression Questionnaire (SADQ),Chinese version,and the Treatment Emergent Symptom Scale (TESS) before and after treatment.Results A total of 48 PSA patients were enrolled in the study.Both the donepezil group and the control group had 24 patients and they all completed the study.There were no significant differences in age,years of education,NIHSS score,SADQ score,stroke duration,as well as the proportions of male,hypertension,diabetes,hyperlipidemia,heart disease,previous stroke or history of transient ischemic attack,smoking alcohol consumption,type of stroke,and lesion site (all P < 0.01).There were significant differences in each language score before and after treatment both in the donepezil group and in the control group (all P <0.01).The difference values of listening comprehension (47.8 ± 24.7 vs.22.0 ± 15.4; t =4.342,P =0.000)and reading comprehension (20.5 ± 14.0 vs.8.1 ± 10.5; t =3.483,P <0.01) scores before and after treatment in the donepezil group were significantly higher than those in the control group,while there were no significant differences in the information quantity of speech,fluency,series language,repetition,naming,and reading scores (all P >0.05).As compared with the control group,there were significant differences in the difference values of the SADQ scores before and after treatment in the donepezil group (6.2 ±6.0 vs.2.5 ±3.0; t =2.717,P=0.009).No serious adverse reactions were observed in both groups.Conclusions On

  20. A clinical research on optimistic design of acupuncture in treatment of post-stroke hemiplegia%针刺优化方案治疗中风后偏瘫的临床研究

    Institute of Scientific and Technical Information of China (English)

    张民; 涂悦; 程世翔; 马铁柱; 张赛

    2011-01-01

    Objective To observe the changes of neural dysfunction of patients with post-stroke hemiplegia treated by the prioritization scheme of acupuncture to look for a proper therapy for this disease.Methods According to the admission sequence, 90 stroke cases were randomly and equally divided into three groups: acupuncture group, rehabilitation group, and acupuncture plus rehabilitation group. Conventional drug therapies were given to all the three groups. In addition, acupuncture group adopted Xingnao Kaiqiao (醒脑开窍) therapy, the prioritization scheme needling Neiguan (内关), Renzhong 〔人中, after 3 days, Yintang (印堂) took the place of Renzhong〕, Sanyinjiao (三阴交), Jiquan (极泉), Chize (尺泽), Weizhong (委中),Fengchi (风池), Wangu (完骨) and Tianzhu (天柱) acupoints with adjustment in the light of different syndromes of traditional Chinese medicine and retention of each needling being 30 minutes. The patients in rehabilitation group performed the rehabilitation training program, once 45 minutes; while acupuncture plus rehabilitation group adopted both Xingnao Kaiqiao acupuncture therapy and rehabilitation training program.Rehabilitation and acupuncture treatment were given 5 times a week for 4 weeks. Before and after the therapy,neural function deficient scale (NDS) was evaluated and the therapeutic results of various groups were compared. Results NDS scores after the therapy of three groups were all comparatively lower than those before the therapy (all P<0.01); and the scores of acupuncture group and acupuncture plus rehabilitation group were lowered more significantly than the score in rehabilitation group (6.13±3.18, 6. 13±4.03 vs.8. 77±3.35, both P<0. 05), whereas the lowering in the former two groups had no obvious difference. The total effective rates of acupuncture group and acupuncture plus rehabilitation group were also markedly higher than the rate in rehabilitation group (100. 0%, 100.0% vs. 93.3%, both P

  1. Temporomandibular pain.

    Science.gov (United States)

    Prasad, S Raghavendra; Kumar, N Ravi; Shruthi, H R; Kalavathi, S D

    2016-01-01

    Temporomandibular joint pain has various medical and dental etiological factors. The etiology of the temporomandibular joint pain is enigmatic, no single etiological factor is regarded as the cause. Its distribution is also not confined to a single area. This article presents the basic etiologic factors, its epidemiology, distribution of pain, classification of patients and the psychosocial behavior of patients suffering with temporomandibular pain. As overwhelming majority of medical and dental conditions/issues related to etiology of temporomandibular pain in patients have traditionally been presented and interpreted from the clinician's point of view. PMID:27601822

  2. Pain in fibromyalgia and related conditions.

    Science.gov (United States)

    Cassisi, G; Sarzi-Puttini, P; Casale, R; Cazzola, M; Boccassini, L; Atzeni, F; Stisi, S

    2014-06-06

    Pain is the hallmark symptom of fibromyalgia (FM) and other related syndromes, but quite different from that of other rheumatic diseases, which depends on the degree of damage or inflammation in peripheral tissues. Sufferers are often defined as patients with chronic pain without an underlying mechanistic cause, and these syndromes and their symptoms are most appropriately described as "central pain", "neuropathic pain", "nonnociceptive pain" or "central sensitivity syndromes". The pain is particular, regional or widespread, and mainly relates to the musculoskeletal system; hyperalgesia or allodynia are typical. Its origin is currently considered to be distorted pain or sensory processing, rather than a local or regional abnormality. FM is probably the most important and extensively described central pain syndrome, but the characteristics and features of FM-related pain are similar in other disorders of particular interest for rheumatologists, such as myofascial pain syndromes and temporo-mandibular joint disorders, and there is also an intriguing overlap between FM and benign joint hypermobility syndrome. This suggests that the distinctive aspects of pain in these idiopathic or functional conditions is caused by central nervous system hypersensitivity and abnormalities. Pharmacological and non-pharmacological therapies have been suggested for the treatment of these conditions, but a multidisciplinary approach is required in order to reduce the abnormal cycle of pain amplification and the related maladaptive and self-limiting behaviours.

  3. Evaluation of analgesic effect of tapentadol, a central novel analgesic versus tramadol, a widely used opioid analgesic in treatment of low back pain: a randomized controlled trial

    OpenAIRE

    Zaki Anwar Zaman; Deepak Kumar

    2013-01-01

    Background: The objective of the study was to compare efficacy and tolerability (safety) of tapentadol with tramadol in the treatment of low back pain. Methods: The study was a prospective, randomized, single blinded, total 102 patients are recruited for study in which 44 patients are prescribed (50mgtwice daily) tapentadol and 58 patients prescribed (50mg twice daily) tramadol for 4 weeks. Follow-up was done on days 7, 14, 28 and 4 week after stoppage of treatment. Assessment of improvement ...

  4. Multimodal pain stimulation of the gastrointestinal tract

    Institute of Scientific and Technical Information of China (English)

    Asbjφrn Mohr Drewes; Hans Gregersen

    2006-01-01

    Understanding and characterization of pain and other sensory symptoms are among the most important issues in the diagnosis and assessment of patient with gastrointestinal disorders. Methods to evoke and assess experimental pain have recently developed into a new area with the possibility for multimodal stimulation (e.g.,electrical, mechanical, thermal and chemical stimulation)of different nerves and pain pathways in the human gut. Such methods mimic to a high degree the pain experienced in the clinic. Multimodal pain methods have increased our basic understanding of different peripheral receptors in the gut in health and disease. Together with advanced muscle analysis, the methods have increased our understanding of receptors sensitive to mechanical,chemical and temperature stimuli in diseases, such as systemic sclerosis and diabetes. The methods can also be used to unravel central pain mechanisms, such as those involved in allodynia, hyperalgesia and referred pain. Abnormalities in central pain mechanisms are often seen in patients with chronic gut pain and hence methods relying on multimodal pain stimulation may help to understand the symptoms in these patients.Sex differences have been observed in several diseases of the gut, and differences in central pain processing between males and females have been hypothesized using multimodal pain stimulations. Finally, multimodal methods have recently been used to gain more insight into the effect of drugs against pain in the GI tract.Hence, the multimodal methods undoubtedly represents a major step forward in the future characterization and treatment of patients with various diseases of the gut.

  5. Heightened cold pain and pressure pain sensitivity in young female adults with moderate-to-severe menstrual pain.

    Science.gov (United States)

    Slater, Helen; Paananen, Markus; Smith, Anne J; OʼSullivan, Peter; Briggs, Andrew M; Hickey, Martha; Mountain, Jenny; Karppinen, Jaro; Beales, Darren

    2015-12-01

    This study investigated the association between menstrual pain severity and psychophysical measures of cold and pressure pain sensitivity. A cross-sectional design was used with young women (n = 432) from the Western Australian Pregnancy Cohort (Raine) Study. Menstrual pain severity and oral contraception use was obtained from questionnaires at 20 and 22-year follow-ups. A visual analog scale (VAS; range from 0 [none] to 10 [unbearable]) was used to measure menstrual pain severity at both 20 and 22 years over the 3-year period, with 3 groups created: (1) no pain or mild pain (VAS 0-3), (2) at least moderate pain at a minimum of 1 of the 2 time points (hereafter named "mixed)", and (3) severe pain (VAS 8-10). Cold pain sensitivity (dorsal wrist) and pressure pain sensitivity (lumbar spine, upper trapezius, dorsal wrist, and tibialis anterior) were assessed using standardised quantitative sensory testing protocols. Confounding variables included number of musculoskeletal pain sites, oral contraceptive use, smoking, physical activity, body mass index, psychological distress, and sleep. Severe menstrual pain and mixed menstrual pain were positively associated with heightened cold pain sensitivity (distant from menstrual pain referral site) and pressure pain sensitivity (local to menstrual pain referral site). These associations remained significant after adjusting for potential confounding variables including multisite musculoskeletal pain. Our findings suggest peripheral and central neurophysiological mechanisms contributing to heightened pain sensitivity in young women with moderate and severe menstrual pain. These data highlight the need for innovative management approaches to attenuate the negative impact of severe menstrual pain in young women. PMID:26262827

  6. Pain Management in Functional Gastrointestinal Disorders

    OpenAIRE

    Vigano, Antonio; Bruera, Eduardo

    1995-01-01

    Pain is a common feature in functional gastrointestinal disorders (FGID). An abnormally low visceral sensory threshold, as well as a number of central, spinal and peripheral pain-modulating abnormalities, have been proposed for this syndrome. Clinical aspects of pain associated with irritable esophagus, functional dyspepsia, biliary dysmotility, inflammatory bowel syndrome and proctalgia fugax are reviewed. Because of its unclear pathophysiology, pain expression is the main target for the suc...

  7. Recent Advances in Postoperative Pain Management

    OpenAIRE

    Vadivelu, Nalini; Mitra, Sukanya; Narayan, Deepak

    2010-01-01

    Good pain control after surgery is important to prevent negative outcomes such as tachycardia, hypertension, myocardial ischemia, decrease in alveolar ventilation, and poor wound healing. Exacerbations of acute pain can lead to neural sensitization and release of mediators both peripherally and centrally. Clinical wind up occurs from the processes of N-Methyl D-Aspartate (NMDA) activation, wind up central sensitization, long-term potentiation of pain (LTP), and transcription-dependent sensiti...

  8. Low back pain - chronic

    Science.gov (United States)

    Nonspecific back pain; Backache - chronic; Lumbar pain - chronic; Pain - back - chronic; Chronic back pain - low ... Low back pain is common. Almost everyone has back pain at some time in their life. Often, the exact cause ...

  9. Autoantibody pain.

    Science.gov (United States)

    Goebel, Andreas

    2016-06-01

    As autoantibodies bind to target tissues, Fc-region dependent inflammation can induce pain via mediators exciting nociceptors. But recently another possibility has emerged, where autoantibody binding to nociceptors can directly cause pain, without inflammation. This is thought to occur as a result of Fab-region mediated modification of nerve transduction, transmission, or neuropeptide release. In three conditions, complex regional pain syndrome, anti-voltage gated potassium channel complex autoimmunity, and chronic fatigue syndrome, all associated with no or only little inflammation, initial laboratory-, and clinical trial-results have suggested a potential role for autoantibody-mediated mechanisms. More research assessing the pathogenic roles of autoantibodies in these and other chronic pain conditions is required. The concept of autoantibody-mediated pain offers hope for the development of novel therapies for currently intractable pains. PMID:26883460

  10. The relationship between neural network damage and the gait function in lower limbs in patients post-stroke%脑卒中后神经网络损害与下肢步行功能结局的关系

    Institute of Scientific and Technical Information of China (English)

    黄东锋; 李乐; 毛玉瑢; 肖湘; 江利; 林玲; 鲍晓; 林强

    2012-01-01

    Objective: To investigate the relationship between the damage of neural network poststroke from functional MRI (fMRI) analysis and the impact on the gait function from 3 dimensional(3D) motion analysis. Method: A total of 11 patients after subactue stroke were recruited in this study and examined with fMRI. In fMRI fraction anistrophy (FA) and apparent diffusion coefficient(ADC) were recorded. 3D-kinematic data of gait were also analyzed. The correlation coefficient between the neural functional damage and the gait changes was investigated. Clinical scales were used to evaluate the motor function,balance and quality of life of the recruited subjects. Result: FA of affected side was significantly lower than that of unaffected side. There was no significant difference in ADC value between the two sides. The correlation analysis showed that there was significant correlation between FA and step time of affected side. There was no significant correlation between FA and scores of function assessment scales. Conclusion: FA value of stroke patients could reflect the damage of corticospinal tract and might monitor the disease course post stroke in certain extent and the analysis of motor function outcome might be helpful to explain the motor recovery mechanism.%目的:应用功能性磁共振(fMRI)研究脑卒中后神经网络受损情况,应用三维运动分析对比下肢步行功能改变结局的关系.方法:11例亚急性期脑梗死患者接受功能性磁共振(fMRI)的弥散张量成像(DTI)和扩散加权成像(DWI),并做三维步态检查,比较中枢神经损伤与肢体运动改变的关系.同时还应用量表对入组患者进行肢体运动功能、平衡及生存质量进行评估.结果:脑卒中患者皮质脊髓束皮质放射纤维部分各向异性(FA)值患侧明显小于健侧(P<0.05),而表观扩散系数(ADC)两侧差异无显著性.脑卒中患侧FA值与患侧步时相关系数为0.615,存在正相关关系(P<0.05).运动功能结局的

  11. 脑卒中偏瘫患者自我感受负担及影响因素分析%Self-perceived burden of post-stroke hemiplegic patients and its influencing factors

    Institute of Scientific and Technical Information of China (English)

    邹小琼; 许少英; 余田桂; 李瑞金

    2016-01-01

    目的:调查脑卒中偏瘫患者自我感受负担(self perceived burden ,SPB)水平,分析其影响因素。方法采用一般资料问卷、自我感受负担量表、心理弹性量表和中文版照顾者负担量表对130例脑卒中偏瘫患者及其主要照顾者进行问卷调查。结果患者的 SPB 得分为(37.75±6.30)分,其中91.54%的患者存在不同程度的 SPB 。 Pearson 分析结果显示,心理弹性与 SPB 呈负相关(r =-0.431,P =0.007),照顾者负担与 SPB 呈正相关(r =0.509,P =0.001)。回归分析显示:家庭经济负担、患病时间、心理弹性、照顾者负担是患者 SPB 的影响因素。结论 SPB 在脑卒中偏瘫患者中具有普遍存在性,护理人员应做好相关评估及采取针对性的措施减轻患者的 SPB 。%Objective To investigate the self-perceived burden (SPB) in hemiplegic patients after stroke and analyze its influencing factors .Methods Totally 130 post-stroke hemiplegic patients and their primary caregivers were investigated using self-designed demographic questionnaire ,self-perceived burden scale (SPBS) ,connor-davidson resilience scale (CD-RISC) and Chinese version of caregiver burden inventory (CBI) . Results The average SPB score was (37 .75 ± 6 .30 ) , and 91 .54% of the patients showed different level of SPB . Pearson analysis showed that mental resilience was negatively correlated to SPB (r = - 0 .431 ,P = 0 .007) ,but the burden of caregivers was positively related to SPB(r = 0 .509 ,P = 0 .001) .Multiple regression analysis found that family economic burden ,time of illness ,resilience and caregiver burden were the influencing factors of SPB .Conclusion SPB is common among hemiplegic patients after stroke .Nurses should evaluate the influencing factors of SPB among the patients and take targeted measures to alleviate it .

  12. The study of relationship between the depressive status and neurological function impairments in post - stroke patient.%脑卒中后抑郁患者抑郁与神经功能缺损的相关性研究

    Institute of Scientific and Technical Information of China (English)

    王春霞

    2011-01-01

    目的 研究脑卒中后抑郁患者(PSD)的抑郁状态与神经功能缺损的相关性.方法 选择62例发病在24 h以内的急性脑梗死患者,采用Zung抑郁自评量表(SDS)将62例患者分为单纯脑梗死组和PSD组,并进行汉密尔顿抑郁量表(Hamilton depression,HAMD)和斯堪的那维亚神经功能缺损评分量表(SSS)评定,并与正常对照组比较.结果 确诊PSD患者27例(43.5%);入院第2、7、14天时,PSD患者HAMD评分均显著高于单纯脑梗死组(P0.05),中重度PSD组患者HAMD及SSS评分结果具有相关性(t=1.894,P<0.05;t=3.638,P<0.01).结论 PSD的发病率为43.7%;中、重度PSD患者的HAMD评分与神经功能缺损程度具有相关性.%Objective To investigate the relationship between the depressive status and neurological tunction impairments in post - stroke depressive (PSD) patients.Methods 62 patients suffering acute cerebral infarction,whose course was less than 24 hours,were divided into pure infarction group and PSD group according to the score of Zung self -rating depression scale (SDS).All patients were investigated with Hamilton depression rating scale (HAMD) and Scandinavia stroke scale (SSS) ,then compared with healthy controls.Results 27 patients (43.5%) were diagnosed as PSD.Scores of HAMD in PSD group were significantly higher than those in pure infarction group at the 2nd ,7th and 14th day (P < 0.01 ).The score of SSS in pure infarction group and mild PSD group decreased at the 2nd day, while increased at the 7th and 14th day.There was significant difference in score of SSS between mild PSD group and pure infarction group (P <0.05).Score of SSS in moderate and severe PSD groups decreased gradually with time passing,and there were significant differences when compared with pure infarction group ( P < 0.01 ).In pure infarction group and the mild group,there was no significant correlation between score of HAMD and of SSS (t = 1.351 ,P >0.05).However, there was significant correlation

  13. 中西医结合治疗在脑卒中后疲劳康复中的效果观察%Observation on Integrated Traditional Chinese and Western Medicine in Post-Stroke Fatigue Rehabilitation

    Institute of Scientific and Technical Information of China (English)

    李兰华; 郑健

    2014-01-01

    Objective:To observe the effect of TCM therapy in fatigue rehabilitation after stroke.Methods:Ninety one patients with stroke fatigue treated in our hospital from June 2010 to July 2013 was selected and randomly divided into control group (n =45)and treatment group (n =46).Patients in the control group received conventional western medicine treatment including oxygen support,blood glucose control,blood pressure,anticoagulation,proper diet,correct body water and electrolyte balance,anti-infective,anti-complications as well as scientific rehabilitation guidance to patients.Patients in the treatment group received extra “moxibustion,intermediate frequen-cy electric acupoint massage”therapy treatment apart from the same therapies as the control group applied.Fifteen days was one treat-ment course.After 2 courses of treatment,the patients clinical symptoms were compared,and the syndrome score improvement and chan-ges with fatigue severity scale (FSS)and the Quality of Life Scale dedicated stroke (SS-QOL)of patients with post-stroke fatigue were evaluated.The therapeutic effects of the two groups were compared.Results:The response rate of the control group was 73.3%,and that of the treatment group was 91.3%,and the difference between the groups was statistically significant (P 0.05);after treatment,fatigue severity scale (FSS)of patients of the both groups were decreased,and quality of life scale before special stroke (SS-QOL)increased,and patients in treatment group got better outcomes (P <0.05).Conclusion:The appli-cation of moxibustion and intermediate frequency electrical acupoint massage combined with western medicine treating post stroke fatigue is a feasible and effective treatment option.It can nourish the yuan qi and consolidate the root,sooth and benefit qi,activate blood so as to effectively relieve clinical symptoms mainly manifested with fatigue,improve quality of life and hence treat both the tip and root of the disease.The therapy shall good

  14. Correlation of video fluoroscopic swallowing study and clinical swallowing function of patients with post-stroke dysphagia%卒中后吞咽障碍荧光透视与临床吞咽功能的相关性

    Institute of Scientific and Technical Information of China (English)

    陈妙; 余梅; 黄建平; 朱文宗; 支英豪

    2014-01-01

    Objective To investigate the correlation between clinical presentations and the findings of video fluoroscopic swallowing study (VFSS)in patients with post-stroke dysphagia. Methods A total of 56 consecutive patients with post-stroke dysphagia admitted to Wenzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University from June 2012 to May 2014 were enrolled. Four different kinds of food were selectively used to complete clinical assessment of swallowing function and VFSS respectively. The SPSS 20. 0 statistical software was used to perform univariate and multivariate Logistic regression analyses for all observed indexes of the 2 methods. Results there were significant correlations in the point correspondence relation among the clinical manifestations and VFSS in food residue in the mouth and abnormal closure of lips in the oral phase (95%CI 1. 430-101. 468;P=0. 022);poor soft palate elevation and food residue in the mouth (95%CI 1. 476-102. 033;P=0. 020);graded swallowing and piecemeal deglutition with delayed oral transit (95% CI 2. 616 -182. 897;P = 0. 004);tongue movement disorders,poor soft palate elevation and tongue dyskinesia with poor bolus formation (95%CI 1. 468-50. 795,1. 220-13. 825;P=0. 017,0. 023);food leak from the corner of mouth,dysphagia,bolus falling to the epiglottis from the base of tongue or trachea (95%CI 1. 146-125. 459,1. 657-174. 400;P=0.038,0. 017). The weakened pharyngeal reflex with weak laryngeal elevation in the pharyngeal phase (95%CI 1. 150-92. 815;P =0. 037);dysphagia and delayed swallowing with prolonged triggering of swallowing reflex (95%CI 2. 123-37. 770,1. 233-114. 176;P=0. 003,0. 032);graded swallowing,hard swallowing, choking sensation,and poor laryngeal elevation with prolonged pharyngeal transit (95%CI 1. 619-223. 316,1. 061-31. 445,2. 834 -132. 707;P =0. 019,0. 042,and 0. 003);dysphagia and the opening of cricopharyngeal muscle insufficiency (95%CI 1. 037 -24. 115;P =0. 045);weak

  15. Orofacial pain management: current perspectives

    Directory of Open Access Journals (Sweden)

    Romero-Reyes M

    2014-02-01

    Full Text Available Marcela Romero-Reyes, James M Uyanik Orofacial and Head Pain Service, Department of Oral and Maxillofacial Pathology Radiology and Medicine, New York University College of Dentistry, New York, NY, USA Abstract: Some of the most prevalent and debilitating pain conditions arise from the structures innervated by the trigeminal system (head, face, masticatory musculature, temporomandibular joint and associated structures. Orofacial pain (OFP can arise from different regions and etiologies. Temporomandibular disorders (TMD are the most prevalent orofacial pain conditions for which patients seek treatment. Temporomandibular disorders include a number of clinical problems that involve the masticatory musculature, the temporomandibular joint (TMJ or both. Trigeminal neuropathic pain conditions can arise from injury secondary to dental procedures, infection, neoplasias, or disease or dysfunction of the peripheral and/or central nervous system. Neurovascular disorders, such as primary headaches, can present as chronic orofacial pain, such as in the case of facial migraine, where the pain is localized in the second and third division of the trigeminal nerve. Together, these disorders of the trigeminal system impact the quality of life of the sufferer dramatically. A multidisciplinary pain management approach should be considered for the optimal treatment of orofacial pain disorders including both non-pharmacological and pharmacological modalities. Keywords: pain, orofacial, neuropathic, TMD, trigeminal, headache

  16. Facial pain: trigeminal neuralgia.

    Science.gov (United States)

    Lee, K H

    1993-03-01

    Atypical facial pain is a loose term used to encompass a wide range of facial pain syndromes including those of dental and ear, nose and throat (ENT) aetiology. Often, it is associated with psychiatric conditions like depression and psychosomatic illnesses. This facial pain typically does not follow anatomical boundaries or its explainable by present day neurophysiological understanding. The pain is often constant with no remission and is aggravated by stress. Treatment is difficult and often directed to the psychiatric cause. Surgical treatment is contraindicated. Trigeminal neuralgia on the other hand, can be effectively treated. Pain in the trigeminal distribution is paroxysmal, precipitated by trigger factors and there is no pain in between attacks. The aetiology of trigeminal neuralgia is still unknown though current thinking is that there is a peripheral disturbance or damage with cerebral brainstem disinhibition of the trigeminal apparatus. This results in a paroxysmal discharge and reverberation of pain impulses when a trigger point is elicited. Therefore, anti-epileptic drugs like tegretol can be effective in controlling trigeminal neuralgia in the majority of patients, at least in the initial stages. For unknown reasons however, medical treatment either is not effective at all from the very beginning or fails after a few years. Surgery then becomes the only available therapeutic option. If the peripheral disturbance is due to an organic cause like a tumour, surgical approaches should be directed towards its removal. Often the pain will also resolve. If the trigeminal neuralgia is of the idiopathic variety, then the surgeon has a choice of either peripheral percutaneous retrogasserian ganglionectomies or central approaches like microvascular decompression and trigeminal tractotomy. PMID:8363331

  17. To centralize or not to centralize?

    OpenAIRE

    Campbell, Andrew; Kunisch, Sven; Müller-Stewens, Günter

    2011-01-01

    The CEO's dilemma-were the gains of centralization worth the pain it could cause?-is a perennial one. Business leaders dating back at least to Alfred Sloan, who laid out GM's influential philosophy of decentralization in a series of memos during the 1920s, have recognized that badly judged centralization can stifle initiative, constrain the ability to tailor products and services locally, and burden business divisions with high costs and poor service.1 Insufficient centralization can deny bus...

  18. Pain frequency moderates the relationship between pain catastrophizing and pain

    OpenAIRE

    Heidi eKjøgx; Robert eZachariae; Mogens ePfeiffer-Jensen; Helge eKasch; Peter eSvensson; Troels Staehelin Jensen; Lene eVase

    2014-01-01

    Background Pain frequency has been shown to influence sensitization, psychological distress and pain modulation. The present study examined if pain frequency moderates the relationship between pain catastrophizing and pain. Method A non-clinical (247 students) and a clinical (223 pain patients) sample completed the Danish versions of the Pain Catastrophizing Scale, Beck Depression Inventory and the State Trait Anxiety Inventory and rated pain intensity, unpleasantness and frequency Results In...

  19. Pain experience of Iraq and Afghanistan Veterans with comorbid chronic pain and posttraumatic stress

    Directory of Open Access Journals (Sweden)

    Samantha D. Outcalt, PhD

    2014-07-01

    Full Text Available Chronic pain and posttraumatic stress disorder (PTSD co-occur at high rates, and Veterans from recent wars in Iraq and Afghanistan may be particularly vulnerable to both conditions. The objective of this study was to identify key aspects of chronic pain, cognitions, and psychological distress associated with comorbid PTSD among this sample of Veterans. Baseline data were analyzed from a randomized controlled trial testing a stepped-care intervention for chronic musculoskeletal pain. Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF Veterans with chronic pain only (n = 173 were compared with those with chronic pain and clinically significant posttraumatic stress symptoms (n = 68. Group differences on pain characteristics, pain cognitions, and psychological distress were evaluated. Results demonstrated that OIF/OEF Veterans with comorbid chronic musculoskeletal pain and PTSD experienced higher pain severity, greater pain-related disability and increased pain interference, more maladaptive pain cognitions (e.g., catastrophizing, self-efficacy, pain centrality, and higher affective distress than those with chronic pain alone. Veterans of recent military conflicts in Iraq and Afghanistan may be particularly vulnerable to the compounded adverse effects of chronic pain and PTSD. These results highlight a more intense and disabling pain and psychological experience for those with chronic pain and PTSD than for those without PTSD.

  20. The role of sensitization in musculoskeletal shoulder pain

    OpenAIRE

    John Borstad; Christopher Woeste

    2015-01-01

    Introduction: Peripheral and central sensitization are neurophysiological processes that can prolong painful conditions. Painful shoulder conditions are often persistent, perhaps due to the presence of sensitization. Method: This manuscript summarizes six studies that have evaluated those with musculoskeletal shoulder pain for the presence of sensitization. Results: All six manuscripts report evidence of peripheral sensitization, while central sensitization was described in five of the studie...

  1. Face pain

    Science.gov (United States)

    ... begin in other places in the body. Abscessed tooth (ongoing throbbing pain on one side of the lower face that ... chap 18. Digre KB. Headaches and other head pain. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine . 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap ...

  2. Flank pain

    Science.gov (United States)

    ... between the upper belly area (abdomen) and the back. ... or brown color) in the urine Unexplained flank pain that continues ... The doctor or nurse will examine you. You will be asked about your ... there or comes and goes, if it's getting worse What the pain ...

  3. La estimulación eléctrica del sistema nervioso central con finalidad analgésica The electrical stimulation of the central nervous system for pain control

    Directory of Open Access Journals (Sweden)

    J. A. López-López

    2006-06-01

    Full Text Available Esta revisión pretende orientar al lector sobre los procedimientos empleados para el control del dolor crónico, preferentemente neuropático, por medio de la electricidad. Historia de la utilización de la electricidad con finalidad analgésica, con descripción de los usos primitivos en el siglo XVIII y su evolución. Estimulación eléctrica medular: Se describen los mecanismos de acción, la selección de los pacientes, las técnicas de implante, la forma de realización de los diferentes procedimientos y sus complicaciones y el manejo de las mismas. Estimulación cerebral: Se sigue el mismo esquema que en el apartado anterior, diferenciándose en dos apartados: la estimulación cerebral profunda y la estimulación de la corteza prefrontal.Different procedures using electricity for pain control (mainly neuropathic are described in this review. History of the so-called utility of electricity for pain control, describing the early attempts at the XVIII century and their evolution. Spinal cord stimulation: How does it works, patient’s selection, implant techniques, how to do the different procedures and complications and their management are described. Brain stimulation: The same scheme as above, concerning both Deep Brain Stimulation and Motor Cortex Stimulation.

  4. Pain frequency moderates the relationship between pain catastrophizing and pain

    Science.gov (United States)

    Kjøgx, Heidi; Zachariae, Robert; Pfeiffer-Jensen, Mogens; Kasch, Helge; Svensson, Peter; Jensen, Troels S.; Vase, Lene

    2014-01-01

    Background: Pain frequency has been shown to influence sensitization, psychological distress, and pain modulation. The present study examined if pain frequency moderates the relationship between pain catastrophizing and pain. Method: A non-clinical (247 students) and a clinical (223 pain patients) sample completed the Danish versions of the Pain Catastrophizing Scale (PCS), Beck Depression Inventory, and th