WorldWideScience

Sample records for evaluating poststroke recovery

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

    Science.gov (United States)

    Graven, Christine; Brock, Kim; Hill, Keith; Ames, David; Cotton, Susan; Joubert, Lynette

    2011-06-18

    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. 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. The results of this trial will assist with the development of a model for community-based rehabilitation management for stroke patients and their carers

  2. 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

  3. Hand Rehabilitation Robotics on Poststroke Motor Recovery

    Directory of Open Access Journals (Sweden)

    Zan Yue

    2017-01-01

    Full Text Available The recovery of hand function is one of the most challenging topics in stroke rehabilitation. Although the robot-assisted therapy has got some good results in the latest decades, the development of hand rehabilitation robotics is left behind. Existing reviews of hand rehabilitation robotics focus either on the mechanical design on designers’ view or on the training paradigms on the clinicians’ view, while these two parts are interconnected and both important for designers and clinicians. In this review, we explore the current literature surrounding hand rehabilitation robots, to help designers make better choices among varied components and thus promoting the application of hand rehabilitation robots. An overview of hand rehabilitation robotics is provided in this paper firstly, to give a general view of the relationship between subjects, rehabilitation theories, hand rehabilitation robots, and its evaluation. Secondly, the state of the art hand rehabilitation robotics is introduced in detail according to the classification of the hardware system and the training paradigm. As a result, the discussion gives available arguments behind the classification and comprehensive overview of hand rehabilitation robotics.

  4. Hand Rehabilitation Robotics on Poststroke Motor Recovery.

    Science.gov (United States)

    Yue, Zan; Zhang, Xue; Wang, Jing

    2017-01-01

    The recovery of hand function is one of the most challenging topics in stroke rehabilitation. Although the robot-assisted therapy has got some good results in the latest decades, the development of hand rehabilitation robotics is left behind. Existing reviews of hand rehabilitation robotics focus either on the mechanical design on designers' view or on the training paradigms on the clinicians' view, while these two parts are interconnected and both important for designers and clinicians. In this review, we explore the current literature surrounding hand rehabilitation robots, to help designers make better choices among varied components and thus promoting the application of hand rehabilitation robots. An overview of hand rehabilitation robotics is provided in this paper firstly, to give a general view of the relationship between subjects, rehabilitation theories, hand rehabilitation robots, and its evaluation. Secondly, the state of the art hand rehabilitation robotics is introduced in detail according to the classification of the hardware system and the training paradigm. As a result, the discussion gives available arguments behind the classification and comprehensive overview of hand rehabilitation robotics.

  5. Hand Rehabilitation Robotics on Poststroke Motor Recovery

    OpenAIRE

    Zan Yue; Xue Zhang; Jing Wang

    2017-01-01

    The recovery of hand function is one of the most challenging topics in stroke rehabilitation. Although the robot-assisted therapy has got some good results in the latest decades, the development of hand rehabilitation robotics is left behind. Existing reviews of hand rehabilitation robotics focus either on the mechanical design on designers’ view or on the training paradigms on the clinicians’ view, while these two parts are interconnected and both important for designers and clinicians. In t...

  6. Home programs for upper extremity recovery post-stroke: a survey of occupational therapy practitioners.

    Science.gov (United States)

    Donoso Brown, Elena V; Fichter, Renae

    2017-12-01

    Upper extremity hemiparesis is an impairment post-stroke that impacts quality of life. Home programs are an intervention strategy used by many occupational therapists to support continued motor recovery post-stroke, yet little is known about how these programs are designed and implemented. The purpose of this study was to describe how occupational therapy practitioners approach this task and specifically what strategies they use to support adherence and what types of technology are most commonly used. An on-line survey methodology was used. Participants were recruited through multiple sources including state associations and occupational therapy educational program directors. A total of 73 occupational therapy practitioners submitted complete surveys. It was found that majority of occupational therapy practitioners in the sample (n = 53) reported creating home programs focused on upper extremity motor recovery more than 80% of the time. Range of motion and strengthening were reported as being in the top three most commonly used interventions by more than half the sample, however incorporating clients' goals and interests were reported most often as strategies to create meaning in the home program. Respondents also reported limited incorporation of technology and strategies to support adherence. Personal motivation was reported by occupational therapy practitioners to be a key moderator of adherence to a home program. Occupational therapy practitioners often provide home programs for individuals post-stroke focusing on upper extremity function. Future research that aims to understand stakeholders' perspectives on home programs and determine effective strategies for ensuring adherence is needed.

  7. Brain regions important for recovery after severe post-stroke upper limb paresis

    Science.gov (United States)

    Rondina, Jane M; Park, Chang-hyun; Ward, Nick S

    2017-01-01

    Background The ability to predict outcome after stroke is clinically important for planning treatment and for stratification in restorative clinical trials. In relation to the upper limbs, the main predictor of outcome is initial severity, with patients who present with mild to moderate impairment regaining about 70% of their initial impairment by 3 months post-stroke. However, in those with severe presentations, this proportional recovery applies in only about half, with the other half experiencing poor recovery. The reasons for this failure to recover are not established although the extent of corticospinal tract damage is suggested to be a contributory factor. In this study, we investigated 30 patients with chronic stroke who had presented with severe upper limb impairment and asked whether it was possible to differentiate those with a subsequent good or poor recovery of the upper limb based solely on a T1-weighted structural brain scan. Methods A support vector machine approach using voxel-wise lesion likelihood values was used to show that it was possible to classify patients as good or poor recoverers with variable accuracy depending on which brain regions were used to perform the classification. Results While considering damage within a corticospinal tract mask resulted in 73% classification accuracy, using other (non-corticospinal tract) motor areas provided 87% accuracy, and combining both resulted in 90% accuracy. Conclusion This proof of concept approach highlights the relative importance of different anatomical structures in supporting post-stroke upper limb motor recovery and points towards methodologies that might be used to stratify patients in future restorative clinical trials. PMID:28642286

  8. 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.

  9. Efficacy of robot-assisted rehabilitation for the functional recovery of the upper limb in post-stroke patients: a randomized controlled study.

    Science.gov (United States)

    Taveggia, Giovanni; Borboni, Alberto; Salvi, Lorena; Mulé, Chiara; Fogliaresi, Stefania; Villafañe, Jorge H; Casale, Roberto

    2016-12-01

    A prompt and effective physical and rehabilitation medicine approach is essential to obtain recovery of an impaired limb to prevent tendon shortening, spasticity and pain. Robot-assisted virtual reality intervention has been shown to be more effective than conventional interventions and achieved greater improvement in upper limb function. The aim of this study was to evaluate the effectiveness of robotic-assisted motion and activity in addition to PRM for the rehabilitation of the upper limb in post-stroke inpatients. Randomized controlled trial. Departments of Physical and Rehabilitation Medicine from three different hospitals (Sarnico, Brescia; Bergamo; Milan). A total of 54 patients and enrolled 23 men and 31 women with post-stroke hemiparesis, aged 18 to 80 years old, enrolled from July 2014 to February 2015. Of the 54 enrolled patients, 57% were female (mean age 71±12 years), and all had upper limb function deficit post-stroke. The experimental group received a passive mobilization of the upper limb through the robotic device ARMEO Spring and the control group received PRM for 6 consecutive weeks (5 days/week) in addition to traditional PRM. We assessed the impact on functional recovery (Functional Independence Measure [FIM] scale), strength (Motricity Index [MI]), spasticity (Modified Ashworth Scale [MAS]) and pain (Numeric Rating Pain Scale [NRPS]). All patients were evaluated by a blinded observer using the outcomes tests at enrollment (T0), after the treatment (T1) and at follow up 6 weeks later (T2). Both control and experimental groups evidenced an improvement of the outcomes after the treatment (MI, Ashworth and NRPS with Pupper limb after stroke, robot-assisted mobilization associated to PRM is as effective as traditional rehabilitation. Robot-assisted treatment has an impact on upper limb motor function in stroke patients.

  10. Poststroke Aphasia Frequency, Recovery, and Outcomes: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Flowers, Heather L; Skoretz, Stacey A; Silver, Frank L; Rochon, Elizabeth; Fang, Jiming; Flamand-Roze, Constance; Martino, Rosemary

    2016-12-01

    To conduct a systematic review to elucidate the frequency, recovery, and associated outcomes for poststroke aphasia over the long-term. Using the Cochrane Stroke Strategy, we searched 10 databases, 13 journals, 3 conferences, and the gray literature. Our a priori protocol criteria included unselected samples of adult stroke patients from randomized controlled trials or consecutive cohorts. Two independent reviewers rated abstracts and articles for exclusion or inclusion, resolving discrepancies by consensus. We documented aphasia frequencies by stroke type and setting, and computed odds ratios (ORs) with their 95% confidence intervals (CIs) for outcomes. We retrieved 2168 citations, reviewed 248 articles, and accepted 50. Median frequencies for mixed stroke (ischemic and hemorrhagic) were 30% and 34% for acute and rehabilitation settings, respectively. Frequencies by stroke type were lowest for acute subarachnoid hemorrhage (9%) and highest for acute ischemic stroke (62%) when arrival to the hospital was ≤3 hours from stroke onset. Articles monitoring aphasia for 1 year demonstrated aphasia frequencies 2% to 12% lower than baseline. Negative outcomes associated with aphasia included greater odds of in-hospital death (OR=2.7; 95% CI, 2.4-3.1) and longer mean length of stay in days (mean=1.6; 95% CI, 1.0-2.3) in acute settings. Patients with aphasia had greater disability from 28 days (OR=1.5; 95% CI, 1.3-1.7) to 2 years (OR=1.7; 95% CI, 1.6-2.0) than those without aphasia. By 2 years, they used more rehabilitation services (OR=1.5; 95% CI, 1.3-1.6) and returned home less frequently (OR=1.4; 95% CI, 1.2-1.7). Reported frequencies of poststroke aphasia range widely, depending on stroke type and setting. Because aphasia is associated with mortality, disability, and use of health services, we recommend long-term interdisciplinary vigilance in the management of aphasia. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All

  11. Functional cortical reorganization after low-frequency repetitive transcranial magnetic stimulation plus intensive occupational therapy for upper limb hemiparesis: evaluation by functional magnetic resonance imaging in poststroke patients.

    Science.gov (United States)

    Yamada, Naoki; Kakuda, Wataru; Senoo, Atsushi; Kondo, Takahiro; Mitani, Sugao; Shimizu, Masato; Abo, Masahiro

    2013-08-01

    Low-frequency repetitive transcranial magnetic stimulation of the nonlesional hemisphere combined with occupational therapy significantly improves motor function of the affected upper limb in poststroke hemiparetic patients, but the recovery mechanism remains unclear. To investigate the recovery mechanism using functional magnetic resonance imaging. Forty-seven poststroke hemiparetic patients were hospitalized to receive 12 sessions of 40-min low-frequency repetitive transcranial magnetic stimulation over the nonlesional hemisphere and daily occupational therapy for 15 days. Motor function was evaluated with the Fugl-Meyer Assessment and Wolf Motor Function Test. The functional magnetic resonance imaging with motor tasks was performed at admission and discharge. The laterality index of activated voxel number in Brodmann areas 4 and 6 on functional magnetic resonance imaging was calculated (laterality index range of -1 to +1). Patients were divided into two groups based on functional magnetic resonance imaging findings before the intervention: group 1: patients who showed bilateral activation (n = 27); group 2: patients with unilateral activation (n = 20). Treatment resulted in improvement in Fugl-Meyer Assessment and Wolf Motor Function Test in the two groups (P functional magnetic resonance imaging indicated that our proposed treatment can induce functional cortical reorganization, leading to motor functional recovery of the affected upper limb. Especially, it seems that neural activation in the lesional hemisphere plays an important role in such recovery in poststroke hemiparetic patients. © 2013 The Authors. International Journal of Stroke © 2013 World Stroke Organization.

  12. Rehabilitation with poststroke motor recovery: a review with a focus on neural plasticity.

    Science.gov (United States)

    Takeuchi, Naoyuki; Izumi, Shin-Ichi

    2013-01-01

    Motor recovery after stroke is related to neural plasticity, which involves developing new neuronal interconnections, acquiring new functions, and compensating for impairment. However, neural plasticity is impaired in the stroke-affected hemisphere. Therefore, it is important that motor recovery therapies facilitate neural plasticity to compensate for functional loss. Stroke rehabilitation programs should include meaningful, repetitive, intensive, and task-specific movement training in an enriched environment to promote neural plasticity and motor recovery. Various novel stroke rehabilitation techniques for motor recovery have been developed based on basic science and clinical studies of neural plasticity. However, the effectiveness of rehabilitative interventions among patients with stroke varies widely because the mechanisms underlying motor recovery are heterogeneous. Neurophysiological and neuroimaging studies have been developed to evaluate the heterogeneity of mechanisms underlying motor recovery for effective rehabilitation interventions after stroke. Here, we review novel stroke rehabilitation techniques associated with neural plasticity and discuss individualized strategies to identify appropriate therapeutic goals, prevent maladaptive plasticity, and maximize functional gain in patients with stroke.

  13. Neurorehabilitation strategies for poststroke oropharyngeal dysphagia: from compensation to the recovery of swallowing function.

    Science.gov (United States)

    Cabib, Christopher; Ortega, Omar; Kumru, Hatice; Palomeras, Ernest; Vilardell, Natalia; Alvarez-Berdugo, Daniel; Muriana, Desirée; Rofes, Laia; Terré, Rosa; Mearin, Fermín; Clavé, Pere

    2016-09-01

    Oropharyngeal dysphagia (OD) is very prevalent among poststroke patients, causing severe complications but lacking specific neurorehabilitation treatment. This review covers advances in the pathophysiology, diagnosis, and physiologically based neurorehabilitation strategies for poststroke OD. The pathophysiology of oropharyngeal biomechanics can be assessed by videofluoroscopy, as delayed laryngeal vestibule closure is closely associated with aspiration. Stroke may affect afferent or efferent neuronal circuits participating in deglutition. The integrity of oropharyngeal-cortical afferent pathways can be assessed by electroencephalography through sensory-evoked potentials by pharyngeal electrical stimulation, while corticopharyngeal efferent pathways can be characterized by electromyography through motor-evoked potentials by transcranial magnetic stimulation. Dysfunction in both cortico-mediated evoked responses is associated with delayed swallow response and aspiration. Studies have reported hemispherical asymmetry on motor control of swallowing and the relevance of impaired oropharyngeal sensitivity on aspiration. Advances in treatment include improvements in compensatory strategies but are mainly focused on (1) peripheral stimulation strategies and (2) central, noninvasive stimulation strategies with evidence of their clinical benefits. Characterization of poststroke OD is evolving from the assessment of impaired biomechanics to the sensorimotor integration processes involved in deglutition. Treatment is also changing from compensatory strategies to promoting brain plasticity, both to recover swallow function and to improve brain-related swallowing dysfunction. © 2016 New York Academy of Sciences.

  14. Post-stroke recovery: the role of activity-dependent release of brain-derived neurotrophic factor.

    Science.gov (United States)

    Berretta, Antonio; Tzeng, Yu-Chieh; Clarkson, Andrew N

    2014-11-01

    Stroke remains the leading cause of long-term disability with no pharmacological approaches available to limit the degree of damage or aid in recovery. Considerable effort has been made to minimize neuronal damage using neuroprotective compounds. However, attempts have so far failed to translate into the clinic. Brain-derived neurotrophic factor (BDNF) and its receptor tropomyosin-related kinase type B are actively produced throughout the brain and are involved in regulating neuronal activity and normal day-to-day function. Further, BDNF has been shown to play a role in both protection and recovery of functions after stroke. This review focuses on the endogenous release of BDNF as well as activity-induced (pharmacological and physical) elevation in BDNF, and the role this plays during both acute (hours to days) and subacute (days to weeks) periods after stroke. Exogenous administration has previously been shown not to cross the blood-brain barrier; therefore, we have focused this review on approaches that allow us to directly stimulate, using pharmacological therapies and mimetics, physical activity and potential drug delivery systems that can be used to administer BDNF. Finally, we also discuss the role of BDNF polymorphisms and the influence of epigenetic regulation of BDNF on post-stroke recovery.

  15. Strengthening to promote functional recovery poststroke: an evidence-based review.

    Science.gov (United States)

    Pak, Sang; Patten, Carolynn

    2008-01-01

    Following stroke, patients/clients suffer from significant impairments. However, weakness is the predominant common denominator. Historically, strengthening or high-intensity resistance training has been excluded from neurorehabilitation programs because of the concern that high-exertion activity, including strengthening, would increase spasticity. Contemporary research studies challenge this premise. This evidence-based review was conducted to determine whether high-intensity resistance training counteracts weakness without increasing spasticity in persons poststroke and whether resistance training is effective in improving functional outcome compared to traditional rehabilitation intervention programs. The studies selected were graded as to the strength of the recommendations and the levels of evidence. The treatment effects including control event rate (CER), experimental event rate (EER), absolute risk reduction (ARR), number needed to treat (NNT), relative benefit increase (RBI), absolute benefit increase (ABI), and relative risk (RR) were calculated when sufficient data were present. A total of 11 studies met the criteria. The levels of evidence ranged from fair to strong (3B to 1B). Despite limited long-term follow-up data, there is evidence that resistance training produces increased strength, gait speed, and functional outcomes and improved quality of life without exacerbation of spasticity.

  16. Electrophysiological evaluation of the Modified Tardieu Scale (MTS) in assessing poststroke wrist flexor spasticity.

    Science.gov (United States)

    Naghdi, Soofia; Ansari, Noureddin Nakhostin; Abolhasani, Hamid; Mansouri, Korosh; Ghotbi, Nastaran; Hasson, Scott

    2014-01-01

    Spasticity is a common impairment following upper motor neuron lesions such as stroke. The appropriate measurement of muscle spasticity using validated tools to evaluate the outcome of therapies is important in clinical and research settings. To determine the concurrent criterion-related validity of the Modified Tardieu Scale (MTS) in assessing poststroke wrist flexor muscle spasticity based on its correlation with H-reflex tests. A total of 20 adult patients poststroke underwent clinical and electrophysiological assessment of wrist flexor muscle spasticity on the affected side. The primary outcome measures were: R2-R1 of the MTS; and the H-reflex indices of Hmax/Mmax ratio and Hslp/Mslp ratio. The Hslp and the latency of H-reflex were also measured. Correlations tests did not reveal significant associations between the clinical and H-reflex tests. This study suggests that the MTS may not be a valid tool to evaluate muscle spasticity in this sample of patients after stroke.

  17. Rehabilitation with Poststroke Motor Recovery: A Review with a Focus on Neural Plasticity

    OpenAIRE

    Naoyuki Takeuchi; Shin-Ichi Izumi

    2013-01-01

    Motor recovery after stroke is related to neural plasticity, which involves developing new neuronal interconnections, acquiring new functions, and compensating for impairment. However, neural plasticity is impaired in the stroke-affected hemisphere. Therefore, it is important that motor recovery therapies facilitate neural plasticity to compensate for functional loss. Stroke rehabilitation programs should include meaningful, repetitive, intensive, and task-specific movement training in an enr...

  18. A critical threshold of rehabilitation involving brain-derived neurotrophic factor is required for poststroke recovery.

    Science.gov (United States)

    MacLellan, Crystal L; Keough, Michael B; Granter-Button, Shirley; Chernenko, Garry A; Butt, Stephanie; Corbett, Dale

    2011-10-01

    Enriched rehabilitation (ER; environmental enrichment plus skilled reaching) improves recovery after middle cerebral artery occlusion (MCAo) in rats. Fundamental issues such as whether ER is effective in other models, optimal rehabilitation intensity, and underlying recovery mechanisms have not been fully assessed. The authors tested whether the efficacy of ER varies with ischemia model and assessed the importance of rehabilitation intensity and brain-derived neurotrophic factor (BDNF) in recovery. Rats in experiment 1 received 8 weeks of ER or remained in standard housing. Functional outcome was assessed with the staircase and cylinder tasks. Surprisingly, ER provided no functional benefit in any model. In this experiment, ER was delivered during the light phase, whereas other studies delivered ER in the dark phase of the light cycle. It was hypothesized that in the light, rats engaged in less rehabilitation or alternatively that BDNF was lower. Experiment 2 tested these hypotheses. Following MCAo, rats received ER in either the light or dark phase of the light cycle. Functional outcome was assessed and BDNF levels were measured in the motor cortex and hippocampus. Recovery was accompanied by increased BDNF. This occurred only in rats that received ER in the dark and these animals reached more than those in the light condition. Data suggest that there is a critical threshold of rehabilitation, below which recovery will not occur, and that BDNF mediates functional recovery. The use of intensive rehabilitation therapies for stroke patients is strongly supported.

  19. General cognition predicts post-stroke recovery defined through minimal clinically important difference (MCID): a cohort study in an Italian rehabilitation clinic.

    Science.gov (United States)

    Ginex, V; Vanacore, N; Lacorte, E; Sozzi, M; Pisani, L; Corbo, M; Clerici, F

    2015-10-01

    In the field of rehabilitation it is crucial to define if changes in functional scores correspond to relevant clinical improvements. To assess whether cognition affects motor recovery in post-stroke patients using a clinical meaningful criterion: the minimal clinically important difference (MCID). Retrospective cohort study. Inpatient rehabilitation clinic Two hundred nine first-ever stroke patients undergoing a post-acute inpatient rehabilitation. Cognitive status was assessed with the cognitive FIM and the Mini-Mental State Examination (MMSE). The response to the rehabilitation was defined as the achievement of the MCID between admission and discharge in the motor FIM (responder) and both in the motor and in the cognitive FIM (best-responder). Subjects with a baseline higher MMSE>24.9 had a near four-fold higher probability of being responder (OR 3.91; 95% CI 1.72-8.89) and a two-fold higher probability of being best-responder (OR 2.69; 95% CI 1.24-5.84) on motor FIM as compared to those with a MMSE≤24.9. A duration of the rehabilitation of 55-61 days implies a three-fold higher probability (OR 3.17; 95% CI 1.15-8.72) to be responder as compared to shorter period of treatment; a treatment >61 days does not involve a greater probability of response. This is the first study that examined post-stroke motor recovery mainly in terms of clinical relevance (MCID). Subjects with a higher cognitive level are more likely to achieve a clinically meaningful recovery. MCID can be applied extensively to post-stroke patients undergoing to an inpatient rehabilitation in order to have a clinically useful instrument that assess the recovery.

  20. Post-stroke visual impairment: a systematic literature review of types and recovery of visual conditions

    OpenAIRE

    Hepworth, Lauren; Rowe, Fiona; Walker, Marion; Rockliffe, Janet; Noonan, Carmel; Howard, Claire; Currie, Jim

    2015-01-01

    Aim: The aim of this literature review was to determine the reported incidence and prevalence of visual impairment due to stroke for all visual conditions including central vision loss, visual field loss, eye movement problems and visual perception problems. A further aim was to document the reported rate and extent of recovery of visual conditions post stroke.\\ud \\ud Methods: A systematic review of the literature was conducted including all languages and translations obtained. The review cov...

  1. The potential dual role of transcallosal inhibition in post-stroke motor recovery.

    Science.gov (United States)

    Bertolucci, Federica; Chisari, Carmelo; Fregni, Felipe

    2018-01-01

    Up to now, the mechanism of motor impairment and recovery after stroke has been thought to be based on the interhemispheric competition model. According to this model, which assumes that suppressing the excitability of contralesional hemisphere will enhance recovery by reducing transcallosal inhibition (TCI) of the stroke hemisphere, many clinical trials used non-invasive brain stimulation to improve motor function. Despite some positive findings, meta-analysis shows an important source of variability in the results, questioning whether the interhemispheric competition model would be exhaustive enough to explain the positive results or whether other mechanisms could explain the motor effects of inhibitory stimulation in the contralesional hemisphere. The goal of this study was to review the relationship between increased TCI and motor impairment after stroke.A systematic review of clinical studies investigating TCI through transcranial magnetic stimulation (TMS) in stroke patients and the relationship of this metric with motor recovery was then performed. After a literary search in PubMed eleven articles were included. The potential role of several covariates was examined and discussed.Overall, the importance of TCI as a putative mechanism for stimulation of the contralesional hemisphere seems to depend on the baseline motor function. In other words, from evidence coming mostly from chronic patients, modulation of abnormal TCI seems to be useful for patients with good motor function and less important in patients with poor motor function. TCI seems to be negatively correlated with mirror movements of the paretic hand. It can be inferred that suppressing the activity of the contralesional hemisphere could be beneficial for patients with good residual motor function and strong TCI, but not for those with poor motor function and weak TCI. Baseline motor function and measure of TCI should be taken into account for stratification of patients in clinical trials and for

  2. THE EVALUATION OF COMPLIANCE TO ANTIHYPERTENSIVE THERAPY IN PATIENTS AFTER STROKE AND POSTSTROKE DEPRESSION DURING ANTIDEPRESSANT THERAPY

    Directory of Open Access Journals (Sweden)

    B. B. Fishman

    2010-01-01

    Full Text Available Aim. To study the effect of the antidepressant paroxetine on the compliance to antihypertensive therapy in patients with arterial hypertension (HT and post-stroke depression.Material and methods. Patients (n=24 aged 55-73 with controlled HT (blood pressure, BP<140/90 mm Hg and with subclinical poststroke depression after rehabilitation course were included into the study. Patients were split into two groups. Patients of group 1 (n=12 received adequate antihypertensive therapy and selective serotonin reuptake inhibitor paroxetine. Patients of group 2 (n=12 received antihypertensive therapy only. The study duration was 16 weeks. Patient compliance to antihypertensive therapy, BP and severity of depressive disorders, motor and intellectual functions was evaluated initially and after 16 weeks.Results. BP>140/80 mmHg after 16 weeks was found in 10 (41.6% patients. Clinical post-stroke depression was found in 7 (30.4% patients, 5 (41.6% of them were from group 2 (OR=0.35, 95% CI 0.12-0.78. High treatment compliance was in 15 (65.2% patients, and 9 (81.8% of them were from group 1. Nine (39.1% patients did not receive an adequate antihypertensive therapy, 5 (41.6% of them were from group 2 and could not explain their refusal from medication. General index of intellectual function was higher in patients of group 1 (p=0.034 than this in group 2; index of motor function did not change significantly (p>0.05.Conclusion. Reduction of compliance to antihypertensive therapy and rehabilitation in hypertensive patients after stroke is associated with unmotivated refusal from treatment because of clinical post-stroke depression.

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

    Directory of Open Access Journals (Sweden)

    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.

  4. Upside down crossed-cerebellar diachisis: Proposing chronic stimulation of the dentatothalamocortical pathway for post-stroke motor recovery.

    Directory of Open Access Journals (Sweden)

    Andre eMachado

    2012-05-01

    Full Text Available Background: Stroke remains the leading cause for long-term motor impairment in the industrialized world. New techniques are needed to improve outcomes.Objective: To propose chronic electrical stimulation of the dentatothalamocortical pathway as a method for enhancing cortical excitability and improving motor recovery following stroke.Method: In previous studies, motor evoked potentials (MEP were derived from intracortical microstimulation (ICMS and used to index cortical excitability in rats undergoing continuous, asynchronous deep cerebellar stimulation. In a separate set of experiments, the effect of chronic deep cerebellar stimulation on motor recovery was tested in rats following large ischemic strokes. Results: Deep cerebellar stimulation modulated cortical excitability in a frequency dependent fashion. Beta band stimulation yielded sustained increment in excitability and was associated with enhanced motor recovery compared to sham stimulation. Conclusion: Chronic deep cerebellar stimulation enhances recovery of motor function following large ischemic strokes in the rat. The effect can be attributed to increased cortical excitability. Given that deep brain stimulation is already a well established method, this new approach to motor recovery may be a viable option for human translation in stroke rehabilitation.

  5. Transcranial direct current stimulation in post-stroke dysphagia: a systematic review of randomized controlled trials

    Directory of Open Access Journals (Sweden)

    Kavian Ghandehari

    2016-07-01

    Full Text Available Introduction: The aim of this research was to systematically review all the randomized controlled trials that have evaluated the effect of transcranial direct current stimulation (tDCS on post-stroke dysphagia. Methods: Three electronic databases were searched for relevant articles that were uploaded from their inception to March 2015: PubMed, Cochrane Library (Cochrane Central Register of Controlled Trials, and Scopus. All data was that was related to the location of the cerebrovascular accident (CVA, the parameters of tDCS, post-stroke time to commencement of tDCS, the stimulated hemisphere, stimulation dose, any outcome measurements, and follow-up duration were extracted and assessed. Finally, a number of observations were generated through a qualitative synthesis of the extracted data.Result: Three eligible randomized controlled trials were included in the systematic review. All three trials reported that, in comparison to a placebo, tDCS had a statistically significant effect on post-stroke dysphagia.Discussion: The results of our systematic review suggest that tDCS may represent a promising novel treatment for post-stroke dysphagia. However, to date, little is known about the optimal parameters of tDCS for relieving post-stroke dysphagia. Further studies are warranted to refine this promising intervention by exploring the optimal parameters of tDCS.Conclusion: Since brainstem swallowing centers have bilateral cortical innervations, measures that enhance cortical input and sensorimotor control of brainstem swallowing may facilitate recovery from dysphagia.

  6. 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.

  7. Post-stroke dyskinesias

    National Research Council Canada - National Science Library

    Nakawah, Mohammad Obadah; Lai, Eugene C

    2016-01-01

    .... Post-stroke dyskinesias are involuntary hyperkinetic movements arising from cerebrovascular insults and often present with mixed phenotypes of hyperkinesia which can sometimes be difficult to classify...

  8. Principles of Motor Recovery in Post-Stroke Patients using Hand Exoskeleton Controlled by the Brain-Computer Interface Based on Motor Imagery

    Czech Academy of Sciences Publication Activity Database

    Frolov, A. A.; Húsek, Dušan; Biryukova, E. V.; Bobrov, P.; Mokienko, O.; Alexandrov, A.V.

    2017-01-01

    Roč. 27, č. 1 (2017), s. 107-137 ISSN 1210-0552 Grant - others:Russian Ministry of Education and Science(RU) RFMEFI60715X0128 Institutional support: RVO:67985807 Keywords : brain computer interface * motor imagery * post-stroke and post-traumatic patients * arm and hand exoskeleton * proportional derivative controller * motor synergy * clinical application Subject RIV: IN - Informatics, Computer Science Impact factor: 0.394, year: 2016

  9. Combined functional task practice and dynamic high intensity resistance training promotes recovery of upper-extremity motor function in post-stroke hemiparesis: a case study.

    Science.gov (United States)

    Patten, Carolynn; Dozono, Jody; Schmidt, Stephen; Jue, Mary; Lum, Peter

    2006-09-01

    Weakness is a significant impairment in persons with post-stroke hemiparesis, yet traditional clinical perspectives caution against strengthening in neurological populations. Significant correlations between weakness and functional movement have been demonstrated, however, a clear relationship between increased strength and functional improvement has been elusive. This case study describes a combined program of dynamic, high-intensity resistance training and functional task practice for the upper-extremity in adult hemiparesis. The patient was a 65-year-old, right hand dominant woman who presented to the Neural Control of Movement Laboratory at the Palo Alto VA Rehabilitation Research and Development Center 16 weeks following clipping of an unruptured aneurysm with consequent dense right hemiparesis. She received 7 weeks of acute rehabilitation according to CARF guidelines (ie, at least 3 hours of two or more disciplines, 6 days per week). Her baseline research evaluation revealed significant upperextremity deficits at the ICF body structure/function level including: weakness, shoulder pain, mild resistance to passive movement, and need for moderate to maximal assistance in many activities of daily living including bathing and dressing. The Stroke Impact Scale score reporting her perspective indicated she had recovered from her stroke only 50%. The hybrid resistance training-functional task practice intervention, detailed in this report, was delivered 3 times per week for 6 weeks with each session lasting 75:00. The subject revealed marked improvements in isometric and dynamic force production in 5 key upper-extremity actions: elbow flexion, elbow extension, shoulder flexion, shoulder abduction, and shoulder external rotation. Strength gains were accompanied by increased EMG activation immediately postintervention and by a combination of increased activation and apparent hypertrophic effects at 6 month follow up. Marked improvements were noted in all clinical and

  10. The Effectiveness of Repetitive Transcranial Magnetic Stimulation for Poststroke Apathy Is Associated with Improved Interhemispheric Functional Connectivity.

    Science.gov (United States)

    Mitaki, Shingo; Onoda, Keiichi; Abe, Satoshi; Oguro, Hiroaki; Yamaguchi, Shuhei

    2016-12-01

    Poststroke apathy is relatively common and has negative effects on the functional recovery of the patient; however, few reports have demonstrated the existence of effective treatments for poststroke apathy. Here, we describe a case of poststroke apathy that was successfully treated with repetitive transcranial magnetic stimulation (rTMS). Using resting-state functional magnetic resonance imaging, we detected improved interhemispheric functional connectivity that was correlated with the patient's recovery from poststroke apathy. Our case suggests that rTMS can improve the transfer of information through the corpus callosum, which is crucial for helping patients recover from poststroke apathy. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  11. Evaluating Math Recovery: Investigating Tutor Learning

    Science.gov (United States)

    Green, Sarah Elizabeth; Smith, Thomas

    2010-01-01

    The goal of the overall study was to evaluate the potential of Math Recovery (MR), a pullout, one-to-one tutoring program, to increase mathematics achievement among low-performing first graders, thereby closing the school-entry achievement gap by enabling them to achieve at the level of their higher-performing peers in the regular mathematics…

  12. Poststroke depression: a review.

    Science.gov (United States)

    Robinson, Robert G; Spalletta, Gianfranco

    2010-06-01

    To review the world's (English-language) publications related to depression following stroke. The databases from MEDLINE and PubMed were reviewed for articles related to poststroke depression (PSD), depression and cerebral vascular accident, depression and cerebral vascular disease, and depression and cerebral infarction. Most studies examined prevalence rates of depression and the clinical correlates of depression. Based on pooled data, the overall prevalence of major depression was 21.7% and minor depression was 19.5%. The strongest single correlate of depression was severity of impairment in activities of daily living. However, the existence of depression at baseline was found to be associated with greater impairment at follow-up, ranging from 6 weeks to 2 years in 83% of studies. Further, depression following acute stroke was also associated with greater cognitive impairment and increased mortality. PSD has been shown in 6 double-blind controlled studies to be effectively treated with antidepressants, and 1 study has recently shown that PSD can be effectively prevented. During the past 20 years, significant progress has been made in the identification and treatment of depression following stroke. In the future, antidepressant treatment will likely play an increasing role in the management of patients with acute stroke. Further research is needed to identify the mechanisms of depression and why antidepressants lead to improved physical and cognitive recovery and decreased mortality.

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

    Science.gov (United States)

    Kijowski, Stanislaw

    2014-01-01

    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. 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. After rehabilitation program gait symmetry was regained 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. Depression limits gait recovery after stroke. The time of initiation of rehabilitation after stroke onset does not limit the motor recovery after rehabilitation program.

  14. Circadian sleep/wake rhythm abnormalities as a risk factor of a poststroke apathy.

    Science.gov (United States)

    Cosin, Charlotte; Sibon, Igor; Poli, Mathilde; Allard, Michèle; Debruxelles, Sabrina; Renou, Pauline; Rouanet, François; Mayo, Willy

    2015-07-01

    Poststroke apathy affects 19-55% of patients following stroke and has a negative impact on functional recovery, general health, and quality of life, as well as being a source of significant burden for caregivers. A major clinical issue is the delayed diagnosis of poststroke apathy, and so the aim of our study is to evaluate the relationship between early poststroke alterations of circadian rhythms of sleep/wake cycles and the occurrence of poststroke apathy. Forty-six patients with a recent magnetic resonance imaging confirmed stroke were included. Main exclusion criteria were a mild to severe disability impeding home discharge from the hospital and the presence of apathy or dementia before stroke. Cerebrovascular lesions were evaluated by magnetic resonance imaging. At hospital discharge, an actigraph was used to measure patient's global activity as well as parameters of circadian rhythmicity (relative amplitude, interdaily stability, intradaily variability) and sleep (sleep duration, sleep efficiency, fragmentation index) over seven-days. Apathy was assessed at hospital discharge as well as at three-months using the Apathy Inventory and the Lille Apathy Rating Scale. Of the 46 patients evaluated, 10 (22%) showed apathy three-months after stroke (median Apathy Inventory = 4·5). Before inclusion, these 10 subjects did not differ significantly from other patients concerning their sleep and, at inclusion, they did not differ concerning apathy, anxiety, depression, or cognitive and functional abilities. However, actigraphy measured at discharged identified significant alterations of sleep (P apathy patients exhibited a decrease in sleep efficiency (actual sleep time expressed as a percentage of time in bed) and an increase in the fragmentation index (degree of fragmentation during the sleep period) at three-months. No association was observed between poststroke apathy and the characteristics of cerebrovascular lesions (stroke location, extent of

  15. Evaluation of Functional Correlation of Task-Specific Muscle Synergies with Motor Performance in Patients Poststroke

    Directory of Open Access Journals (Sweden)

    Si Li

    2017-07-01

    Full Text Available The central nervous system produces movements by activating specifically programmed muscle synergies that are also altered with injuries in the brain, such as stroke. In this study, we hypothesize that there exists a positive correlation between task-specific muscle synergy and motor functions at joint and task levels in patients following stroke. The purpose here is to define and evaluate neurophysiological metrics based on task-specific muscle synergy for assessing motor functions in patients. A patient group of 10 subjects suffering from stroke and a control group of nine age-matched healthy subjects were recruited to participate in this study. Electromyography (EMG signals and movement kinematics were recorded in patients and control subjects while performing arm reaching tasks. Muscle synergies of individual patients were extracted off-line from EMG records of each patient, and a baseline pattern of muscle synergy was obtained from the pooled EMG data of all nine control subjects. Peak velocities and movement durations of each reaching movement were computed from measured kinematics. Similarity indices of matching components to those of the baseline synergy were defined by synergy vectors and time profiles, respectively, as well as by a combined similarity of vector and time profile. Results showed that pathological synergies of patients were altered from the characteristics of baseline synergy with missing components, or varied vector patterns and time profiles. The kinematic performance measured by peak velocities and movement durations was significantly poorer for the patient group than the control group. In patients, all three similarity indices were found to correlate significantly to the kinematics of movements for the reaching tasks. The correlation to the Fugl-Meyer score of arm was the highest with the vector index, the lowest with the time profile index, and in between with the combined index. These findings illustrate that the

  16. Case studies in poststroke hemiplegic patients using SEMUL: a passive 2-DOF rehabilitation robot.

    Science.gov (United States)

    Koyanagi, Ken'ichi; Kuwahara, Yuya; Kamida, Takehiro; Ozawa, Takuya; Mizukami, Rieko; Genda, Kiyokazu; Mori, Ayaka; Motoyoshi, Tatsuo; Masuta, Hiroyuki; Oshima, Toru

    2016-08-01

    Following stroke, rehabilitation exercises paired with medical treatment are important for the recovery and maintenance of upper limb function. We developed a 2-DOF passive haptic system for upper limb rehabilitation and software focusing on reaching exercises, known as the coin collecting program, which provides training and evaluation of motor function, particularly dexterity. Past studies have revealed quantitative, reproducible evaluation indices using this software. In this paper, we compared case studies of post-stroke patients with results from healthy participants, and confirmed the reliability of the evaluation indices in grading or scoring motor skills.

  17. Atomoxetine administration combined with intensive speech therapy for post-stroke aphasia: evaluation by a novel SPECT method.

    Science.gov (United States)

    Yamada, Naoki; Kakuda, Wataru; Yamamoto, Kazuma; Momosaki, Ryo; Abo, Masahiro

    2016-09-01

    We clarified the safety, feasibility, and efficacy of atomoxetine administration combined with intensive speech therapy (ST) for patients with post-stroke aphasia. In addition, we investigated the effect of atomoxetine treatment on neural activity of surrounding lesioned brain areas. Four adult patients with motor-dominant aphasia and a history of left hemispheric stroke were studied. We have registered on the clinical trials database (ID: JMA-IIA00215). Daily atomoxetine administration of 40 mg was initiated two weeks before admission and raised to 80 mg 1 week before admission. During the subsequent 13-day hospitalization, administration of atomoxetine was raised to 120 mg and daily intensive ST (120 min/day, one-on-one training) was provided. Language function was assessed using the Japanese version of The Western Aphasia Battery (WAB) and the Token test two weeks prior to admission, on the day of admission, and at discharge. At two weeks prior to admission and at discharge, each patient's cortical blood flow was measured using (123)I-IMP-single photon emission computed tomography (SPECT). This protocol was successfully completed by all patients without any adverse effects. Four patients showed improved language function with the median of the Token Test increasing from 141 to 149, and the repetition score of WAB increasing from 88 to 99. In addition, cortical blood flow surrounding lesioned brain areas was found to increase following intervention in all patients. Atomoxetine administration and intensive ST were safe and feasible for post-stroke aphasia, suggesting their potential usefulness in the treatment of this patient population.

  18. Reservoir evaluation: key to recovery success

    Energy Technology Data Exchange (ETDEWEB)

    Bachwald, R.W. Jr.; Neinast, G.S.

    1972-12-01

    Importance of detailed evaluation of the reservoir in determining the right type of secondary recovery technique to be used was reflected at the old Bull Bayou field of Red River Parish, Louisiana, where Sun Oil Co. has a successful waterflood program under way. To assure that an effective injection program is being conducted, it was recognized that a method of investigation, designing, and monitoring the program would be necessary. It was necessary to include such pertinent items as petro-physical properties, fluid saturation, well locations, and fluid injection and fluid withdrawals. This was accomplished by selecting a 2-dimensional mathematical model to track the position of the flood front as a function of time. Using the simulation model, it was possible to determine for any designated location of injectors and producers the progress of the front of the injected water.

  19. Simplify heat recovery steam generator evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Ganapathy, V. (ABCO Industries, Abilene, TX (US))

    1990-03-01

    Heat recovery steam generators (HRSGs) are widely used in process and power plants, refineries and in several cogeneration/combined cycle systems. They are usually designed for a set of gas and steam conditions but often operate under different parameters due to plant constraints, steam demand, different ambient conditions (which affect the gas flow and exhaust gas temperature in a gas turbine plant), etc. As a result, the gas and steam temperature profiles in the HRSG, steam production and the steam temperature differ from the design conditions, affecting the entire plant performance and economics. Also, consultants and process engineers who are involved in evaluating the performance of the steam system as a whole, often would like to simulate the performance of an HRSG under different gas flows, inlet gas temperature and analysis, steam pressure and feed water temperature to optimize the entire steam system and select proper auxiliaries such as steam turbines, condensers, deaerators, etc.

  20. Poststroke Cell Therapy of the Aged Brain

    Directory of Open Access Journals (Sweden)

    Aurel Popa-Wagner

    2015-01-01

    Full Text Available During aging, many neurodegenerative disorders are associated with reduced neurogenesis and a decline in the proliferation of stem/progenitor cells. The development of the stem cell (SC, the regenerative therapy field, gained tremendous expectations in the diseases that suffer from the lack of treatment options. Stem cell based therapy is a promising approach to promote neuroregeneration after brain injury and can be potentiated when combined with supportive pharmacological drug treatment, especially in the aged. However, the mechanism of action for a particular grafted cell type, the optimal delivery route, doses, or time window of administration after lesion is still under debate. Today, it is proved that these protections are most likely due to modulatory mechanisms rather than the expected cell replacement. Our group proved that important differences appear in the aged brain compared with young one, that is, the accelerated progression of ischemic area, or the delayed initiation of neurological recovery. In this light, these age-related aspects should be carefully evaluated in the clinical translation of neurorestorative therapies. This review is focused on the current perspectives and suitable sources of stem cells (SCs, mechanisms of action, and the most efficient delivery routes in neurorestoration therapies in the poststroke aged environment.

  1. Learning classifier to evaluate movement quality in unassisted pick-and-place exercises for post-stroke patients: A preliminary study.

    Science.gov (United States)

    Hee-Tae Jung; Hwan Kim; Mi Young Oh; Taekyeong Ryu; Yangsoo Kim

    2017-07-01

    The use of service robots is gaining increasing interest in stroke rehabilitation research. In autonomous robot therapy sessions, it is important to monitor the qualitative motor performance of the patient and to evaluate if therapeutically desirable movements are reinforced as per the therapist's instructions. Research on computational means to address this issue has received little attention, despite the acknowledged importance thereof. This paper poses the question of whether the subjective evaluation of the therapist on the qualitative motor performance of the individual patient can be modelled. In an attempt to answer this question, we frame it as a supervised machine learning problem and investigate if kinematic sensor readings to the subjective evaluation of the therapist can be correlated. We further examine if the personalized classifier trained with the data of the individual patient should be favored over the general classifier. Our preliminary results suggest that, given kinematic observation, trained classifiers may be able to imitate the evaluation of the therapist for the movement quality of the post-stroke patient. In our experiments, the general classifier outperformed the personalized classifiers, however, further investigation is necessary to generalize this finding.

  2. Evaluation of complete functional status of patients with stroke by Functional Independence Measure scale on admission, discharge, and six months poststroke

    Science.gov (United States)

    Rayegani, Seyed Mansoor; Raeissadat, Seyed Ahmad; Alikhani, Ebrahim; Bayat, Masume; Bahrami, Mohammad Hasan; Karimzadeh, Afshin

    2016-01-01

    Background: To evaluate the patients with stroke by Functional Independence Measure (FIM) scale, at the times of admission to hospital, discharge, and six-month poststroke, and to determine the level of improvement in patients after rehabilitative procedures. Methods: A total number of 108 patients with stroke entered the study who were admitted to neurology ward. They all received rehabilitation consultation, and occupational and physical therapies were prescribed for them. Finally, their functional status was evaluated by FIM scale. Results: The median (and range) of FIM scores were 86 (15-119), 102 (16-123) and 119 (17-126) at admission, discharge, and after six-month follow-up, respectively. Our observations showed a significant improvement in FIM scores (P < 0.001). About 13, 30, and 76 percent of the patients in individual functional tasks of motor domain and 61, 75, and 86 percent in cognitive domain got the score of 6 or 7 (complete or partial independence) on admission, discharge, and after six months, respectively. There was a reverse correlation between age and FIM improvement and also duration of hospitalization (P = 0.002). Conclusion: The study showed that the FIM is a valid tool for evaluation of patients with stroke, their follow-up and tracking the disease course. Moreover, we concluded that patients with stroke make a significant improvement in their functional status overtime. The exact effect of rehabilitative procedures and comparison with no treatment, must be assessed in separate studies. PMID:28435628

  3. Post-stroke dyskinesias

    Directory of Open Access Journals (Sweden)

    Nakawah MO

    2016-11-01

    Full Text Available Mohammad Obadah Nakawah, Eugene C Lai Stanely H. Appel Department of Neurology, Houston Methodist Neurological Institute, Houston, TX, USA Abstract: Strokes, whether ischemic or hemorrhagic, are among the most common causes of secondary movement disorders in elderly patients. Stroke-related (vascular movement disorders, however, are uncommon complications of this relatively common disease. The spectrum of post-stroke movement disorders is broad and includes both hypo- and hyperkinetic syndromes. Post-stroke dyskinesias are involuntary hyperkinetic movements arising from cerebrovascular insults and often present with mixed phenotypes of hyperkinesia which can sometimes be difficult to classify. Nevertheless, identification of the most relevant motor phenotype, whenever possible, allows for a more specific phenomenological categorization of the dyskinesia and thus helps guide its treatment. Fortunately, post-stroke dyskinesias are usually self-limiting and resolve within 6 to 12 months of onset, but a short-term pharmacotherapy might sometimes be required for symptom control. Functional neurosurgical interventions targeting the motor thalamus or globus pallidus interna might be considered for patients with severe, disabling, and persistent dyskinesias (arbitrarily defined as duration longer than 12 months. Keywords: vascular dyskinesia, stroke, movement disorders

  4. Socially assistive robotics for post-stroke rehabilitation

    OpenAIRE

    Feil-Seifer David J; Eriksson Jon; Matarić Maja J; Winstein Carolee J

    2007-01-01

    Abstract Background Although there is a great deal of success in rehabilitative robotics applied to patient recovery post stroke, most of the research to date has dealt with providing physical assistance. However, new rehabilitation studies support the theory that not all therapy need be hands-on. We describe a new area, called socially assistive robotics, that focuses on non-contact patient/user assistance. We demonstrate the approach with an implemented and tested post-stroke recovery robot...

  5. Use of Computational Modeling to Inform tDCS Electrode Montages for the Promotion of Language Recovery in Post-stroke Aphasia.

    Science.gov (United States)

    Galletta, Elizabeth E; Cancelli, Andrea; Cottone, Carlo; Simonelli, Ilaria; Tecchio, Franca; Bikson, Marom; Marangolo, Paola

    2015-01-01

    Although pilot trials of transcranial direct current stimulation (tDCS) in aphasia are encouraging, protocol optimization is needed. Notably, it has not yet been clarified which of the varied electrode montages investigated is the most effective in enhancing language recovery. To consider and contrast the predicted brain current flow patterns (electric field distribution) produced by varied 1×1 tDCS (1 anode, 1 cathode, 5 × 7 cm pad electrodes) montages used in aphasia clinical trials. A finite element model of the head of a single left frontal stroke patient was developed in order to study the pattern of the cortical EF magnitude and inward/outward radial EF under five different electrode montages: Anodal-tDCS (A-tDCS) over the left Wernicke's area (Montage A) and over the left Broca's area (Montage B); Cathodal tDCS (C-tDCS) over the right homologue of Wernicke's area (Montage C), and of Broca's area (Montage D), where for all montages A-D the "return" electrode was placed over the supraorbital contralateral forehead; bilateral stimulation with A-tDCS over the left Broca's and CtDCS over the right Broca's homologue (Montage E). In all cases, the "return" electrode over the contralesional supraorbital forehead was not inert and influenced the current path through the entire brain. Montage B, although similar to montage D in focusing the current in the perilesional area, exerted the greatest effect over the left perilesional cortex, which was even stronger in montage E. The position and influence of both electrodes must be considered in the design and interpretation of tDCS clinical trials for aphasia. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. A single-subject study to evaluate the inhibitory repetitive transcranial magnetic stimulation combined with traditional dysphagia therapy in patients with post-stroke dysphagia.

    Science.gov (United States)

    Ghelichi, Leila; Joghataei, Mohammad Taghi; Jalaie, Shohreh; Nakhostin-Ansari, Noureddin; Forogh, Bijan; Mehrpour, Masoud

    2016-07-06

    Post-stroke dysphagia is common and is associated with the development of pneumonia. To investigate the effects of repetitive transcranial magnetic stimulation (rTMS) combined with traditional dysphagia therapy (TDT) on swallowing function in patients with post-stroke dysphagia. In this single-subject study, four patients with dysphagia post-stroke included. The patients received the rTMS applied to the intact cerebral hemisphere at 1 Hz with train of 1200 for 5 consecutive days combined with TDT 3 days per week for 6 weeks. The main outcome measure was the Mann Assessment of Swallowing Ability (MASA). Measurements were taken before, after the end of 5(th), 10(th), 15(th) treatment sessions, and after the end of the treatment (18(th) session). The MASA scores improved in all patients following treatment. The maximum and minimum change in level between the baseline phase and treatment phase was +84 and +36. The greatest percentage improvement was observed after 5(th) treatment sessions ranging between 11 and 35%. The treatment trend was upward shown by the directions of the slopes indicated by positive values (+9.1-+20.7). The dysphagia was resolved after 10(th) treatment session in all participants. The aspiration resolved in two participants after the 5(th) treatment session and resolved in another 2 participants after the 10(th) treatment session. The combination therapy of rTMS plus TDT improved swallowing function in patients with post-stroke dysphagia. Further research with a larger sample size is recommended.

  7. [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.

  8. Evaluation of Motor Recovery in Adult Patients with Hemiplegic stroke

    African Journals Online (AJOL)

    Background: Assessment of treatment efficacy through outcomes evaluation is an established practice in stroke rehabilitation. The evaluation of motor recovery is a cornerstone of the assessment of patients with stroke; and an integral component of stroke rehabilitation. Objective: The purpose of this study was to evaluate ...

  9. Influence of Inflammation on Poststroke Plasticity

    Science.gov (United States)

    Kossut, Malgorzata

    2013-01-01

    Age-related brain injuries including stroke are a leading cause of morbidity and mental disability worldwide. Most patients who survive stroke experience some degree of recovery. The restoration of lost functions can be explained by neuronal plasticity, understood as brain ability to reorganize and remodel itself in response to changed environmental requirements. However, stroke triggers a cascade of events which may prevent the normal development of the plastic changes. One of them may be inflammatory response initiated immediately after stroke, which has been found to contribute to neuronal injury. Some recent evidence though has suggested that inflammatory reaction can be also neuroprotective. This paper attempts to discuss the influence of poststroke inflammatory response on brain plasticity and stroke outcome. We also describe the recent anti-inflammatory strategies that have been effective for recovery in experimental stroke. PMID:23533818

  10. Post-Stroke Depression, Apathy and Alexithymia

    Directory of Open Access Journals (Sweden)

    Oriana Horta Rendeiro Correia Pinto

    2015-06-01

    Full Text Available Introduction: Several behavioural changes can occur as a consequence of stroke. A large number of studies have evaluated the frequency and severity of post-stroke depression,  apathy  and  alexithymia  that  result from stroke, however the published data is contradictory.Aims: The aim of this article is to present a literature review of the concepts of depression, apathy  and  alexithymia  and  post-stroke neuroanatomical  findings  that  support these psychopathological observations.Methods: Literature review of selected articles and books deemed relevant by the authors, using Medline/Pubmed database with the combination of the following key-words: “stroke”, “apathy”, “alexithymia”, “depression”,  published  between  1973  and  2013. References of the selected articles and books were also considered.Results  and  Conclusions: After  stroke, many patients are left with variable levels of disability, resulting in a mourning process, and this emotional response is thought to be a normative one to post-stroke problems. It has been understood that the depressive dimension is associated with left frontal lobe functioning  (the  so-called  left  frontal  lobe theory, whereas the apathetic dimension is associated with the basal ganglia. The rate of apathy is lower in patients without previous cerebrovascular  disease;  the  rate  of ‘pure’ apathy (without concomitant depression is twice as frequent as the rate of ‘pure’ depression  (without  concomitant  apathy. Apathetic patients are more frequently and severely depressed and cognitively impaired in comparison to nonapathetic patients. The mechanisms  underlying reduced  emotional  consciousness  and  emotional  blunting following stroke of the MCA are still poorly understood. Apathy and adynamia can be attributed to lesions in the insula and basal ganglia, however reduced emotional awareness can occur as a consequence of changes in

  11. The added value of kinematic evaluation of the timed finger-to-nose test in persons post-stroke

    National Research Council Canada - National Science Library

    Johansson, Gudrun M; Grip, Helena; Levin, Mindy F; Häger, Charlotte K

    2017-01-01

    ...), which is also part of the Fugl-Meyer Assessment. The total movement time (TMT) is used as a clinical outcome measure, while kinematic evaluation also enables an objective quantification of movement quality and motor performance...

  12. Evaluating Math Recovery: Assessing the Causal Impact of Math Recovery on Student Achievement

    Science.gov (United States)

    Smith, Thomas; Cobb, Paul; Farran, Dale; Cordray, David; Munter, Charles; Dunn, Alfred

    2010-01-01

    The authors' goal was to evaluate the potential of Math Recovery (MR), a pullout, one-to-one tutoring program that has been designed to increase mathematics achievement among low-performing first graders, thereby closing the school-entry achievement gap and enabling participants to achieve at the level of their higher-performing peers in the…

  13. Brain bioelectrical activity changes in patients with poststroke depression and apathy

    Directory of Open Access Journals (Sweden)

    I. V. Kichuk

    2015-01-01

    Full Text Available Objective: to study the specific features of brain bioelectrical activity in patents with poststroke apathy and depressive disorders.Patients and methods. The investigation enrolled 175 patients (84 men and 91 women with new-onset cerebral stroke at different sites. A total of 107 (61% patients of them were observed to have depressive disorders (n=41 (38% and apathy (n=66 (62% within a year after disease onset. A control group included 68 (39% patients without poststroke affective disorders. The mean age of the study group patients was 66±10 years and that of the control patients was 68±11 years. The severity and magnitude of neurological deficit were evaluated using the U.S. National Institutes of Health Stroke Scale (NIHSS. The patients underwent electroencephalography (EEG, brain computed tomography and magnetic resonance imaging. The investigators used diagnostic and statistical manual of mental disorders (DSM-IV criteria to diagnose depression and the Hamilton depression rating scale (HAM-D and the mini-mental status examination (MMSE to evaluate the mental status. The basic rhythmic power indices in the affected and unaffected hemispheres were calculated, as well as anteroposterior alpha rhythm distribution coefficient and interhemispheric asymmetry coefficient. Results and discussion. The computer EEG analysis was shown to identify the hallmark characteristics of brain bioelectric activity in patients with different types of affective disorders in the acute, early and late recovery periods of stroke. The patients with affective disorders were found to have brain bioelectrical activity changes predominantly in the rapid frequency sub-band on EEG, suggesting midbrain structural dysfunction. In the patients with poststroke depression, depressive disorder scale scores were related to the power of bioelectric activity in the slow and alpha frequency bands manly in the acute stroke period whereas those were correlated with the EEG

  14. Rapid Airfield Damage Recovery: Deployable Saw Technology Evaluation

    Science.gov (United States)

    2017-12-29

    ER D C/ G SL T R- 17 -2 9 Rapid Airfield Damage Recovery: Deployable Saw Technology Evaluation G eo te ch ni ca l a nd S tr uc tu re s...Deployable Saw Technology Evaluation Haley P. Bell and Jay Rowland Geotechnical and Structures Laboratory U.S. Army Engineer Research and Development...evaluation of selected saw technologies , tools, and methodologies for improving the efficiency of sawing around damaged pavement associated with crater

  15. Evaluating Math Recovery: Implications for Policy and Practice

    Science.gov (United States)

    Smith, Thomas

    2010-01-01

    This presentation focuses on an initial evaluation study of Math Recovery (MR), a pullout, one-to-one tutoring program that has been designed to increase mathematics achievement among low-performing first graders, thereby closing the school-entry achievement gap and enabling participants to achieve at the level of their higher-performing peers in…

  16. Post-Stroke Depression, Apathy and Alexithymia

    OpenAIRE

    Correia Pinto, Oriana Horta Rendeiro; Ribeiro, Lúcia

    2015-01-01

    Introduction: Several behavioural changes can occur as a consequence of stroke. A large number of studies have evaluated the frequency and severity of post-stroke depression,  apathy  and  alexithymia  that  result from stroke, however the published data is contradictory.Aims: The aim of this article is to present a literature review of the concepts of depression, apathy  and  alexithymia  and  post-stroke neuroanatomical  findings  that  support these psychopathological observations.Methods:...

  17. Muscle Strength and Poststroke Hemiplegia

    DEFF Research Database (Denmark)

    Kristensen, Otto H; Stenager, Egon; Dalgas, Ulrik

    2017-01-01

    OBJECTIVES: To systematically review (1) psychometric properties of criterion isokinetic dynamometry testing of muscle strength in persons with poststroke hemiplegia (PPSH); and (2) literature that compares muscle strength in patients poststroke with that in healthy controls assessed by criterion...... isokinetic dynamometry. DATA SOURCES: A systematic literature search of 7 databases was performed. STUDY SELECTION: Included studies (1) enrolled participants with definite poststroke hemiplegia according to defined criteria; (2) assessed muscle strength or power by criterion isokinetic dynamometry; (3) had...... undergone peer review; and (4) were available in English or Danish. DATA EXTRACTION: The psychometric properties of isokinetic dynamometry were reviewed with respect to reliability, validity, and responsiveness. Furthermore, comparisons of strength between paretic, nonparetic, and comparable healthy muscles...

  18. Post-stroke language disorders.

    Science.gov (United States)

    Sinanović, Osman; Mrkonjić, Zamir; Zukić, Sanela; Vidović, Mirjana; Imamović, Kata

    2011-03-01

    Post-stroke language disorders are frequent and include aphasia, alexia, agraphia and acalculia. There are different definitions of aphasias, but the most widely accepted neurologic and/or neuropsychological definition is that aphasia is a loss or impairment of verbal communication, which occurs as a consequence of brain dysfunction. It manifests as impairment of almost all verbal abilities, e.g., abnormal verbal expression, difficulties in understanding spoken or written language, repetition, naming, reading and writing. During the history, many classifications of aphasia syndromes were established. For practical use, classification of aphasias according to fluency, comprehension and abilities of naming it seems to be most suitable (nonfluent aphasias: Broca's, transcortical motor, global and mixed transcortical aphasia; fluent aphasias: anomic, conduction, Wernicke's, transcortical sensory, subcortical aphasia). Aphasia is a common consequence of left hemispheric lesion and most common neuropsychological consequence of stroke, with a prevalence of one-third of all stroke patients in acute phase, although there are reports on even higher figures. Many speech impairments have a tendency of spontaneous recovery. Spontaneous recovery is most remarkable in the first three months after stroke onset. Recovery of aphasias caused by ischemic stroke occurs earlier and it is most intensive in the first two weeks. In aphasias caused by hemorrhagic stroke, spontaneous recovery is slower and occurs from the fourth to the eighth week after stroke. The course and outcome of aphasia depend greatly on the type of aphasia. Regardless of the fact that a significant number of aphasias spontaneously improve, it is necessary to start treatment as soon as possible. The writing and reading disorders in stroke patients (alexias and agraphias) are more frequent than verified on routine examination, not only in less developed but also in large neurologic departments. Alexia is an acquired

  19. Spatial asymmetry of post-stroke hemiparetic gait: assessment and ...

    African Journals Online (AJOL)

    The objective of this study was to evaluate the potential of the footprint and Symmetry Index (SI) methods for the assessment of gait asymmetry in hemiparetic post-stroke patients with the goal of achieving recommendations regarding physical rehabilitation. Methods: The study was conducted at the Queen Elizabeth Central ...

  20. Poststroke neuroplasticity processes

    Directory of Open Access Journals (Sweden)

    I. V. Damulin

    2014-01-01

    Full Text Available The paper considers different aspects of neuroplasticity in patients with stroke. It underlines the dynamism of this process and the ambiguity of involvement of the structures of the contralateral cerebral hemisphere in the restorative process. It considers the periods after onset of stroke and the activation of different brain regions (of both the involved and intact hemisphere in the poststroke period. Particular emphasis is placed on the issues of neurorehabilitation in this category of patients. Delay in rehabilitation measures leads to a worse outcome, the patients must be at hospital longer. It is emphasized that the neurorehabilitaton measures should use strategies aimed at improving plasticity processes at the level of synaptic transmission and neuronal communications. At the same time, of great importance are the processes of structural and functional remodeling of neuronal communications with the involvement of surviving neurons that are located in the peri-infarct area and partially damaged during ischemia. To recover stroke-induced lost motor functions, measures are implemented to modulate the ipsilateral motor cortex, contralateral motor cortex, and sensory afferentation. Remodeling processes, one of the manifestations of neuroplasticity, vary with the size and location of an ischemic focus. The specific features of this process with subcortical and cortical foci are considered. It is stressed that there are genetically determined neurotrophic factors that may enhance remodeling processes in the peri-infarct area, as well as factors that inhibit these processes. The sensory system is noted to have a high potential of compensation, which is appreciably associated with the considerable extent of sensory fibers even at the level of the cerebral cortex.

  1. Characterizing differential poststroke corticomotor drive to the dorsi- and plantarflexor muscles during resting and volitional muscle activation.

    Science.gov (United States)

    Palmer, Jacqueline A; Zarzycki, Ryan; Morton, Susanne M; Kesar, Trisha M; Binder-Macleod, Stuart A

    2017-04-01

    Imbalance of corticomotor excitability between the paretic and nonparetic limbs has been associated with the extent of upper extremity motor recovery poststroke, is greatly influenced by specific testing conditions such as the presence or absence of volitional muscle activation, and may vary across muscle groups. However, despite its clinical importance, poststroke corticomotor drive to lower extremity muscles has not been thoroughly investigated. Additionally, whereas conventional gait rehabilitation strategies for stroke survivors focus on paretic limb foot drop and dorsiflexion impairments, most contemporary literature has indicated that paretic limb propulsion and plantarflexion impairments are the most significant limiters to poststroke walking function. The purpose of this study was to compare corticomotor excitability of the dorsi- and plantarflexor muscles during resting and active conditions in individuals with good and poor poststroke walking recovery and in neurologically intact controls. We found that plantarflexor muscles showed reduced corticomotor symmetry between paretic and nonparetic limbs compared with dorsiflexor muscles in individuals with poor poststroke walking recovery during active muscle contraction but not during rest. Reduced plantarflexor corticomotor symmetry during active muscle contraction was a result of reduced corticomotor drive to the paretic muscles and enhanced corticomotor drive to the nonparetic muscles compared with the neurologically intact controls. These results demonstrate that atypical corticomotor drive exists in both the paretic and nonparetic lower limbs and implicate greater severity of corticomotor impairments to plantarflexor vs. dorsiflexor muscles during muscle activation in stroke survivors with poor walking recovery.NEW & NOTEWORTHY The present study observed that lower-limb corticomotor asymmetry resulted from both reduced paretic and enhanced nonparetic limb corticomotor excitability compared with

  2. Mental Health Recovery: Evaluation of a Recovery-Oriented Training Program

    OpenAIRE

    Wilrycx, G. K. M. L.; Croon, M.A.; van den Broek, A. H. S.; Ch. van Nieuwenhuizen

    2012-01-01

    Aim. This study investigates the effectiveness of a recovery-oriented training program on knowledge and attitudes of mental health care professionals towards recovery of people with serious mental illness. Methods. Using data from a longitudinal study of recovery, changes in knowledge and attitudes of 210 mental health care professionals towards recovery were explored using the Recovery Attitude Questionnaire and the Recovery Knowledge Inventory. The study uses a two-group multiple interventi...

  3. An Evaluation of Tail Loss Recovery Mechanisms for TCP

    OpenAIRE

    Rajiullah, Mohammad; Hurtig, Per; Brunstrom, Anna; Petlund, Andreas; Welzl, Michael

    2015-01-01

    Interactive applications do not require more bandwidth to go faster. Instead, they require less latency. Unfortunately, the current design of transport protocols such as TCP limits possible latency reductions. In this paper we evaluate and compare different loss recovery enhancements to fight tail loss latency. The two recently proposed mechanisms "RTO Restart" (RTOR) and "Tail Loss Probe" (TLP) as well as a new mechanism that applies the logic of RTOR to the TLP timer management (TLPR) are con...

  4. Transcranial brain stimulation (TMS and tDCS for post-stroke aphasia rehabilitation: Controversies

    Directory of Open Access Journals (Sweden)

    Lucia Iracema Zanotto de Mendonça

    Full Text Available Transcranial brain stimulation (TS techniques have been investigated for use in the rehabilitation of post-stroke aphasia. According to previous reports, functional recovery by the left hemisphere improves recovery from aphasia, when compared with right hemisphere participation. TS has been applied to stimulate the activity of the left hemisphere or to inhibit homotopic areas in the right hemisphere. Various factors can interfere with the brain's response to TS, including the size and location of the lesion, the time elapsed since the causal event, and individual differences in the hemispheric language dominance pattern. The following questions are discussed in the present article: [a] Is inhibition of the right hemisphere truly beneficial?; [b] Is the transference of the language network to the left hemisphere truly desirable in all patients?; [c] Is the use of TS during the post-stroke subacute phase truly appropriate? Different patterns of neuroplasticity must occur in post-stroke aphasia.

  5. Mental health recovery: evaluation of a recovery-oriented training program.

    Science.gov (United States)

    Wilrycx, G K M L; Croon, M A; van den Broek, A H S; van Nieuwenhuizen, Ch

    2012-01-01

    This study investigates the effectiveness of a recovery-oriented training program on knowledge and attitudes of mental health care professionals towards recovery of people with serious mental illness. Using data from a longitudinal study of recovery, changes in knowledge and attitudes of 210 mental health care professionals towards recovery were explored using the Recovery Attitude Questionnaire and the Recovery Knowledge Inventory. The study uses a two-group multiple intervention interrupted time-series design which is a variant of the stepped-wedge trial design. A total of six measurements occasions took place. This study shows that professionals' attitudes towards recovery from mental illness can improve with training. After two intensive recovery-oriented training sessions, mental health care professionals have a more positive attitude towards recovery in clinical practice. A recovery-oriented training program can change attitudes of mental health care professionals towards recovery of serious mental illness.

  6. Right hemisphere structures predict poststroke speech fluency.

    Science.gov (United States)

    Pani, Ethan; Zheng, Xin; Wang, Jasmine; Norton, Andrea; Schlaug, Gottfried

    2016-04-26

    We sought to determine via a cross-sectional study the contribution of (1) the right hemisphere's speech-relevant white matter regions and (2) interhemispheric connectivity to speech fluency in the chronic phase of left hemisphere stroke with aphasia. Fractional anisotropy (FA) of white matter regions underlying the right middle temporal gyrus (MTG), precentral gyrus (PreCG), pars opercularis (IFGop) and triangularis (IFGtri) of the inferior frontal gyrus, and the corpus callosum (CC) was correlated with speech fluency measures. A region within the superior parietal lobule (SPL) was examined as a control. FA values of regions that significantly predicted speech measures were compared with FA values from healthy age- and sex-matched controls. FA values for the right MTG, PreCG, and IFGop significantly predicted speech fluency, but FA values of the IFGtri and SPL did not. A multiple regression showed that combining FA of the significant right hemisphere regions with the lesion load of the left arcuate fasciculus-a previously identified biomarker of poststroke speech fluency-provided the best model for predicting speech fluency. FA of CC fibers connecting left and right supplementary motor areas (SMA) was also correlated with speech fluency. FA of the right IFGop and PreCG was significantly higher in patients than controls, while FA of a whole CC region of interest (ROI) and the CC-SMA ROI was significantly lower in patients. Right hemisphere white matter integrity is related to speech fluency measures in patients with chronic aphasia. This may indicate premorbid anatomical variability beneficial for recovery or be the result of poststroke remodeling. © 2016 American Academy of Neurology.

  7. Is Pelvic Floor Muscle Training Effective for Men With Poststroke Lower Urinary Tract Symptoms?

    DEFF Research Database (Denmark)

    Tibaek, Sigrid; Gard, Gunvor; Dehlendorff, Christian

    2017-01-01

    The aim of the current study was to evaluate the effect of pelvic floor muscle training in men with poststroke lower urinary tract symptoms. Thirty-one poststroke men, median age 68 years, were included in this single-blinded randomized controlled trial. Thirty participants, 15 in each group...... that pelvic floor muscle training has an effect for lower urinary tract symptoms, although statistical significance was only seen for pelvic floor muscle....

  8. Modafinil May Alleviate Poststroke Fatigue

    DEFF Research Database (Denmark)

    Poulsen, Mai Bang; Damgaard, Bodil; Zerahn, Bo

    2015-01-01

    was randomized, double-blinded, and placebo-controlled. Patients were treated with 400-mg modafinil or placebo for 90 days. Assessments were done at inclusion, 30, 90, and 180 days. The primary end point was fatigue at 90 days measured by the Multidimensional Fatigue Inventory-20 general fatigue domain......BACKGROUND AND PURPOSE: Poststroke fatigue is common and reduces quality of life. Current evidence for intervention is limited, and this is the first placebo-controlled trial to investigate treatment of poststroke fatigue with the wakefulness promoting drug modafinil. METHODS: The trial....... Secondary end points included the Fatigue Severity Scale, the Montreal Cognitive Assessment, the modified Rankin Scale and the Stroke-specific quality of Life questionnaire. Adult patients with a recent stroke achieving a score of ≥12 on the Multidimensional Fatigue Inventory-20 general fatigue domain were...

  9. Post-stroke depression: an update.

    Science.gov (United States)

    Espárrago Llorca, G; Castilla-Guerra, L; Fernández Moreno, M C; Ruiz Doblado, S; Jiménez Hernández, M D

    2015-01-01

    Post-stroke depression (PSD) is the most common mood disorder following a stroke, and also the main factor limiting recovery and rehabilitation in stroke patients. In addition, it may increase mortality by up to ten times. PSD occurs in 1 in 3 stroke patients and more than half of all cases are neither diagnosed nor treated. Several mechanisms, including biological, behavioral, and social factors, are involved in its pathogenesis. Symptoms usually occur within the first three months after stroke (early onset PSD), and less frequently at a later time (late onset PSD). Symptoms resemble those of other types of depression, although there are some differences: PSD patients experience more sleep disturbances, vegetative symptoms, and social withdrawal. For PSD diagnosis, we recommended vigilance and use of specific diagnostic tools such as the Patient Health Questionnaire-2 (PHQ-2). The treatments of choice are selective serotonin reuptake inhibitors (SSRI). However, there are still many unanswered questions in the treatment of PSD, such as the best time to start treatment or the effects of antidepressants on cognition and motor function, among others. Neurologists play a pivotal role in the care and management of patients recovering from stroke. They must be familiar with methods for early detection and treatment of PSD, as this can facilitate a patient's functional recovery and social reintegration, and improve quality of life for patients and their families. Copyright © 2012 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.

  10. Post-Stroke Language Disorders

    OpenAIRE

    Sinanović, Osman; MRKONJIĆ, ZAMIR; Zukić, Sanela; Vidović, Mirjana; Imamović, Kata

    2011-01-01

    Post-stroke language disorders are frequent and include aphasia, alexia, agraphia and acalculia. There are different definitions of aphasias, but the most widely accepted neurologic and/or neuropsychological definition is that aphasia is a loss or impairment of verbal communication, which occurs as a consequence of brain dysfunction. It manifests as impairment of almost all verbal abilities, e.g., abnormal verbal expression, difficulties in understanding spoken or written language, repetition...

  11. Botulinum Toxin in Poststroke Spasticity

    OpenAIRE

    Ozcakir, Suheda; Sivrioglu, Koncuy

    2007-01-01

    Poststroke hemiparesis, together with abnormal muscle tone, is a major cause of morbidity and disability. Although most hemiparetic patients are able to reach different ambulatory levels with rehabilitation efforts, upper and lower limb spasticity can impede activities of daily living, personal hygiene, ambulation and, in some cases, functional improvement. The goals of spasticity management include increasing mobility and range of motion, attaining better hygiene, improving splint wear and o...

  12. Neurophysiologic Correlates of Post-stroke Mood and Emotional Control

    Science.gov (United States)

    Doruk, Deniz; Simis, Marcel; Imamura, Marta; Brunoni, André R.; Morales-Quezada, Leon; Anghinah, Renato; Fregni, Felipe; Battistella, Linamara R.

    2016-01-01

    Objective: Emotional disturbance is a common complication of stroke significantly affecting functional recovery and quality of life. Identifying relevant neurophysiologic markers associated with post-stroke emotional disturbance may lead to a better understanding of this disabling condition, guiding the diagnosis, development of new interventions and the assessments of treatment response. Methods: Thirty-five subjects with chronic stroke were enrolled in this study. The emotion sub-domain of Stroke Impact Scale (SIS-Emotion) was used to assess post-stroke mood and emotional control. The relation between SIS-Emotion and neurophysiologic measures was assessed by using covariance mapping and univariate linear regression. Multivariate analyses were conducted to identify and adjust for potential confounders. Neurophysiologic measures included power asymmetry and coherence assessed by electroencephalography (EEG); and motor threshold, intracortical inhibition (ICI) and intracortical facilitation (ICF) measured by transcranial magnetic stimulation (TMS). Results: Lower scores on SIS-Emotion was associated with (1) frontal EEG power asymmetry in alpha and beta bands, (2) central EEG power asymmetry in alpha and theta bands, and (3) lower inter-hemispheric coherence over frontal and central areas in alpha band. SIS-Emotion also correlated with higher ICF and MT in the unlesioned hemisphere as measured by TMS. Conclusions: To our knowledge, this is the first study using EEG and TMS to index neurophysiologic changes associated with post-stroke mood and emotional control. Our results suggest that inter-hemispheric imbalance measured by EEG power and coherence, as well as an increased ICF in the unlesioned hemisphere measured by TMS might be relevant markers associated with post-stroke mood and emotional control which can guide future studies investigating new diagnostic and treatment modalities in stroke rehabilitation. PMID:27625600

  13. Neurophysiologic Correlates of Post-Stroke Mood and Emotional Control

    Directory of Open Access Journals (Sweden)

    Deniz Doruk

    2016-08-01

    Full Text Available Objective: Emotional disturbance is a common complication of stroke significantly affecting functional recovery and quality of life. Identifying relevant neurophysiologic markers associated with post-stroke emotional disturbance may lead to a better understanding of this disabling condition, guiding the diagnosis, development of new interventions and the assessments of treatment response. Methods: Thirty-five subjects with chronic stroke were enrolled in this study. The emotion sub-domain of Stroke Impact Scale (SIS-Emotion was used to assess post-stroke mood and emotional control. The relation between SIS-Emotion and neurophysiologic measures was assessed by using covariance mapping and univariate linear regression. Multivariate analyses were conducted to identify and adjust for potential confounders. Neurophysiologic measures included power asymmetry and coherence assessed by electroencephalography (EEG; and motor threshold, intracortical inhibition (ICI and intracortical facilitation (ICF measured by transcranial magnetic stimulation (TMS. Results: Lower scores on SIS-Emotion was associated with 1 frontal EEG power asymmetry in alpha and beta bands, 2 central EEG power asymmetry in alpha and theta bands, and 3 lower inter-hemispheric coherence over frontal and central areas in alpha band. SIS-Emotion also correlated with higher ICF and MT in the unlesioned hemisphere as measured by TMS. Conclusions: To our knowledge, this is the first study using EEG and TMS to index neurophysiologic changes associated with post-stroke mood and emotional control. Our results suggest that inter-hemispheric imbalance measured by EEG power and coherence, as well as an increased intracortical facilitation in the unlesioned hemisphere measured by TMS might be relevant markers associated with post-stroke mood and emotional control which can guide future studies investigating new diagnostic and treatment modalities in stroke rehabilitation.

  14. Post-stroke dementia - a comprehensive review

    NARCIS (Netherlands)

    Mijajlovic, M.D.; Pavlovic, A.; Brainin, M.; Heiss, W.D.; Quinn, T.J.; Ihle-Hansen, H.B.; Hermann, D.M.; Assayag, E.B.; Richard, E.; Thiel, A.; Kliper, E.; Shin, Y.I.; Kim, Y.H.; Choi, S.; Jung, S.; Lee, Y.B.; Sinanovic, O.; Levine, D.A.; Schlesinger, I.; Mead, G.; Milosevic, V.; Leys, D.; Hagberg, G.; Ursin, M.H.; Teuschl, Y.; Prokopenko, S.; Mozheyko, E.; Bezdenezhnykh, A.; Matz, K.; Aleksic, V.; Muresanu, D.; Korczyn, A.D.; Bornstein, N.M.

    2017-01-01

    Post-stroke dementia (PSD) or post-stroke cognitive impairment (PSCI) may affect up to one third of stroke survivors. Various definitions of PSCI and PSD have been described. We propose PSD as a label for any dementia following stroke in temporal relation. Various tools are available to screen and

  15. [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. Copyright © 2015 SEGG. Published by Elsevier Espana. All rights reserved.

  16. [Recovery].

    Science.gov (United States)

    Estingoy, Pierrette; Gilliot, Élodie; Parisot, Clément

    2015-01-01

    The historical fatalism of the impossibility of recovering from psychosis eased from the 1970s with the shaping of the idea of a possible recovery. Recovery is today the objective for the patient and caregivers. The key to achieving this lies in the encounter with Others. A collective approach, on the level of the institution, must be established. The aim is to create opportunities for the patient to express their doubts and feelings. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  17. Of mice and men: modelling post-stroke depression experimentally

    Science.gov (United States)

    Kronenberg, G; Gertz, K; Heinz, A; Endres, M

    2014-01-01

    At least one-third of stroke survivors suffer from depression. The development of comorbid depression after stroke is clinically highly significant because post-stroke depression is associated with increased mortality, slows recovery and leads to worse functional outcomes. Here, we review the evidence that post-stroke depression can be effectively modelled in experimental rodents via a variety of approaches. This opens an exciting new window onto the neurobiology of depression and permits probing potential underlying mechanisms such as disturbed cellular plasticity, neuroendocrine dysregulation, neuroinflammation, and neurodegeneration in a novel context. From the point of view of translational stroke research, extending the scope of experimental investigations beyond the study of short-term end points and, in particular, acute lesion size, may help improve the relevance of preclinical results to human disease. Furthermore, accumulating evidence from both clinical and experimental studies offers the tantalizing prospect of 5-hydroxytryptaminergic antidepressants as the first pharmacological therapy for stroke that would be available during the subacute and chronic phases of recovery. Interdisciplinary neuropsychiatric research will be called on to dissect the mechanisms underpinning the beneficial effects of antidepressants on stroke recovery. Linked Articles This article is part of a themed section on Animal Models in Psychiatry Research. To view the other articles in this section visit http://dx.doi.org/10.1111/bph.2014.171.issue-20 PMID:24838087

  18. [The principal approaches to the treatment of post-stroke shoulder pain syndrome].

    Science.gov (United States)

    Bondarenko, F V; Makarova, M R; Turova, E A

    2014-01-01

    Post-stroke pain syndrome is one of the serious complications of stroke preventing the restoration of motor activity, routine everyday and professional independence of the patients. This review is focused on pathogenesis of central and peripheral shoulder pain syndromes on the affected side of the body and the principal approaches to their treatment during the post-stroke recovery period. The paper describes the main manual and robotic methods for the treatment of shoulder pain depending on its pathogenesis and the typical therapeutic protocols. The special emphasis is laid on the necessity of the pathogenetic approach to the pain alleviation as well as clinical significance of the correction of biomechanical disorders in the upper body and the restoration of the functional ability of the upper limbs in the patients presenting with post-stroke hemiparesis associated with pain syndrome.

  19. Evaluation of clinical outcomes of patients with post-stroke wrist and finger spasticity after ultrasonography-guided BTX-A injection and rehabilitation training.

    Science.gov (United States)

    Jiang, Li; Dou, Zu-Lin; Wang, Qing; Wang, Qiao-Yuan; Dai, Meng; Wang, Zhen; Wei, Xiao-Mei; Chen, Ying-Bei

    2015-01-01

    Using ultrasonography (US) to guide botulinum toxin type A (BTX-A) injection in patients with post-stroke wrist and finger flexor muscle spasticity and assessing clinical outcomes after the injection and rehabilitation intervention. Twenty-three patients with wrist and finger spasticity after stroke were recruited in this study from May 2012 to May 2013. Under US guidance, the proper dose (250 U) of BTX-A was injected into each spastic muscle at two injection sites. Then, conventional rehabilitation training started next day after BTX-A injection. The degree of spasticity was assessed by modified Ashworth scale (MAS) and wrist and finger motor function by active rang of movement (AROM), and Fugl-Meyer assessment (FMA) at the baseline, 1, 2, 4 and 12 weeks after BTX-A injection. Significant decreases (p exercise decrease spasticity of the wrist and finger flexor muscles and improve their motor function in stroke patients up to 12 weeks following BTX-A injection.

  20. Non-invasive Brain Stimulation in the Treatment of Post-stroke and Neurodegenerative Aphasia: Parallels, Differences, and Lessons Learned

    Science.gov (United States)

    Norise, Catherine; Hamilton, Roy H.

    2017-01-01

    Numerous studies over the span of more than a decade have shown that non-invasive brain stimulation (NIBS) techniques, namely transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), can facilitate language recovery for patients who have suffered from aphasia due to stroke. While stroke is the most common etiology of aphasia, neurodegenerative causes of language impairment—collectively termed primary progressive aphasia (PPA)—are increasingly being recognized as important clinical phenotypes in dementia. Very limited data now suggest that (NIBS) may have some benefit in treating PPAs. However, before applying the same approaches to patients with PPA as have previously been pursued in patients with post-stroke aphasia, it will be important for investigators to consider key similarities and differences between these aphasia etiologies that is likely to inform successful approaches to stimulation. While both post-stroke aphasia and the PPAs have clear overlaps in their clinical phenomenology, the mechanisms of injury and theorized neuroplastic changes associated with the two etiologies are notably different. Importantly, theories of plasticity in post-stroke aphasia are largely predicated on the notion that regions of the brain that had previously been uninvolved in language processing may take on new compensatory roles. PPAs, however, are characterized by slow distributed degeneration of cellular units within the language system; compensatory recruitment of brain regions to subserve language is not currently understood to be an important aspect of the condition. This review will survey differences in the mechanisms of language representation between the two etiologies of aphasia and evaluate properties that may define and limit the success of different neuromodulation approaches for these two disorders. PMID:28167904

  1. Sieving wastewater--cellulose recovery, economic and energy evaluation.

    Science.gov (United States)

    Ruiken, C J; Breuer, G; Klaversma, E; Santiago, T; van Loosdrecht, M C M

    2013-01-01

    Application of fine-mesh sieves (wastewater treatment gives an opportunity to recover resources and increase sustainability of wastewater treatment processes. Sieves are traditionally used for single stage mechanical treatment (typical mesh of 0.35 mm) or in combination with an MBR (typical mesh >0.7 mm). When sieves with a mesh of 0.35 mm are used on raw sewage we observed that cellulose fibres mainly originating from toilet paper are removed efficiently from the influent with a high recovery and purity. The application of sieves as pretreatment for conventional activated sludge processes has been evaluated based on pilot plant research at three WWTPs in the Netherlands. With sieving applied to the dry weather flow only the overall energy usage of the WWTP including sludge treatment can be decreased by at least 40% with a payback time of 7 years. Copyright © 2012 Elsevier Ltd. All rights reserved.

  2. 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

  3. [Therapeutic effect of lisuride maleate on post-stroke depression].

    Science.gov (United States)

    Hougaku, H; Matsumoto, M; Hata, R; Handa, N; Imaizumi, M; Sugitani, Y; Yoneda, S; Etani, H; Sueyoshi, K; Kusunoki, M

    1994-01-01

    Twenty post-stroke depressive patients who obtained more than 11 points on Self-Rating Questionnaire for Depression, were treated with 0.075 mg/day lisuride maleate for 12 weeks. The drug effect on depression was evaluated quantitatively by the Hamilton Rating Scale for Depression. The relationships between brain CT or MRI and SRQ-D score were investigated in 24 subjects. More than 80% of post-stroke depressive patients improved after lisuride maleate treatment for 8 or 12 weeks. In particular, depressed mood, hypobulia, sleep disturbance, anxiety, etc. were significantly improved compared to the baseline condition. As for the relationships with CT and/or MRI findings, the group with moderate to severe brain atrophy had a significantly higher grade of depressive state than those without.

  4. Ultrasonic Measurement of Dynamic Muscle Behavior for Poststroke Hemiparetic Gait

    Directory of Open Access Journals (Sweden)

    Xin Chen

    2017-01-01

    Full Text Available Quantitative evaluation of the hemiparesis status for a poststroke patient is still challenging. This study aims to measure and investigate the dynamic muscle behavior in poststroke hemiparetic gait using ultrasonography. Twelve hemiparetic patients walked on a treadmill, and EMG, joint angle, and ultrasonography were simultaneously recorded for the gastrocnemius medialis muscle. Pennation angle was automatically extracted from ultrasonography using a tracking algorithm reported previously. The characteristics of EMG, joint angle, and pennation angle in gait cycle were calculated for both (affected and unaffected sides of lower limbs. The results suggest that pennation angle could work as an important morphological index to continuous muscle contraction. The change pattern of pennation angle between the affected and unaffected sides is different from that of EMG. These findings indicate that morphological parameter extracted from ultrasonography can provide different information from that provided by EMG for hemiparetic gait.

  5. Evaluation of Clinical Outcomes of Patients with Post-Stroke Wrist and Finger Spasticity after Ultrasonography-Guided BTX-A Injection and Rehabilitation Training

    Directory of Open Access Journals (Sweden)

    Li eJiang

    2015-09-01

    Full Text Available Objective: Using ultrasonography (US to guide botulinum toxin type A (BTX-A injection in patients with post-stroke wrist and finger flexor muscle spasticity and assessing clinical outcomes after the injection and rehabilitation intervention. Methods: Twenty-three patients with wrist and finger spasticity after stroke were recruited in this study from May 2012 to May 2013. Under US guidance, the proper dose (250U of BTX-A was injected into each spastic muscle at two injection sites. Then, conventional rehabilitation training started next day after BTX-A injection. The degree of spasticity was assessed by modified Ashworth scale (MAS and wrist and finger motor function by active rang of movement (AROM, and Fugl-Meyer assessment (FMA at the baseline, 1, 2, 4 and 12 weeks after BTX-A injection. Results: Significant decreases (p < 0.02 in the MAS scores of both the finger flexor muscle tone and wrist flexor muscle tone measured at 1, 2, 4, and 12 weeks after the BTX-A injection were found in comparison with the baseline scores. Compared with the baseline, the AROM values of the wrist and finger extensions and the FMA scores of the wrist and hand significantly increased (p < 0.02 at 2, 4 and 12 weeks after the BTX-A injection. Conclusions: US-guided BTX-A injection combined with rehabilitation exercise decrease spasticity of the wrist and finger flexor muscles and improve their motor function in stroke patients up to 12 weeks following BTX-A injection.

  6. [Kinesiotherapy prevents shoulder pain in hemiplegic/paretic patients on sub-acute stage post-stroke].

    Science.gov (United States)

    Horn, Agnes Irna; Fontes, Sissy Veloso; de Carvalho, Sebastião Marcos Ribeiro; Silvado, Rubens Augusto Brazil; Barbosa, Pedro Marco Karan; Durigan, Alcides; Atallah, Alvaro Nagib; Fukujima, Marcia Maiumi; do Prado, Gilmar Fernandes

    2003-09-01

    Painful shoulder is considered the most common complication of hemiplegic/parethic (H/P) stroke patients. It is a negative factor for neuromotor recovery. 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. 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. 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 improvement also for functional mobility on moving from dorsal to lateral recumb, from lateral recumb to a seated position and in keeping the seated position (p<0.001). Kinesiotherapy in acute phase of stroke prevented shoulder pain.

  7. Benign Effect of Extremely Low-Frequency Electromagnetic Field on Brain Plasticity Assessed by Nitric Oxide Metabolism during Poststroke Rehabilitation

    Directory of Open Access Journals (Sweden)

    Natalia Cichoń

    2017-01-01

    Full Text Available Nitric oxide (NO is one of the most important signal molecules, involved in both physiological and pathological processes. As a neurotransmitter in the central nervous system, NO regulates cerebral blood flow, neurogenesis, and synaptic plasticity. The aim of our study was to investigate the effect of the extremely low-frequency electromagnetic field (ELF-EMF on generation and metabolism of NO, as a neurotransmitter, in the rehabilitation of poststroke patients. Forty-eight patients were divided into two groups: ELF-EMF and non-ELF-EMF. Both groups underwent the same 4-week rehabilitation program. Additionally, the ELF-EMF group was exposed to an extremely low-frequency electromagnetic field of 40 Hz, 7 mT, for 15 min/day. Levels of 3-nitrotyrosine, nitrate/nitrite, and TNFα in plasma samples were measured, and NOS2 expression was determined in whole blood samples. Functional status was evaluated before and after a series of treatments, using the Activity Daily Living, Geriatric Depression Scale, and Mini-Mental State Examination. We observed that application of ELF-EMF significantly increased 3-nitrotyrosine and nitrate/nitrite levels, while expression of NOS2 was insignificantly decreased in both groups. The results also show that ELF-EMF treatments improved functional and mental status. We conclude that ELF-EMF therapy is capable of promoting recovery in poststroke patients.

  8. Post-stroke urinary incontinence.

    Science.gov (United States)

    Mehdi, Z; Birns, J; Bhalla, A

    2013-11-01

    To provide a comprehensive review of the current evidence on post-stroke urinary incontinence. An electronic database search was performed to identify relevant studies and review articles related to Urinary Incontinence (UI) in the stroke population between the years 1966 and 2012. Urinary incontinence following stroke is a common problem affecting more than one-third of acute stroke patients and persisting in up to a quarter at 1 year. It is well established that this condition is a strong marker of stroke severity and is associated with poorer functional outcomes and increased institutionalisation and mortality rates compared with those who remain continent. Despite evidence linking better outcomes to those patients who regain continence, the results of national audits have demonstrated that the management of UI following stroke is suboptimal, with less than two-thirds of stroke units having a documented plan to promote continence. Current evidence supports a thorough assessment to categorise the type and severity of post-stroke urinary incontinence. An individually tailored, structured management strategy to promote continence should be employed. This has been associated with better stroke outcomes and should be the aim of all stroke health professionals. © 2013 John Wiley & Sons Ltd.

  9. Socially assistive robotics for post-stroke rehabilitation

    Directory of Open Access Journals (Sweden)

    Feil-Seifer David J

    2007-02-01

    Full Text Available Abstract Background Although there is a great deal of success in rehabilitative robotics applied to patient recovery post stroke, most of the research to date has dealt with providing physical assistance. However, new rehabilitation studies support the theory that not all therapy need be hands-on. We describe a new area, called socially assistive robotics, that focuses on non-contact patient/user assistance. We demonstrate the approach with an implemented and tested post-stroke recovery robot and discuss its potential for effectiveness. Results We describe a pilot study involving an autonomous assistive mobile robot that aids stroke patient rehabilitation by providing monitoring, encouragement, and reminders. The robot navigates autonomously, monitors the patient's arm activity, and helps the patient remember to follow a rehabilitation program. We also show preliminary results from a follow-up study that focused on the role of robot physical embodiment in a rehabilitation context. Conclusion We outline and discuss future experimental designs and factors toward the development of effective socially assistive post-stroke rehabilitation robots.

  10. Frontal Cortical Atrophy as a Predictor of Poststroke Apathy.

    Science.gov (United States)

    Mihalov, Ján; Mikula, Peter; Budiš, Jaroslav; Valkovič, Peter

    2016-07-01

    The aim of the study was to identify associations between the symptoms of poststroke apathy and sociodemographic, stroke-related (severity of stroke, degree of disability, and performance in activities of daily living), and radiological correlates. We determined the degree of cortical and subcortical brain atrophy, the severity of white matter and basal ganglia lesions on baseline computed tomography (CT) scans, and the localization of acute ischemia on control CT or magnetic resonance imaging scans in subacute stages of stroke. During follow-up examinations, in addition to the assessment of apathy symptoms using the Apathy Scale, we also evaluated symptoms of depression and anxiety using the Hospital Anxiety and Depression Scale. The study included 47 consecutive patients with acute ischemic stroke. Correlates significantly associated with apathy, determined at baseline and during follow-up, were entered into the "predictive" and "associative" multiple regression models, respectively. Frontal cortical atrophy and symptoms of depression were most strongly associated with poststroke apathy symptoms. In order to model an interrelation between both cortical atrophy and white matter lesions and aging, we supplemented 2 additional "predictive" models using interaction variables, whereby we confirmed the role of frontal cortical atrophy as a predictor of poststroke apathy also as a function of the increasing age of patients. © The Author(s) 2016.

  11. Establishing a recovery orientation in mental health services: Evaluating the Recovery Self-Assessment (RSA) in a Swedish context.

    Science.gov (United States)

    Rosenberg, David; Svedberg, Petra; Schön, Ulla-Karin

    2015-12-01

    Although there has been an emphasis on developing knowledge regarding recovery in Sweden, it is unclear to what extent this has been translated into a recovery orientation in the provision of mental health services. Instruments, which present the components of recovery as measurable dimensions of change, may provide a framework for program development. Involving users is an essential factor in the utilization of such tools. The purpose of this study was to evaluate the psychometric properties of the Recovery Self-Assessment (RSA) measure and its potential for being utilized in a Swedish context. The sample consisted of 78 participants from 6 community mental health services targeting people with serious mental illnesses in a municipality in Sweden. They completed the RSA at the study baseline and two weeks later. User panels participated in the translation and administration of the RSA and the reporting of results. The Swedish version of the RSA had good face and content validity, satisfactory internal consistency, and a moderate to good level of stability in test-retest reliability. The user panels contributed to establishing validity and as collaborators in the study. Establishing the RSA as a valid and reliable instrument with which to focus on the recovery orientation of services is a first step in beginning to study the types of interventions that may effect and contribute to recovery oriented practice in Sweden. (c) 2015 APA, all rights reserved).

  12. Biomechanical Assessment of Reaching Movements in Post-Stroke Patients During a Robot-Aided Rehabilitation

    Directory of Open Access Journals (Sweden)

    S. Mazzoleni

    2011-01-01

    Full Text Available The main goal of this paper is to describe a method for the assessment of the motor performance in post-stroke subjects who have been undergone a robot-aided upper limb rehabilitation treatment. The motivation for adopting such methodology relies on the need of quantitative methods for the evaluation of the effects of robot-aided rehabilitation treatments, which assumes great importance from the clinical point of view. The method is based on the analysis of biomechanical parameters computed from force data recorded during the execution of planar reaching movements. Data from 17 chronic post-stroke patients and 5 healthy subjects were analysed. The results show the effectiveness of the proposed method, which can contribute to quantitatively evaluate the effects of a robot-mediated therapy on the upper limb of chronic post-stroke subjects.

  13. Is Pelvic Floor Muscle Training Effective for Men With Poststroke Lower Urinary Tract Symptoms?

    DEFF Research Database (Denmark)

    Tibaek, Sigrid; Gard, Gunvor; Dehlendorff, Christian

    2017-01-01

    The aim of the current study was to evaluate the effect of pelvic floor muscle training in men with poststroke lower urinary tract symptoms. Thirty-one poststroke men, median age 68 years, were included in this single-blinded randomized controlled trial. Thirty participants, 15 in each group......, completed the study. The intervention consisted of 3 months (12 weekly sessions) of pelvic floor muscle training in groups and home exercises. The effect was evaluated by the DAN-PSS-1 (Danish Prostate Symptom Score) questionnaire, a voiding diary, and digital anal palpation of the pelvic floor muscle...... statistically significantly in pelvic floor muscle function (p

  14. An empirical evaluation of recovery transformation at a large community psychiatric rehabilitation organization.

    Science.gov (United States)

    Malinovsky, Igor; Lehrer, Paul; Silverstein, Steven M; Shankman, Stewart A; O'Brien, William; Samuelson, Tracy; van Nostrand, Gary

    2013-11-01

    In recent decades, the concept of "recovery" from Severe Mental Illness (SMI) has gained increased prominence among organizations providing behavioral health services. Many states and organizations are currently developing plans to transform their mental health systems in accordance with recovery-oriented care. Even though efforts to bring the principles of recovery to mental health agencies have been well documented in the United States and abroad, there is little empirical evidence to suggest that recovery-oriented services are advantageous. The purpose of this longitudinal study was to evaluate the effectiveness of a recovery-oriented transformation carried out by a large, private, not-for-profit psychiatric rehabilitation organization serving individuals with SMI. This transformation targeted the philosophy and specific procedures involved in the provision of care to residents within the organization. The outcome variables selected to evaluate the impact of the transformation were grouped into the following categories: (a) objective indicators of recovery, (b) self-report indicators of recovery, (c) indicators of staff competency, and (d) processes that promote recovery. Six-hundred and 27 residents and 490 staff participated in the evaluation. The findings suggest that recovery-oriented services had a positive impact on rates of overnight hospitalization, residents' ability to function in the community, some professional skills of employees, and working alliance between direct care providers and residents. This indicates that comprehensive and well-structured recovery-oriented care may offer a cost-efficient and effective alternative to the deficit approach to mental health care.

  15. Post-Stroke Depression: A Review.

    Science.gov (United States)

    Robinson, Robert G; Jorge, Ricardo E

    2016-03-01

    Poststroke depression (PSD) has been recognized by psychiatrists for more than 100 years, but controlled systematic studies did not begin until the 1970s. Meta-analyses addressing almost all major clinical issues in the field have emerged because of the relatively small number of patients included in some stroke studies. In order to build large databases, these meta-analyses have merged patients with rigorously assessed mood disorders with major depressive features with patients scoring above arbitrary cutoff points on depression rating scales, thus missing important findings such as cognitive impairment associated with major but not minor depression. Nevertheless, PSD occurs in a significant number of patients and constitutes an important complication of stroke, leading to greater disability as well as increased mortality. The most clinically important advances, however, have been in the treatment and prevention of PSD. Recent meta-analyses of randomized controlled trials for the treatment of PSD have demonstrated the efficacy of antidepressants. Similarly, randomized controlled trials for prevention of PSD have shown that antidepressants significantly decrease the incidence of PSD compared with placebo. Early antidepressant treatment of PSD appears to enhance both physical and cognitive recovery from stroke and might increase survival up to 10 years following stroke. There has also been progress in understanding the pathophysiology of PSD. Inflammatory processes might be associated with the onset of at least some depressive symptoms. In addition, genetic and epigenetic variations, white matter disease, cerebrovascular deregulation, altered neuroplasticity, and changes in glutamate neurotransmission might be relevant etiological factors. Further elucidation of the mechanism of PSD may ultimately lead to specific targeted treatments.

  16. ELECTROCHEMICAL DESIGN ASSOCIATES (FORMERLY GEOKINETICS INTERNATIONAL, INC.) LEAD RECOVERY TECHNOLOGY EVALUATION ITER

    Science.gov (United States)

    This report presents performance and economic data from U.S. Environmental Protection Agency (EPA) Superfund Innovative Technology Evaluation (SITE) Program evaluation of Electrochemical Design Associates (EDA), formerly known as Geokinetics International Inc., Lead Recovery Tech...

  17. Rehabilitation Interventions for Poststroke Hand Oedema: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Thuy Anh Giang

    2016-06-01

    Conclusion: Further study needs to focus solely on interventions for poststroke hand oedema and their long-term effects. No conclusion can be made on the most effective management of poststroke hand oedema until much more evidence is available.

  18. Evaluation of Reservoir Wettability and its Effect on Oil Recovery

    Energy Technology Data Exchange (ETDEWEB)

    Buckley, Jill S.

    2002-01-29

    The objectives of this five-year project were: (1) to achieve improved understanding of the surface and interfacial properties of crude oils and their interactions with mineral surfaces, (2) to apply the results of surface studies to improve predictions of oil production from laboratory measurements, and (3) to use the results of this research to recommend ways to improve oil recovery by waterflooding.

  19. Poststroke fatigue: the patient perspective.

    Science.gov (United States)

    Young, C A; Mills, R J; Gibbons, C; Thornton, E W

    2013-01-01

    Fatigue is reported as a prevalent symptom post stroke. The purpose of this study is to explore the patent perspective of this symptom, how it is experienced, and its subjective impact on the patient. The qualitative procedure of interpretative phenomenological analysis (IPA) was used to analyze the narratives of 10 subjects with previous stroke, who each undertook a single, semi-structured interview. Fatigue was a salient symptom for all the patients. Six main themes were identified. Tiredness/sleep was recognized in all the narratives, and themes of restriction, frustration, and determination/coping reflected varying degrees of physical, cognitive, and psychological dimensions to fatigue. Depression/motivation was also identified, reflecting low mood and helplessness. The remaining theme support indicated a social dimension, with patients recognizing the need for professional and familial support. Further subthemes were identified, and the thematic descriptions of the physical and psychosocial aspects indicated the complexity of fatigue and unique patient profiles. A holistic overview of each narrative furthered an understanding of the dynamic interrelationships between these aspects and their impact on the patient. There were prevalent patterns, but these were different for each patient. A better understanding of the varied dimensions or themes elaborated for poststroke fatigue, and their interrelationships, should help in mitigating its impact. The analysis cautions against giving any simplistic and unitary advice to patients about dealing with fatigue.

  20. Botulinum toxin in poststroke spasticity.

    Science.gov (United States)

    Ozcakir, Suheda; Sivrioglu, Koncuy

    2007-06-01

    Poststroke hemiparesis, together with abnormal muscle tone, is a major cause of morbidity and disability. Although most hemiparetic patients are able to reach different ambulatory levels with rehabilitation efforts, upper and lower limb spasticity can impede activities of daily living, personal hygiene, ambulation and, in some cases, functional improvement. The goals of spasticity management include increasing mobility and range of motion, attaining better hygiene, improving splint wear and other functional activities. Conservative measures, such as positioning, stretching and exercise are essential in spasticity management, but alone often are inadequate to effectively control it. Oral antispastic medications often provide limited effects with short duration and frequent unwanted systemic side effects, such as weakness, sedation and dry mouth. Therefore, neuromuscular blockade by local injections have become the first choice for the treatment of focal spasticity, particularly in stroke patients. Botulinum toxin (BTX), being one of the most potent biological toxins, acts by blocking neuromuscular transmission via inhibiting acetylcholine release. Currently, focal spasticity is being treated successfully with BTX via injecting in the spastic muscles. Two antigenically distinct serotypes of BTX are available on the market as type A and B. Clinical studies of BTX used for spastic hemiplegic patients are reviewed in this article in two major categories, upper and lower limb applications. This review addresses efficacy in terms of outcome measures, such as muscle tone reduction and functional outcome, as well as safety issues. Application modifications of dose, dilutions, site of injections and combination therapies with BTX injections are also discussed.

  1. Evaluation of a Group-Based Trauma Recovery Program in Gaza: Students' Subjective Experiences

    Science.gov (United States)

    Barron, Ian; Abdullah, Ghassan

    2012-01-01

    Internationally, evaluation of group-based trauma recovery programs has relied upon normative outcome measures, with no studies systematically analyzing children's subjective experience for program development. In contrast, the current study explored children's experience of a Gazan recovery program "in their own words." Twenty-four…

  2. Assessment of poststroke mania and diagnosis

    Directory of Open Access Journals (Sweden)

    Shoaib M

    2017-02-01

    Full Text Available Maria Shoaib,1 Muhammad Aadil2 1Department of Medicine, DOW Medical College, Karachi, Pakistan; 2Department of Psychiatry, Rush University Medical Center, Chicago, IL, USAWe would like to applaud the authors of the case report “Post-stroke emotional incontinence or bipolar disorder?” which highlights a rare yet treatable condition of mania and emotional incontinence after a cerebrovascular accident. We would like to add our views regarding poststroke mania supporting the significant psychiatric distress patients suffer. As the review mentions, psychiatric sequelae of stroke and cerebrovascular disease include anxiety, psychosis, posttraumatic stress disorder (PTSD, and poststroke depression (PSD.1 This case report also mentions development of treatment response to selective serotonin reuptake inhibitors, which also shows that poststroke emotional incontinence is related predominantly to serotonergic system dysfunction.2View the original paper by Mnif and colleagues.

  3. Protocol for the Locomotor Experience Applied Post-stroke (LEAPS trial: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Wu Samuel S

    2007-11-01

    Full Text Available Abstract Background Locomotor training using body weight support and a treadmill as a therapeutic modality for rehabilitation of walking post-stroke is being rapidly adopted into clinical practice. There is an urgent need for a well-designed trial to determine the effectiveness of this intervention. The objective of the Locomotor Experience Applied Post-Stroke (LEAPS trial is to determine if there is a difference in the proportion of participants who recover walking ability at one year post-stroke when randomized to a specialized locomotor training program (LTP, conducted at 2- or 6-months post-stroke, or those randomized to a home based non-specific, low intensity exercise intervention (HEP provided 2 months post-stroke. We will determine if the timing of LTP delivery affects gait speed at 1 year and whether initial impairment severity interacts with the timing of LTP. The effect of number of treatment sessions will be determined by changes in gait speed taken pre-treatment and post-12, -24, and -36 sessions. Methods/Design We will recruit 400 adults with moderate or severe walking limitations within 30 days of stroke onset. At two months post stroke, participants are stratified by locomotor impairment severity as determined by overground walking speed and randomly assigned to one of three groups: (a LTP-Early; (b LTP-Late or (c Home Exercise Program -Early. The LTP program includes body weight support on a treadmill and overground training. The LTP and HEP interventions are delivered for 36 sessions over 12 weeks. Primary outcome measure include successful walking recovery defined as the achievement of a 0.4 m/s gait speed or greater by persons with initial severe gait impairment or the achievement of a 0.8 m/s gait speed or greater by persons with initial moderate gait impairment. LEAPS is powered to detect a 20% difference in the proportion of participants achieving successful locomotor recovery between the LTP groups and the HEP group, and

  4. 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.

  5. The "Living with Dysarthria" Group for Post-Stroke Dysarthria: The Participant Voice

    Science.gov (United States)

    Mackenzie, C.; Kelly, S.; Paton, G.; Brady, M.; Muir, M.

    2013-01-01

    Background:The "Living with Dysarthria" group programme, devised for people with post-stroke dysarthia and family members, was piloted twice. Feedback from those who experience an intervention contributes to the evaluation of speech and language therapy programmes, giving the participant view of the intervention's value and guiding…

  6. 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

  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. Early Detection of Post-Stroke Depression

    NARCIS (Netherlands)

    de Man - van Ginkel, J.M.|info:eu-repo/dai/nl/304811424

    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,

  9. Evaluating the Effectiveness of Intervention in Long-Term Aphasia Post-Stroke: The Experience from CHANT (Communication Hub for Aphasia in North Tyneside)

    Science.gov (United States)

    Mumby, Katharyn; Whitworth, Anne

    2012-01-01

    Background: Despite recognition of the need for increased long-term support for people with aphasia following stroke, there remains limited evidence for effective service-level interventions. Aims: To evaluate the outcomes and experiences of people participating in the Communication Hub for Aphasia in North Tyneside (CHANT), a 2-year partnership…

  10. Pay attention to the early and late post-stroke depression

    Directory of Open Access Journals (Sweden)

    Yu ZHANG

    2015-04-01

    Full Text Available Post-stroke depression (PSD is one of the common complications after stroke. However, it is often overlooked in clinical practice. As a result, many patients have been misdiagnosed or never been diagnosed. Post-stroke depression directly affect cognitive function, late rehabilitation, functional recovery and the quality of life in stroke patients, and is closely related to the high recurrence rate, disability rate and mortality of stroke. In order to deepen the understanding of early and late PSD, this paper summarized recent progress of PSD at home and abroad, and made a brief introduction on the epidemiology, pathogenesis, influencing factors, screening and diagnosis, treatment and prevention of PSD. DOI: 10.3969/j.issn.1672-6731.2015.04.003

  11. Behavioural and Psychological Symptoms in Poststroke Vascular Cognitive Impairment

    Directory of Open Access Journals (Sweden)

    Meena Gupta

    2014-01-01

    Full Text Available Background. Behavioural and psychological symptoms of dementia (BPSD cause significant patient and caregiver morbidity in vascular cognitive impairment (VCI. Objectives. To study and compare the occurrence and severity of BPSD between multi-infarct dementia (MID, subcortical ischaemic vascular disease (SIVD, and strategic infarct subtypes of poststroke VCI and to evaluate the relationship of these symptoms with the severity of cognitive impairment. Methods. Sixty patients with poststroke VCI were classified into MID, SIVD, and strategic infarct subtypes. BPSD were studied by the neuropsychiatric inventory (NPI. The severity of cognitive impairment was evaluated by the clinical dementia rating scale (CDR. Results. 95% of cases had at least one neuropsychiatric symptom, with depression being the commonest, irrespective of subtype or severity of VCI. Strategic infarct patients had the lowest frequency of all symptoms. SIVD showed a higher frequency and severity of apathy and higher total NPI scores, compared to MID. Apathy and appetite disturbances occurred more commonly with increasing CDR scores. The total NPI score correlated positively with the CDR score. Conclusion. Depression was the commonest neuropsychiatric symptom in VCI. The neuropsychiatric profiles of MID and SIVD were similar. The frequency and severity of apathy and the net burden of BPSD increased with increasing cognitive impairment.

  12. Evaluation of Reservoir Wettability and its Effect on Oil Recovery

    Energy Technology Data Exchange (ETDEWEB)

    Buckley, Jill S.

    1999-07-01

    The objective of this five-year project are: (1) to achieve improved understanding of the surface and interfacial properties of crude oils and their interactions with mineral surfaces, (2) to apply the results of surface studies to improve predictions of oil production from laboratory measurements, and (3) to use the results of this research to recommend ways to improve oil recovery by waterflooding. During the second year of this project we have tested the generality of the proposed mechanisms by which crude oil components can alter wetting. Using these mechanisms, we have begun a program of characterizing crude oils with respect to their wettability altering potential. Wettability assessment has been improved by replacing glass with mica as a standard surface material and crude oils have been used to alter wetting in simple square glass capillary tubes in which the subsequent imbibition of water can be followed visually.

  13. Measurement variability of quantitative sensory testing in persons with post-stroke shoulder pain.

    Science.gov (United States)

    Lindgren, Ingrid; Ekstrand, Elisabeth; Brogårdh, Christina

    2016-04-28

    To evaluate the measurement variability of quantitative sensory testing (QST) in persons with post-stroke shoulder pain. A test-retest design. Twenty-three persons with post-stroke shoulder pain (median age 65 years). Thermal detection thresholds (cold and warm), pain thresholds (cold and heat) and mechanical pain thresholds (pressure and pin prick) were assessed twice in both arms, 2-3 weeks apart. Measurement variability was analysed with the intraclass correlation coefficient (ICC2.1), the change in mean (đ) with 95% confidence interval (logarithmic scales), and the relative standard error of measurement (SEM%; re-transformed scales). The ICCs for thermal thresholds ranged from 0.48 to 0.89 in the affected (painful) arm and from 0.50 to 0.63 in the unaffected arm, and for mechanical pain thresholds from 0.66 to 0.90 in both arms. No systematic changes in the mean (đ) were found. The SEM% ranged from 4% to 10% for thermal detection and heat pain thresholds, and from 17% to 42% for cold pain and mechanical pain thresholds in both arms. QST measurements, especially cold pain thresholds and mechanical pain thresholds, vary in persons with post-stroke shoulder pain. Before QST can be used routinely to evaluate post-stroke shoulder pain, a test protocol with decreased variability needs to be developed.

  14. Music-supported therapy (MST) in improving post-stroke patients' upper-limb motor function: a randomised controlled pilot study.

    Science.gov (United States)

    Tong, Yanna; Forreider, Brian; Sun, Xinting; Geng, Xiaokun; Zhang, Weidong; Du, Huishan; Zhang, Tong; Ding, Yuchuan

    2015-05-01

    Music-supported therapy (MST) is a new approach for motor rehabilitation of stroke patients. Recently, many studies have demonstrated that MST improved the motor functions of post-stroke patients. However, the underlying mechanism for this effect is still unclear. It may result from repeated practice or repeated practice combined with musical stimulation. Currently, few studies have been designed to clarify this discrepancy. In this study, the application of "mute" musical instruments allowed for the study of music as an independent factor. Thirty-three post-stroke patients with no substantial previous musical training were included. Participants were assigned to either audible music group (MG) or mute music group (CG), permitting observation of music's independent effect. All subjects received the conventional rehabilitation treatments. Patients in MG (n = 15) received 20 extra sessions of audible musical instrument training over 4 weeks. Patients in CG (n = 18) received "mute" musical instrument training of the same protocol as that of MG. Wolf motor function test (WMFT) and Fugl-Meyer assessment (FMA) for upper limbs were utilised to evaluate motor functions of patients in both groups before and after the treatment. Three patients in CG dropped out. All participants in both groups showed significant improvements in motor functions of upper limbs after 4  weeks' treatment. However, significant differences in the WMFT were found between the two groups (WMFT-quality: P = 0.025; WMFT-time: P = 0.037), but not in the FMA (P = 0.448). In short, all participants showed significant improvement after 4 weeks' treatment, but subjects in MG demonstrated greater improvement than those in CG. This study supports that MST, when combined with conventional treatment, is effective for the recovery of motor skills in post-stroke patients. Additionally, it suggests that apart from the repetitive practices of MST, music may play a unique role in improving

  15. A novel robotic system for quantifying arm kinematics and kinetics: description and evaluation in therapist-assisted passive arm movements post-stroke.

    Science.gov (United States)

    Culmer, P R; Jackson, A E; Makower, S G; Cozens, J A; Levesley, M C; Mon-Williams, M; Bhakta, B

    2011-04-30

    We developed a system for quantitatively measuring arm movement. Our approach provides a method to simultaneously capture upper limb kinetic and kinematic data during assisted passive arm movements. Data are analysed with respect to Cartesian and upper limb coordinate systems to obtain upper limb joint angles and torques. We undertook an evaluation of the system in participants with stroke to show the feasibility of this approach. During rehabilitation after stroke, one aspect of treatment includes the physiotherapist applying assistive forces to move the impaired arm of the patient who remains passive. There is a dearth of published data on the relationship between upper limb kinematics and the underlying forces (kinetics) in this mode of physiotherapy treatment. Such quantitative data are crucial in facilitating research into therapy practice, for example by measuring variation in practice and determining dosage. An experienced therapist prescribed passive movements tailored to the needs of 16 participants with stroke (41-81 years) with a range of anthropometric sizes and motor impairments. Our novel measurement tool recorded kinematic and kinetic data at 100 Hz for 6-11 movements per participant. The kinetic data show that the majority of movements fall within upper limits of 36.7 N in shoulder elevation, 22.4N in shoulder protraction, 4.6 Nm in shoulder abduction, 12.8 Nm in shoulder flexion, 2.4 Nm in shoulder rotation and 5.5 Nm in elbow flexion. These data show the potential of this system to better understand arm movement, in particular to objectively evaluate physical therapy treatments and support development of robotic devices to facilitate upper limb rehabilitation. Copyright © 2011 Elsevier B.V. All rights reserved.

  16. Predicting Recovery Potential for Individual Stroke Patients Increases Rehabilitation Efficiency.

    Science.gov (United States)

    Stinear, Cathy M; Byblow, Winston D; Ackerley, Suzanne J; Barber, P Alan; Smith, Marie-Claire

    2017-04-01

    Several clinical measures and biomarkers are associated with motor recovery after stroke, but none are used to guide rehabilitation for individual patients. The objective of this study was to evaluate the implementation of upper limb predictions in stroke rehabilitation, by combining clinical measures and biomarkers using the Predict Recovery Potential (PREP) algorithm. Predictions were provided for patients in the implementation group (n=110) and withheld from the comparison group (n=82). Predictions guided rehabilitation therapy focus for patients in the implementation group. The effects of predictive information on clinical practice (length of stay, therapist confidence, therapy content, and dose) were evaluated. Clinical outcomes (upper limb function, impairment and use, independence, and quality of life) were measured 3 and 6 months poststroke. The primary clinical practice outcome was inpatient length of stay. The primary clinical outcome was Action Research Arm Test score 3 months poststroke. Length of stay was 1 week shorter for the implementation group (11 days; 95% confidence interval, 9-13 days) than the comparison group (17 days; 95% confidence interval, 14-21 days; P=0.001), controlling for upper limb impairment, age, sex, and comorbidities. Therapists were more confident (P=0.004) and modified therapy content according to predictions for the implementation group (Prehabilitation efficiency after stroke without compromising clinical outcome. URL: http://anzctr.org.au. Unique identifier: ACTRN12611000755932. © 2017 American Heart Association, Inc.

  17. 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 prefrontal cortex activation, particularly in the right prefrontal cortex (p prefrontal cortex activity and improves working memory performance in post-stroke patients.

  18. Clinical Characteristics, Management, and Outcomes of Suspected Poststroke Acute Coronary Syndrome

    Directory of Open Access Journals (Sweden)

    Sylvia Marie Biso

    2017-01-01

    Full Text Available Background. Acute coronary syndrome (ACS can complicate acute ischemic stroke, causing significant morbidity and mortality. To date, literatures that describe poststroke acute coronary syndrome and its morbidity and mortality burden are lacking. Methods. This is a single center, retrospective study where clinical characteristics, cardiac evaluation, and management of patients with suspected poststroke ACS were compared and analyzed for their association with inpatient mortality and 1-year all-cause mortality. Results. Of the 82 patients, 32% had chest pain and 88% had ischemic ECG changes; mean peak troponin level was 18, and mean ejection fraction was 40%. The medical management group had older individuals (73 versus 67 years, p<0.05, lower mean peak troponin levels (12 versus 49, p<0.05, and lower mean length of stay (12 versus 25 days, p<0.05 compared to those who underwent stent or CABG. Troponin levels were significantly associated with 1-year all-cause mortality. Conclusion. Age and troponin level appear to play a role in the current clinical decision making for patient with suspected poststroke ACS. Troponin level appears to significantly correlate with 1-year all-cause mortality. In the management of poststroke acute coronary syndrome, optimal medical therapy had similar inpatient and all-cause mortality compared to PCI and/or CABG.

  19. Australian mental health consumers contributions to the evaluation and improvement of recovery-oriented service provision.

    Science.gov (United States)

    Marshal, Sarah L; Oades, Lindsay G; Growe, Trevor P

    2010-01-01

    One key component of recovery-oriented mental health services, typically overlooked, involves genuine collaboration between researchers and consumers to evaluate and improve services delivered within a recovery framework. Eighteen mental health consumers working with staff who had received training in the Collaborative Recovery Model (CRM) took part in in-depth focus group meetings, of approximately 2.5 hours each, to generate feedback to guide improvement of the CRM and its use in mental health services. Consumers identified clear avenues for improvement for the CRM both specific to the model and broadly applicable to recovery-oriented service provision. Findings suggest consumers want to be more engaged and empowered in the use of the CRM from the outset. Improved sampling procedures may have led to the identification of additional dissatisfied consumers. Collaboration with mental health consumers in the evaluation and improvement of recovery-oriented practice is crucial with an emphasis on rebuilding mental health services that are genuinely oriented to support recovery.

  20. Evaluation of undergraduate nursing students' clinical confidence following a mental health recovery camp.

    Science.gov (United States)

    Cowley, Thomas; Sumskis, Sue; Moxham, Lorna; Taylor, Ellie; Brighton, Renee; Patterson, Chris; Halcomb, Elizabeth

    2016-02-01

    In the present study, we evaluate the impact of participation in a mental health recovery camp on the clinical confidence of undergraduate nursing students in dealing with individuals with mental illness. Twenty undergraduate nursing students who participated in the recovery camp completed the Mental Health Nursing Clinical Confidence Scale both before and directly after attending the camp. Data were analysed using descriptive and inferential statistics. Participation in the recovery camp was associated with a statistically-significant increase in students' level of overall confidence between the pretest and post-test data (P students over the age of 25 years and who do not have a family history of mental illness are more likely to self-report a higher level of confidence in both the pre- and post-results. The clinical confidence of undergraduate nursing students improved through participation in an immersive clinical experience within the recovery camp. © 2016 Australian College of Mental Health Nurses Inc.

  1. Effectiveness evaluation of whole-body electromyostimulation as a post-exercise recovery method.

    Science.gov (United States)

    DE LA Camara, Miguel A; Pardos, Ana I; Veiga, Óscar L

    2018-01-04

    Whole-body electromyostimulation (WB-EMS) devices are now being used in health and sports training, although there are few studies investigating their benefits. The objective of this research was to evaluate the effectiveness of WB-EMS as a post-exercise recovery method, and compare it with other methods like active and passive recovery. The study included nine trained men (age = 21 ± 1years, height = 1.77 ± 0.4 m, mass = 62 ± 7 kg). Three trials were performed in three different sessions, 1 week apart. Each trial, the participants completed the same exercise protocol and a different recovery method each time. A repeated measures design was used to check the basal reestablishing on several physiological variables [lactate, heart rate, percentage of tissue hemoglobin saturation, temperature, and neuromuscular fatigue] and to evaluate the quality of recovery. The non-parametric Wilcoxon and Friedman ANOVA tests were used to examine the differences between recovery methods. The results showed no differences between methods in the physiological and psychological variables analyzed. Although, the blood lactate concentration showed borderline statistical significance between methods (P = 0.050). Likewise, WB-EMS failed to recover baseline blood lactate concentration (P = 0.021) and percentage of tissue hemoglobin saturation (P = 0.023), in contrast to the other two methods. These findings suggest that WB-EMS is not a good recovery method because the power of reestablishing of several physiological and psychological parameters is not superior to other recovery methods like active and passive recovery.

  2. Combined Dextroamphetamine and Transcranial Direct Current Stimulation in Poststroke Aphasia.

    Science.gov (United States)

    Keser, Zafer; Dehgan, Michelle Weber; Shadravan, Shaparak; Yozbatiran, Nuray; Maher, Lynn M; Francisco, Gerard E

    2017-10-01

    There is a growing need for various effective adjunctive treatment options for speech recovery after stroke. A pharmacological agent combined with noninvasive brain stimulation has not been previously reported for poststroke aphasia recovery. In this "proof of concept" study, we aimed to test the safety of a combined intervention consisting of dextroamphetamine, transcranial direct current stimulation, and speech and language therapy in subjects with nonfluent aphasia. Ten subjects with chronic nonfluent aphasia underwent two experiments where they received dextroamphetamine or placebo along with transcranial direct current stimulation and speech and language therapy on two separate days. The Western Aphasia Battery-Revised was used to monitor changes in speech performance. No serious adverse events were observed. There was no significant increase in blood pressure with amphetamine or deterioration in speech and language performance. Western Aphasia Battery-Revised aphasia quotient and language quotient showed a statistically significant increase in the active experiment. Comparison of proportional changes of aphasia quotient and language quotient in active experiment with those in placebo experiment showed significant difference. We showed that the triple combination therapy is safe and implementable and seems to induce positive changes in speech and language performance in the patients with chronic nonfluent aphasia due to stroke.

  3. Does the Motor Level of the Paretic Extremities Affect Balance in Poststroke Subjects?

    Directory of Open Access Journals (Sweden)

    Kamal Narayan Arya

    2014-01-01

    Full Text Available Background. Poststroke impairment may lead to fall and unsafe functional performance. The underlying mechanism for the balance dysfunction is unclear. Objective. To analyze the relation between the motor level of the affected limbs and balance in poststroke subjects. Method. A prospective, cross-sectional, and nonexperimental design was conducted in a rehabilitation institute. A convenience sample of 44 patients was assessed for motor level using Brunnstrom recovery stage (BRS and Fugl-Meyer Assessment: upper (FMA-UE and lower extremities (FMA-LE. The balance was measured by Berg Balance Scale (BBS, Postural Assessment Scale for Stroke Patients (PASS, and Functional Reach Test (FRT. Results. BRS showed moderate correlation with BBS (ρ=0.54 to 0.60; P<0.001, PASS (r=0.48 to 0.64; P<0.001 and FRT (ρ=0.48 to 0.59; P<0.001. FMA-UE also exhibited moderate correlation with BBS (ρ=0.59; P<0.001 and PASS (ρ=0.60; P<0.001. FMA-LE showed fair correlation with BBS (ρ=0.50; P=0.001 and PASS (ρ=0.50; P=0.001. Conclusion. Motor control of the affected limbs plays an important role in balance. There is a moderate relation between the motor level of the upper and lower extremities and balance. The findings of the present study may be applied in poststroke rehabilitation.

  4. A Short and Distinct Time Window for Recovery of Arm Motor Control Early After Stroke Revealed With a Global Measure of Trajectory Kinematics.

    Science.gov (United States)

    Cortes, Juan C; Goldsmith, Jeff; Harran, Michelle D; Xu, Jing; Kim, Nathan; Schambra, Heidi M; Luft, Andreas R; Celnik, Pablo; Krakauer, John W; Kitago, Tomoko

    2017-06-01

    Studies demonstrate that most arm motor recovery occurs within three months after stroke, when measured with standard clinical scales. Improvements on these measures, however, reflect a combination of recovery in motor control, increases in strength, and acquisition of compensatory strategies. To isolate and characterize the time course of recovery of arm motor control over the first year poststroke. Longitudinal study of 18 participants with acute ischemic stroke. Motor control was evaluated using a global kinematic measure derived from a 2-dimensional reaching task designed to minimize the need for antigravity strength and prevent compensation. Arm impairment was evaluated with the Fugl-Meyer Assessment of the upper extremity (FMA-UE), activity limitation with the Action Research Arm Test (ARAT), and strength with biceps dynamometry. Assessments were conducted at: 1.5, 5, 14, 27, and 54 weeks poststroke. Motor control in the paretic arm improved up to week 5, with no further improvement beyond this time point. In contrast, improvements in the FMA-UE, ARAT, and biceps dynamometry continued beyond 5 weeks, with a similar magnitude of improvement between weeks 5 and 54 as the one observed between weeks 1.5 and 5. Recovery after stroke plateaued much earlier for arm motor control, isolated with a global kinematic measure, compared to motor function assessed with clinical scales. This dissociation between the time courses of kinematic and clinical measures of recovery may be due to the contribution of strength improvement to the latter. Novel interventions, focused on the first month poststroke, will be required to exploit the narrower window of spontaneous recovery for motor control.

  5. Evaluation of the Recovery Rate of Different Swabs for Microbial Environmental Monitoring.

    Science.gov (United States)

    Goverde, Marcel; Willrodt, Julian; Staerk, Alexandra

    Contact plates, dipslides, and swabs are used for the microbiological monitoring of surfaces in controlled environments such as pharmaceutical clean rooms. In the present study, three different swab types using two different methods (direct streaking on agar versus elution followed by membrane filtration) were evaluated. In a first study, representative surfaces in pharmaceutical clean rooms were artificially inoculated using three different environmental strains (in vitro study). In a second study, a naturally inoculated floor was swabbed with the same three swab types, again using the two different recovery methods (in situ study). With the in vitro study, clear differences were found between the three swab types as well as between the two recovery methods. In addition, recovery rate of the swab type was dependent on the recovery method (interactive effect). One swab type showed a higher recovery rate with direct streaking on agar, while the other swab type showed better results using the elution/membrane filtration method. This difference can be explained by the fact that both swabs were each developed for their specific application. The type of surface also had a highly significant effect on the recovery rates. Recovery on stainless steel was better than for the other surfaces, while lexan had the lowest recovery rate. From the three different strains applied in the in vitro study, Micrococcus luteus had significantly higher recovery results compared to the other two strains (Bacillus thuringiensis, Aspergillus brasiliensis). The differences in recovery between the swab type and recovery method were less pronounced in the in situ study. In particular, the recovery of the swab type depending on the recovery method was not found. In conclusion, if swabs are to be used for environmental monitoring, their suitability should first be evaluated. This can be approached with artificially inoculated surfaces. However, naturally inoculated surfaces might be more

  6. Comparison of Brunnstrom movement therapy and Motor Relearning Program in rehabilitation of post-stroke hemiparetic hand: a randomized trial.

    Science.gov (United States)

    Pandian, Shanta; Arya, Kamal Narayan; Davidson, E W Rajkumar

    2012-07-01

    Motor recovery of the hand usually plateaus in chronic stroke patients. Various conventional and contemporary approaches have been used to rehabilitate the hand post-stroke. However, the evidence for their effectiveness is still limited. To compare the hand therapy protocols based on Brunnstrom approach and motor relearning program in rehabilitation of the hand of chronic stroke patients. Randomized trial. Outpatients attending the occupational therapy department of a rehabilitation institute. 30 post-stroke subjects (35.06 ± 14.52 months) were randomly assigned into two equal groups (Group A and Group B), Outcome Measures: Brunnstrom recovery stages of hand (BRS-H), Fugl-Meyer assessment: wrist and hand (FMA-WH). Group A received Brunnstrom hand manipulation (BHM). BHM is the hand treatment protocol of the Brunnstrom movement therapy, which uses synergies and reflexes to develop voluntary motor control. Group B received the Motor Relearning Program (MRP) based hand protocol. MRP is the practice of specific motor skills, which results in the ability to perform a task. Active practice of context-specific motor task such as reaching and grasping helps regain the lost motor functions. Both the therapy protocols were effective in rehabilitation of the hand (BRS-H; p = 0.003 to 0.004, FMA-WH; p hand motor recovery) (p hand in chronic post-stroke patients. Copyright © 2011 Elsevier Ltd. All rights reserved.

  7. 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...

  8. Longitudinal Analysis of Somatic Cell Count for Joint Genetic Evaluation of Mastitis and Recovery Liability

    DEFF Research Database (Denmark)

    Welderufael, Berihu Gebremedhin; de Koning, D J; Janss, Luc

    Abstract Text: Better models of genetic evaluation for mastitis can be developed through longitudinal analysis of somatic cell count (SCC) which usually is used as a proxy for mastitis. Mastitis and recovery data with weekly observations of SCC were simulated for daughter groups of 60 and 240 per...

  9. Poststroke delusions: What about the neuroanatomical and neurofunctional basis?

    Science.gov (United States)

    Torrisi, Michele; De Luca, Rosaria; Pollicino, Patrizia; Leonardi, Simona; Marino, Silvia; Maresca, Giuseppa; Maggio, Maria Grazia; Piccolo, Adriana; Bramanti, Placido; Calabrò, Rocco Salvatore

    2018-01-19

    Delusion is a belief about yourself, people, or events that has no accordance with reality. Although it is known that stroke could cause various psychiatric and psychological effects, including depression, anxiety, and aggressiveness, psychotic symptoms, especially delusions, are rather uncommon. The most investigated poststroke delusions are paranoid type, nihilistic, and Fregoli syndrome. We will describe two patients showing delusion symptoms (Cotard-like and erotomanic ones) that occurred after a stroke involving the right temporal lobe, the basal ganglia and insular region, persisting for a long period after the stroke onset. We have, therefore, supposed that the simultaneous involvement of these brain areas could be involved in the neuroanatomical basis of delusions, as also demonstrated by the neurofunctional evaluation.

  10. The value of the NDT-Bobath method in post-stroke gait training.

    Science.gov (United States)

    Mikołajewska, Emilia

    2013-01-01

    Stroke is perceived a major cause of disability, including gait disorders. Looking for more effective methods of gait reeducation in post-stroke survivors is one of the most important issues in contemporary neurorehabilitation. Following a stroke, patients suffer from gait disorders. The aim of this paper is to present the outcomes of a study of post-stroke gait reeducation using the NeuroDevelopmental Treatment-Bobath (NDT-Bobath) method. The research was conducted among 60 adult patients who had undergone ischemic stroke. These patients were treated using the NDT-Bobath method. These patients' gait reeducation was assessed using spatio-temporal gait parameters (gait velocity, cadence and stride length). Measurements of these parameters were conducted by the same therapist twice: on admission, and after the tenth session of gait reeducation. Among the 60 patients involved in the study, the results were as follows: in terms of gait velocity, recovery was observed in 39 cases (65%), in terms of cadence, recovery was observed in 39 cases (65%), in terms of stride length, recovery was observed in 50 cases (83.33%). Benefits were observed after short-term therapy, reflected by measurable statistically significant changes in the patients' gait parameters.

  11. Four birds with one stone? Reparative, neuroplastic, cardiorespiratory, and metabolic benefits of aerobic exercise poststroke.

    Science.gov (United States)

    Ploughman, Michelle; Kelly, Liam P

    2016-12-01

    Converging evidence from animal models of stroke and clinical trials suggests that aerobic exercise has effects across multiple targets. The subacute phase is characterized by a period of heightened neuroplasticity when aerobic exercise has the potential to optimize recovery. In animals, low intensity aerobic exercise shrinks lesion size and reduces cell death and inflammation, beginning 24 h poststroke. Also in animals, aerobic exercise upregulates brain-derived neurotrophic factor near the lesion and improves learning. In terms of neuroplastic effects, clinical trial results are less convincing and have only examined effects in chronic stroke. Stroke patients demonstrate cardiorespiratory fitness levels below the threshold required to carry out daily activities. This may contribute to a 'neurorehabilitation ceiling' that limits capacity to practice at a high enough frequency and intensity to promote recovery. Aerobic exercise when delivered 2-5 days per week at moderate to high intensity beginning as early as 5 days poststroke improves cardiorespiratory fitness, dyslipidemia, and glucose tolerance. Based on the evidence discussed and applying principles of periodization commonly used to prepare athletes for competition, we have created a model of aerobic training in subacute stroke in which training is delivered in density blocks (duration × intensity) matched to recovery phases.

  12. Post-stroke depressive symptoms are associated with post-stroke characteristics.

    NARCIS (Netherlands)

    Snaphaan, L.J.A.E.; Werf, S.P. van der; Kanselaar, K.; Leeuw, H.F. de

    2009-01-01

    BACKGROUND: Several studies have described the frequency and risk factors of post-stroke depressive symptoms (PSDS). However, most studies did not exclude patients with depressive symptoms shortly before stroke and paid little attention to prestroke risk factors of depression, including previous

  13. Non-invasive repeated therapeutic stimulation for aphasia recovery: a multilingual, multicenter aphasia trial.

    Science.gov (United States)

    Thiel, Alexander; Black, Sandra E; Rochon, Elizabeth A; Lanthier, Sylvain; Hartmann, Alexander; Chen, Joyce L; Mochizuki, George; Zumbansen, Anna; Heiss, Wolf-Dieter

    2015-04-01

    Noninvasive brain stimulation such as repetitive transcranial magnetic stimulation (rTMS) or transcranial direct current stimulation (tDCS) has been used in case series and small randomized controlled trials to improve recovery from poststroke aphasia in combination with speech and language therapy. Results of these studies suggest possible clinical efficacy and an excellent safety profile. Therefore, a larger international multicenter proof-of-concept trial was launched, to directly compare the safety and efficacy of rTMS, tDCS, and sham stimulation as adjuvant therapy to speech and language therapy in subacute poststroke aphasia. In the 4 participating centers, subacute stroke patients with aphasia are randomized between 5 and 30 days after ischemic stroke to either receive rTMS, tDCS, or sham stimulation in combination with a daily 45 minutes speech and language therapy session for 10 days. Efficacy is evaluated at 1 and 30 days after the last of the 10 treatment sessions using 3 outcome measures, validated in all participating languages: Boston naming test, Token test, and verbal fluency test. Additionally, adverse events are recorded to prove safety. In this study, a total of 90 patients will be recruited, and data analysis will be completed in 2016. This is the first multilingual and multinational randomized and controlled trial in poststroke aphasia and if positive, will add an effective new strategy for early stage poststroke aphasia rehabilitation. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  14. Evaluating recovery following hip fracture : a qualitative interview study of what is important to patients\\ud

    OpenAIRE

    Griffiths, Frances; Mason, Victoria; Boardman, Felicity K.; Dennick, Kathryn J.; Haywood, Kirstie L.; Achten, Juul; Parsons, Nicholas R; Griffin, Xavier L.; Costa, Matthew L.

    2015-01-01

    Objective: \\ud To explore what patients consider important when evaluating their recovery from hip fracture and to consider how these priorities could be used in the evaluation of the quality of hip fracture services.\\ud \\ud Design:\\ud Semistructured interviews exploring the experience of recovery from hip fracture at two time points—4 weeks and 4 months postoperative hip fixation. Two approaches to analysis: thematic analysis of data specifically related to recovery from hip fracture; summar...

  15. Post anesthesia recovery rate evaluated by using White fast tracking scoring system

    Directory of Open Access Journals (Sweden)

    Munevera Hadžimešić

    2013-12-01

    Full Text Available Introduction: Postponed recuperation from anesthesia can lead to different complications such as apnoea, aspiration of gastric content whit consequent development of aspiration pneumonia, laryngospasm, bradycardia, and hypoxia. Aim of this research was to determine infl uence of propofol, sevoflurane and isoflurane anesthesia on post anesthesia recovery rate.Methods: This was a prospective study; it included 90 patients hospitalized in period form October 2011 to may 2012 year, all patients included in the study underwent lumbar microdiscectomy surgery. Patients were randomly allocated to one of three groups: group 1: propofol maintained anesthesia, group 2: sevoflurane and group 3: isofl urane maintained anesthesia. Assessments of recovery rate were done 1, 5 and 10 minutes post extubation using White fast tracking scoring system.Results: Significant difference was observed only 1 minute after extubation (p=0,025 finding recovery rate to be superior in propofol group. Propofol group compared to inhaled anesthesia with sevoflurane group, shows significantly faster recovery from anesthesia only one minute after extubation (p=0,046. In comparison of propofol group and isofl urane anesthesia group, statistical significance was noticed one minute following extubation (p=0,008. Comparison of propofol group and inhaled anesthesia groups recovery rates were not significantly different at all times measured. When we were comparing sevoflurane and isoflurane anesthesia, recovery rates shoved no signifi cant statistical difference.Conclusions: Recovery rate evaluated by using White fast tracking scoring system was superior and with fewer complications in propofol maintained in comparison to sevoflurane and isoflurane maintained anesthesia only one minute post extubation, while after fifth and tenth minute difference was lost.

  16. Design and evaluation of fluidized bed heat recovery for diesel engine systems

    Science.gov (United States)

    Hamm, J. R.; Newby, R. A.; Vidt, E. J.; Lippert, T. E.

    1985-01-01

    The potential of utilizing fluidized bed heat exchangers in place of conventional counter-flow heat exchangers for heat recovery from adiabatic diesel engine exhaust gas streams was studied. Fluidized bed heat recovery systems were evaluated in three different heavy duty transport applications: (1) heavy duty diesel truck; (2) diesel locomotives; and (3) diesel marine pushboat. The three applications are characterized by differences in overall power output and annual utilization. For each application, the exhaust gas source is a turbocharged-adiabatic diesel core. Representative subposed exhaust gas heat utilization power cycles were selected for conceptual design efforts including design layouts and performance estimates for the fluidized bed heat recovery heat exchangers. The selected power cycles were: organic rankine with RC-1 working fluid, turbocompound power turbine with steam injection, and stirling engine. Fuel economy improvement predictions are used in conjunction with capital cost estimates and fuel price data to determine payback times for the various cases.

  17. Determining the barriers and facilitators to adopting best practices in the management of poststroke unilateral spatial neglect: results of a qualitative study.

    Science.gov (United States)

    Petzold, Anita; Korner-Bitensky, Nicol; Salbach, Nancy M; Ahmed, Sara; Menon, Anita; Ogourtsova, Tatiana

    2014-01-01

    A gap exists between best and actual management of poststroke unilateral spatial neglect (USN). Given the negative impact of USN on poststroke recovery, knowledge translation efforts are needed to optimize USN management. To date, no study has investigated the specific barriers and facilitators affecting USN management during the acute care process. To identify the facilitators and barriers that affect evidence-based practice use by occupational therapists (the primary discipline managing USN) when treating individuals with acute poststroke USN. Focus group methodology elicited information from 9 acute care occupational therapists. Key barriers identified included lack of basic evidence-based practice skills specific to USN treatment and personal motivation to change current practices and engrained habits. Key facilitators included the presence of a multidisciplinary stroke team, recent graduation, and an environment with access to learning time and resources. Synthesized Web-based learning was also seen as important to uptake of best practices. It is estimated that upwards of 40% of patients experience poststroke USN in the acute phase, and we have evidence of poor early management. This study identified several modifiable factors that prepare the ground for the creation and testing of a multimodal knowledge translation intervention aimed at improving clinicians' best practice management of poststroke USN.

  18. Formative evaluation: Developing measures for online family mental health recovery education.

    Science.gov (United States)

    Rue, Lisa A; Estrada, Samantha; Floren, Michael; MacKinnon, Krista

    2016-04-01

    Families facing mental health challenges have very limited access to ongoing support. A formative evaluation of Families Healing Together (FHT), a new online family mental health recovery program was conducted using five waves (N=108) of data. Exploratory factor analysis of the measures identified as important to the program theory found strong reliability evidence (α=.77-.86) for 6 constructs. A poor response rate (25%) did not allow for valid pre and postoutcome evaluation, however we did have enough information to assess the psychometric properties of the new measures. The new evaluation tool accounted for 34% of the variance in Capacity to Support Family Member, and nearly 50% of the variance in Hopefulness toward Recovery. New programs without existing measures require formative evaluation strategies that accurately describe program activities in order to develop outcome measures sensitive to novel aspects of program components. Most outcome measures are developed for individuals with mental health challenges not family members. These new measures may be beneficial to effectively evaluate programs that promote family recovery and wellness. Copyright © 2015 Elsevier Ltd. All rights reserved.

  19. Non-Speech Oro-Motor Exercises in Post-Stroke Dysarthria Intervention: A Randomized Feasibility Trial

    Science.gov (United States)

    Mackenzie, C.; Muir, M.; Allen, C.; Jensen, A.

    2014-01-01

    Background: There has been little robust evaluation of the outcome of speech and language therapy (SLT) intervention for post-stroke dysarthria. Non-speech oro-motor exercises (NSOMExs) are a common component of dysarthria intervention. A feasibility study was designed and executed, with participants randomized into two groups, in one of which…

  20. When Does Return of Voluntary Finger Extension Occur Post-Stroke? A Prospective Cohort Study.

    Directory of Open Access Journals (Sweden)

    Caroline Winters

    Full Text Available Patients without voluntary finger extension early post-stroke are suggested to have a poor prognosis for regaining upper limb capacity at 6 months. Despite this poor prognosis, a number of patients do regain upper limb capacity. We aimed to determine the time window for return of voluntary finger extension during motor recovery and identify clinical characteristics of patients who, despite an initially poor prognosis, show upper limb capacity at 6 months post-stroke.Survival analysis was used to assess the time window for return of voluntary finger extension (Fugl-Meyer Assessment hand sub item finger extension≥1. A cut-off of ≥10 points on the Action Research Arm Test was used to define return of some upper limb capacity (i.e. ability to pick up a small object. Probabilities for regaining upper limb capacity at 6 months post-stroke were determined with multivariable logistic regression analysis using patient characteristics.45 of the 100 patients without voluntary finger extension at 8 ± 4 days post-stroke achieved an Action Research Arm Test score of ≥10 points at 6 months. The median time for regaining voluntary finger extension for these recoverers was 4 weeks (lower and upper percentile respectively 2 and 8 weeks. The median time to return of VFE was not reached for the whole group (N = 100. Patients who had moderate to good lower limb function (Motricity Index leg≥35 points, no visuospatial neglect (single-letter cancellation test asymmetry between the contralesional and ipsilesional sides of <2 omissions and sufficient somatosensory function (Erasmus MC modified Nottingham Sensory Assessment≥33 points had a 0.94 probability of regaining upper limb capacity at 6 months post-stroke.We recommend weekly monitoring of voluntary finger extension within the first 4 weeks post-stroke and preferably up to 8 weeks. Patients with paresis mainly restricted to the upper limb, no visuospatial neglect and sufficient somatosensory function are

  1. Stimulus electrodiagnosis and motor and functional evaluations during ulnar nerve recovery

    Directory of Open Access Journals (Sweden)

    Luciane F. R. M. Fernandes

    2016-01-01

    Full Text Available BACKGROUND: Distal ulnar nerve injury leads to impairment of hand function due to motor and sensorial changes. Stimulus electrodiagnosis (SE is a method of assessing and monitoring the development of this type of injury. OBJECTIVE: To identify the most sensitive electrodiagnostic parameters to evaluate ulnar nerve recovery and to correlate these parameters (Rheobase, Chronaxie, and Accommodation with motor function evaluations. METHOD: A prospective cohort study of ten patients submitted to ulnar neurorrhaphy and evaluated using electrodiagnosis and motor assessment at two moments of neural recovery. A functional evaluation using the DASH questionnaire (Disability of the Arm, Shoulder, and Hand was conducted at the end to establish the functional status of the upper limb. RESULTS: There was significant reduction only in the Chronaxie values in relation to time of injury and side (with and without lesion, as well as significant correlation of Chronaxie with the motor domain score. CONCLUSION: Chronaxie was the most sensitive SE parameter for detecting differences in neuromuscular responses during the ulnar nerve recovery process and it was the only parameter correlated with the motor assessment.

  2. Environmental, economic, and energy impacts of material recovery facilities. A MITE Program evaluation

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1995-10-01

    This report documents an evaluation of the environmental, economic, and energy impacts of material recovery facilities (MRFs) conducted under the Municipal Solid Waste Innovative Technology Evaluation (MITE) Program. The MITE Program is sponsored by the US Environmental Protection Agency to foster the demonstration and development of innovative technologies for the management of municipal solid waste (MSW). This project was also funded by the National Renewable Energy Laboratory (NREL). Material recovery facilities are increasingly being used as one option for managing a significant portion of municipal solid waste (MSW). The owners and operators of these facilities employ a combination of manual and mechanical techniques to separate and sort the recyclable fraction of MSW and to transport the separated materials to recycling facilities.

  3. Efficacy of Occupational Therapy Task-oriented Approach in Upper Extremity Post-stroke Rehabilitation.

    Science.gov (United States)

    Almhdawi, Khader A; Mathiowetz, Virgil G; White, Matthew; delMas, Robert C

    2016-12-01

    There is a need for more effective rehabilitation methods for individuals post-stroke. Occupational Therapy Task-Oriented (TO) approach has not been evaluated in a randomized clinical trial. The purpose of this study was to evaluate functional and impairment efficacies of TO approach on the more-affected Upper Extremity (UE) of persons post-stroke. A randomized single-blinded cross-over trial recruited 20 participants post-stroke (mean chronicity = 62 months) who demonstrated at least 10° active more-affected shoulder flexion and abduction and elbow flexion-extension. Participants were randomized into immediate (n = 10) and delayed intervention (n = 10) groups. Immediate group had 6 weeks of 3 hr/week TO intervention followed by 6 weeks of no-intervention control. Delayed intervention group underwent the reversed order. Functional measures included Canadian Occupational Performance Measure (COPM), Motor Activity Log (MAL), and Wolf Motor Function Test (WMFT). Impairment measures included UE Active Range of Motion (AROM) and handheld dynamometry strength. Measurements were obtained at baseline, cross over, and end of the study. TO intervention showed statistically higher functional change scores. COPM performance and satisfaction scores were 2.83 and 3.46 units greater respectively (p approach appears to be an effective UE post-stroke rehabilitation approach inducing clinically meaningful functional improvements. More studies are needed with larger samples and specific stroke chronicity and severity. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

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

    Directory of Open Access Journals (Sweden)

    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

  5. Prevalence and management of poststroke spasticity in Thai stroke patients: a multicenter study.

    Science.gov (United States)

    Dajpratham, Piyapat; Kuptniratsaikul, Vilai; Kovindha, Apichana; Kuptniratsaikul, Patcharawimol Srisa-an; Dejnuntarat, Kalaya

    2009-10-01

    To study the prevalence, associated factors and management of poststroke spasticity in two muscle groups namely elbow flexor and knee flexor. The Thai stroke rehabilitation registry (TSRR) was conducted among 9 rehabilitation centers. All subjects received the conventional rehabilitation program until they reached their rehabilitation goals or discharge criteria. The Brunnstrom motor recovery stage, Barthel Index, Thai Mental State Examination, Modified Ashworth Scale (MAS), and WHOQOL-BREF-Thai (26 items) questionnaires were used to assess the motor recovery, functional disability, cognition, spasticity and quality of life on admission respectively. The management of spasticity was also recorded. There were 327 patients with a mean age of 62.2-years-old participating in the study. The prevalence of poststroke spasticity was 41.6%. Among these the prevalences of spasticity of both elbow and knee flexors was 31.2% and of either elbow or knee flexor were 4.9% and 5.5% respectively. Spasticity with MAS grade 1 was found in the majority. The patients with spasticity had a significantly longer time to rehabilitation admission interval after the stroke (p = 0.049), had the Brunnstrom motor recovery stages of arm (p spasticity group. The factor associated with spasticity was Brunnstrom motor recovery stage 2 and 3 of the arm with the odds ratio being 6.1 (95% CI = 2.5-14.9) and 3.5 respectively (95% CI = 1.3-9.2). Management of spasticity was demonstrated in 83 patients (25.4%). Therapeutic exercise, oral antispastic medication and assistive device were the first three managements frequently prescribed respectively. Spasticity was a common complication after stroke. Although the prevalence was quite high, spasticity with MAS grade 1 was found in the majority of cases. The associated factor was the Brunnstrom motor recovery stage of the arm. Therapeutic exercise was the mainstay of the management.

  6. Poststroke Communication Disorders and Dysphagia.

    Science.gov (United States)

    González-Fernández, Marlís; Brodsky, Martin B; Palmer, Jeffrey B

    2015-11-01

    Communication and swallowing disorders are common after stroke. Targeted surveillance followed by prompt evaluation and treatment is of paramount importance. The overall goals of rehabilitation for impaired swallowing and communication and swallowing deficits may differ based on the specific deficits caused by the stroke but the main goal is always to improve the patient's everyday interpersonal interactions and optimize participation in society. Fortunately, therapeutic or compensatory interventions can decrease the effects that communication and swallowing deficits have on the quality of life of stroke survivors. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Virtual Reality to Assess and Treat Lower Extremity Disorders in Post-stroke Patients.

    Science.gov (United States)

    Luque-Moreno, C; Oliva-Pascual-Vaca, A; Kiper, P; Rodríguez-Blanco, C; Agostini, M; Turolla, A

    2016-01-01

    This article is part of the Focus Theme of Methods of Information in Medicine on "Methodologies, Models and Algorithms for Patients Rehabilitation". To identify support of a virtual reality system in the kinematic assessment and physiotherapy approach to gait disorders in individuals with stroke. We adapt Virtual Reality Rehabilitation System (VRRS), software widely used in the functional recovery of the upper limb, for its use on the lower limb of hemiplegic patients. Clinical scales have been used to relate them with the kinematic assessment provided by the system. A description of the use of reinforced feedback provided by the system on the recovery of deficits in several real cases in the field of physiotherapy is performed. Specific examples of functional tasks have been detailed, to be considered in creating intelligent health technologies to improve post-stroke gait. Both participants improved scores on the clinical scales, the kinematic parameters in leg stance on plegic lower extremity and walking speed > Minimally Clinically Important Difference (MCID). The use of the VRRS software attached to a motion tracking capture system showed their practical utility and safety in enriching physiotherapeutic assessment and treatment in post-stroke gait disorders.

  8. Upper Limb Immobilisation: A Neural Plasticity Model with Relevance to Poststroke Motor Rehabilitation.

    Science.gov (United States)

    Furlan, Leonardo; Conforto, Adriana Bastos; Cohen, Leonardo G; Sterr, Annette

    2016-01-01

    Advances in our understanding of the neural plasticity that occurs after hemiparetic stroke have contributed to the formulation of theories of poststroke motor recovery. These theories, in turn, have underpinned contemporary motor rehabilitation strategies for treating motor deficits after stroke, such as upper limb hemiparesis. However, a relative drawback has been that, in general, these strategies are most compatible with the recovery profiles of relatively high-functioning stroke survivors and therefore do not easily translate into benefit to those individuals sustaining low-functioning upper limb hemiparesis, who otherwise have poorer residual function. For these individuals, alternative motor rehabilitation strategies are currently needed. In this paper, we will review upper limb immobilisation studies that have been conducted with healthy adult humans and animals. Then, we will discuss how the findings from these studies could inspire the creation of a neural plasticity model that is likely to be of particular relevance to the context of motor rehabilitation after stroke. For instance, as will be elaborated, such model could contribute to the development of alternative motor rehabilitation strategies for treating poststroke upper limb hemiparesis. The implications of the findings from those immobilisation studies for contemporary motor rehabilitation strategies will also be discussed and perspectives for future research in this arena will be provided as well.

  9. Upper Limb Immobilisation: A Neural Plasticity Model with Relevance to Poststroke Motor Rehabilitation

    Science.gov (United States)

    Furlan, Leonardo; Conforto, Adriana Bastos; Cohen, Leonardo G.; Sterr, Annette

    2016-01-01

    Advances in our understanding of the neural plasticity that occurs after hemiparetic stroke have contributed to the formulation of theories of poststroke motor recovery. These theories, in turn, have underpinned contemporary motor rehabilitation strategies for treating motor deficits after stroke, such as upper limb hemiparesis. However, a relative drawback has been that, in general, these strategies are most compatible with the recovery profiles of relatively high-functioning stroke survivors and therefore do not easily translate into benefit to those individuals sustaining low-functioning upper limb hemiparesis, who otherwise have poorer residual function. For these individuals, alternative motor rehabilitation strategies are currently needed. In this paper, we will review upper limb immobilisation studies that have been conducted with healthy adult humans and animals. Then, we will discuss how the findings from these studies could inspire the creation of a neural plasticity model that is likely to be of particular relevance to the context of motor rehabilitation after stroke. For instance, as will be elaborated, such model could contribute to the development of alternative motor rehabilitation strategies for treating poststroke upper limb hemiparesis. The implications of the findings from those immobilisation studies for contemporary motor rehabilitation strategies will also be discussed and perspectives for future research in this arena will be provided as well. PMID:26843992

  10. Upper Limb Immobilisation: A Neural Plasticity Model with Relevance to Poststroke Motor Rehabilitation

    Directory of Open Access Journals (Sweden)

    Leonardo Furlan

    2016-01-01

    Full Text Available Advances in our understanding of the neural plasticity that occurs after hemiparetic stroke have contributed to the formulation of theories of poststroke motor recovery. These theories, in turn, have underpinned contemporary motor rehabilitation strategies for treating motor deficits after stroke, such as upper limb hemiparesis. However, a relative drawback has been that, in general, these strategies are most compatible with the recovery profiles of relatively high-functioning stroke survivors and therefore do not easily translate into benefit to those individuals sustaining low-functioning upper limb hemiparesis, who otherwise have poorer residual function. For these individuals, alternative motor rehabilitation strategies are currently needed. In this paper, we will review upper limb immobilisation studies that have been conducted with healthy adult humans and animals. Then, we will discuss how the findings from these studies could inspire the creation of a neural plasticity model that is likely to be of particular relevance to the context of motor rehabilitation after stroke. For instance, as will be elaborated, such model could contribute to the development of alternative motor rehabilitation strategies for treating poststroke upper limb hemiparesis. The implications of the findings from those immobilisation studies for contemporary motor rehabilitation strategies will also be discussed and perspectives for future research in this arena will be provided as well.

  11. Evaluating the Vegetation Recovery in the Damage Area of Wenchuan Earthquake Using MODIS Data

    Directory of Open Access Journals (Sweden)

    Wei-Guo Jiang

    2015-07-01

    Full Text Available The catastrophic 8.0 Richter magnitude earthquake that occurred on 12 May 2008 in Wenchuan, China caused extensive damage to vegetation due to widespread landslides and debris flows. In the past five years, the Chinese government has implemented a series of measures to restore the vegetation in the severely afflicted area. How is the vegetation recovering? It is necessary and important to evaluate the vegetation recovery effect in earthquake-stricken areas. Based on MODIS NDVI data from 2005 to 2013, the vegetation damage area was extracted by the quantified threshold detection method. The vegetation recovery rate after five years following the earthquake was evaluated with respect to counties, altitude, fault zones, earthquake intensity, soil texture and vegetation types, and assessed over time. We have proposed a new method to obtain the threshold with vegetation damage quantitatively, and have concluded that: (1 The threshold with vegetation damage was 13.47%, and 62.09% of the field points were located in the extracted damaged area; (2 The total  vegetation damage area was 475,688 ha, which accounts for 14.34% of the study area and was primarily distributed in the central fault zone, the southwest mountainous areas and along rivers in the Midwest region of the study area; (3 Vegetation recovery in the damaged area was better in the northeast regions of the study area, and in the western portion of the Wenchuan-Maoxian fracture; vegetation recovery was better with increasing altitude; there is no obvious relationship between clay content in the topsoil and vegetation recovery; (4 Meadows recovered best and the worst recovery was in mixed coniferous broad-leaved forest; (5 81,338 ha of vegetation in the damage area is currently undergoing degradation and the main vegetation types in the degradation area are coniferous forest (31.39% and scrub (34.17%; (6 From 2009 to 2013, 41% has been restored to the level before the earthquake, 9% has not

  12. Randomized controlled trial of yoga for chronic poststroke hemiparesis: motor function, mental health, and quality of life outcomes.

    Science.gov (United States)

    Immink, Maarten A; Hillier, Susan; Petkov, John

    2014-01-01

    To assess the efficacy of yoga for motor function, mental health, and quality of life outcomes in persons with chronic poststroke hemiparesis. Twenty-two individuals participated in a randomized controlled trial involving assessment of task-orientated function, balance, mobility, depression, anxiety, and quality of life domains before and after either a 10-week yoga intervention (n = 11) or no treatment (n = 11). The yoga intervention did not result in any significant improvements in objective motor function measures, however there was a significant improvement in quality of life associated with perceived motor function (P = .0001) and improvements in perceived recovery approached significance (P = .072). Memory-related quality of life scores significantly improved after yoga intervention (P = .022), and those participating in the intervention exhibited clinically relevant decreases in state and trait anxiety. Preliminary results offer promise for yoga as an intervention to address mental health and quality of life in persons with stroke-related activity limitations. There is a need to more rigorously evaluate these yoga benefits with a larger randomized controlled trial, which, based on this preliminary trial, is feasible.

  13. 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. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. 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.

  15. 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. PMID:27346996

  16. Evaluation of extractant-coated ferromagnetic microparticles for the recovery of hazardous metals from waste solution.

    Energy Technology Data Exchange (ETDEWEB)

    Kaminski, M. D.

    1998-05-08

    A magnetically assisted chemical separation (MACS) process was developed earlier at Argonne National Laboratory (ANL). This compact process was designed for the separation of transuranics (TRU) and radionuclides from the liquid waste streams that exist at many DOE sites, with an overall reduction in waste volume requiring disposal. The MACS process combines the selectivity afforded by solvent extractant/ion exchange materials with magnetic separation to provide an efficient chemical separation. Recently, the MACS process has been evaluated with acidic organophosphorus extractants for hazardous metal recovery from waste solutions. Moreover, process scale-up design issues have been addressed with respect to particle filtration and recovery. Two acidic organophosphorus compounds have been investigated for hazardous metal recovery, bis(2,4,4-trimethylpentyl) phosphinic acid (Cyanex{reg_sign} 272) and bis(2,4,4-trimethylpentyl) dithiophosphinic acid (Cyanex{reg_sign} 301). Coated onto magnetic microparticles, these extractants demonstrated superior recovery of hazardous metals from solution, relative to what was expected on the basis of results from solvent extraction experiments. The results illustrate the diverse applications of MACS technology for dilute waste streams. Preliminary process scale-up experiments with a high-gradient magnetic separator at Oak Ridge National Laboratory have revealed that very low microparticle loss rates are possible.

  17. Cigarette smoking is an independent risk factor for post-stroke delirium.

    Science.gov (United States)

    Lim, Tae Sung; Lee, Jin Soo; Yoon, Jung Han; Moon, So Young; Joo, In Soo; Huh, Kyoon; Hong, Ji Man

    2017-03-23

    Post-stroke delirium is a common problem in the care of stroke patients, and is associated with longer hospitalization, high short-term mortality, and an increased need for long-term care. Although post-stroke delirium occurs in approximately 10 ~ 30% of patients, little is known about the risk factors for post-stroke delirium in patients who experience acute stroke. A total of 576 consecutive patients who experienced ischemic stroke (mean age, 65.2 years; range, 23-93 years) were screened for delirium over a 2-year period in an acute stroke care unit of a tertiary referral hospital. We screened for delirium using the Confusion Assessment Method. Once delirium was suspected, we evaluated the symptoms using the Korean Version of the Delirium Rating Scale-Revised-98. Neurological deficits were assessed using the National Institutes of Health Stroke Scale at admission and discharge, and functional ability was assessed using the Barthel Index and modified Rankin Scale at discharge and 3 months after discharge. Thirty-eight (6.7%) patients with stroke developed delirium during admission to the acute stroke care unit. Patients with delirium were significantly older (70.6 vs. 64.9 years of age, P = .001) and smoked cigarettes more frequently (40% vs. 24%, P = .033) than patients without delirium. In terms of clinical features, the delirium group experienced a significantly higher rate of major hemispheric stroke (55% vs. 26%, P delirium were older age, history of cigarette smoking, and major hemispheric stroke. Abrupt cessation of cigarette smoking may be a risk factor for post-stroke delirium in ischemic stroke patients. The development of delirium after stroke is associated with worse outcome and longer hospitalization.

  18. A significant risk factor for poststroke depression: the depression-related subnetwork.

    Science.gov (United States)

    Yang, Songran; Hua, Ping; Shang, Xinyuan; Cui, Zaixu; Zhong, Suyu; Gong, Gaolang; Humphreys, Glyn W

    2015-07-01

    Despite being one of the direct causes of depression, whether stroke-induced neuroanatomical deterioration actually plays an important role in the onset of poststroke depression (PSD) is controversial. We assessed the structural basis of PSD, particularly with regard to white matter connectivity. We evaluated lesion index, fractional anisotropy (FA) reduction and brain structural networks and then analyzed whole brain voxel-based lesions and FA maps. To understand brain damage in the context of brain connectivity, we used a graph theoretical approach. We selected nodes whose degree correlated with the Hamilton Rating Scale for Depression score (p Mental State Examination score and National Institutes of Health Stroke Scale score. We used Poisson regression with robust standard errors to assess the contribution of the identified network toward poststroke major depression. We included 116 stroke patients in the study. Fourteen patients (12.1%) had diagnoses of major depression and 26 (22.4%) had mild depression. We found that lesions in the right insular cortex, left putamen and right superior longitudinal fasciculus as well as FA reductions in broader areas were all associated with major depression. Seventeen nodes were selected to build the depression-related subnetwork. Decreased local efficiency of the subnetwork was a significant risk factor for poststroke major depression (relative risk 0.84, 95% confidence interval 0.72-0.98, p = 0.027). The inability of DTI tractography to process fibre crossings may have resulted in inaccurate construction of white matter networks and affected statistical findings. The present study provides, to our knowledge, the first graph theoretical analysis of white matter networks linked to poststroke major depression. These findings provide new insights into the neuroanatomical substrates of depression that develops after stroke.

  19. Post-stroke infection: A systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Dijkgraaf Marcel G

    2011-09-01

    Full Text Available Abstract Background stroke is the main cause of disability in high-income countries, and ranks second as a cause of death worldwide. Patients with acute stroke are at risk for infections, but reported post-stroke infection rates vary considerably. We performed a systematic review and meta-analysis to estimate the pooled post-stroke infection rate and its effect on outcome. Methods MEDLINE and EMBASE were searched for studies on post-stroke infection. Cohort studies and randomized clinical trials were included when post-stroke infection rate was reported. Rates of infection were pooled after assessment of heterogeneity. Associations between population- and study characteristics and infection rates were quantified. Finally, we reviewed the association between infection and outcome. Results 87 studies were included involving 137817 patients. 8 studies were restricted to patients admitted on the intensive care unit (ICU. There was significant heterogeneity between studies (P 2 = 97%. The overall pooled infection rate was 30% (24-36%; rates of pneumonia and urinary tract infection were 10% (95% confidence interval [CI] 9-10% and 10% (95%CI 9-12%. For ICU studies, these rates were substantially higher with 45% (95% CI 38-52%, 28% (95%CI 18-38% and 20% (95%CI 0-40%. Rates of pneumonia were higher in studies that specifically evaluated infections and in consecutive studies. Studies including older patients or more females reported higher rates of urinary tract infection. Pneumonia was significantly associated with death (odds ratio 3.62 (95%CI 2.80-4.68. Conclusions Infection complicated acute stroke in 30% of patients. Rates of pneumonia and urinary tract infection after stroke were 10%. Pneumonia was associated with death. Our study stresses the need to prevent infections in patients with stroke.

  20. Feasibility of Virtual Reality Augmented Cycling for Health Promotion of People Post-Stroke

    Science.gov (United States)

    Deutsch, Judith E; Myslinski, Mary Jane; Kafri, Michal; Ranky, Richard; Sivak, Mark; Mavroidis, Constantinos; Lewis, Jeffrey A

    2013-01-01

    Background and Purpose A virtual reality (VR) augmented cycling kit (VRACK) was developed to address motor control and fitness deficits of individuals with chronic stroke. In this paper we report on the safety, feasibility and efficacy of using the VRACK to train cardio-respiratory (CR) fitness of individuals in the chronic phase poststroke. Methods Four individuals with chronic stroke (47–65 years old and three or more years post-stroke), with residual lower extremity impairments (Fugl Meyer 24–26/34) who were limited community ambulators (gait speed range 0.56 to 1.1 m/s) participated in this study. Safety was defined as the absence of adverse events. Feasibility was measured using attendance, total exercise time, and “involvement” measured with the Presence Questionnaire (PQ). Efficacy of CR fitness was evaluated using a sub-maximal bicycle ergometer test before and after an 8-week training program. Results The intervention was safe and feasible with participants having 1 adverse event, 100% adherence, achieving between 90 and 125 minutes of cycling each week and a mean PQ score of 39 (SD 3.3). There was a statistically significant 13% (p = 0.035) improvement in peak VO2 with a range of 6–24.5 %. Discussion and Conclusion For these individuals post-stroke, VR augmented cycling, using their heart rate to set their avatar’s speed, fostered training of sufficient duration and intensity to promote CR fitness. In addition, there was a transfer of training from the bicycle to walking endurance. VR augmented cycling may be an addition to the therapist’s tools for concurrent training of mobility and health promotion of individuals post-stroke. Video Abstract available (see Video, Supplemental Digital Content 1) for more insights from the authors. PMID:23863828

  1. 76 FR 72006 - Draft Interim Staff Guidance: Evaluations of Uranium Recovery Facility Surveys of Radon and Radon...

    Science.gov (United States)

    2011-11-21

    ... COMMISSION Draft Interim Staff Guidance: Evaluations of Uranium Recovery Facility Surveys of Radon and Radon... Recovery Facility Surveys of Radon and Radon Progeny in Air and Demonstrations of Compliance with 10 CFR 20... that existing guidance does not sufficiently detail how the NRC staff reviews surveys of radon and...

  2. High-technology augmentative communication for adults with post-stroke aphasia: a systematic review.

    Science.gov (United States)

    Russo, Maria Julieta; Prodan, Valeria; Meda, Natalia Nerina; Carcavallo, Lucila; Muracioli, Anibal; Sabe, Liliana; Bonamico, Lucas; Allegri, Ricardo Francisco; Olmos, Lisandro

    2017-05-01

    Augmentative and alternative communication (AAC) systems were introduced into clinical practice by therapists to help compensate for persistent language deficits in people with aphasia. Although, there is currently a push towards an increased focus on compensatory approaches in an attempt to maximize communication function for social interaction, available studies including AAC systems, especially technologically advanced communication tools and systems, known as 'high-technology AAC', show key issues and obstacles for these tools to become utilized in mainstream clinical practice. Areas covered: The current review synthesizes communication intervention studies that involved the use of high-technology communication devices to enhance linguistic communication skills for adults with post-stroke aphasia. The review focuses on compensatory approaches that emphasized functional communication. It also summarizes recommendations for the report of studies evaluating high-technology devices that may be potentially relevant for other researchers working with adults with post-stroke aphasia. Expert commentary: Taken together with positive results in heterogeneous studies, high-technology devices represent a compensatory strategy to enhance communicative skills in individuals with post-stroke aphasia. Improvements in the design of studies and reporting of results may lead to better interpretation of the already existing scientific results from aphasia management.

  3. Effectiveness of low-frequency rTMS and intensive speech therapy in poststroke patients with aphasia: a pilot study based on evaluation by fMRI in relation to type of aphasia.

    Science.gov (United States)

    Abo, Masahiro; Kakuda, Wataru; Watanabe, Motoi; Morooka, Azusa; Kawakami, Katsuya; Senoo, Atsushi

    2012-01-01

    To assess the safety and clinical efficacy of low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) combined with intensive speech therapy (ST) in poststroke patients with aphasia. Twenty-four patients with left-hemispheric stroke and aphasia were subjected. During 11-day hospitalization, each patient received 10 treatment sessions consisting of 40-min 1-Hz LF-rTMS and 60-min intensive ST, excluding Sundays. The scalp area for stimulation was selected based on the findings of fMRI with language tasks and the type of aphasia. LF-rTMS was applied to the inferior frontal gyrus (IGF) for patients with nonfluent aphasia and to the superior temporal gyrus (STG) for patients with fluent aphasia. On pretreatment fMRI, the most activated areas were in the left hemisphere (n=16) and right hemisphere (n=8). The types of aphasia were nonfluent (n=14) and fluent (n=10). The LF-rTMS was applied to the right STG (n=5), left STG (n=5), right IFG (n=11) and left IFG (n=3). Nonfluent aphasic patients showed significant improvement of auditory comprehension, reading comprehension and repetition. Fluent aphasic patients showed significant improvement in spontaneous speech only. The fMRI with aphasic type-based therapeutic LF-rTMS/intensive ST for chronic aphasia seems feasible and a potentially useful neurorehabilitative protocol. Copyright © 2012 S. Karger AG, Basel.

  4. Diagnosis, phenomenology and treatment of poststroke depression

    Directory of Open Access Journals (Sweden)

    Starkstein Sergio E

    2002-01-01

    Full Text Available Diagnosing depression in stroke patients is a challenge in neuropsychiatry since depression symptoms may overlap neurological deficit signs. The best approach is to assess the presence of depressive symptoms using semi-structured or structured psychiatric interviews, such as the Present State Exam, the Structured Clinical Interview for DSM-IV or the Schedules for Clinical Assessment in Neuropsychiatry. The diagnosis of a depressive syndrome should be made according to standardized diagnostic criteria for mood disorders due to neurological disease such as in the DSM-IV or ICD-10. Depression rating scales such as the Hamilton Depression Scale and the Center for Epidemiologic Scales for Depression may be used to rate the depression severity and monitor the progression of antidepressant treatment. Most studies have reported the effectiveness of pharmacological treatment in patients with post-stroke depression, and there is preliminary evidence that the degree of impairment in activities of daily living (ADL may improve as well.

  5. A review of post-stroke urinary incontinence.

    Science.gov (United States)

    Tuong, Nicole E; Klausner, Adam P; Hampton, Lance J

    2016-06-01

    Cerebrovascular accidents, or strokes, are a common cause of morbidity and mortality in the United States. Urinary incontinence is a prevalent morbidity experienced by post-stroke patients that is associated with long term disability and institutionalization effects on these patients. An extensive literature review was conducted using multiple academic search engines using the keywords: 'stroke,' 'CVA,' 'urinary incontinence,' 'urodynamics,' 'pharmacologic treatments,' and 'conservative treatments.' Articles were reviewed and summarized to explain incidence, assessment, and treatments of urinary incontinence in post-stroke individuals. Twenty-eight percent to seventy-nine percent of stroke survivors experience urinary incontinence with detrusor overactivity being the most common type of incontinence assessed by urodynamic studies. There continues to be insufficient data studying the effects and benefits of non-pharmacologic and pharmacologic treatments in post-stroke patients. Similarly, urinary incontinence remains an indicator of increased morbidity, disability, and institutionalization rates in the post-stroke patient. Stroke is a debilitating disease which causes urinary incontinence in many patients. As a result, patients have increased rates of hospitalization and disability compared to post-stroke patients without urinary incontinence. The history and physical exam are key in diagnosing the type of urinary incontinence with urodynamic studies being an adjunctive study. Non-pharmacologic treatment, such as behavioral therapy, and pharmacologic agents including antimuscarinics and beta adrenergic medications, are not well studied in the post-stroke patient. Urinary incontinence in stroke patients needs to be further studied to help decrease morbidity and mortality rates within this population.

  6. Monitoring and evaluating recovery from natural disasters using remote sensing - towards creating guidelines on the use of satellite images in the context of disaster recovery

    Science.gov (United States)

    Saito, K.; Brown, D.; Spence, R.; Chenvidyakarn, T.; Adams, B.; Bevington, J.; Platt, S.; Chuenpagdee, R.; Juntarashote, K.; Khan, A.

    2009-04-01

    The use of high-resolution optical satellite images is being investigated for evaluating and monitoring recovery after natural disasters. Funded by EPSRC, UK, the aim of the RECOVERY project is to develop indicators of recovery that can exploit the wealth of data now available, including those from satellite imagery, internet-based statistics and advanced field survey techniques. The final output will be a set of guidelines that suggests how remote sensing can be used to help monitor and evaluate the recovery process after natural disasters. The final guideline that will be produced at the end of the two year project, which started in February 2008, will be freely available to aid agencies and anyone that is interested. Currently there is no agreed standard approach for evaluating the effectiveness of recovery aid, although international frameworks such as PDNA (Post-Disaster Needs Assessment, United Nations Development Program, European Commission and World Bank) is currently being developed, and TRIAMS (Tsunami Recovery and Impact Assessment and Monitoring System, by UNDP and WHO) is being implemented to monitor the recovery from the Indian Ocean Tsunami. The RECOVERY project consists of three phases. Phase 1 was completed by September 2008 and focused on user needs survey, developing the recovery indicators and satellite image data identification/acquisition. The user needs survey was conducted to identify whether there were any indicators that the aid community would like to see prioritised. The survey result suggested that most indicators are equally important. Based on this result and also referring to the TRIAMS framework, a comprehensive list of indicators were developed which belong to six large categories, i.e. housing, infrastructure, services, livelihood, environment, social/security, risk reduction. For the RECOVERY project, two case study sites have been identified, i.e. the village of Baan Nam Khem on the west coast of Thailand, which was heavily

  7. Evaluating recovery following hip fracture: a qualitative interview study of what is important to patients.

    Science.gov (United States)

    Griffiths, Frances; Mason, Victoria; Boardman, Felicity; Dennick, Katherine; Haywood, Kirstie; Achten, Juul; Parsons, Nicholas; Griffin, Xavier; Costa, Matthew

    2015-01-06

    To explore what patients consider important when evaluating their recovery from hip fracture and to consider how these priorities could be used in the evaluation of the quality of hip fracture services. Semistructured interviews exploring the experience of recovery from hip fracture at two time points-4 weeks and 4 months postoperative hip fixation. Two approaches to analysis: thematic analysis of data specifically related to recovery from hip fracture; summarising the participant's experience overall. 31 participants were recruited, of whom 20 were women and 12 were cognitively impaired. Mean age was 81.5 years. Interviews were provided by 19 patients, 14 carers and 8 patient/carer dyad; 10 participants were interviewed twice. Single major trauma centre in the West Midlands of the UK. Stable mobility (without falls or fear of falls) for valued activities was considered most important by participants who had some prefracture mobility and were able to articulate what they valued during recovery. Mobility was important for managing personal care, for day-to-day activities such as shopping and gardening, and for maintenance of mental well-being. Some participants used assistive mobility devices or adapted to their limitations. Others maintained their previous limited function through increased care provision. Many participants were unable to articulate what they valued as hip fracture was perceived as part of their decline with age. The fracture and problems from other health conditions were an inseparable part of one health experience. Prefracture mobility, adaptations to reduced mobility before or after fracture, and whether or not patients perceive themselves to be declining with age influence what patients consider important during recovery from hip fracture. No single patient-reported outcome measure could evaluate quality of care for all patients following hip fracture. General health-related quality of life tools may provide useful information within

  8. The steps to recovery program: Evaluation of a group-based intervention for older individuals receiving mental health services.

    Science.gov (United States)

    Flaherty-Jones, Graeme M; Carne, Alexandra S; Dexter-Smith, Sarah

    2016-03-01

    This study reports on the evaluation of a group-based intervention for older individuals receiving mental health services. A prospective cohort repeated-measure design was used for 48 participants who accessed secondary care mental health services for older people. Changes on the Recovery Assessment Scale (RAS), the Warwick-Edinburgh Mental Well-Being Scale (WEMWEBS), and a postevaluation questionnaire were analyzed. A paired sample t test examined changes in participant's scores on the WEMWEBS and RAS from baseline to postintervention. Participants qualitatively evaluated the Steps to Recovery group as having a positive effect on their recovery. Following involvement in this group intervention, participants reported improved mental well-being and recovery from mental health difficulty. These results suggest that the program has the potential to provide an accessible framework for developing recovery-orientated approaches in mental health care that can be delivered by care staff at all levels. (c) 2016 APA, all rights reserved).

  9. Patient and Family Member Factors Influencing Outcomes of Poststroke Inpatient Rehabilitation.

    Science.gov (United States)

    Fang, Yunhua; Tao, Qian; Zhou, Xiaoxuan; Chen, Shanjia; Huang, Jia; Jiang, Yingping; Wu, Yi; Chen, Lidian; Tao, Jing; Chan, Chetwyn C

    2017-02-01

    To investigate how family members' attitudes toward functional regain, and patients' knowledge and intention of independence influence poststroke rehabilitation. Cross-sectional study. Three rehabilitation inpatient settings. Younger (n=79) and older (n=84) poststroke patients, along with their family members (spouses, n=104; children, n=59). Not applicable. Custom-designed questionnaires were used to tap into the patients' knowledge about rehabilitation (Patient's Rehabilitation Questionnaire-Knowledge About Rehabilitation) and intention of independence (Patient's Rehabilitation Questionnaire-Intention of Independence), and family members' attitudes toward patients in performing basic activities of daily living (BADL) (Family Member Attitudes Questionnaire-BADL) and instrumental activities of daily living (Family Member Attitudes Questionnaire-instrumental activities of daily living). The rehabilitation outcomes included gains in motor, cognitive, and emotional functions, and self-care independence, measured with common clinical instruments. The Family Member Attitudes Questionnaire-BADL predicted cognitive outcome and the Patient's Rehabilitation Questionnaire-Intention of Independence predicted motor outcome for both groups. Differential age-related effects were revealed for the Patient's Rehabilitation Questionnaire-Intention of Independence in predicting emotional outcome only for the younger group, and self-care independence only for the older group. Patients' intention of independence positively affected motor recovery, while family members' positive attitudes promoted cognitive regain. The findings suggested plausible age-related differences in how patients' intentions affect emotion versus self-care independence outcomes. Future studies should explore strategies for promoting positive attitudes toward independence among patients and family members during poststroke rehabilitation. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by

  10. Long-term treatment with citicoline may improve poststroke vascular cognitive impairment.

    Science.gov (United States)

    Alvarez-Sabín, Jose; Ortega, Gemma; Jacas, Carlos; Santamarina, Estevo; Maisterra, Olga; Ribo, Marc; Molina, Carlos; Quintana, Manuel; Román, Gustavo C

    2013-01-01

    Cognitive decline after stroke is more common than stroke recurrence. Stroke doubles the risk of dementia and is a major contributor to vascular cognitive impairment and vascular dementia. Nonetheless, few pharmacological studies have addressed vascular cognitive impairment after stroke. We assessed the safety of long-term administration and its possible efficacy of citicoline in preventing poststroke cognitive decline in patients with first-ever ischemic stroke. Open-label, randomized, parallel study of citicoline vs. usual treatment. All subjects were selected 6 weeks after suffering a qualifying stroke and randomized by age, gender, education and stroke type into parallel arms of citicoline (1 g/day) for 12 months vs. no citicoline (control group). Medical management was similar otherwise. All patients underwent neuropsychological evaluation at 1 month, 6 months and 1 year after stroke. Tests results were combined to give indexes of 6 neurocognitive domains: attention and executive function, memory, language, spatial perception, motor speed and temporal orientation. Using adjusted logistic regression models we determined the association between citicoline treatment and cognitive decline for each neurocognitive domain at 6 and 12 months. We recruited 347 subjects (mean age 67.2 years, 186 male (56.6%), mean education 5.7 years); 172 (49.6%) received citicoline for 12 months (no significant differences from controls n = 175). Demographic data, risk factors, initial stroke severity (NIHSS), clinical and etiological classification were similar in both groups. Only 37 subjects (10.7%) discontinued treatment (10.5% citicoline vs. 10.9% control) at 6 months; 30 (8.6%) due to death (16 (9.3%) citicoline vs. 14 (8.0%) control, p = 0.740), 7 lost to follow-up or incorrect treatment, and 4 (2.3%) had adverse events from citicoline without discontinuation. 199 patients underwent neuropsychological evaluation at 1 year. Cognitive functions improved 6 and 12 months after

  11. Executive dysfunction post-stroke: an insight into the perspectives of physiotherapists.

    Science.gov (United States)

    Hayes, Sara; Donnellan, Claire; Stokes, Emma

    2015-01-01

    To gain an understanding of physiotherapy practice in relation to executive dysfunction (ED) post-stroke. Three focus groups were conducted using semi-structured interview schedules to highlight how ED post-stroke was understood by 12 physiotherapists with greater than 1 year of experience working in the area of stroke care. The focus group data were analysed using qualitative data analysis. The themes extracted from the data on physiotherapists' self-reported knowledge of ED post-stroke were: physiotherapists' lack of knowledge of ED post-stroke; current physiotherapy practice regarding ED post-stroke; the negative impact of ED on physiotherapy rehabilitation post-stroke and the future learning needs of physiotherapists regarding ED post-stroke. Current results demonstrate that ED has negative implications for physiotherapy rehabilitation post-stroke. Although further interdisciplinary research is warranted, the present results suggest that physiotherapists should be aware of the presence of ED in people post-stroke and develop strategies to minimise the impact of ED on physiotherapy rehabilitation. Implications for Rehabilitation Physiotherapists report a lack of knowledge of ED post-stroke and a requirement for future learning and training regarding the optimal management of people with ED undergoing physiotherapy rehabilitation post-stroke. ED has negative implications for physiotherapy rehabilitation post-stroke and physiotherapists should be aware of the presence of ED in people post-stroke and develop strategies to minimise the impact of ED on physiotherapy rehabilitation.

  12. Fluoxetine Enhances Neurogenesis in Aged Rats with Cortical Infarcts, but This is not Reflected in a Behavioral Recovery.

    Science.gov (United States)

    Sun, Xiaoyu; Zhou, Zhike; Liu, Tingting; Zhao, Mei; Zhao, Shanshan; Xiao, Ting; Jolkkonen, Jukka; Zhao, Chuansheng

    2016-02-01

    Age is associated with poor outcome and impaired functional recovery after stroke. Fluoxetine, which is widely used in clinical practice, can regulate hippocampal neurogenesis in young rodents. As the rate of neurogenesis is dramatically reduced during aging, we studied the effect of post-stroke fluoxetine treatment on neurogenesis in the subventricular zone (SVZ) and subgranular zone (SGZ) of dentate gyrus (DG) and whether this would be associated with any behavioral recovery after the cortical infarct in aged rats. Aged rats were randomly assigned to four groups: sham-operated rats, sham-operated rats treated with fluoxetine, rats subjected to cerebral ischemia, and rats with ischemia treated with fluoxetine. Focal cortical ischemia was induced by intracranial injection of vasoconstrictive peptide, endothelin-1 (ET-1). Fluoxetine was administered in the drinking water for 3 weeks starting 1 week after ischemia at a dose of 18 mg/kg/day. Behavioral recovery was evaluated on post-stroke days 29 to 31 after which the survival rate and fate of proliferating cells in the SVZ and DG were assessed by immunohistochemistry. Apoptosis was measured with the TUNEL assay. The results indicated that chronic fluoxetine treatment after stroke enhanced the proliferation of newborn neurons in the SVZ, but not in SGZ, and it suppressed perilesional apoptosis. Fluoxetine treatment did not affect the survival or differentiation of newly generated cells in the SVZ i.e., the enhanced neurogenesis was not translated into a behavioral outcome.

  13. Evaluation of Synthetic Vision Display Concepts for Improved Awareness in Unusual Attitude Recovery Scenarios

    Science.gov (United States)

    Nicholas, Stephanie

    2016-01-01

    A recent study conducted by the Commercial Aviation Safety Team (CAST) determined 40 percent of all fixed-wing fatal accidents, between 2001 and 2011, were caused by Loss-of-Control (LOC) in flight (National Transportation Safety Board, 2015). Based on their findings, CAST recommended manufacturers develop and implement virtual day-visual meteorological conditions (VMC) display systems, such as synthetic vision or equivalent systems (CAST, 2016). In a 2015 simulation study conducted at NASA Langley Research Center (LaRC), researchers gathered to test and evaluate virtual day-VMC displays under realistic flight operation scenarios capable of inducing reduced attention states in pilots. Each display concept was evaluated to determine its efficacy to improve attitude awareness. During the experiment, Evaluation Pilots (EPs) were shown the following three display concepts on the Primary Flight Display (PFD): Baseline, Synthetic Vision (SV) with color gradient, and SV with texture. The baseline configuration was a standard, conventional 'blue over brown' display. Experiment scenarios were simulated over water to evaluate Unusual Attitude (UA) recovery over 'featureless terrain' environments. Thus, the SV with color gradient configuration presented a 'blue over blue' display with a linear blue color progression, to differentiate attitude changes between sky and ocean. The SV with texture configuration presented a 'blue over blue' display with a black checkerboard texture atop a synthetic ocean. These displays were paired with a Background Attitude Indicator (BAI) concept. The BAI was presented across all four Head-Down Displays (HDDs), displaying a wide field-of-view blue-over-blue attitude indicator. The BAI aligned with the PFD and showed through the background of the navigation displays with opaque transparency. Each EP participated in a two-part experiment series with a total seventy-five trial runs: Part I included a set of twenty-five Unusual Attitude Recovery (UAR

  14. Localization of impaired kinesthetic processing post-stroke

    Directory of Open Access Journals (Sweden)

    Jeffrey Michael Kenzie

    2016-10-01

    Full Text Available Kinesthesia is our sense of limb motion, and allows us to gauge the speed, direction, and amplitude of our movements. Over half of stroke survivors have significant impairments in kinesthesia, which leads to greatly reduced recovery and function in everyday activities. Despite the high reported incidence of kinesthetic deficits after stroke, very little is known about how damage beyond just primary somatosensory areas affects kinesthesia. Stroke provides an ideal model to examine structure-function relationships specific to kinesthetic processing, by comparing lesion location with behavioral impairment. To examine this relationship, we performed voxel-based lesion-symptom mapping and statistical region of interest analyses on a large sample of sub-acute stroke subjects (N=142 and compared kinesthetic performance with stroke lesion location. Subjects with first unilateral, ischemic stroke underwent neuroimaging and a comprehensive robotic kinesthetic assessment (~9 days post-stroke. The robotic exoskeleton measured subjects’ ability to perform a kinesthetic mirror-matching task of the upper limbs without vision. The robot moved the stroke-affected arm and subjects’ mirror-matched the movement with the unaffected arm. We found that lesions both within and outside primary somatosensory cortex were associated with significant kinesthetic impairments. Further, sub-components of kinesthesia were associated with different lesion locations. Impairments in speed perception were primarily associated with lesions to the right post-central and supramarginal gyri whereas impairments in amplitude of movement perception were primarily associated with lesions in the right pre-central gyrus, anterior insula, and superior temporal gyrus. Impairments in perception of movement direction were associated with lesions to bilateral post-central and supramarginal gyri, right superior temporal gyrus and parietal operculum. All measures of impairment shared a common

  15. Constraint-induced aphasia therapy in post-stroke aphasia rehabilitation: A systematic review and meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Zhang, Jiaqi; Yu, Jiadan; Bao, Yong; Xie, Qing; Xu, Yang; Zhang, Junmei; Wang, Pu

    2017-01-01

    Constraint-induced aphasia therapy (CIAT) has been widely used in post-stroke aphasia rehabilitation. An increasing number of clinical controlled trials have investigated the efficacy of the CIAT for the post-stroke aphasia. To systematically review the randomized controlled trials (RCTs) concerning the effect of the CIAT in post-stroke patients with aphasia, and to identify the useful components of CIAT in post-stroke aphasia rehabilitation. A computerized database search was performed through five databases (Pubmed, EMbase, Medline, ScienceDirect and Cochrane library). Cochrane handbook domains were used to evaluate the methodological quality of the included RCTs. Eight RCTs qualified in the inclusion criteria. Inconsistent results were found in comparing the CIAT with conventional therapies without any component from the CIAT based on the results of three RCTs. Five RCTs showed that the CIAT performed equally well as other intensive aphasia therapies, in terms of improving language performance. One RCT showed that therapies embedded with social interaction were likely to enhance the efficacy of the CIAT. CIAT may be useful for improving chronic post-stroke aphasia, however, limited evidence to support its superiority to other aphasia therapies. Massed practice is likely to be a useful component of CIAT, while the role of "constraint" is needed to be further explored. CIAT embedded with social interaction may gain more benefits.

  16. Efficacy of Upper Extremity Robotic Therapy in Subacute Poststroke Hemiplegia: An Exploratory Randomized Trial.

    Science.gov (United States)

    Takahashi, Kayoko; Domen, Kazuhisa; Sakamoto, Tomosaburo; Toshima, Masahiko; Otaka, Yohei; Seto, Makiko; Irie, Katsumi; Haga, Bin; Takebayashi, Takashi; Hachisuka, Kenji

    2016-05-01

    Our aim was to study the efficacy of robotic therapy as an adjuvant to standard therapy during poststroke rehabilitation. Prospective, open, blinded end point, randomized, multicenter exploratory clinical trial in Japan of 60 individuals with mild to moderate hemiplegia 4 to 8 weeks post stroke randomized to receive standard therapy plus 40 minutes of either robotic or self-guided therapy for 6 weeks (7 days/week). Upper extremity impairment before and after intervention was measured using the Fugl-Meyer assessment, Wolf Motor Function Test, and Motor Activity Log. Robotic therapy significantly improved Fugl-Meyer assessment flexor synergy (2.1±2.7 versus -0.1±2.4; P<0.01) and proximal upper extremity (4.8±5.0 versus 1.9±5.5; P<0.05) compared with self-guided therapy. No significant changes in Wolf Motor Function Test or Motor Activity Log were observed. Robotic therapy also significantly improved Fugl-Meyer assessment proximal upper extremity among low-functioning patients (baseline Fugl-Meyer assessment score <30) and among patients with Wolf Motor Function Test ≥120 at baseline compared with self-guided therapy (P<0.05 for both). Robotic therapy as an adjuvant to standard rehabilitation may improve upper extremity recovery in moderately impaired poststroke patients. Results of this exploratory study should be interpreted with caution. URL: http://www.umin.ac.jp/. Unique identifier: UMIN000001619. © 2016 American Heart Association, Inc.

  17. Development of an ELISA for evaluation of swab recovery efficiencies of bovine serum albumin.

    Directory of Open Access Journals (Sweden)

    Nadja Sparding

    Full Text Available After a potential biological incident the sampling strategy and sample analysis are crucial for the outcome of the investigation and identification. In this study, we have developed a simple sandwich ELISA based on commercial components to quantify BSA (used as a surrogate for ricin with a detection range of 1.32-80 ng/mL. We used the ELISA to evaluate different protein swabbing procedures (swabbing techniques and after-swabbing treatments for two swab types: a cotton gauze swab and a flocked nylon swab. The optimal swabbing procedure for each swab type was used to obtain recovery efficiencies from different surface materials. The surface recoveries using the optimal swabbing procedure ranged from 0-60% and were significantly higher from nonporous surfaces compared to porous surfaces. In conclusion, this study presents a swabbing procedure evaluation and a simple BSA ELISA based on commercial components, which are easy to perform in a laboratory with basic facilities. The data indicate that different swabbing procedures were optimal for each of the tested swab types, and the particular swab preference depends on the surface material to be swabbed.

  18. Integrating research and clinical neuroimaging for the evaluation of traumatic brain injury recovery

    Science.gov (United States)

    Senseney, Justin; Ollinger, John; Graner, John; Lui, Wei; Oakes, Terry; Riedy, Gerard

    2015-03-01

    Advanced MRI research and other imaging modalities may serve as biomarkers for the evaluation of traumatic brain injury (TBI) recovery. However, these advanced modalities typically require off-line processing which creates images that are incompatible with radiologist viewing software sold commercially. AGFA Impax is an example of such a picture archiving and communication system(PACS) that is used by many radiology departments in the United States Military Health System. By taking advantage of Impax's use of the Digital Imaging and Communications in Medicine (DICOM) standard, we developed a system that allows for advanced medical imaging to be incorporated into clinical PACS. Radiology research can now be conducted using existing clinical imaging display platforms resources in combination with image processingtechniques that are only available outside of the clinical scanning environment. We extracted the spatial and identification elements of theDICOM standard that are necessary to allow research images to be incorporatedinto a clinical radiology system, and developed a tool that annotates research images with the proper tags. This allows for the evaluation of imaging representations of biological markers that may be useful in theevaluation of TBI and TBI recovery.

  19. Noninvasive brain stimulation for treatment of right- and left-handed poststroke aphasics.

    Science.gov (United States)

    Heiss, Wolf-Dieter; Hartmann, Alexander; Rubi-Fessen, Ilona; Anglade, Carole; Kracht, Lutz; Kessler, Josef; Weiduschat, Nora; Rommel, Thomas; Thiel, Alexander

    2013-01-01

    Accumulating evidence from single case studies, small case series and randomized controlled trials seems to suggest that inhibitory noninvasive brain stimulation (NIBS) over the contralesional inferior frontal gyrus (IFG) of right-handers in conjunction with speech and language therapy (SLT) improves recovery from poststroke aphasia. Application of inhibitory NIBS to improve recovery in left-handed patients has not yet been reported. A total of 29 right-handed subacute poststroke aphasics were randomized to receive either 10 sessions of SLT following 20 min of inhibitory repetitive transcranial magnetic stimulation (rTMS) over the contralesional IFG or 10 sessions of SLT following sham stimulation; 2 left-handers were treated according to the same protocol with real rTMS. Language activation patterns were assessed with positron emission tomography prior to and after the treatment; 95% confidence intervals for changes in language performance scores and the activated brain volumes in both hemispheres were derived from TMS- and sham-treated right-handed patients and compared to the same parameters in left-handers. Right-handed patients treated with rTMS showed better recovery of language function in global aphasia test scores (t test, p right-handers. In treated right-handers, a shift of activation to the ipsilesional hemisphere was observed, while sham-treated patients consolidated network activity in the contralesional hemisphere (repeated-measures ANOVA, p = 0.009). Both left-handed patients also improved, with 1 patient within the confidence limits of TMS-treated right-handers (23 points, 15.9-28.9) and the other patient within the limits of sham-treated subjects (8 points, 2.8-14.5). Both patients exhibited only a very small interhemispheric shift, much less than expected in TMS-treated right-handers, and more or less consolidated initially active networks in both hemispheres. Inhibitory rTMS over the nondominant IFG appears to be a safe and effective treatment

  20. What about self-management post-stroke? Challenges for stroke survivors, spouses and professionals

    NARCIS (Netherlands)

    Satink, A.J.H.

    2016-01-01

    Self-management post-stroke is challenging for many persons after a stroke. In this thesis is explored how stroke survivors, spouses and professionals perceived self-management post-stroke and how the process of self-management post-stroke evolved over time. The following studies are conducted: a

  1. Developing and evaluating an instrument to measure Recovery After INtensive care: the RAIN instrument.

    Science.gov (United States)

    Bergbom, Ingegerd; Karlsson, Veronika; Ringdal, Mona

    2018-01-01

    Measuring and evaluating patients' recovery, following intensive care, is essential for assessing their recovery process. By using a questionnaire, which includes spiritual and existential aspects, possibilities for identifying appropriate nursing care activities may be facilitated. The study describes the development and evaluation of a recovery questionnaire and its validity and reliability. A questionnaire consisting of 30 items on a 5-point Likert scale was completed by 169 patients (103 men, 66 women), 18 years or older (m=69, SD 12.5) at 2, 6, 12 or 24 months following discharge from an ICU. An exploratory factor analysis, including a principal component analysis with orthogonal varimax rotation, was conducted. Ten initial items, with loadings below 0.40, were removed. The internal item/scale structure obtained in the principal component analysis was tested in relation to convergent and discrimination validity with a multi-trait analysis. Items consistency and reliability were assessed by Cronbach's alpha and internal item consistency. Test of scale quality, the proportion of missing values and respondents' scoring at maximum and minimum levels were also conducted. A total of 20 items in six factors - forward looking, supporting relations, existential ruminations, revaluation of life, physical and mental strength and need of social support were extracted with eigen values above one. Together, they explained 75% of the variance. The half-scale criterion showed that the proportion of incomplete scale scores ranged from 0% to 4.3%. When testing the scale's ability to differentiate between levels of the assessed concept, we found that the observed range of scale scores covered the theoretical range. Substantial proportions of respondents, who scored at the ceiling for forward looking and supporting relations and at floor for the need of social support, were found. These findings should be further investigated. The factor analysis, including discriminant validity

  2. Factors Associated with Poststroke Fatigue: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Amélie Ponchel

    2015-01-01

    Full Text Available Background. Poststroke fatigue (PSF is a frequent, disabling symptom that lacks a consensual definition and a standardized evaluation method. The (multiple causes of PSF have not been formally characterized. Objective. To identify factors associated with PSF. Method. A systematic review of articles referenced in MEDLINE. Only original studies having measured PSF and potentially associated factors were included. Data was extracted from articles using predefined data fields. Results. Although PSF tends to be more frequent in female patients and older patients, sociodemographic factors do not appear to have a major impact. There are strong associations between PSF and emotional disturbances (such as depression and anxiety. PSF may also be linked to attentional disturbances (mainly slowing in processing speed. The literature data have failed to demonstrate a clear impact of the type and severity of stroke. It has been suggested that PSF results from alterations in the frontothalamostriatal system and/or inflammatory processes. Pain, sleep disorders, and prestroke fatigue also appeared to be associated with PSF. Implications. A better understanding of PSF may improve stroke patient care and facilitate the development of effective treatments.

  3. An intelligent recovery progress evaluation system for ACL reconstructed subjects using integrated 3-D kinematics and EMG features.

    Science.gov (United States)

    Malik, Owais A; Senanayake, S M N Arosha; Zaheer, Dansih

    2015-03-01

    An intelligent recovery evaluation system is presented for objective assessment and performance monitoring of anterior cruciate ligament reconstructed (ACL-R) subjects. The system acquires 3-D kinematics of tibiofemoral joint and electromyography (EMG) data from surrounding muscles during various ambulatory and balance testing activities through wireless body-mounted inertial and EMG sensors, respectively. An integrated feature set is generated based on different features extracted from data collected for each activity. The fuzzy clustering and adaptive neuro-fuzzy inference techniques are applied to these integrated feature sets in order to provide different recovery progress assessment indicators (e.g., current stage of recovery, percentage of recovery progress as compared to healthy group, etc.) for ACL-R subjects. The system was trained and tested on data collected from a group of healthy and ACL-R subjects. For recovery stage identification, the average testing accuracy of the system was found above 95% (95-99%) for ambulatory activities and above 80% (80-84%) for balance testing activities. The overall recovery evaluation performed by the proposed system was found consistent with the assessment made by the physiotherapists using standard subjective/objective scores. The validated system can potentially be used as a decision supporting tool by physiatrists, physiotherapists, and clinicians for quantitative rehabilitation analysis of ACL-R subjects in conjunction with the existing recovery monitoring systems.

  4. Evaluating the "recovery level" of endangered species without prior information before alien invasion.

    Science.gov (United States)

    Watari, Yuya; Nishijima, Shota; Fukasawa, Marina; Yamada, Fumio; Abe, Shintaro; Miyashita, Tadashi

    2013-11-01

    For maintaining social and financial support for eradication programs of invasive species, quantitative assessment of recovery of native species or ecosystems is important because it provides a measurable parameter of success. However, setting a concrete goal for recovery is often difficult owing to lack of information prior to the introduction of invaders. Here, we present a novel approach to evaluate the achievement level of invasive predator management based on the carrying capacity of endangered species estimated using long-term monitoring data. In Amami-Oshima Island, Japan, where the eradication project of introduced small Indian mongoose is ongoing since 2000, we surveyed the population densities of four endangered species threatened by the mongoose (Amami rabbit, the Otton frog, Amami tip-nosed frog, and Amami Ishikawa's frog) at four time points ranging from 2003 to 2011. We estimated the carrying capacities of these species using the logistic growth model combined with the effects of mongoose predation and environmental heterogeneity. All species showed clear tendencies toward increasing their density in line with decreased mongoose density, and they exhibited density-dependent population growth. The estimated carrying capacities of three endangered species had small confidence intervals enough to measure recovery levels by the mongoose management. The population density of each endangered species has recovered to the level of the carrying capacity at about 20-40% of all sites, whereas no individuals were observed at more than 25% of all sites. We propose that the present approach involving appropriate monitoring data of native organism populations will be widely applicable to various eradication projects and provide unambiguous goals for management of invasive species.

  5. Central Poststroke Pain: An Abstruse Outcome

    Directory of Open Access Journals (Sweden)

    James L Henry

    2008-01-01

    Full Text Available Central poststroke pain (CPSP, formerly known as thalamic pain syndrome of Déjerine and Roussy, is a central neuropathic pain occurring in patients affected by stroke. It is one manifestation of central pain, which is broadly defined as central neuropathic pain caused by lesions or dysfunction in the central nervous system. Thalamic pain was first described 100 years ago by Déjerine and Roussy and has been described as “among the most spectacular, distressing, and intractable of pain syndromes”. CPSP is characterized by constant or intermittent pain and is associated with sensory abnormalities, particularly of thermal sensation. While the pain is frequently described as burning, scalding, or burning and freezing, other symptoms are usually vague and hard to characterize, making an early diagnosis particularly difficult. In fact, those who develop CPSP may no longer be under the care of health care professionals when their symptoms begin to manifest, resulting in misdiagnosis or a significant delay before treatment begins. Diagnosis is further complicated by cognitive and speech limitations that may occur following stroke, as well as by depression, anxiety and sleep disturbances. Patients may also exhibit spontaneous dysesthesia and the stimulus-evoked sensory disturbances of dysesthesia, allodynia and hyperalgesia. The present study offers a historical reference point for future clinical and basic research into this elusive type of debilitating pain.

  6. Neuroscience insights improve neurorehabilitation of poststroke aphasia.

    Science.gov (United States)

    Berthier, Marcelo L; Pulvermüller, Friedemann

    2011-02-01

    The treatment of aphasias-acquired language disorders-caused by stroke and other neurological conditions has benefitted from insights from neuroscience and neuropsychology. Hebbian mechanisms suggest that massed practice and exploitation of residual neurological capacities can aid neurorehabilitation of patients with poststroke aphasia, and progress in basic neuroscience research indicates that the language system of the human brain is functionally interwoven with perceptual and motor systems. Intensive speech and language therapies, including constraint-induced aphasia therapy, that activate both the linguistic and concordant motor circuits utilize the knowledge gained from these advances in neuroscience research and can lead to surprisingly rapid improvements in language performance, even in patients with chronic aphasia. Drug-based therapies alone and in conjunction with behavioral language therapies also increase language performance in patients with aphasia. Furthermore, noninvasive transcranial magnetic stimulation and electrical stimulation techniques that target neuronal activity within perilesional areas might help patients with aphasia to regain lost language functions. Intensive language-action therapies that lead to rapid improvements in language skills might provide a new opportunity for investigating fast plastic neuronal changes in the areas of the brain associated with language processing. Here, we review progress in basic neuroscience research and its translational impact on the neurorehabilitation of language disorders after stroke.

  7. Mechanisms in the pathogenesis of poststroke spasticity

    Directory of Open Access Journals (Sweden)

    Elina Anatolyevna Katushkina

    2011-01-01

    Full Text Available Objective: to study the mechanisms of poststroke spasticity and the role of structural and functional impairments of skeletal muscles in its pathogenesis. Patients and methods. Thirty-two patients with prior hemispheric stroke and evolving spastic paresis were examined. Neurophysiological studies of upper and lower motor neuron functions and morphological, histochemical, and immunohistochemical studies of soleus muscle biopsy specimens were conducted. Results. There was diminished excitability of cortical neurons, impaired conduction along the pyramidal tracts, and hyperexcitability of the segmental apparatus of the spinal cord. The muscle exhibited myosin phenotype transformation with a preponderance of fast type II fibers, as well as a higher fiber diameter variability and a lower muscle tissue capillarization. The late periods of spasticity were marked by better conduction along the pyramidal tract, at the same time structural changes tended to increase in skeletal muscle tissue. The time course of the changes suggests that there is partial reversibility in the central nervous system and skeletal muscle, which allows elaboration of approaches to differentiated therapy for the above conditions.

  8. 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.

  9. Psychometric evaluation of the Dutch version of the Mental Health Recovery Measure (MHRM)

    NARCIS (Netherlands)

    van Nieuwenhuizen, Ch.; Wilrycx, G.K.M.L.; Moradi, M.; Brouwers, E.P.M.

    2014-01-01

    Background: During the past decade, the mental health consumer movement has drawn the attention of mental health providers, researchers and policy makers to the concept of recovery. Traditionally, recovery primarily refers to the remission of symptoms. Nowadays, recovery is also regarded in a sense

  10. Early filiform needle acupuncture for poststroke depression: a meta-analysis of 17 randomized controlled clinical trials

    OpenAIRE

    Zhang, Jiping; Chen, Jing; Chen, Junqi; Li, Xiaohui; Lai, Xueyan; Zhang, Shaoqun; Wang, Shengxu

    2014-01-01

    OBJECTIVE: To evaluate the effectiveness and safety of filiform needle acupuncture for poststroke depression, and to compare acupuncture with the therapeutic efficacy of antidepressant drugs. DATA RETRIEVAL: We retrieved data from the Chinese National Knowledge Infrastructure (1979–2012), Wanfang (1980–2012), VIP (1989–2012), Chinese Biomedical Literature (1975–2012), PubMed (1966–2012), Ovid Lww (–2012), and Cochrane Library (–2012) Database using the internet. SELECTION CRITERIA: Randomized...

  11. Quality of life and post-stroke aphasic syndromes

    OpenAIRE

    Sinanović, Osman; MRKONJIĆ, ZAMIR; ZEČIĆ, SADETA

    2012-01-01

    Objective: Quality of life of patients with post-stroke aphasia is very important aspect of research and rehabilitation of these persons. The aim of this study was to investigate the impact of severity and type of aphasia on quality of life in patients after one year of onset of first-ever stroke. Subjects and Methods: It was investigated 51 post-stroke adult aphasic patients (23 males and 28 females) who were treated at the Department of Neurology, University Clinical Center Tuzla, Bo...

  12. Natural history of post-stroke apathy during acute rehabilitation

    Science.gov (United States)

    Kennedy, Juliana M.; Granato, Dora A.; Goldfine, Andrew M.

    2015-01-01

    To better understand the natural history of post-stroke apathy, the authors tested 96 patients undergoing acute rehabilitation for stroke using the Apathy Inventory (AI). 28% of patients had apathy, and their AI scores improved on average 1 point by week 2 and 2 points by week 3 with the majority apathetic at discharge. Apathy severity correlated with aphasia, weakness, and impaired cognition, but not with depression. The findings suggest that acute rehabilitation is an optimal setting for clinical trials for post-stroke apathy because apathy is associated with poor outcomes and shows only a small degree of spontaneous improvement. PMID:26185903

  13. Natural History of Poststroke Apathy During Acute Rehabilitation.

    Science.gov (United States)

    Kennedy, Juliana M; Granato, Dora A; Goldfine, Andrew M

    2015-01-01

    To better understand the natural history of poststroke apathy, the authors tested 96 patients undergoing acute rehabilitation for stroke using the Apathy Inventory. A total of 28% of patients had apathy. Their Apathy Inventory scores improved a mean of 1 point by week 2 and 2 points by week 3, with the majority of patients remaining apathetic at discharge. Apathy severity correlated with aphasia, weakness, and impaired cognition but did not correlate with depression. These findings suggest that acute rehabilitation is an optimal setting for clinical trials for poststroke apathy, because apathy is associated with poor outcomes and shows only a small degree of spontaneous improvement.

  14. Increased work and social engagement is associated with increased stroke specific quality of life in stroke survivors at 3 months and 12 months post-stroke: a longitudinal study of an Australian stroke cohort.

    Science.gov (United States)

    Tse, Tamara; Binte Yusoff, Siti Zubaidah; Churilov, Leonid; Ma, Henry; Davis, Stephen; Donnan, Geoffrey Alan; Carey, Leeanne M

    2017-09-01

    There is a relative lack of longitudinal studies investigating stroke-specific outcomes and quality of life (QOL). This study aimed to identify which factors (level of disability, cognitive functioning, depressive symptoms, physical activity, and work and social engagement) were independently associated with each stroke-specific domain of QOL, adjusting for age and gender, at 3 months and 12 months post-stroke in an Australian cohort. Survivors of ischemic stroke were recruited from 18 sites of the STroke imAging pRevention and Treatment (START) longitudinal cohort study. Survivors were assessed at 3 months (n = 185) and 12 months (n = 170) post-stroke using the Stroke Impact Scale (SIS), modified Rankin Scale (mRS), Montreal Cognitive Assessment (MoCA), Montgomery-Asberg Depression Rating Scale, Rapid Assessment of Physical Activity, and Work and Social Adjustment Scale (WSAS). WSAS was independently associated with the SIS domains of: Physical Composite function; Participation; and Perceived Recovery at 3 months and 12 months and SIS domain of Emotion at 12 months post-stroke. The presence of depressive symptoms was independently associated with the SIS domains of: Memory and Thinking; and Emotion at 3 months. At 12 months post-stroke, mRS was independently associated with SIS domain of Physical Composite function and MoCA with SIS domain of Communication. Engaging in work and social activities is an important factor associated with stroke-specific domains of QOL over time. It is recommended that services focus on improving work and social engagement given their importance related to QOL in the first year of recovery post-stroke. Identifying and treating those with depressive symptoms may enhance QOL in the early months post-stroke. START-PrePARE Australian New Zealand Clinical Trials, www.anzctr.org.au , Registry number: ACTRN12610000987066. EXTEND ClinicalTrial.gov identifier: NCT00887328.

  15. Evaluating post-wildfire hydrologic recovery using ParFlow in southern California

    Science.gov (United States)

    Lopez, S. R.; Kinoshita, A. M.; Atchley, A. L.

    2016-12-01

    Wildfires are naturally occurring hazards that can have catastrophic impacts. They can alter the natural processes within a watershed, such as surface runoff and subsurface water storage. Generally, post-fire hydrologic models are either one-dimensional, empirically-based models, or two-dimensional, conceptually-based models with lumped parameter distributions. These models are useful in providing runoff measurements at the watershed outlet; however, do not provide distributed hydrologic simulation at each point within the watershed. This research demonstrates how ParFlow, a three-dimensional, distributed hydrologic model can simulate post-fire hydrologic processes by representing soil burn severity (via hydrophobicity) and vegetation recovery as they vary both spatially and temporally. Using this approach, we are able to evaluate the change in post-fire water components (surface flow, lateral flow, baseflow, and evapotranspiration). This model is initially developed for a hillslope in Devil Canyon, burned in 2003 by the Old Fire in southern California (USA). The domain uses a 2m-cell size resolution over a 25 m by 25 m lateral extent. The subsurface reaches 2 m and is assigned a variable cell thickness, allowing an explicit consideration of the soil burn severity throughout the stages of recovery and vegetation regrowth. Vegetation regrowth is incorporated represented by satellite-based Enhanced Vegetation Index (EVI) products. The pre- and post-fire surface runoff, subsurface storage, and surface storage interactions are evaluated and will be used as a basis for developing a watershed-scale model. Long-term continuous simulations will advance our understanding of post-fire hydrological partitioning between water balance components and the spatial variability of watershed processes, providing improved guidance for post-fire watershed management.

  16. Research and Evaluations of the Health Aspects of Disasters, Part VII: The Relief/Recovery Framework.

    Science.gov (United States)

    Birnbaum, Marvin L; Daily, Elaine K; O'Rourke, Ann P

    2016-04-01

    The principal goal of research relative to disasters is to decrease the risk that a hazard will result in a disaster. Disaster studies pursue two distinct directions: (1) epidemiological (non-interventional); and (2) interventional. Both interventional and non-interventional studies require data/information obtained from assessments of function. Non-interventional studies examine the epidemiology of disasters. Interventional studies evaluate specific interventions/responses in terms of their effectiveness in meeting their respective objectives, their contribution to the overarching goal, other effects created, their respective costs, and the efficiency with which they achieved their objectives. The results of interventional studies should contribute to evidence that will be used to inform the decisions used to define standards of care and best practices for a given setting based on these standards. Interventional studies are based on the Disaster Logic Model (DLM) and are used to change or maintain levels of function (LOFs). Relief and Recovery interventional studies seek to determine the effects, outcomes, impacts, costs, and value of the intervention provided after the onset of a damaging event. The Relief/Recovery Framework provides the structure needed to systematically study the processes involved in providing relief or recovery interventions that result in a new LOF for a given Societal System and/or its component functions. It consists of the following transformational processes (steps): (1) identification of the functional state prior to the onset of the event (pre-event); (2) assessments of the current functional state; (3) comparison of the current functional state with the pre-event state and with the results of the last assessment; (4) needs identification; (5) strategic planning, including establishing the overall strategic goal(s), objectives, and priorities for interventions; (6) identification of options for interventions; (7) selection of the most

  17. Health care in patients 1 year post-stroke in general practice : research on the utilisation of the Dutch Transmural Protocol transient ischaemic attack/cerebrovascular accident

    NARCIS (Netherlands)

    de Weerd, L.; Rutgers, A.W.F.; Groenier, K.H.; van der Meer, K.

    2012-01-01

    This study evaluates the kind of aftercare that ischaemic stroke patients receive and the extent that aftercare fulfils the criteria of the 'Dutch Transmural Protocol transient ischaemic attack/cerebrovascular accident'. Fifty-seven patients were interviewed 1 year post-stroke about secondary

  18. Evaluation of different flooding scenarios as enhanced oil recovery method in a fractured reservoir: a case study

    Energy Technology Data Exchange (ETDEWEB)

    Shahvaranfard, A. [Petroleum University of Technology, Abadan (Iran, Islamic Republic of); Moradi, B. [Iranian Central Oil Fields Company (Iran, Islamic Republic of)], E-mail: morady.babak@gmail.com; Tahami, S.A.; Gholami, A. [Petropars Oil and Gas Institute (POGI), Tehran (Iran, Islamic Republic of)

    2009-07-15

    Because of technological complexity and financial requirements to initiate a gas flooding project, a thorough evaluation is necessary before it is performed. In this paper, a reservoir modeling approach was used to evaluate different flooding processes (miscible and immiscible) in a fractured oil reservoir. This study included: (1) equation of state (EOS) modeling of experimental PVT data, (2) determination of MMP for different gas compositions using a slim-tube model and study of the effect of grid number on the results (numerical dispersion), (3) study of the effect of completion pattern and injection rate on recovery performance, and (4) comparison of the recovery performance in different flooding scenarios. (author)

  19. [Clinical observation on the therapeutic effect of electroacupuncture combined with cupping on post-stroke fatigue].

    Science.gov (United States)

    Zhou, Yuan; Zhou, Guo-Ying; Li, Shao-Kun; Jin, Jian-Hong

    2010-10-01

    To observe the therapeutic effect of electroacupuncture (EA) combined with cupping at the lumbo-back on post-stroke fatigue. A total of 128 cases of post-stroke fatigue patients were randomly divided into EA + cupping group and medication group, with 64 cases in each group. EA (20 Hz, 2 mA) was applied to Baihui (GV 20), Yintang (EX-HN 3), Shuigou (GV 26), Hegu (LI 4), Zusanli (ST 36), Sanyinjiao (SP 6), and Taichong (LR 3) for 30 min, once daily for 30 times, and cupping was applied at the patient's lumbo-back region once every two days, and continuously for 5 weeks. Patients of medication group were ordered to take compound aminobutyric acid vitamin E capsule (20 mg, t. i.d, po), magnesium gluconate solution (10 mL, t. i. d, po), sertraline hydrochloridetablet (50 mg, qd, po) for 5 weeks. The Stroke Specific Quality of Life Scale (SS-QOL) was used to evaluate the patients' energy state. After the treatment, the energy scores of SS-QOL of both EA + cupping and medication groups were increased significantly in comparison with the pre-treatment in each group (P cupping group was significantly higher than the score of the medication group (P cupping group and medication group, 42 and 23 were recovered basically, 13 and 13 experienced marked improvement, 7 and 18 were effective, 2 and 10 failed in the treatment, with the effective rates being 96.87% and 84.37% respectively. The effective rate of EA + cupping group was obviously higher than that of medication group (P cupping at the lumbo-back can effectively relieve fatigue of post-stroke patients, and its therapeutic effect is superior to medication.

  20. Reducing depressive or anxiety symptoms in post-stroke patients: Pilot trial of a constructive integrative psychosocial intervention.

    Science.gov (United States)

    Fang, Yihong; Mpofu, Elias; Athanasou, James

    2017-01-01

    About 30% of stroke survivors clinically have depressive symptoms at some point following stroke and anxiety prevalence is around 20-25%. The purpose of this brief report is to evaluate a pilot trial of a constructive integrative psychosocial intervention (CIPI) over standard care in post-stroke depression or anxiety. Patients were randomly assigned to either CIPI ( n = 23) or standard care ( n = 19). Patients were assessed using the Hospital Anxiety and Depression Scale at the 1 st , 3 rd , and 6 th months to monitor changes of mood. A Wilcoxon signed-rank test indicated that compared to admission baseline, patients with the intervention had significantly normal post-stroke depression symptom levels at the 1 st , 3 rd , and 6 th months ( P < 0.005). CIPI appears to be of incremental value in treating depression as well as anxiety in subacute care.

  1. Vitamin D profile of patients with spinal cord injury and post-stroke hemiplegia: All in the same boat.

    Science.gov (United States)

    Coskun Benlidayi, Ilke; Basaran, Sibel; Seydaoglu, Gulsah; Guzel, Rengin

    2016-04-27

    Patients with spinal cord injury (SCI) and hemiplegia are at risk of fractures partly due to decreased bone mineral density with relation to the low levels of vitamin D. The objective of this study is to evaluate the vitamin D profile of patients with SCI and post-stroke hemiplegia. 25(OH)D levels of patients with SCI and hemiplegia were obtained from the electronic medical record database and compared with age- and sex-matched non-disabled controls. Furthermore, the effect of Functional Ambulation Category (FAC), American Spinal Injury Association (ASIA) level and Brunnstrom's recovery stage, on vitamin D insufficiency, was studied. The study sample consisted of 173 individuals (118 patients and 55 controls). Vitamin D levels and sufficiency rates of the neurologically disabled patients was significantly lower than that of controls (p= 0.000 and p= 0.000, respectively). However, there was no difference between patients with SCI and hemiplegia regarding the 25(OH)D levels and vitamin D insufficiency (p= 0.303 and p= 0.952, respectively). There were no statistically significant differences in vitamin D status by American Spinal Injury Association (ASIA) level and Brunnstrom's score. However, regression analysis revealed that vitamin D insufficiency rate of non-functionally ambulatory (FAC = 0-2) patients was higher than that of functionally ambulatory (FAC = 3-5) ones (p= 0.044). Vitamin D status of patients with neurological disabilities was lower than that of controls. Non-functionally ambulatory patients had higher vitamin D insufficiency rate than functionally ambulatory patients. Preventative measures including adequate supplementation of vitamin D should be directed to neurologically disabled subjects, particularly those with non-functional ambulation.

  2. Preliminary evaluation of resinite recovery from Illinois coal. [Quarterly] technical report, September 1--November 30, 1994

    Energy Technology Data Exchange (ETDEWEB)

    Crelling, J.C. [Southern Illinois Univ., Carbondale, IL (United States). Dept. of Geology

    1994-12-31

    Resinite is a naturally occurring substance found in coal and derived from original plant resins. It is ubiquitous in North American coals. It makes up one to four percent by volume of most Illinois coals. It has been commercially exploited in the western USA for use in adhesives, varnishes and thermal setting inks. The overall objective of this project is to compare the properties of the resinite contained in Illinois Basin coals to resinite being commercially exploited in the western United States, and to recover the resinite from Illinois coals by microbubble column floatation techniques. The significance of this study is that it has the potential to show the way to recover a valuable chemical, resinite, from coal using only physical processing techniques. The value of the resinite at $1.00/kg or $0.50/lb makes it about fifty times more valuable than steam coal. The removal of resinite from coal does not decrease the value of the remaining coal in any way. The unique aspects are that: (1) it is the first examination of the resinite recovery potential of Illinois coal, (2) it integrates the latest characterization techniques such as density Gradient centrifugation, microspectrofluorometry, and gas chromatography- mass spectrometry, and (3) it uses microbubble column flotation to determine the resinite recovery potential. During this quarter samples were obtained, information from both the databases of both the Illinois State Geological Survey (ISGS) and the Pennsylvania State University (PSU) was obtained and evaluated, and EBCSP samples from the Herrin No. 6, the Springfield No. 5 and the Colchester No. 2 seams were analyzed petrographically and the resinites in these samples were characterized by fluorescence spectral analysis.

  3. Preliminary evaluation of resinite recovery from Illinois coal. Technical report, December 1, 1994--February 28, 1995

    Energy Technology Data Exchange (ETDEWEB)

    Crelling, J.C.

    1995-12-31

    Resinite is a naturally occurring substance found in coal and derived from original plant resins. It is ubiquitous in North American coals. It makes up one to four percent by volume of most Illinois coals. It has been commercially exploited in the western USA for use in adhesives, varnishes and thermal setting inks. The overall objective of this project is to compare the properties of the resinite contained in Illinois Basin coals to resinite being commercially exploited in the western United States, and to recover the resinite from Illinois coals by microbubble column floatation techniques. This project is relevant to priority 1.4A identified in ICCI/RFP93-1. The significance of this study is that it has the potential to show the way to recover a valuable chemical, resinite, from coal using only physical processing techniques. The value of the resinite at $1.00/kg or $0.50/lb makes it about fifty times more valuable than steam coal. The removal of resinite from coal does not decrease the value of the remaining coal in any way. The unique aspects are that: (1) it is the first examination of the resinite recovery potential of Illinois coal, (2) it integrates the latest characterization techniques such as density gradient centrifugation, microspectrofluorometry, and gas chromatography-mass spectrometry, and (3) it uses microbubble column flotation to determine the resinite recovery potential. During this quarter samples were obtained, information from both the databases of both the Illinois State Geological Survey (ISGS) and the Pennsylvania State University (PSU) was obtained and evaluated, and IBCSP samples from the Herrin No. 6, the Springfield No. 5 and the Colchester No. 2 seams were analyzed petrographically and the resinites in these samples were characterized by fluorescence spectral analysis.

  4. Assessing neuro-motor recovery in a stroke survivor with high-resolution EEG, robotics and Virtual Reality.

    Science.gov (United States)

    Comani, Silvia; Schinaia, Lorenzo; Tamburro, Gabriella; Velluto, Lucia; Sorbi, Sandro; Conforto, Silvia; Guarnieri, Biancamaria

    2015-01-01

    One post-stroke patient underwent neuro-motor rehabilitation of one upper limb with a novel system combining a passive robotic device, Virtual Reality training applications and high resolution electroencephalography (HR-EEG). The outcome of the clinical tests and the evaluation of the kinematic parameters recorded with the robotic device concurred to highlight an improved motor recovery of the impaired limb despite the age of the patient, his compromised motor function, and the start of rehabilitation at the 3rd week post stroke. The time frequency and functional source analysis of the HR-EEG signals permitted to quantify the functional changes occurring in the brain in association with the rehabilitation motor tasks, and to highlight the recovery of the neuro-motor function.

  5. Sleep disturbance impairs stroke recovery in the rat.

    Science.gov (United States)

    Zunzunegui, Cristina; Gao, Bo; Cam, Ertugrul; Hodor, Aleksandra; Bassetti, Claudio L

    2011-09-01

    There is a lack of experimental evidence to support the hypothesis that sleep may modulate stroke outcome as suggested by clinical observations. We have previously shown that sleep disturbance (SDis) over 3 days aggravates brain damage in a rat model of focal cerebral ischemia. The aim of this study is to further investigate effects of SDis on long-term stroke recovery and neuroplasticity as assessed by axonal sprouting, neurogenesis, and angiogenesis. Focal cerebral ischemia was induced by permanent occlusion of the distal branches of middle cerebral artery. Twelve hours after initiation of ischemia, SDis was performed over 3 consecutive days (deprivation of 80% sleep during the 12-h light phase). Weekly assessments on sensorimotor function by the single pellet reaching test (SPR) were performed for 5 weeks after surgery. Axonal sprouting was evaluated by anterograde tracing with biotinylated dextran amine (BDA) and neurogenesis/angiogenesis by bromodeoxyuridine (BrdU) labelling along with cell-type markers. Control groups included ischemia without SDis, sham with SDis, and sham without SDis. Basic sleep research laboratory. Rats subjected to SDis after ischemia showed significantly less recovery of forearm motor skills during the post-stroke period of 5 weeks. This effect was accompanied by a substantial reduction in axonal sprouting, expression of synaptophysin, and the ischemia-stimulated neural and vascular cell proliferation. SDis has detrimental effects on functional and morphological/structural outcomes after stroke, suggesting a role of sleep in the modulation of recovery processes and neuroplasticity.

  6. Post-stroke depression among stroke survivors attending two ...

    African Journals Online (AJOL)

    Background: The burden of stroke worldwide is increasing rapidly. There is paucity of data on post-stroke depression (PSD) among stroke survivors in Uganda, despite the high prevalence of PSD reported elsewhere. Methods: In a cross-sectional study, we assessed adult participants with confirmed first stroke with a ...

  7. Poststroke epilepsy in the Copenhagen stroke study: incidence and predictors

    DEFF Research Database (Denmark)

    Kammersgaard, Lars Peter; Olsen, Tom Skyhøj

    2005-01-01

    Poststroke epilepsy (PSE) is a feared complication after stroke and is reported in 3% to 5% of stroke survivors. In this study we sought to identify incidence and predictors of PSE in an unselected stroke population with a follow-up period of 7 years. The study was community-based and comprises...

  8. POST-STROKE COGNITIVE IMPAIRMENT – PHENOMENOLOGY AND PROGNOSTIC FACTORS

    Directory of Open Access Journals (Sweden)

    Maya Danovska

    2012-09-01

    Full Text Available Stroke patients are at higher risk of developing cognitive impairment. Cognitive dysfunctions, especially progressive ones, worsen stroke prognosis and outcome. A longitudinal follow-up of cognitive disorders, however, is rendered difficult by their heterogeneity and the lack of definitions generally agreed upon. Stroke is a major cause of cognitive deficit. The identification of risk factors, clinical determinants and laboratory markers of post-stroke cognitive deficit may help detect patients at increased risk of cognitive deterioration, and prevent or delay the occurrence of post-stroke cognitive impairments. Though inflammatory processes have been implicated in the pathogenesis of stroke, their role in the complex pathophysiological mechanisms of post-stroke cognitive impairment is not completely understood. Evidence suggests that elevated serum C-reactive protein is associated with both the increased risk of stroke and post-stroke cognitive deficit. The hypothesis of a possible relationship between markers of systemic inflammation and cognitive dysfunctions raises the question of how rational the option of applying non-steroidal anti-inflammatory drugs in a proper therapeutic window will be, especially during the acute phase of stroke, to prevent cognitive decline and dementia.

  9. Patients' Experiences of Disruptions Associated with Post-Stroke Dysarthria

    Science.gov (United States)

    Dickson, Sylvia; Barbour, Rosaline S.; Brady, Marian; Clark, Alexander M.; Paton, Gillian

    2008-01-01

    Background: Post-stroke dysarthria rehabilitation should consider social participation for people with dysarthria, but before this approach can be adopted, an understanding of the psychosocial impact of dysarthria is required. Despite the prevalence of dysarthria as a result of stroke, there is a paucity of research into this communication…

  10. POST-STROKE ARTHROPATHIES: PHENOMENOLOGY AND STRUCTURAL JOINT ABNORMALITIES

    Directory of Open Access Journals (Sweden)

    A. A. Telenkov

    2015-01-01

    Full Text Available Background: In the post-stroke period, arthropathies of paretic limbs are frequently seen. They may lead to formation of contractures, with significant limitation of active and passive movements due to severe pain in affected joints. This can hinder restoration of motor functions and consequently lead to a dramatic deterioration of quality of life.Aim: To study phenomenology of a post-stroke arthropathic syndrome and specific types of joint abnormalities.Materials and methods: The study included 148 patients with post-stroke hemiparesis. In all patients we analyzed demographic characteristics, stroke type, localization and size, absence or presence of concurrent circulatory encephalopathy and diabetes mellitus. A full neurologic examination was done with assessment of a degree of motor dysfunction. Pathogenetic subtypes of ischemic strokes were determined by means of duplex scanning of major head arteries, assessment of blood rheology and lipid profile. Assessment of joints was done by ultrasound examination and computer tomography.Results: One hundred and eighteen of 148 patients had post-stroke hemiparesis without joint abnormalities, whereas 30 patients had post-stroke hemiparesis with associated arthropathies. Most patients were elderly (≥ 60 years, 75 patients, 16 of them having arthropathies. One hundred and twenty of patients had ischemic strokes, 28 patients had hemorrhagic strokes. A lacunar subtype of stroke was the most prevalent among all patients (29 of patients, or 24%, whereas among those with arthropathies, the most prevalent type of stroke was cardioembolic (8 of patients, 33%. From 30 patients with arthropathies, isolated shoulder arthropathy was seen in 26, in combination with other arthropathies, in 2; isolated wrist arthropathy was seen in 2 patients. Arthropathies manifested within the first two to three weeks after a stroke in 9 patients (including shoulder arthropathies in 7 of them. In all other patients, arthropathies

  11. Relationship between postural alignment in sitting by photogrammetry and seated postural control in post-stroke subjects.

    Science.gov (United States)

    Iyengar, Y R; Vijayakumar, K; Abraham, J M; Misri, Z K; Suresh, B V; Unnikrishnan, B

    2014-01-01

    This study was executed to find out correlation between postural alignment in sitting measured through photogrammetry and postural control in sitting following stroke. A cross-sectional study with convenient sampling consisting of 45 subjects with acute and sub-acute stroke. Postural alignment in sitting was measured through photogrammetry and relevant angles were obtained through software MB Ruler (version 5.0). Seated postural control was measured through Function in Sitting Test (FIST). Correlation was obtained using Spearman's Rank Correlation co-efficient in SPSS software (version 17.0). Moderate positive correlation (r = 0.385; p < 0.01) was found between angle of lordosis and angle between acromion, lateral epicondyle and point between radius and ulna. Strong negative correlation (r = -0.435; p < 0.01) was found between cranio-vertebral angle and kyphosis. FIST showed moderate positive correlation (r = 0.3446; p < 0.05) with cranio-vertebral angle and strong positive correlation (r = 0.4336; p < 0.01) with Brunnstrom's stage of recovery in upper extremity. Degree of forward head posture in sitting correlates directly with seated postural control and inversely with degree of kyphosis in sitting post-stroke. Postural control in sitting post-stroke is directly related with Brunnstrom's stage of recovery in affected upper extremity in sitting.

  12. Decoding post-stroke motor function from structural brain imaging

    Directory of Open Access Journals (Sweden)

    Jane M. Rondina

    2016-01-01

    Full Text Available Clinical research based on neuroimaging data has benefited from machine learning methods, which have the ability to provide individualized predictions and to account for the interaction among units of information in the brain. Application of machine learning in structural imaging to investigate diseases that involve brain injury presents an additional challenge, especially in conditions like stroke, due to the high variability across patients regarding characteristics of the lesions. Extracting data from anatomical images in a way that translates brain damage information into features to be used as input to learning algorithms is still an open question. One of the most common approaches to capture regional information from brain injury is to obtain the lesion load per region (i.e. the proportion of voxels in anatomical structures that are considered to be damaged. However, no systematic evaluation has yet been performed to compare this approach with using patterns of voxels (i.e. considering each voxel as a single feature. In this paper we compared both approaches applying Gaussian Process Regression to decode motor scores in 50 chronic stroke patients based solely on data derived from structural MRI. For both approaches we compared different ways to delimit anatomical areas: regions of interest from an anatomical atlas, the corticospinal tract, a mask obtained from fMRI analysis with a motor task in healthy controls and regions selected using lesion-symptom mapping. Our analysis showed that extracting features through patterns of voxels that represent lesion probability produced better results than quantifying the lesion load per region. In particular, from the different ways to delimit anatomical areas compared, the best performance was obtained with a combination of a range of cortical and subcortical motor areas as well as the corticospinal tract. These results will inform the appropriate methodology for predicting long term motor outcomes

  13. Effect of inversion time on the precision of myocardial late gadolinium enhancement quantification evaluated with synthetic inversion recovery MR imaging

    NARCIS (Netherlands)

    Varga-Szemes, Akos; van der Geest, Rob J; Schoepf, U Joseph; Spottiswoode, Bruce S; De Cecco, Carlo N; Muscogiuri, Giuseppe; Wichmann, Julian L; Mangold, Stefanie; Fuller, Stephen R; Maurovich-Horvat, Pal; Merkely, Bela; Litwin, Sheldon E; Vliegenthart, Rozemarijn; Suranyi, Pal

    OBJECTIVES: To evaluate the influence of inversion time (TI) on the precision of myocardial late gadolinium enhancement (LGE) quantification using synthetic inversion recovery (IR) imaging in patients with myocardial infarction (MI). METHODS: Fifty-three patients with suspected prior MI underwent

  14. Evaluation of functionalized silica¿s for the adsorptive recovery of homogenous catalysts through interaction with the metal centre

    NARCIS (Netherlands)

    Djekic, T.; van der Ham, Aloysius G.J.; de Haan, A.B.

    2007-01-01

    The goal of this paper is the evaluation of functionalized silica's for the recovery of homogeneous catalysts by adsorption via its metal centre. As model catalysts, we selected bis(triphenylphosphine)cobalt(II)dichloride (CoCl2(PPh3)2), bis(triphenylphosphine)palladium(II)dichloride (PdCl2(PPh3)2)

  15. Methods to evaluate functional nerve recovery in adult rats : walking track analysis, video analysis and the withdrawal reflex

    NARCIS (Netherlands)

    Dijkstra, [No Value; Meek, MF; Robinson, PH; Gramsbergen, A

    2000-01-01

    The aim of this study was to compare different methods for the evaluation of functional nerve recovery. Three groups of adult male Wistar rats were studied. In group A, a 12-mm gap between nerve ends was bridged by an autologous nerve graft; in rats of group B we performed a crush lesion of the

  16. A quantitative method to evaluate microbial electrolysis cell effectiveness for energy recovery and wastewater treatment

    KAUST Repository

    Ivanov, Ivan

    2013-10-01

    Microbial electrolysis cells (MECs) are potential candidates for sustainable wastewater treatment as they allow for recovery of the energy input by producing valuable chemicals such as hydrogen gas. Evaluating the effectiveness of MEC treatment for different wastewaters requires new approaches to quantify performance, and the establishment of specific procedures and parameters to characterize the outcome of fed-batch treatability tests. It is shown here that Coulombic efficiency can be used to directly calculate energy consumption relative to wastewater treatment in terms of COD removal, and that the average current, not maximum current, is a better metric to evaluate the rate of the bioelectrochemical reactions. The utility of these methods was demonstrated using simulated current profiles and actual wastewater tests. Industrial and domestic wastewaters were evaluated using small volume MECs, and different inoculation strategies. The energy needed for treatment was 2.17kWhkgCOD-1 for industrial wastewater and 2.59kWhkgCOD-1 for domestic wastewater. When these wastewaters were combined in equal amounts, the energy required was reduced to 0.63kWhkgCOD-1. Acclimation of the MEC to domestic wastewater, prior to tests with industrial wastewaters, was the easiest and most direct method to optimize MEC performance for industrial wastewater treatment. A pre-acclimated MEC accomplished the same removal (1847 ± 53 mg L-1) as reactor acclimated to only the industrial wastewater (1839 ± 57 mg L-1), but treatment was achieved in significantly less time (70 h versus 238 h). © 2013, Hydrogen Energy Publications, LLC. Published by Elsevier Ltd. All rights reserved.

  17. Evaluation of chondromalacia of the patella with axial inversion recovery-fast spin-echo imaging.

    Science.gov (United States)

    Lee, S H; Suh, J S; Cho, J; Kim, S J; Kim, S J

    2001-03-01

    The purpose of our study was to assess the accuracy of inversion recovery-fast spin-echo (IR-FSE) imaging for the evaluation of chondromalacia of the patella. Eighty-six patients were included, they underwent magnetic resonance (MR) examination and subsequent knee arthroscopy. Medial and lateral facets of the patella were evaluated separately. Axial images were obtained by using IR-FSE (TR/TE/TI = 3000/25/150 msec; echo train length, 8; 4-mm thickness; 12-cm field of view; 512 x 256 matrix; two, number of excitations) with a 1.5-T MR machine. MR interpretation of chondromalacia was made on the basis of the arthroscopic grading system. Of a total of 172 facets graded, arthroscopy revealed chondromalacia in 14 facets with various grades (G0, 158; G1, 1; G2, 3; G3, 6; G4, 4). Sensitivity, specificity, and accuracy in the chondromalacia grades were 57.1%, 93.0%, and 90.1%, respectively. There was one false-negative case (G4) and 11 false-positive cases (G1, eight; G2, two; G3, one). Sensitivity and specificity corrected by one grade difference were improved to 85.7% and 98.1%, respectively. When cartilage changes were grouped into early (corresponding to grade 1 and 2) and advanced (grade 3 and 4) diseases, sensitivity and specificity of the early and advanced diseases were 75% and 94% and 80% and 99%, respectively. IR-FSE imaging of the knee revealed high specificity but low sensitivity for the evaluation of chondromalacia of the patella.

  18. Evaluation of an Ultrafiltration-Based Procedure for Simultaneous Recovery of Diverse Microbes in Source Waters

    Directory of Open Access Journals (Sweden)

    Amy M. Kahler

    2015-03-01

    Full Text Available In this study, hollow-fiber ultrafiltration (UF was assessed for recovery of Escherichia coli, Clostridium perfringens spores, Cryptosporidium parvum oocysts, echovirus 1, and bacteriophages MS2 and ΦX174 from ground and surface waters. Microbes were seeded into twenty-two 50-L water samples that were collected from the Southeastern United States and concentrated to ~500 mL by UF. Secondary concentration was performed for C. parvum by centrifugation followed by immunomagnetic separation. Secondary concentration for viruses was performed using centrifugal ultrafilters or polyethylene glycol precipitation. Nine water quality parameters were measured in each water sample to determine whether water quality data correlated with UF and secondary concentration recovery efficiencies. Average UF recovery efficiencies were 66%–95% for the six enteric microbes. Average recovery efficiencies for the secondary concentration methods were 35%–95% for C. parvum and the viruses. Overall, measured water quality parameters were not significantly associated with UF recovery efficiencies. However, recovery of ΦX174 was negatively correlated with turbidity. The recovery data demonstrate that UF can be an effective method for concentrating diverse microbes from ground and surface waters. This study highlights the utility of tangential-flow hollow fiber ultrafiltration for recovery of bacteria, viruses, and parasites from large volume environmental water samples.

  19. Evaluation of a rapid method for recovery of norovirus and hepatitis A virus from oysters and blue mussels

    DEFF Research Database (Denmark)

    Uhrbrand, Katrine; Myrmel, Mette; Maunula, Leena

    2010-01-01

    Foodborne outbreaks caused by noroviruses (NoVs) and hepatitis A virus (HAV) are often linked to consumption of contaminated shellfish. The objective of this study was to identify an appropriate virus recovery method for real-time reverse transcriptase (RT)-PCR detection and subsequently to evalu......Foodborne outbreaks caused by noroviruses (NoVs) and hepatitis A virus (HAV) are often linked to consumption of contaminated shellfish. The objective of this study was to identify an appropriate virus recovery method for real-time reverse transcriptase (RT)-PCR detection and subsequently...

  20. The therapeutic effect of neurologic music therapy and speech language therapy in post-stroke aphasic patients.

    Science.gov (United States)

    Lim, Kil-Byung; Kim, Yong-Kyun; Lee, Hong-Jae; Yoo, Jeehyun; Hwang, Ji Youn; Kim, Jeong-Ah; Kim, Sung-Kyun

    2013-08-01

    To investigate the therapeutic effect of neurologic music therapy (NMT) and speech language therapy (SLT) through improvement of the aphasia quotient (AQ) in post-stroke aphasic patients. Twenty-one post-stroke, nonfluent aphasia patients who had ischemic/hemorrhagic stroke on radiologic evaluation were divided into the NMT and SLT groups. They received NMT and SLT for 1 month. Language function was assessed by Korean version-Western Aphasia Battery before and after therapy. NMT consisted of therapeutic singing and melodic intonation therapy, and SLT consisted of language-oriented therapy. Significant improvements were revealed in AQ, repetition, and naming after therapy in the NMT group and improvements in repetition in the SLT group of chronic stroke patients (p<0.05). There were significant improvements in language ability in the NMT group of subacute stroke patients. However, there was no significant improvement in the SLT group of subacute stroke patients. We concluded that the two therapies are effective treatments in the chronic stage of stroke and NMT is effective in subacute post-stroke aphasic patients.

  1. Short-term effects of thermotherapy for spasticity on tibial nerve F-waves in post-stroke patients

    Science.gov (United States)

    Matsumoto, Shuji; Kawahira, Kazumi; Etoh, Seiji; Ikeda, Satoshi; Tanaka, Nobuyuki

    2006-03-01

    Thermotherapy is generally considered appropriate for post-stroke patients with spasticity, yet its acute antispastic effects have not been comprehensively investigated. F-wave parameters have been used to demonstrate changes in motor neuron excitability in spasticity and pharmacological antispastic therapy. The present study aimed to confirm the efficacy of thermotherapy for spasticity by evaluating alterations in F-wave parameters in ten male post-stroke patients with spastic hemiparesis (mean age: 49.0±15.0 years) and ten healthy male controls (mean age: 48.7±4.4 years). The subjects were immersed in water at 41°C for 10 min. Recordings were made over the abductor hallucis muscle, and antidromic stimulation was performed on the tibial nerve at the ankle. Twenty F-waves were recorded before, immediately after, and 30 min following thermotherapy for each subject. F-wave amplitude and F-wave/M-response ratio were determined. Changes in body temperature and surface-skin temperature were monitored simultaneously. The mean and maximum values of both F-wave parameters were higher on the affected side before thermotherapy. In the post-stroke patients, the mean and maximum values of both parameters were significantly reduced after thermotherapy ( Prole in decreased spasticity. Surface-skin temperature increased immediately after thermotherapy in both groups and returned to baseline 30 min later. These findings demonstrate that thermotherapy is an effective nonpharmacological antispastic treatment that might facilitate stroke rehabilitation.

  2. Effect of electroacupuncture in patients with post-stroke motor aphasia : Neurolinguistic and neuroimaging characteristics.

    Science.gov (United States)

    Chang, Jingling; Zhang, Hua; Tan, Zhongjian; Xiao, Juan; Li, Shuren; Gao, Ying

    2017-02-01

    In this study we investigated the neurolinguistic and neuroimaging characteristics of post-stroke motor aphasia patients. The effects of acupuncture on cortex activation by using magnetic resonance imaging (MRI) in patients with motor aphasia were also studied. In this study 43 patients with motor aphasia after stroke were assessed according to Clinical Rehabilitation Research Center aphasia examination (CRRCAE) for linguistic evaluation and MRI and computed tomography (CT) were used for the analyses of brain lesions. The MRI imaging data were also examined using statistical parametric mapping (SPM8) software. Cortex activation images during acupuncture were analyzed using generalized linear model analysis. The results of MRI and CT showed diverse brain lesion regions of post-stroke motor aphasia including the cortex, subcortex and cortex together with the subcortex. The language-related brain areas are activated by acupuncture including frontal, temporal, parietal and occipital lobes as well as insula, precuneus and other wide range of brain function areas as shown by MRI. Our study showed that the brain lesion regions in post-stroke motor aphasia were not completely consistent with the classical motor speech center. By using MRI our study results suggest that the formation of cognitive language may be involved with the cortical-subcortical functional networks. Acupuncture may be useful for treatment of motor aphasia after stroke.

  3. Evaluating humidity recovery efficiency of currently available heat and moisture exchangers: a respiratory system model study.

    Science.gov (United States)

    Lucato, Jeanette Janaina Jaber; Adams, Alexander Bernard; Souza, Rogério; Torquato, Jamili Anbar; Carvalho, Carlos Roberto Ribeiro; Marini, John J

    2009-01-01

    To evaluate and compare the efficiency of humidification in available heat and moisture exchanger models under conditions of varying tidal volume, respiratory rate, and flow rate. Inspired gases are routinely preconditioned by heat and moisture exchangers to provide a heat and water content similar to that provided normally by the nose and upper airways. The absolute humidity of air retrieved from and returned to the ventilated patient is an important measurable outcome of the heat and moisture exchangers' humidifying performance. Eight different heat and moisture exchangers were studied using a respiratory system analog. The system included a heated chamber (acrylic glass, maintained at 37 degrees C), a preserved swine lung, a hygrometer, circuitry and a ventilator. Humidity and temperature levels were measured using eight distinct interposed heat and moisture exchangers given different tidal volumes, respiratory frequencies and flow-rate conditions. Recovery of absolute humidity (%RAH) was calculated for each setting. Increasing tidal volumes led to a reduction in %RAH for all heat and moisture exchangers while no significant effect was demonstrated in the context of varying respiratory rate or inspiratory flow. Our data indicate that heat and moisture exchangers are more efficient when used with low tidal volume ventilation. The roles of flow and respiratory rate were of lesser importance, suggesting that their adjustment has a less significant effect on the performance of heat and moisture exchangers.

  4. Evaluation of two different alternatives of energy recovery from municipal solid waste in Brazil.

    Science.gov (United States)

    Medina Jimenez, Ana Carolina; Nordi, Guilherme Henrique; Palacios Bereche, Milagros Cecilia; Bereche, Reynaldo Palacios; Gallego, Antonio Garrido; Nebra, Silvia Azucena

    2017-11-01

    Brazil has a large population with a high waste generation. The municipal solid waste (MSW) generated is deposited mainly in landfills. However, a considerable fraction of the waste is still improperly disposed of in dumpsters. In order to overcome this inadequate deposition, it is necessary to seek alternative routes. Between these alternatives, it is possible to quote gasification and incineration. The objective of this study is to compare, from an energetic and economic point of view, these technologies, aiming at their possible implementation in Brazilian cities. A total of two configurations were evaluated: (i) waste incineration with energy recovery and electricity production in a steam cycle; and (ii) waste gasification, where the syngas produced is used as fuel in a boiler of a steam cycle for electricity production. Simulations were performed assuming the same amount of available waste for both configurations, with a composition corresponding to the MSW from Santo André, Brazil. The thermal efficiencies of the gasification and incineration configurations were 19.3% and 25.1%, respectively. The difference in the efficiencies was caused by the irreversibilities associated with the gasification process, and the additional electricity consumption in the waste treatment step. The economic analysis presented a cost of electrical energy produced of 0.113 (US$ kWh -1 ) and 0.139 (US$ kWh -1 ) for the incineration and gasification plants respectively.

  5. Germanium recovery from gasification fly ash: evaluation of end-products obtained by precipitation methods.

    Science.gov (United States)

    Arroyo, Fátima; Font, Oriol; Fernández-Pereira, Constantino; Querol, Xavier; Juan, Roberto; Ruiz, Carmen; Coca, Pilar

    2009-08-15

    In this study the purity of the germanium end-products obtained by two different precipitation methods carried out on germanium-bearing solutions was evaluated as a last step of a hydrometallurgy process for the recovery of this valuable element from the Puertollano Integrated Gasification Combined Cycle (IGCC) fly ash. Since H(2)S is produced as a by-product in the gas cleaning system of the Puertollano IGCC plant, precipitation of germanium as GeS(2) was tested by sulfiding the Ge-bearing solutions. The technological and hazardous issues that surround H(2)S handling conducted to investigate a novel precipitation procedure: precipitation as an organic complex by adding 1,2-dihydroxy benzene pyrocatechol (CAT) and cetyltrimethylammonium bromide (CTAB) to the Ge-bearing solutions. Relatively high purity Ge end-products (90 and 93% hexagonal-GeO(2) purity, respectively) were obtained by precipitating Ge from enriched solutions, as GeS(2) sulfiding the solutions with H(2)S, or as organic complex with CAT/CTAB mixtures and subsequent roasting of the precipitates. Both methods showed high efficiency (>99%) to precipitate selectively Ge using a single precipitation stage from germanium-bearing solutions.

  6. Evaluating the Energy Recovery Potential of Nigerian Coals under Non-Isothermal Thermogravimetry

    Science.gov (United States)

    Bevan Nyakuma, Bemgba; Oladokun, Olagoke; Jauro, Aliyu; Damian Nyakuma, Denen

    2017-07-01

    This study investigated the fuel properties and energy recovery potential of two coal samples from Ihioma (IHM) and Ogboligbo (OGB) environs in Nigeria. The ultimate, proximate, and bomb calorimetric analyses of the coal were examined. Next, the rank classification and potential application of the coals were evaluated according to the ASTM standard D388. Lastly, thermal decomposition behaviour was examined by non-isothermal thermogravimetry (TG) under pyrolysis conditions from 30 - 900 °C. The results indicated IHM and OGB contain high proportions of combustible elements for potential thermal conversion. The higher heating value (HHV) of IHM was 20.37 MJ/kg whereas OGB was 16.33 MJ/kg. TG analysis revealed 55% weight loss for OGB and 76% for IHM. The residual mass was 23% for IHM and 44% for OGB. Based on the temperature profile characteristics (TPCs); Ton , Tmax , and Toff , IHM was more reactive than OGB due to its higher volatile matter (VM). Overall, results revealed the coals are Lignite (Brown) low-rank coals (LRCs) with potential for electric power generation.

  7. Clinical evaluation of developed product for recovery of immune system in the treatment of cancer patients

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Chul-Ku; Choi, Soo Yong; Rhyu, Sung Ryeol; Kim, Ki Wha; Kim, Ji Yun; Yun, Na Ra [Korea Institute of Radiological and Medical Sciences, Seoul (Korea, Republic of)

    2006-01-15

    We evaluate the clinical efficacy of pilot product (HemoHIM) on recovery from hematopoiesis damage in cancer patients who received radiotherapy and chemotherapy. The cancer patients studied were as follows : cancer of the breast(47 intakers and 136 non-intakers), uterine cervix(38 intakers and 73 non-intakers), and head and neck(7 intakers and 15 non-intakers). The clinical efficacy of pilot product(HemoHIM) in cancer patients who received radiotherapy and chemotherapy was analyzed. In breast cancer patients, the number of leukocytes decreased according to duration of treatment in both groups. However, intakers showed a less decreasing trend compared with non-intakers. Especially, under limiting value in range of leukocyte number of intakers was significantly higher than that of non-intakers. This result incicates that HemoHIM reduce the severe leukopenia. Values of lymphocyte in both groups decreased similarly after treatment, and it was similar to that of leukocyte. Values of erythrocyte in both groups decreased similarly after treatment, but the values were within normal range. In cervix cancer patients, the results were similar to that of breast cancer patients. In cancer of head and neck, values of leukocyte slightly decreased according to duration of treatment in both group. However, it needs to collect more subjects continuously because of small number of cancer patients. No toxicological side effects of HemoHIM were observed in serological analysis, and possibility to alleviate fatigue and inflammation was investigated in some cases.

  8. Revisiting the Neural Basis of Acquired Amusia: Lesion Patterns and Structural Changes Underlying Amusia Recovery

    Directory of Open Access Journals (Sweden)

    Aleksi J. Sihvonen

    2017-07-01

    Full Text Available Although, acquired amusia is a common deficit following stroke, relatively little is still known about its precise neural basis, let alone to its recovery. Recently, we performed a voxel-based lesion-symptom mapping (VLSM and morphometry (VBM study which revealed a right lateralized lesion pattern, and longitudinal gray matter volume (GMV and white matter volume (WMV changes that were specifically associated with acquired amusia after stroke. In the present study, using a larger sample of stroke patients (N = 90, we aimed to replicate and extend the previous structural findings as well as to determine the lesion patterns and volumetric changes associated with amusia recovery. Structural MRIs were acquired at acute and 6-month post-stroke stages. Music perception was behaviorally assessed at acute and 3-month post-stroke stages using the Scale and Rhythm subtests of the Montreal Battery of Evaluation of Amusia (MBEA. Using these scores, the patients were classified as non-amusic, recovered amusic, and non-recovered amusic. The results of the acute stage VLSM analyses and the longitudinal VBM analyses converged to show that more severe and persistent (non-recovered amusia was associated with an extensive pattern of lesions and GMV/WMV decrease in right temporal, frontal, parietal, striatal, and limbic areas. In contrast, less severe and transient (recovered amusia was linked to lesions specifically in left inferior frontal gyrus as well as to a GMV decrease in right parietal areas. Separate continuous analyses of MBEA Scale and Rhythm scores showed extensively overlapping lesion pattern in right temporal, frontal, and subcortical structures as well as in the right insula. Interestingly, the recovered pitch amusia was related to smaller GMV decreases in the temporoparietal junction whereas the recovered rhythm amusia was associated to smaller GMV decreases in the inferior temporal pole. Overall, the results provide a more comprehensive picture of

  9. Evaluating nest supplementation as a recovery strategy for the endangered rodents of the Florida Keys

    Science.gov (United States)

    Cove, Michael V.; Simons, Theodore R.; Gardner, Beth; Maurer, Andrew S.; O'Connell, Allan F.

    2017-01-01

    The Key Largo woodrat (Neotoma floridana smalli) and Key Largo cotton mouse (Peromyscus gossypinus allapaticola) are federally endangered subspecies endemic to the tropical hardwood hammocks of Key Largo, Florida. Woodrats are considered generalists in habitat and diet, yet a steady decline in natural stick nests and capture rates over the past several decades suggests that they are limited by the availability of nesting habitat due to habitat loss and fragmentation. The more specialized Key Largo cotton mouse appears to rely on old growth hammock, a habitat type that is rare following past land clearing. In 2004, the U.S. Fish and Wildlife Service started building supplemental nest structures to restore habitat quality and connectivity for these endangered rodents, but nest use requires evaluation. We used camera traps and occupancy models to evaluate the factors influencing woodrat and cotton mouse use of the supplemental nests. We detected woodrats at 65 and cotton mice at 175 of 284 sampled nest structures, with co-occurrence at 38 nests. Woodrat nest use followed a gradient from low nest use in the north to high nest use in the south, which might relate to the proximity of free-ranging domestic cat (Felis catus) colonies in residential developments. Cotton mouse nest use, however, was related positively to mature hammock and related negatively to disturbed areas (e.g. scarified lands). The two species occurred independently of each other. Stick-stacking behavior was observed at supplemental nests and, although it was correlated with detection of woodrats, it was not a strong predictor of their occurrence. We suggest that nest supplementation can be an important tool for species recovery as habitat quality continues to improve with succession.

  10. Skills for Psychological Recovery: Evaluation of a post-disaster mental health training program.

    Science.gov (United States)

    Wade, Darryl; Crompton, David; Howard, Alexandra; Stevens, Naomi; Metcalf, Olivia; Brymer, Melissa; Ruzek, Josef; Watson, Patricia; Bryant, Richard; Forbes, David

    2014-01-01

    Skills for Psychological Recovery (SPR) is a brief skills-based approach to assist community members to better cope after a disaster or other tragedy. This paper reports on an evaluation of a large SPR training and support program following floods and cyclones in Queensland, Australia. The program sought to recruit, train and support competent SPR trainers; provide systematic high-quality training in SPR skills for practitioners; improve the confidence of a large number of practitioners to use SPR; and encourage practitioners' use of SPR with community members. Trainers recruited to the program facilitated 49 training sessions for 788 practitioners across Queensland. Trainers were assessed by practitioners to have high-level competencies to run training sessions. Practitioners reported improved confidence to use each SPR intervention following training and at 6 months post-training. Based on available data, more than 6 out of 10 practitioners used an SPR intervention during the follow up period, with each intervention used by over half of the practitioners at both 3 and 6 months. The most frequently reported barrier to using SPR was not having seen a community member with problems requiring SPR. For trainers, a psychology background and cognitive-behavioral therapy (CBT) orientation were unrelated to their competencies to facilitate practitioner training sessions. For practitioners, a psychology background and to some extent a CBT orientation were related to confidence to use SPR interventions. In summary, this study provides details of an evaluation of a large-scale mental health training and support program to enhance response to meet the mental health needs of those affected by disaster.

  11. Muscle Synergies-Based Characterization and Clustering of Poststroke Patients in Reaching Movements

    Directory of Open Access Journals (Sweden)

    Alessandro Scano

    2017-10-01

    Full Text Available BackgroundA deep characterization of neurological patients is a crucial step for a detailed knowledge of the pathology and maximal exploitation and customization of the rehabilitation therapy. The muscle synergies analysis was designed to investigate how muscles coactivate and how their eliciting commands change in time during movement production. Few studies investigated the value of muscle synergies for the characterization of neurological patients before rehabilitation therapies. In this article, the synergy analysis was used to characterize a group of chronic poststroke hemiplegic patients.MethodsTwenty-two poststroke patients performed a session composed of a sequence of 3D reaching movements. They were assessed through an instrumental assessment, by recording kinematics and electromyography to extract muscle synergies and their activation commands. Patients’ motor synergies were grouped by the means of cluster analysis. Consistency and characterization of each cluster was assessed and clinically profiled by comparison with standard motor assessments.ResultsMotor synergies were successfully extracted on all 22 patients. Five basic clusters were identified as a trade-off between clustering precision and synthesis power, representing: healthy-like activations, two shoulder compensatory strategies, two elbow predominance patterns. Each cluster was provided with a deep characterization and correlation with clinical scales, range of motion, and smoothness.ConclusionThe clustering of muscle synergies enabled a pretherapy characterization of patients. Such technique may affect several aspects of the therapy: prediction of outcomes, evaluation of the treatments, customization of doses, and therapies.

  12. Functional goal achievement in post-stroke spasticity patients: the BOTOX® Economic Spasticity Trial (BEST).

    Science.gov (United States)

    Ward, Anthony B; Wissel, Jörg; Borg, Jörgen; Ertzgaard, Per; Herrmann, Christoph; Kulkarni, Jai; Lindgren, Kristina; Reuter, Iris; Sakel, Mohamed; Säterö, Patrik; Sharma, Satyendra; Wein, Theodore; Wright, Nicola; Fulford-Smith, Antony

    2014-06-01

    Evaluate changes in active and passive function with onabotulinumtoxinA + standard of care within goal-oriented rehabilitation programmes in adults with focal post-stroke spasticity. Prospective, 24-week double-blind study with an open-label extension. Subjects were randomized to onabotulinumtoxinA + standard of care or placebo + standard of care, at baseline and at 12 weeks, if judged appropriate, with follow-up to 52 weeks. The primary endpoint was the number of patients achieving their principal active functional goal at 24 weeks (or 10 weeks after an optional second injection). Secondary endpoints included achievement of a different active or a passive goal at this timepoint. The intent-to-treat population comprised 273 patients. The proportion of patients achieving their principal active functional goal and secondary active functional goal with onabotulinumtoxinA + standard of care was not statistically different from placebo + standard of care. Significantly more patients achieved their secondary passive goal with onabotulinumtoxinA + standard of care (60.0%) vs. placebo + standard of care (38.6%) (odds ratio, 2.46; 95% confidence interval, 1.18-5.14) as well as higher Goal Attainment Scaling levels for upper limb and ankle flexor subgroups. Addition of onabotulinumtoxinA to standard of care as part of goal-oriented rehabilitation in post-stroke spasticity patients significantly increased passive goal achievement and was associated with higher levels of active function.

  13. A neuromechanics-based powered ankle exoskeleton to assist walking post-stroke: a feasibility study.

    Science.gov (United States)

    Takahashi, Kota Z; Lewek, Michael D; Sawicki, Gregory S

    2015-02-25

    In persons post-stroke, diminished ankle joint function can contribute to inadequate gait propulsion. To target paretic ankle impairments, we developed a neuromechanics-based powered ankle exoskeleton. Specifically, this exoskeleton supplies plantarflexion assistance that is proportional to the user's paretic soleus electromyography (EMG) amplitude only during a phase of gait when the stance limb is subjected to an anteriorly directed ground reaction force (GRF). The purpose of this feasibility study was to examine the short-term effects of the powered ankle exoskeleton on the mechanics and energetics of gait. Five subjects with stroke walked with a powered ankle exoskeleton on the paretic limb for three 5 minute sessions. We analyzed the peak paretic ankle plantarflexion moment, paretic ankle positive work, symmetry of GRF propulsion impulse, and net metabolic power. The exoskeleton increased the paretic plantarflexion moment by 16% during the powered walking trials relative to unassisted walking condition (p exoskeleton assistance appeared to reduce the net metabolic power gradually with each 5 minute repetition, though no statistical significance was found. In three of the subjects, the paretic soleus activation during the propulsion phase of stance was reduced during the powered assistance compared to unassisted walking (35% reduction in the integrated EMG amplitude during the third powered session). This feasibility study demonstrated that the exoskeleton can enhance paretic ankle moment. Future studies with greater sample size and prolonged sessions are warranted to evaluate the effects of the powered ankle exoskeleton on overall gait outcomes in persons post-stroke.

  14. Providing Sources of Self-Efficacy Through Technology Enhanced Post-Stroke Rehabilitation in the Home.

    Science.gov (United States)

    Parker, Jack; Mawson, Susan

    2017-01-01

    This research explores the impact of receiving feedback through a Personalised Self-Managed Rehabilitation System (PSMrS) for home-based post-stroke rehabilitation on the users' self-efficacy; more specifically, mastery experiences and the interpretation of biomechanical data. Embedded within a realistic evaluation methodological approach, exploring the promotion of self-efficacy from the utilisation of computer-based technology to facilitate post-stroke upper-limb rehabilitation in the home included; semi-structured interviews, quantitative user data (activity and usage), observations and field notes. Data revealed that self-efficacy was linked with obtaining positive knowledge of results feedback. Encouragingly, this also transferred to functional activities such as, confidence to carry out kitchen tasks and bathroom personal activities. Findings suggest the PSMrS was able to provide key sources of self-efficacy by providing feedback which translated key biomechanical data to the users. Users could interpret and understand their performance, gain a sense of mastery and build their confidence which in some instances led to increased confidence to carry out functional activities. However, outcome expectations and socio-structural factors impacted on the self-efficacy associated with the use of the system. Increasing the understanding of how these factors promote or inhibit self-management and self-efficacy is therefore crucial to the successful adoption of technology solutions and promotion of self-efficacy.

  15. Viscosity threshold that allows safe swallow in elderly with post-stroke dysphagia

    Directory of Open Access Journals (Sweden)

    Rodolfo Peña

    2017-08-01

    Full Text Available Objective: To determine the viscosity threshold that allows safe swallowing in older adults with post-stroke dysphagia. Method: Cross-sectional analytical study. 6 patients over 60 years old with dysphagia participated. Were given six viscosities (50mPa s, 110mPa s, 170mPa s, 230mPa s, 290mPa s and 350mPa s made from no carbonated water and a corn starch-based thickener. Swallowing safety signs (wet voice, cough and oxygen saturation were assessed in each viscosity by Fiberoptic Endoscopic Evaluation of Swallowing (FEES. Viscosities’ performances in swallowing safety signs were compared in order to know which viscosity would be the safest. Results: 100% of swallowing safety signs did not appear in any viscosity assessed. Conclusions: It is not possible to determine the viscosity threshold that allows safe swallowing in patients with post-stroke dysphagia in the viscosities assessed. We discuss about multiple factors that had had affect our results: size sample, use of FEES to assess low viscosities, and viscosities’ intervals used.

  16. Application of a volar static splint in poststroke spasticity of the upper limb.

    Science.gov (United States)

    Pizzi, Assunta; Carlucci, Giovanna; Falsini, Catuscia; Verdesca, Sonia; Grippo, Antonello

    2005-09-01

    To evaluate clinical and neurophysiologic effects of 3-month reflex inhibitory splinting (RIS) for poststroke upper-limb spasticity. Pretest-posttest trial. Outpatient rehabilitation center. Forty consecutive patients with hemiplegia and upper-limb spasticity after stroke that had occurred at least 4 months before. Patients wore an immobilizing hand splint custom-fitted in the functional position for at least 90 minutes daily for 3 months. Patients underwent measurement of (1) spasticity at the elbow and wrist according to Modified Ashworth Scale; (2) passive range of motion (PROM) at the wrist and elbow; (3) pain at the shoulder, elbow, and wrist using a visual analog scale; (4) spasms; and (5) comfort and time of splint application. The instrumental measure of spasticity was the ratio between the maximum amplitude of the H-reflex and the maximum amplitude of the M response (Hmax/Mmax ratio). A significant improvement of wrist PROM (F=8.92, P=.001) with greater changes in extension than in flexion, and a reduction of elbow spasticity (F=5.39, P=.002), wrist pain (F=2.89, P=.04), and spasms (F=4.33, P=.008) were observed. The flexor carpi radialis Hmax/Mmax ratio decreased significantly (F=4.2, P=.007). RIS was well tolerated. RIS may be used as an integrative treatment of poststroke upper-limb spasticity. It can be used comfortably at home, in selected patients without functional hand movements, and in cases of poor response or tolerance to antispastic drugs.

  17. Animal Robot Assisted-therapy for Rehabilitation of Patient with Post-Stroke Depression

    Science.gov (United States)

    Zikril Zulkifli, Winal; Shamsuddin, Syamimi; Hwee, Lim Thiam

    2017-06-01

    Recently, the utilization of therapeutic animal robots has expanded. This research aims to explore robotics application for mental healthcare in Malaysia through human-robot interaction (HRI). PARO, the robotic seal PARO was developed to give psychological effects on humans. Major Depressive Disorder (MDD) is a common but severe mood disorder. This study focuses on the interaction protocol between PARO and patients with MDD. Initially, twelve rehabilitation patients gave subjective evaluation on their first interaction with PARO. Next, therapeutic interaction environment was set-up with PARO in it to act as an augmentation strategy with other psychological interventions for post-stroke depression. Patient was exposed to PARO for 20 minutes. The results of behavioural analysis complemented with information from HRI survey question. The analysis also observed that the individual interactors engaged with the robot in diverse ways based on their needs Results show positive reaction toward the acceptance of an animal robot. Next, therapeutic interaction is set-up for PARO to contribute as an augmentation strategy with other psychological interventions for post-stroke depression. The outcome is to reduce the stress level among patients through facilitated therapy session with PARO

  18. Preservation of structural brain network hubs is associated with less severe post-stroke aphasia.

    Science.gov (United States)

    Gleichgerrcht, Ezequiel; Kocher, Madison; Nesland, Travis; Rorden, Chris; Fridriksson, Julius; Bonilha, Leonardo

    2015-01-01

    Post-stroke aphasia is typically associated with ischemic damage to cortical areas or with loss of connectivity among spared brain regions. It remains unclear whether the participation of spared brain regions as networks hubs affects the severity of aphasia. We evaluated language performance and magnetic resonance imaging from 44 participants with chronic aphasia post-stroke. The individual structural brain connectomes were constructed from diffusion tensor. Hub regions were defined in accordance with the rich club classification and studied in relation with language performance. Number of remaining left hemisphere rich club nodes was associated with aphasia, including comprehension, repetition and naming sub-scores. Importantly, among participants with relative preservation of regions of interest for language, aphasia severity was lessened if the region was not only spared, but also participated in the remaining network as a rich club node: Brodmann area (BA) 44/45 - repetition (p = 0.009), BA 39 - repetition (p = 0.045) and naming (p aphasia severity after stroke.

  19. Evaluation of Waste Heat Recovery and Utilization from Residential Appliances and Fixtures

    Energy Technology Data Exchange (ETDEWEB)

    Tomlinson, John J [ORNL; Christian, Jeff [Oak Ridge National Laboratory (ORNL); Gehl, Anthony C [ORNL

    2012-09-01

    Executive Summary In every home irrespective of its size, location, age, or efficiency, heat in the form of drainwater or dryer exhaust is wasted. Although from a waste stream, this energy has the potential for being captured, possibly stored, and then reused for preheating hot water or air thereby saving operating costs to the homeowner. In applications such as a shower and possibly a dryer, waste heat is produced at the same time as energy is used, so that a heat exchanger to capture the waste energy and return it to the supply is all that is needed. In other applications such as capturing the energy in drainwater from a tub, dishwasher, or washing machine, the availability of waste heat might not coincide with an immediate use for energy, and consequently a heat exchanger system with heat storage capacity (i.e. a regenerator) would be necessary. This study describes a two-house experimental evaluation of a system designed to capture waste heat from the shower, dishwasher clothes washer and dryer, and to use this waste heat to offset some of the hot water energy needs of the house. Although each house was unoccupied, they were fitted with equipment that would completely simulate the heat loads and behavior of human occupants including operating the appliances and fixtures on a demand schedule identical to Building American protocol (Hendron, 2009). The heat recovery system combined (1) a gravity-film heat exchanger (GFX) installed in a vertical section of drainline, (2) a heat exchanger for capturing dryer exhaust heat, (3) a preheat tank for storing the captured heat, and (4) a small recirculation pump and controls, so that the system could be operated anytime that waste heat from the shower, dishwasher, clothes washer and dryer, and in any combination was produced. The study found capturing energy from the dishwasher and clothes washer to be a challenge since those two appliances dump waste water over a short time interval. Controls based on the status of the

  20. Dry needling for the treatment of poststroke muscle spasticity: a prospective case report.

    Science.gov (United States)

    Ansari, Noureddin Nakhostin; Naghdi, Soofia; Fakhari, Zahra; Radinmehr, Hojjat; Hasson, Scott

    2015-01-01

    Spasticity is a common symptom that can be detrimental to the quality of life and daily function of patients with stroke. To introduce the use of dry needling (DN) as a novel method for the treatment of affected upper limb spasticity in a patient with chronic ischemic stroke who was admitted at the Stroke Physiotherapy Clinic. The pronator teres (PT), flexor carpi radialis (FCR), and flexor carpi ulnaris (FCU) on the affected side were needled. The patient received deep DN for 1 session, and the duration of needling for each muscle was 1 minute. The main outcomes were the Modified Modified Ashworth Scale (MMAS) muscle spasticity score, and the Hmax/Mmax ratio which were measured before (T0), immediately after (T1), and 15 minutes after the end of needling (T2). The case was a 53-year-old man with a 13-year history of right hemiparesis poststroke. After DN, the spasticity scores improved and maintained as indicated in the MMAS grades (PT 3 to 2, finger flexors 1 to 0) and the Hmax/Mmax ratio (0.39, 0. 29, and 0.32 at T0, T1, and T2, respectively). The patient was able to voluntarily extend the wrist and fingers slightly after DN. The upper limb Brunnstrom recovery stage (3 to 4) and hand function (2 to 3) improved and maintained. The passive supination increased at T1 (75°) and T2 (50°) compared to T0 (38°). This prospective case report presents dry needling as a novel method in neurorehabilitation for the treatment of poststroke spasticity. Further research is recommended.

  1. The eastern Baltic cod fishery: a fleet-based management strategy evaluation framework to assess the cod recovery plan of 2008

    DEFF Research Database (Denmark)

    Bastardie, Francois; Nielsen, J. Rasmus; Kraus, Gerd

    2010-01-01

    The eastern Baltic cod fishery: a fleet-based management strategy evaluation framework to assess the cod recovery plan of 2008. - ICES Journal of Marine Science, 67: 71-86.......The eastern Baltic cod fishery: a fleet-based management strategy evaluation framework to assess the cod recovery plan of 2008. - ICES Journal of Marine Science, 67: 71-86....

  2. Evaluation of using Smart Water to enhance oil recovery from Norwegian Continental Shelf sandstone reservoirs.

    OpenAIRE

    Piotrowska, Natalia

    2016-01-01

    Master's thesis in Petroleum engineering. Recently, the scale of studies on smart water – one of EOR method - has increased. From decades, water flooding is one of the most used methods to increase oil recovery. However, more effective in sandstone reservoirs is injecting low salinity brine. Due to changing wettability, improved oil mobility in pores can be reached. The studies show, that the significant increase of oil recovery might be achieved. Main objective of the thesis is to answ...

  3. Transforming mental health services: a participatory mixed methods study to promote and evaluate the implementation of recovery-oriented services.

    Science.gov (United States)

    Park, Melissa M; Zafran, Hiba; Stewart, Janet; Salsberg, Jon; Ells, Carolyn; Rouleau, Suzanne; Estein, Orly; Valente, Thomas W

    2014-09-10

    systematic theory-based evaluation of changes in attitudes and practices within the service-user/service-provider partnership group relative to the overall provider network of the department and identify the barriers and supports within the local context. Our anticipated outcome is a participatory toolkit to tailor recovery-oriented services, which will be disseminated to the Mental Health Commission of Canada and Accreditation Canada at the federal level, agencies at the provincial levels, and local knowledge end-users.

  4. [Clinical research on post-stroke hemiplegia treated with the optimized rehabilitation program of integrated Chinese and western medicine].

    Science.gov (United States)

    Zhang, Xiao-Li; Qi, Rui; Yan, Jun-Tao

    2013-12-01

    To explore the optimized rehabilitation program in the treatment of post-stroke hemiplegia at the recovery stage. Based on the randomized controlled principle, 60 patients were randomized into an rehabilita tion + massage group (group A) and an rehabilitation + acupuncture group (group B), 30 cases in each one. Bobath sport therapy and functional training were adopted in the two groups. In the group A, the massage therapy was added. The rolling method and palm-rubbing method were used on the affected side, the pressing, kneading and plucking methods were applied to Jianliao (LI 15), Jianzhen (SI 9), Quchi (LI 11), Huantiao (GB 30), Weizhong (BL 40), Chengshan (BL 57), Zusanli (ST 36) and the other acu points; and the nipping method was adopted at the twelve Jing-well points. In the group B, acupuncture was applied to Baihui (BL 20), Jianliao (LI 15), Quchi (LI 11), Shousanli (LI 10), Huantiao (GB 30), Yanglingquan (GB 34), Jiexi (ST 41) and the other acupoints. The treatment was given once a day, 5 treatments a week in the two groups. The efficacy was evaluated in 3 weeks. Fugl-Meyer scale, Barthel index (BI) score, modified Rankin scale and stroke-specific quality of life (SS-QOL) were used to assess the limb motor function, the activity of daily life (ADL), independent activity of life and the quality of life of the patients in the two groups before and after treatment. Based on the total cost and benefit, the health economics evaluation was conducted in the patients of the two groups. The treatments all improved the limb motor function (group A: 26.00 (22) vs 37.00 (33); group B: 30.50 (21) vs 39.50 (36)), the independent activity of life, ADL (group A: 43.50 +/- 22.25 vs 57.50 +/- 22.25; group B: 52.83 +/- 16.59 vs 66.67 +/- 12.82) and the quality of life (group A: 122.23 +/- 30.00 vs 145.50 +/- 28.14; group B: 132.43 +/- 23.87 vs 151.47 +/- 22.37) in the patients of the two groups. The differences in all the indices were significant statistically before and

  5. Effectiveness of elastic band-type ankle–foot orthoses on postural control in poststroke elderly patients as determined using combined measurement of the stability index and body weight-bearing ratio

    Directory of Open Access Journals (Sweden)

    Kim JH

    2015-11-01

    Full Text Available Jong Hyun Kim, Woo Sang Sim, Byeong Hee Won Usability Evaluation Technology Center, Advanced Biomedical and Welfare R&D Group, Korea Institute of Industrial Technology, Cheonan-si, Chungcheongnam-do, South Korea Purpose: Poor recovery of postural stability poststroke is the primary cause of impairment in activities and social participation in elderly stroke survivors. The purpose of our study was to experimentally evaluate the effectiveness of our new elastic ankle–foot orthosis (AFO, compared to a traditional AFO fabricated with hard plastic, in improving postural stability in elderly chronic stroke survivors. Patients and methods: Postural stability was evaluated in ten chronic stroke patients, 55.7±8.43 years old. Postural stability was evaluated using the standardized methods of the Biodex Balance System combined with a foot pressure system, under three experimental conditions, no AFO, rigid plastic AFO, and elastic AFO (E-AFO. The following dependent variables of postural stability were analyzed: plantar pressure under the paretic and nonparetic foot, area of the center of balance (COB and % time spent in each location, distance traveled by the COB away from the body center, distance traveled by the center of pressure, and calculated index of overall stability, as well as indices anterior–posterior and medial–lateral stability. Results: Both AFO designs improved all indices of postural stability. Compared to the rigid plastic AFO, the E-AFO produced additional positive effects in controlling anterior–posterior body sway, equalizing weight bearing through the paretic and nonparetic limbs, and restraining the displacement of the center of pressure and of the COB. Conclusion: Based on our outcomes, we recommend the prescription of E-AFOs as part of a physiotherapy rehabilitation program to promote recovery of postural stability poststroke. When possible, therapeutic outcomes should be documented using the Biodex Balance System and

  6. An evaluation of known remaining oil resources in the United States. Appendix, Project on Advanced Oil Recovery and the States

    Energy Technology Data Exchange (ETDEWEB)

    1994-10-01

    This volume contains appendices for the following: Overview of improved oil recovery methods (enhanced oil recovery methods and advanced secondary recovery methods); Benefits of improved oil recovery, selected data for the analyzed states; and List of TORIS fields and reservoirs.

  7. 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.

  8. Evaluation of Traumatic Spine by Magnetic Resonance Imaging and Correlation with Neurological Recovery.

    Science.gov (United States)

    Magu, Sarita; Singh, Deepak; Yadav, Rohtas Kanwar; Bala, Manju

    2015-10-01

    Prospective study. To compare magnetic resonance imaging (MRI) findings with clinical profile and neurological status of the patient and to correlate the MRI findings with neurological recovery of the patients and predict the outcome. Previous studies have reported poor neurological recovery in patients with cord hemorrhage, as compared to cord edema in spine injury patients. High canal compromise, cord compression along with higher extent of cord injury also carries poor prognostic value. Neurological status of patients was assessed at the time of admission and discharge in as accordance with the American Spine Injury Association (ASIA) impairment scale. Mean stay in hospital was 14.11±5.74 days. Neurological status at admission and neurological recovery at discharge was compared with various qualitative cord findings and quantitative parameters on MRI. In 27 patients, long-term follow-up was done at mean time of 285.9±43.94 days comparing same parameters. Cord edema and normal cord was associated with favorable neurological outcome. Cord contusion showed lesser neurological recovery, as compared to cord edema. Cord hemorrhage was associated with worst neurological status at admission and poor neurological recovery. Mean canal compromise (MCC), mean spinal cord compression (MSCC) and lesion length values were higher in patients presenting with ASIA A impairment scale injury and showed decreasing trends towards ASIA E impairment scale injury. Patients showing neurological recovery had lower mean MCC, MSCC, and lesion length, as compared to patients showing no neurological recovery (p<0.05). Cord hemorrhage, higher MCC, MSCC, and lesion length values have poor prognostic value in spine injury patients.

  9. Application of noninvasive brain stimulation for post-stroke dysphagia rehabilitation.

    Science.gov (United States)

    Wang, Zhuo; Song, Wei-Qun; Wang, Liang

    2017-02-01

    Noninvasive brain stimulation (NIBS), commonly consisting of transcranial magnetic stimulation (TMS), transcranial direct-current stimulation (tDCS), as well as paired associative stimulation (PAS), has attracted increased interest and been applied experimentally in the treatment of post-stroke dysphagia (PSD). This review presented a synopsis of the current research for the application of NIBS on PSD. The intention here was to understand the current research progress and limitations in this field and to stimulate potential research questions not yet investigated for the application of NIBS on patients with PSD. Here we successively reviewed advances of repetitive TMS (rTMS), tDCS, and PAS techniques on both healthy participants and PSD patients in three aspects, including scientific researches about dysphagia mechanism, applied studies about stimulation parameters, and clinical trials about their therapeutic effects. The techniques of NIBS, especially rTMS, have been used by the researchers to explore the different mechanisms between swallowing recovery and extremity rehabilitation. The key findings included the important role of intact hemisphere reorganization for PSD recovery, and the use of NIBS on the contra-lesional side as a therapeutic potential for dysphagia rehabilitation. Though significant results were achieved in most studies by using NIBS on swallowing rehabilitation, it is still difficult to draw conclusions for the efficacy of these neurostimulation techniques, considering the great disparities between studies. Copyright © 2016. Published by Elsevier Taiwan.

  10. Association between hemorrhagic transformation after endovascular therapy and poststroke seizures.

    Science.gov (United States)

    Thevathasan, Arthur; Naylor, Jillian; Churilov, Leonid; Mitchell, Peter J; Dowling, Richard J; Yan, Bernard; Kwan, Patrick

    2017-12-30

    Endovascular therapy has recently become standard therapy for select patients with acute ischemic stroke. Infarcted brain tissue may undergo hemorrhagic transformation (HT) after endovascular therapy. We investigated the association between HT and occurrence of poststroke seizures in patients treated with endovascular therapy. Consecutive patients treated with endovascular therapy for acute anterior circulation ischemic stroke were included. HT was assessed with computed tomography/magnetic resonance imaging (CT/MRI) at 24 h after stroke onset. Patients were followed for up to 2 years for seizure occurrence. A total of 205 (57.1% male) patients were analyzed. Median age was 69 years (interquartile range [IQR] 57-78). Among patients with HT, 17.9% (10/56) developed poststroke seizures compared with 4.0% (6/149) among those without HT (hazard ratio [HR] 5.52; 95% confidence interval [CI] 2.00-15.22; P = .001). The association remained significant after adjustment for cortical involvement, baseline National Institutes of Health Stroke Scale score, age and use of intravenous tissue plasminogen activator and clot retrieval (HR 4.85; 95% CI 1.60-14.76; P = .005). In patients who developed seizures within the follow-up period, median time to first seizure was 111 days (IQR 28-369) in patients with HT and 36 days (IQR 0.5-183) in patients without HT. A patient who develops HT following endovascular therapy for acute ischemic stroke had a nearly 5 times higher rate of developing poststroke seizures within 2 years. HT may be used as an imaging biomarker for poststroke seizures. Wiley Periodicals, Inc. © 2017 International League Against Epilepsy.

  11. Development of a psychological intervention for post-stroke fatigue

    OpenAIRE

    Wu, Simiao

    2016-01-01

    Background Post-stroke fatigue (PSF) is a common and distressing problem after stroke. It impedes patients’ participation in daily activities and is associated with higher risks of institutionalisation and death following stroke. Despite its high prevalence and detrimental consequences, little research has been conducted to develop effective treatments for PSF. Psychological interventions are effective in treating fatigue in other conditions such as cancer and chronic fatigu...

  12. 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. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  13. Evaluation of performance indicators applied to a material recovery facility fed by mixed packaging waste.

    Science.gov (United States)

    Mastellone, Maria Laura; Cremiato, Raffaele; Zaccariello, Lucio; Lotito, Roberta

    2017-06-01

    Most of the integrated systems for municipal solid waste management aim to increase the recycling of secondary materials by means of physical processes including sorting, shredding and reprocessing. Several restrictions prevent from reaching a very high material recycling efficiency: the variability of the composition of new-marketed materials used for packaging production and its shape and complexity are critical issues. The packaging goods are in fact made of different materials (aluminium, polymers, paper, etc.), possibly assembled, having different shape (flat, cylindrical, one-dimensional, etc.), density, colours, optical properties and so on. These aspects limit the effectiveness and efficiency of the sorting and reprocessing plants. The scope of this study was to evaluate the performance of a large scale Material Recovery Facility (MRF) by utilizing data collected during a long period of monitoring. The database resulted from the measured data has been organized in four sections: (1) data related to the amount and type of inlet waste; (2) amount and composition of output products and waste; (3) operating data (such as worked hours for shift, planned and unscheduled maintenance time, setting parameters of the equipment, and energy consumption for shift); (4) economic data (value of each product, disposal price for the produced waste, penalty for non-compliance of products and waste, etc.). A part of this database has been utilized to build an executive dashboard composed by a set of performance indicators suitable to measure the effectiveness and the efficiency of the MRF operations. The dashboard revealed itself as a powerful tool to support managers and engineers in their decisions in respect to the market demand or compliance regulation variation as well as in the designing of the lay-out improvements. The results indicated that the 40% of the input waste was recovered as valuable products and that a large part of these (88%) complied with the standards of

  14. Psychometric evaluation of the Dutch version of the mental health recovery measure (MHRM).

    Science.gov (United States)

    van Nieuwenhuizen, Chijs; Wilrycx, Greet; Moradi, Mozhgan; Brouwers, Evelien

    2014-03-01

    During the past decade, the mental health consumer movement has drawn the attention of mental health providers, researchers and policy makers to the concept of recovery. Traditionally, recovery primarily refers to the remission of symptoms. Nowadays, recovery is also regarded in a sense that all individuals, even those with severe psychiatric disabilities, can improve. Accordingly, recovery for people with severe mental illness refers to hope and optimism, empowerment, regained control and increased self-esteem, illness self-management and engagement in meaningful daily activities (Corrigan, Giffort, Rashid, Leary & Okeke, 1999; Jacobson & Greenley, 2001; Leamy, Bird, le Boutillier, Williams & Slade, 2011; van Gestel-Timmermans, Brouwers, van Assen, Bongers & van Nieuwenhuizen, 2012). Little empirical research, however, has been done and instruments to measure recovery are scarce. In the current study, the psychometric properties of the Dutch version of the Mental Health Recovery Measure (MHRM) are explored. Convergent and divergent validity of the MHRM was assessed using standardized measures of hope (Hope Herth Index (HHI)), recovery-promoting professional competence (Recovery Promoting Relationships Scale (RPRS)) and general physical health and well-being (RAND Measure of Health-Related Quality of Life (RAND-36)). A factor analysis was conducted and Cronbach's α of the MHRM scales was assessed. The construct validity was assessed by computing the intercorrelations of the MHRM, HHI, RPRS and RAND-36. Data were available for 212 patients: 70 patients completed the MHRM, HHI and RAND 36 and 142 filled out the MHRM and RPRS. Exploratory factor analysis resulted in an interpretable three-factor solution. Cronbach's α ranged from 0.86 to 0.94. The convergent validity of the instrument was satisfactory; the divergent validity was less clear. This study offers evidence to suggest that the Dutch version of the MHRM is a reliable measure (in terms of internal

  15. Economic evaluation of an electrochemical process for the recovery of metals from electronic waste.

    Science.gov (United States)

    Diaz, Luis A; Lister, Tedd E

    2017-12-08

    As the market of electronic devices continues to evolve, the waste stream generated from antiquated technology is increasingly view as an alternative to substitute primary sources of critical a value metals. Nevertheless, the sustainable recovery of materials can only be achieved by environmentally friendly processes that are economically competitive with the extraction from mineral ores. Hence, This paper presents the techno-economic assessment for a comprehensive process for the recovery of metals and critical materials from e-waste, which is based in an electrochemical recovery (ER) technology. Economic comparison is performed with the treatment of e-waste via smelting, which is currently the primary route for recycling metals from electronics. Results indicate that the electrochemical recovery process is a competitive alternative for the recovery of value from electronic waste when compared with the traditional black Cu smelting process. A significantly lower capital investment, 2.9 kg e-waste per dollar of capital investment, can be achieved with the ER process vs. 1.3 kg per dollar in the black Cu smelting process. Copyright © 2017 Elsevier Ltd. All rights reserved.

  16. Evaluating work/recovery schedules in terms of whole body heat storage

    Energy Technology Data Exchange (ETDEWEB)

    Hardcastle, S.G. [Natural Resources Canada, Sudbury, ON (Canada). CANMET Mining and Mineral Sciences Laboratories; Stapleton, J.M.; Kenny, G.P. [Ottawa Univ., Ottawa, ON (Canada). School of Human Kinetics, Human and Environmental Physiology Research Unit; Allen, C. [Vale Inco, Copper Cliff, ON (Canada)

    2010-07-01

    This paper reported on heat stress related research aimed at better managing the heat exposure of underground miners. The potential for underground miners to experience heat stress or strain is increasing due to greater mining depth; mechanization, and a trend towards larger diesel equipment; an aging workforce; an increasing amount of personal protective equipment worn to prevent injuries (that has led to most of the miner's body being covered) and increases in the surface climate that are superimposed through the underground workplace. This paper focused on research involving metabolic heat storage and the possibility of heat strain from elevated core temperatures. It targeted work/recovery cycles and the recovery strategies between work bouts. The first study examined the cumulative change in body heat content for a moderate metabolic rate and increasing the recovery allocation as per the TLV screening criteria to offset an increase in the wet bulb globe temperature (WBGT). The second study examined strategies that could be used between work bouts and how they affect the thermoregulatory system, heat generation or losses and net cumulative heat storage. The calorimeter based work suggested that a miner's clothing may be improved to promote evaporative cooling, and that work recovery regimes could be modified to maximize recovery. 10 refs., 1 tab., 6 figs.

  17. Using Brain Oscillations and Corticospinal Excitability to Understand and Predict Post-Stroke Motor Function

    Directory of Open Access Journals (Sweden)

    Aurore Thibaut

    2017-05-01

    Full Text Available What determines motor recovery in stroke is still unknown and finding markers that could predict and improve stroke recovery is a challenge. In this study, we aimed at understanding the neural mechanisms of motor function recovery after stroke using neurophysiological markers by means of cortical excitability (transcranial magnetic stimulation—TMS and brain oscillations (electroencephalography—EEG. In this cross-sectional study, 55 subjects with chronic stroke (62 ± 14 yo, 17 women, 32 ± 42 months post-stroke were recruited in two sites. We analyzed TMS measures (i.e., motor threshold—MT—of the affected and unaffected sides and EEG variables (i.e., power spectrum in different frequency bands and different brain regions of the affected and unaffected hemispheres and their correlation with motor impairment as measured by Fugl-Meyer. Multiple univariate and multivariate linear regression analyses were performed to identify the predictors of good motor function. A significant interaction effect of MT in the affected hemisphere and power in beta bandwidth over the central region for both affected and unaffected hemispheres was found. We identified that motor function positively correlates with beta rhythm over the central region of the unaffected hemisphere, while it negatively correlates with beta rhythm in the affected hemisphere. Our results suggest that cortical activity in the affected and unaffected hemisphere measured by EEG provides new insights on the association between high-frequency rhythms and motor impairment, highlighting the role of an excess of beta in the affected central cortical region in poor motor function in stroke recovery.

  18. Joint genetic evaluation of mastitis susceptibility and recovery ability in Holstein cows

    DEFF Research Database (Denmark)

    Welderufael, Berihu Gebremedhin; Janss, Luc; De Koning, Dirk-Jan

    Mastitis in dairy cows is an unavoidable problem and variation in recovery from mastitis is therefore of interest, in addition to resistance to mastitis. Genetic parameters for mastitis resistance and recovery were estimated for Danish Holstein-Friesian cows using data from Automatic Milking...... were -0.853 (PSD=0.108), -0.909 (PSD=0.076), -0.292 (PSD=0.105) and 0.052 (PSD=0.157) for the random effects of genetic, permanent environment, cow-parity interaction, and herd-test-week, respectively. Heritabilities were 0.080 (PSD=0.026) for HD and 0.075 (PSD=0.030) for DH. Recovery could...

  19. Participants' and staffs' evaluation of the Illness Management and Recovery program

    DEFF Research Database (Denmark)

    Dalum, Helle Stentoft; Waldemar, Anna Kristine; Korsbek, Lisa

    2017-01-01

    BACKGROUND: Psychoeducational interventions for people with severe mental illness are developed to enable them to manage their illness effectively to improve prognosis and recovery. AIM: The aim was to investigate the benefits and harms of the Illness Management and Recovery (IMR) program among...... people with severe mental illness in Denmark. IMR builds among other approaches on a psychoeducational approach. METHODS: A randomized, multi-center, clinical trial of the IMR program compared with treatment as usual among 198 participants with schizophrenia or bipolar disorder investigating outcomes....... CONCLUSIONS: IMR appears not to be better than treatment as usual in any of the outcomes. Further studies with a longer follow-up period, better assessments of recovery and a systematic review of the existing trials are needed to assess if the program is effective....

  20. Exploring barriers and facilitators to the clinical use of virtual reality for post-stroke unilateral spatial neglect assessment.

    Science.gov (United States)

    Ogourtsova, Tatiana; Archambault, Philippe S; Lamontagne, Anouk

    2017-11-07

    Hemineglect, defined as a failure to attend to the contralesional side of space, is a prevalent and disabling post-stroke deficit. Conventional hemineglect assessments lack sensitivity as they contain mainly non-functional tasks performed in near-extrapersonal space, using static, two-dimensional methods. This is of concern given that hemineglect is a strong predictor for functional deterioration, limited post-stroke recovery, and difficulty in community reintegration. With the emerging field of virtual reality, several virtual tools have been proposed and have reported better sensitivity in neglect-related deficits detection than conventional methods. However, these and future virtual reality-based tools are yet to be implemented in clinical practice. The present study aimed to explore the barriers/facilitators perceived by clinicians in the use of virtual reality for hemineglect assessment; and to identify features of an optimal virtual assessment. A qualitative descriptive process, in the form of focus groups, self-administered questionnaire and individual interviews was used. Two focus groups (n = 11 clinicians) were conducted and experts in the field (n = 3) were individually interviewed. Several barriers and facilitators, including personal, institutional, client suitability, and equipment factors, were identified. Clinicians and experts in the field reported numerous features for the virtual tool optimization. Factors identified through this study lay the foundation for the development of a knowledge translation initiative towards an implementation of a virtual assessment for hemineglect. Addressing the identified barriers/facilitators during implementation and incorporating the optimal features in the design of the virtual assessment could assist and promote its eventual adoption in clinical settings. Implications for rehabilitation A multimodal and active knowledge translation intervention built on the presently identified modifiable factors is

  1. 'We have got the tools': Qualitative evaluation of a mental health Wellness Recovery Action Planning (WRAP) education programme in Ireland.

    Science.gov (United States)

    Keogh, B; Higgins, A; Devries, J; Morrissey, J; Callaghan, P; Ryan, D; Gijbels, H; Nash, M

    2014-04-01

    In recent years, there has been a consistent drive to incorporate Recovery principles into the Irish mental health services. A group of Irish mental health service providers came together and delivered a 5-day Wellness Recovery Action Planning (WRAP) facilitator's programme. The programme was developed and delivered by key stakeholders including people with self-experience of mental health problem. This paper presents the qualitative findings from an evaluation of these facilitator's programmes. Three focus groups were held with 22 people, the majority of who described themselves as mental health professionals and/or people with self-experience of mental health problems. Data were analysed using a thematic approach and yielded four themes. Although the participants were positive about the programme and felt that their knowledge of Recovery and WRAP had improved, they felt that they still lacked confidence in terms of the presentation skills required for facilitating Recovery and WRAP programmes. The findings suggest that mental health service providers who wish to develop service users and clinicians as WRAP facilitators need to put more emphasis on the provision of facilitation and presentation skills in the programmes they develop. © 2013 John Wiley & Sons Ltd.

  2. Evaluation of TA10 Broth for Recovery of Listeria monocytogenes from Ground Beef.

    Science.gov (United States)

    Kamisaki-Horikoshi, Naoko; Okada, Yukio; Takeshita, Kazuko; Takada, Makoto; Kawamoto, Shinichi; Kawasaki, Susumu

    2017-03-01

    In 2009, the enrichment broth TA10 was released for simultaneous recovery of Salmonella spp., Listeria monocytogenes, and Escherichia coli O157:H7. This medium was compared with other Salmonella enrichment broths [lactose (LAC) broth, buffered peptone water (BPW), and universal pre-enrichment (UP) broth] for the recovery of heat- and freeze-injured Salmonella spp. in beef by the conventional culture method. There was a significant difference between TA10 and LAC enrichment broths for detecting injured Salmonella spp. In this study, the International Organization for Standardization Listeria pre-enrichment broth (Half-Fraser/Fraser) was compared with TA10 broth for the recovery of L. monocytogenes from ground beef. Ground beef samples were contaminated with single Listeria serovars at levels of 0.096 to 0.001 most probable number/g. Twenty 25 g test portions of the contaminated ground beef were pre-enriched in each broth, and the ISO-11290-1 Listeria official isolation protocol was used thereafter. There was a significant difference between TA10 broth (48 h) and Half-Fraser/Fraser broth (72 h) in the recovery of L. monocytogenes. In addition, the incubation time for TA10 broth was shorter than for Half-Fraser/Fraser broth. The results indicate that TA10 broth should be used instead of Half-Fraser/Fraser broth for analysis of beef that may be contaminated with very low levels of L. monocytogenes.

  3. Experimental Evaluation of a Total Heat Recovery Unit with Polymer Membrane Foils

    DEFF Research Database (Denmark)

    Fang, Lei; Yuan, Shu; Nie, Jinzhe

    2014-01-01

    A laboratory experimental study was conducted to investigate the energy performance of a total heat recovery unit using a polymer membranes heat exchanger. The study was conducted in twin climate chambers. One of the chambers simulated outdoor climate conditions and the other simulated the climat...

  4. Annex III-evaluation of past and ongoing enhanced oil recovery projects

    Energy Technology Data Exchange (ETDEWEB)

    1995-02-01

    The Infill Drilling Predictive Model (IDPM) was developed by Scientific Software-Intercomp (SSI) for the Bartlesville Project Office (BPO) of the United States Department of Energy (DOE). The model and certain adaptations thereof were used in conjunction with other models to support the Interstate Oil and Gas Compact Commission`s (IOGCC) 1993 state-by-state assessment of the potential domestic reserves achievable through the application of Advanced Secondary Recovery (ASR) and Enhanced Oil Recovery (EOR) techniques. Funding for this study was provided by the DOE/BPO, which additionally provided technical support. The IDPM is a three-dimensional (stratified, five-spot), two-phase (oil and water) model which uses a minimal amount of reservoir and geologic data to generate production and recovery forecasts for ongoing waterflood and infill drilling projects. The model computes water-oil displacement and oil recovery using finite difference solutions within streamtubes. It calculates the streamtube geometries and uses a two-dimensional reservoir simulation to track fluid movement in each streamtube slice. Thus the model represents a hybrid of streamtube and numerical simulators.

  5. Motion Rehab AVE 3D: A VR-based exergame for post-stroke rehabilitation.

    Science.gov (United States)

    Trombetta, Mateus; Bazzanello Henrique, Patrícia Paula; Brum, Manoela Rogofski; Colussi, Eliane Lucia; De Marchi, Ana Carolina Bertoletti; Rieder, Rafael

    2017-11-01

    Recent researches about games for post-stroke rehabilitation have been increasing, focusing in upper limb, lower limb and balance situations, and showing good experiences and results. With this in mind, this paper presents Motion Rehab AVE 3D, a serious game for post-stroke rehabilitation of patients with mild stroke. The aim is offer a new technology in order to assist the traditional therapy and motivate the patient to execute his/her rehabilitation program, under health professional supervision. The game was developed with Unity game engine, supporting Kinect motion sensing input device and display devices like Smart TV 3D and Oculus Rift. It contemplates six activities considering exercises in a tridimensional space: flexion, abduction, shoulder adduction, horizontal shoulder adduction and abduction, elbow extension, wrist extension, knee flexion, and hip flexion and abduction. Motion Rehab AVE 3D also report about hits and errors to the physiotherapist evaluate the patient's progress. A pilot study with 10 healthy participants (61-75 years old) tested one of the game levels. They experienced the 3D user interface in third-person. Our initial goal was to map a basic and comfortable setup of equipment in order to adopt later. All the participants (100%) classified the interaction process as interesting and amazing for the age, presenting a good acceptance. Our evaluation showed that the game could be used as a useful tool to motivate the patients during rehabilitation sessions. Next step is to evaluate its effectiveness for stroke patients, in order to verify if the interface and game exercises contribute into the motor rehabilitation treatment progress. Copyright © 2017 Elsevier B.V. All rights reserved.

  6. Quantitative performance of advanced resolution recovery strategies on SPECT images: evaluation with use of digital phantom models.

    Science.gov (United States)

    Onishi, Hideo; Motomura, Nobutoku; Fujino, Koichi; Natsume, Takahiro; Haramoto, Yasuhiro

    2013-01-01

    Several resolution recovery (RR) methods have been developed. This study was aimed to validate the following performance of the advanced RR methods: Evolution, Astonish, Flash3D, and 3D-OSEM. We compared the advanced RR method with filtered back projection (FBP) and standard order-subset expectation maximization (OSEM) using resolution (RES), cylinder/sphere (CYS), and myocardial (MYD) digital phantoms. The RES phantom was placed in three spheres. Sixteen spheres (hot and cold) were then placed in a concentric configuration (diameter: 96-9.6 mm) inside the CYS phantom. The MYD phantom was created by computer simulation with the use of an electron γ-shower 4 (EGS4) and it included two left ventricular defects in the myocardium. The performance was evaluated at source-to-detector distances (R-distance) of 166, 200, and 250 mm with reconstruction parameters (product of subset and iteration: SI) with use of the resolution recovery factor, count recovery, normalized mean square error (NMSE), and %CV. According to increased SI updates, the value of the FWHM decreased, and the effect was more obvious as the R-distance increased. The spatial resolution of the advanced RR method was 20 % better than that of FBP and OSEM. The resolution recovery ratio was 80 %, and the count recovery was maintained only in objects with a diameter of >30 mm in the advanced RR method. The NMSE and %CV was 50 and 30 % improved over FBP and OSEM, respectively. The advanced RR method caused overestimation due to Gibbs's phenomenon in the marginal region when the diameter of the sphere was 16-28.8 mm.

  7. Evaluation of a novel waste heat recovery system for the cement industry using multi-criteria analysis (MCA) approach

    Science.gov (United States)

    Han, Yue; Guo, Junshan; Zheng, Wei; Ding, Junqi; Zhu, Lingkai; Che, Yongqiang; Zhang, Yanpeng

    2017-12-01

    Based on a novel waste heat recovery project established in a cement plant, this paper aims to evaluate the performance of the project using multi-criteria analysis (MCA) approach. Economic, environmental, social, and technical perspectives were concerned and analyzed. Different sustainability criteria and indicators related with the project were evaluated through ranking/rating process and pairwise comparison. Results have shown similar outcomes, that ten out of eleven criteria are favorable at a high standard, which reveals the project’s success. Although the project has performed so well in economic, environmental and technical terms, social aspects have some weak points, and measures should be taken to improve social benefit.

  8. Evaluation of functional nerve recovery after reconstruction with a poly (DL-lactide-epsilon-caprolactone) nerve guide, filled with modified denatured muscle tissue

    NARCIS (Netherlands)

    Meek, MF; Den Dunnen, WFA; Schakenraad, JM; Robinson, PH

    1996-01-01

    The aim of this study was to compare the speed of functional nerve recovery after reconstruction with a biodegradable p(DLLA-epsilon -CL) nerve guide, as filled with either modified denatured muscle tissue (MDMT) or phosphate-buffered saline (PBS). To evaluate both motor and sensory nerve recovery,

  9. Lower Urinary Tract Symptoms, Erectile Dysfunction, and Quality of Life in Poststroke Men

    DEFF Research Database (Denmark)

    Tibaek, Sigrid; Gard, Gunvor; Dehlendorff, Christian

    2017-01-01

    The aim of the current study was to compare lower urinary tract symptoms (LUTS), erectile dysfunction (ED), and quality of life (QoL) in poststroke and healthy men. Thirty poststroke men with stroke-related LUTS, and as controls, 96 healthy men participated in this controlled, cross-sectional study...

  10. Botulinum therapy for poststroke spasticity of the lower extremity (clinical cases

    Directory of Open Access Journals (Sweden)

    L. V. Krylova

    2014-01-01

    Full Text Available The paper deals with the topical problem – the medical rehabilitation of patients with poststroke spasticity. It describes clinical cases of patients with poststroke spasticity of the upper and lower extremities who have received combined therapy using botulinum toxin type A (Botox injections.

  11. Is Cognitive Functioning 1 Year Poststroke Related to Quality of Life Domain?

    NARCIS (Netherlands)

    Verhoeven, Clara L. M.; Post, Marcel W. M.; Schiemanck, Sven K.; van Zandvoort, Martine J. E.; Vrancken, Peter H.; van Heugten, Caroline M.

    2011-01-01

    Previous studies on the association between poststroke cognitive impairment and quality of life (QoL) have shown divergent results. In this study, we investigated the relationships between cognitive functioning and various QoL domains at 1 year poststroke. This was a cross-sectional study, examining

  12. Kinematics of the contralateral and ipsilateral shoulder: A possible relationship with post-stroke shoulder pain

    NARCIS (Netherlands)

    Niessen, M.H.M.; Janssen, T.W.J.; Meskers, C.G.M.; Koppe, P.; Konijnenbelt, M.; Veeger, H.E.J.

    2008-01-01

    Objective: Post-stroke shoulder pain is a common phenomenon in hemiplegia and impedes rehabilitation. The aim of this study was to identify a possible relationship between post-stroke shoulder pain, scapula resting position and shoulder motion. Methods: Shoulder kinematics of 27 patients after

  13. Environmental evaluation of the electric and cogenerative configurations for the energy recovery of the Turin municipal solid waste incineration plant.

    Science.gov (United States)

    Panepinto, Deborah; Genon, Giuseppe

    2014-07-01

    Given the desirability of reducing fossil fuel consumption, together with the increasing production of combustible solid wastes, there is clearly a need for waste treatment systems that achieve both volume reduction and energy recovery. Direct incineration method is one such system. The aim of this work was to analyze the municipal solid waste incineration plant currently under construction in the province of Turin (Piedmont, North Italy), especially the potential for energy recovery, and the consequent environmental effects. We analyzed two kinds of energy recovery: electric energy (electrical configuration) only, and both electric and thermal energy (cogenerative configuration), in this case with a different connection hypothesis to the district heating network. After we had evaluated the potential of the incinerator and considered local demographic, energy and urban planning effects, we assumed different possible connections to the district heating network. We computed the local and global environmental balances based on the characteristics of the flue gas emitted from the stack, taking into consideration the emissions avoided by the substituted sources. The global-scale results provided relevant information on the carbon dioxide emissions parameter. The results on the local scale were used as reference values for the implementation of a Gaussian model (Aermod) that allows evaluation of the actual concentration of the pollutants released into the atmosphere. The main results obtained highlight the high energy efficiency of the combined production of heat and electricity, and the opportunity to minimize the environmental impact by including cogeneration in a district heating scheme. © The Author(s) 2014.

  14. Physical Therapy for a Child Poststroke With a Left Ventricular Assist Device.

    Science.gov (United States)

    Lombard, Kelly A

    2016-01-01

    To describe physical therapy (PT) examination and intervention during rehabilitation for a child poststroke with an implanted left ventricular assist device (LVAD). A 10-year-old boy with a history of congenital heart disease awaiting heart transplant was admitted to a pediatric rehabilitation hospital with right hemiplegia, and an external, portable LVAD. This child participated in standard PT examination procedures and interventions with accommodations for the LVAD. Observation was used to evaluate exercise response because of inability to measure vital signs. At admission, impaired muscle tone, balance, and endurance contributed to limitations in functional mobility. By discharge, improvements were seen in all impairments and also in ambulation distance, speed, and independence. This child awaiting heart transplant with an LVAD was able to tolerate intensive individualized PT. With monitoring and adjustments to the plan of care, he demonstrated improvements in functional mobility.

  15. Evaluation of Baermann apparatus sedimentation time on recovery of Strongylus vulgaris and S. edentatus third stage larvae from equine coprocultures.

    Science.gov (United States)

    Bellaw, Jennifer L; Nielsen, Martin K

    2015-06-30

    Traditional methods of diagnosing equine Strongylinae infections require culturing feces, sedimenting the culture media in Baermann apparatuses, collecting the sediment, and morphologically identifying recovered third stage larvae. However, this method is plagued by low negative predictive values. This study evaluated sedimentation time within the Baermann apparatus by comparing larval recovery from the traditionally collected sediment, "sediment 1", and from the usually discarded remaining fluid contents, "sediment 2", of the Baermann apparatus after 12, 24, and 48 h. A grand total of 147,482 larvae were recovered and examined. Sedimentation time did not significantly influence total larval recovery. At all three durations, significantly more Cyathostominae and Strongylus vulgaris larvae were covered from sediment 1 than from sediment 2. However, less than 60% of all recovered Strongylus edentatus were recovered from sediment 1. As 95% of S. vulgaris larvae were always recovered from sediment 1, the need for collection and examination of the remaining fluid contents of the Baermann apparatus is obviated when performing coprocultures for diagnosis of S. vulgaris infections, and sedimentation for 12h is adequate. Approximately 70% of Cyathostominae were recovered in sediment 1 at all durations, suggesting that 12h of sedimentation is adequate, although there is a need for future research to evaluate the risk of selection bias at differing sedimentation times among individual cyathostomin species. In contrast to S. vulgaris, collecting and examining the entire contents of the Baermann apparatus may be necessary when an increased diagnostic sensitivity and negative predictive value is desired in diagnosing S. edentatus infections as only 38-61% of larvae were recovered from sediment 1 portion of the Baermann apparatus. This information will allow researchers and practitioners to make more informed decisions in choosing appropriate larval recovery techniques, balancing

  16. Evaluation of a rapid method for recovery of norovirus and hepatitis A virus from oysters and blue mussels.

    Science.gov (United States)

    Uhrbrand, Katrine; Myrmel, Mette; Maunula, Leena; Vainio, Kirsti; Trebbien, Ramona; Nørrung, Birgit; Schultz, Anna Charlotte

    2010-10-01

    Foodborne outbreaks caused by noroviruses (NoVs) and hepatitis A virus (HAV) are often linked to consumption of contaminated shellfish. The objective of this study was to identify an appropriate virus recovery method for real-time reverse transcriptase (RT)-PCR detection and subsequently to evaluate this method on shellfish bioaccumulated with virus in a collaborative study. Five methods were compared for recovery of NoV GII.7 and feline calicivirus from spiked digestive tissue of oysters and mussels. A method based on proteinase K digestion followed by NucliSENS miniMAG extraction was found to be the most efficient with a 50% limit of detection (LOD(50)) of 62 and 12 RT-PCR U/1.5 g digestive tissue for NoV GII.7 in oysters and mussels, respectively. Evaluation of the method in four laboratories found the percentage of sensitivity, based on low/high levels of virus bioaccumulated in oysters, to be 33/80 for NoV GI.3b, 13/92 for NoV GII.4 and 50/42 for HAV. A specificity of 100% was found for all three viruses in non-bioaccumulated oysters. As process control Mengovirus (vMC(0)) showed an average recovery of 1.8% from oysters and 1.2% from mussels. The study demonstrates that this recovery method can be useful for harmonized data generation and routine viral analyses of shellfish. Copyright (c) 2010 Elsevier B.V. All rights reserved.

  17. [Randomized Controlled Clinical Trials of Eye-acupuncture Therapy for Patients with Post-stroke Insomnia].

    Science.gov (United States)

    Liu, Lu-Yang; Wang, Peng-Qin

    2017-02-25

    To observe the therapeutic effect of eye-acupuncture therapy for post-stroke insomnia. Sixty patients (45-70 years in age) with post-stroke insomnia were randomized into eye-acupuncture group and routine acupuncture (body acupuncture) group (30 cases in each). Patients of the eye-acupuncture group were treated by acupuncture stimulation of bilateral Shangjiao (Upper-energizer) and Xin (Heart) regions and those of the routine acupuncture group treated by acupuncture stimulation of Baihui (GV 20), Sishencong (EX-HN 1), Anmian (EX-HN 16), etc. After Deqi, the filiform needles were retained for 20 min, and the treatment in both groups was conducted once a day, with 15 days being one therapeutic course and 2 courses altogether. The Pittsburgh Sleep Quality Index (PSQI) including the subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, daytime dysfunction, and total PSQI score was used to evaluate the overall sleep quality. The clinical efficacy was assessed according to the "Guiding Principles of Clinical Trials for New Drugs of Traditional Chinese Medicine" formulated by Chinese Ministry of Health. Following the treatment, of the two 30 cases in the eye-and routine acupuncture groups, 21 and 9 experienced a marked improvement in their symptoms, 8 and 17 were effective, and 1 and 4 invalid, with the effective rate being 96.7% and 86.7%, respectively. The PSQI scores of the subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, daytime dysfunction, and the total PSQI score were all significantly decreased in comparison with pre-treatment in each group (Pacupuncture was markedly superior to those of routine acupuncture in reducing sleep latency, sleep disturbances and daytime dysfunction (Pefficiency and total PSQI score (P>0.05). Both eye-acupuncture and routine acupunture are effective in the treatment of post-stroke insomnia, and the eye-acupuncture is better than

  18. A robotic test of proprioception within the hemiparetic arm post-stroke.

    Science.gov (United States)

    Simo, Lucia; Botzer, Lior; Ghez, Claude; Scheidt, Robert A

    2014-04-30

    Proprioception plays important roles in planning and control of limb posture and movement. The impact of proprioceptive deficits on motor function post-stroke has been difficult to elucidate due to limitations in current tests of arm proprioception. Common clinical tests only provide ordinal assessment of proprioceptive integrity (eg. intact, impaired or absent). We introduce a standardized, quantitative method for evaluating proprioception within the arm on a continuous, ratio scale. We demonstrate the approach, which is based on signal detection theory of sensory psychophysics, in two tasks used to characterize motor function after stroke. Hemiparetic stroke survivors and neurologically intact participants attempted to detect displacement- or force-perturbations robotically applied to their arm in a two-interval, two-alternative forced-choice test. A logistic psychometric function parameterized detection of limb perturbations. The shape of this function is determined by two parameters: one corresponds to a signal detection threshold and the other to variability of responses about that threshold. These two parameters define a space in which proprioceptive sensation post-stroke can be compared to that of neurologically-intact people. We used an auditory tone discrimination task to control for potential comprehension, attention and memory deficits. All but one stroke survivor demonstrated competence in performing two-alternative discrimination in the auditory training test. For the remaining stroke survivors, those with clinically identified proprioceptive deficits in the hemiparetic arm or hand had higher detection thresholds and exhibited greater response variability than individuals without proprioceptive deficits. We then identified a normative parameter space determined by the threshold and response variability data collected from neurologically intact participants. By plotting displacement detection performance within this normative space, stroke survivors

  19. Evaluation of nuclear facility decommissioning projects. Summary report: Three Mile Island Unit 2 polar crane recovery

    Energy Technology Data Exchange (ETDEWEB)

    Doerge, D.H.; Miller, R.L.

    1984-08-01

    This document summarizes information concerning restoration of the Three Mile Island-Unit 2 Polar Crane to a fully operational condition following the loss of coolant accident experienced on March 28, 1979. The data collected from activity reports, reactor containment entry records, and other sources were placed in a computerized information retrieval/manipulation system which permits extraction/manipulation of specific data which could be utilized in planning for recovery activities should a similar accident occur in a nuclear generating plant. The information is presented in both computer output form and a manually assembled summarization. This report contains only the manpower requirements and radiation exposures actually incurred during recovery operations within the reactor containment and does not include support activities or costs.

  20. Evaluating the economic viability of a material recovery system: the case of cathode ray tube glass.

    Science.gov (United States)

    Gregory, Jeremy R; Nadeau, Marie-Claude; Kirchain, Randolph E

    2009-12-15

    This paper presents an analysis of the material recovery system for leaded glass from cathode ray tubes (CRTs) using a dynamic material flow analysis. In particular, the global mass flow of primary and secondary CRT glass and the theoretical capacities for using secondary CRT glass to make new CRT glass are analyzed. The global mass flow analysis indicates that the amount of new glass required is decreasing, but is much greater than the amount of secondary glass collected, which is increasing. The comparison of the ratio of secondary glass collected to the amount of new glass required from the mass flow analysis indicates that the material recovery system is sustainable for the foreseeable future. However, a prediction of the time at which the market for secondary glass will collapse due to excess capacity is not possible at the moment due to several sources of uncertainty.

  1. Thermodynamic evaluation of the Kalina split-cycle concepts for waste heat recovery applications

    DEFF Research Database (Denmark)

    Nguyen, Tuong-Van; Knudsen, Thomas; Larsen, Ulrik

    2014-01-01

    of varying boundary conditions by conducting an exergy analysis. The design parameters of each configuration were determined by performing a multi-variable optimisation. The results indicate that the Kalina split-cycle with reheat presents an exergetic efficiency by 2.8% points higher than a reference Kalina...... and condenser, and indicates a reduction of the exergy destruction by about 23% in the heat recovery system compared to the baseline cycle....

  2. Evaluation of the Waste Tire Resources Recovery Program and Environmental Health Policy in Taiwan

    OpenAIRE

    Chen, Chia-Ching; Yamada, Tetsuji; Chiu, I-Ming; Liu, Yi-Kuen

    2009-01-01

    This paper examines the effectiveness of Taiwanese environmental health policies, whose aim is to improve environmental quality by reducing tire waste via the Tire Resource Recovery Program. The results confirm that implemented environmental health policies improve the overall health of the population (i.e. a decrease in death caused by bronchitis and other respiratory diseases). Current policy expenditures are far below the optimal level, as it is estimated that a ten percent increase in the...

  3. Gait cycle analysis: parameters sensitive for functional evaluation of peripheral nerve recovery in rat hind limbs.

    Science.gov (United States)

    Rui, Jing; Runge, M Brett; Spinner, Robert J; Yaszemski, Michael J; Windebank, Anthony J; Wang, Huan

    2014-10-01

    Video-assisted gait kinetics analysis has been a sensitive method to assess rat sciatic nerve function after injury and repair. However, in conduit repair of sciatic nerve defects, previously reported kinematic measurements failed to be a sensitive indicator because of the inferior recovery and inevitable joint contracture. This study aimed to explore the role of physiotherapy in mitigating joint contracture and to seek motion analysis indices that can sensitively reflect motor function. Data were collected from 26 rats that underwent sciatic nerve transection and conduit repair. Regular postoperative physiotherapy was applied. Parameters regarding step length, phase duration, and ankle angle were acquired and analyzed from video recording of gait kinetics preoperatively and at regular postoperative intervals. Stride length ratio (step length of uninjured foot/step length of injured foot), percent swing of the normal paw (percentage of the total stride duration when the uninjured paw is in the air), propulsion angle (toe-off angle subtracted by midstance angle), and clearance angle (ankle angle change from toe off to midswing) decreased postoperatively comparing with baseline values. The gradual recovery of these measurements had a strong correlation with the post-nerve repair time course. Ankle joint contracture persisted despite rigorous physiotherapy. Parameters acquired from a 2-dimensional motion analysis system, that is, stride length ratio, percent swing of the normal paw, propulsion angle, and clearance angle, could sensitively reflect nerve function impairment and recovery in the rat sciatic nerve conduit repair model despite the existence of joint contractures.

  4. In vitro Percutaneous Absorption of Niacinamide and Phytosterols and in vivo Evaluation of their Effect on Skin Barrier Recovery.

    Science.gov (United States)

    Offerta, Alessia; Bonina, Francesco; Gasparri, Franco; Zanardi, Andrea; Micicche, Lucia; Puglia, Carmelo

    2016-01-01

    In this study, we evaluated different strategies to optimize the percutaneous absorption of niacinamide (NA) and soy phytosterols (FITO) by making use of solid lipid nanoparticles (SLN) and penetration enhancers, such as the hydrogenated lecithin. The evaluation of the skin permeation of NA and FITO has been effected in vitro using excised human skin (i.e., stratum corneum-epidermis or SCE). Furthermore, we evaluated the in vivo effect that NA and FITO has on skin barrier recovery after the topical application; using the extent of methyl nicotinate (MN)-induced erythema in damaged skin as a parameter to determine the rate of stratum corneum recovery. Results pointed out the importance of these strategies as valid tools for NA and FITO topical delivery. In fact, soy lecithin based formulations were able to increase the percutaneous absorption of the two active ingredients, while SLN guaranteed an interesting delayed and sustained release of FITO. In vivo evaluation showed clearly that the formulation containing both the actives (NA and FITO) is able to recover about 95% of skin barrier integrity eight days after tape stripping. This effect is probably due to the "synergistic effect" of NA and FITO.

  5. Familiarization, reliability, and evaluation of a multiple sprint running test using self-selected recovery periods.

    Science.gov (United States)

    Glaister, Mark; Witmer, Chad; Clarke, Dustin W; Guers, John J; Heller, Justin L; Moir, Gavin L

    2010-12-01

    The aims of the present study were to investigate the process of self-selected recovery in a multiple sprint test with a view to using self-selected recovery time as a means of reliably quantifying an individual's ability to resist fatigue in this type of exercise. Twenty physically active exercise science students (means ± SD for age, height, body mass, body fat, and VO2max of the subjects were 21 ± 2 yr, 1.79 ± 0.09 m, 83.7 ± 10.8 kg, 16.6 ± 3.9%, and 52.7 ± 7.2 ml·kg·min, respectively) completed 4 trials of a 12 × 30 m multiple sprint running test under the instruction that they should allow sufficient recovery time between sprints to enable maximal sprint performance to be maintained throughout each trial. Mean recovery times across the 4 trials were 73.9 ± 24.7, 82.3 ± 23.8, 77.6 ± 19.1, and 77.5 ± 13.9 seconds, respectively, with variability across the first 3 trials considered evidence of learning effects. Test-retest reliability across trials 3 to 4 revealed a good level of reliability as evidenced by a coefficient of variation of 11.1% (95% likely range: 8.0-18.1%) and an intraclass correlation coefficient of 0.76 (95% likely range: 0.40-0.91). Despite no change in sprint performance throughout the trials, ratings of perceived exertion increased progressively and significantly (p < 0.001) from a value of 10 ± 2 after sprint 3 to 14 ± 2 after sprint 12. The correlation between relative VO2max and mean recovery time was 0.14 (95% likely range: -0.37-0.58). The results of the present study show that after the completion of 2 familiarization trials, the ability to maintain sprinting performance in a series of repeated sprints can be self-regulated by an athlete to a high degree of accuracy without the need for external timepieces.

  6. Virtual rehabilitation via Nintendo Wii® and conventional physical therapy effectively treat post-stroke hemiparetic patients.

    Science.gov (United States)

    da Silva Ribeiro, Nildo Manoel; Ferraz, Daniel Dominguez; Pedreira, Érika; Pinheiro, Ígor; da Silva Pinto, Ana Cláudia; Neto, Mansueto Gomes; Dos Santos, Luan Rafael Aguiar; Pozzato, Michele Gea Guimarães; Pinho, Ricardo Silva; Masruha, Marcelo Rodrigues

    2015-08-01

    The Nintendo® Wii is a simple and affordable virtual therapy alternative. It may be used at home, and it is a motivating recreational activity that provides continuous feedback. However, studies comparing the use of the Nintendo® Wii to conventional physical therapy are needed. To compare the effect of a rehabilitation treatment using the Nintendo® Wii (NW) with conventional physical therapy (CPT) to improve the sensorimotor function and quality of life for post-stroke hemiparetic patients. The present study applied a randomized, blind, and controlled clinical trial. In total, 30 patients with post-stroke hemiparesis were evaluated. A total of 15 patients were randomly assigned to each group. The SF-36 quality of life and Fugl-Meyer scales were used to evaluate the patients. After treatment, the only variable that differed between the groups was the physical functioning domain of the SF-36 in the group that received conventional physical therapy. A significant difference was observed between both groups before and after treatment in terms of the following Fugl-Meyer scale items: passive movement and pain, motor function of the upper limbs (ULs), and balance. The CPT group also showed a significant difference with regard to their UL and lower limb (LL) coordination. The SF-36 scale analysis revealed a significant difference within both groups with regard to the following domains: physical functioning, role limitation due to physical aspects, vitality, and role limitation due to emotional aspects. The NW group also exhibited a significant difference in the mental health domain. The results indicate that both approaches improved the patients' performance in a similar manner. Virtual rehabilitation using the Nintendo Wii® and CPT both effectively treat post-stroke hemiparetic patients by improving passive movement and pain scores, motor function of the upper limb, balance, physical functioning, vitality, and the physical and emotional aspects of role functioning.

  7. Post-stroke sexual functioning in first stroke patients.

    Science.gov (United States)

    Tamam, Y; Tamam, L; Akil, E; Yasan, A; Tamam, B

    2008-07-01

    Although physical problems after stroke have been well studied, there is little information on one of the crucial aspects of the quality of life of those patients, namely sexual functioning and satisfaction. The aim of this study was to assess the impact of stroke on sexual functioning in a stable cohort of Turkish stroke patients with mild or no disability and to assess the relationship between post-stroke sexuality and a number of socio-demographic, clinical and laboratory variables. The sexual functioning of 103 Turkish stroke patients with no disability or mild disability was assessed in two consecutive interviews along with clinical and sociodemographic features. NIH stroke, Glasgow coma, Barthel, and Rankin scales were also applied to assess neurologic status and disability. Most of the patients were male (61%) and illiterate (70%). There was a significant difference between the baseline and post-stroke frequency of sexual activity of the patients. The differences between baseline and post-stroke vaginal lubrication, orgasms and satisfaction were all statistically significant. This latter difference was significant for both genders. Frequency of coitus both prior to and after the stroke was significantly different between males and females. Erection and ejaculation of the males was significantly affected by the stroke, and lubrication and orgasm was affected in the females. Interestingly, fear of recurrent stroke did not differ between genders. Our study has shown that Turkish stroke survivors have sexual health needs during the rehabilitation process, though this has not been addressed previously. Sexual health needs seem to be affected by cultural factors and biases.

  8. Predictors of poststroke quality of life in older Chinese adults.

    Science.gov (United States)

    Lee, Angel Chu Kee; Tang, Siu Wa; Tsoi, Tak Hong; Fong, Daniel Yee Tak; Yu, Gabriel Ka Kui

    2009-03-01

    This paper is a report of a study to identify the changes in poststroke quality of life and other clinical issues among older Chinese adults from 1 month to 6 months after stroke and the predictors of poststroke quality of life at 6 months. Stroke survivors are known to suffer from prolonged and multiple impairments leading to a compromised quality of life, but few studies report early predictors for quality of life among older Chinese adults after active rehabilitation has been undertaken during the first 6 months after stroke. A total of 214 patients with first-ever ischaemic stroke were interviewed by a research nurse at 1 month and 188 patients were interviewed again 6 months after hospital admission for stroke. Assessment of quality of life was done using the Modified Rankin Scale for Quality of Life. Changes in and relationships between quality of life and variables in five domains were explored: bio-anatomical, physical, emotional, cognitive, communicative and social support. The data were collected in 2004-2005. Quality of life among two-thirds of participants was unchanged or lower when scores at 1 month and 6 months after stroke were compared. Length of hospital stay after admission for stroke and other 1-month factors - level of worry over current health, cognitive and self-care deficits - were identified as having independent effects on quality of life at 6 months. Clinicians need to observe for early signs of mild cognitive impairments and emotional needs of stroke survivors, as well as to consider longer-term interventions to enhance poststroke quality of life.

  9. Evaluation of hydrotherapy, using passive tests and power tests, for recovery across a cyclic week of competitive rugby union.

    Science.gov (United States)

    Higgins, Trevor R; Climstein, Mike; Cameron, Melainie

    2013-04-01

    In team sports, a cycle of training, competition, and recovery occurs weekly during the competitive season. In this research, we evaluated hydrotherapy for recovery from a simulated game of rugby union tracked over a week of training. Twenty-four experienced male rugby union players (mean ± SD age 19.46 ± 0.82 years, weight 82.38 ± 11.12 kg, height 178.54 ± 5.75 cm) were randomly divided into 3 groups: cold water immersion (n = 8), contrast bath therapy (n = 8), and a control group (n = 8). The 2 forms of hydrotherapy were administered immediately after a simulated rugby game. Testing was conducted 1 hour before the game and at 5 intervals postgame: 1, 48, 72, 96, and 144 hours. Dependent variables included countermovement jump, 10- and 40-m sprints, sessional rating of perceived exertion (RPE), flexibility, thigh circumference, and self-reported delayed onset muscle soreness (DOMS). Significant differences in DOMS were found between the cold water immersion and contrast bath groups at 48 hours post intervention (p = 0.02), and between the control and contrast bath groups at 72 (p = 0.03) and 96 (p = 0.04) hours post intervention. Cold water immersion and contrast bath groups reported significantly different RPE at 72 hours (p = ?) and 96 hours post (p = 0.05) intervention. Athletes' perceptions of muscle soreness and sessional RPE scores for training were greater in the contrast bath group (20%) after the simulated game and throughout the training week. Although results from passive and power tests were inconclusive in determining whether cold water immersion or passive recovery was more effective in attenuating fatigue, results indicated contrast baths had little benefit in enhancing recovery during a cyclic week of rugby union.

  10. Transcriptomics of Post-Stroke Angiogenesis in the Aged Brain

    Science.gov (United States)

    Buga, Ana Maria; Margaritescu, Claudiu; Scholz, Claus Juergen; Radu, Eugen; Zelenak, Christine; Popa-Wagner, Aurel

    2014-01-01

    Despite the obvious clinical significance of post-stroke angiogenesis in aged subjects, a detailed transcriptomic analysis of post-stroke angiogenesis has not yet been undertaken in an aged experimental model. In this study, by combining stroke transcriptomics with immunohistochemistry in aged rats and post-stroke patients, we sought to identify an age-specific gene expression pattern that may characterize the angiogenic process after stroke. We found that both young and old infarcted rats initiated vigorous angiogenesis. However, the young rats had a higher vascular density by day 14 post-stroke. “New-for-stroke” genes that were linked to the increased vasculature density in young animals included Angpt2, Angptl2, Angptl4, Cib1, Ccr2, Col4a2, Cxcl1, Lef1, Hhex, Lamc1, Nid2, Pcam1, Plod2, Runx3, Scpep1, S100a4, Tgfbi, and Wnt4, which are required for sprouting angiogenesis, reconstruction of the basal lamina (BL), and the resolution phase. The vast majority of genes involved in sprouting angiogenesis (Angpt2, Angptl4, Cib1, Col8a1, Nrp1, Pcam1, Pttg1ip, Rac2, Runx1, Tnp4, Wnt4); reconstruction of a new BL (Col4a2, Lamc1, Plod2); or tube formation and maturation (Angpt1, Gpc3, Igfbp7, Sparc, Tie2, Tnfsf10), had however, a delayed upregulation in the aged rats. The angiogenic response in aged rats was further diminished by the persistent upregulation of “inflammatory” genes (Cxcl12, Mmp8, Mmp12, Mmp14, Mpeg1, Tnfrsf1a, Tnfrsf1b) and vigorous expression of genes required for the buildup of the fibrotic scar (Cthrc1, Il6ra, Il13ar1, Il18, Mmp2, Rassf4, Tgfb1, Tgfbr2, Timp1). Beyond this barrier, angiogenesis in the aged brains was similar to that in young brains. We also found that the aged human brain is capable of mounting a vigorous angiogenic response after stroke, which most likely reflects the remaining brain plasticity of the aged brain. PMID:24672479

  11. Chinese Medicine Patterns in Patients with Post-Stroke Dementia

    Directory of Open Access Journals (Sweden)

    Nou-Ying Tang

    2012-04-01

    Full Text Available A stroke often results in post-stroke dementia, a rapid decline in memory and intelligence causing dysfunctions in daily life. The Chinese medicine doctor uses 4 examinations of inspection, listening, smelling, and feeling to determine the Chinese medicine pattern (CMP. Therefore, the purpose of the present study was to investigate the CMP in patients with post-stroke dementia. A total of 101 stroke patients were examined, consistent with the DSM IV diagnostic criteria of the American Psychiatric Association, as well as the National Institute of Neurological Disorders and Stroke-Association International pour Ia Recherche et I’Enseignement en Neurosciences vascular dementia diagnostic criteria of post-stroke dementia. Results: 100 patients (99.0% were KEDP (kidney essence deficiency pattern, shèn jīng kuī xū zhèng, 腎精虧虛證, 83 patients were AHLYP (ascendant hyperactivity of liver yang pattern, gān yáng shàng kàng zhèng, 肝陽上亢證, 83 patients were QBDP (qi-blood deficiency pattern, qì xuè kuī xū zhèng, 氣血虧虛證, 81 patients were SBOCP (static blood obstructing the collaterals pattern, yū xuè zǔ luò zhèng, 瘀血阻絡證, 72 patients were BSTRP (bowels stagnation turbidity retention pattern, fǔ zhì zhuó liú zhèng, 腑滯濁留證, 50 patients were FHIEP (fire heat interior excess pattern, huǒ rè nèi sheng zhèng, 火熱內盛證, and 39 participants (38.6% were PTOOP (phlegm turbidity obstructing the orifices pattern, tán zhuó zǔ qiào zhèng, 痰濁阻竅證; one to 31 patients have at least 2 CMPs simultaneously. In conclusion, the most CMP is KEDP CMP in the post-stroke dementia patients, and one patient may have one or at least 2 CMPs simultaneously.

  12. Field Evaluation of the Restorative Capacity of the Aquifer Downgradient of a Uranium In-Situ Recovery Mining Site

    Energy Technology Data Exchange (ETDEWEB)

    Reimus, Paul William [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2015-05-22

    A two-part field study was conducted in Smith Ranch-Highland in-situ recovery (ISR) near Douglas, Wyoming, to evaluate the restorative capacity of the aquifer downgradient (i.e., hydrologically downstream) of a Uranium ISR mining site with respect to the transport of uranium and other potential contaminants in groundwater after mining has ceased. The study was partially conducted by checking the Uranium content and the alkalinity of separate wells, some wells had been restored and others had not. A map and in-depth procedures of the study are included.

  13. Evaluation of the Waste Tire Resources Recovery Program and Environmental Health Policy in Taiwan

    Directory of Open Access Journals (Sweden)

    Chia-Ching Chen

    2009-03-01

    Full Text Available This paper examines the effectiveness of Taiwanese environmental health policies, whose aim is to improve environmental quality by reducing tire waste via the Tire Resource Recovery Program. The results confirm that implemented environmental health policies improve the overall health of the population (i.e. a decrease in death caused by bronchitis and other respiratory diseases. Current policy expenditures are far below the optimal level, as it is estimated that a ten percent increase in the subsidy would decrease the number of deaths caused by bronchitis and other respiratory diseases by 0.58% per county/city per year on average.

  14. NDT-Bobath method in normalization of muscle tone in post-stroke patients.

    Science.gov (United States)

    Mikołajewska, Emilia

    2012-01-01

    Ischaemic stroke is responsible for 80-85% of strokes. There is great interest in finding effective methods of rehabilitation for post-stroke patients. The aim of this study was to assess the results of rehabilitation carried out in the normalization of upper limb muscle tonus in patients, estimated on the Ashworth Scale for Grading Spasticity. The examined group consisted of 60 patients after ischaemic stroke. 10 sessions of NDT-Bobath therapy were provided within 2 weeks (ten days of therapy). Patient examinations using the Ashworth Scale for Grading Spasticity were done twice: the first time on admission and the second after the last session of the therapy to assess rehabilitation effects. Among the patients involved in the study, the results measured on the Ashworth Scale (where possible) were as follows: recovery in 16 cases (26.67%), relapse in 1 case (1.67%), no measurable changes (or change within the same grade of the scale) in 8 cases (13.33%). Statistically significant changes were observed in the health status of the patients. These changes, in the area of muscle tone, were favorable and reflected in the outcomes of the assessment using the Ashworth Scale for Grading Spasticity.

  15. β1 integrin signaling promotes neuronal migration along vascular scaffolds in the post-stroke brain

    Directory of Open Access Journals (Sweden)

    Teppei Fujioka

    2017-02-01

    Full Text Available Cerebral ischemic stroke is a main cause of chronic disability. However, there is currently no effective treatment to promote recovery from stroke-induced neurological symptoms. Recent studies suggest that after stroke, immature neurons, referred to as neuroblasts, generated in a neurogenic niche, the ventricular-subventricular zone, migrate toward the injured area, where they differentiate into mature neurons. Interventions that increase the number of neuroblasts distributed at and around the lesion facilitate neuronal repair in rodent models for ischemic stroke, suggesting that promoting neuroblast migration in the post-stroke brain could improve efficient neuronal regeneration. To move toward the lesion, neuroblasts form chain-like aggregates and migrate along blood vessels, which are thought to increase their migration efficiency. However, the molecular mechanisms regulating these migration processes are largely unknown. Here we studied the role of β1-class integrins, transmembrane receptors for extracellular matrix proteins, in these migrating neuroblasts. We found that the neuroblast chain formation and blood vessel-guided migration critically depend on β1 integrin signaling. β1 integrin facilitated the adhesion of neuroblasts to laminin and the efficient translocation of their soma during migration. Moreover, artificial laminin-containing scaffolds promoted neuroblast chain formation and migration toward the injured area. These data suggest that laminin signaling via β1 integrin supports vasculature-guided neuronal migration to efficiently supply neuroblasts to injured areas. This study also highlights the importance of vascular scaffolds for cell migration in development and regeneration.

  16. Virtual reality treatment and assessments for post-stroke unilateral spatial neglect: A systematic literature review.

    Science.gov (United States)

    Ogourtsova, Tatiana; Souza Silva, Wagner; Archambault, Philippe S; Lamontagne, Anouk

    2017-04-01

    Unilateral spatial neglect (USN) is a highly prevalent post-stroke deficit. Currently, there is no gold standard USN assessment which encompasses the heterogeneity of this disorder and that is sensitive to detect mild deficits. Similarly, there is a limited number of high quality studies suggesting that conventional USN treatments are effective in improving functional outcomes and reducing disability. Virtual reality (VR) provides enhanced methods for USN assessment and treatment. To establish best-practice recommendations with respect to its use, it is necessary to appraise the existing evidence. This systematic review aimed to identify and appraise existing VR-based USN assessments; and to determine whether VR is more effective than conventional therapy. Assessment tools were critically appraised using standard criteria. The methodological quality of the treatment trials was rated by two authors. The level of evidence according to stage of recovery was determined. Findings were compiled into a VR-based USN Assessment and Treatment Toolkit (VR-ATT). Twenty-three studies were identified. The proposed VR tools augmented the conventional assessment strategies. However, most studies lacked analysis of psychometric properties. There is limited evidence that VR is more effective than conventional therapy in improving USN symptoms in patients with stroke. It was concluded that VR-ATT could facilitate identification and decision-making as to the appropriateness of VR-based USN assessments and treatments across the continuum of stroke care, but more evidence is required on treatment effectiveness.

  17. Integration of augmented reality and assistive devices for post-stroke hand opening rehabilitation.

    Science.gov (United States)

    Luo, Xun; Kline, Tiffany; Fischer, Heidi; Stubblefield, Kathy; Kenyon, Robert; Kamper, Derek

    2005-01-01

    Impairment of hand function is prevalent among stroke survivors, motivating the search for effective rehabilitation therapy. Recent studies have suggested that for upper extremity functional recovery, repetitive training with virtual reality is helpful. Repetitive training can be facilitated with assistance from mechanical devices. Thus, we have developed a training environment that integrates augmented reality (AR) with assistive devices for post-stroke hand rehabilitation. The AR element of our environment utilizes head mounted display and virtual objects for reach-and-grasp task training. The assistive device consists of either a body-powered orthosis (BPO) or a pneumatic-powered device (PPD), both of which are incorporated into gloves. This environment can be easily set up and calibrated, is customizable for individual users, and requires active user participation. Additionally, it can be used with both real and virtual objects, as desired. We are currently conducting pilot case studies to assess ease of use and efficacy. At present, one stroke survivor from each of the three training conditions, AR-with-BPO, AR-with-PPD and AR-only (acting as the control), has completed the 6-week training paradigm. Preliminary findings suggest user acceptance of the technology and some potential for beneficial effects.

  18. Older adult stroke survivors discussing poststroke depressive symptoms with a healthcare provider: a preliminary analysis.

    Science.gov (United States)

    Klinedinst, N Jennifer; Clark, Patricia C; Dunbar, Sandra B

    2013-08-01

    The purposes of this study were to examine the relationship between the poststroke depressive symptoms, older adult stroke survivors' perceptions of the depressive symptoms, and the congruence with an informal caregiver about the presence of depressive symptoms, and comfort talking to the health care provider with whether or not older stroke survivors discussed their depressive symptoms with a health care provider. A cross-sectional study where 44 caregiver/older adult stroke survivor dyads completed questionnaires including the Center for Epidemiologic Studies Depression Scale, Symptom Perception Questionnaire, and reporting of depressive symptoms to the health care provider via one time interview. Thirty-seven percent (n = 16) of all older stroke survivors reported depressive symptoms to their health care provider. Of the stroke survivors who had high levels of depressive symptoms (CESD ≥ 16; n = 11), seven reported the depressive symptoms to their health care provider. Identifying the symptoms as possible depression and attributing the cause of the depressive symptoms to the stroke were related to stroke survivors reporting the depressive symptoms to a health care provider. High functioning, older stroke survivors may benefit from strategies to help them identify when they experience depressive symptoms, in order to be able to play an active role in their recovery by appropriately discussing their symptoms with a health care provider. (c) 2013 APA, all rights reserved.

  19. Assessment of biofeedback rehabilitation in post-stroke patients combining fMRI and gait analysis: a case study.

    Science.gov (United States)

    Del Din, Silvia; Bertoldo, Alessandra; Sawacha, Zimi; Jonsdottir, Johanna; Rabuffetti, Marco; Cobelli, Claudio; Ferrarin, Maurizio

    2014-04-09

    The ability to walk independently is a primary goal for rehabilitation after stroke. Gait analysis provides a great amount of valuable information, while functional magnetic resonance imaging (fMRI) offers a powerful approach to define networks involved in motor control. The present study reports a new methodology based on both fMRI and gait analysis outcomes in order to investigate the ability of fMRI to reflect the phases of motor learning before/after electromyographic biofeedback treatment: the preliminary fMRI results of a post stroke subject's brain activation, during passive and active ankle dorsal/plantarflexion, before and after biofeedback (BFB) rehabilitation are reported and their correlation with gait analysis data investigated. A control subject and a post-stroke patient with chronic hemiparesis were studied. Functional magnetic resonance images were acquired during a block-design protocol on both subjects while performing passive and active ankle dorsal/plantarflexion. fMRI and gait analysis were assessed on the patient before and after electromyographic biofeedback rehabilitation treatment during gait activities. Lower limb three-dimensional kinematics, kinetics and surface electromyography were evaluated. Correlation between fMRI and gait analysis categorical variables was assessed: agreement/disagreement was assigned to each variable if the value was in/outside the normative range (gait analysis), or for presence of normal/diffuse/no activation of motor area (fMRI). Altered fMRI activity was found on the post-stroke patient before biofeedback rehabilitation with respect to the control one. Meanwhile the patient showed a diffuse, but more limited brain activation after treatment (less voxels). The post-stroke gait data showed a trend towards the normal range: speed, stride length, ankle power, and ankle positive work increased. Preliminary correlation analysis revealed that consistent changes were observed both for the fMRI data, and the gait

  20. Evaluating anthropogenic threats to endangered killer whales to inform effective recovery plans.

    Science.gov (United States)

    Lacy, Robert C; Williams, Rob; Ashe, Erin; Balcomb Iii, Kenneth C; Brent, Lauren J N; Clark, Christopher W; Croft, Darren P; Giles, Deborah A; MacDuffee, Misty; Paquet, Paul C

    2017-10-26

    Understanding cumulative effects of multiple threats is key to guiding effective management to conserve endangered species. The critically endangered, Southern Resident killer whale population of the northeastern Pacific Ocean provides a data-rich case to explore anthropogenic threats on population viability. Primary threats include: limitation of preferred prey, Chinook salmon; anthropogenic noise and disturbance, which reduce foraging efficiency; and high levels of stored contaminants, including PCBs. We constructed a population viability analysis to explore possible demographic trajectories and the relative importance of anthropogenic stressors. The population is fragile, with no growth projected under current conditions, and decline expected if new or increased threats are imposed. Improvements in fecundity and calf survival are needed to reach a conservation objective of 2.3% annual population growth. Prey limitation is the most important factor affecting population growth. However, to meet recovery targets through prey management alone, Chinook abundance would have to be sustained near the highest levels since the 1970s. The most optimistic mitigation of noise and contaminants would make the difference between a declining and increasing population, but would be insufficient to reach recovery targets. Reducing acoustic disturbance by 50% combined with increasing Chinook by 15% would allow the population to reach 2.3% growth.

  1. Assessing Cognitive Ability and Simulator-Based Driving Performance in Poststroke Adults

    Science.gov (United States)

    Falkmer, Torbjörn; Willstrand, Tania Dukic

    2017-01-01

    Driving is an important activity of daily living, which is increasingly relied upon as the population ages. It has been well-established that cognitive processes decline following a stroke and these processes may influence driving performance. There is much debate on the use of off-road neurological assessments and driving simulators as tools to predict driving performance; however, the majority of research uses unlicensed poststroke drivers, making the comparability of poststroke adults to that of a control group difficult. It stands to reason that in order to determine whether simulators and cognitive assessments can accurately assess driving performance, the baseline should be set by licenced drivers. Therefore, the aim of this study was to assess differences in cognitive ability and driving simulator performance in licensed community-dwelling poststroke drivers and controls. Two groups of licensed drivers (37 poststroke and 43 controls) were assessed using several cognitive tasks and using a driving simulator. The poststroke adults exhibited poorer cognitive ability; however, there were no differences in simulator performance between groups except that the poststroke drivers demonstrated less variability in driver headway. The application of these results as a prescreening toolbox for poststroke drivers is discussed. PMID:28559646

  2. Neuronox versus BOTOX in the Treatment of Post-Stroke Upper Limb Spasticity: A Multicenter Randomized Controlled Trial

    Science.gov (United States)

    Seo, Han Gil; Paik, Nam-Jong; Lee, Shi-Uk; Oh, Byung-Mo; Chun, Min Ho; Kwon, Bum Sun; Bang, Moon Suk

    2015-01-01

    Background Botulinum toxin type A is widely used for treating spasticity. Neuronox (Neu-BoNT/A), a newly manufactured botulinum toxin a, has not yet been investigated for its efficacy and safety in the treatment of post-stroke upper limb spasticity. Objective We evaluated the efficacy and safety of Neuronox (Neu-BoNT/A) compared with BOTOX (onabotulinum toxin A) for treating post-stroke upper limb spasticity. Methods In total, 196 stroke patients with moderate to severe upper limb spasticity were randomly assigned to either Neuronox or BOTOX intervention. The wrist flexors were mandatory and elbow, finger, and thumb flexors were optional muscles to be injected. Assessments were performed at baseline and 4, 8, and 12 weeks after the intervention. The primary outcome measure was the change from baseline of the Modified Ashworth Scale (MAS) at the wrist flexors at week 4. Secondary outcome measures included the change of MAS at each visit, response rate, Disability Assessment Scale (DAS), Carer Burden Scale, and Global Assessment of treatment benefit. Results Primary outcome measures were -1.39±0.79 and -1.56±0.81 in the Neuronox and BOTOX groups, respectively. The difference was within the noninferiority margin of 0.45 (95% upper limit=0.40). There were no significant differences between the groups in the secondary outcome and safety measures, except the change of the MAS at the elbow flexors at week 12 (-0.88±0.75 in the Neuronox group, -0.65±0.74 in the BOTOX group; P=0.0429). Both groups showed significant improvements in the MAS, DAS, and Carer Burden Scale at weeks 4, 8, and 12. Conclusion Neuronox showed equivalent efficacy and safety compared with BOTOX for treating post-stroke upper limb spasticity. Trial Registration ClinicalTrials.gov NCT01313767 PMID:26030192

  3. Neuronox versus BOTOX in the Treatment of Post-Stroke Upper Limb Spasticity: A Multicenter Randomized Controlled Trial.

    Directory of Open Access Journals (Sweden)

    Han Gil Seo

    Full Text Available Botulinum toxin type A is widely used for treating spasticity. Neuronox (Neu-BoNT/A, a newly manufactured botulinum toxin a, has not yet been investigated for its efficacy and safety in the treatment of post-stroke upper limb spasticity.We evaluated the efficacy and safety of Neuronox (Neu-BoNT/A compared with BOTOX (onabotulinum toxin A for treating post-stroke upper limb spasticity.In total, 196 stroke patients with moderate to severe upper limb spasticity were randomly assigned to either Neuronox or BOTOX intervention. The wrist flexors were mandatory and elbow, finger, and thumb flexors were optional muscles to be injected. Assessments were performed at baseline and 4, 8, and 12 weeks after the intervention. The primary outcome measure was the change from baseline of the Modified Ashworth Scale (MAS at the wrist flexors at week 4. Secondary outcome measures included the change of MAS at each visit, response rate, Disability Assessment Scale (DAS, Carer Burden Scale, and Global Assessment of treatment benefit.Primary outcome measures were -1.39±0.79 and -1.56±0.81 in the Neuronox and BOTOX groups, respectively. The difference was within the noninferiority margin of 0.45 (95% upper limit=0.40. There were no significant differences between the groups in the secondary outcome and safety measures, except the change of the MAS at the elbow flexors at week 12 (-0.88±0.75 in the Neuronox group, -0.65±0.74 in the BOTOX group; P=0.0429. Both groups showed significant improvements in the MAS, DAS, and Carer Burden Scale at weeks 4, 8, and 12.Neuronox showed equivalent efficacy and safety compared with BOTOX for treating post-stroke upper limb spasticity.ClinicalTrials.gov NCT01313767.

  4. Cerebrovascular recovery after stroke with individual and combined losartan and captopril treatment of SHRsp.

    Science.gov (United States)

    Smeda, John S; Daneshtalab, Noriko

    2017-09-01

    We assessed whether the superior restoration of cerebrovascular function after hemorrhagic stroke by losartan versus captopril treatment was due to better BP, uremia, uricaemia, or aldosterone control in Kyoto Wistar stroke-prone-hypertensive rats and evaluated whether elevated angiotensin II (A2) levels enhanced the effectiveness of losartan treatment. Constriction was studied in the middle cerebral arteries (MCAs) using a pressure myograph. Post-stroke survival increased from 21 to 310 and 189days respectively with losartan and captopril treatment. Neither treatment reduced BP, both reversed uremia and hyperaldosteronism equally after 7days. Plasma uric acid remained low. At stroke, MCA constriction to pressure (PDC), protein kinase C (PKC) activation, depolarization, and sarcoplasmic Ca2+ were attenuated. Endothelial-dependent-vasodilation by bradykinin and endogenous NO release were lost. Both treatments recovered these functions within 7days. These functions deteriorated after 116days of captopril but not losartan treatment. Inhibiting A2 formation during losartan treatment didn't alter BP or vascular recovery. The superior recovery of PDC by losartan over captopril was not produced by better BP, uremia or aldosterone control or elevated A2. PDC recovery was associated with improved PKC function and enhanced basal NO release. The re-establishment of PDC could reduce cerebrovascular over-perfusion and hematoma expansion after stroke. Copyright © 2017 Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

    Louie, Dennis R; Eng, Janice J

    2016-06-08

    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

  6. 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.

  7. 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.

  8. Initial evaluation of protein A modified capillary-channeled polymer fibers for the capture and recovery of immunoglobulin G.

    Science.gov (United States)

    Schadock-Hewitt, Abby J; Marcus, R Kenneth

    2014-03-01

    A novel protein A affinity chromatography stationary phase has been developed from polypropylene capillary-channeled polymer fibers modified with a recombinant protein A ligand for the capture and recovery of immunoglobulin G (IgG) with high specificity and yield. An SPE micropipette tip format was employed so that solvent, protein, and antibody consumption was minimized. The adsorption modification of the fiber surfaces with protein A was evaluated as a function of feed concentration and volume. Optimal modification of the fiber surface with protein A yielded a 5.7 mg/mL (bed volume) ligand capacity with the modified fibers showing stability across numerous solvent environments. Performance was evaluated through exposure to human IgG and myoglobin, individually and as a mixture. Myoglobin was used as a surrogate for host cell proteins common to growth media. The efficacy of the selective binding to the ligand is demonstrated by the 2.9:1 (IgG/protein A) binding stoichiometry. Elution with 0.1 M acetic acid yielded an 89% recovery of the captured IgG based on absorption measurements of the collected eluents. Regeneration was possible with 10 mM NaOH. Protein A modified polypropylene capillary-channeled polymer fibers show promising initial results as an affinity phase for efficient capture and purification of IgG. © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  9. Evaluation of the efficacy of tradizional recovery interventions in historical buildings. A new selection methodology

    Science.gov (United States)

    Cardinale, Tiziana; Colapietro, Domenico

    2013-04-01

    The interaction between material, energy and cultural resources and between the functional, structural and linguistic organization of the architecture are the basis of the concept of "environmental culture". In the vernacular architecture, with this term it's meant the set of knowledge and techniques that form the symbiosis between architecture and nature, able to ensure conditions of comfort and building safety, to contrast the vulnerability resulting from Geo-environmental adversity. The traditional Mediterranean architecture is configured to be so a system in which the forms and the construction techniques come together in an original unit. This represents the result of the balance between nature and human activities, whose conservation cannot in any way ignore the local materials and the low and traditional recovery technologies. Any energy, functional and structural intervention cannot ignore the understanding of the building as a whole, which is indispensable for a correct design and construction "process" in any renovation interventions in architectural heritage, even if it's a minor construction. In this way the intervention that emerges is certainly appropriate because it isn't a distortion of the "own logic" (formal-spatial-material) of the pre-existent and in continuity with the "modal logic" (IE procedural) that it requires. The need for conservation isn't an obstacle but rather a guide to the restoration design of really effective recovery interventions, by avoiding heavy distortions and by favoring the criterion of minimum intervention. You want to try to give shape to what can only be carried out in full compliance with the historical nature on which one works and excluding the rest. We try to embody only to what that can be realized in full respect of the historical nature on which one works and excluding the rest. Research has found a complete systematization starting from the identification of housing types representative of historical local

  10. Yoga and exercise for symptoms of depression and anxiety in people with poststroke disability: a randomized, controlled pilot trial.

    Science.gov (United States)

    Chan, Weili; Immink, Maarten A; Hillier, Susan

    2012-01-01

    Mood disorders are prevalent in people after stroke, and a disorder's onset can exacerbate stroke-related disabilities. While evidence supports the mental-health benefits of participation in exercise and yoga, it is unknown whether such benefits extend to a population with poststroke hemiparesis. The study investigated whether supplementing exercise with participation in a yoga program would provide further improvements in self-reported symptoms of depression and anxiety in a chronic poststroke population, and it also assessed trial feasibility for future studies. The research team designed a randomized, controlled pilot trial that included an exercise-only group (EX, control) and a yoga-and-exercise group (YEX, intervention). The study took place at the Centre for Physical Activity in Ageing an exercise rehabilitation and activity center at the Royal Adelaide Hospital in South Australia. The participants included 14 individuals with chronic poststroke hemiparesis: eight in the intervention group and six in the control group. The YEX group participated in a 6-week standardized program that included yoga in weekly group sessions and home practice in addition to exercise in a weekly group class. The EX group participated only in the group exercise class weekly for 6 weeks. The research team assessed self-reported symptoms of depression using the Geriatric Depression Scale (GDS15) and symptoms of anxiety and negative affect using the State Trait Anxiety Inventory (STAI). The team based the feasibility evaluation on recruitment outcomes, retention of participants, participants' compliance with the intervention program, and the safety of the intervention. Changes in depression and state and trait anxiety did not significantly differ between intervention groups (GDS15 P=.749, STAI-Y1, P=.595, STAI-Y2, P=.407). Comparison of individuals' case results indicated clinically relevant improvements in both groups, although members of the intervention group had greater

  11. Extracorporeal shock wave therapy for the treatment of poststroke plantar-flexor muscles spasticity: a prospective open-label study.

    Science.gov (United States)

    Santamato, Andrea; Micello, Maria Francesca; Panza, Francesco; Fortunato, Francesca; Logroscino, Giancarlo; Picelli, Alessandro; Manganotti, Paolo; Smania, Nicola; Fiore, Pietro; Ranieri, Maurizio

    2014-01-01

    To assess the use of extracorporeal shock wave therapy (ESWT) for the treatment of equinus foot after stroke and to correlate the ESWT effect on spastic plantar-flexor muscles with echo intensity on the Heckmatt scale. The prospective open-label study examined 23 patients with poststroke lower limb spasticity. Adults with spastic equinus foot after stroke received one ESWT session on hypertonic plantar-flexor muscles. The effect on spasticity, degree of passive ankle dorsiflexion, and neurophysiological values were evaluated. Before treatment, participants underwent a sonography evaluation of calf muscles to identify echo intensity on the Heckmatt scale. Immediately after the session, ESWT induced a statistically significant reduction in muscle tone, increasing passive ankle dorsiflexion motion. At 30 days of follow-up, the effect persisted only in patients with echo intensity of spastic plantar-flexor muscles graded I, II, or III on the Heckmatt scale without any action related to spinal excitability. Mild adverse events were reported after the treatment but were resolved in a few days. ESWT is safe and efficacious for the treatment of poststroke plantar-flexor muscles spasticity, reducing muscle tone and improving passive ankle dorsiflexion motion. The effect was long lasting in subjects with echo intensity of calf muscles graded I, II, or III but was brief for echo intensity graded IV on the Heckmatt scale. The ESWT effect did not appear to be related to spinal excitability.

  12. Methylphenidate modulates cerebral post-stroke reorganization.

    Science.gov (United States)

    Tardy, Jean; Pariente, Jérémie; Leger, Anne; Dechaumont-Palacin, Sophie; Gerdelat, Angélique; Guiraud, Vincent; Conchou, Fabrice; Albucher, Jean-François; Marque, Philippe; Franceries, Xavier; Cognard, Christophe; Rascol, Olivier; Chollet, François; Loubinoux, Isabelle

    2006-11-15

    We hypothesized that a single dose of methylphenidate (MP) would modulate cerebral motor activation and behavior in patients having suffered a subcortical stroke. Eight men with a single stroke on the corticospinal tract resulting in a pure motor hemiparesia were included in a randomized, cross-over, double-blind, placebo-controlled study. Patients were first evaluated 17 days after stroke onset by validated neurological scales, motor tests and fMRI (flexion/extension of the digits) after 20 mg MP or placebo. Seven days later, the patients underwent the same protocol and received the drug they had not taken at the first evaluation. Each patient was his own control. Placebo intake did not change performance. MP compared to placebo elicited a significant improvement in motor performance of the affected hand at the finger tapping test. MP induced: (1) a hyperactivation of the ipsilesional primary sensorimotor cortex including the motor hand and face areas and of the contralesional premotor cortex; (2) a hypoactivation of the ipsilesional anterior cingulum. Hyperactivation in the face motor area correlated positively with the improvement in performance. We demonstrated that the reorganized network may efficiently be targeted by the drug and that the effect of MP might partly rely on an improvement in attention/effort through cingulum modulation.

  13. The Role of the Cognitive Control System in Recovery from Bilingual Aphasia: A Multiple Single-Case fMRI Study

    Directory of Open Access Journals (Sweden)

    Narges Radman

    2016-01-01

    Full Text Available Aphasia in bilingual patients is a therapeutic challenge since both languages can be impacted by the same lesion. Language control has been suggested to play an important role in the recovery of first (L1 and second (L2 language in bilingual aphasia following stroke. To test this hypothesis, we collected behavioral measures of language production (general aphasia evaluation and picture naming in each language and language control (linguistic and nonlinguistic switching tasks, as well as fMRI during a naming task at one and four months following stroke in five bilingual patients suffering from poststroke aphasia. We further applied dynamic causal modelling (DCM analyses to the connections between language and control brain areas. Three patients showed parallel recovery in language production, one patient improved in L1, and one improved in L2 only. Language-control functions improved in two patients. Consistent with the dynamic view of language recovery, DCM analyses showed a higher connectedness between language and control areas in the language with the better recovery. Moreover, similar degrees of connectedness between language and control areas were found in the patients who recovered in both languages. Our data suggest that engagement of the interconnected language-control network is crucial in the recovery of languages.

  14. The Role of the Cognitive Control System in Recovery from Bilingual Aphasia: A Multiple Single-Case fMRI Study

    Science.gov (United States)

    Mouthon, Michael; Di Pietro, Marie; Gaytanidis, Chrisovalandou; Abutalebi, Jubin; Annoni, Jean-Marie

    2016-01-01

    Aphasia in bilingual patients is a therapeutic challenge since both languages can be impacted by the same lesion. Language control has been suggested to play an important role in the recovery of first (L1) and second (L2) language in bilingual aphasia following stroke. To test this hypothesis, we collected behavioral measures of language production (general aphasia evaluation and picture naming) in each language and language control (linguistic and nonlinguistic switching tasks), as well as fMRI during a naming task at one and four months following stroke in five bilingual patients suffering from poststroke aphasia. We further applied dynamic causal modelling (DCM) analyses to the connections between language and control brain areas. Three patients showed parallel recovery in language production, one patient improved in L1, and one improved in L2 only. Language-control functions improved in two patients. Consistent with the dynamic view of language recovery, DCM analyses showed a higher connectedness between language and control areas in the language with the better recovery. Moreover, similar degrees of connectedness between language and control areas were found in the patients who recovered in both languages. Our data suggest that engagement of the interconnected language-control network is crucial in the recovery of languages. PMID:27965899

  15. Non-Invasive Brain Stimulation to Enhance Upper Limb Motor Practice Poststroke: A Model for Selection of Cortical Site

    Directory of Open Access Journals (Sweden)

    Michelle L. Harris-Love

    2017-05-01

    Full Text Available Motor practice is an essential part of upper limb motor recovery following stroke. To be effective, it must be intensive with a high number of repetitions. Despite the time and effort required, gains made from practice alone are often relatively limited, and substantial residual impairment remains. Using non-invasive brain stimulation to modulate cortical excitability prior to practice could enhance the effects of practice and provide greater returns on the investment of time and effort. However, determining which cortical area to target is not trivial. The implications of relevant conceptual frameworks such as Interhemispheric Competition and Bimodal Balance Recovery are discussed. In addition, we introduce the STAC (Structural reserve, Task Attributes, Connectivity framework, which incorporates patient-, site-, and task-specific factors. An example is provided of how this framework can assist in selecting a cortical region to target for priming prior to reaching practice poststroke. We suggest that this expanded patient-, site-, and task-specific approach provides a useful model for guiding the development of more successful approaches to neuromodulation for enhancing motor recovery after stroke.

  16. Technical evaluation of a tank-connected food waste disposer system for biogas production and nutrient recovery.

    Science.gov (United States)

    Davidsson, Å; Bernstad Saraiva, A; Magnusson, N; Bissmont, M

    2017-07-01

    In this study, a tank-connected food waste disposer system with the objective to optimise biogas production and nutrient recovery from food waste in Malmö was evaluated. The project investigated the source-separation ratio of food waste through waste composition analyses, determined the potential biogas production in ground food waste, analysed the organic matter content and the limiting components in ground food waste and analysed outlet samples to calculate food waste losses from the separation tank. It can be concluded that the tank-connected food waste disposer system in Malmö can be used for energy recovery and optimisation of biogas production. The organic content of the collected waste is very high and contains a lot of energy rich fat and protein, and the methane potential is high. The results showed that approximately 38% of the food waste dry matter is collected in the tank. The remaining food waste is either found in residual waste (34% of the dry matter) or passes the tank and goes through the outlet to the sewer (28%). The relatively high dry matter content in the collected fraction (3-5% DM) indicates that the separation tank can thicken the waste substantially. The potential for nutrient recovery is rather limited considering the tank content. Only small fractions of the phosphorus (15%) and nitrogen (21%) are recyclable by the collected waste in the tank. The quality of the outlet indicates a satisfactory separation of particulate organic matter and fat. The organic content and nutrients, which are in dissolved form, cannot be retained in the tank and are rather led to the sewage via the outlet. Copyright © 2017 Elsevier Ltd. All rights reserved.

  17. Poststroke hypertonicity: upper limb assessment and treatment.

    Science.gov (United States)

    Marciniak, Christina

    2011-01-01

    Hypertonicity is common in patients with upper limb dysfunction following hemiplegic stroke and is associated with greater impairment, worse function, and lower health-related quality of life. In addition to increased rest activity, abnormal patterns of muscle activation, such as spastic co-contraction, may contribute to disability. In the upper limb, flexor muscles are more commonly involved distally, and at the shoulder, spasticity of adductors, flexors, and internal rotators is most often observed. Prior to interventions, a history regarding prior interventions, comorbid diagnoses, and limitations imposed by abnormal tone should be elicited. Commonly used scales to assess hypertonicity include the Modified Ashworth, the Modified Tardieu, the Spasm Frequency, the Disability Assessment, the Fugl-Meyer, and the Motor Assessment Scales. Treatment interventions for upper limb hypertonicity include stretching, splinting, strengthening of antagonist muscles, oral medications, and focal injections (phenol or botulinum toxins). Intrathecal baclofen may also impact upper limb tone. For focal injections, correct identification of muscles contributing to problematic tone is evaluated by eliciting resistance to movement at rest and observation of patterns of tightness as the limb is used functionally. The botulinum toxins have been shown to decrease tone in stroke survivors and improve active and passive functioning. Because secondary changes such as contractures and weakness may occur with prolonged hypertonicity, therapy to improve range of motion, strengthen weakened muscles, and incorporate use of the limb should be considered following focal injections, oral medications, or intrathecal pump placement.

  18. Evaluation of an anaerobic digestion system for processing CELSS crop residues for resource recovery

    Science.gov (United States)

    Strayer, R. F.; Finger, B. W.; Alazraki, M. P.

    1997-01-01

    Three bioreactors, connected in series, were used to process CELSS potato residues for recovery of resources. The first stage was an anaerobic digestor (8 L working volume; cow rumen contents inoculum; fed-batch; 8 day retention time; feed rate 25 gdw day^-1) that converted 33% of feed (dry weight loss) to CO_2 and ``volatile fatty acids'' (vfa, 83:8:8 mmolar ratio acetic:propionic:butyric). High nitrate-N in the potato residue feed was absent in the anaerobic effluent, with a high portion converted to NH_4^+-N and the remainder unaccounted and probably lost to denitrification and NH_4^+ volatilization. Liquid anaerobic effluent was fed to an aerobic, yeast biomass production vessel (2 L volume; Candida ingens inoculum; batch [pellicle] growth; 2 day retention time) where the VFAs and some NH_4^+-N were converted into yeast biomass. Yeast yields accounted for up to 8% of potato residue fed into the anaerobic bioreactor. The third bioreactor (0.5 L liquid working volume; commercial nitrifier inoculum; packed-bed biofilm; continuous yeast effluent feed; recirculating; constant volume; 2 day hydraulic retention time) was used to convert successfully the remaining NH_4^+-N into nitrate-N (preferred form of N for CELSS crop production) and to remove the remaining degradable soluble organic carbon. Effluents from the last two stages were used for partial replenishment of minerals for hydroponic potato production.

  19. Synthesis and Evaluation of a Water-Soluble Hyperbranched Polymer as Enhanced Oil Recovery Chemical

    Directory of Open Access Journals (Sweden)

    Nanjun Lai

    2013-01-01

    Full Text Available A novel hyperbranched polymer was synthesized using acrylamide (AM, acrylic acid (AA, N-vinyl-2-pyrrolidone (NVP, and dendrite functional monomer as raw materials by redox initiation system in an aqueous medium. The hyperbranched polymer was characterized by infrared (IR spectroscopy, 1H NMR spectroscopy, 13C NMR spectroscopy, elemental analysis, and scanning electron microscope (SEM. The viscosity retention rate of the hyperbranched polymer was 22.89% higher than that of the AM/AA copolymer (HPAM at 95°C, and the viscosity retention rate was 8.17%, 12.49%, and 13.68% higher than that of HPAM in 18000 mg/L NaCl, 1800 mg/L CaCl2, and 1800 mg/L MgCl2·6H2O brine, respectively. The hyperbranched polymer exhibited higher apparent viscosity (25.2 mPa·s versus 8.1 mPa·s under 500 s−1 shear rate at 80°C. Furthermore, the enhanced oil recovery (EOR of 1500 mg/L hyperbranched polymer solutions was up to 23.51% by the core flooding test at 80°C.

  20. Evaluation of asialoglycoprotein receptor imaging agent as a marker of hepatic ischemia-reperfusion injury and recovery

    Energy Technology Data Exchange (ETDEWEB)

    Toyama, Hiroshi; Suzuki, Kazuo; Naito, Aiko [Fujita Health Univ., Toyoake, Aichi (Japan)] [and others

    1999-06-01

    Protection of hepatocytes from ischemia-reperfusion injury is a clinically important issue. The purpose of this study was to evaluate changes in acute liver damage and recovery after ischemia-reperfusion in rats with asialoglycoprotein receptor (ASGP-R) ligand. Ischemia was induced by clamping the hepatoduodenal ligament for 90 min. At 1, 3, 24, 48 hr, 1 and 2 wk after reperfusion, I-125-GSA was injected. Five min after injection, blood samples were obtained and the liver was removed. Several regions from each lobe were dissected, weighed and counted. Mean uptakes (% dose/g) in the liver and blood samples were calculated. Histologic sections stained with hematoxylin-eosin (H-E) stain showed ischemic damage at 1 and 3 hr, and focal hepatocyte necrosis at 24 hr. Predominant massive necrosis was not seen. The mitotic index with H-E stain and proliferating cell nuclear antigen (PCNA) labeling index were highest at 1 wk, indicating liver regeneration. At 1 and 3 hr, liver uptake was significantly decreased, and blood uptake was significantly increased, indicating decreased tissue blood flow and ischemic damage. Liver uptake showed significant increases at 48 hr and 1 wk, and was the highest at 1 wk, indicating liver regeneration during the convalescence stage. ASGP-R binding may provide valuable information on ischemia-reperfusion injury and recovery. (author)

  1. Evaluation of new polymers for enhanced oil recovery; Avaliacao de novos polimeros para recuperacao aumentada de petroleo

    Energy Technology Data Exchange (ETDEWEB)

    Maia, Ana M.S.; Chagas, Emanuel F.; Costa, Marta; Garcia, Rosangela B. [Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN (Brazil)

    2004-07-01

    The main polymers used nowadays for enhanced oil recovery, partially hydrolysed polyacrylamides and xanthan gum, show some limitations, such as low tolerance to salt presence and biological degradation. Therefore, it is necessary the improvement of the polymeric properties. With this goal, a new class of polymers, named 'water-soluble polymers hydrophobically modified' or simply 'amphiphilic polymers', has been developed. In this work, it was obtained a water-soluble acrylamide polymer hydrophobically modified with N,N-dihexyl acrylamide, using the micellar copolymerization technique. After the structural and rheological characterization of the copolymer, its performance in porous medium was evaluated through core flood tests in Botucatu sandstone. In the presence of sodium chloride, the amphiphilic copolymer presented a great increase of viscosity, besides values of resistance factor and of residual resistance factor higher than for the commercial polyacrylamide. This behavior can favor the oil recovery, mainly in high salinity and permeability reservoirs, by improving the water flooding sweep efficiency. (author)

  2. Monitoring and toxicity evaluation of phytoplankton on lithium manganese oxide adsorbents at lithium recovery pilot plant field.

    Science.gov (United States)

    Yoon, H. O.; Kim, J. A.; Kim, J. C.; Chung, K. S.; Ryu, J. H.

    2015-12-01

    For recovery of rare mineral resources such as lithium or boron from seawater, the lithium adsorbent material have been made by Korea Institute of Geoscience and Mineral Resources (KIGAM) and pilot plant was conducted in Okgye Harbor, Gangneung, Korea. The application of lithium adsorbent in pilot plant, it is important to consider the impact on the marine environment. Especially phytoplankton communities are important marine microorganism to represent marine primary product. At the same time, phytoplankton is possible to induce the decrease of lithium recovery rate due to cause of biofouling to surfaces of lithium adsorbents. Therefore long-term and periodic monitoring of phytoplankton is necessary to understand the environmental impact and biofouling problems near the lithium pilot plant. The abundance and biomass of phytoplankton have been evaluated through monthly interval sampling from February 2013 to May 2015. Abundance and species diversity of phytoplankton went up to summer from winter. When lithium adsorbents were immersing to seawater, eco-toxicities of released substances were determined using Microtox with bioluminescence bacteria Vibrio fischeri. The adsorbents were soaked in sterilized seawater and aeration for 1, 3, 5, 7, 10 and 14 days intervals under controlled temperature. Maximum EC50 concentration was 61.4% and this toxicity was showed in more than 10 days exposure.

  3. Low-frequency rTMS with language therapy over a 3-month period for sensory-dominant aphasia: case series of two post-stroke Japanese patients.

    Science.gov (United States)

    Kakuda, Wataru; Abo, Masahiro; Uruma, Go; Kaito, Nobuyoshi; Watanabe, Motoi

    2010-01-01

    To examine the safety and feasibility of therapeutic application of low-frequency repetitive transcranial magnetic stimulation (rTMS) combined with language therapy for post-stroke patients with sensory-dominant aphasia. Two post-stroke Japanese patients with sensory-dominant aphasia were studied. In both patients, 10 sessions of 20-minute low-frequency rTMS with 1 Hz to the Wernicke's area were provided throughout 6-day hospitalization, followed by weekly outpatient rTMS treatment for 3 months. The language therapy was also provided through the period of in- and out-patient treatment. Language function was evaluated using the Token test and the Standard Language Test of Aphasia (SLTA) at the start and end of the in-patient treatment and the end of the outpatient treatment. The therapeutic protocol was well tolerated throughout the in- and out-patient treatments, without any adverse effects. The scores of the Token test and certain sub-categories of SLTA increased in both patients after the in-patient rTMS treatment. Persistent improvement of the score was noted over the 3-month post-discharge period. The proposed protocol of long-term application of low-frequency rTMS to the Wernicke's area and language therapy is considered a safe and feasible therapeutic approach for post-stroke patients with sensory-dominant aphasia.

  4. The value of the NDT-Bobath method in post-stroke gait training

    National Research Council Canada - National Science Library

    Mikołajewska, Emilia

    2013-01-01

    .... Following a stroke, patients suffer from gait disorders. The aim of this paper is to present the outcomes of a study of post-stroke gait reeducation using the NeuroDevelopmental Treatment-Bobath (NDT-Bobath) method...

  5. Bobath and traditional approaches in post-stroke gait rehabilitation in adults

    Directory of Open Access Journals (Sweden)

    Mikołajewska Emilia

    2017-02-01

    Full Text Available Study aim: The aim of this study was to compare the outcomes of a study of post-stroke gait reeducation using the Bobath neuro‑developmental treatment (NDT-Bobath method and the traditional approach.

  6. Bobath and traditional approaches in post-stroke gait rehabilitation in adults

    OpenAIRE

    Mikołajewska Emilia

    2017-01-01

    Study aim: The aim of this study was to compare the outcomes of a study of post-stroke gait reeducation using the Bobath neuro‑developmental treatment (NDT-Bobath) method and the traditional approach.

  7. Risk Factors for Poststroke Depression : Identification of Inconsistencies Based on a Systematic Review

    NARCIS (Netherlands)

    De Ryck, Annemieke; Brouns, Raf; Geurden, Marleen; Elseviers, Monique; De Deyn, Peter P.; Engelborghs, Sebastiaan

    Objective: Depression after stroke or poststroke depression (PSD) has a negative impact on the rehabilitation process and the associated rehabilitation outcome. Consequently, defining risk factors for development of PSD is important. The relationship between stroke and depression is described

  8. Influence of posture and muscle length on stretch reflex activity in poststroke patients with spasticity

    NARCIS (Netherlands)

    Fleuren, J.F.M.; Fleuren, Judith F.; Nederhand, Marcus Johannes; Hermens, Hermanus J.

    Objective To investigate the influence of different positions on stretch reflex activity of knee flexors and extensors measured by electromyography in poststroke patients with spasticity and its expression in the Ashworth Scale.

  9. 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.

  10. Submovements grow larger, fewer, and more blended during stroke recovery.

    Energy Technology Data Exchange (ETDEWEB)

    Rohrer, Brandon Robinson; Hogan, Neville (Massachusetts Institute of Technology, Cambridge, MA); Stein, Joel (Harvard Medical School, Boston, MA); Frontera, Walter R. (Spaulding Rehabilitation Hospital/ Harvard Mcdical School, Boston, MA); Volpe, Bruce T. (Burke Medical Research Institute, White Plains, NY); Krebs, Hermano Igo (Massachusetts Institute of Technology, Cambridge, MA); Fasoli, Susan (Massachusetts Institute of Technology, Cambridge, MA)

    2003-07-01

    Submovements are hypothesized building blocks of human movement, discrete ballistic movements of which more complex movements are composed. Using a novel algorithm, submovements were extracted from the point-to-point movements of 41 persons recovering from stroke. Analysis of the extracted submovements showed that, over the course of therapy, patients' submovements tended to increase in peak speed and duration. The number of submovements employed to produce a given movement decreased. The time between the peaks of adjacent submovements decreased for inpatients (those less than 1 month post-stroke), but not for outpatients (those greater than 12 months post-stroke) as a group. Submovements became more overlapped for all patients, but more markedly for inpatients. The strength and consistency with which it quantified patients' recovery indicates that analysis of submovement overlap might be a useful tool for measuring learning or other changes in motor behavior in future human movement studies.

  11. Evaluation of a recovery-oriented care training program for mental healthcare professionals : Effects on mental health consumer outcomes

    NARCIS (Netherlands)

    Wilrycx, G.K.M.L.; Croon, M.A.; van den Broek, A.; van Nieuwenhuizen, Ch.

    2015-01-01

    Objectives: To examine the effects of a recovery-oriented care training program for mental healthcare professionals on mental health consumer outcomes. Methods: The Mental Health Recovery Measure (MHRM) and the Recovery-Promoting Relationship Scale (RPRS) were administered to a sample of 142

  12. Sewage sludge drying by energy recovery from OFMSW composting: Preliminary feasibility evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Rada, Elena Cristina; Ragazzi, Marco; Villotti, Stefano [University of Trento, Department of Civil, Environmental and Mechanical Engineering, via Mesiano 77, I-38123 Trento (Italy); Torretta, Vincenzo, E-mail: vincenzo.torretta@uninsubria.it [Insubria University of Varese, Department of Biotechnologies and Life Sciences, Via G.B. Vico 46, I-21100 Varese (Italy)

    2014-05-01

    Highlights: • The aim is to support the drying of sewage sludge, using a solar greenhouse. • The system allows the exploitation of heat available from OFMSW aerobic process. • Another aim is to face the problem of OFMSW treatment, in particular food waste. • Energy and mass balances are presented for a case study. - Abstract: In this paper an original energy recovery method from composting is analyzed. The integrated system exploits the heat available from the aerobic biochemical process in order to support the drying of sewage sludge, using a specific solar greenhouse. The aim is to tackle the problem of organic waste treatment, with specific regard to food waste. This is done by optimizing the energy consumption of the aerobic process of composting, using the heat produced to solve a second important waste management problem such as the sewage waste treatment. Energy and mass balances are presented in a preliminary feasibility study. Referring to a composting plant with a capacity of 15,000 t/y of food waste, the estimation of the power from recovered heat for the entire plant resulted about 42 kW. The results demonstrated that the energy recoverable can cover part of the heat necessary for the treatment of sludge generated by the population served by the composting plant (in terms of food waste and green waste collection). The addition of a renewable source such as solar energy could cover the residual energy demand. The approach is presented in detail in order for it to be replicated in other case studies or at full scale applications.

  13. Evaluating Double Entry Logging for Forest Residue Recovery in Southwestern Oregon.

    Energy Technology Data Exchange (ETDEWEB)

    Brown, Lawrence F.; Craig, Linda S.; Buscaglia, Phillip

    1985-09-01

    The objective of this research was to compare actual cost and production between conventional logging practices and double entry methods for residue removal in old-growth fir and pine of southwest Oregon using an actual timber sale, to determine and report benefits of the double entry concept to the study cooperators, any uncontrolled variables in the study which could influence the results, and how the order of yarding influences the results; and to compute the cost of logging with the double-entry method, the cost and quantity of the residue removed, and the cost of delivering the fuel to a theoretical cogeneration plant 14 miles from the timber sale. As a result of the study it might be concluded that situations where double entry appears to be cost effective would be those which have a large variation in piece size, require YUM yarding to a 6'' by 8' or smaller size piece, are on steep terrain, and have an understory with many small unmerchantable logs and residue mixed with the large overstory trees. A similar study in the intermountain region by Leonard Johnson of the University of Idaho found that a 29% increased sawlog recovery was accompanied by a 63% increased gross return per acre and a 58% increased cost per acre. The added cost of double entry did not offset all traditional costs of slash disposal. However, if slash disposal requires yarding of residues, the cost per acre is reduced by the double entry method. Johnson made similar findings of the need to determine most optimum terrain and tree species for the method and to improve the yarder and various loading options. 6 refs., 13 figs., 23 tabs.

  14. Kinematics of the contralateral and ipsilateral shoulder: A possible relationship with post-stroke shoulder pain

    OpenAIRE

    Niessen, M.H.M.; Janssen, T.W.J.; Meskers, C.G.M.; Koppe, P.; Konijnenbelt, M.; Veeger, H.E.J.

    2008-01-01

    Objective: Post-stroke shoulder pain is a common phenomenon in hemiplegia and impedes rehabilitation. The aim of this study was to identify a possible relationship between post-stroke shoulder pain, scapula resting position and shoulder motion. Methods: Shoulder kinematics of 27 patients after stroke (17 men) were compared with 10 healthy age-matched control subjects. Using an electromagnetic tracking device, the kinematics of both the contralateral and ipsilateral (i.e. paretic and non-paret...

  15. Exacerbation of Brain Injury by Post-Stroke Exercise Is Contingent Upon Exercise Initiation Timing

    OpenAIRE

    Li, Fengwu; Geng, Xiaokun; Khan, Hajra; Pendy Jr., John T.; Peng, Changya; Li, Xiaorong; Rafols, Jose A.; Ding, Yuchuan

    2017-01-01

    Accumulating evidence has demonstrated that post-stroke physical rehabilitation may reduce morbidity. The effectiveness of post-stroke exercise, however, appears to be contingent upon exercise initiation. This study assessed the hypothesis that very early exercise exacerbates brain injury, induces reactive oxygen species (ROS) generation, and promotes energy failure. A total of 230 adult male Sprague-Dawley rats were subjected to middle cerebral artery (MCA) occlusion for 2 h, and randomized ...

  16. Effects of botulinum toxin A therapy and multidisciplinary rehabilitation on upper and lower limb spasticity in post-stroke patients.

    Science.gov (United States)

    Hara, Takatoshi; Abo, Masahiro; Hara, Hiroyoshi; Kobayashi, Kazushige; Shimamoto, Yusuke; Samizo, Yuta; Sasaki, Nobuyuki; Yamada, Naoki; Niimi, Masachika

    2017-06-01

    The purpose of this study was to examine the effects of combined botulinum toxin type A (BoNT-A) and inpatient multidisciplinary (MD) rehabilitation therapy on the improvement of upper and lower limb function in post-stroke patients. In this retrospective study, a 12-day inpatient treatment protocol was implemented on 51 post-stroke patients with spasticity. Assessments were performed on the day of admission, at discharge, and at 3 months following discharge. At the time of discharge, all of the evaluated items showed a statistically significant improvement. Only the Functional Reach Test (FRT) showed a statistically significant improvement at 3 months. In subgroup analyses, the slowest walking speed group showed a significantly greater change ratio of the 10 Meter Walk Test relative to the other groups, from the time of admission to discharge. This group showed a greater FRT change ratio than the other groups from the time of admission to the 3-month follow-up. Inpatient combined therapy of simultaneous injections of BoNT-A to the upper and lower limbs and MD may improve motor function.

  17. Proton Magnetic Resonance Spectroscopy Study on the Metabolism Changes of Cerebellum in Patients with Post-Stroke Depression.

    Science.gov (United States)

    Zhang, Lei; Sui, Ru-Bo

    2017-01-01

    To study the metabolic changes of cerebellum by proton magnetic resonance Spectroscopy (1H-MRS) and discuss the relationships between the cerebellar changes and depression severity in patients with post-stroke depression. Data of demographic characteristics, individual history and life style of all subjects were collected. 40 patients with stroke and 20 controls were enrolled. All groups received T1WI, T2WI, DWI and 1H-MRS examination. The cerebral infarction volume and the distribution and severity of leukoaraiosis were evaluated. The ratios of NAA/Cr, Cho/Cr and Cho/NAA in the cerebellum were calculated. There were no statistical significant difference in the NAA/Cr, Cho/Cr and Cho/NAA ratios in bilateral cerebellum between CONT group and NORM group. The Cho/Cr and Cho/NAA ratios in the cerebellum contralateral to the stroke region were higher in PSD group than those in NORM and CONT groups, and the Cho/Cr and Cho/NAA ratios in the cerebellum ipsilateral to the stroke region were similar with those in NORM and CONT groups. However, there were no statistical significant difference in the NAA/Cr ratios in bilateral cerebellum among three groups. The result shows preliminarily that the cerebellum involves in the development of post-stroke depression. © 2017 The Author(s). Published by S. Karger AG, Basel.

  18. Test-retest reliability, internal consistency and concurrent validity of Fatigue Severity Scale in measuring post-stroke fatigue.

    Science.gov (United States)

    Nadarajah, Mohanasuntharaam; Mazlan, Mazlina; Abdul-Latif, Lydia; Goh, Hui-Ting

    2017-10-01

    Post-stroke fatigue (PSF) is a common complaint among stroke survivors and has significant impacts on recovery and quality of life. Limited tools that measure fatigue have been validated in stroke. The purpose of this study was to determine the psychometric properties of Fatigue Severity Scale (FSS) in patients with stroke. Cross-sectional study. Teaching hospital outpatient setting. Fifty healthy controls (mean age 61.1±7.4 years; 22 males) and 50 patients with stroke (mean age 63.6±10.3 years; 34 males). FSS was administered twice approximately a week apart through face-to-face interview. In addition, we measured fatigue with Visual Analogue Scale - Fatigue (VAS-F) and Short-Form Health Survey 36 version 2 vitality scale. We used Cronbach alpha to determine internal consistency of FSS. Reliability and validity of FSS were determined by intraclass correlation coefficient (ICC) and Spearman correlation coefficient (r). FSS showed excellent internal consistency for both stroke and healthy groups (Cronbach's alpha >0.90). FSS had excellent test-retest reliability for stroke patients and healthy controls (ICC=0.93 and ICC=0.90, respectively). The scale demonstrated good concurrent validity with VAS-Fatigue (all r>.60) and a moderate validity with the SF36-vitality scale. Furthermore, FSS was sensitive to distinguish fatigue in stroke from the healthy controls (Pvalidity with VAS-F for both groups. This study provides evidence that FSS is a reliable and valid tool to measure post-stroke fatigue and is readily to be used in clinical settings.

  19. Non-paretic arm force does not over-inhibit the paretic arm in chronic post-stroke hemiparesis

    Science.gov (United States)

    Dimyan, Michael A.; Perez, Monica A.; Auh, Sungyoung; Tarula, Erick; Wilson, Matthew; Cohen, Leonardo G.

    2014-01-01

    Objective To determine whether non-paretic arm force over-inhibits the paretic arm in patients with chronic unilateral post-stroke hemiparesis. We hypothesized that interhemispheric inhibition would increase more in healthy controls than in hemiparetic patients. Design Case-control neurophysiologic and behavioral study of patients with chronic stroke. Setting Federal research institution, outpatient clinical research setting Participants Eighty-six referred patients were screened to enroll 9 participants with greater than 6 month history of one unilateral ischemic infarct that resulted in arm hemiparesis, with residual ability to produce 1Nm of wrist flexion torque, without contraindication to transcranial magnetic stimulation. 8 age- and handedness-matched healthy volunteers without neurologic diagnosis were studied for comparison. Interventions Not Applicable Main Outcome Measures Change in interhemispheric inhibition targeting the ipsilesional primary-motor-cortex (M1) during non-paretic arm force. Results Healthy age-matched controls had significantly greater increases in inhibition from their active to resting M1 than did stroke patients from their active contralesional to resting ipsilesional M1 in the same scenario (20% ±7 vs. −1% ±4, F1,12=6.61, p=0.0245). Patients with greater increases in contralesional to ipsilesional inhibition were better performers on the nine-hole-peg-test of paretic arm function. Conclusions Our findings reveal that producing force with the non-paretic arm does not necessarily over-inhibit the paretic arm. Though limited in generalizability by the small sample size, we found that greater active contralesional to resting ipsilesional M1 inhibition was related to better recovery in this subset of chronic post-stroke patients. PMID:24440364

  20. American Recovery and Reinvestment Act (ARRA) FEMP Technical Assistance for Geothermal Resource Evaluation Projects

    Energy Technology Data Exchange (ETDEWEB)

    Robert P. Breckenridge; Thomas R. Wood; Joel Renner

    2010-09-01

    The purpose of this document is to report on the evaluation of geothermal resource potential on and around three different United States (U. S.) Air Force Bases (AFBs): Nellis AFB and Air Force Range (AFR) in the State of Nevada (see maps 1 and 5), Holloman AFB in the State of New Mexico (see map 2), and Mountain Home AFB in the State of Idaho (see map 3). All three sites are located in semi-arid parts of the western U. S. The U. S. Air Force, through its Air Combat Command (ACC) located at Langley AFB in the State of Virginia, asked the Federal Energy Management Program (FEMP) for technical assistance to conduct technical and feasibility evaluations for the potential to identify viable geothermal resources on or around three different AFBs. Idaho National Laboratory (INL) is supporting FEMP in providing technical assistance to a number of different Federal Agencies. For this report, the three different AFBs are considered one project because they all deal with potential geothermal resource evaluations. The three AFBs will be evaluated primarily for their opportunity to develop a geothermal resource of high enough quality grade (i.e., temperature, productivity, depth, etc.) to consider the possibility for generation of electricity through a power plant. Secondarily, if the resource for the three AFBs is found to be not sufficient enough for electricity generation, then they will be described in enough detail to allow the base energy managers to evaluate if the resource is suitable for direct heating or cooling. Site visits and meetings by INL personnel with the staff at each AFB were held in late FY-2009 and FY-2010. This report provides a technical evaluation of the opportunities and challenges for developing geothermal resources on and around the AFBs. An extensive amount of literature and geographic information was evaluated as a part of this assessment. Resource potential maps were developed for each of the AFBs.

  1. Piloted Simulation Evaluation of a Model-Predictive Automatic Recovery System to Prevent Vehicle Loss of Control on Approach

    Science.gov (United States)

    Litt, Jonathan S.; Liu, Yuan; Sowers, Thomas S.; Owen, A. Karl; Guo, Ten-Huei

    2014-01-01

    This paper describes a model-predictive automatic recovery system for aircraft on the verge of a loss-of-control situation. The system determines when it must intervene to prevent an imminent accident, resulting from a poor approach. It estimates the altitude loss that would result from a go-around maneuver at the current flight condition. If the loss is projected to violate a minimum altitude threshold, the maneuver is automatically triggered. The system deactivates to allow landing once several criteria are met. Piloted flight simulator evaluation showed the system to provide effective envelope protection during extremely unsafe landing attempts. The results demonstrate how flight and propulsion control can be integrated to recover control of the vehicle automatically and prevent a potential catastrophe.

  2. The Evaluation of the Effectiveness of Motivational Interviewing on Lifestyle Changes in Female Addicts under Way for Recovery

    Directory of Open Access Journals (Sweden)

    hamed ghasemi

    2015-02-01

    Full Text Available Objectives: This study aimed to evaluate the efficacy of motivational interviewing on lifestyle changes in female addicts under way for recovery. Method: A quasi-experimental design along with pretest-posttest and control group was used for this study. The number of 32 female addicts referring to rehab centers constituted the study sample. With regard to the inclusion and exclusion criteria they were selected and randomly assigned to an experimental group and a control group. The experimental group was treated with eight sessions of group motivational interviewing along with lifestyle change program. Lifestyle questionnaire was used for data collection. Results: Intervention led the experimental group to higher lifestyle scores compared to the control group. Conclusion: It can be concluded from the findings of this study that the addition of motivational interviewing to lifestyle change programs is an effective way to change addictive behaviors and, thus, improve lifestyle.

  3. Associations between executive function and physical function poststroke: a pilot study.

    Science.gov (United States)

    Hayes, Sara; Donnellan, Claire; Stokes, Emma

    2013-06-01

    Associations between executive function and physical function poststroke have not been extensively studied. More complex physiotherapy interventions poststroke require a greater degree of cognitive ability, especially executive function. This pilot study aimed to inform the methodology of a larger study by examining the associations between executive function and the performance of basic and complex gait tasks in people poststroke. A cross-sectional pilot study was conducted in a convenience sample of 20 participants recruited from a community-based voluntary stroke organisation and from the outpatient services of two urban hospitals. A battery of tests was used to measure executive function (Trail Making Test, Stroop Word-Colour Test, Zoo Map test, Frontal Assessment Battery and Digit Span backward test). Basic and complex 10metre gait tests were used to mimic aspects of physiotherapy intervention poststroke. Other measures included the Mini-Mental State Examination (MMSE) and the Motor Assessment Scale (MAS). Observational comparisons between participant executive function scores and age- and/or education-matched normative data demonstrated that executive dysfunction ranged between 55% and 100%. Poorer performance in measures of executive function was more frequently associated with poorer performance in complex gait tests compared with basic gait tests. The MAS was not significantly associated with any measure of executive function. Executive dysfunction is a common sequel poststroke which may negatively affect physical performance. Physiotherapists should consider executive dysfunction when developing rehabilitation strategies to improve physical function poststroke. Copyright © 2012 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

  4. Is poststroke complex regional pain syndrome the combination of shoulder pain and soft tissue injury of the wrist?: A prospective observational study: STROBE of ultrasonographic findings in complex regional pain syndrome.

    Science.gov (United States)

    Kim, Yong Wook; Kim, Yoon; Kim, Jong Moon; Hong, Ji Seong; Lim, Hyun Sun; Kim, Hyoung Seop

    2016-08-01

    Patients with poststroke complex regional pain syndrome (CRPS) show different symptoms compared to other types of CRPS, as they usually complain of shoulder and wrist pain with the elbow relatively spared. It is thus also known by the term "shoulder-hand syndrome."The aim of this study is to present a possible pathophysiology of poststroke CRPS through ultrasonographic observation of the affected wrist before and after steroid injection at the extensor digitorum communis (EDC) tendon in patients suspected with poststroke CRPS.Prospective evaluation and observation, the STROBE guideline checklist was used.Twenty-three patients diagnosed as poststroke CRPS in accordance to clinical criteria were enrolled. They had a Three Phase Bone Scan (TPBS) done and the cross-sectional area (CSA) of EDC tendon was measured by using ultrasonography. They were then injected with steroid at the EDC tendon. The CSA of EDC tendon, visual analogue scale (VAS), and degree of swelling of the wrist were followed up 1 week after the injection.TPBS was interpreted as normal for 4 patients, suspected CRPS for 10 patients, and CRPS for 9 patients. Ultrasonographic findings of the affected wrist included swelling of the EDC tendon. After the injection of steroid to the wrist, CSA and swelling of the affected wrist compared to that before the treatment was significantly decreased (P shoulder or rotator cuff tear of shoulder and soft tissue injury of the wrist caused by the hemiplegic nature of patients with stroke.

  5. Poststroke balance improves with yoga: a pilot study.

    Science.gov (United States)

    Schmid, Arlene A; Van Puymbroeck, Marieke; Altenburger, Peter A; Schalk, Nancy L; Dierks, Tracy A; Miller, Kristine K; Damush, Teresa M; Bravata, Dawn M; Williams, Linda S

    2012-09-01

    Balance impairment is common after stroke; modified yoga may be able to improve balance and other important poststroke variables. Scientific-evidence is needed to support such treatment interventions. The purpose of this study was to assess the impact of a yoga-based rehabilitation intervention on balance, balance self-efficacy, fear of falling (FoF), and quality of life after stroke. This was a prospective, randomized, pilot study of yoga-based rehabilitation for people with chronic stroke. All yoga sessions were taught by a registered yoga therapist, occurred twice per week for 8 weeks and included seated, standing, and floor postures with relaxation and meditation. Balance was assessed with the Berg Balance Scale, balance self-efficacy with the Activities-specific Balance Confidence Scale, FoF with a dichotomous yes/no question, and quality of life with the Stroke Specific Quality of Life scale. There were no significant differences between wait-list control (n=10) and yoga (n=37) groups in baseline or follow-up scores. However, using within-group comparisons, yoga group data demonstrated significant improvement in balance (Berg Balance Scale, 41.3±11.7 vs 46.3±9.1; Pyoga-based rehabilitation intervention for people with chronic stroke has potential in improving multiple poststroke variables. Group yoga may be complementary to rehabilitation, may be possible in medical-based and community-based settings, and may be cost-effective. Further testing of group yoga-based rehabilitation interventions is warranted. Clinical Trial Registration- URL: http://clinicaltrials.gov. Unique Identifier: NCT01109602.

  6. Effect of Yi-nao-jie-yu decoction on γ-aminobutyric acid type A receptor in the hippocampus and serum inflammatory factors in a rat model of poststroke anxiety

    Directory of Open Access Journals (Sweden)

    Zhang W

    2016-11-01

    Full Text Available Wen Zhang,1 Ruizhen Zhao,1 Xiaoli Li,1 Xia Cui,1 Zijun Zhao,1 Yingqiu Mao,2 Fengzhi Wu,3 Qisheng Tang1 1Department of Encephalopathy, The Third Affiliated Hospital, 2Center of Scientific Research, 3Center of Journals, Beijing University of Chinese Medicine, Chaoyang District, Beijing, People’s Republic of China Background: The Yi-nao-jie-yu decoction (YNJYD is a herbal preparation widely used in the clinics of traditional Chinese medicine and has been recently used as an important new therapeutic agent in poststroke anxiety (PSA. The neuroendocrine–immune system plays an important role in PSA mechanisms, although the modulating effects of YNJYD remain unknown. This study investigated the potential effects of YNJYD on the neuroendocrine–immune system in a rat model of PSA.Materials and methods: The PSA model was induced by injecting collagenase (type VII into the right globus pallidus, accompanied by empty water bottle stimulation for 2 weeks. The sham group and the PSA model group were gavaged with saline, while the treatment groups received buspirone (BuSpar or YNJYD. Behavior was evaluated with the open field test and elevated plus maze once a week. Pathological changes were observed by hematoxylin and eosin staining. Serum levels of tumor necrosis factor, interleukin (IL-6, adrenocorticotropic hormone, thyroid stimulating hormone, free triiodothyronine, free thyroxine, IL-1α, and cortisol were detected by radioimmunoassay. Expression of the γ-aminobutyric acid type A receptor (GABAAR α2 subunit was examined by Western blot and real-time polymerase chain reaction.Results: YNJYD-treated rats exhibited significantly better recovery than BuSpar-treated rats at 21 days and 28 days in the open field test and elevated plus maze. Hematoxylin and eosin staining revealed neural repair in the hippocampus in the treatment groups. Serum levels of IL-1α in the YNJYD group were significantly less than those in the model group and the Bu

  7. Evaluating the Credibility of Transport Processes in the Global Modeling Initiative 3D Model Simulations of Ozone Recovery

    Science.gov (United States)

    Strahan, Susan E.; Douglass, Anne R.

    2003-01-01

    The Global Modeling Initiative has integrated two 35-year simulations of an ozone recovery scenario with an offline chemistry and transport model using two different meteorological inputs. Physically based diagnostics, derived from satellite and aircraft data sets, are described and then used to evaluate the realism of temperature and transport processes in the simulations. Processes evaluated include barrier formation in the subtropics and polar regions, and extratropical wave-driven transport. Some diagnostics are especially relevant to simulation of lower stratospheric ozone, but most are applicable to any stratospheric simulation. The temperature evaluation, which is relevant to gas phase chemical reactions, showed that both sets of meteorological fields have near climatological values at all latitudes and seasons at 30 hPa and below. Both simulations showed weakness in upper stratospheric wave driving. The simulation using input from a general circulation model (GMI(sub GCM)) showed a very good residual circulation in the tropics and northern hemisphere. The simulation with input from a data assimilation system (GMI(sub DAS)) performed better in the midlatitudes than at high latitudes. Neither simulation forms a realistic barrier at the vortex edge, leading to uncertainty in the fate of ozone-depleted vortex air. Overall, tracer transport in the offline GMI(sub GCM) has greater fidelity throughout the stratosphere than the GMI(sub DAS).

  8. Evaluating the Credibility of Transport Processes in Simulations of Ozone Recovery using the Global Modeling Initiative Three-dimensional Model

    Science.gov (United States)

    Strahan, Susan E.; Douglass, Anne R.

    2004-01-01

    The Global Modeling Initiative (GMI) has integrated two 36-year simulations of an ozone recovery scenario with an offline chemistry and tra nsport model using two different meteorological inputs. Physically ba sed diagnostics, derived from satellite and aircraft data sets, are d escribed and then used to evaluate the realism of temperature and transport processes in the simulations. Processes evaluated include barri er formation in the subtropics and polar regions, and extratropical w ave-driven transport. Some diagnostics are especially relevant to sim ulation of lower stratospheric ozone, but most are applicable to any stratospheric simulation. The global temperature evaluation, which is relevant to gas phase chemical reactions, showed that both sets of me teorological fields have near climatological values at all latitudes and seasons at 30 hPa and below. Both simulations showed weakness in upper stratospheric wave driving. The simulation using input from a g eneral circulation model (GMI(GCM)) showed a very good residual circulation in the tropics and Northern Hemisphere. The simulation with inp ut from a data assimilation system (GMI(DAS)) performed better in the midlatitudes than it did at high latitudes. Neither simulation forms a realistic barrier at the vortex edge, leading to uncertainty in the fate of ozone-depleted vortex air. Overall, tracer transport in the offline GML(GCM) has greater fidelity throughout the stratosphere tha n it does in the GMI(DAS)

  9. A commercial microbial enhanced oil recovery process: statistical evaluation of a multi-project database

    Energy Technology Data Exchange (ETDEWEB)

    Portwood, J.T.

    1995-12-31

    This paper discusses a database of information collected and organized during the past eight years from 2,000 producing oil wells in the United States, all of which have been treated with special applications techniques developed to improve the effectiveness of MEOR technology. The database, believed to be the first of its kind, has been generated for the purpose of statistically evaluating the effectiveness and economics of the MEOR process in a wide variety of oil reservoir environments, and is a tool that can be used to improve the predictability of treatment response. The information in the database has also been evaluated to determine which, if any, reservoir characteristics are dominant factors in determining the applicability of MEOR.

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

    Directory of Open Access Journals (Sweden)

    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

  11. The Living with Dysarthria group for post-stroke dysarthria: the participant voice.

    Science.gov (United States)

    Mackenzie, C; Kelly, S; Paton, G; Brady, M; Muir, M

    2013-01-01

    The Living with Dysarthria group programme, devised for people with post-stroke dysarthia and family members, was piloted twice. Feedback from those who experience an intervention contributes to the evaluation of speech and language therapy programmes, giving the participant view of the intervention's value and guiding further developments. What feedback do participants in the Living with Dysarthria programme provide, informing on its perceived usefulness and guiding its future development? Nine people with chronic dysarthria following stroke and four family members who completed the Living with Dysarthria programme all contributed to Focus Group (FG) discussion, transcribed and thematically analysed, and completed an Anonymous Questionnaire Evaluation (AQE), comprising closed statements and open questions. An anonymous descriptive adjective selection task (ADAST) was also used. The varied forms of feedback provided complementary information. Thematic analysis of FG data and AQE open question responses were configured around programme benefits, programme structure and content, and programme practicalities. Benefits associated with participation included learning and insight, being supported by peers and professionals, and improved speech and confidence. These are consistent with the main programme elements of education, support and speech practice. All activities were seen as relevant and positively received. Flexibility, recognition of and catering to individual needs were valued characteristics. The community location was approved by all. Most participants thought the format of eight weekly sessions of 2 h was appropriate. Responses to AQE closed statements provided almost unanimous confirmation of the very positive feedback conveyed in FG discussions. The main response to suggested improvements in AQEs was that the number of sessions should be increased. Feedback indicated that for a few individuals there was negative reaction to some facts about stroke, home

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

    Science.gov (United States)

    2012-01-01

    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 pain questionnaires and scales scores. Importantly, CPSP patients with and without MPS did not differ in pain intensity

  13. 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 post-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

  14. Development and evaluation of methods for recovery of Noroviruses from food, water and air

    DEFF Research Database (Denmark)

    Uhrbrand, Katrine

    in the both oysters and mussels. Consequently, the method was found to be a good candidate as a future qualitative standard for routine viral analysis of oysters and mussels. The ability of a rapid method to recover NoV GI, NoV GII and adenovirus (AdV) from Nordic drinking water (tap water) of various types...... evaluated the efficiency of a surface decontamination strategy based on combined treatment with steam and ultrasound to inactivate the NoV surrogates FCV, MNV and bacteriophage MS2. The steam-ultrasound treatment was found to be effective for decontamination of plastic surfaces with near complete...

  15. Re-evaluation of the formalin-ether sedimentation method for the improvement of parasite egg recovery efficiency.

    Science.gov (United States)

    Sato, C; Rai, S K; Uga, S

    2014-09-01

    The formalin-ether sedimentation (FES) method is considered as reliable method of fecal examination for the detection of parasites. In this study, we re-evaluated several aspects of FES such as (i) pretreatment of feces; (ii) filtration of fecal suspensions; (iii) test-tube material and (iv) substitution of ether by other organic solvents as to see an improvement in parasite egg recovery. The egg count was represented by the number of ova detected per 100 μg of sediment. Pre-treatment of feces with formalin (pH 7) increased egg detection rate remarkably compared with original FES method. Use of three layers of gauze dramatically reduced the sediment in the final product, and led to an increase in the number of ova detected. Use of polypropylene test tubes instead of glass test tubes also increased the number of egg detection. None of the organic solvents used to replace the ether produced better results. Based on these findings, we proposed a modified FES procedure. Further, we also compared the parasite positive rate and the number of ova recovered by using original FES and the modified FES procedures by examining 112 fecal samples collected from school children of parasite endemic area in Nepal. Feces collected from Nepal had many parasite ova, and these fecal samples barely displayed false-negative results even by method with low sensitivity. When the mean number of Hemenolepis nana, hookworm, T. trichiura, and A. lumbricoides ova recovered by original FES and the modified FES methods was compared, the values obtained by modified FES were superior (higher). This result suggested that the modified FES is effective and better for the recovery of parasite ova in areas of low-intensity parasitic infection.

  16. Evaluation of resistance development and viability recovery by a non-enveloped virus after repeated cycles of aPDT.

    Science.gov (United States)

    Costa, Liliana; Tomé, João P C; Neves, Maria G P M S; Tomé, Augusto C; Cavaleiro, José A S; Faustino, Maria A F; Cunha, Ângela; Gomes, Newton C M; Almeida, Adelaide

    2011-09-01

    Nowadays, the emergence of drug resistant microorganisms is a public health concern. The antimicrobial photodynamic therapy (aPDT) has an efficient action against a wide range of microorganisms and can be viewed as an alternative approach for treating microbial infections. The aim of this study was to determine if a model target virus (T4-like bacteriophage), in the presence of the tricationic porphyrin 5,10,15-tris(1-methylpyridinium-4-yl)-20-(pentafluorophenyl)porphyrin tri-iodide (Tri-Py(+)-Me-PF), can develop resistance to aPDT and recover its viability after photodynamic treatments. To assess the development of aPDT resistance after repeated treatments, a suspension of T4-like bacteriophage was irradiated with white light (40 Wm(-2)) for 120 min in the presence of 5.0 μM of Tri-Py(+)-Me-PF (99.99% of inactivation) and new phage suspensions were produced from the surviving phages, after each cycle of light exposure. The procedure was repeated ten times. To evaluate the recovery of viral viability after photoinactivation, a suspension of T4-like bacteriophage was irradiated with white light for 120 min in the presence of 5.0 μM of Tri-Py(+)-Me-PF on five consecutive days. In each day, an aliquot of the irradiated suspension was plated and the number of lysis plaques was counted after 24, 48, 72, 96 and 120 h of dark incubation at 37 °C. The profile of bacteriophage photoinactivation did not change after ten consecutive cycles and no recovery of viability was detected after five accumulated cycles of photodynamic treatment. The results suggest that aPDT represents a valuable and promising alternative therapy to treat viral infections, overcoming the problem of microbial resistance. Copyright © 2011 Elsevier B.V. All rights reserved.

  17. Negative emotions affect postoperative scores for evaluating functional knee recovery and quality of life after total knee replacement

    Directory of Open Access Journals (Sweden)

    A. Qi

    2016-01-01

    Full Text Available This study aimed to determine whether psychological factors affect health-related quality of life (HRQL and recovery of knee function in total knee replacement (TKR patients. A total of 119 TKR patients (male: 38; female: 81 completed the Beck Anxiety Inventory (BAI, Beck Depression Inventory (BDI, State Trait Anxiety Inventory (STAI, Eysenck Personality Questionnaire-revised (EPQR-S, Knee Society Score (KSS, and HRQL (SF-36. At 1 and 6 months after surgery, anxiety, depression, and KSS scores in TKR patients were significantly better compared with those preoperatively (P<0.05. SF-36 scores at the sixth month after surgery were significantly improved compared with preoperative scores (P<0.001. Preoperative Physical Component Summary Scale (PCS and Mental Component Summary Scale (MCS scores were negatively associated with extraversion (E score (B=-0.986 and -0.967, respectively, both P<0.05. Postoperative PCS and State Anxiety Inventory (SAI scores were negatively associated with neuroticism (N score; B=-0.137 and -0.991, respectively, both P<0.05. Postoperative MCS, SAI, Trait Anxiety Inventory (TAI, and BAI scores were also negatively associated with the N score (B=-0.367, -0.107, -0.281, and -0.851, respectively, all P<0.05. The KSS function score at the sixth month after surgery was negatively associated with TAI and N scores (B=-0.315 and -0.532, respectively, both P<0.05, but positively associated with the E score (B=0.215, P<0.05. The postoperative KSS joint score was positively associated with postoperative PCS (B=0.356, P<0.05. In conclusion, for TKR patients, the scores used for evaluating recovery of knee function and HRQL after 6 months are inversely associated with the presence of negative emotions.

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

    Science.gov (United States)

    Beinotti, Fernanda; Correia, Nilzete; Christofoletti, Gustavo; Borges, Guilherme

    2010-12-01

    To evaluate the hippotherapy influence on gait training in post-stroke hemiparetic individuals. 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. 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). 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.

  19. 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.

  20. Training in positivity for stroke? A qualitative study of acceptability of use of Positive Mental Training (PosMT) as a tool to assist stroke survivors with post-stroke psychological problems and in coping with rehabilitation.

    Science.gov (United States)

    Mavaddat, Nahal; Ross, Sheila; Dobbin, Alastair; Williams, Kate; Graffy, Jonathan; Mant, Jonathan

    2017-01-01

    Post-stroke psychological problems predict poor recovery, while positive affect enables patients to focus on rehabilitation and may improve functional outcomes. Positive Mental Training (PosMT), a guided self-help audio shows promise as a tool in promoting positivity, optimism and resilience. To assess acceptability of training in positivity with PosMT for prevention and management of post-stroke psychological problems and to help with coping with rehabilitation. A modified PosMT tool consisted of 12 audio tracks each lasting 18 minutes, one listened to every day for a week. Survivors and carers were asked to listen for 4 weeks, but could volunteer to listen for more. Interviews took place about experiences of the tool after 4 and 12 weeks. 10 stroke survivors and 5 carers from Stroke Support Groups in the UK. Three stroke survivors did not engage with the tool. The remainder reported positive physical and psychological benefits including improved relaxation, better sleep and reduced anxiety after four weeks. Survivors who completed the programme gained a positive outlook on the future, increased motivation, confidence and ability to cope with rehabilitation. No adverse effects were reported. The PosMT shows potential as a tool for coping with rehabilitation and overcoming post-stroke psychological problems including anxiety and depression.

  1. Effectiveness of mirror therapy on lower extremity motor recovery, balance and mobility in patients with acute stroke: A randomized sham-controlled pilot trial

    Directory of Open Access Journals (Sweden)

    Uthra Mohan

    2013-01-01

    Full Text Available Objective: To evaluate the effectiveness of mirror therapy on lower extremity motor recovery, balance and mobility in patients with acute stroke. Design: A randomized, sham-controlled, assessor blinded, pilot trial. Setting: Inpatient stroke rehabilitation unit. Subjects: First time onset of stroke with mean post-stroke duration of 6.41 days, able to respond to verbal instructions, and Brunnstrom recovery stage 2 and above were enrolled. Intervention: Mirror therapy group performed 30 minutes of functional synergy movements of non-paretic lower extremity, whereas control group underwent sham therapy with similar duration. In addition, both groups were administered with conventional stroke rehabilitation regime. Altogether 90 minutes therapy session per day, six days a week, for two weeks duration was administered to both groups. Outcome Measures: Lower extremity motor subscale of Fugl Meyer Assessment (FMA, Brunnel Balance Assessment (BBA and Functional Ambulation Categories (FAC. Results: Amongst the 22 patients included, equal number of patients participated in mirror group (N = 11 and control group (N = 11. Baseline variables were similar in both groups, except for Brunnstrom recovery stage. There was no statistical difference between groups, except for FAC. (FMA: P = 0.894; BBA: P = 0.358; FAC: P = 0.02. Significance was set at P < 0.05. Conclusion: Administration of mirror therapy early after stroke is not superior to conventional treatment in improving lower limb motor recovery and balance, except for improvement in mobility.

  2. Municipal solid waste incineration plant: A multi-step approach to the evaluation of an energy-recovery configuration.

    Science.gov (United States)

    Panepinto, D; Zanetti, M C

    2017-07-31

    This study proposes a multi-step approach to evaluating the environmental and economic aspects of a thermal treatment plant with an energy-recovery configuration. In order to validate the proposed approach, the Turin incineration plant was analyzed, and the potential of the incinerator and several different possible connections to the district heating network were then considered. Both local and global environmental balances were defined. The global-scale results provided information on carbon dioxide emissions, while the local-scale results were used as reference values for the implementation of a Gaussian model that could evaluate the actual concentrations of pollutants released into the atmosphere. The economic aspects were then analyzed, and a correspondence between the environmental and economic advantages defined. The results showed a high energy efficiency for the combined production of heat and electricity, and the opportunity to minimize environmental impacts by including cogeneration in a district heating scheme. This scheme showed an environmental advantage, whereas the electricity-only configuration showed an economic advantage. A change in the thermal energy price (specifically, to 40 €/MWh), however, would make it possible to obtain both environmental and economic advantages. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. Evaluation of a medium (STGG) for transport and optimal recovery of Streptococcus pneumoniae from nasopharyngeal secretions collected during field studies.

    Science.gov (United States)

    O'Brien, K L; Bronsdon, M A; Dagan, R; Yagupsky, P; Janco, J; Elliott, J; Whitney, C G; Yang, Y H; Robinson, L G; Schwartz, B; Carlone, G M

    2001-03-01

    Field studies of Streptococcus pneumoniae (pneumococci) nasopharyngeal (NP) colonization are hampered by the need to directly plate specimens in order to ensure isolate viability. A medium containing skim milk, tryptone, glucose, and glycerin (STGG) has been used to transport and store NP material, but its ability to preserve pneumococci has not been evaluated. Our objective was to qualitatively and semiquantitatively evaluate the ability of STGG to preserve pneumococci in NP secretions. Entwined duplicate calcium alginate NP swab samples were obtained from children. One swab was plated directly onto a gentamicin blood agar plate; the other was placed in STGG. Growth from the directly plated specimen was compared with growth from an STGG aliquot immediately cultured or stored at -70 degrees C for 9 weeks, -20 degrees C for 9 weeks, or 4 degrees C for 5 days. Of 186 specimens, 96 (52%) were positive for pneumococci from the direct plating; 94 (98%) of these were positive from the fresh STGG specimen. Pneumococci were recovered from all 38 positive specimens frozen at -70 degrees C, all 18 positive specimens frozen at -20 degrees C, and 18 of 20 positive specimens stored at 4 degrees C. Recovery of pneumococci after storage of NP material in STGG medium at -70 degrees C is at least as good as that from direct plating. Storage at -20 degrees C is also acceptable. Storage at 4 degrees C for 5 days is not ideal.

  4. Evaluation of solution and rheological properties for hydrophobically associated polyacrylamide copolymer as a promised enhanced oil recovery candidate

    Directory of Open Access Journals (Sweden)

    A.N. El-hoshoudy

    2017-09-01

    Full Text Available Crude oil is the most critical energy source in the world, especially for transportation, provision of heat and light as there has not been a sufficient energy source to replace crude oil has broadly integrated, so there is an urgent need to maximize the extraction of the original oil in-place for every reservoir, and accelerating the development of enhanced oil recovery (EOR technologies. Polymer flooding by hydrophobically associated polyacrylamides (HAPAM is a widely used technique through EOR technology. For successful application of these polymers, one should evaluate rheological and solution properties at simulated reservoir conditions as a function of polymer concentration, salinity, temperature and shear rate. The results showed that these copolymers exhibit favorable salt tolerance, temperature resistance, and recoverable viscosity after shearing, reasonable thickening behavior and improved viscosity enhancement properties due to presence of hydrophobic association in the copolymer main chains. Moreover, its capacity for oil production improvement was evaluated during flooding experiments through one dimensional sandstone model at simulated reservoir conditions.

  5. Human Adult Dental Pulp Stem Cells Enhance Poststroke Functional Recovery Through Non‐Neural Replacement Mechanisms

    National Research Council Canada - National Science Library

    Leong, Wai Khay; Henshall, Tanya L; Arthur, Agnes; Kremer, Karlea L; Lewis, Martin D; Helps, Stephen C; Field, John; Hamilton-Bruce, Monica A; Warming, Scott; Manavis, Jim; Vink, Robert; Gronthos, Stan; Koblar, Simon A

    2012-01-01

    Human adult dental pulp stem cells (DPSCs), derived from third molar teeth, are multipotent and have the capacity to differentiate into neurons under inductive conditions both in vitro and following transplantation into the avian embryo...

  6. Restoration of gait and motor recovery by functional electrical stimulation therapy in persons with stroke.

    Science.gov (United States)

    Sabut, Sukanta K; Sikdar, Chanda; Mondal, Ramkrishna; Kumar, Ratnesh; Mahadevappa, Manjunatha

    2010-01-01

    To evaluate the clinical efficacy of functional electrical stimulation (FES) therapy of the tibialis anterior (TA) muscle on gait restoration and enhancing motor recovery with stroke patients. Thirty hemiparetic participants with spastic foot-drop impairments who were at least 3 months post-stroke were recruited from a rehabilitation institute and were assigned either to a control group or a FES group. Both the groups participated in a conventional stroke rehabilitation program for 60 min per day, 5 days a week, for 12-weeks. The FES group received the electrical stimulation to the TA muscle for correction of foot-drop. Functional electric stimulation (FES) resulted in a 26.3% (p control group was only 11.5% (p control group in other gait parameters (e.g. cadence, step length), physiological cost index (PCI), ankle range of motion, spasticity of calf muscle, Fugl-Meyer scores, and the maximum value of the root mean square (RMS(max)), which reflects the capacity of the muscle output. These findings suggest that, the FES therapy combined with conventional therapy treatment more effectively improves the walking ability and enhances the motor recovery when compared with conventional therapy alone in stroke survivors.

  7. The One-Year Attributable Cost of Post-Stroke Dysphagia

    Science.gov (United States)

    Bonilha, Heather Shaw; Simpson, Annie N.; Ellis, Charles; Mauldin, Patrick; Martin-Harris, Bonnie; Simpson, Kit

    2014-01-01

    With the recent emphasis on evidence-based practice and healthcare reform, understanding the cost of dysphagia management has never been more important. It is helpful for clinicians to understand and objectively report the costs associated with dysphagia when they advocate for their services in this economy. Having carefully estimated cost of illness, inputs are needed for cost-effectiveness analyses that help support the value of treatments. This study sought to address this issue by examining the 1-year cost associated with a diagnosis of dysphagia post-stroke in South Carolina. Furthermore, this study investigated whether ethnicity and residence differences exist in the cost of dysphagia post-stroke. Data on 3,200 patients in the South Carolina Medicare database from 2004 who had ICD-9 codes for ischemic stroke, 434 and 436, were retrospectively included in this study. Differences between persons with and without dysphagia post-stroke were compared with respect to age, gender, ethnicity, mortality, length of stay, comorbidity, rurality, discharge disposition, and cost to Medicare. Univariate analyses and a gamma-distributed generalized linear multivariable model with a log link function were completed. We found that the 1-year cost to Medicare for persons with dysphagia post ischemic stroke was $4,510 higher than that for persons without dysphagia post ischemic stroke when controlling for age, comorbidities, ethnicity, and proportion of time alive. Univariate analysis revealed that rurality, ethnicity, and gender were not statistically significantly different in comparisons of individuals with or without dysphagia post-stroke. Post-stroke dysphagia significantly increases post-stroke medical expenses. Understanding the expenditures associated with post-stroke dysphagia is helpful for optimal allocation and use of resources. Such information is needed to conduct cost-effectiveness studies. PMID:24948438

  8. Preliminary evaluation of resinite recovery from Illinois coal. Technical report, March 1--May 31, 1995

    Energy Technology Data Exchange (ETDEWEB)

    Crelling, J.C.

    1995-12-31

    Resinite is a naturally occurring substance found in coal and derived from original plant resins. It has been commercially exploited in the western USA for use in adhesives, varnishes and thermal setting inks. The overall objective of this project is to compare the properties of the resinite contained in Illinois Basin coals to resinite being commercially exploited in the western US, and to recover the resinite from Illinois coals by microbubble column floatation techniques. The significance of this study is that it has the potential to show the way to recover a valuable chemical, resinite, from coal using only physical processing techniques. The value of the resinite at $1.00/kg or $0.50/lb makes it about fifty times more valuable than steam coal. The removal of resinite from coal does not decrease the value of the remaining coal in any way. During this quarter pure concentrates of resinite from Herrin No. 6 Seam were produced by the density gradient centrifugation technique. This material is also now being characterized by petrographic and chemical methods. Another accomplishment this quarter was the completion of a series of microbubble column flotation tests under eight different conditions. The tests were successful in producing concentrates that are now being evaluated. The significance of the work done during this quarter is the confirmation that the resinite in an Illinois coal can be successfully separated in quantities useful for testing and analysis.

  9. Evaluation of recovery in lip closing pressure and occlusal force and contact area after orthognathic surgery.

    Science.gov (United States)

    Ueki, Koichiro; Moroi, Akinori; Sotobori, Megumi; Ishihara, Yuri; Marukawa, Kohei; Iguchi, Ran; Kosaka, Akihiko; Ikawa, Hiroumi; Nakazawa, Ryuichi; Higuchi, Masatoshi

    2014-10-01

    The purpose of this study was to evaluate the relationship between lip closing force, occlusal contact area and occlusal force after orthognathic surgery in skeletal Class III patients. The subjects consisted of 54 patients (28 female and 26 male) diagnosed with mandibular prognathism who underwent sagittal split ramus osteotomy with and without Le Fort I osteotomy. Maximum and minimum lip closing forces, occlusal contact area and occlusal force were measured pre-operatively, 6 months and 1 year post-operative. Maximum and minimum lip closing forces, occlusal contact area and occlusal force increased with time after surgery, however a significant increase was not found in the occlusal contact area in women. In increased ratio (6 months/pre-operative and 1 year/pre-operative), the maximum lip closing force was significantly correlated with the occlusal contact area (P orthognathic surgery could improve the occlusal force, contact area and lip closing force, and an increase ratio in maximum lip closing force was associated with an increased ratio in occlusal contact area. Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  10. Measurement of post-stroke spasticity based on tonic stretch reflex threshold: implications of stretch velocity for clinical practice.

    Science.gov (United States)

    Marques, Isabela Alves; Silva, Maristella Borges; Silva, Andrei Nakagawa; Luiz, Luiza Maire David; Soares, Alcimar Barbosa; Naves, Eduardo Lázaro Martins

    2017-10-02

    The most commonly used method for the clinical evaluation of spasticity is the modified Ashworth scale (MAS), which is subjective. In this regard, the spasticity assessment through the tonic stretch reflex threshold, which is an objective method, has emerged as an alternative. It is based on the value of the dynamic stretch reflex threshold, which is measured at different stretch velocities. However, by this definition, it is not possible to define the speed at which passive stretches should be performed during evaluation. This study aimed to evaluate whether the speed-variation sequence used to acquire the dynamic stretch reflex threshold influences the tonic stretch reflex threshold (TSRT) and, consequently, the estimation of spasticity by this method. Three forms of stretching-variation speed were adopted, i.e., increasing, decreasing, and randomised. The study was performed using 10 post-stroke patients. The results showed that the stretch protocols were not all the same and that the method of increasing was most suitable for performing manual passive stretches to evaluate TSRT in these patients. Another analysis was the correlation between MAS and tonic stretch reflex threshold; a weak correlation was observed between the increasing and decreasing methods, and moderate correlation was observed between the random methods. Implications for Rehabilitation We demonstrated that the protocol of execution of passive stretches influences in the measurement of the tonic stretch reflex threshold (TSRT). We recommend the method of increasing velocity for performing manual passive stretches. We also build software with a reliable biological data acquisition system, which makes acquisition and processing of data in real time. In this way, the TSRT is a promising quantitative measure to assess post-stroke spasticity, calculated automatically. We also we provided the use of portable instruments to facilitate the assessment of spasticity in clinical practice.

  11. Taking Sides: An Integrative Review of the Impact of Laterality and Polarity on Efficacy of Therapeutic Transcranial Direct Current Stimulation for Anomia in Chronic Poststroke Aphasia

    Directory of Open Access Journals (Sweden)

    Margaret Sandars

    2016-01-01

    Full Text Available Anomia is a frequent and persistent symptom of poststroke aphasia, resulting from damage to areas of the brain involved in language production. Cortical neuroplasticity plays a significant role in language recovery following stroke and can be facilitated by behavioral speech and language therapy. Recent research suggests that complementing therapy with neurostimulation techniques may enhance functional gains, even amongst those with chronic aphasia. The current review focuses on the use of transcranial Direct Current Stimulation (tDCS as an adjunct to naming therapy for individuals with chronic poststroke aphasia. Our survey of the literature indicates that combining therapy with anodal (excitatory stimulation to the left hemisphere and/or cathodal (inhibitory stimulation to the right hemisphere can increase both naming accuracy and speed when compared to the effects of therapy alone. However, the benefits of tDCS as a complement to therapy have not been yet systematically investigated with respect to site and polarity of stimulation. Recommendations for future research to help determine optimal protocols for combined therapy and tDCS are outlined.

  12. Measuring mental health in the clinical setting: what is important to service users? The Mini-Service user Recovery Evaluation scale (Mini-SeRvE).

    Science.gov (United States)

    Barber, Joanna M; Parsons, Helen; Wilson, Carol A; Cook, Christopher C H

    2017-07-04

    Since 2001, a policy of positive mental health recovery has been promoted in the UK, with service user involvement. This has not been easy to implement in the clinical setting. To develop and validate a brief self-report, service user-designed, outcome measure (Mini-SeRvE), for clinical use, including spiritual and religious issues. From the previously developed Service user Recovery Evaluation scale (SeRvE), 15 questions were selected for Mini-SeRvE which was self-completed by 207 people; 100 service users and, for comparison, 107 staff. Results were analysed using SPSS software (SPSS Inc., Chicago, IL). Mini-SeRvE is reliable, Cronbach's alpha 0.852. Correlation with another recovery scale, Mental Health Recovery Measure, was high, r = 0.819. Three reliable subscales emerged; existential well-being (EWB), mental ill-being (MIB) and religious well-being (RWB). Scores of the EWB and MIB subscales were higher for staff, consistent with higher mental well-being. Religious well-being scores were higher in service users, who also rated religion as more important to them. Mini-SeRvE is a valid measure of service user recovery. The importance of religion/spiritual belief for our users is highlighted, this being reflected in the subject matter of Mini-SeRvE. Mini-SeRvE assessments could show individual priorities, evaluate therapy and aid clinical decision-making.

  13. Preliminary evaluation of the effects of photobiomodulation therapy and physical rehabilitation on early postoperative recovery of dogs undergoing hemilaminectomy for treatment of thoracolumbar intervertebral disk disease.

    Science.gov (United States)

    Bennaim, Michael; Porato, Mathilde; Jarleton, Astrid; Hamon, Martin; Carroll, James D; Gommeren, Kris; Balligand, Marc

    2017-02-01

    OBJECTIVE To evaluate the effects of postoperative photobiomodulation therapy and physical rehabilitation on early recovery variables for dogs after hemilaminectomy for treatment of intervertebral disk disease. ANIMALS 32 nonambulatory client-owned dogs. PROCEDURES Dogs received standard postoperative care with photobiomodulation therapy (n = 11), physical rehabilitation with sham photobiomodulation treatment (11), or sham photobiomodulation treatment only (10) after surgery. Neurologic status at admission, diagnostic and surgical variables, duration of postoperative IV analgesic administration, and recovery grades (over 10 days after surgery) were assessed. Time to reach recovery grades B (able to support weight with some help), C (initial limb movements present), and D (ambulatory [≥ 3 steps unassisted]) was compared among groups. Factors associated with ability to ambulate on day 10 or at last follow-up were assessed. RESULTS Time to reach recovery grades B, C, and D and duration of postoperative IV opioid administration did not differ among groups. Neurologic score at admission and surgeon experience were negatively associated with the dogs' ability to ambulate on day 10. The number of disk herniations identified by diagnostic imaging before surgery was negatively associated with ambulatory status at last follow-up. No other significant associations and no adverse treatment-related events were identified. CONCLUSIONS AND CLINICAL RELEVANCE This study found no difference in recovery-related variables among dogs that received photobiomodulation therapy, physical rehabilitation with sham photobiomodulation treatment, or sham photobiomodulation treatment only. Larger studies are needed to better evaluate effects of these postoperative treatments on dogs treated surgically for intervertebral disk disease.

  14. Evaluation of left ventricular outflow tract gradient during treadmill exercise and in recovery period in orthostatic position, in patients with hypertrophic cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Cordeiro Pedro

    2008-05-01

    Full Text Available Abstract Background- Left ventricular outflow tract obstruction is an independent predictor of adverse outcome in hypertrophic cardiomyopathy (HCM. The classical quantification of intraventricular obstruction is performed in resting conditions in supine position, but this assessment does not reflect what happens in HCM patients (pts in their daily activities, neither during effort nor during orthostatic recovery. Aim- To assess intraventricular gradients with echocardiography during treadmill exercise and in the recovery period in upright position, in HCM pts. Methods- We studied 17 HCM pts (9 males, mean age 53 ± 16 years, 11 with obstructive HCM. Each pt had 2 echocardiographic evaluations at rest (left lateral decubitus (LLD and orthostatic position. The pts then underwent a treadmill exercise test and intraventricular gradients were measured at peak exercise and during recovery in orthostatic position. Results- 3 pts with non-obstructive HCM at rest developed intraventricular gradients during exercise. 1 pt developed this gradient only during orthostatic recovery. The mean intraventricular gradient in LLD was 49 ± 24 mmHg; in orthostatic position was 62 ± 29 mmHg (p Conclusion- In HCM pts the intraventricular gradient increases in orthostatic position, increases significantly during treadmill exercise and continues increasing in the recovery period in orthostatic position. This type of evaluation can help us to better understand the physiopathology, the symptoms and the efficacy of different therapeutic modalities in this disease and should be routinely used in the assessment of HCM pts.

  15. Evaluation of the Effect of Magnetic Field on PET Spatial Resolution and Contrast Recovery Using Clinical PET Scanners and EGSnrc Simulations

    NARCIS (Netherlands)

    Cheng, J.C.; Boellaard, R.; Laforest, R.

    2015-01-01

    We describe an evaluation of the effect of the magnetic field on the PET spatial resolution and contrast recovery for short and long range positron emitters using experimental phantoms scanned on clinical PET/CT and PET/MR scanners as well as using electron transport simulations. A

  16. Evaluation of the addition of charcoals to broiler diets on the recovery of Salmonella Typhimurium during grow-out and processing

    Science.gov (United States)

    Two experiments evaluated prebiotics added to feed on the recovery of Salmonella in broilers during grow-out and processing. In experiment 1, "seeder" chicks were inoculated with Salmonella Typhimurium and placed with penmates. Treatments were: basal control, 0.3% bamboo charcoal, 0.6% bamboo charco...

  17. Evaluating the utility and seasonality of NDVI values for assessing post-disturbance recovery in a subalpine forest.

    Science.gov (United States)

    Buma, Brian

    2012-06-01

    Forest disturbances around the world have the potential to alter forest type and cover, with impacts on diversity, carbon storage, and landscape composition. These disturbances, especially fire, are common and often large, making ground investigation of forest recovery difficult. Remote sensing offers a means to monitor forest recovery in real time, over the entire landscape. Typically, recovery monitoring via remote sensing consists of measuring vegetation indices (e.g., NDVI) or index-derived metrics, with the assumption that recovery in NDVI (for example) is a meaningful measure of ecosystem recovery. This study tests that assumption using MODIS 16-day imagery from 2000 to 2010 in the area of the Colorado's Routt National Forest Hinman burn (2002) and seedling density counts taken in the same area. Results indicate that NDVI is rarely correlated with forest recovery, and is dominated by annual and perennial forb cover, although topography complicates analysis. Utility of NDVI as a means to delineate areas of recovery or non-recovery are in doubt, as bootstrapped analysis indicates distinguishing power only slightly better than random. NDVI in revegetation analyses should carefully consider the ecology and seasonal patterns of the system in question.

  18. 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

    (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 post-stroke.

  19. Early filiform needle acupuncture for poststroke depression: a meta-analysis of 17 randomized controlled clinical trials

    Science.gov (United States)

    Zhang, Jiping; Chen, Jing; Chen, Junqi; Li, Xiaohui; Lai, Xueyan; Zhang, Shaoqun; Wang, Shengxu

    2014-01-01

    OBJECTIVE: To evaluate the effectiveness and safety of filiform needle acupuncture for poststroke depression, and to compare acupuncture with the therapeutic efficacy of antidepressant drugs. DATA RETRIEVAL: We retrieved data from the Chinese National Knowledge Infrastructure (1979–2012), Wanfang (1980–2012), VIP (1989–2012), Chinese Biomedical Literature (1975–2012), PubMed (1966–2012), Ovid Lww (–2012), and Cochrane Library (–2012) Database using the internet. SELECTION CRITERIA: Randomized controlled trials on filiform needle acupuncture versus antidepressant drugs for treatment of poststroke depression were included. Moreover, the included articles scored at least 4 points on the Jadad scale. Exclusion criteria: other acupuncture therapies as treatment group, not stroke-induced depression patients, score animal trials. MAIN OUTCOME MEASURES: These were the Hamilton Depression Scale scores, clinical effective rate, Self-Rating Depression Scale scores, Side Effect Rating Scale scores, and incidence of adverse reaction and events. RESULTS: A total of 17 randomized controlled clinical trials were included. Meta-analysis results displayed that after 4 weeks of treatment, clinical effective rate was better in patients treated with filiform needle acupuncture than those treated with simple antidepressant drugs [relative risk = 1.11, 95% confidence interval (CI): 1.03–1.21, P = 0.01]. At 6 weeks, clinical effective rate was similar between filiform needle acupuncture and antidepressant drug groups. At 2 weeks after filiform needle acupuncture, Hamilton Depression Scale (17 items) scores were lower than in the antidepressant drug group (mean difference = −2.34, 95%CI: −3.46 to −1.22, P acupuncture and antidepressant drug groups. Self-Rating Depression Scale scores were lower in filiform needle acupuncture group than in the antidepressant drug group. Side Effect Rating Scale was used in only two articles, and no meta-analysis was conducted. Safety

  20. Cognitive impairment and memory dysfunction after a stroke diagnosis: a post-stroke memory assessment.

    Science.gov (United States)

    Al-Qazzaz, Noor Kamal; Ali, Sawal Hamid; Ahmad, Siti Anom; Islam, Shabiul; Mohamad, Khairiyah

    2014-01-01

    Cognitive impairment and memory dysfunction following stroke diagnosis are common symptoms that significantly affect the survivors' quality of life. Stroke patients have a high potential to develop dementia within the first year of stroke onset. Currently, efforts are being exerted to assess stroke effects on the brain, particularly in the early stages. Numerous neuropsychological assessments are being used to evaluate and differentiate cognitive impairment and dementia following stroke. This article focuses on the role of available neuropsychological assessments in detection of dementia and memory loss after stroke. This review starts with stroke types and risk factors associated with dementia development, followed by a brief description of stroke diagnosis criteria and the effects of stroke on the brain that lead to cognitive impairment and end with memory loss. This review aims to combine available neuropsychological assessments to develop a post-stroke memory assessment (PSMA) scheme based on the most recognized and available studies. The proposed PSMA is expected to assess different types of memory functionalities that are related to different parts of the brain according to stroke location. An optimal therapeutic program that would help stroke patients enjoy additional years with higher quality of life is presented.

  1. Feedback-Mediated Upper Extremities Exercise: Increasing Patient Motivation in Poststroke Rehabilitation

    Directory of Open Access Journals (Sweden)

    Maša D. Popović

    2014-01-01

    Full Text Available Purpose. This proof-of-concept study investigated whether feedback-mediated exercise (FME of the affected arm of hemiplegic patients increases patient motivation and promotes greater improvement of motor function, compared to no-feedback exercise (NFE. Method. We developed a feedback-mediated treatment that uses gaming scenarios and allows online and offline monitoring of both temporal and spatial characteristics of planar movements. Twenty poststroke hemiplegic inpatients, randomly assigned to the FME and NFE group, received therapy five days a week for three weeks. The outcome measures were evaluated from the following: (1 the modified drawing test (mDT, (2 received therapy time—RTT, and (3 intrinsic motivation inventory—IMI. Results. The FME group patients showed significantly higher improvement in the speed metric (P<0.01, and smoothness metric (P<0.01, as well as higher RTT (P<0.01. Significantly higher patient motivation is observed in the FME group (interest/enjoyment subscale (P<0.01 and perceived competence subscale (P<0.01. Conclusion. Prolonged endurance in training and greater improvement in certain areas of motor function, as well as very high patient motivation and strong positive impressions about the treatment, suggest the positive effects of feedback-mediated treatment and its high level of acceptance by patients.

  2. [Efficacy of tramadol/acetaminophen medication for central post-stroke pain].

    Science.gov (United States)

    Tanei, Takafumi; Kajita, Yasukazu; Noda, Hiroshi; Takebayashi, Shigenori; Hirano, Masaki; Nakahara, Norimoto; Wakabayashi, Toshihiko

    2013-08-01

    Central post-stroke pain(CPSP)is the most difficult type of central neuropathic pain to control with medical treatment. Opioids are commonly used for chronic neuropathic pain, but their efficacy in treating central neuropathic pain, particularly CPSP, is not clear. Tramadol is an opioid analgesic that, in combination with acetaminophen, has been approved since 2011 for the treatment of non-cancer pain in Japan. In this study we evaluated the efficacy of tramadol/acetaminophen medication for CPSP. We retrospectively reviewed nine cases of CPSP that received oral tramadol/acetaminophen medication. All cases received tramadol/acetaminophen medication after first taking pregabalin then antidepressant medication. Pain levels were assessed before tramadol/acetaminophen medication began and one month after a maintenance dose was reached, using a visual analogue scale(VAS)and the McGill pain questionnaire(MPQ). The mean dose of tramadol was 121±61.6 mg/day. Tramadol/acetaminophen medication was effective in reducing pain in seven of nine cases(77.8%). The VAS improved 32.9±13.8% from pre-to post-medication, and the MPQ improved from 15.4±9.1 pre-medication to 8.1±4.7 post-medication(pmedication was continued in eight cases. Oral tramadol/acetaminophen medication was effective at reducing pain levels in patients with CPSP, and is a medication option for the treatment of CPSP.

  3. Risk Factors for Symptoms of Depression and Anxiety One Year Poststroke: A Longitudinal Study.

    Science.gov (United States)

    Kootker, Joyce A; van Mierlo, Maria L; Hendriks, Jan C; Sparidans, Judith; Rasquin, Sascha M; de Kort, Paul L; Visser-Meily, Johanna M; Geurts, Alexander C

    2016-06-01

    To estimate the relative contribution of psychological factors next to sociodemographic and premorbid/stroke-related factors to the risk of developing symptoms of depression and anxiety after stroke. Multicenter, longitudinal cohort study. Patients after stroke from 6 general hospitals. Patients (N=331) were included at stroke onset and followed up 2 and 12 months after stroke. Not applicable. Sociodemographic and premorbid/stroke-related information was recorded during hospital admission, whereas psychological characteristics were determined with postal questionnaires 2 months poststroke. Symptoms of depression and anxiety were assessed with the Hospital Anxiety and Depression Scale (HADS) 2 and 12 months poststroke. Multivariable logistic analysis was performed to analyze the influence of sociodemographic, premorbid/stroke-related, and psychological characteristics on depressive symptoms (depression subscale of HADS >7) and symptoms of anxiety (anxiety subscale of HADS >7) 1 year after stroke. Early depression, stroke severity, posterior cerebral artery stroke, and neuroticism independently explained the variance of depressive symptoms 1 year poststroke (discriminative power, 83%; adjusted R(2) value, 36%). Neuroticism and early anxiety independently explained the variance of symptoms of anxiety 1 year poststroke (discriminative power, 88%; adjusted R(2) value, 44%). Based on these predictive models, nomograms were constructed to visually reflect the individual contribution of each risk factor to the development of long-term mood disorders after stroke. Psychological characteristics are important risk factors for poststroke symptoms of depression and anxiety. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  4. Suicidal ideation at 1-year post-stroke: A nationwide survey in China.

    Science.gov (United States)

    Yang, Yang; Shi, Yu-Zhi; Zhang, Ning; Wang, Shuo; Ungvari, Gabor S; Ng, Chee H; Wang, Yi-Long; Zhao, Xing-Quan; Wang, Yong-Jun; Wang, Chun-Xue; Xiang, Yu-Tao

    Few studies on suicidal ideation have been conducted in post-stroke patients in China. This national study examined suicidal ideation at 1-year post-stroke and explored its demographic and clinical correlates. A total of 1418 patients with ischemic stroke were included in 56 hospitals nationwide. Demographic, clinical characteristics and neuro-imaging information were collected with standardized instruments, including assessment of stroke severity, depression, cognitive impairment, stroke recurrence, physical disability and insomnia. Suicidal ideation was measured using item 3 of the Hamilton Rating Scale for Depression. The frequency of suicidal ideation in this study was 6.6%. Multivariate analyses revealed that disability (OR=2.07, 95% CI=1.09-3.05), stroke recurrence (OR=4.13, 95% CI=1.74-9.77) and insomnia early (OR=1.87, 95% CI=1.03-3.39), middle (OR=2.66, 95% CI=1.46-4.85) and late (OR=2.35, 95% CI=1.31-4.19) at the 1-year follow-up and post-stroke depression (OR=2.16, 95% CI=1.23-3.82) were significantly associated with post-stroke suicidal ideation. Post-stroke depression, disability, insomnia and stroke recurrence are possible risk factors of suicidal ideation that warrant attention in clinical practice. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Impact of Work-Related Burn Injury on Social Reintegration Outcomes: A Life Impact Burn Recovery Evaluation (LIBRE) Study.

    Science.gov (United States)

    Schneider, Jeffrey C; Shie, Vivian L; Espinoza, Leda F; Shapiro, Gabriel D; Lee, Austin; Acton, Amy; Marino, Molly; Jette, Alan; Kazis, Lewis E; Ryan, Colleen M

    2017-11-26

    To examine differences in long-term social reintegration outcomes for burn survivors with and without work-related injuries. Cross-sectional survey. Community-dwelling burn survivors. Burn survivors (N=601) aged ≥18 years with injuries to ≥5% total body surface area or burns to critical areas (hands, feet, face, or genitals). Not applicable. The Life Impact Burn Recovery Evaluation Profile was used to examine the following previously validated 6 scale scores of social participation: Family and Friends, Social Interactions, Social Activities, Work and Employment, Romantic Relationships, and Sexual Relationships. Older participants, those who were married, and men were more likely to be burned at work (Preintegration outcomes than those without work-related injuries. Identification of those at higher risk for work reintegration challenges after burn injury may enable survivors, providers, employers, and insurers to better use appropriate resources to promote and target optimal employment outcomes. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  6. Muscle phosphocreatine post-exercise recovery rate is related to functional evaluation in hospitalized and community-living older people.

    Science.gov (United States)

    Bourdel-Marchasson, I; Biran, M; Dehail, P; Traissac, T; Muller, F; Jenn, J; Raffard, G; Franconi, J M; Thiaudiere, E

    2007-01-01

    to explore muscle mitochondria function with respect to age, functional status and nutrition in community-living and recovering hospitalized older subjects. subjects were assessed for nutrition, hand-grip strength, 10-meter gait time, a modified timed get-up-and-go test and activities of daily living score (ADL). 31P magnetic resonance spectroscopy (31P MRS) was used to assess the initial rate of post-exercise phosphocreatine recovery (ViPCr) for mitochondrial function evaluation in 25 hospitalized older subjects (86.1 + 5.3 y) and in 25 community-living younger ones (74.5 + 6.2 y). in multiple linear regression, longer time on the get-up-and-go test was independently associated with lower values of ViPCr (p = 0.008). For all subjects and in the 8 patients unable to perform this test, ViPCr was negatively correlated with the ADL score (respectively p < 0.001 and p = 0.025). particularly in hospitalized and frail older subjects, muscle mitochondrial function was related to the global physical functional assessment.

  7. Compositional evaluation of selected agro-industrial wastes as valuable sources for the recovery of complex carbohydrates.

    Science.gov (United States)

    Vojvodić, Aleksandra; Komes, Draženka; Vovk, Irena; Belščak-Cvitanović, Ana; Bušić, Arijana

    2016-11-01

    Re-utilization of various agro-industrial wastes is of growing importance from many aspects. Considering the variety and complexity of such materials, compositional data and compliant methodology is still undergoing many updates and improvements. Present study evaluated sugar beet pulp (SBP), walnut shell (WS), cocoa bean husk (CBH), onion peel (OP) and pea pods (PP) as potentially valuable materials for carbohydrate recovery. Macrocomponent analyses revealed carbohydrate fraction as the most abundant, dominating in dietary fibres. Upon complete acid hydrolysis of sample alcohol insoluble residues, developed procedures of high performance thin-layer chromatography (HPTLC) and high performance liquid chromatography (HPLC) coupled with 3-methyl-1-phenyl-2-pyrazolin-5-one pre-column derivatization (PMP-derivatization) were used for carbohydrate monomeric composition determination. HPTLC exhibited good qualitative features useful for multi-sample rapid analysis, while HPLC superior separation and quantification characteristics. Distinctive monomeric patterns were obtained among samples. OP, SBP and CBH, due to the high galacturonic acid content (20.81%, 13.96% and 6.90% dry matter basis, respectively), may be regarded as pectin sources, while WS and PP as materials abundant in xylan-rich hemicellulose (total xylan content 15.53%, 9.63% dry matter basis, respectively). Present study provides new and valuable compositional data for different plant residual materials and a reference for the application of established methodology. Copyright © 2016 Elsevier Ltd. All rights reserved.

  8. Plugging the Patient Evidence Gap: What Patients with Swallowing Disorders Post-Stroke Say about Thickened Liquids

    Science.gov (United States)

    McCurtin, Arlene; Healy, Chiara; Kelly, Linda; Murphy, Fiona; Ryan, Jean; Walsh, Joanne

    2018-01-01

    Background: Oropharyngeal dysphagia post-stroke is well known, with its presence increasing the risk of poor outcomes in particular aspiration and aspiration pneumonia. Management to minimize the risk of aspiration and improve swallow safety post-stroke includes the treatment of thickened liquids (TL), an established bolus modification…

  9. EEG patterns from acute to chronic stroke phases in focal cerebral ischemic rats: correlations with functional recovery.

    Science.gov (United States)

    Zhang, Shao-jie; Ke, Zheng; Li, Le; Yip, Shea-ping; Tong, Kai-yu

    2013-04-01

    Monitoring the neural activities from the ischemic penumbra provides critical information on neurological recovery after stroke. The purpose of this study is to evaluate the temporal alterations of neural activities using electroencephalography (EEG) from the acute phase to the chronic phase, and to compare EEG with the degree of post-stroke motor function recovery in a rat model of focal ischemic stroke. Male Sprague-Dawley rats were subjected to 90 min transient middle cerebral artery occlusion surgery followed by reperfusion for seven days (n = 58). The EEG signals were recorded at the pre-stroke phase (0 h), acute phase (3, 6 h), subacute phase (12, 24, 48, 72 h) and chronic phase (96, 120, 144, 168 h) (n = 8). This study analyzed post-stroke seizures and polymorphic delta activities (PDAs) and calculated quantitative EEG parameters such as the alpha-to-delta ratio (ADR). The ADR represented the ratio between alpha power and delta power, which indicated how fast the EEG activities were. Forelimb and hindlimb motor functions were measured by De Ryck's test and the beam walking test, respectively. In the acute phase, delta power increased fourfold with the occurrence of PDAs, and the histological staining showed that the infarct was limited to the striatum and secondary sensory cortex. In the subacute phase, the alpha power reduced to 50% of the baseline, and the infarct progressed to the forelimb cortical region. ADRs reduced from 0.23 ± 0.09 to 0.04 ± 0.01 at 3 h in the acute phase and gradually recovered to 0.22 ± 0.08 at 168 h in the chronic phase. In the comparison of correlations between the EEG parameters and the limb motor function from the acute phase to the chronic phase, ADRs were found to have the highest correlation coefficients with the beam walking test (r = 0.9524, p EEG activities after focal cerebral ischemia and showed that functional recovery was closely correlated with the neural activities in the penumbra. Longitudinal EEG

  10. Effectiveness of the California Tri-Pull Taping method for shoulder subluxation poststroke: a single-subject ABA design.

    Science.gov (United States)

    Hayner, Kate A

    2012-01-01

    I evaluated the effectiveness of the California Tri-Pull Taping method for clients with poststroke inferior shoulder subluxation of the glenohumeral joint. Ten participants were followed for 9 wk using an interrupted time series quasi-experimental single-subject ABA design to examine shoulder pain, activities of daily living (ADL) function, active range of motion, tape comfort, and subluxation. The California Tri-Pull Taping method decreased inferior subluxation significantly from baseline to intervention but not at postintervention. Active range of motion was significantly increased in shoulder flexion and abduction between the baseline and intervention and the intervention and postintervention phases. Functional ADL scores were significant. The taping was reported to be comfortable. No significant difference in pain was found. This intervention is a promising adjunct to the management of the hemiplegic subluxed shoulder that warrants further research. Copyright © 2012 by the American Occupational Therapy Association, Inc.

  11. [Factors associated with post-stroke oropharingeal dysphagia].

    Science.gov (United States)

    Peña-Chávez, Rodolfo; López-Espinoza, Miguel; Guzmán-Inostroza, Madelein; Jara-Parra, Mirna; Sepúlveda-Arriagada, Claudia; Sepulveda-Arriagada, Constanza; Zapata-Sepúlveda, Priscila

    2015-10-01

    Neurogenic dysphagia is a consequence of stroke that sometimes threatens the patient's life. The magnitude of the brain damage commonly generated by stroke generates the emergence of other disorders that accompany dysphagia and worsen the patient's health. To analyze possible associations between communication disorders, disease factors, demographic factors and comorbidities with post-stroke dysphagia in years 2009 to 2011. We studied 1519 medical records of patients that suffered stroke between 2009 and 2011. From medical records reviewed, 206 had dysphagia (13.6%). 80,1% from dysphagic patients had between 60 to 89 years old. 66% from them stayed hospitalized for more than 11 days. Age (odds ratio = 2.36; p aphasia (odds ratio = 4.47; p dysarthria (odds ratio = 4.95; p aphasia or dysarthria or apraxia of speech, however, 26,7% only had dysphagia. Neurogenic dysphagia seems to be associated with communication disorders, increase the time of hospitalization and associated with a hypertension. However, prospective studies consider a great time to confirm these findings are required.

  12. Increased Th17/Treg Ratio in Poststroke Fatigue

    Directory of Open Access Journals (Sweden)

    Xinjing Liu

    2015-01-01

    Full Text Available Fatigue is a major debilitating symptom after stroke. The biological mechanisms underlying poststroke fatigue (PFS are unknown. We hypothesized that PSF is associated with an alteration in the balance between Th17 and Treg cells. To test this hypothesis we assessed fatigue in 30 stroke survivors using the Fatigue Scale for Motor and Cognitive Functions (FSMC. Peripheral blood was collected for assessment of Th17 and Treg cell populations and measurement of interleukin-10 (IL-10. Participants were dichotomized into severe fatigue n=14 and low-moderate fatigue n=16 groups by K-mean cluster analysis of FSMC scores. There were no group differences in age, gender, stroke type, stroke severity, or time since stroke. Stroke survivors in the severe fatigue group reported greater anxiety p=0.004 and depression p=0.001 than in the low-moderate fatigue group. The ratio of Th17 to Treg cells was significantly increased in the severe fatigue group relative to the mild-moderate fatigue group p=0.035. Serum levels of IL-10 negatively correlated withTh17/Treg ratio (r=-0.408,  p=0.025. Our preliminary findings suggest that an imbalance in the Th17/Treg ratio is associated with the severity of PSF.

  13. Post-stroke cognitive impairment at 3 months

    Directory of Open Access Journals (Sweden)

    Sundar Uma

    2010-01-01

    Full Text Available Background: Vascular cognitive impairment, being the only treatable cause of dementia in the early stages, and having a diverse etiology, requires sensitive criteria for definition. Aim: This study aimed to study cognitive functions at 3 months post-stroke, utilising the Mini mental scale examination (MMSE and the Frontal assessment battery (FAB, and to correlate the same with subgroups of ischemic stroke. Results: 164 patients were studied, 108 of these having multiple infarcts. Pure cortical infarcts were seen in 41 patients.At 3 months, 112/164 patients had MMSE more than 24, with no frontal executive dysfunction.MMSE score less than 24 was seen in 24 patients, all of them having FAB score below 10. Normal MMSE with impaired FAB was seen in 28 patients. Conclusions: Impairment on either the MMSE or the FAB was thus seen in 31.7% patients (52/164, at 3 months after stroke.FAB impairment alone, with MMSE in normal range, was seen in 28/52 (53.8 % patients. Memory was significantly more commonly affected in muti-infarct strokes as compared to single infarcts. Frontal executive dysfunction was not significantly different when single and multiple infarcts, or cortical and subcortical infarcts, were compared.

  14. 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.

  15. Both projection and commissural pathways are disrupted in individuals with chronic stroke: investigating microstructural white matter correlates of motor recovery.

    Science.gov (United States)

    Borich, Michael R; Mang, Cameron; Boyd, Lara A

    2012-08-29

    Complete recovery of motor function after stroke is rare with deficits persisting into the chronic phase of recovery. Diffusion tensor imaging (DTI) can evaluate relationships between white matter microstructure and motor function after stroke. The objective of this investigation was to characterize microstructural fiber integrity of motor and sensory regions of the corpus callosum (CC) and descending motor outputs of the posterior limb of the internal capsule (PLIC) in individuals with chronic stroke and evaluate the relationships between white matter integrity and motor function. Standardized measures of upper extremity motor function were measured in thirteen individuals with chronic stroke. Manual dexterity was assessed in thirteen healthy age-matched control participants. DTI scans were completed for each participant. Fractional anisotropy (FA) of a cross-section of sensory and motor regions of the CC and the PLIC bilaterally were quantified. Multivariate analysis of variance evaluated differences between stroke and healthy groups. Correlational analyses were conducted for measures of motor function and FA. The stroke group exhibited reduced FA in the sensory (p = 0.001) region of the CC, contra- (p = 0.032) and ipsilesional (p = 0.001) PLIC, but not the motor region of the CC (p = 0.236). In the stroke group, significant correlations between contralesional PLIC FA and level of physical impairment (p = 0.005), grip strength (p = 0.006) and hand dexterity (p = 0.036) were observed. Microstructural status of the sensory region of the CC is reduced in chronic stroke. Future work is needed to explore relationships between callosal sensorimotor fiber integrity and interhemispheric interactions post-stroke. In addition, contralesional primary motor output tract integrity is uniquely and closely associated with multiple dimensions of motor recovery in the chronic phase of stroke suggesting it may be an important biomarker of overall motor recovery.

  16. A Randomized Controlled Trial of the Effect of Early Upper-Limb Training on Stroke Recovery and Brain Activation.

    Science.gov (United States)

    Hubbard, Isobel J; Carey, Leeanne M; Budd, Timothy W; Levi, Christopher; McElduff, Patrick; Hudson, Steven; Bateman, Grant; Parsons, Mark W

    2015-09-01

    Upper-limb (UL) dysfunction is experienced by up to 75% of patients poststroke. The greatest potential for functional improvement is in the first month. Following reperfusion, evidence indicates that neuroplasticity is the mechanism that supports this recovery. This preliminary study hypothesized increased activation of putative motor areas in those receiving intensive, task-specific UL training in the first month poststroke compared with those receiving standard care. This was a single-blinded, longitudinal, randomized controlled trial in adult patients with an acute, first-ever ischemic stroke; 23 participants were randomized to standard care (n = 12) or an additional 30 hours of task-specific UL training in the first month poststroke beginning week 1. Patients were assessed at 1 week, 1 month, and 3 months poststroke. The primary outcome was change in brain activation as measured by functional magnetic resonance imaging. When compared with the standard-care group, the intensive-training group had increased brain activation in the anterior cingulate and ipsilesional supplementary motor areas and a greater reduction in the extent of activation (P = .02) in the contralesional cerebellum. Intensive training was associated with a smaller deviation from mean recovery at 1 month (Pr>F0 = 0.017) and 3 months (Pr>F = 0.006), indicating more consistent and predictable improvement in motor outcomes. Early, more-intensive, UL training was associated with greater changes in activation in putative motor (supplementary motor area and cerebellum) and attention (anterior cingulate) regions, providing support for the role of these regions and functions in early recovery poststroke. © The Author(s) 2014.

  17. Concept Analysis of Burden in Caregivers of Stroke Survivors During the Early Poststroke Period.

    Science.gov (United States)

    Byun, Eeeseung; Evans, Lois K

    2015-10-01

    It is important to understand burden in caregivers of stroke survivors during the early poststroke period if we are to prevent or decrease the longer-term experience of caregiver burden and its consequences. This article reports a concept analysis of burden in caregivers of stroke survivors during the early poststroke period. A literature review using MEDLINE, PubMed, CINAHL, PsycINFO, and ISI Web of Knowledge databases (1960-2014) identified 32 relevant articles published from 1993 to 2013. Rodgers's evolutionary method of concept analysis was used. Three attributes--objective and subjective aspects, time spent caring for the stroke survivor, and uncertainty about the future for the stroke survivor and caregiver--were identified. Multiple definitions of caregiver burden have been used. In the early poststroke period, burden appears closely interconnected with other factors, some of which may be modifiable. © The Author(s) 2014.

  18. Requiring remission of undue influence of weight and shape on self-evaluation in the definition of recovery for bulimia nervosa.

    Science.gov (United States)

    Cogley, Catherine B; Keel, Pamela K

    2003-09-01

    The current study evaluated the concurrent validity of requiring remission of undue influence of weight and shape on self-evaluation (undue influence) in defining recovery from bulimia nervosa (BN). Three groups completed the Beck Depression Inventory, the Mood and Anxiety Symptom Questionnaire, the Body Shape Questionnaire, and the Social Adjustment Scale: 31 women were fully recovered from BN (FR), 28 women had no behavioral symptoms of BN (partially recovered [PR]), and 59 matched non-eating-disordered controls (MC). The PR group had more pathologic scores on depression, anxiety, body dissatisfaction, and social adjustment compared with both the FR and MC groups, which did not differ from each other. These findings suggest that including remission of cognitive symptoms in a standardized definition of recovery may prove to be clinically useful in establishing reliable prognostic indicators. Future research should evaluate the role played by cognitive symptoms in triggering relapse. Copyright 2003 by Wiley Periodicals, Inc.

  19. Experimental Evaluation of Hybrid Distillation-Vapor Permeation Process for Efficient Ethanol Recovery from Ethanol-Water Mixtures

    Science.gov (United States)

    The energy demand of distillation-based systems for ethanol recovery and dehydration can be significant, particularly for dilute solutions [1]. An alternative separation process integrating vapor stripping with a vapor compression step and a vapor permeation membrane separation ...

  20. Disaster Debris Recovery Database - Recovery

    Data.gov (United States)

    U.S. Environmental Protection Agency — The US EPA Disaster Debris Recovery Database (DDRD) promotes the proper recovery, recycling, and disposal of disaster debris for emergency responders at the federal,...

  1. Assessment of recovery in older patients hospitalized with different diagnoses and functional levels, evaluated with and without geriatric assessment.

    Science.gov (United States)

    Abrahamsen, Jenny Foss; Haugland, Cathrine; Ranhoff, Anette Hylen

    2016-01-01

    The objective of the present study was to investigate 1) the role of different admission diagnoses and 2) the degree of functional loss, on the rate of recovery of older patients after acute hospitalization. Furthermore, to compare the predictive value of simple assessments that can be carried out in a hospital lacking geriatric service, with assessments including geriatric screening tests. Prospective, observational cohort study, including 961community dwelling patients aged ≥ 70 years, transferred from medical, cardiac, pulmonary and orthopedic acute hospital departments to intermediate care in nursing home. Functional assessment with Barthel index (BI) was performed at admission to the nursing home and further geriatric assessment tests was performed during the first week. Logistic regression models with and without geriatric assessment were compared concerning the patients having 1) slow recovery (nursing home stay up to 2 months before return home) or, 2) poor recovery (dead or still in nursing home at 2 months). Slow recovery was independently associated with a diagnosis of non-vertebral fracture, BI subgroups 50-79 and geriatric assessment, also with cognitive impairment. Poor recovery was more complex, and independently associated both with BI geriatric assessment model, cognitive impairment. Geriatric assessment is optimal for determining the recovery potential of older patients after acute hospitalization. As some hospitals lack geriatric services and ability to perform geriatric screening tests, a simpler assessment based on admission diagnoses and ADL function (BI), gives good information regarding the possible rehabilitation time and possibility to return home.

  2. Multidisciplinary rehabilitation following botulinum toxin and other focal intramuscular treatment for post-stroke spasticity.

    Science.gov (United States)

    Demetrios, Marina; Khan, Fary; Turner-Stokes, Lynne; Brand, Caroline; McSweeney, Shane

    2013-06-05

    Spasticity may affect stroke survivors by contributing to activity limitations, caregiver burden, pain and reduced quality of life (QoL). Spasticity management guidelines recommend multidisciplinary (MD) rehabilitation programmes following botulinum toxin (BoNT) treatment for post-stroke spasticity. However, the evidence base for the effectiveness of MD rehabilitation is unclear. To assess the effectiveness of MD rehabilitation, following BoNT and other focal intramuscular treatments such as phenol, in improving activity limitations and other outcomes in adults and children with post-stroke spasticity. To explore what settings, types and intensities of rehabilitation programmes are effective. We searched the Cochrane Stroke Group Trials Register (February 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 12), MEDLINE (1948 to December 2011), EMBASE (1980 to January 2012), CINAHL (1982 to January 2012), AMED (1985 to January 2012), LILACS (1982 to September 2012), PEDro, REHABDATA and OpenGrey (September 2012). In an effort to identify further published, unpublished and ongoing trials we searched trials registries and reference lists, handsearched journals and contacted authors. We included randomised controlled trials (RCTs) that compared MD rehabilitation (delivered by two or more disciplines in conjunction with medical input) following BoNT and other focal intramuscular treatments for post-stroke spasticity with placebo, routinely available local services, or lower levels of intervention; or studies that compared MD rehabilitation in different settings, of different types, or at different levels of intensity. We excluded RCTs that assessed the effectiveness of unidisciplinary therapy (for example physiotherapy only) or a single modality (for example stretching, casting, electrical stimulation or splinting only). The primary outcomes were validated measures of activity level (active and passive function

  3. Therapeutic Effect of Virtual Reality on Post-Stroke Patients: Randomized Clinical Trial.

    Science.gov (United States)

    Pedreira da Fonseca, Erika; Ribeiro da Silva, Nildo Manoel; Pinto, Elen Beatriz

    2017-01-01

    The study aimed to check the therapeutic effect of virtual reality associated with conventional physiotherapy on gait balance and the occurrence of falls after a stroke. This was a randomized, blinded clinical trial conducted with post-stroke patients, randomized into two groups-treatment group and control group-and subjected to balance assessments by the Dynamic Gait Index and investigation of falls before and after 20 intervention sessions. Statistically significant difference was considered at P rehabilitation in post-stroke patients, with repercussions on the reduction of falls. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  4. Increased frequency of first episode poststroke depression following discontinuation of escitalopram

    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.

    2011-01-01

    Background and Purpose To compare escitalopram, problem-solving therapy (PST), and placebo, to prevent poststroke depression during 6 months after discontinuation of treatment. Methods We examined for depression, 33 patients assigned to placebo, 34 to escitalopram, and 41 to PST. Results After controlling for age, gender, prior mood disorder, and severity of stroke, new onset major depression and Hamilton Depression scores were significantly higher 6 months after escitalopram was discontinued, compared to the PST or placebo groups. Conclusions Discontinuation of escitalopram may increase poststroke depressive symptoms. PMID:21868736

  5. Increased frequency of first-episode poststroke depression after discontinuation of escitalopram.

    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

    2011-11-01

    The purpose of this study was to compare escitalopram, problem-solving therapy, and placebo to prevent poststroke depression during 6 months after discontinuation of treatment. We examined for depression 33 patients assigned to placebo, 34 to escitalopram, and 41 to problem-solving therapy. After controlling for age, gender, prior mood disorder, and severity of stroke, new-onset major depression and Hamilton Depression scores were significantly higher 6 months after escitalopram was discontinued compared with the problem-solving therapy or placebo groups. Discontinuation of escitalopram may increase poststroke depressive symptoms.

  6. Recovery and creative practices in people with severe mental illness: evaluating well-being and social inclusion.

    Science.gov (United States)

    Saavedra, Javier; Pérez, Elvira; Crawford, Paul; Arias, Samuel

    2018-04-01

    This mixed (quantitative-qualitative) study evaluates the impact of an artistic workshop on a group of people with severe mental illness (SMI). This study focuses on the impact of creative practices on well-being and social inclusion outcomes. After participating in a creative workshop, 31 people diagnosed with a SMI completed pre/post-intervention measures, namely, the Warwick-Edinburgh Mental Well-Being Scale and the Social Inclusion questionnaire. It was applied in two-way repeated measures analysis of variance. The statistic Wilcoxon and Kruskal-Wallis were applied for non-parametric data to measure pre/post-test effects and workshop experience effects, respectively. In addition to quantitative measures, one observer participated in each workshop that ran in parallel in order to deepen and triangulate quantitative outcomes. The qualitative and quantitative results show that social inclusion improved in a significant way with an important size effect. Psychological wellbeing increased significantly with a low size effect. In accordance with these results, creative practices with people diagnosed with SMI are recommended. In order to increase the impact of these interventions, it is recommended to utilize public space away from clinical environments and to include people without SMI in creative activities together with SMI patients. Implications for Rehabilitation: Creative practices can significantly improve social inclusions and well-being in people with severe mental illness. Participating in creative workshops helps to elaborate personal meanings and promote recovery. Creative practices in mental health services can challenge professional roles and institutional practices. Participation of people with and without severe mental illness engaged together in artistic activities can decrease public stigma.

  7. Effect of inversion time on the precision of myocardial late gadolinium enhancement quantification evaluated with synthetic inversion recovery MR imaging.

    Science.gov (United States)

    Varga-Szemes, Akos; van der Geest, Rob J; Schoepf, U Joseph; Spottiswoode, Bruce S; De Cecco, Carlo N; Muscogiuri, Giuseppe; Wichmann, Julian L; Mangold, Stefanie; Fuller, Stephen R; Maurovich-Horvat, Pal; Merkely, Bela; Litwin, Sheldon E; Vliegenthart, Rozemarijn; Suranyi, Pal

    2017-08-01

    To evaluate the influence of inversion time (TI) on the precision of myocardial late gadolinium enhancement (LGE) quantification using synthetic inversion recovery (IR) imaging in patients with myocardial infarction (MI). Fifty-three patients with suspected prior MI underwent 1.5-T cardiac MRI with conventional magnitude (MagIR) and phase-sensitive IR (PSIR) LGE imaging and T1 mapping at 15 min post-contrast. T1-based synthetic MagIR and PSIR images were calculated with a TI ranging from -100 to +150 ms at 5-ms intervals relative to the optimal TI (TI0). LGE was quantified using a five standard deviation (5SD) and full width at half-maximum (FWHM) thresholds. Measurements were compared using one-way analysis of variance. The MagIRsy technique provided precise assessment of LGE area at TIs ≥ TI0, while precision was decreased below TI0. The LGE area showed significant differences at ≤ -25 ms compared to TI0 using 5SD (P T1 map-based PSIRsy images provide precise quantification of MI independent of TI at the investigated time point post-contrast. MagIRsy-based MI quantification is precise at TI0 and at longer TIs while showing decreased precision at TI values below TI0. • Synthetic IR imaging retrospectively generates LGE images at any theoretical TI • Synthetic IR imaging can simulate the effect of TI on LGE quantification • Fifteen minutes post-contrast MagIR sy accurately quantifies infarcts from TI 0 to TI 0   + 150 ms • Fifteen minutes post-contrast PSIR sy provides precise infarct size independent of TI • Synthetic IR imaging has further advantages in reducing operator dependence.

  8. Effect of inversion time on the precision of myocardial late gadolinium enhancement quantification evaluated with synthetic inversion recovery MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Varga-Szemes, Akos; Schoepf, U.J.; De Cecco, Carlo N.; Fuller, Stephen R.; Suranyi, Pal [Medical University of South Carolina, Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Charleston, SC (United States); Geest, Rob J. van der [Leiden University Medical Center, Department of Radiology, Leiden (Netherlands); Spottiswoode, Bruce S. [Siemens Medical Solutions, Chicago, IL (United States); Muscogiuri, Giuseppe [Medical University of South Carolina, Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Charleston, SC (United States); Bambino Gesu Children' s Hospital IRCCS, Department of Imaging, Rome (Italy); Wichmann, Julian L. [Medical University of South Carolina, Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Charleston, SC (United States); University Hospital Frankfurt, Department of Diagnostic and Interventional Radiology, Frankfurt (Germany); Mangold, Stefanie [Medical University of South Carolina, Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Charleston, SC (United States); Eberhard-Karls University Tuebingen, Department of Diagnostic and Interventional Radiology, Tuebingen (Germany); Maurovich-Horvat, Pal; Merkely, Bela [Semmelweis University, MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Budapest (Hungary); Litwin, Sheldon E. [Medical University of South Carolina, Division of Cardiology, Department of Medicine, Charleston, SC (United States); Vliegenthart, Rozemarijn [Medical University of South Carolina, Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Charleston, SC (United States); University of Groningen, University Medical Center Groningen, Center for Medical Imaging-North East Netherlands, Department of Radiology, Groningen (Netherlands)

    2017-08-15

    To evaluate the influence of inversion time (TI) on the precision of myocardial late gadolinium enhancement (LGE) quantification using synthetic inversion recovery (IR) imaging in patients with myocardial infarction (MI). Fifty-three patients with suspected prior MI underwent 1.5-T cardiac MRI with conventional magnitude (MagIR) and phase-sensitive IR (PSIR) LGE imaging and T1 mapping at 15 min post-contrast. T1-based synthetic MagIR and PSIR images were calculated with a TI ranging from -100 to +150 ms at 5-ms intervals relative to the optimal TI (TI{sub 0}). LGE was quantified using a five standard deviation (5SD) and full width at half-maximum (FWHM) thresholds. Measurements were compared using one-way analysis of variance. The MagIR{sub sy} technique provided precise assessment of LGE area at TIs ≥ TI{sub 0}, while precision was decreased below TI{sub 0}. The LGE area showed significant differences at ≤ -25 ms compared to TI{sub 0} using 5SD (P < 0.001) and at ≤ -65 ms using the FWHM approach (P < 0.001). LGE measurements did not show significant difference over the analysed TI range in the PSIR{sub sy} images using either of the quantification methods. T1 map-based PSIR{sub sy} images provide precise quantification of MI independent of TI at the investigated time point post-contrast. MagIR{sub sy}-based MI quantification is precise at TI{sub 0} and at longer TIs while showing decreased precision at TI values below TI{sub 0}. (orig.)

  9. Synthesis and evaluation of fluorine-substituted phenyl acetate derivatives as ultra-short recovery sedative/hypnotic agents.

    Directory of Open Access Journals (Sweden)

    Heng Zhang

    Full Text Available BACKGROUND: Soft drugs are molecules that are purposefully designed to be rapidly metabolized (metabolically labile. In anesthesia, the soft drug is useful because it enables precise titration to effect and rapid recovery, which might allow swift and clear-headed recovery of consciousness and early home readiness. Propofol may cause delayed awakening after prolonged infusion. Propanidid and AZD3043 have a different metabolic pathway compared to propofol, resulting in a short-acting clinical profile. Fluorine imparts a variety of properties to certain medicines, including an enhanced absorption rate and improved drug transport across the blood-brain barrier. We hypothesized that the introduction of fluorine to the frame structure of propanidid and AZD3043 would further accelerate the swift and clear-headed recovery of consciousness. To test this hypothesis, we developed a series of fluorine-containing phenyl acetate derivatives. METHODOLOGY/PRINCIPAL FINDINGS: Fluorine-containing phenyl acetate derivatives were synthesized, and their hypnotic potencies and durations of LORR following bolus or infusion administration were determined in mice, rats and rabbits. The metabolic half-lives in the blood of various species were determined chromatographically. In vitro radioligand binding and γ-aminobutyric acidA (GABAA receptor electrophysiology studies were performed. Among the 12 synthesized fluorine-containing phenyl acetate derivatives, compound 5j induced comparable duration of LORR with AZD3043, but more rapid recovery than AZD3043, propanidid and propofol. The time of compound 5j to return to walk and behavioral recovery are approximately reduced by more than 50% compared to AZD3043 in mice and rats and rabbits. The HD50 of compound 5j decreased with increasing animal size. CONCLUSIONS/SIGNIFICANCE: The rapid recovery might make compound 5j suitable for precise titration and allow swift and clear-headed recovery of consciousness and early home

  10. [Clinical study of post-stroke upper limb spasmodic hemiplegia treated withjingou diaoyuneedling technique and Bobath therapy].

    Science.gov (United States)

    Sun, Runjie; Tian, Liang; Fang, Xiaoli; Du, Xiaozheng; Zhu, Bowen; Song, Zhongyang; Xu, Xuan; Qin, Xiaoguang

    2017-04-12

    To compare the difference in the clinical efficacy on post-stroke upper limb spasmodic hemiplegia between the combined therapy of jingou diaoyu needling technique and Bobath technology and simple Bobath technology. Sixty patients were randomized into an observation group and a control group, 30 cases in each one. The usual medication of neurological internal medicine was used in the two groups. In the control group, Bobath facilitation technology was applied to the rehabilitation training. In the observation group, on the basis of the treatment as the control group, jingou diaoyu needling technique was used to stimulate Zhongfu (LU 1), Tianfu (LU 3), Chize (LU 5), Quchi (LI 11), Jianshi (PC 5) and Daling (PC 7). The treatment was given once a day; 5 treatments made one session and totally 4-week treatment was required in the two groups. The modified Ashworth scale, the modified Fugle-Meyer assessment (FMA) and the Barthel index (BI) were adopted to evaluate the muscular tension, the upper limb motor function and the activities of daily living (ADL) before and after treatment in the two groups. The clinical efficacy was compared between the two groups. Compared with those before treatment, the modified Ashworth scale, Fugl-Meyer score and BI score were all improved after treatment in the two groups (all P Bobath therapy achieve the superior efficacy on post-stroke upper limb spasmodic hemiplegia as compared with the simple application Bobath therapy. This combined treatment effectively relieve spasmodic state and improve the upper limb motor function and the activities of daily living.

  11. The effect of ankle-foot orthoses on self-reported balance confidence in persons with chronic poststroke hemiplegia.

    Science.gov (United States)

    Zissimopoulos, Angelika; Fatone, Stefania; Gard, Steven

    2014-04-01

    One intervention often used to address physical impairments post stroke is an ankle-foot orthosis. Ankle-foot orthoses may improve walking speed, stride length, and gait pattern. However, effects on balance, crucial for safe ambulation, are thus far inconclusive. One aspect of balance shown to contribute to functional ability is self-efficacy. Self-efficacy, defined as the belief in one's ability to succeed in particular situations, has been shown to be more strongly associated with activity and participation (as defined by the International Classification of Functioning, Disability, and Health) than physical performance measures of gait or balance. We investigated whether self-efficacy, or balance confidence when referred to in the context of balance capabilities, is improved with ankle-foot orthosis use. Repeated measures study design. Balance confidence was measured using the Activities-specific Balance Confidence Scale in 15 persons with chronic poststroke hemiplegia, with and without their regular ankle-foot orthosis. Activities-specific Balance Confidence Scale scores were significantly higher (p ≤ 0.01) for the ankle-foot orthosis condition compared to no ankle-foot orthosis. One mechanism by which ankle-foot orthosis use may influence balance is improved balance confidence. Future work should explore the specific mechanisms underlying this improvement in self-efficacy. Clinical relevance Self-efficacy may be an important factor to consider when evaluating functioning post stroke. Rehabilitative interventions that improve balance confidence may help restore participation and overall functioning in pathological populations, particularly in the fall-prone poststroke population. Study results provide evidence for improvements in balance confidence with ankle-foot orthosis use.

  12. Observational Study of 180° Turning Strategies Using Inertial Measurement Units and Fall Risk in Poststroke Hemiparetic Patients.

    Science.gov (United States)

    Barrois, Rémi Pierre-Marie; Ricard, Damien; Oudre, Laurent; Tlili, Leila; Provost, Clément; Vienne, Aliénor; Vidal, Pierre-Paul; Buffat, Stéphane; Yelnik, Alain P

    2017-01-01

    We analyzed spontaneous 180° turning strategies in poststroke hemiparetic patients by using inertial measurement units (IMUs) and the association of turning strategies with risk of falls. We included right paretic (RP) and left paretic (LP) post-stroke patients, and healthy controls (HCs) from a physical and rehabilitation department in France between July 2015 and October 2015. All subjects were right-handed and right-footed for mobilization tasks. Participants were instructed to turn 180° in a self-selected direction after a 10-m walk while wearing three IMUs on their trunk and both feet. We defined three turning patterns based on the number of external steps (pattern I = 1; II = 2-4 steps; and III ≥ 5) and four turning strategies based on the side chosen to turn (healthy or paretic) and the stance limb used during the first step of the turn (healthy or paretic). Falls in the 6 months after measurement were investigated. We included 17 RP [mean (SD) age 57.5 (9.5) years (range 43-73)], 20 LP patients [mean age 60.7 (8.8) years (range 43-63)], and 15 HCs [mean age 56.7 (16.1) years (range 36-83)]. The LP and RP groups behaved similarly in turning patterns, but 90% of LP patients turned spontaneously to the paretic side versus 59% of RP patients. This difference increased with turning strategies: 85% of LP versus 29% of RP patients used strategy 4 (paretic turn side with paretic limb). Patients using strategy 4 had the highest rate of falls. We propose to consider spontaneous turning strategies as new indicators to evaluate the risk of fall after stroke. IMU could be routinely used to identify this risk and guide balance rehabilitation programs.

  13. Clinical evaluation of reducing acquisition time on single-photon emission computed tomography image quality using proprietary resolution recovery software.

    Science.gov (United States)

    Aldridge, Matthew D; Waddington, Wendy W; Dickson, John C; Prakash, Vineet; Ell, Peter J; Bomanji, Jamshed B

    2013-11-01

    A three-dimensional model-based resolution recovery (RR) reconstruction algorithm that compensates for collimator-detector response, resulting in an improvement in reconstructed spatial resolution and signal-to-noise ratio of single-photon emission computed tomography (SPECT) images, was tested. The software is said to retain image quality even with reduced acquisition time. Clinically, any improvement in patient throughput without loss of quality is to be welcomed. Furthermore, future restrictions in radiotracer supplies may add value to this type of data analysis. The aims of this study were to assess improvement in image quality using the software and to evaluate the potential of performing reduced time acquisitions for bone and parathyroid SPECT applications. Data acquisition was performed using the local standard SPECT/CT protocols for 99mTc-hydroxymethylene diphosphonate bone and 99mTc-methoxyisobutylisonitrile parathyroid SPECT imaging. The principal modification applied was the acquisition of an eight-frame gated data set acquired using an ECG simulator with a fixed signal as the trigger. This had the effect of partitioning the data such that the effect of reduced time acquisitions could be assessed without conferring additional scanning time on the patient. The set of summed data sets was then independently reconstructed using the RR software to permit a blinded assessment of the effect of acquired counts upon reconstructed image quality as adjudged by three experienced observers. Data sets reconstructed with the RR software were compared with the local standard processing protocols; filtered back-projection and ordered-subset expectation-maximization. Thirty SPECT studies were assessed (20 bone and 10 parathyroid). The images reconstructed with the RR algorithm showed improved image quality for both full-time and half-time acquisitions over local current processing protocols (Pquality compared with local processing protocols and has been introduced into

  14. Poststroke Depression: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association.

    Science.gov (United States)

    Towfighi, Amytis; Ovbiagele, Bruce; El Husseini, Nada; Hackett, Maree L; Jorge, Ricardo E; Kissela, Brett M; Mitchell, Pamela H; Skolarus, Lesli E; Whooley, Mary A; Williams, Linda S

    2017-02-01

    Poststroke depression (PSD) is common, affecting approximately one third of stroke survivors at any one time after stroke. Individuals with PSD are at a higher risk for suboptimal recovery, recurrent vascular events, poor quality of life, and mortality. Although PSD is prevalent, uncertainty remains regarding predisposing risk factors and optimal strategies for prevention and treatment. This is the first scientific statement from the American Heart Association on the topic of PSD. Members of the writing group were appointed by the American Heart Association Stroke Council's Scientific Statements Oversight Committee and the American Heart Association's Manuscript Oversight Committee. Members were assigned topics relevant to their areas of expertise and reviewed appropriate literature, references to published clinical and epidemiology studies, clinical and public health guidelines, authoritative statements, and expert opinion. This multispecialty statement provides a comprehensive review of the current evidence and gaps in current knowledge of the epidemiology, pathophysiology, outcomes, management, and prevention of PSD, and provides implications for clinical practice. © 2016 American Heart Association, Inc.

  15. 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.

  16. Older Adult Stroke Survivors Discussing Post-stroke Depressive Symptoms with a Healthcare Provider: A Preliminary Analysis

    Science.gov (United States)

    Klinedinst, N. Jennifer; Clark, Patricia C.; Dunbar, Sandra B.

    2014-01-01

    Purpose The purposes of this study were to examine the relationship between the post-stroke depressive symptoms, older adult stroke survivors’ perceptions of the depressive symptoms, and the congruence with an informal caregiver about the presence of depressive symptoms, and comfort talking to the healthcare provider with whether or not older stroke survivors discussed their depressive symptoms with a healthcare provider. Method A cross-sectional study where 44 caregiver/older adult stroke survivor dyads completed questionnaires including the Center for Epidemiologic Studies Depression Scale, Symptom Perception Questionnaire, and reporting of depressive symptoms to the healthcare provider via one time interview. Results Thirty-seven percent (n=16) of all older stroke survivors reported depressive symptoms to their healthcare provider. Of the stroke survivors who had high levels of depressive symptoms (CESD≥16; n=11), seven reported the depressive symptoms to their healthcare provider. Identifying the symptoms as possible depression and attributing the cause of the depressive symptoms to the stroke were related to stroke survivors reporting the depressive symptoms to a health care provider. Conclusions High functioning, older stroke survivors may benefit from strategies to help them identify when they experience depressive symptoms, in order to be able to play an active role in their recovery by appropriately discussing their symptoms with a healthcare provider. PMID:23855380

  17. Evaluation of the United States public health service guidelines for discontinuation of anticytomegalovirus therapy after immune recovery in patients with cytomegalovirus retinitis.

    Science.gov (United States)

    Holbrook, Janet T; Colvin, Ryan; van Natta, Mark L; Thorne, Jennifer E; Bardsley, Mark; Jabs, Douglas A

    2011-10-01

    To evaluate United States Public Health Service (USPHS) guidelines for discontinuing anticytomegalovirus (CMV) therapy in patients with AIDS who have immune recovery and quiescent retinitis after initiating highly active antiretroviral therapy. Cohort study of patients with CMV retinitis (Longitudinal Study of Ocular Complications of AIDS). Participants had CMV retinitis and CD4+ T-cell counts of 50 cells/μL or fewer enrolled from 1998 through 2009 who demonstrated sustained immune recovery (2 consecutive CD4+ T-cell counts of 100 cells/μL or more at least 6 months apart) and inactive retinitis. Participants were classified into 2 groups according to anti-CMV treatment after immune recover: (1) continued anti-CMV therapy and (2) discontinued therapy. We evaluated survival, visual acuity, and CMV retinitis activity; we used propensity scores to adjust for confounding factors for these analyses. Of 152 participants reviewed, 71 demonstrated immune recovery, 37 of whom discontinued therapy and 34 of whom continued therapy. At immune recovery, participants continuing therapy tended to be older (44 vs 40 years; P = .09), have bilateral retinitis (53% vs 32%; P = .10), and have lower CD4+ T-cell counts (148 vs 207 cells/μL; P visual acuity, or incidence of bilateral retinitis). Both groups lost visual acuity during follow-up, on average 1.2 letters per year (P risk of poor outcomes. These results support the current guidelines for discontinuation of anti-CMV therapy after achievement of sustained immune recovery. Copyright © 2011 Elsevier Inc. All rights reserved.

  18. [Observation on the clinical efficacy of shoulder pain in post-stroke shoulder-hand syndrome treated with floating acupuncture and rehabilitation training].

    Science.gov (United States)

    Wang, Jun; Cui, Xiao; Ni, Huan-Huan; Huang, Chun-Shui; Zhou, Cui-Xia; Wu, Ji; Shi, Jun-Chao; Wu, Yi

    2013-04-01

    To compare the efficacy difference in the treatment of shoulder pain in post-stroke shoulder-hand syndrome among floating acupuncture, oral administration of western medicine and local fumigation of Chinese herbs. Ninety cases of post-stroke shoulder-hand syndrome (stage I) were randomized into a floating acupuncture group, a western medicine group and a local Chinese herbs fumigation group, 30 cases in each one. In the floating acupuncture group, two obvious tender points were detected on the shoulder and the site 80-100 mm inferior to each tender point was taken as the inserting point and stimulated with floating needling technique. In the western medicine group, mobic 7.5 mg was prescribed for oral administration. In the local Chinese herbs fumigation group, the formula for activating blood circulation and relaxing tendon was used for local fumigation. All the patients in three groups received rehabilitation training. The floating acupuncture, oral administration of western medicine, local Chinese herbs fumigation and rehabilitation training were given once a day respectively in corresponding group and the cases were observed for 1 month. The visual analogue scale (VAS) and Takagishi shoulder joint function assessment were adopted to evaluate the dynamic change of the patients with shoulder pain before and after treatment in three groups. The modified Barthel index was used to evaluate the dynamic change of daily life activity of the patients in three groups. With floating acupuncture, shoulder pain was relieved and the daily life activity was improved in the patients with post-stroke shoulder-hand syndrome, which was superior to the oral administration of western medicine and local Chinese herbs fumigation (P shoulder pain was superior to the oral administration of western medicine. The difference in the improvement of daily life activity was not significant statistically between the local Chinese herbs fumigation and oral administration of western medicine

  19. Decision Support System for Aquifer Recharge (AR) and Aquifer Storage and Recovery (ASR) Planning, Design, and Evaluation Decision Support System for Aquifer Recharge (AR) and Aquifer Storage and Recovery (ASR) Planning, Design, and Evaluation – Principles and Technical Basis

    Science.gov (United States)

    Aquifer recharge (AR) is a technical method being utilized to enhance groundwater resources through man-made replenishment means, such as infiltration basins and injections wells. Aquifer storage and recovery (ASR) furthers the AR techniques by withdrawal of stored groundwater at...

  20. Reliability of Two Methods for Identifying the Postural Phase of Gait Initiation in Healthy and Poststroke Subjects.

    Science.gov (United States)

    Sousa, Andreia S; Silva, Augusta; Santos, Rubim

    2015-10-01

    This study aims to compare 2 methods of assessing the postural phase of gait initiation, in regard to intrasession reliability, in healthy and poststroke subjects. As a secondary aim, this study aims to analyze anticipatory postural adjustments during gait initiation based on the center of pressure (CoP) displacements in poststroke participants. The CoP signal was acquired during gait initiation in 15 poststroke subjects and 23 healthy controls. Postural phase was identified through a baseline-based method and a maximal displacement-based method. In both healthy and poststroke participants, higher intraclass correlation coefficient and lower coefficient of variation values were obtained with the baseline-based method when compared with the maximal displacement-based method. Poststroke participants presented decreased CoP displacement backward and toward the first swing limb compared with controls when the baseline-based method was used. With the maximal displacement based method, there were differences between groups only regarding backward CoP displacement. Postural phase duration in medial-lateral direction was also increased in poststroke participants when using the maximal displacement based method. The findings obtained indicate that the baseline-based method is more reliable detecting the onset of gait initiation in both groups, while the maximal displacement-based method presents greater sensitivity for poststroke participants.

  1. Can energy expenditure be accurately assessed using accelerometry-based wearable motion detectors for physical activity monitoring in post-stroke patients in the subacute phase?

    Science.gov (United States)

    Mandigout, Stéphane; Lacroix, Justine; Ferry, Béatrice; Vuillerme, Nicolas; Compagnat, Maxence; Daviet, Jean-Christophe

    2017-12-01

    Background In the subacute stroke phase, the monitoring of ambulatory activity and activities of daily life with wearable sensors may have relevant clinical applications. Do current commercially available wearable activity trackers allow us to objectively assess the energy expenditure of these activities? The objective of the present study was to compare the energy expenditure evaluated by indirect calorimetry during the course of a scenario consisting of everyday activities while estimating the energy expenditure using several commercialised wearable sensors in post-stroke patients (less than six months since stroke). Method Twenty-four patients (age 68.2 ± 13.9; post-stroke delay 34 ± 25 days) voluntarily participated in this study. Each patient underwent a scenario of various everyday tasks (transfer, walking, etc.). During the implementation, patients wore 14 wearable sensors (Armband, Actigraph GT3X, Actical, pedometer) to obtain an estimate of the energy expenditure. The actual energy expenditure was concurrently determined by indirect calorimetry. Results Except for the Armband worn on the non-plegic side, the results of our study show a significant difference between the energy expenditure values estimated by the various sensors and the actual energy expenditure when the scenario is considered as a whole. Conclusion The present results suggest that, for a series of everyday tasks, the wearable sensors underestimate the actual energy expenditure values in post-stroke patients in the subacute phase and are therefore not accurate. Several factors are likely to confound the results: types of activity, prediction equations, the position of the sensor and the hemiplegia side.

  2. Combined rTMS and virtual reality brain-computer interface training for motor recovery after stroke.

    Science.gov (United States)

    Johnson, N N; Carey, J; Edelman, B J; Doud, A; Grande, A; Lakshminarayan, K; He, B

    2018-02-01

    Combining repetitive transcranial magnetic stimulation (rTMS) with brain-computer interface (BCI) training can address motor impairment after stroke by down-regulating exaggerated inhibition from the contralesional hemisphere and encouraging ipsilesional activation. The objective was to evaluate the efficacy of combined rTMS  +  BCI, compared to sham rTMS  +  BCI, on motor recovery after stroke in subjects with lasting motor paresis. Three stroke subjects approximately one year post-stroke participated in three weeks of combined rTMS (real or sham) and BCI, followed by three weeks of BCI alone. Behavioral and electrophysiological differences were evaluated at baseline, after three weeks, and after six weeks of treatment. Motor improvements were observed in both real rTMS  +  BCI and sham groups, but only the former showed significant alterations in inter-hemispheric inhibition in the desired direction and increased relative ipsilesional cortical activation from fMRI. In addition, significant improvements in BCI performance over time and adequate control of the virtual reality BCI paradigm were observed only in the former group. When combined, the results highlight the feasibility and efficacy of combined rTMS  +  BCI for motor recovery, demonstrated by increased ipsilesional motor activity and improvements in behavioral function for the real rTMS  +  BCI condition in particular. Our findings also demonstrate the utility of BCI training alone, as shown by behavioral improvements for the sham rTMS  +  BCI condition. This study is the first to evaluate combined rTMS and BCI training for motor rehabilitation and provides a foundation for continued work to evaluate the potential of both rTMS and virtual reality BCI training for motor recovery after stroke.

  3. Combined rTMS and virtual reality brain–computer interface training for motor recovery after stroke

    Science.gov (United States)

    Johnson, N. N.; Carey, J.; Edelman, B. J.; Doud, A.; Grande, A.; Lakshminarayan, K.; He, B.

    2018-02-01

    Objective. Combining repetitive transcranial magnetic stimulation (rTMS) with brain–computer interface (BCI) training can address motor impairment after stroke by down-regulating exaggerated inhibition from the contralesional hemisphere and encouraging ipsilesional activation. The objective was to evaluate the efficacy of combined rTMS  +  BCI, compared to sham rTMS  +  BCI, on motor recovery after stroke in subjects with lasting motor paresis. Approach. Three stroke subjects approximately one year post-stroke participated in three weeks of combined rTMS (real or sham) and BCI, followed by three weeks of BCI alone. Behavioral and electrophysiological differences were evaluated at baseline, after three weeks, and after six weeks of treatment. Main results. Motor improvements were observed in both real rTMS  +  BCI and sham groups, but only the former showed significant alterations in inter-hemispheric inhibition in the desired direction and increased relative ipsilesional cortical activation from fMRI. In addition, significant improvements in BCI performance over time and adequate control of the virtual reality BCI paradigm were observed only in the former group. Significance. When combined, the results highlight the feasibility and efficacy of combined rTMS  +  BCI for motor recovery, demonstrated by increased ipsilesional motor activity and improvements in behavioral function for the real rTMS  +  BCI condition in particular. Our findings also demonstrate the utility of BCI training alone, as shown by behavioral improvements for the sham rTMS  +  BCI condition. This study is the first to evaluate combined rTMS and BCI training for motor rehabilitation and provides a foundation for continued work to evaluate the potential of both rTMS and virtual reality BCI training for motor recovery after stroke.

  4. Evaluation of left ventricular outflow tract gradient during treadmill exercise and in recovery period in orthostatic position, in patients with hypertrophic cardiomyopathy.

    Science.gov (United States)

    Miranda, Rita; Cotrim, Carlos; Cardim, Nuno; Almeida, Sofia; Lopes, Luís; Loureiro, Maria José; Simões, Otília; Cordeiro, Pedro; Fazendas, Paula; João, Isabel; Carrageta, Manuel

    2008-05-15

    Left ventricular outflow tract obstruction is an independent predictor of adverse outcome in hypertrophic cardiomyopathy (HCM). The classical quantification of intraventricular obstruction is performed in resting conditions in supine position, but this assessment does not reflect what happens in HCM patients (pts) in their daily activities, neither during effort nor during orthostatic recovery. To assess intraventricular gradients with echocardiography during treadmill exercise and in the recovery period in upright position, in HCM pts. We studied 17 HCM pts (9 males, mean age 53 +/- 16 years, 11 with obstructive HCM). Each pt had 2 echocardiographic evaluations at rest (left lateral decubitus (LLD) and orthostatic position). The pts then underwent a treadmill exercise test and intraventricular gradients were measured at peak exercise and during recovery in orthostatic position. 3 pts with non-obstructive HCM at rest developed intraventricular gradients during exercise. 1 pt developed this gradient only during orthostatic recovery. The mean intraventricular gradient in LLD was 49 +/- 24 mmHg; in orthostatic position was 62 +/- 29 mmHg (p us to better understand the physiopathology, the symptoms and the efficacy of different therapeutic modalities in this disease and should be routinely used in the assessment of HCM pts.

  5. Lack of repercussions of sleep apnea syndrome on recovery and attention disorders at the subacute stage after stroke: a study of 45 patients.

    Science.gov (United States)

    Lefèvre-Dognin, C; Stana, L; Jousse, M; Lucas, C; Sportouch, P; Bradai, N; Guettard, E; Vicaut, E; Yelnik, A P

    2014-12-01

    Sleep apnea syndrome (SAS) frequently occurs after a stroke. Its association with a poor prognosis is open to discussion. To study, in a physical and rehabilitation medicine (PRM) unit, the possible repercussions of SAS on neurological and functional recovery as well as attentional abilities following a stroke. Forty-five patients, all of whom had recently had a stroke without previously documented SAS, were screened using the ApneaLink(®) system. An apnea-hypopnea index (AHI) score ≥10 was considered as indicative of SAS. The NIHSS, Fugl-Meyer (FM) and Functional Independence Measure (FIM) Scales were applied on admission and at two months as means of assessing neurological and functional recovery, which was expressed by the difference between the first and the second scores (delta FM, delta NIHSS, delta FIM). The Battery Attention William Lennox (BAWL) Test was given once in order to evaluate attention disorders. SAS severity was categorized according to the AHI. We compared the groups formed (mild, moderate and severe) using the same method. Twenty-eight patients (62.2%) presented AHI ≥ 10. Stroke characteristics were comparable in the SAS+ and the SAS- groups, with average post-stroke time lapse of 26 days, initial average FIM score of 71.2 points ± 26.3 and initial average NIHSS score of 8.9 ± 4.9. The demographic characteristics of the two groups were likewise comparable with the exception of age, as the SAS+ group was pronouncedly older (65.4 vs. 53.5 years). As for delta FIM, which evaluated functional recovery, it averaged 31.8 ± 20.6. Cases of SAS were found to be mild (37.1%), moderate (28.6%) or severe (34.3%). No significant difference was observed on admission or at 2 months as regards the clinical scales or the BAWL test between the two groups or according to severity, except for the NIHSS score at 2 months in the severe sub-group. This study did not demonstrate the supposed repercussions of SAS on the recovery or attentional

  6. Spasticity, Motor Recovery, and Neural Plasticity after Stroke.

    Science.gov (United States)

    Li, Sheng

    2017-01-01

    Spasticity and weakness (spastic paresis) are the primary motor impairments after stroke and impose significant challenges for treatment and patient care. Spasticity emerges and disappears in the course of complete motor recovery. Spasticity and motor recovery are both related to neural plasticity after stroke. However, the relation between the two remains poorly understood among clinicians and researchers. Recovery of strength and motor function is mainly attributed to cortical plastic reorganization in the early recovery phase, while reticulospinal (RS) hyperexcitability as a result of maladaptive plasticity, is the most plausible mechanism for poststroke spasticity. It is important to differentiate and understand that motor recovery and spasticity have different underlying mechanisms. Facilitation and modulation of neural plasticity through rehabilitative strategies, such as early interventions with repetitive goal-oriented intensive therapy, appropriate non-invasive brain stimulation, and pharmacological agents, are the keys to promote motor recovery. Individualized rehabilitation protocols could be developed to utilize or avoid the maladaptive plasticity, such as RS hyperexcitability, in the course of motor recovery. Aggressive and appropriate spasticity management with botulinum toxin therapy is an example of how to create a transient plastic state of the neuromotor system that allows motor re-learning and recovery in chronic stages.

  7. Short-Term Effects of Whole-Body Vibration Combined with Task-Related Training on Upper Extremity Function, Spasticity, and Grip Strength in Subjects with Poststroke Hemiplegia: A Pilot Randomized Controlled Trial.

    Science.gov (United States)

    Lee, Jung-Sun; Kim, Chang-Yong; Kim, Hyeong-Dong

    2016-08-01

    The aim of this study was to determine the effect of whole-body vibration training combined with task-related training on arm function, spasticity, and grip strength in subjects with poststroke hemiplegia. Forty-five subjects with poststroke were randomly allocated to 3 groups, each with 15 subjects as follows: control group, whole-body vibration group, and whole-body vibration plus task-related training group. Outcome was evaluated by clinical evaluation and measurements of the grip strength before and 4 weeks after intervention. Our results show that there was a significantly greater increase in the Fugl-Meyer scale, maximal grip strength of the affected hand, and grip strength normalized to the less affected hand in subjects undergoing the whole-body vibration training compared with the control group after the test. Furthermore, there was a significantly greater increase in the Wolf motor function test and a decrease in the modified Ashworth spasticity total scores in subjects who underwent whole-body vibration plus task-related training compared with those in the other 2 groups after the test. The findings indicate that the use of whole-body vibration training combined with task-related training has more benefits on the improvement of arm function, spasticity, and maximal grip strength than conventional upper limb training alone or with whole-body vibration in people with poststroke hemiplegia.

  8. Strategic infarct location for post-stroke cognitive impairment: A multivariate lesion-symptom mapping study.

    Science.gov (United States)

    Zhao, Lei; Biesbroek, J Matthijs; Shi, Lin; Liu, Wenyan; Kuijf, Hugo J; Chu, Winnie Wc; Abrigo, Jill M; Lee, Ryan Kl; Leung, Thomas Wh; Lau, Alexander Yl; Biessels, Geert J; Mok, Vincent; Wong, Adrian

    2017-01-01

    Lesion location is an important determinant for post-stroke cognitive impairment. Although several 'strategic' brain regions have previously been identified, a comprehensive map of strategic brain regions for post-stroke cognitive impairment is lacking due to limitations in sample size and methodology. We aimed to determine strategic brain regions for post-stroke cognitive impairment by applying multivariate lesion-symptom mapping in a large cohort of 410 acute ischemic stroke patients. Montreal Cognitive Assessment at three to six months after stroke was used to assess global cognitive functioning and cognitive domains (memory, language, attention, executive and visuospatial function). The relation between infarct location and cognition was assessed in multivariate analyses at the voxel-level and the level of regions of interest using support vector regression. These two assumption-free analyses consistently identified the left angular gyrus, left basal ganglia structures and the white matter around the left basal ganglia as strategic structures for global cognitive impairment after stroke. A strategic network involving several overlapping and domain-specific cortical and subcortical structures was identified for each of the cognitive domains. Future studies should aim to develop even more comprehensive infarct location-based models for post-stroke cognitive impairment through multicenter studies including thousands of patients.

  9. Temporal Evolution of Poststroke Cognitive Impairment Using the Montreal Cognitive Assessment

    NARCIS (Netherlands)

    Nijsse, Britta; Visser-Meily, Johanna M.A.; van Mierlo, Maria L.; Post, Marcel W. M.; de Kort, Paul. L. M.; van Heugten, Caroline M.

    Background and Purpose-The Montreal Cognitive Assessment (MoCA) is nowadays recommended for the screening of poststroke cognitive impairment. However, little is known about the temporal evolution of MoCA-assessed cognition after stroke. The objective of this study was to examine the temporal pattern

  10. Burden and factors associated with post-stroke depression in East ...

    African Journals Online (AJOL)

    Objective: To determine the burden and factors associated with post-stroke depression in East central Nigeria. Method: We carried out this cross-sectional study of 50 stroke survivors (mean age=54.8 ± 8.8 years), at the physiotherapy Department of the University of Nigeria Teaching Hospital, Enugu. Data were collected ...

  11. Post-stroke infection: a systematic review and meta-analysis

    NARCIS (Netherlands)

    Westendorp, Willeke F.; Nederkoorn, Paul J.; Vermeij, Jan-Dirk; Dijkgraaf, Marcel G.; van de Beek, Diederik

    2011-01-01

    stroke is the main cause of disability in high-income countries, and ranks second as a cause of death worldwide. Patients with acute stroke are at risk for infections, but reported post-stroke infection rates vary considerably. We performed a systematic review and meta-analysis to estimate the

  12. Psychological factors are associated with subjective cognitive complaints 2 months post-stroke

    NARCIS (Netherlands)

    Nijsse, Britta; van Heugten, Caroline M.; van Mierlo, Marloes|info:eu-repo/dai/nl/345480856; Post, Marcel W M|info:eu-repo/dai/nl/137146426; de Kort, Paul L M; Visser-Meily, Anne|info:eu-repo/dai/nl/180428047

    2017-01-01

    The aim of this study was to investigate which psychological factors are related to post-stroke subjective cognitive complaints, taking into account the influence of demographic and stroke-related characteristics, cognitive deficits and emotional problems. In this cross-sectional study, 350 patients

  13. Early clinical predictors of motor function in the upper extremity one month post-stroke.

    Science.gov (United States)

    Snickars, Jenny; Persson, Hanna C; Sunnerhagen, Katharina S

    2017-03-06

    To investigate factors within 3 days post-stroke that could predict severe impairment in motor function in the upper extremity at one month post-stroke. This cross-sectional study included 104 patients with first-ever stroke and impaired motor function in the upper extremity. Initial impairment in motor function, demographic data, type of stroke and stroke risk factors were chosen as possible predictors. Severe impairment in motor function was defined as ≤ 31p according to the Fugl-Meyer Assessment for Upper Extremity (FMA-UE). Logistic regression was used to predict severe impairment in motor function at one month post-stroke. Three possible prediction models were found, comprising stroke severity combined with grip strength and sex, finger extension or shoulder abduction. Models including grip strength or finger extension gave the most accurate predictions, with overall predictive ability 90.4% (95% confidence interval (95% CI) 0.847-0.961) and sensitivity 92.9% (95% CI 0.851-1.0) and 90.5% (95% CI 0.816-0.979), respectively. Within 3 days post-stroke, severe impairment in motor function in the upper extremity at one month can be predicted using assessment of stroke severity in combination with grip strength, finger extension or shoulder abduction. This may facilitate early planning of rehabilitation for patients with impaired upper extremity in the stroke unit.

  14. Behavior Correlates of Post-Stroke Disability Using Data Mining and Infographics.

    Science.gov (United States)

    Yoon, Sunmoo; Gutierrez, Jose

    Disability is a potential risk for stroke survivors. This study aims to identify disability risk factors associated with stroke and their relative importance and relationships from a national behavioral risk factor dataset. Data of post-stroke individuals in the U.S (n=19,603) including 397 variables were extracted from a publically available national dataset and analyzed. Data mining algorithms including C4.5 and linear regression with M5s methods were applied to build association models for post-stroke disability using Weka software. The relative importance and relationship of 70 variables associated with disability were presented in infographics for clinicians to understand easily. Fifty-five percent of post-stroke patients experience disability. Exercise, employment and satisfaction of life were relatively important factors associated with disability among stroke patients. Modifiable behavior factors strongly associated with disability include exercise (OR: 0.46, PData mining is promising to discover factors associated with post-stroke disability from a large population dataset. The findings can be potentially valuable for establishing the priorities for clinicians and researchers and for stroke patient education. The methods may generalize to other health conditions.

  15. 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.

  16. Changes in Post-Stroke Gait Biomechanics Induced by One Session of Gait Training.

    Science.gov (United States)

    Kesar, T M; Reisman, D S; Higginson, J S; Awad, L N; Binder-Macleod, S A

    2015-01-01

    The objective of this study was to determine whether one session of targeted locomotor training can induce measurable improvements in the post-stroke gait impairments. Thirteen individuals with chronic post-stroke hemiparesis participated in one locomotor training session combining fast treadmill training and functional electrical stimulation (FES) of ankle dorsi- and plantar-flexor muscles. Three dimensional gait analysis was performed to assess within-session changes (after versus before training) in gait biomechanics at the subject's self-selected speed without FES. Our results showed that one session of locomotor training resulted in significant improvements in peak anterior ground reaction force (AGRF) and AGRF integral for the paretic leg. Additionally, individual subject data showed that a majority of study participants demonstrated improvements in the primary outcome variables following the training session. This study demonstrates, for the first time, that a single session of intense, targeted post-stroke locomotor retraining can induce significant improvements in post-stroke gait biomechanics. We posit that the within-session changes induced by a single exposure to gait training can be used to predict whether an individual is responsive to a particular gait intervention, and aid with the development of individualized gait retraining strategies. Future studies are needed to determine whether these single-session improvements in biomechanics are accompanied by short-term changes in corticospinal excitability, and whether single-session responses can serve as predictors for the longer-term effects of the intervention with other targeted gait interventions.

  17. Evaluation of fisher (Pekania pennanti) restoration in Olympic National Park and the Olympic Recovery Area: 2014 annual progress report

    Science.gov (United States)

    Happe, Patricia J.; Jenkins, Kurt J.; Kay, Thomas J.; Pilgrim, Kristy L.; Schwartz, Michael K.; Lewis, Jeffrey C.; Aubry, Keith B.

    2015-01-01

    With the translocation and release of 90 fishers (Pekania pennanti) from British Columbia to Olympic National Park during 2008–2010, the National Park Service and Washington Department of Fish and Wildlife accomplished the first phase of fisher restoration in Washington State. Beginning in 2013, we initiated a new research project to determine the current status of fishers on Washington’s Olympic Peninsula 3–5 years after the releases and evaluate the short-term success of the restoration program. Objectives of the study are to determine the current distribution of fishers and proportion of the recovery area that is currently occupied by fishers, determine several genetic characteristics of the reintroduced population, and determine reproductive success of the founding animals through genetic studies. During 2014, we continued working with a broad coalition of cooperating agencies, tribes, and nongovernmental organizations (NGO) to collect data on fisher distribution and genetics using noninvasive sampling methods. The primary sampling frame consisted of 157 24-square-kilometer hexagons (hexes) distributed across all major land ownerships within the Olympic Peninsula target survey area. In 2014 we expanded the study by adding 58 more hexes to an expanded study area in response to incidental fisher observations outside of the target area obtained in 2013; 49 hexes were added south and 9 to the east of the target area. During 2014, federal, state, tribal and NGO biologists and volunteers established three baited motion-sensing camera stations, paired with hair snaring devices, in 80 hexes; 69 in the targeted area 11 in the expansion areas. Each paired camera/hair station was left in place for approximately 6 weeks, with three checks on 2-week intervals. We documented fisher presence in 5 of the 80 hexagons, and identified 5 different fishers through a combination of microsatellite DNA analyses and camera detections. All fisher detections were in the target area

  18. Evaluation of fisher (Pekania pennanti) restoration in Olympic National Park and the Olympic Recovery Area: 2015 final annual progress report

    Science.gov (United States)

    Happe, Patricia J.; Jenkins, Kurt J.; Kay, Thomas J.; Pilgrim, Kristie; Schwartz, Michael K; Lewis, Jeffrey C.; Aubry, Keith B.

    2016-01-01

    With the translocation and release of 90 fishers (Pekania pennanti) from British Columbia to Olympic National Park during 2008–2010, the National Park Service (NPS) and Washington Department of Fish and Wildlife (WDFW) accomplished the first phase of fisher restoration in Washington State. Beginning in 2013, we initiated a new research project to determine the current status of fishers on Washington’s Olympic Peninsula 3–8 years after the releases and evaluate the short-term success of the restoration program. Objectives of the study are to determine the current distribution of fishers and proportion of the recovery area that is currently occupied by fishers, determine several genetic characteristics of the reintroduced population, and determine reproductive success of the founding animals through genetic studies. During 2015, we continued working with a broad coalition of cooperating agencies, tribes, and nongovernmental organizations (NGO) to collect data on fisher distribution and genetics using noninvasive sampling methods. The primary sampling frame consisted of 157 24-km2 hexagons (hexes) distributed across all major land ownerships within the Olympic Peninsula target survey area. In 2014 we expanded the study by adding 58 more hexes to an expanded study area in response to incidental fisher observations outside of the target area obtained in 2013; 49 hexes were added south and 9 to the east of the target area. During 2015, Federal, State, Tribal and NGO biologists and volunteers established three Distributioned motion-sensing camera stations, paired with hair snaring devices, in 87 hexes; 75 in the targeted area and 12 in the expansion areas. Each paired camera/hair station was left in place for approximately 6 weeks, with three checks on 2-week intervals. We documented fisher presence in 7 of the 87 hexagons. Four fishers were identified through microsatellite DNA analyses. The 4 identified fishers included 1 of the original founding population of 90

  19. Evaluation of strength muscle recovery with isokinetic, squat jump and stiffness tests in athletes with ACL reconstruction: a case control study.

    Science.gov (United States)

    Jacopetti, Marco; Pasquini, Andrea; Costantino, Cosimo

    2016-05-06

    BackgroundThe anterior cruciate ligament (ACL) rupture accounting for about 50% of all knee ligament injuries. The rehabilitation program requires a long time to rebuild muscle strength and to reestablish joint mobility and neuromuscular control. The purpose of the study is to evaluate the muscle strength recovery in athletes with ACL reconstruction. MethodsWe enrolled soccer atlethes, with isolated anterior cruciate ligament rupture treated with bone-patellar tendon-bone autograft artroscopic reconstruction. Each patients were evaluated comparing operated and controlateral limb by isokinetic test and triaxial accelerometer test. Isokinetic movements tested were knee flexion-extension with concentric-concentric contraction. Accelerometer test were Squat Jump Test (SJT)  and Stiffness Test (ST). Results17 subjects were selected, there was no significant difference in isokinetic quadriceps and hamstrings results in strength and endurance values. Parameters of ST were comparable between the operated and unoperated side. In SJT a significant statistical difference was in height of jump (p=0,02) no statistical difference was evidenced in the other measures.ConclusionCurrently complete recovery of symmetric explosive strength seems to be an important parameter for evaluating the performance after ACL reconstruction and the symmetry in test results jump could be associated with an adequate return to sports. In our study the explosive strenght is lower in the limb operated than the healthy one. Explosive strength recovery with pliometric training should be included in the post-surgical rehabilitation protocol and its measurement should be performed to assess the full recovery before the restart of sport activities.

  20. Evaluation of a recovery-oriented care training program for mental healthcare professionals: effects on mental health consumer outcomes.

    Science.gov (United States)

    Wilrycx, Greet; Croon, Marcel; Van den Broek, Anneloes; van Nieuwenhuizen, Chijs

    2015-03-01

    To examine the effects of a recovery-oriented care training program for mental healthcare professionals on mental health consumer outcomes. The Mental Health Recovery Measure (MHRM) and the Recovery-Promoting Relationship Scale (RPRS) were administered to a sample of 142 consumers with severe mental illness. A repeated measurement design with six measurement occasions was used. Separate analyses were performed for the MHRM and RPRS subscales. Data were analyzed by means of the software package AMOS for structural equation modeling. First, the means of the five scales were computed at each measurement occasion. Next, two series of regression analyses were conducted: the first series aimed to ascertain whether gender and age have a significant effect on the MHRM and RPRS scores, and the second series aimed to detect a systematic trend in the average scale response of the MHRM and RPRS. Scores showed a significant change over time for the subscale 'Learning & new potentials' of the MHRM. Significant effects were also found for gender, with men scoring higher than women on the subscales 'Self-empowerment' and 'Learning & new potentials'. Age had no effect on the MHRM and RPRS. The scores on the RPRS showed no significant change over time. One year after completion of the recovery-oriented training program for professionals, positive results were found for two subscales of the MHRM, that is, 'Self- empowerment' and 'Learning & new potentials'. © The Author(s) 2014.

  1. The evaluation of surgical factors related to recovery period of upper lip hypoaesthesia after Le Fort I osteotomy.

    Science.gov (United States)

    Ueki, Koichiro; Hashiba, Yukari; Marukawa, Kohei; Nakagawa, Kiyomasa; Alam, Shamiul; Yamamoto, Etsuhide

    2008-10-01

    It is unclear whether surgical factors can affect the upper lip sensitivity. The aim of this study was to assess the factors that can affect the recovery period of hypoaesthesia of the upper lip after Le Fort I osteotomy, using trigeminal somatosensory evoked potential (TSEP) objectively. Twenty-nine patients with mandibular prognathism underwent Le Fort I osteotomy with and without artificial pterygoid plate fracture. Trigeminal nerve hypoaesthesia at the region of the upper lip was assessed bilaterally by the TSEP method. The distance between the infraorbital foramen and the osteotomy line (IO) or the nearest plate/screw position (IP) was measured on three-dimensional computed tomography (CT). The relationship between the recovery period in upper lip hypoaesthesia and surgical factors (these distances, movement amount, pterygoid plate fracture) were analysed statistically. The recovery period in upper lip hypoaesthesia did not significantly correlate with IO, IP and movement amount. There was no significant difference between pterygoid plate fracture group and non-fracture group. Temporary hypoaesthesia of upper lip after Le Fort I osteotomy could not be avoided, however, osteotomy line, plate/screw position and pterygoid plate fracture in Le Fort I osteotomy did not affect the recovery period of upper lip hypoaesthesia with TSEP.

  2. 42 CFR 486.344 - Condition: Evaluation and management of potential donors and organ placement and recovery.

    Science.gov (United States)

    2010-10-01

    ... recovery, and organ placement, including donation after cardiac death, if the OPO has implemented a... and blood type. (f) Donation after cardiac death. If an OPO recovers organs from donors after cardiac... potential donors are thoroughly assessed for medical suitability for organ donation and clinically managed...

  3. An evaluation of known remaining oil resources in the state of Kansas and Oklahoma. Volume 5, Project on Advanced Oil Recovery and the States

    Energy Technology Data Exchange (ETDEWEB)

    1994-11-01

    The Interstate Oil and Gas Compact Commission (IOGCC) has conducted a series of studies to evaluate the known, remaining oil resource in twenty-three (23) states. The primary objective of the IOGCC`s effort is to examine the potential impact of an aggressive and focused program of research, development, and demonstration (RD&D) and technology transfer on future oil recovery in the United States. As part of a larger effort by the IOGCC, this report focuses on the potential economic benefits of improved oil recovery in the states of Kansas, Illinois and Oklahoma for five other oil producing states and a national report have been separately published by the IOGCC. The analysis presented in this report is based on the databases and models available in the Tertiary Oil Recovery Information System (TORIS). Overall, well abandonments and more stringent environmental regulations could limit economic access to Kansas` known, remaining oil resource. The high risk of near-term abandonment and the significant benefits of future application of improved oil recovery technology, clearly point to a need for more aggressive transfer of currently available technologies to domestic oil producers. Development and application of advanced oil recovery technologies could have even greater benefits to the state and the nation. A collaborative, focused RD&D effort, integrating the resources and expertise of industry, state and local governments, and the Federal government, is clearly warranted. With effective RD&D and a program of aggressive technology transfer to widely disseminate its results, oil production could be maximized. The resulting increase in production rates, employment, operator profits, state and Federal tax revenues, and energy security will benefit both the state of Kansas, Illinois and Oklahoma and the nation as a whole.

  4. Evaluation of liquid and solid culture media for the recovery and enrichment of Burkholderia cenocepacia from distilled water.

    Science.gov (United States)

    Ahn, Youngbeom; Kim, Jeong Myeong; Ahn, Hyeri; Lee, Yong-Jin; LiPuma, John J; Hussong, David; Cerniglia, Carl E

    2014-07-01

    Burkholderia cepacia complex (BCC) presence has been the cause of recalls of both sterile and non-sterile pharmaceutical products since these opportunistic pathogens have been implicated to cause infections to susceptible individuals. BCC are ubiquitous in nature, but in pharmaceutical settings the most common source is contaminated water systems. Some strains of BCC, previously described as Pseudomonas cepacia, were not readily detected by standard culture methods. We have explored different strategies to recover and enrich Burkholderia cenocepacia previously cultured in distilled water for 40 days. Enrichment media of varied nutrient concentrations and composition were used, including modified Tryptic Soy Agar or Broth (TSA or TSB), Reasoner's 2nd Agar or Broth (R2A or R2AB), Brain-Heart Infusion Broth (BHIB), Mueller-Hinton Broth (MHB), and Ashdown's (ASH) medium. Of the various broth media tested, cell growth was significantly greater in TSB and R2AB than in BHIB, MHB, or ASH broth. TSB and R2AB were also compared for their recovery efficiency. Generally, there was no significant difference between the numbers of B. cenocepacia grown on 15 differently modified TSA and five modified R2A solid media. Overall, however, diluted TSA and TSB media, and R2A and R2AB showed better recovery efficiency than TSA and TSB for inocula containing small numbers of cells. All strains persisted in distilled water for 40 days. Broth media were more effective than solid media for recovery of B. cenocepacia from distilled water. These results may assist in improving detection assays with recovery and enrichment strategies to maximize recovery of these fastidious organisms.

  5. Cognitive impairment and memory dysfunction after a stroke diagnosis: a post-stroke memory assessment

    Directory of Open Access Journals (Sweden)

    Al-Qazzaz NK

    2014-09-01

    Full Text Available Noor Kamal Al-Qazzaz,1,5 Sawal Hamid Ali,1 Siti Anom Ahmad,2 Shabiul Islam,3 Khairiyah Mohamad41Department of Electrical, Electronic and Systems Engineering, Faculty of Engineering and Built Environment, Universiti Kebangsaan Malaysia, Bangi, Selangor, Malaysia; 2Department of Electrical and Electronic Engineering, Faculty of Engineering, Universiti Putra Malaysia, Serdang, Selangor, Malaysia; 3Institute of Microengineering and Nanoelectronics (IMEN, Universiti Kebangsaan Malaysia, Bangi, Selangor, Malaysia; 4Neurology Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Center, Cheras, Kuala Lumpur, Malaysia; 5Department of Biomedical Engineering, Al-Khwarizmi College of Engineering, Baghdad University, Baghdad, IraqAbstract: Cognitive impairment and memory dysfunction following stroke diagnosis are common symptoms that significantly affect the survivors’ quality of life. Stroke patients have a high potential to develop dementia within the first year of stroke onset. Currently, efforts are being exerted to assess stroke effects on the brain, particularly in the early stages. Numerous neuropsychological assessments are being used to evaluate and differentiate cognitive impairment and dementia following stroke. This article focuses on the role of available neuropsychological assessments in detection of dementia and memory loss after stroke. This review starts with stroke types and risk factors associated with dementia development, followed by a brief description of stroke diagnosis criteria and the effects of stroke on the brain that lead to cognitive impairment and end with memory loss. This review aims to combine available neuropsychological assessments to develop a post-stroke memory assessment (PSMA scheme based on the most recognized and available studies. The proposed PSMA is expected to assess different types of memory functionalities that are related to different parts of the brain according to stroke location. An

  6. A Randomized, Placebo-Controlled, Double-Blind Efficacy Study of Nefiracetam to Treat Poststroke Apathy.

    Science.gov (United States)

    Starkstein, Sergio E; Brockman, Simone; Hatch, Katherine K; Bruce, David G; Almeida, Osvaldo P; Davis, Wendy A; Robinson, Robert G

    2016-05-01

    To evaluate the efficacy of treatment with nefiracetam compared to placebo in poststroke apathy. A parallel group, randomized, placebo-controlled, double-blind two-center trial in patients with recent stroke and apathy was conducted in 2 tertiary teaching hospitals in Perth, Western Australia, between March 2010 and October 2014. Consenting patients hospitalized with stroke were screened for participation at the time of hospitalization and, if diagnosed with apathy 8-36 weeks later, they were randomized to 12 weeks of 900 mg/day nefiracetam or placebo. The primary efficacy parameter was change in apathy at 12 weeks defined by the 14-item Apathy Scale (AS). Of 2514 patients screened, only 377 (15%) were eligible for the study after the first screening, 233 declined further participation, and 144 were assessed for apathy at 8-36 weeks post stroke to confirm eligibility. Twenty patients out of 106 with a complete psychiatric assessment had apathy (19%). Of this sample, 13 patients were randomized. Overall, the AS score decreased by a mean of 7.0 points (95% CI = -14.6 to .6), but there was no significant between-group difference at week 12 (mean paired t-tests, P > .14). Treatment with nefiracetam did not prove to be more efficacious than placebo in ameliorating apathy in stroke. The main limitation was the very small sample randomized, highlighting the limitations of conducting drug trials for behavioral problems among stroke patients. Pharmacological studies of apathy in stroke will require a large multicenter study and a massive sample of patients. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  7. Backup & Recovery

    CERN Document Server

    Preston, W

    2009-01-01

    Packed with practical, freely available backup and recovery solutions for Unix, Linux, Windows, and Mac OS X systems -- as well as various databases -- this new guide is a complete overhaul of Unix Backup & Recovery by the same author, now revised and expanded with over 75% new material.

  8. Generalized Recovery

    DEFF Research Database (Denmark)

    Jensen, Christian Skov; Lando, David; Pedersen, Lasse Heje

    of Ross (2015). Our characterization is simple and intuitive, linking recovery to the relation between the number of time periods on the number of states. When recovery is feasible, our model is easy to implement, allowing a closed-form linearized solution. We implement our model empirically, testing...... the predictive power of the recovered expected return, crash risk, and other recovered statistics....

  9. Impaired H-Reflex Gain during Postural Loaded Locomotion in Individuals Post-Stroke.

    Directory of Open Access Journals (Sweden)

    Jing Nong Liang

    Full Text Available Successful execution of upright locomotion requires coordinated interaction between controllers for locomotion and posture. Our earlier research supported this model in the non-impaired and found impaired interaction in the post-stroke nervous system during locomotion. In this study, we sought to examine the role of the Ia afferent spinal loop, via the H-reflex response, under postural influence during a locomotor task. We tested the hypothesis that the ability to increase stretch reflex gain in response to postural loads during locomotion would be reduced post-stroke.Fifteen individuals with chronic post-stroke hemiparesis and 13 non-impaired controls pedaled on a motorized cycle ergometer with specialized backboard support system under (1 seated supported, and (2 non-seated postural-loaded conditions, generating matched pedal force outputs of two levels. H-reflexes were elicited at 90° crank angle.We observed increased H-reflex gain with postural influence in non-impaired individuals, but a lack of increase in individuals post-stroke. Furthermore, we observed decreased H-reflex gain at higher postural loads in the stroke-impaired group.These findings suggest an impaired Ia afferent pathway potentially underlies the defects in the interaction between postural and locomotor control post-stroke and may explain reduced ability of paretic limb support during locomotor weight-bearing in individuals post-stroke.These results support the judicious use of bodyweight support training when first helping individuals post-stroke to regain locomotor pattern generation and weight-bearing capability.

  10. Impact of Gender and Blood Pressure on Post-Stroke Cognitive Decline among Older Latinos

    Science.gov (United States)

    Levine, Deborah A.; Haan, Mary N.; Langa, Kenneth M.; Morgenstern, Lewis B.; Neuhaus, John; Lee, Anne; Lisabeth, Lynda D.

    2012-01-01

    Background Post-stroke cognitive decline (PSCD) is an important consequence of stroke that may be more severe in women than men. The existence of any gender differences in PSCD among Mexican Americans, and their potential mechanisms, such as blood pressure (BP), remain unknown. We assessed PSCD stratified on gender in older Mexican Americans and explored the influence of pre-stroke and post-stroke systolic BP on PSCD. Methods Among 1,576 non-demented, stroke-free adults 60 years or older when recruited in 1998–99 in the Sacramento Area Latino Study on Aging (SALSA) cohort, we examined pre-stroke and post-stroke longitudinal changes in Spanish English Verbal Learning test scores (WL), a verbal memory test, and errors on the Modified Mini Mental State Exam (3MSE) scores, a global cognition test, stratified by gender, adjusting for baseline and time-varying covariates with linear mixed-effects models. Results We identified 151 adults (mean age, 72 ± 8 years) with incident first-ever stroke during ten years of follow-up. After adjustment for age, education and time-varying depressive symptoms, 3MSE errors increased by 22%/year (95% CI, 6.8%–36.7%) in men and 13.2%/year (95% CI, 3.5%–22.9%) in women over the post-stroke period. Post-stroke WL scores improved by 0.05 words/year (95% CI, −0.24–0.33) in men and by 0.09 words/year (95% CI, −0.16–0.34) in women. Results persisted after adjustment for time-varying systolic BP. Conclusions Among this population of older Mexican Americans, PSCD did not differ by gender. We found no evidence that systolic BP influenced PSCD in women or men. PMID:22748715

  11. Pre-operative dextrose infusion to diminish Post-operative stress and recovery in elective canine ovariohysterectomy - Evaluation of a novel approach

    Directory of Open Access Journals (Sweden)

    Laiju Philip

    2010-04-01

    Full Text Available The present study was conducted to evaluate the effect preoperative dextrose infusion in promoting post operative recovery. The bitches presented for panhysterectomy were divided into two groups consisting of six each. Physiological and Haematological Parameters were estimated before and after surgery. Cortisol concentration and glucose concentration were also estimated. Sedation score and pain score were recorded from immediately after surgery up to 3rd postoperative day. A significant reduction in stress in the immediate postoperative period was noted as indicated by lowered elevation of cortisol and glucose level, and early anaesthetic recovery in animals received dextrose infusion in the preoperative period. The positive benefits in terms of improved postoperative outcome and patient well being after elective surgery recommends preoperative dextrose infusion in dogs as a general protocol in future practice in animal surgery. [Vet. World 2010; 3(2.000: 88-89

  12. Assessment of Cognitive and Neurologic Recovery in Ischemic Stroke Drug Trials: Results from a Randomized, Double-blind, Placebo-controlled Study.

    Science.gov (United States)

    Di Cesare, Franco; Mancuso, Jessica; Silver, Brian; Loudon, Peter T

    2016-01-01

    Objective. Ischemic stroke is a serious medical condition with limited therapeutic options. The evaluation of the therapeutic potential of novel pharmacological interventions is carried-out in Phase II trials. The study design, primarily intended to evaluate efficacy and safety, is a balance between utilizing as few patients as possible to minimize safety risk and enrolling sufficient patients to detect unambiguous efficacy signals. We sought to determine whether post-stroke recovery outcomes based on behavioral measures of cognitive and motor impairment yielded additional information beyond that of clinician-based methods. Design. This was a multicenter, multinational, randomized, parallel group, controlled versus placebo, efficacy, and safety study of PF-03049423 for treatment of acute ischemic stroke. Settings and participants. Our study subjects were acute ischemic stroke inpatients. Measurements. Outcome measures were derived from rating scales (Modified Rankin Scale, Barthel Index, and National Institutes of Health Stroke Scale) and behavioral tests (Box and Blocks Test, Hand Grip Strength Test, 10-Meter Walk Test, Repeatable Battery Assessment of Neuropsychological Status Naming and Coding Subtests, Line Cancellation Test, and Recognition Memory Test). Assessments were performed at Days 7, 14, 30, 60, and 90. Post-hoc analyses of correlations among the outcome measures at each measurement time point on a cohort of 137 subjects were conducted. Results. Results support the validity of measures from Box and Blocks Test, Hand Grip Strength Test, 10-Meter Walk Test, and Repeatable Battery Assessment of Neuropsychological Status Coding Subtests to monitor post-stroke recovery in clinical trial settings. Notably, the Recognition Memory Test did not show a correlation with the Modified Rankin Scale, and, in fact, did not show improvement over time. Conclusion. The behavioral measures of cognitive and motor functions included in this study may extend the evaluation

  13. The evaluation of surgical factors related to recovery period of upper lip hypoaesthesia after Le Fort I osteotomy

    OpenAIRE

    Ueki, Koichiro; Hashiba, Yukari; Marukawa, Kohei; Nakagawa, Kiyomasa; Alam, S.; Yamamoto, Etsuhide

    2008-01-01

    Purpose: It is unclear whether surgical factors can affect the upper lip sensitivity. The aim of this study was to assess the factors that can affect the recovery period of hypoaesthesia of the upper lip after Le Fort I osteotomy, using trigeminal somatosensory evoked potential (TSEP) objectively. Patients and methods: Twenty-nine patients with mandibular prognathism underwent Le Fort I osteotomy with and without artificial pterygoid plate fracture. Trigeminal nerve hypoaesthesia at the regio...

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

    National Research Council Canada - National Science Library

    Spitoni, Grazia Fernanda; Pireddu, Giorgio; Galati, Gaspare; Sulpizio, Valentina; Paolucci, Stefano; Pizzamiglio, Luigi

    2016-01-01

    .... 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...

  15. Evaluation of long-term community recovery from Hurricane Andrew: sources of assistance received by population sub-groups.

    Science.gov (United States)

    McDonnell, S; Troiano, R P; Barker, N; Noji, E; Hlady, W G; Hopkins, R

    1995-12-01

    Two three-stage cluster surveys were conducted in South Dade County, Florida, 14 months apart, to assess recovery following Hurricane Andrew. Response rates were 75 per cent and 84 per cent. Sources of assistance used in recovery from Hurricane Andrew differed according to race, per capita income, ethnicity, and education. Reports of improved living situation post-hurricane were not associated with receiving relief assistance, but reports of a worse situation were associated with loss of income, being exploited, or job loss. The number of households reporting problems with crime and community violence doubled between the two surveys. Disaster relief efforts had less impact on subjective long-term recovery than did job or income loss or housing repair difficulties. Existing sources of assistance were used more often than specific post-hurricane relief resources. The demographic make-up of a community may determine which are the most effective means to inform them after a disaster and what sources of assistance may be useful.

  16. Multistate evaluation of an ultrafiltration-based procedure for simultaneous recovery of enteric microbes in 100-liter tap water samples.

    Science.gov (United States)

    Hill, Vincent R; Kahler, Amy M; Jothikumar, Narayanan; Johnson, Trisha B; Hahn, Donghyun; Cromeans, Theresa L

    2007-07-01

    Ultrafiltration (UF) is increasingly being recognized as a potentially effective procedure for concentrating and recovering microbes from large volumes of water and treated wastewater. Because of their very small pore sizes, UF membranes are capable of simultaneously concentrating viruses, bacteria, and parasites based on size exclusion. In this study, a UF-based water sampling procedure was used to simultaneously recover representatives of these three microbial classes seeded into 100-liter samples of tap water collected from eight cities covering six hydrologic areas of the United States. The UF-based procedure included hollow-fiber UF as the primary step for concentrating microbes and then used membrane filtration for bacterial culture assays, immunomagnetic separation for parasite recovery and quantification, and centrifugal UF for secondary concentration of viruses. Water samples were tested for nine water quality parameters to investigate whether water quality data correlated with measured recovery efficiencies and molecular detection levels. Average total method recovery efficiencies were 71, 97, 120, 110, and 91% for phiX174 bacteriophage, MS2 bacteriophage, Enterococcus faecalis, Clostridium perfringens spores, and Cryptosporidium parvum oocysts, respectively. Real-time PCR and reverse transcription-PCR (RT-PCR) for seeded microbes and controls indicated that tap water quality could affect the analytical performance of molecular amplification assays, although no specific water quality parameter was found to correlate with reduced PCR or RT-PCR performance.

  17. Laboratory evaluation of airborne particulate control treatments for simulated aircraft crash recovery operations involving carbon fiber composite materials.

    Science.gov (United States)

    Ferreri, Matthew; Slagley, Jeremy; Felker, Daniel

    2015-01-01

    This study compared four treatment protocols to reduce airborne composite fiber particulates during simulated aircraft crash recovery operations. Four different treatments were applied to determine effectiveness in reducing airborne composite fiber particulates as compared to a "no treatment" protocol. Both "gold standard" gravimetric methods and real-time instruments were used to describe mass per volume concentration, particle size distribution, and surface area. The treatment protocols were applying water, wetted water, wax, or aqueous film-forming foam (AFFF) to both burnt and intact tickets of aircraft composite skin panels. The tickets were then cut using a small high-speed rotary tool to simulate crash recovery operations. Aerosol test chamber. None. Airborne particulate control treatments. Measures included concentration units of milligrams per cubic meter of air, particle size distribution as described by both count median diameter and mass median diameter and geometric standard deviation of particles in micrometers, and surface area concentration in units of square micrometers per cubic centimeter. Finally, a Monte Carlo simulation was run on the particle size distribution results. Comparison was made via one-way analysis of variance. A significant difference (pcrash recovery operations should include a treatment of the debris with water or wetted water. The resulting increase in particle size will make respiratory protection more effective in protecting the response crews.

  18. Comparative evaluation of three alternative power cycles for waste heat recovery from the exhaust of adiabatic diesel engines

    Science.gov (United States)

    Bailey, M. M.

    1985-01-01

    Three alternative power cycles were compared in application as an exhaust-gas heat-recovery system for use with advanced adiabatic diesel engines. The power cycle alternatives considered were steam Rankine, organic Rankine with RC-1 as the working fluid, and variations of an air Brayton cycle. The comparison was made in terms of fuel economy and economic payback potential for heavy-duty trucks operating in line-haul service. The results indicate that, in terms of engine rated specific fuel consumption, a diesel/alternative-power-cycle engine offers a significant improvement over the turbocompound diesel used as the baseline for comparison. The maximum imporvement resulted from the use of a Rankine cycle heat-recovery system in series with turbocompounding. The air Brayton cycle alternatives studied, which included both simple-cycle and compression-intercooled configurations, were less effective and provided about half the fuel consumption improvement of the Rankine cycle alternatives under the same conditions. Capital and maintenance cost estimates were also developed for each of the heat-recovery power cycle systems. These costs were integrated with the fuel savings to identify the time required for net annual savings to pay back the initial capital investment. The sensitivity of capital payback time to arbitrary increases in fuel price, not accompanied by corresponding hardware cost inflation, was also examined. The results indicate that a fuel price increase is required for the alternative power cycles to pay back capital within an acceptable time period.

  19. Evaluation of four virus recovery methods for detecting noroviruses on fresh lettuce, sliced ham, and frozen raspberries.

    Science.gov (United States)

    Summa, Maija; von Bonsdorff, Carl-Henrik; Maunula, Leena

    2012-08-01

    Although noroviruses play a significant role in causing foodborne illness in developed countries, no standardised method for detecting noroviruses in foodstuffs is currently available. This study compared four virus recovery methods based on ultrafiltration, immunomagnetic separation, ultracentrifugation and PEG precipitation techniques using identical real-time RT-PCR protocols for detection of RNA in eluates from lettuce, sliced ham and raspberries inoculated artificially with genogroup II norovirus. Noroviruses in all the food source matrices were successfully detected by all four methods. Ultracentrifugation yielded the highest recovery efficiencies in lettuce and ham, whereas PEG precipitation recovered the highest yield of noroviruses from raspberries. The repeatability of the results and the applicability of the methods to all food matrices were best with PEG precipitation, which had average virus recoveries of 19%, 47% and 28% for lettuce, ham and raspberries (viral RNA in dilution 1:10), respectively. In each case, a tenfold dilution of the extracted RNA clearly reduced the level of PCR inhibitors, which were released from raspberries in particular. The results of this study show that the detection of noroviruses in food is challenging, and more efforts to develop sensitive methods are still needed to detect noroviruses in food containing viruses in low numbers. Copyright © 2012 Elsevier B.V. All rights reserved.

  20. Three-dimensional phase-sensitive inversion recovery sequencing in the evaluation of left ventricular myocardial scars in ischemic and non-ischemic cardiomyopathy: Comparison to three-dimensional inversion recovery sequencing

    Energy Technology Data Exchange (ETDEWEB)

    Kido, Tomoyuki, E-mail: tomozo0421@gmail.com [Department of Radiology, Ehime University Graduate School of Medicine (Japan); Kido, Teruhito; Nakamura, Masashi; Kawaguchi, Naoto; Nishiyama, Yoshiko [Department of Radiology, Ehime University Graduate School of Medicine (Japan); Ogimoto, Akiyoshi [Department of Cardiovascular Internal Medicine, Ehime University Graduate School of Medicine (Japan); Miyagawa, Masao; Mochizuki, Teruhito [Department of Radiology, Ehime University Graduate School of Medicine (Japan)

    2014-12-15

    Highlights: • We evaluate 3D PSIR compared with 3D IR for the detection of myocardial scars. • In image quality, there was no significant difference between IR and PSIR. • A quantitative analysis of LGE volume shows a strong correlation between PSIR and IR. • PSIR detected greater LGE volume in non-ischemic cardiomyopathy patients than IR. • PSIR may have a specific role in scar evaluation of non-ischemic cardiomyopathy. - Abstract: Background: Late gadolinium enhancement (LGE) magnetic resonance imaging (MRI) is a useful technique for detecting myocardial fibrosis. LGE images are typically acquired using the inversion recovery (IR) method. Recently, phase-sensitive inversion recovery (PSIR) technology has been developed. The purpose of this study was to evaluate free-breathing 3D PSIR sequencing in comparison with breath-held 3D IR sequencing for the detection of myocardial fibrosis. Methods: One hundred twenty-three patients with suspected ischemic cardiac disease (n = 27) or non-ischemic cardiomyopathy (hypertrophic cardiomyopathy, n = 29; dilated cardiomyopathy, n = 22; sarcoidosis, n = 21; arrhythmia, n = 9; myocarditis, n = 4; amyloidosis, n = 3; and others, n = 8) were evaluated by LGE–MRI, which was performed first with the IR sequence and then with the PSIR sequence, using a 3 T MRI scanner. Image quality was scored by two independent readers using a four-point scale. The 3D LGE volume was analyzed quantitatively and compared between both sequencing methods. Results: There was no significant difference in overall image quality (p = 0.19). LGE was detected in 73 patients, who were evaluated visually. Ultimately, 58 patients with acceptable image quality were enrolled in further quantitative analyses (volume assessment). Although quantification of LGE volume revealed a strong correlation between both methods, larger LGE volumes were detected with PSIR compared to IR in patients suspected of non-ischemic cardiomyopathy (39.5 ± 25.9 cm{sup 3} for

  1. 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

    2017-01-01

    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...... and intensive PFMT programme over 3 months (12 weekly sessions). The participants randomised to the control group did not receive specific LUTS treatment. The effect was measured on the 36-Item Short Form Health Survey (SF-36) and the Nocturia Quality-of-Life (N-QoL) Questionnaire. RESULTS: The results on SF-36...... indicated significant improvement within pre- and post- test in the domains emotional role (median 77 to 100, P = 0.03) and vitality (median 65 to 70, P = 0.03) in the treatment group, but not the control group. There were no statistically significant differences between groups at pre-test, post-test or 6...

  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. Evaluation of two types of sponges used to collect cervical secretions and assessment of antibody extraction protocols for recovery of neutralizing anti-human papillomavirus type 16 antibodies.

    Science.gov (United States)

    Kemp, Troy J; Hildesheim, Allan; Falk, Roni T; Schiller, John T; Lowy, Douglas R; Rodriguez, Ana Cecilia; Pinto, Ligia A

    2008-01-01

    Immunogenicity evaluations in human papillomavirus (HPV) vaccine trials have relied on serological samples, yet cervical antibodies are likely to be most relevant for protection against infection. In order to assess functional antibody levels at the cervix, the secreted-alkaline-phosphatase neutralization assay (SEAPNA) was used to measure HPV-neutralizing activity. We assessed the variability of the SEAPNA with serum samples after vaccination with an HPV type 16 (HPV16) L1 virus-like particle vaccine and whether the SEAPNA can be used to monitor neutralizing activity at the cervix. The SEAPNA has an overall coefficient of variation of 29.3%. Recovery from ophthalmic sponges was assessed by spiking V5 (mouse anti-HPV16) antibody onto and extracting it from sterile Merocel and Ultracell sponges and sponges used to collect specimens from participants. V5 recovery from sterile Merocel sponges was complete, yet that from Ultracell sponges was null. The mean V5 recoveries from participant Ultracell and Merocel sponges were 61.2% and 93.5%, respectively, suggesting that Merocel sponges are more appropriate for specimen collection. The SEAPNA can be applied to determine the surrogates of protection and to examine the durability of protection at the cervix.

  4. Comparative evaluation of analytical procedures for the recovery of Enterobacteriaceae in coastal marine waters; Valutazione comparativa di procedure analitiche per il rilevamento di Enterobacteriaceae in acque marine costiere

    Energy Technology Data Exchange (ETDEWEB)

    Bonadonna, Lucia; Chiaretti, Gianluca; Coccia, Anna Maria; Semproni, Maurizio [Istituto Superiore di Sanita`, Rome (Italy). Lab. di Igiene Ambientale

    1997-03-01

    The use of quick and reliable procedures is fundamental for water quality evaluation control. In order to improve the analytical methods for microbiological examination of bathing waters, a comparison of different substrates for the recovery of Enterobacteriaceae from coastal marine waters was carried out. The medium indicated in the Italian technical normative has shown a good selectivity when the red colonies with a green metallic surface sheen were counted, as stated in the Standard Methods. On the other hand, the chronogenic substrate used in this study resulted easy to read, selective and specific for both Escherichia coli and total coliforms.

  5. Evaluation of Possible Prognostic Factors of Fulminant Acute Disseminated Encephalomyelitis (ADEM) on Magnetic Resonance Imaging with Fluid-Attenuated Inversion Recovery (FLAIR) and Diffusion-Weighted Imaging

    Energy Technology Data Exchange (ETDEWEB)

    Donmez, F.Y.; Aslan, H.; Coskun, M. (Dept. of Radiology, Faculty of Medicine, Baskent Univ., Ankara (Turkey))

    2009-04-15

    Background: Acute disseminated encephalomyelitis (ADEM) may be a rapidly progressive disease with different clinical outcomes. Purpose: To investigate the radiological findings of fulminant ADEM on diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) images, and to correlate these findings with clinical outcome. Material and Methods: Initial and follow-up magnetic resonance imaging (MRI) scans in eight patients were retrospectively evaluated for distribution of lesions on FLAIR images and presence of hemorrhage or contrast enhancement. DWI of the patients was evaluated as to cytotoxic versus vasogenic edema. The clinical records were analyzed, and MRI results and clinical outcome were correlated. Results: Four of the eight patients died, three had full recovery, and one had residual cortical blindness. The distribution of the hyperintense lesions on FLAIR sequence was as follows: frontal (37.5%), parietal (50%), temporal (37.5%), occipital (62.5%), basal ganglia (50%), pons (37.5%), mesencephalon (37.5%), and cerebellum (50%). Three of the patients who died had brainstem involvement. Two patients had a cytotoxic edema, one of whom died, and the other developed cortical blindness. Six patients had vasogenic edema: three of these patients had a rapid progression to coma and died; three of them recovered. Conclusion: DWI is not always helpful for evaluating the evolution or predicting the outcome of ADEM. However, extension of the lesions, particularly brainstem involvement, may have an influence on the prognosis.

  6. An Empirical Model for Carbon Recovery in a Rotating Belt Filter and Its Application in the Frame of Plantwide Evaluation

    DEFF Research Database (Denmark)

    Behera, Chitta Ranjan; Daynouri-Pancino, Farnaz; Santoro, Domenico

    2017-01-01

    performance to maximize plant-wide benefits when retrofitted in existing wastewater treatment plants (WWTPs). Thus, a rigorous plant-wide study is required to interpret the deeper influence of an RBF on the major downstream units (such as activated sludge tanks, sludge digester, etc.). This study emphasizes...... and nutrient recovery in comparison to a conventional PC. Moreover, it is also believed that the RBF can fractionate carbon (enrichment of cellulose, namely toilet paper) based on particulate size, more efficiently than a PC. It is, therefore, necessary to understand and quantify the uniqueness of the RBF...

  7. Assessment of agreement among diplomates of the American College of Veterinary Anesthesia and Analgesia for scoring the recovery of horses from anesthesia by use of subjective grading scales and development of a system for evaluation of the recovery of horses from anesthesia by use of accelerometry.

    Science.gov (United States)

    Clark-Price, Stuart C; Lascola, Kara M; Carter, Jennifer E; da Cunha, Anderson F; Donaldson, Lydia L; Doherty, Thomas J; Martin-Flores, Manuel; Hofmeister, Erik H; Keating, Stephanie C J; Mama, Khursheed R; Mason, Diane E; Posner, Lysa P; Sano, Hiroki; Seddighi, Reza; Shih, Andre C; Weil, Ann B; Schaeffer, David J

    2017-06-01

    OBJECTIVE To evaluate agreement among diplomates of the American College of Veterinary Anesthesia and Analgesia for scores determined by use of a simple descriptive scale (SDS) or a composite grading scale (CGS) for quality of recovery of horses from anesthesia and to investigate use of 3-axis accelerometry (3AA) for objective evaluation of recovery. ANIMALS 12 healthy adult horses. PROCEDURES Horses were fitted with a 3AA device and then were anesthetized. Eight diplomates evaluated recovery by use of an SDS, and 7 other diplomates evaluated recovery by use of a CGS. Agreement was tested with κ and AC1 statistics for the SDS and an ANOVA for the CGS. A library of mathematical models was used to map 3AA data against CGS scores. RESULTS Agreement among diplomates using the SDS was slight (κ = 0.19; AC1 = 0.22). The CGS scores differed significantly among diplomates. Best fit of 3AA data against CGS scores yielded the following equation: RS = 9.998 × SG0.633 × ∑UG0.174, where RS is a horse's recovery score determined with 3AA, SG is acceleration of the successful attempt to stand, and ∑UG is the sum of accelerations of unsuccessful attempts to stand. CONCLUSIONS AND CLINICAL RELEVANCE Subjective scoring of recovery of horses from anesthesia resulted in poor agreement among diplomates. Subjective scoring may lead to differences in conclusions about recovery quality; thus, there is a need for an objective scoring method. The 3AA system removed subjective bias in evaluations of recovery of horses and warrants further study.

  8. 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.

  9. Disaster Debris Recovery Database - Recovery

    Data.gov (United States)

    U.S. Environmental Protection Agency — The US EPA Region 5 Disaster Debris Recovery Database includes public datasets of over 6,000 composting facilities, demolition contractors, transfer stations,...

  10. Hydrologic and Geochemical Evaluation of Aquifer Storage Recovery in the Santee Limestone/Black Mingo Aquifer, Charleston, South Carolina, 1998-2002

    Science.gov (United States)

    Petkewich, Matthew D.; Parkhurst, David L.; Conlon, Kevin J.; Campbell, Bruce G.; Mirecki, June E.

    2004-01-01

    The hydrologic and geochemical effects of aquifer storage recovery were evaluated to determine the potential for supplying the city of Charleston, South Carolina, with large quantities of potable water during emergencies, such as earthquakes, hurricanes, or hard freezes. An aquifer storage recovery system, including a production well and three observation wells, was installed at a site located on the Charleston peninsula. The focus of this study was the 23.2-meter thick Tertiary-age carbonate and sand aquifer of the Santee Limestone and the Black Mingo Group, the northernmost equivalent of the Floridan aquifer system. Four cycles of injection, storage, and recovery were conducted between October 1999 and February 2002. Each cycle consisted of injecting between 6.90 and 7.19 million liters of water for storage periods of 1, 3, or 6 months. The volume of recovered water that did not exceed the U.S. Environmental Protection Agency secondary standard for chloride (250 milligrams per liter) varied from 1.48 to 2.46 million liters, which is equivalent to 21 and 34 percent of the total volume injected for the individual tests. Aquifer storage recovery testing occurred within two productive zones of the brackish Santee Limestone/Black Mingo aquifer. The individual productive zones were determined to be approximately 2 to 4 meters thick, based on borehole geophysical logs, electromagnetic flow-meter testing, and specific-conductance profiles collected within the observation wells. A transmissivity and storage coefficient of 37 meters squared per day and 3 x 10-5, respectively, were determined for the Santee Limestone/Black Mingo aquifer. Water-quality and sediment samples collected during this investigation documented baseline aquifer and injected water quality, aquifer matrix composition, and changes in injected/aquifer water quality during injection, storage, and recovery. A total of 193 water-quality samples were collected and analyzed for physical properties, major and

  11. A double-blind, placebo-controlled, randomized phase II pilot study to investigate the potential efficacy of the traditional chinese medicine Neuroaid (MLC 601) in enhancing recovery after stroke (TIERS).

    Science.gov (United States)

    Kong, Keng He; Wee, Seng Kwee; Ng, Chwee Yin; Chua, Karen; Chan, Kay Fei; Venketasubramanian, N; Chen, Christopher

    2009-01-01

    Previous clinical studies have shown that Neuroaid (MLC 601) may be beneficial in post-stroke rehabilitation. Our aim was to investigate the efficacy of Neuroaid on motor recovery in ischemic stroke patients using rehabilitation endpoints in accordance with the International Conference on Harmonization/Good Clinical Practice guidelines, in order to provide predictive information for further larger trials. This is a phase II double-blind, placebo-controlled pilot study of 40 subjects admitted with a recent (less than 1 month) ischemic stroke. All subjects were given either Neuroaid or placebo, 4 capsules 3 times a day for 4 weeks. Fugl-Meyer Assessment (FMA), National Institutes of Health Stroke Scale and Functional Independence Measure scores were measured at initiation of the treatment, and at 4 and 8 weeks. None of the outcomes was statistically significant between the two groups. However, FMA scores showed a positive trend for improvement with Neuroaid treatment over time. Subgroup analysis of subjects with posterior circulation infarction and severe stroke both showed a tendency for better recovery. Some positive trends were observed in the Neuroaid group. A larger multicenter trial focusing on severe stroke patients is needed to better evaluate the role of Neuroaid in aiding stroke recovery in rehabilitation. Copyright 2009 S. Karger AG, Basel.

  12. Using virtual reality to improve walking post-stroke: translation to individuals with diabetes.

    Science.gov (United States)

    Deutsch, Judith E

    2011-03-01

    Use of virtual reality (VR) technology to improve walking for people post-stroke has been studied for its clinical application since 2004. The hardware and software used to create these systems has varied but has predominantly been constituted by projected environments with users walking on treadmills. Transfer of training from the virtual environment to real-world walking has modest but positive research support. Translation of the research findings to clinical practice has been hampered by commercial availability and costs of the VR systems. Suggestions for how the work for individuals post-stroke might be applied and adapted for individuals with diabetes and other impaired ambulatory conditions include involvement of the target user groups (both practitioners and clients) early in the design and integration of activity and education into the systems. © 2011 Diabetes Technology Society.

  13. The effects of music listening interventions on cognition and mood post-stroke: a systematic review.

    Science.gov (United States)

    Baylan, Satu; Swann-Price, Rhiannon; Peryer, Guy; Quinn, Terry

    2016-11-01

    Music listening may have beneficial psychological effects but there has been no comprehensive synthesis of the available data describing efficacy of music listening in stroke. Areas covered: We performed a systematic review examining the effects of music listening interventions on cognition and mood post-stroke. We found five published trials (n = 169 participants) and four ongoing trials. All studies demonstrated benefits of music listening on at least one measure of cognition or mood. Heterogeneity precluded meta-analysis and all included studies had potential risk of bias. Common reporting or methodological issues including lack of blinding, lack of detail on the intervention and safety reporting. Expert commentary: It is too early to recommend music listening as routine treatment post-stroke, available studies have been under-powered and at risk of bias. Accepting these caveats, music listening may have beneficial effects on both mood and cognition and we await the results of ongoing controlled studies.

  14. Neck proprioceptive training for balance function in patients with chronic poststroke hemiparesis: a case series.

    Science.gov (United States)

    Kim, Gyoung-Mo; Oh, Duck-Won

    2014-10-01

    [Purpose] This study investigated the effects of neck proprioceptive training on the balance of patients with chronic poststroke hemiparesis. [Subjects] Three patients with chronic stroke were recruited for this study. [Methods] The subjects underwent neck proprioceptive training using the red light of a laser pointer (30 min daily, five times per week for 4 weeks). Outcome measures included the stability and weight distribution indices measured with a Tetrax system and Timed Up and Go (TUG) and proprioception tests. [Results] For all subjects, the stability and weight distribution indices increased by 1.87-9.66% in the eyes-open and eyes-closed conditions, and the TUG and proprioception test scores improved by 2.49-15.27%. [Conclusion] Neck proprioceptive training may be a good option for improving the balance function of