Physical fitness in persons with hemiparetic stroke: its structure and longitudinal changes during an inpatient rehabilitation programme.

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Tsuji, Tetsuya; Liu, Meigen; Hase, Kimitaka; Masakado, Yoshihisa; Takahashi, Hidetoshi; Hara, Yukihiro; Chino, Naoichi

2004-06-01

To test the hypothesis that the structure of fitness in patients with hemiparetic stroke can be categorized into impairment/disability, cardiopulmonary, muscular and metabolic domains, and to study longitudinal changes in their fitness during an inpatient rehabilitation programme. Structure analysis of multiple fitness parameters with principal component analysis (PCA), and a before and after trial. Tertiary rehabilitation centre in Japan. One hundred and seven consecutive inpatients with hemiparetic stroke. A conventional stroke rehabilitation programme consisting of 80 minutes of physical therapy and occupational therapy sessions five days a week, and daily rehabilitation nursing for a median duration of 105.5 days. Principal component scores extracted from measurement of paresis/daily living (the Stroke Impairment Assessment Set (SIAS) and the Functional Independence Measure (FIM)); muscular (grip strength (GS), knee extensor torque, and cross-sectional areas of thigh muscles); metabolic (body mass index (BMI) and fat accumulation on CT); cardiopulmonary (heart rate oxygen coefficient (HR-O2-Coeff) obtained with a graded bridging activity and a 12-minute propulsion distance). PCA categorized the original 15 variables into four factors corresponding to paresis/activities of daily living, muscular, metabolic and cardiopulmonary domains, and explained 78.1% of the total variance at admission and 69.6% at discharge. Except the metabolic domain, PCA scores for the other three domains improved significantly at discharge (paired t-test, p < 0.05). The hypothetical structure of fitness was confirmed, and the PCA scores were useful in following longitudinal changes of fitness during inpatient rehabilitation.

Assessment of test-retest reliability and internal consistency of the Wisconsin Gait Scale in hemiparetic post-stroke patients

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Guzik Agnieszka

2016-09-01

Full Text Available Introduction: A proper assessment of gait pattern is a significant aspect in planning the process of teaching gait in hemiparetic post-stroke patients. The Wisconsin Gait Scale (WGS is an observational tool for assessing post-stroke patients’ gait. The aim of the study was to assess test-retest reliability and internal consistency of the WGS and examine correlations between gait assessment made with the WGS and gait speed, Brunnström scale, Ashworth’s scale and the Barthel Index.

Muscle and reflex changes with varying joint angle in hemiparetic stroke

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Alibiglou Laila

2008-02-01

Full Text Available Abstract Background Despite intensive investigation, the origins of the neuromuscular abnormalities associated with spasticity are not well understood. In particular, the mechanical properties induced by stretch reflex activity have been especially difficult to study because of a lack of accurate tools separating reflex torque from torque generated by musculo-tendinous structures. The present study addresses this deficit by characterizing the contribution of neural and muscular components to the abnormally high stiffness of the spastic joint. Methods Using system identification techniques, we characterized the neuromuscular abnormalities associated with spasticity of ankle muscles in chronic hemiparetic stroke survivors. In particular, we systematically tracked changes in muscle mechanical properties and in stretch reflex activity during changes in ankle joint angle. Modulation of mechanical properties was assessed by applying perturbations at different initial angles, over the entire range of motion (ROM. Experiments were performed on both paretic and non-paretic sides of stroke survivors, and in healthy controls. Results Both reflex and intrinsic muscle stiffnesses were significantly greater in the spastic/paretic ankle than on the non-paretic side, and these changes were strongly position dependent. The major reflex contributions were observed over the central portion of the angular range, while the intrinsic contributions were most pronounced with the ankle in the dorsiflexed position. Conclusion In spastic ankle muscles, the abnormalities in intrinsic and reflex components of joint torque varied systematically with changing position over the full angular range of motion, indicating that clinical perceptions of increased tone may have quite different origins depending upon the angle where the tests are initiated. Furthermore, reflex stiffness was considerably larger in the non-paretic limb of stroke patients than in healthy control subjects

Altered Neuromodulatory Drive May Contribute to Exaggerated Tonic Vibration Reflexes in Chronic Hemiparetic Stroke

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Jacob G. McPherson

2018-04-01

Full Text Available Exaggerated stretch-sensitive reflexes are a common finding in elbow flexors of the contralesional arm in chronic hemiparetic stroke, particularly when muscles are not voluntarily activated prior to stretch. Previous investigations have suggested that this exaggeration could arise either from an abnormal tonic ionotropic drive to motoneuron pools innervating the paretic limbs, which could bring additional motor units near firing threshold, or from an increased influence of descending monoaminergic neuromodulatory pathways, which could depolarize motoneurons and amplify their responses to synaptic inputs. However, previous investigations have been unable to differentiate between these explanations, leaving the source(s of this excitability increase unclear. Here, we used tonic vibration reflexes (TVRs during voluntary muscle contractions of increasing magnitude to infer the sources of spinal motor excitability in individuals with chronic hemiparetic stroke. We show that when the paretic and non-paretic elbow flexors are preactivated to the same percentage of maximum prior to vibration, TVRs remain significantly elevated in the paretic arm. We also show that the rate of vibration-induced torque development increases as a function of increasing preactivation in the paretic limb, even though the amplitude of vibration-induced torque remains conspicuously unchanged as preactivation increases. It is highly unlikely that these findings could be explained by a source that is either purely ionotropic or purely neuromodulatory, because matching preactivation should control for the effects of a potential ionotropic drive (and lead to comparable tonic vibration reflex responses between limbs, while a purely monoaminergic mechanism would increase reflex magnitude as a function of preactivation. Thus, our results suggest that increased excitability of motor pools innervating the paretic limb post-stroke is likely to arise from both ionotropic and

Gait pattern of severely disabled hemiparetic subjects on a new controlled gait trainer as compared to assisted treadmill walking with partial body weight support.

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Hesse, S; Uhlenbrock, D; Sarkodie-Gyan, T

1999-10-01

To investigate to what extent and with how much therapeutic effort nonambulatory stroke patients could train a gait-like movement on a newly developed, machine-supported gait trainer. Open study comparing the movement on the gait trainer with assisted walking on the treadmill. Motion analysis laboratory of a rehabilitation centre. Fourteen chronic, nonambulatory hemiparetic patients. Complex gait analysis while training on the gait trainer and while walking on the treadmill. Gait kinematics, kinesiological EMG of several lower limb muscles and the required assistance. Patients could train a gait-like movement on the gait trainer, characterized kinematically by a perfect symmetry, larger hip extension during stance, less knee flexion and less ankle plantar flexion during swing as compared to treadmill walking (p gait trainer (p gait trainer offered severely disabled hemiparetic subjects the possibility of training a gait-like, highly symmetrical movement with a favourable facilitation of relevant anti-gravity muscles. At the same time, the effort required of the therapists was reduced.

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

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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.

Use of hippotherapy in gait training for hemiparetic post-stroke

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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.

The ankle-foot orthosis improves balance and reduces fall risk of chronic spastic hemiparetic patients.

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Cakar, E; Durmus, O; Tekin, L; Dincer, U; Kiralp, M Z

2010-09-01

Ankle foot orthoses (AFO) are commonly used orthotic device in order to restore the ankle foot function and to improve the balance and gait in post-stroke hemiparetic patients. However, there remain some discussions about their effectiveness on long term hemiparetic patients who had mild to moderate spasticity. To investigate the relative effect of prefabricated thermoplastic posterior leaf spring AFO (PLS-AFO) on balance and fall risk. A cross-over interventional study The Department of PMR of a tertiary hospital. Twenty-five chronic post-stroke long duration hemiparetic patients who had Ashworth grade 1-2 spasticity at affected calf muscles and lower limb Brunnstrom stage 2-3 and also able to walk independently without an assistive device. Berg Balance Scale (BERG), and the postural stability test (PST) and the fall risk test (FRT) of Biodex balance systems were used for the assessments. All of the patients were assessed with AFO and without AFO. All assessments were made with footwear. The mean post-stroke duration was 20,32±7,46 months. The BERG scores were 42,12±9,05 without AFO and 47,52±7,77 with AFO; the overall stability scores of FRT were 3,35±1,97 without AFO and 2,69±1,65 with AFO (Pbalance and provide fall risk reduction in chronic post-stroke ambulatory hemiparetic patients who had mild to moderate spasticity on their affected lower limb. These results encourage the usage of AFO on long duration hemiparetic patients in order to provide better balance and lesser fall risk.

[Cyclic movement training versus conventional physiotherapy for rehabilitation of hemiparetic gait after stroke: a pilot study].

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Podubecka, J; Scheer, S; Theilig, S; Wiederer, R; Oberhoffer, R; Nowak, D A

2011-07-01

Recovery of impaired motor functions following stroke is commonly incomplete in spite of intensive rehabilitation programmes. At 6 months following a stroke up to 60 % of affected individuals still suffer from permanent motor deficits, in particular hemiparetic gait, that are relevant for daily life. Novel innovative therapeutic strategies are needed to enhance the recovery of impaired gait function following stroke. This pilot study has investigated the effectiveness of conventional physiotherapy in comparison to an apparative cyclic movement training over a period of 4 weeks to improve (i) power during a submaximal cyclic movement training of the lower limbs, (ii) cardiac fitness, (iii) balance and gait ability, and (iv) quality of life in stroke patients. In comparison to physiotherapy apparative cyclic movement training improved power, balance, cardiac fitness and quality of life to a greater extent. However, there was a statistically significant difference between both intervention groups only for balance but not for the other parameters assessed. The present pilot study should inspire future research with larger patient cohorts to allow appropriate judgement on the effectiveness of apparative cyclic movement training in stroke rehabilitation. © Georg Thieme Verlag KG Stuttgart · New York.

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

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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.

Evaluating the effects of delivering integrated kinesthetic and tactile cues to individuals with unilateral hemiparetic stroke during overground walking.

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Afzal, Muhammad Raheel; Pyo, Sanghun; Oh, Min-Kyun; Park, Young Sook; Yoon, Jungwon

2018-04-16

Integration of kinesthetic and tactile cues for application to post-stroke gait rehabilitation is a novel concept which needs to be explored. The combined provision of haptic cues may result in collective improvement of gait parameters such as symmetry, balance and muscle activation patterns. Our proposed integrated cue system can offer a cost-effective and voluntary gait training experience for rehabilitation of subjects with unilateral hemiparetic stroke. Ten post-stroke ambulatory subjects participated in a 10 m walking trial while utilizing the haptic cues (either alone or integrated application), at their preferred and increased gait speeds. In the system a haptic cane device (HCD) provided kinesthetic perception and a vibrotactile feedback device (VFD) provided tactile cue on the paretic leg for gait modification. Balance, gait symmetry and muscle activity were analyzed to identify the benefits of utilizing the proposed system. When using kinesthetic cues, either alone or integrated with a tactile cue, an increase in the percentage of non-paretic peak activity in the paretic muscles was observed at the preferred gait speed (vastus medialis obliquus: p kinesthetic cue, at their preferred gait speed (p <  0.001, partial η 2  = 0.702). When combining haptic cues, the subjects walked at their preferred gait speed with increased temporal stance symmetry and paretic muscle activity affecting their balance. Similar improvements were observed at higher gait speeds. The efficacy of the proposed system is influenced by gait speed. Improvements were observed at a 20% increased gait speed, whereas, a plateau effect was observed at a 40% increased gait speed. These results imply that integration of haptic cues may benefit post-stroke gait rehabilitation by inducing simultaneous improvements in gait symmetry and muscle activity.

Musical motor feedback (MMF) in walking hemiparetic stroke patients: randomized trials of gait improvement.

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Schauer, Michael; Mauritz, Karl-Heinz

2003-11-01

To demonstrate the effect of rhythmical auditory stimulation in a musical context for gait therapy in hemiparetic stroke patients, when the stimulation is played back measure by measure initiated by the patient's heel-strikes (musical motor feedback). Does this type of musical feedback improve walking more than a less specific gait therapy? The randomized controlled trial considered 23 registered stroke patients. Two groups were created by randomization: the control group received 15 sessions of conventional gait therapy and the test group received 15 therapy sessions with musical motor feedback. Inpatient rehabilitation hospital. Median post-stroke interval was 44 days and the patients were able to walk without technical aids with a speed of approximately 0.71 m/s. Gait velocity, step duration, gait symmetry, stride length and foot rollover path length (heel-on-toe-off distance). The test group showed more mean improvement than the control group: stride length increased by 18% versus 0%, symmetry deviation decreased by 58% versus 20%, walking speed increased by 27% versus 4% and rollover path length increased by 28% versus 11%. Musical motor feedback improves the stroke patient's walk in selected parameters more than conventional gait therapy. A fixed memory in the patient's mind about the song and its timing may stimulate the improvement of gait even without the presence of an external pacemaker.

Effect of infrared-C radiation on skin temperature, electrodermal conductance and pain in hemiparetic stroke patients.

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Lin, Chun-Chih; Chiang, Yong-Shun; Lung, Chia-Chi

2015-01-01

A novel application of infrared-C (IR-C) radiation (3-1000 μm) on hemiparetic stroke patients was evaluated. Hot compresses (HC) were used on the paretic shoulders of patients in this placebo-controlled trial to investigate the effects of IR-C on skin temperature, electrodermal conductance (EC) and pain relief. Skin temperature at the center of the middle deltoid (CMD), Quchi (LI11), and the center of the third metacarpal bone on dorsum of hand (COT) of the subjects at Brunnstrom stage 3-5 before and after IR-C HC, were examined. Meanwhile, EC was measured on Hegu (LI4), Quchi and Juanyu (LI15). Pain intensity was evaluated before and after treatment. Skin temperature increased significantly at the CMD and COT on the paretic side in males. In females after treatment, similar skin temperatures were found in each measured region on both the paretic and non-paretic sides. The EC on the paretic side tended to be higher than the non-paretic side before treatment. After treatment, the EC on paretic side declined in both sexes and became even lower than the non-paretic side in females. Pain intensity was lessened after treatment especially in males, which appeared to correspond with an increase in skin temperature and a decrease in EC. IR-C hot compress is a promising method for stroke patients in rehabilitation. Physiological mechanisms of this treatment were proposed and summarized from this research.

Effects of Innovative WALKBOT Robotic-Assisted Locomotor Training on Balance and Gait Recovery in Hemiparetic Stroke: A Prospective, Randomized, Experimenter Blinded Case Control Study With a Four-Week Follow-Up.

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Kim, Soo-Yeon; Yang, Li; Park, In Jae; Kim, Eun Joo; JoshuaPark, Min Su; You, Sung Hyun; Kim, Yun-Hee; Ko, Hyun-Yoon; Shin, Yong-Il

2015-07-01

The present clinical investigation was to ascertain whether the effects of WALKBOT-assisted locomotor training (WLT) on balance, gait, and motor recovery were superior or similar to the conventional locomotor training (CLT) in patients with hemiparetic stroke. Thirty individuals with hemiparetic stroke were randomly assigned to either WLT or CLT. WLT emphasized on a progressive, conventional locomotor retraining practice (40 min) combined with the WALKBOT-assisted, haptic guidance and random variable locomotor training (40 min) whereas CLT involved conventional physical therapy alone (80 min). Both intervention dosages were standardized and provided for 80 min, five days/week for four weeks. Clinical outcomes included function ambulation category (FAC), Berg balance scale (BBS), Korean modified Barthel index (K-MBI), modified Ashworth scale (MAS), and EuroQol-5 dimension (EQ-5D) before and after the four-week program as well as at follow-up four weeks after the intervention. Two-way repeated measure ANOVA showed significant interaction effect (time × group) for FAC (p=0.02), BBS (p=0.03) , and K-MBI (p=0.00) across the pre-training, post-training, and follow-up tests, indicating that WLT was more beneficial for balance, gait and daily activity function than CLT alone. However, no significant difference in other variables was observed. This is the first clinical trial that highlights the superior, augmented effects of the WALKBOT-assisted locomotor training on balance, gait and motor recovery when compared to the conventional locomotor training alone in patients with hemiparetic stroke.

Taping of the elbow extensor muscle in chronic stroke patients: comparison between before and after three-dimensional motion analysis

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Lee, Dong-Hun; Kim, Won-Jin; Oh, Jae-Seop; Chang, Moonyoung

2015-01-01

[Purpose] This study aimed to observe the effect of kinesio taping on the quality of movement of each arm during a reaching task in patients with right-sided hemiparetic stroke. [Subjects and Methods] Sixteen right-handed participants who had had a right-sided hemiparetic stroke were requested to perform a reaching task with each arm, with and without kinesio taping. A three-dimensional motion analysis system was used to measure peak angular velocity, time to reach peak angular velocity, and ...

The effects of physical therapy on exaggerated muscle tonicity, balance and quality of life on hemiparetic patients due to stroke

International Nuclear Information System (INIS)

Hoseinabadi, M.R.; Taheri, H.R.; Keavanloo, F.

2013-01-01

Objective: To determine the effects of physical therapy on balance, exaggerated muscle tonicity and quality of life on patients with hemiparesis. Methods: This quasi-experimental study was conducted in 2011 among male hemiparetic patients secondary to stroke, at a physiotherapy centre in Neyshabur, Iran. Twenty-four patients were randomly assigned to two equal groups representing the cases and the controls. The cases were assigned to do the practical protocol for 4 weeks. To collect the data, Berg Balance Scaling, Modified Ashworth Scale, Barthel Activities of Daily Living Index and demographic questionnaires were used. Paired and un-paired t-tests were used to analyse data. All analyses were done on SPSS 16. Results: The two groups were similar before intervention. Post-test analysis showed that the average balance and quality of life significantly improved (p<0.001) among the cases, and the quadriceps muscle tonicity decreased (p<0.001). Among the controls, there was no significant change between pre-test and post-test readings. Conclusions: Physical therapy can enhance balance and quality of life of hemiparetic patients and reduces their exaggerated muscle tonicity. (author)

Motor unit properties of biceps brachii in chronic stroke patients assessed with high-density surface EMG

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Kallenberg, L.A.C.; Hermens, Hermanus J.

2009-01-01

The aim of this study was to investigate motor unit (MU) characteristics of the biceps brachii in post-stroke patients, using high-density surface electromyography (sEMG). Eighteen chronic hemiparetic stroke patients took part. The Fugl-Meyer score for the upper extremity was assessed. Subjects

Upper Extremity Motor Impairments and Microstructural Changes in Bulbospinal Pathways in Chronic Hemiparetic Stroke

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Meriel Owen

2017-06-01

Full Text Available Following hemiparetic stroke, precise, individuated control of single joints is often replaced by highly stereotyped patterns of multi-joint movement, or abnormal limb synergies, which can negatively impact functional use of the paretic arm. One hypothesis for the expression of these synergies is an increased dependence on bulbospinal pathways such as the rubrospinal (RubST tract and especially the reticulospinal (RetST tracts, which co-activate multiple muscles of the shoulder, elbow, wrist, and fingers. Despite indirect evidence supporting this hypothesis in humans poststroke, it still remains unclear whether it is correct. Therefore, we used high-resolution diffusion tensor imaging (DTI to quantify white matter microstructure in relation to severity of arm synergy and hand-related motor impairments. DTI was performed on 19 moderately to severely impaired chronic stroke individuals and 15 healthy, age-matched controls. In stroke individuals, compared to controls, there was significantly decreased fractional anisotropy (FA and significantly increased axial and radial diffusivity in bilateral corona radiata and body of the corpus callosum. Furthermore, poststroke, the contralesional (CL RetST FA correlated significantly with both upper extremity (UE synergy severity (r = −0.606, p = 0.003 and hand impairment (r = −0.609, p = 0.003. FA in the ipsilesional RubST significantly correlated with hand impairment severity (r = −0.590, p = 0.004. For the first time, we separately evaluate RetST and RubST microstructure in chronic stroke individuals with UE motor impairment. We demonstrate that individuals with the greatest UE synergy severity and hand impairments poststroke have the highest FA in the CL RetST a pattern consistent with increased myelination and suggestive of neuroplastic reorganization. Since the RetST pathway microstructure, in particular, is sensitive to abnormal joint coupling and hand-related motor

The link between weight shift asymmetry and gait disturbances in chronic hemiparetic stroke patients

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Szopa A

2017-12-01

Full Text Available Andrzej Szopa,1 Małgorzata Domagalska-Szopa,2 Anetta Lasek-Bal,3 Amadeusz Żak3 1Department of Physiotherapy, 2Department of Medical Rehabilitation, School of Health Sciences in Katowice, 3Department of Neurology, Professor Leszek Giec Upper Silesian Medical Centre, Medical University of Silesia, Katowice, Poland Introduction: While the asymmetry of body posture and the asymmetrical nature of hemiparetic gait in poststroke (PS patients are well documented, the role of weight shift asymmetry in gait disorders after stroke remains unclear. Objective: We examined the association of weight-bearing asymmetry (WBA between paretic and nonparetic lower limbs during quiet standing with the degree of deviation of hemiplegic gait from normal gait evaluated by the Gillette Gait Index (GGI incorporating 16 distinct clinically important kinematic and temporal parameters in chronic PS patients.Participants and methods: Twenty-two ambulatory patients with chronic stroke aged between 50 and 75 years were included in this study. Fourteen patients had hemiparesis on the nondominant side and 8 on the dominant side. The mean time PS was 2 years and 6 months. The reference group consisted of 22 students from the University of the Third Age presenting no neurological disorders. The examination consisted of posturographic weight-bearing (WB distribution and 3-dimensional gait analyses.Results: A significant positive relationship between WBA and GGI was revealed. Moreover, we observed a significant negative association between WBA and paretic step length and walking speed. With regard to kinematic data, the range of motion of knee flexion and peak dorsiflexion in the swing phase of the paretic leg were significantly negatively associated with WBA.Conclusion: Although further research is needed to determine a causal link between postural control asymmetry and gait disturbance in hemiplegics, our findings support the inclusion of WB measurements between paretic and

An evaluation of the somatosensory profile of hemiparetic individuals

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R.S. Mota

2010-01-01

Full Text Available The purpose of this study was to evaluate the somatosensory profile of 18 hemiparetic spastic victims of stroke with and without blocking vision. Maximal isometric contraction test was used for flexor and extensor muscles of the hip and knee, and flexor plantar muscles. The number of cycles per minute on stationary bike was also measured with eyes opened and closed. Significant differences were found suggesting the existence of miscommunication between sensory-motor neural mechanisms responsible for voluntary motor actions in these individuals.

Altering length and velocity feedback during a neuro-musculoskeletal simulation of normal gait contributes to hemiparetic gait characteristics.

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Jansen, Karen; De Groote, Friedl; Aerts, Wouter; De Schutter, Joris; Duysens, Jacques; Jonkers, Ilse

2014-04-30

Spasticity is an important complication after stroke, especially in the anti-gravity muscles, i.e. lower limb extensors. However the contribution of hyperexcitable muscle spindle reflex loops to gait impairments after stroke is often disputed. In this study a neuro-musculoskeletal model was developed to investigate the contribution of an increased length and velocity feedback and altered reflex modulation patterns to hemiparetic gait deficits. A musculoskeletal model was extended with a muscle spindle model providing real-time length and velocity feedback of gastrocnemius, soleus, vasti and rectus femoris during a forward dynamic simulation (neural control model). By using a healthy subject's base muscle excitations, in combination with increased feedback gains and altered reflex modulation patterns, the effect on kinematics was simulated. A foot-ground contact model was added to account for the interaction effect between the changed kinematics and the ground. The qualitative effect i.e. the directional effect and the specific gait phases where the effect is present, on the joint kinematics was then compared with hemiparetic gait deviations reported in the literature. Our results show that increased feedback in combination with altered reflex modulation patterns of soleus, vasti and rectus femoris muscle can contribute to excessive ankle plantarflexion/inadequate dorsiflexion, knee hyperextension/inadequate flexion and increased hip extension/inadequate flexion during dedicated gait cycle phases. Increased feedback of gastrocnemius can also contribute to excessive plantarflexion/inadequate dorsiflexion, however in combination with excessive knee and hip flexion. Increased length/velocity feedback can therefore contribute to two types of gait deviations, which are both in accordance with previously reported gait deviations in hemiparetic patients. Furthermore altered modulation patterns, in particular the reduced suppression of the muscle spindle feedback during

Feasibility of task-specific brain-machine interface training for upper-extremity paralysis in patients with chronic hemiparetic stroke.

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Nishimoto, Atsuko; Kawakami, Michiyuki; Fujiwara, Toshiyuki; Hiramoto, Miho; Honaga, Kaoru; Abe, Kaoru; Mizuno, Katsuhiro; Ushiba, Junichi; Liu, Meigen

2018-01-10

Brain-machine interface training was developed for upper-extremity rehabilitation for patients with severe hemiparesis. Its clinical application, however, has been limited because of its lack of feasibility in real-world rehabilitation settings. We developed a new compact task-specific brain-machine interface system that enables task-specific training, including reach-and-grasp tasks, and studied its clinical feasibility and effectiveness for upper-extremity motor paralysis in patients with stroke. Prospective beforeâ€"after study. Twenty-six patients with severe chronic hemiparetic stroke. Participants were trained with the brain-machine interface system to pick up and release pegs during 40-min sessions and 40 min of standard occupational therapy per day for 10 days. Fugl-Meyer upper-extremity motor (FMA) and Motor Activity Log-14 amount of use (MAL-AOU) scores were assessed before and after the intervention. To test its feasibility, 4 occupational therapists who operated the system for the first time assessed it with the Quebec User Evaluation of Satisfaction with assistive Technology (QUEST) 2.0. FMA and MAL-AOU scores improved significantly after brain-machine interface training, with the effect sizes being medium and large, respectively (pmachine interface system is feasible for use in real-world clinical settings.

Modification of Spastic Stretch Reflexes at the Elbow by Flexion Synergy Expression in Individuals With Chronic Hemiparetic Stroke.

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McPherson, Jacob G; Stienen, Arno H; Drogos, Justin M; Dewald, Julius P

2018-03-01

To systematically characterize the effect of flexion synergy expression on the manifestation of elbow flexor stretch reflexes poststroke, and to relate these findings to elbow flexor stretch reflexes in individuals without neurologic injury. Controlled cohort study. Academic medical center. Participants (N=20) included individuals with chronic hemiparetic stroke (n=10) and a convenience sample of individuals without neurologic or musculoskeletal injury (n=10). Participants with stroke were interfaced with a robotic device that precisely manipulated flexion synergy expression (by regulating shoulder abduction loading) while delivering controlled elbow extension perturbations over a wide range of velocities. This device was also used to elicit elbow flexor stretch reflexes during volitional elbow flexor activation, both in the cohort of individuals with stroke and in a control cohort. In both cases, the amplitude of volitional elbow flexor preactivation was matched to that generated involuntarily during flexion synergy expression. The amplitude of short- and long-latency stretch reflexes in the biceps brachii, assessed by electromyography, and expressed as a function of background muscle activation and stretch velocity. Increased shoulder abduction loading potentiated elbow flexor stretch reflexes via flexion synergy expression in the paretic arm. Compared with stretch reflexes in individuals without neurologic injury, paretic reflexes were larger at rest but were approximately equal to control muscles at matched levels of preactivation. Because flexion synergy expression modifies stretch reflexes in involved muscles, interventions that reduce flexion synergy expression may confer the added benefit of reducing spasticity during functional use of the arm. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Effect of Tendon Vibration on Hemiparetic Arm Stability in Unstable Workspaces.

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Megan O Conrad

Full Text Available Sensory stimulation of wrist musculature can enhance stability in the proximal arm and may be a useful therapy aimed at improving arm control post-stroke. Specifically, our prior research indicates tendon vibration can enhance stability during point-to-point arm movements and in tracking tasks. The goal of the present study was to investigate the influence of forearm tendon vibration on endpoint stability, measured at the hand, immediately following forward arm movements in an unstable environment. Both proximal and distal workspaces were tested. Ten hemiparetic stroke subjects and 5 healthy controls made forward arm movements while grasping the handle of a two-joint robotic arm. At the end of each movement, the robot applied destabilizing forces. During some trials, 70 Hz vibration was applied to the forearm flexor muscle tendons. 70 Hz was used as the stimulus frequency as it lies within the range of optimal frequencies that activate the muscle spindles at the highest response rate. Endpoint position, velocity, muscle activity and grip force data were compared before, during and after vibration. Stability at the endpoint was quantified as the magnitude of oscillation about the target position, calculated from the power of the tangential velocity data. Prior to vibration, subjects produced unstable, oscillating hand movements about the target location due to the applied force field. Stability increased during vibration, as evidenced by decreased oscillation in hand tangential velocity.

Interactive cueing with walk-Mate for Hemiparetic Stroke Rehabilitation

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Muto Takeshi

2012-08-01

Full Text Available Abstract Background Many techniques that compensate for locomotion problems in daily life using externally controlled stimulation have recently been reported. These techniques are beneficial for effortlessly supporting patients’ locomotive functions, but the users of such devices must necessarily remain dependent on them. It is possible that some individuals with gait impairment may be prevented recovering locomotive function. From a rehabilitation viewpoint, it may therefore be supposed that ideally, devices that can be used in daily life to improve the locomotive functions of the body itself should be proposed. Methods We evaluate the effectiveness of Walk-Mate, which has been used mainly as a gait compensation device, as a gait rehabilitation training device by analyzing improvement in locomotion before, during and after rehabilitation in hemiparetic patients and comparing it with a previous gait training method. Walk-Mate generates a model walking rhythm in response to a user’s locomotion in real time, and by indicating this rhythm using auditory stimuli, provides a technology that supports walking by reducing asymmetries and fluctuations in foot contact rhythm. If patients can use the system to learn a regulated walking rhythm, then it may also be expected to fulfil the functions of a gait rehabilitation training device for daily life. Results With regard to asymmetry, significantly improvements were seen for compensatory movement during training using Walk-Mate, but improvements were not retained as rehabilitative results. Regarding fluctuations in the foot contact period, significant improvement was observed for compensatory movement during training and these significant improvements were retained as rehabilitative results. In addition, it became clear that such improvement could not be adequately obtained by the previously proposed training technique utilizing constant rhythmic auditory stimulation. Conclusions Walk-Mate effectively

An exploratory investigation on the use of closed-loop electrical stimulation to assist individuals with stroke to perform fine movements with their hemiparetic arm

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Brian eLew

2016-03-01

Full Text Available Stroke is the leading cause of upper limb impairments resulting in disability. Modern rehabilitation includes training with robotic exoskeletons and functional electrical stimulation (FES. However, there is a gap in knowledge to define the detailed use of FES in stroke rehabilitation. In this paper, we explore applying closed-loop FES to the upper extremities (UE of healthy volunteers and individuals with a hemiparetic arm resulting from stroke. We used a set of gyroscopes to monitor arm movements and used a non-linear controller, namely the robust integral of the sign of the error (RISE, to assess the viability of controlling FES in closed-loop. Further, we explored the application of closed-loop FES in improving functional tasks performed by individuals with stroke. Four healthy individuals of ages 27 to 32 years old and five individuals with stroke of ages 61 to 83 years old participated in this study. We used the Rehastim FES unit (Hasomed Ltd. with real-time modulation of pulse width and amplitude. Both healthy and stroke individuals were tested in RISE controlled single and multi-joint upper limb motions following first a sinusoidal trajectory. Individuals with stroke were also asked to perform the following functional tasks: picking up a basket, picking and placing an object on a table, cutting a pizza, pulling back a chair, eating with a spoon, as well as using a stapler and grasping a pen. Healthy individuals were instructed to keep their arm relaxed during the experiment. Most individuals with stroke were able to follow the sinusoid trajectories with their arm joints under the sole excitation of the closed-loop controlled FES. One individual with stroke who was unable to perform any of the functional tasks independently, succeeded in completing all the tasks when FES was used. Three other individuals with stroke, who were unable to complete a few tasks independently, completed some of them when FES was used. The remaining stroke

An Automatic Identification Procedure to Promote the use of FES-Cycling Training for Hemiparetic Patients

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Emilia Ambrosini

2014-01-01

Full Text Available Cycling induced by Functional Electrical Stimulation (FES training currently requires a manual setting of different parameters, which is a time-consuming and scarcely repeatable procedure. We proposed an automatic procedure for setting session-specific parameters optimized for hemiparetic patients. This procedure consisted of the identification of the stimulation strategy as the angular ranges during which FES drove the motion, the comparison between the identified strategy and the physiological muscular activation strategy, and the setting of the pulse amplitude and duration of each stimulated muscle. Preliminary trials on 10 healthy volunteers helped define the procedure. Feasibility tests on 8 hemiparetic patients (5 stroke, 3 traumatic brain injury were performed. The procedure maximized the motor output within the tolerance constraint, identified a biomimetic strategy in 6 patients, and always lasted less than 5 minutes. Its reasonable duration and automatic nature make the procedure usable at the beginning of every training session, potentially enhancing the performance of FES-cycling training.

Benefits of aerobic exercise after stroke.

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Potempa, K; Braun, L T; Tinknell, T; Popovich, J

1996-05-01

The debilitating loss of function after a stroke has both primary and secondary effects on sensorimotor function. Primary effects include paresis, paralysis, spasticity, and sensory-perceptual dysfunction due to upper motor neuron damage. Secondary effects, contractures and disuse muscle atrophy, are also debilitating. This paper presents theoretical and empirical benefits of aerobic exercise after stroke, issues relevant to measuring peak capacity, exercise training protocols, and the clinical use of aerobic exercise in this patient population. A stroke, and resulting hemiparesis, produces physiological changes in muscle fibres and muscle metabolism during exercise. These changes, along with comorbid cardiovascular disease, must be considered when exercising stroke patients. While few studies have measured peak exercise capacity in hemiparetic populations, it has been consistently observed in these studies that stroke patients have a lower functional capacity than healthy populations. Hemiparetic patients have low peak exercise responses probably due to a reduced number of motor units available for recruitment during dynamic exercise, the reduced oxidative capacity of paretic muscle, and decreased overall endurance. Consequently, traditional methods to predict aerobic capacity are not appropriate for use with stroke patients. Endurance exercise training is increasingly recognised as an important component in rehabilitation. An average improvement in maximal oxygen consumption (VO2max) of 13.3% in stroke patients who participated in a 10-week aerobic exercise training programme has been reported compared with controls. This study underscored the potential benefits of aerobic exercise training in stroke patients. In this paper, advantages and disadvantages of exercise modalities are discussed in relation to stroke patients. Recommendations are presented to maximise physical performance and minimise potential cardiac risks during exercise.

Forward propulsion asymmetry is indicative of changes in plantarflexor coordination during walking in individuals with post-stroke hemiparesis.

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Allen, Jessica L; Kautz, Steven A; Neptune, Richard R

2014-08-01

A common measure of rehabilitation effectiveness post-stroke is self-selected walking speed, yet individuals may achieve the same speed using different coordination strategies. Asymmetry in the propulsion generated by each leg can provide insight into paretic leg coordination due to its relatively strong correlation with hemiparetic severity. Subjects walking at the same speed can exhibit different propulsion asymmetries, with some subjects relying more on the paretic leg and others on the nonparetic leg. The goal of this study was to assess whether analyzing propulsion asymmetry can help distinguish between improved paretic leg coordination versus nonparetic leg compensation. Three-dimensional forward dynamics simulations were developed for two post-stroke hemiparetic subjects walking at identical speeds before/after rehabilitation with opposite changes in propulsion asymmetry. Changes in the individual muscle contributions to forward propulsion were examined. The major source of increased forward propulsion in both subjects was from the ankle plantarflexors. How they were utilized differed and appears related to changes in propulsion asymmetry. Subject A increased propulsion generated from the paretic plantarflexors, while Subject B increased propulsion generated from the nonparetic plantarflexors. Each subject's strategy to increase speed also included differences in other muscle groups (e.g., hamstrings) that did not appear to be related to propulsion asymmetry. The results of this study highlight how speed cannot be used to elucidate underlying muscle coordination changes following rehabilitation. In contrast, propulsion asymmetry appears to provide insight into changes in plantarflexor output affecting propulsion generation and may be useful in monitoring rehabilitation outcomes. Copyright © 2014 Elsevier Ltd. All rights reserved.

Oxygen uptake response to cycle ergometry in post-acute stroke patients with different severity of hemiparesis.

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Chen, Chun-Kai; Weng, Ming-Cheng; Chen, Tien-Wen; Huang, Mao-Hsiung

2013-11-01

This study evaluated the impact of severity of hemiparesis on oxygen uptake (VO2) response in post-acute stroke patients. Sixty-four patients with a mean poststroke interval of 8.6 ± 3.8 days underwent a ramp cardiopulmonary exercise test on a cycling ergometer to volitional termination. Mean peak VO2 (VO2peak) and work efficiency (ΔVO2/ΔWR) were measured by open-circuit spirometry during standard upright ergometer cycling. Severity of the hemiparetic lower limb was assessed by Brunnstrom's motor recovery stages lower extremity (BMRSL). VO2peak was 10% lower in hemiparetic leg with BMRSL V than in that with BMRSL VI, 20% lower in BMRSL IV, and 50% lower in BMRSL III. ΔVO2/ΔWR was higher for the group with increased BMRSL. The relations were consistent after adjustment for age, sex, body mass index, stroke type, hemiparetic side, modified Ashworth Scale, time poststroke, comorbidities, and medications. Our findings revealed that O2peak is dependent on the severity of hemiparesis in leg, and along with ΔO2/ΔWR closely related to the severity of hemiparesis in post-acute stroke patients, regardless of the types and locations of lesion after stroke, as well as the differences in comorbidities and medications. Copyright © 2013. Published by Elsevier B.V.

Assessment of the correlations between gait speed in post-stroke patients and the time from stroke onset, the level of motor control in the paretic lower limb, proprioception, visual field impairment and functional independence

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Drużbicki Mariusz

2016-09-01

Full Text Available Introduction: Gait recovery is one of the main objectives in the rehabilitation of post-stroke patients. The study aim was to assess the correlations between gait speed in post-stroke hemiparetic patients and the level of motor control in the paretic lower limb, the time from stroke onset, the subjects’ age as well as the impairment of proprioception and visual field.

Effect of Symmetry Improvement in Weight Bearing on Postural Stability of Hemiparetic Patients

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Hossein Asghar-Hosseini

2008-07-01

Full Text Available Objective: Impaired postural control has been known as the main cause of fall in hemiparesis after stroke. Is Asymmetry of weight bearing on lower limb is one of the prominent characteristics of postural imbalance in these patients. The aim of this study was to evaluate the effect of symmetry improvement in weight bearing through therapeutic interventions on postural stability in hemiparetic patients. Materials & Methods: In this quasi – experimental study which 27 hemiparetic patients were selected through sample of convenience by simple method from men and women who were referred to neurology clinic of Hazrat-e-Rasool hospital. For postural assessment patients stood quietly with open eyes and close eyes on force plates. Primary assessments included evaluation of asymmetry index (AI, RMS COP displacement (Root Mean Square of Center of Pressure and RMS COP velocity in both frontal and sagital planes. Then a 10mm lift was inserted under the unaffected limb and primary assessments were repeated. Data were analyzed by repeated measure ANOVA test. Results: Simple main effect of lift on asymmetry index was significant (P<0/0001. There was no significant interaction between vision and lift. Simple main effect of lift on postural stability variables was also non significant (for RMS COP displacement in frontal and sagital planes P=0.186 and P=0.245, respectively and for RMS COP velocity P=0.259 and P=0.342 respectively. Conclusion: Inserting a lift can improve symmetry by shifting center of gravity to midline. Since symmetry improvement did not decrease postural instability, asymmetric weight bearing can not be the primary cause of postural instability and may not be the principal target of rehabilitation programs aiming at restoring standing balance after stroke.

Hemorrhagic versus ischemic stroke: Who can best benefit from blended conventional physiotherapy with robotic-assisted gait therapy?

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Dierick, Frédéric; Dehas, Mélanie; Isambert, Jean-Luc; Injeyan, Soizic; Bouché, Anne-France; Bleyenheuft, Yannick; Portnoy, Sigal

2017-01-01

Contrary to common belief of clinicians that hemorrhagic stroke survivors have better functional prognoses than ischemic, recent studies show that ischemic survivors could experience similar or even better functional improvements. However, the influence of stroke subtype on gait and posture outcomes following an intervention blending conventional physiotherapy with robotic-assisted gait therapy is missing. This study compared gait and posture outcome measures between ambulatory hemorrhagic patients and ischemic patients, who received a similar 4 weeks' intervention blending a conventional bottom-up physiotherapy approach and an exoskeleton top-down robotic-assisted gait training (RAGT) approach with Lokomat. Forty adult hemiparetic stroke inpatient subjects were recruited: 20 hemorrhagic and 20 ischemic, matched by age, gender, side of hemisphere lesion, stroke severity, and locomotor impairments. Functional Ambulation Category, Postural Assessment Scale for Stroke, Tinetti Performance Oriented Mobility Assessment, 6 Minutes Walk Test, Timed Up and Go and 10-Meter Walk Test were performed before and after a 4-week long intervention. Functional gains were calculated for all tests. Hemorrhagic and ischemic subjects showed significant improvements in Functional Ambulation Category (Pbenefits from the same type, length and frequency of blended conventional physiotherapy and RAGT protocol. The use of intensive treatment plans blending top-down physiotherapy and bottom-up robotic approaches is promising for post-stroke rehabilitation.

Biomechanical mechanisms underlying exosuit-induced improvements in walking economy after stroke.

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Bae, Jaehyun; Awad, Louis N; Long, Andrew; O'Donnell, Kathleen; Hendron, Katy; Holt, Kenneth G; Ellis, Terry D; Walsh, Conor J

2018-03-07

Stroke-induced hemiparetic gait is characteristically asymmetric and metabolically expensive. Weakness and impaired control of the paretic ankle contribute to reduced forward propulsion and ground clearance - walking subtasks critical for safe and efficient locomotion. Targeted gait interventions that improve paretic ankle function after stroke are therefore warranted. We have developed textile-based, soft wearable robots that transmit mechanical power generated by off-board or body-worn actuators to the paretic ankle using Bowden cables (soft exosuits) and have demonstrated the exosuits can overcome deficits in paretic limb forward propulsion and ground clearance, ultimately reducing the metabolic cost of hemiparetic walking. This study elucidates the biomechanical mechanisms underlying exosuit-induced reductions in metabolic power. We evaluated the relationships between exosuit-induced changes in the body center of mass (COM) power generated by each limb, individual joint power and metabolic power. Compared with walking with an exosuit unpowered, exosuit assistance produced more symmetrical COM power generation during the critical period of the step-to-step transition (22.4±6.4% more symmetric). Changes in individual limb COM power were related to changes in paretic ( R 2 =0.83, P= 0.004) and non-paretic ( R 2 = 0.73, P= 0.014) ankle power. Interestingly, despite the exosuit providing direct assistance to only the paretic limb, changes in metabolic power were related to changes in non-paretic limb COM power ( R 2 =0.80, P= 0.007), not paretic limb COM power ( P> 0.05). These findings contribute to a fundamental understanding of how individuals post-stroke interact with an exosuit to reduce the metabolic cost of hemiparetic walking. © 2018. Published by The Company of Biologists Ltd.

Arm rehabilitation in post stroke subjects: A randomized controlled trial on the efficacy of myoelectrically driven FES applied in a task-oriented approach.

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Jonsdottir, Johanna; Thorsen, Rune; Aprile, Irene; Galeri, Silvia; Spannocchi, Giovanna; Beghi, Ettore; Bianchi, Elisa; Montesano, Angelo; Ferrarin, Maurizio

2017-01-01

Motor recovery of persons after stroke may be enhanced by a novel approach where residual muscle activity is facilitated by patient-controlled electrical muscle activation. Myoelectric activity from hemiparetic muscles is then used for continuous control of functional electrical stimulation (MeCFES) of same or synergic muscles to promote restoration of movements during task-oriented therapy (TOT). Use of MeCFES during TOT may help to obtain a larger functional and neurological recovery than otherwise possible. Multicenter randomized controlled trial. Eighty two acute and chronic stroke victims were recruited through the collaborating facilities and after signing an informed consent were randomized to receive either the experimental (MeCFES assisted TOT (M-TOT) or conventional rehabilitation care including TOT (C-TOT). Both groups received 45 minutes of rehabilitation over 25 sessions. Outcomes were Action Research Arm Test (ARAT), Upper Extremity Fugl-Meyer Assessment (FMA-UE) scores and Disability of the Arm Shoulder and Hand questionnaire. Sixty eight subjects completed the protocol (Mean age 66.2, range 36.5-88.7, onset months 12.7, range 0.8-19.1) of which 45 were seen at follow up 5 weeks later. There were significant improvements in both groups on ARAT (median improvement: MeCFES TOT group 3.0; C-TOT group 2.0) and FMA-UE (median improvement: M-TOT 4.5; C-TOT 3.5). Considering subacute subjects (time since stroke rehabilitation (57.9%) than in the C-TOT group (33.2%) (difference in proportion improved 24.7%; 95% CI -4.0; 48.6), though the study did not meet the planned sample size. This is the first large multicentre RCT to compare MeCFES assisted TOT with conventional care TOT for the upper extremity. No adverse events or negative outcomes were encountered, thus we conclude that MeCFES can be a safe adjunct to rehabilitation that could promote recovery of upper limb function in persons after stroke, particularly when applied in the subacute phase.

Subjective memory complaints and the risk of stroke

NARCIS (Netherlands)

A. Sajjad (Ayesha); S.S. Mirza (Saira); M.L.P. Portegies (Marileen); M.J. Bos (Michiel); A. Hofman (Albert); P.J. Koudstaal (Peter Jan); H.W. Tiemeier (Henning); M.A. Ikram (Arfan)

2015-01-01

textabstractBackground and Purpose-Persons with cognitive impairment, as assessed by cognitive tests, are at a higher risk of stroke. Subjective memory complaints might be an earlier marker for stroke, especially in persons with higher education. Their cognitive reserve might mask their cognitive

Brain stimulation and constraint for perinatal stroke hemiparesis: The PLASTIC CHAMPS Trial.

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Kirton, Adam; Andersen, John; Herrero, Mia; Nettel-Aguirre, Alberto; Carsolio, Lisa; Damji, Omar; Keess, Jamie; Mineyko, Aleksandra; Hodge, Jacquie; Hill, Michael D

2016-05-03

To determine whether the addition of repetitive transcranial magnetic stimulation (rTMS) and/or constraint-induced movement therapy (CIMT) to intensive therapy increases motor function in children with perinatal stroke and hemiparesis. A factorial-design, blinded, randomized controlled trial (clinicaltrials.gov/NCT01189058) assessed rTMS and CIMT effects in hemiparetic children (aged 6-19 years) with MRI-confirmed perinatal stroke. All completed a 2-week, goal-directed, peer-supported motor learning camp randomized to daily rTMS, CIMT, both, or neither. Primary outcomes were the Assisting Hand Assessment and the Canadian Occupational Performance Measure at baseline, and 1 week, 2 and 6 months postintervention. Outcome assessors were blinded to treatment. Interim safety analyses occurred after 12 and 24 participants. Intention-to-treat analysis examined treatment effects over time (linear mixed effects model). All 45 participants completed the trial. Addition of rTMS, CIMT, or both doubled the chances of clinically significant improvement. Assisting Hand Assessment gains at 6 months were additive and largest with rTMS + CIMT (β coefficient = 5.54 [2.57-8.51], p = 0.0004). The camp alone produced large improvements in Canadian Occupational Performance Measure scores, maximal at 6 months (Cohen d = 1.6, p = 0.002). Quality-of-life scores improved. Interventions were well tolerated and safe with no decrease in function of either hand. Hemiparetic children participating in intensive, psychosocial rehabilitation programs can achieve sustained functional gains. Addition of CIMT and rTMS increases the chances of improvement. This study provides Class II evidence that combined rTMS and CIMT enhance therapy-induced functional motor gains in children with stroke-induced hemiparetic cerebral palsy. © 2016 American Academy of Neurology.

Electromyography-controlled exoskeletal upper-limb-powered orthosis for exercise training after stroke.

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Stein, Joel; Narendran, Kailas; McBean, John; Krebs, Kathryn; Hughes, Richard

2007-04-01

Robot-assisted exercise shows promise as a means of providing exercise therapy for weakness that results from stroke or other neurological conditions. Exoskeletal or "wearable" robots can, in principle, provide therapeutic exercise and/or function as powered orthoses to help compensate for chronic weakness. We describe a novel electromyography (EMG)-controlled exoskeletal robotic brace for the elbow (the active joint brace) and the results of a pilot study conducted using this brace for exercise training in individuals with chronic hemiparesis after stroke. Eight stroke survivors with severe chronic hemiparesis were enrolled in this pilot study. One subject withdrew from the study because of scheduling conflicts. A second subject was unable to participate in the training protocol because of insufficient surface EMG activity to control the active joint brace. The six remaining subjects each underwent 18 hrs of exercise training using the device for a period of 6 wks. Outcome measures included the upper-extremity component of the Fugl-Meyer scale and the modified Ashworth scale of muscle hypertonicity. Analysis revealed that the mean upper-extremity component of the Fugl-Meyer scale increased from 15.5 (SD 3.88) to 19 (SD 3.95) (P = 0.04) at the conclusion of training for the six subjects who completed training. Combined (summated) modified Ashworth scale for the elbow flexors and extensors improved from 4.67 (+/-1.2 SD) to 2.33 (+/-0.653 SD) (P = 0.009) and improved for the entire upper limb as well. All subjects tolerated the device, and no complications occurred. EMG-controlled powered elbow orthoses can be successfully controlled by severely impaired hemiparetic stroke survivors. This technique shows promise as a new modality for assisted exercise training after stroke.

Decreased contribution from afferent feedback to the soleus muscle during walking in patients with spastic stroke

DEFF Research Database (Denmark)

Mazzaro, Nazarena; Nielsen, Jørgen Feldbæk; Grey, Michael James

2007-01-01

We investigated the contribution of afferent feedback to the soleus (SOL) muscle activity during the stance phase of walking in patients with spastic stroke. A total of 24 patients with hemiparetic spastic stroke and age-matched healthy volunteers participated in the study. A robotic actuator...... by the Ashworth score. These results indicate that although the stretch reflex response is facilitated during spastic gait, the contribution of afferent feedback to the ongoing locomotor SOL activity is depressed in patients with spastic stroke....

Nitrogen balance in patients with hemiparetic stroke during the subacute rehabilitation phase.

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Wada, A; Kawakami, M; Otsuka, T; Aoki, H; Anzai, A; Yamada, Y; Liu, F; Otaka, E; Akaboshi, K; Liu, M

2017-06-01

In highly invasive diseases, metabolism commonly changes. Hypercatabolism is frequent in acute stroke, and nitrogen balance tends to be negative. However, there has been no study describing nitrogen balance in subacute and chronic stroke patients. The present study aimed to examine nitrogen balance in the subacute and chronic phases and to identify the factors related to it. Nitrogen balance was calculated from the collected urine of 56 patients with subacute stroke [mean (SD) 53.8 (18.4) days post-stroke] who were admitted for rehabilitation for their first-ever ischaemic or nonsurgical haemorrhagic stroke. In the first experiment, their nitrogen balance was measured during the rehabilitation phase, and factors (type, severity of hemiparesis, activities of daily living, dysphagia and malnutrition status) related to it were evaluated. The second experiment was performed to describe the time course of nitrogen balance in 31 consecutive patients, with assessments made at admission and at discharge. Nitrogen balance was positive in all patients in the subacute phase. A significant difference was seen in nitrogen balance between high and low fat-free mass in male patients. In the chronic phase, nitrogen balance was positive in 96% of the patients. There was no significant difference in nitrogen balance between discharge and admission. In the subacute and chronic phases of stroke, it was confirmed that hypercatabolism had resolved and that intensive rehabilitation is possible in the convalescent period of stroke. © 2017 The British Dietetic Association Ltd.

Innovative gait robot for the repetitive practice of floor walking and stair climbing up and down in stroke patients.

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Hesse, Stefan; Waldner, Andreas; Tomelleri, Christopher

2010-06-28

Stair climbing up and down is an essential part of everyday's mobility. To enable wheelchair-dependent patients the repetitive practice of this task, a novel gait robot, G-EO-Systems (EO, Lat: I walk), based on the end-effector principle, has been designed. The trajectories of the foot plates are freely programmable enabling not only the practice of simulated floor walking but also stair climbing up and down. The article intended to compare lower limb muscle activation patterns of hemiparetic subjects during real floor walking and stairs climbing up, and during the corresponding simulated conditions on the machine, and secondly to demonstrate gait improvement on single case after training on the machine. The muscle activation pattern of seven lower limb muscles of six hemiparetic patients during free and simulated walking on the floor and stair climbing was measured via dynamic electromyography. A non-ambulatory, sub-acute stroke patient additionally trained on the G-EO-Systems every workday for five weeks. The muscle activation patterns were comparable during the real and simulated conditions, both on the floor and during stair climbing up. Minor differences, concerning the real and simulated floor walking conditions, were a delayed (prolonged) onset (duration) of the thigh muscle activation on the machine across all subjects. Concerning stair climbing conditions, the shank muscle activation was more phasic and timely correct in selected patients on the device. The severely affected subject regained walking and stair climbing ability. The G-EO-Systems is an interesting new option in gait rehabilitation after stroke. The lower limb muscle activation patterns were comparable, a training thus feasible, and the positive case report warrants further clinical studies.

The importance of the patient's subjective experience in stroke rehabilitation.

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Prigatano, George P

2011-01-01

Kaufman's observation that the patients' reactions to their impairments and disabilities need to be addressed in stroke rehabilitation has been shown to be an accurate and perceptive statement. In this article, 3 levels of stroke rehabilitation are outlined, and the importance of focusing on the third level (the level of subjective experience) is emphasized. Identification of the patients' subjective experience allows one to understand what is most frustrating to them. After addressing those frustrations, patients are more eager to engage the rehabilitation process. Within the context of this rehabilitation process, helping patients clarify what their subjective or phenomenological state is as it relates to their stroke is crucial in having them not only engage the rehabilitation process, but ultimately find meaning in life in the face of their stroke. This can be a difficult task because patients often do not have the words to clarify what their inner psychological experiences are following a stroke. Helping to provide guidelines for this can result in a meaningful experience for both the patient and the therapists involved in their care.

Dinamometria de preensão manual como parâmetro de avaliação funcional do membro superior de pacientes hemiparéticos por acidente vascular cerebral Handgrip dynamometry as a parameter of functional evaluation of the upper extremity hemiparetic after stroke

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Antonio Vinicius Soares

2011-12-01

Full Text Available A força muscular é a valência física mais importante. É provável que exista correlação entre a força de preensão manual e outros testes para o membro superior afetado por um acidente vascular cerebral (AVC. O propósito deste estudo é analisar o valor preditivo da dinamometria de preensão manual (DPM para recuperação do membro superior parético por AVC. Foram avaliados 43 pacientes hemiparéticos pós-AVC (60,7 anos±12,1. Vários testes (Escala de movimento da mão (EMM, Estesiometria, Teste de caixa e blocos, 9 buracos e pinos, Escala de Ashworth modificada e Índice de Barthel foram relacionados com a DPM. Os resultados apontaram que a DPM apresenta boa correlação com EMM e, contrariamente, os testes de destreza manual, a sensibilidade e o índice de independência funcional não apresentaram valores significativos. A DPM é um teste rápido, fácil e acessível, e pode fazer parte dos protocolos de avaliação funcional do membro superior de pacientes hemiparéticos por AVC.Muscle strength is the most important physical valence. It is likely that there is a correlation between handgrip strength and other tests for the upper extremity affected by stroke. The purpose of this study is to analyze the predictive value of handgrip dynamometry (HD for upper limb recovery in stroke. Were studied 43 hemiparetic patients after stroke (60.7 years±12.1. Several tests (Hand moviment scale (HMS, Esthesiometry, Box and blocks test, 9 hole and peg test, Modified Ashworth scale and Barthel index were related to HD. The results showed that there is good correlation of the HD with HMS and, by contrast, the tests of manual dexterity, the sensitivity and index of functional independence showed no significant values. The HD is a quick, easy and affordable test, and can be part of protocols for functional evaluation of upper extremity of hemiparetic patients by stroke.

5 Hz repetitive transcranial magnetic stimulation over the ipsilesional sensory cortex enhances motor learning after stroke

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Sonia M Brodie

2014-03-01

Full Text Available Sensory feedback is critical for motor learning, and thus to neurorehabilitation after stroke. Whether enhancing sensory feedback by applying excitatory repetitive transcranial magnetic stimulation (rTMS over the ipsilesional primary sensory cortex (IL-S1 might enhance motor learning in chronic stroke has yet to be investigated. The present study investigated the effects of 5 Hz rTMS over IL-S1 paired with skilled motor practice on motor learning, hemiparetic cutaneous somatosensation, and motor function. Individuals with unilateral chronic stroke were pseudo-randomly divided into either Active or Sham 5 Hz rTMS groups (n=11/group. Following stimulation, both groups practiced a Serial Tracking Task (STT with the hemiparetic arm; this was repeated for 5 days. Performance on the STT was quantified by response time, peak velocity, and cumulative distance tracked at baseline, during the 5 days of practice, and at a no-rTMS retention test. Cutaneous somatosensation was measured using two-point discrimination. Standardized sensorimotor tests were performed to assess whether the effects might generalize to impact hemiparetic arm function. The active 5Hz rTMS + training group demonstrated significantly greater improvements in STT performance [response time (F1,286.04=13.016, p< 0.0005, peak velocity (F1,285.95=4.111, p=0.044, and cumulative distance (F1,285.92=4.076, p=0.044] and cutaneous somatosensation (F1,21.15=8.793, p=0.007 across all sessions compared to the sham rTMS + training group. Measures of upper extremity motor function were not significantly different for either group. Our preliminary results suggest that, when paired with motor practice, 5Hz rTMS over IL-S1 enhances motor learning related change in individuals with chronic stroke, potentially as a consequence of improved cutaneous somatosensation, however no improvement in general upper extremity function was observed.

The Reticulospinal Pathway Does Not Increase Its Contribution to the Strength of Contralesional Muscles in Stroke Survivors as Compared to Ipsilesional Side or Healthy Controls

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Sheng Li

2017-11-01

Full Text Available ObjectiveStartling acoustic stimulation (SAS, via activation of reticulospinal (RS pathways, has shown to increase muscle strength in healthy subjects. We hypothesized that, given RS hyperexcitability in stroke survivors, SAS could increase muscle strength in stroke survivors. The objective was to quantify the effect of SAS on maximal and sub-maximal voluntary elbow flexion on the contralesional (impaired side in stroke survivors as compared to ipsilesional (non-impaired side and healthy controls.DesignThirteen hemiparetic stroke survivors and 12 healthy subjects volunteered for this investigation. Acoustic stimulation was given at rest, during ballistic maximal and sustained sub-maximal isometric elbow contractions using low (80 dB and high intensity sound (105 dB. The effect of acoustic stimuli was evaluated from EMG and force recordings.ResultsPrevalence of acoustic startle reflex with shorter latency in the impaired biceps was greater as compared to the response in the non-impaired side of stroke subjects and in healthy subjects. Delivery of SAS resulted in earlier initiation of elbow flexion and greater peak torque in healthy subjects and in stroke subjects with spastic hemiplegia during maximal voluntary elbow flexion tasks. During sub-maximal elbow flexion tasks, SAS-induced force responses were slightly greater on the impaired side than the non-impaired side. However, no statistically significant difference was found in SAS-induced responses between impaired and non-impaired sides at maximal and sub-maximal elbow flexion tasks.ConclusionThe findings suggest RS hyperexcitability in stroke survivors with spastic hemiplegia. The results of similar SAS-induced responses between healthy and stroke subjects indicate that RS projections via acoustic stimulation are not likely to contribute to muscle strength for stroke survivors to a significant extent.

Falls-risk post-stroke: Examining contributions from paretic versus non paretic limbs to unexpected forward gait slips.

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Kajrolkar, Tejal; Bhatt, Tanvi

2016-09-06

Community-dwelling stroke survivors show a high incidence of falls with unexpected external perturbations during dynamic activities like walking. Previous evidence has demonstrated the importance of compensatory stepping to restore dynamic stability in response to perturbations in hemiparetic stroke survivors. However, these studies were limited to either stance perturbations or perturbation induced under the unaffected limb. This study aimed to compare the differences, if any, between the non-paretic and paretic sides in dynamic stability and protective stepping strategies when exposed to unexpected external perturbation during walking. Twenty hemiparetic subjects experienced an unexpected forward slip during walking on the laboratory walkway either on the paretic (n=10) or the nonparetic limb (n=10). Both groups demonstrated a backward loss of balance with a compensatory stepping response, with the nonparetic-side slip group resorting mainly to an aborted step response (60%) and the paretic-side slip group mainly exhibiting a recovery step response (90%). Although both groups showed an equal incidence of falls, the nonparetic-side slip group demonstrated a higher stability at recovery step touchdown, resulting from lower perturbation magnitudes (slip displacement and velocity) compared to the paretic-side slip group. The results indicate that the paretic side had difficulty initiating and executing a successful stepping response (nonparetic-side slip) and also in reactive limb control while in stance (paretic-side slip). Based on these results it is suggested that intervention strategies for fall-prevention in chronic stroke survivors should focus on paretic limb training for both reactive stepping and weight bearing for improving balance control for recovery from unpredictable perturbations during dynamic activities such as walking. Copyright © 2016. Published by Elsevier Ltd.

A comparison of the effects of visual deprivation and regular body weight support treadmill training on improving over-ground walking of stroke patients: a multiple baseline single subject design.

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Kim, Jeong-Soo; Kang, Sun-Young; Jeon, Hye-Seon

2015-01-01

The body-weight-support treadmill (BWST) is commonly used for gait rehabilitation, but other forms of BWST are in development, such as visual-deprivation BWST (VDBWST). In this study, we compare the effect of VDBWST training and conventional BWST training on spatiotemporal gait parameters for three individuals who had hemiparetic strokes. We used a single-subject experimental design, alternating multiple baselines across the individuals. We recruited three individuals with hemiparesis from stroke; two on the left side and one on the right. For the main outcome measures we assessed spatiotemporal gait parameters using GAITRite, including: gait velocity; cadence; step time of the affected side (STA); step time of the non-affected side (STN); step length of the affected side (SLA); step length of the non-affected side (SLN); step-time asymmetry (ST-asymmetry); and step-length asymmetry (SL-asymmetry). Gait velocity, cadence, SLA, and SLN increased from baseline after both interventions, but STA, ST-asymmetry, and SL-asymmetry decreased from the baseline after the interventions. The VDBWST was significantly more effective than the BWST for increasing gait velocity and cadence and for decreasing ST-asymmetry. VDBWST is more effective than BWST for improving gait performance during the rehabilitation for ground walking.

Age, subjective stress, and depression after ischemic stroke.

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McCarthy, Michael J; Sucharew, Heidi J; Alwell, Kathleen; Moomaw, Charles J; Woo, Daniel; Flaherty, Matthew L; Khatri, Pooja; Ferioli, Simona; Adeoye, Opeolu; Kleindorfer, Dawn O; Kissela, Brett M

2016-02-01

The incidence of stroke among younger adults in the United States is increasing. Few studies have investigated the prevalence of depressive symptoms after stroke among different age groups or the extent to which subjective stress at the time of stroke interacts with age to contribute to post-stroke depression. The present study examined whether there exists an age gradient in survivors' level of depressive symptoms and explored the extent to which financial, family, and health-related stress may also impact on depression. Bivariate analyses (N = 322) indicated significant differences in depression and stress by age group, as well as differences in age and stress by 3-month depression status. Linear regression analyses indicated that survivors between the ages of 25-54 and 55-64 years old had, on average, significantly higher depressive symptom scores. Those with financial, family, and health-related stress at the time of stroke, irrespective of age, also had significantly higher scores.

Innovative gait robot for the repetitive practice of floor walking and stair climbing up and down in stroke patients

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Waldner Andreas

2010-06-01

Full Text Available Abstract Background Stair climbing up and down is an essential part of everyday's mobility. To enable wheelchair-dependent patients the repetitive practice of this task, a novel gait robot, G-EO-Systems (EO, Lat: I walk, based on the end-effector principle, has been designed. The trajectories of the foot plates are freely programmable enabling not only the practice of simulated floor walking but also stair climbing up and down. The article intended to compare lower limb muscle activation patterns of hemiparetic subjects during real floor walking and stairs climbing up, and during the corresponding simulated conditions on the machine, and secondly to demonstrate gait improvement on single case after training on the machine. Methods The muscle activation pattern of seven lower limb muscles of six hemiparetic patients during free and simulated walking on the floor and stair climbing was measured via dynamic electromyography. A non-ambulatory, sub-acute stroke patient additionally trained on the G-EO-Systems every workday for five weeks. Results The muscle activation patterns were comparable during the real and simulated conditions, both on the floor and during stair climbing up. Minor differences, concerning the real and simulated floor walking conditions, were a delayed (prolonged onset (duration of the thigh muscle activation on the machine across all subjects. Concerning stair climbing conditions, the shank muscle activation was more phasic and timely correct in selected patients on the device. The severely affected subject regained walking and stair climbing ability. Conclusions The G-EO-Systems is an interesting new option in gait rehabilitation after stroke. The lower limb muscle activation patterns were comparable, a training thus feasible, and the positive case report warrants further clinical studies.

EFFECT OF MODIFIED CONSTRAINT INDUCED THERAPY ON UPPERLIMB FUNCTIONAL RECOVERY IN YOUNG STROKE SUBJECTS

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Kiran Prakash Pappala

2014-10-01

Full Text Available Background: The aim of this study is to evaluate the effect of modified constraint induced therapy on upper limb functional recovery in young stroke subjects. Most of the stroke rehabilitation units following conventional rehabilitation methods for treatment of the stroke patients where these methods have been proved to be less useful especially in the young stroke subjects. Hence the purpose of this study is to see the effect of modified constraint induced therapy which is a task specific training method for upperlimb in young stroke subjects. Methods: Total of 40 young stroke subjects who is having minimal motor criterion and met other inclusion criteria were recruited from department of physiotherapy, g.s.l.general hospital. Pre and post intervention measures were taken using Wolf motor function test and Jebsen Taylor hand function test. Results: In this study had shown significant improvements in the modified constraint induced therapy group when compared to the conventional rehabilitation alone. P value between groups was < 0.05. Conclusion: In this study concludes that addition of 15 minutes modified constraint induced movement therapy to conventional physiotherapy is a useful adjunct in functional recovery of upper limb among young stroke subjects

The impact of shoulder abduction loading on EMG-based intention detection of hand opening and closing after stroke.

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Lan, Yiyun; Yao, Jun; Dewald, Julius P A

2011-01-01

Many stroke patients are subject to limited hand functions in the paretic arm due to a significant loss of Corticospinal Tract (CST) fibers. A possible solution for this problem is to classify surface Electromyography (EMG) signals generated by hand movements and uses that to implement Functional Electrical Stimulation (FES). However, EMG usually presents an abnormal muscle coactivation pattern shown as increased coupling between muscles within and/or across joints after stroke. The resulting Abnormal Muscle Synergies (AMS) could make the classification more difficult in individuals with stroke, especially when attempting to use the hand together with other joints in the paretic arm. Therefore, this study is aimed at identifying the impact of AMS following stroke on EMG pattern recognition between two hand movements. In an effort to achieve this goal, 7 chronic hemiparetic chronic stroke subjects were recruited and asked to perform hand opening and closing movements at their paretic arm while being either fully supported by a virtual table or loaded with 25% of subject's maximum shoulder abduction force. During the execution of motor tasks EMG signals from the wrist flexors and extensors were simultaneously acquired. Our results showed that increased synergy-induced activity at elbow flexors, induced by increasing shoulder abduction loading, deteriorated the performance of EMG pattern recognition for hand opening for those with a weak grasp strength and EMG activity. However, no such impact on hand closing has yet been observed possibly because finger/wrist flexion is facilitated by the shoulder abduction-induced flexion synergy.

Feasibility of a smartphone-based balance assessment system for subjects with chronic stroke.

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Hou, You-Ruei; Chiu, Ya-Lan; Chiang, Shang-Lin; Chen, Hui-Ya; Sung, Wen-Hsu

2018-07-01

Stroke is a cerebral artery disease that may lead to long-term disabilities or death. Patients that survive a stroke usually suffer balance impairments, which affect their performance in activities of daily living (ADLs) and quality of life (QoL). In recent years, smartphones have become very popular and have many capabilities. Smartphone built-in sensors have shown their ability and potential in balance performance assessment. However, the feasibility of smartphones on subjects with chronic strokes remains to be proved. Therefore, the purpose of this study is to evaluate the feasibility of a smartphone-based balance assessment system for subjects with chronic stroke. Ten subjects with chronic stroke and thirteen healthy adults were recruited in the study. The smartphone HTC 10 (HTC Corporation, Taiwan) was used to perform the balance assessment, and its built-in accelerometer and gyroscope were used to record data from the subjects. Six postures were tested for thirty seconds each: shoulder-width stance (SWS) with eyes opened (E/O) and eyes closed (E/C), feet-together stance (FTS) with E/O and E/C, and semi-tandem stance (STS) with E/O and E/C. The smartphone was fixed to the back of subjects at the second sacral spine (S2) level. The changes registered in the accelerometer and gyroscope data were used to represent the balance performance, in which higher values indicate more instability. Data was analyzed using the independent t-test with the software SPSS 20, and the statistical significance level was set to α balance performances between healthy adults and subjects with chronic stroke. This study shows that smartphones are feasible to assess balance for subjects with chronic stroke. Copyright © 2018 Elsevier B.V. All rights reserved.

Anticipatory planning of movement sequences in hemiparetic cerebral palsy

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Mutsaarts, M.J.H.; Steenbergen, B.; Bekkering, H.

2005-01-01

Anticipatory planning was examined in detail for a complex object manipulation task, by capitalizing on both the complexity and the number of elements in the movement sequences in seven individuals with Hemiparetic Cerebral Palsy (HCP) and seven left-handed control participants. Participants had to

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

African Journals Online (AJOL)

of this study was to evaluate the potential of the footprint and Symmetry Index ... asymmetry increase risk of falls and related injuries of patients (Weerdesteyn et al., 2008). ... This limits the opportunities for the assessment of gait pattern in many hospitals and ... duration post-stroke period of at least 6 months; (ii) ability to walk ...

Novel assessment of cortical response to somatosensory stimuli in children with hemiparetic cerebral palsy.

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Maitre, Nathalie L; Barnett, Zachary P; Key, Alexandra P F

2012-10-01

The brain's response to somatosensory stimuli is essential to experience-driven learning in children. It was hypothesized that advances in event-related potential technology could quantify the response to touch in somatosensory cortices and characterize the responses of hemiparetic children. In this prospective study of 8 children (5-8 years old) with hemiparetic cerebral palsy, both event-related potential responses to sham or air puff trials and standard functional assessments were used. Event-related potential technology consistently measured signals reflecting activity in the primary and secondary somatosensory cortices as well as complex cognitive processing of touch. Participants showed typical early responses but less efficient perceptual processes. Significant differences between affected and unaffected extremities correlated with sensorimotor testing, stereognosis, and 2-point discrimination (r > 0.800 and P = .001 for all). For the first time, a novel event-related potential paradigm shows that hemiparetic children have slower and less efficient tactile cortical perception in their affected extremities.

An EMG-driven exoskeleton hand robotic training device on chronic stroke subjects: task training system for stroke rehabilitation.

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

2011-01-01

An exoskeleton hand robotic training device is specially designed for persons after stroke to provide training on their impaired hand by using an exoskeleton robotic hand which is actively driven by their own muscle signals. It detects the stroke person's intention using his/her surface electromyography (EMG) signals from the hemiplegic side and assists in hand opening or hand closing functional tasks. The robotic system is made up of an embedded controller and a robotic hand module which can be adjusted to fit for different finger length. Eight chronic stroke subjects had been recruited to evaluate the effects of this device. The preliminary results showed significant improvement in hand functions (ARAT) and upper limb functions (FMA) after 20 sessions of robot-assisted hand functions task training. With the use of this light and portable robotic device, stroke patients can now practice more easily for the opening and closing of their hands at their own will, and handle functional daily living tasks at ease. A video is included together with this paper to give a demonstration of the hand robotic system on chronic stroke subjects and it will be presented in the conference. © 2011 IEEE

Hemorrhagic versus ischemic stroke: Who can best benefit from blended conventional physiotherapy with robotic-assisted gait therapy?

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Frédéric Dierick

Full Text Available Contrary to common belief of clinicians that hemorrhagic stroke survivors have better functional prognoses than ischemic, recent studies show that ischemic survivors could experience similar or even better functional improvements. However, the influence of stroke subtype on gait and posture outcomes following an intervention blending conventional physiotherapy with robotic-assisted gait therapy is missing.This study compared gait and posture outcome measures between ambulatory hemorrhagic patients and ischemic patients, who received a similar 4 weeks' intervention blending a conventional bottom-up physiotherapy approach and an exoskeleton top-down robotic-assisted gait training (RAGT approach with Lokomat.Forty adult hemiparetic stroke inpatient subjects were recruited: 20 hemorrhagic and 20 ischemic, matched by age, gender, side of hemisphere lesion, stroke severity, and locomotor impairments. Functional Ambulation Category, Postural Assessment Scale for Stroke, Tinetti Performance Oriented Mobility Assessment, 6 Minutes Walk Test, Timed Up and Go and 10-Meter Walk Test were performed before and after a 4-week long intervention. Functional gains were calculated for all tests.Hemorrhagic and ischemic subjects showed significant improvements in Functional Ambulation Category (P<0.001 and P = 0.008, respectively, Postural Assessment Scale for Stroke (P<0.001 and P = 0.003, 6 Minutes Walk Test (P = 0.003 and P = 0.015 and 10-Meter Walk Test (P = 0.001 and P = 0.024. Ischemic patients also showed significant improvements in Timed Up and Go. Significantly greater mean Functional Ambulation Category and Tinetti Performance Oriented Mobility Assessment gains were observed for hemorrhagic compared to ischemic, with large (dz = 0.81 and medium (dz = 0.66 effect sizes, respectively.Overall, both groups exhibited quasi similar functional improvements and benefits from the same type, length and frequency of blended conventional physiotherapy and RAGT

Recovery of gait and other motor functions after stroke: novel physical and pharmacological treatment strategies.

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Hesse, S

2004-01-01

The gait-lab at Klinik Berlin developed and evaluated novel physical and pharmacological strategies promoting the repetitive practise of hemiparetic gait in line with the slogan: who wants to relearn walking, has to walk. Areas of research are treadmill training with partial body weight support, enabling wheelchair-bound subjects to repetitively practice gait, the electromechanical gait trainer GT I reducing the effort on the therapists as compared to the manually assisted locomotor therapy, and the future HapticWalker which will allow the additional practise of stair climbing up and down and of perturbations. Further means to promote gait practice after stroke was the application of botulinum toxin A for the treatment of lower limb spasticity and the early use of walking aids. New areas of research are also the study of D-Amphetamine, which failed to promote motor recovery in acute stroke patients as compared to placebo, and the development of a computerized arm trainer, Bi-Manu-T rack, for the bilateral treatment of patients with a severe upper limb paresis.

A pilot clinical trial on a Variable Automated Speed and Sensing Treadmill (VASST) for hemiparetic gait rehabilitation in stroke patients.

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Chua, Karen S G; Chee, Johnny; Wong, Chin J; Lim, Pang H; Lim, Wei S; Hoo, Chuan M; Ong, Wai S; Shen, Mira L; Yu, Wei S

2015-01-01

Impairments in walking speed and capacity are common problems after stroke which may benefit from treadmill training. However, standard treadmills, are unable to adapt to the slower walking speeds of stroke survivors and are unable to automate training progression. This study tests a Variable Automated Speed and Sensing Treadmill (VASST) using a standard clinical protocol. VASST is a semi-automated treadmill with multiple sensors and micro controllers, including wireless control to reposition a fall-prevention harness, variable pre-programmed exercise parameters and laser beam foot sensors positioned on the belt to detect subject's foot positions. An open-label study with assessor blinding was conducted in 10 community-dwelling chronic hemiplegic patients who could ambulate at least 0.1 m/s. Interventions included physiotherapist-supervised training on VASST for 60 min three times per week for 4 weeks (total 12 h). Outcome measures of gait speed, quantity, balance, and adverse events were assessed at baseline, 2, 4, and 8 weeks. Ten subjects (8 males, mean age 55.5 years, 2.1 years post stroke) completed VASST training. Mean 10-m walk test speed was 0.69 m/s (SD = 0.29) and mean 6-min walk test distance was 178.3 m (84.0). After 4 weeks of training, 70% had significant positive gains in gait speed (0.06 m/s, SD = 0.08 m/s, P = 0.037); and 90% improved in walking distance. (54.3 m, SD = 30.9 m, P = 0.005). There were no adverse events. This preliminary study demonstrates the initial feasibility and short-term efficacy of VASST for walking speed and distance for people with chronic post-stroke hemiplegia.

Measurement of passive ankle stiffness in subjects with chronic hemiparesis using a novel ankle robot

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Roy, Anindo; Bever, Christopher T.; Forrester, Larry W.; Macko, Richard F.; Hogan, Neville

2011-01-01

Our objective in this study was to assess passive mechanical stiffness in the ankle of chronic hemiparetic stroke survivors and to compare it with those of healthy young and older (age-matched) individuals. Given the importance of the ankle during locomotion, an accurate estimate of passive ankle stiffness would be valuable for locomotor rehabilitation, potentially providing a measure of recovery and a quantitative basis to design treatment protocols. Using a novel ankle robot, we characterized passive ankle stiffness both in sagittal and in frontal planes by applying perturbations to the ankle joint over the entire range of motion with subjects in a relaxed state. We found that passive stiffness of the affected ankle joint was significantly higher in chronic stroke survivors than in healthy adults of a similar cohort, both in the sagittal as well as frontal plane of movement, in three out of four directions tested with indistinguishable stiffness values in plantarflexion direction. Our findings are comparable to the literature, thus indicating its plausibility, and, to our knowledge, report for the first time passive stiffness in the frontal plane for persons with chronic stroke and older healthy adults. PMID:21346215

Psychological factors and subjective cognitive complaints after stroke : Beyond depression and anxiety

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van Rijsbergen, Marielle; Mark, R.E.; Kop, W.J.; Kort, P.L.M.; Sitskoorn, M.M.

2018-01-01

Subjective Cognitive Complaints (SCC) are common after stroke and adversely affect quality of life. In the present study, we determined the associations of depression, anxiety, perceived stress and fatigue with post-stroke SCC, and whether these associations were independent of objective cognitive

Effects of game-based virtual reality on health-related quality of life in chronic stroke patients: A randomized, controlled study.

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Shin, Joon-Ho; Bog Park, Si; Ho Jang, Seong

2015-08-01

In the present study, we aimed to determine whether game-based virtual reality (VR) rehabilitation, combined with occupational therapy (OT), could improve health-related quality of life, depression, and upper extremity function. We recruited 35 patients with chronic hemiparetic stroke, and these participants were randomized into groups that underwent VR rehabilitation plus conventional OT, or the same amount of conventional OT alone, for 20 sessions over 4 weeks. Compared to baseline, the VR rehabilitation plus OT group exhibited significantly improved role limitation due to emotional problems (p=0.047). Compared to baseline, both groups also exhibited significantly improved depression (p=0.017) and upper extremity function (p=0.001), although the inter-group differences were not significant. However, a significant inter-group difference was observed for role limitation due to physical problems (p=0.031). Our results indicate that game-based VR rehabilitation has specific effects on health-related quality of life, depression, and upper extremity function among patients with chronic hemiparetic stroke. Copyright © 2015 Elsevier Ltd. All rights reserved.

Hemiparetic stepping to the beat: asymmetric response to metronome phase shift during treadmill gait.

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Pelton, Trudy A; Johannsen, Leif; Huiya Chen; Wing, Alan M

2010-06-01

Walking in time with a metronome is associated with improved spatiotemporal parameters in hemiparetic gait; however, the mechanism linking auditory and motor systems is poorly understood. Hemiparetic cadence control with metronome synchronization was examined to determine specific influences of metronome timing on treadmill walking. A within-participant experiment examined correction processes used to maintain heel strike synchrony with the beat by applying perturbations to the timing of a metronome. Eight chronic hemiparetic participants (mean age = 70 years; standard deviation = 12) were required to synchronize heel strikes with metronome pulses set according to each individual's comfortable speed (mean 0.4 m/s). During five 100-pulse trials, a fixed-phase baseline was followed by 4 unpredictable metronome phase shifts (20% of the interpulse interval), which amounted to 10 phase shifts on each foot. Infrared cameras recorded the motion of bilateral heel markers at 120 Hz. Relative asynchrony between heel strike responses and metronome pulses was used to index compensation for metronome phase shifts. Participants demonstrated compensation for phase shifts with convergence back to pre-phase shift asynchrony. This was significantly slower when the error occurred on the nonparetic side (requiring initial correction with the paretic limb) compared with when the error occurred on the paretic side (requiring initial nonparetic correction). Although phase correction of gait is slowed when the phase shift is delivered to the nonparetic side compared with the paretic side, phase correction is still present. This may underlie the utility of rhythmic auditory cueing in hemiparetic gait rehabilitation.

Grip type and task goal modify reach-to-grasp performance in post-stroke hemiparesis

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Schaefer, Sydney Y.; DeJong, Stacey L.; Cherry, Kendra M.; Lang, Catherine E.

2011-01-01

This study investigated whether grip type and/or task goal influenced reaching and grasping performance in post-stroke hemiparesis. Sixteen adults with post-stroke hemiparesis and twelve healthy adults reached to and grasped a cylindrical object using one of two grip types (3-finger or palmar) to achieve one of two task goals (hold or lift). Performance of the stroke group was characteristic of hemiparetic limb movement during reach-to-grasp, with more curved handpaths and slower velocities compared to the control group. These effects were present regardless of grip type or task goal. Other measures of reaching (reach time and reach velocity at object contact) and grasping (peak thumb-index finger aperture during the reach and peak grip force during the grasp) were differentially affected by grip type, task goal, or both, despite the presence of hemiparesis, providing new evidence that changes in motor patterns after stroke may occur to compensate for stroke-related motor impairment. PMID:22357103

The H2 robotic exoskeleton for gait rehabilitation after stroke: early findings from a clinical study.

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Bortole, Magdo; Venkatakrishnan, Anusha; Zhu, Fangshi; Moreno, Juan C; Francisco, Gerard E; Pons, Jose L; Contreras-Vidal, Jose L

2015-06-17

Stroke significantly affects thousands of individuals annually, leading to considerable physical impairment and functional disability. Gait is one of the most important activities of daily living affected in stroke survivors. Recent technological developments in powered robotics exoskeletons can create powerful adjunctive tools for rehabilitation and potentially accelerate functional recovery. Here, we present the development and evaluation of a novel lower limb robotic exoskeleton, namely H2 (Technaid S.L., Spain), for gait rehabilitation in stroke survivors. H2 has six actuated joints and is designed to allow intensive overground gait training. An assistive gait control algorithm was developed to create a force field along a desired trajectory, only applying torque when patients deviate from the prescribed movement pattern. The device was evaluated in 3 hemiparetic stroke patients across 4 weeks of training per individual (approximately 12 sessions). The study was approved by the Institutional Review Board at the University of Houston. The main objective of this initial pre-clinical study was to evaluate the safety and usability of the exoskeleton. A Likert scale was used to measure patient's perception about the easy of use of the device. Three stroke patients completed the study. The training was well tolerated and no adverse events occurred. Early findings demonstrate that H2 appears to be safe and easy to use in the participants of this study. The overground training environment employed as a means to enhance active patient engagement proved to be challenging and exciting for patients. These results are promising and encourage future rehabilitation training with a larger cohort of patients. The developed exoskeleton enables longitudinal overground training of walking in hemiparetic patients after stroke. The system is robust and safe when applied to assist a stroke patient performing an overground walking task. Such device opens the opportunity to study means

Prediction of motor outcomes and activities of daily living function using diffusion tensor tractography in acute hemiparetic stroke patients.

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Imura, Takeshi; Nagasawa, Yuki; Inagawa, Tetsuji; Imada, Naoki; Izumi, Hiroaki; Emoto, Katsuya; Tani, Itaru; Yamasaki, Hiroyuki; Ota, Yuichiro; Oki, Shuichi; Maeda, Tadanori; Araki, Osamu

2015-05-01

[Purpose] The efficacy of diffusion tensor imaging in the prediction of motor outcomes and activities of daily living function remains unclear. We evaluated the most appropriate diffusion tensor parameters and methodology to determine whether the region of interest- or tractography-based method was more useful for predicting motor outcomes and activities of daily living function in stroke patients. [Subjects and Methods] Diffusion tensor imaging data within 10 days after stroke onset were collected and analyzed for 25 patients. The corticospinal tract was analyzed. Fractional anisotropy, number of fibers, and apparent diffusion coefficient were used as diffusion tensor parameters. Motor outcomes and activities of daily living function were evaluated on the same day as diffusion tensor imaging and at 1 month post-onset. [Results] The fractional anisotropy value of the affected corticospinal tract significantly correlated with the motor outcome and activities of daily living function within 10 days post-onset and at 1 month post-onset. Tthere were no significant correlations between other diffusion tensor parameters and motor outcomes or activities of daily living function. [Conclusion] The fractional anisotropy value of the affected corticospinal tract obtained using the tractography-based method was useful for predicting motor outcomes and activities of daily living function in stroke patients.

Psychological factors are associated with subjective cognitive complaints 2 months post-stroke.

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Nijsse, Britta; van Heugten, Caroline M; van Mierlo, Marloes L; Post, Marcel W M; de Kort, Paul L M; Visser-Meily, Johanna M A

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 were assessed at 2 months post-stroke, using the Checklist for Cognitive and Emotional consequences following stroke (CLCE-24) to identify cognitive complaints. Psychological factors were: proactive coping, passive coping, self-efficacy, optimism, pessimism, extraversion, and neuroticism. Associations between CLCE-24 cognition score and psychological factors, emotional problems (depressive symptoms and anxiety), cognitive deficits, and demographic and stroke characteristics were examined using Spearman correlations and multiple regression analyses. Results showed that 2 months post-stroke, 270 patients (68.4%) reported at least one cognitive complaint. Age, sex, presence of recurrent stroke(s), comorbidity, cognitive deficits, depressive symptoms, anxiety, and all psychological factors were significantly associated with the CLCE-24 cognition score in bivariate analyses. Multiple regression analysis showed that psychological factors explained 34.7% of the variance of cognitive complaints independently, and 8.5% (p psychological factors, proactive coping was independently associated with cognitive complaints (p cognitive complaints. Because cognitive complaints are common after stroke and are associated with psychological factors, it is important to focus on these factors in rehabilitation programmes.

The effects of Pilates exercise training on static and dynamic balance in chronic stroke patients: a randomized controlled trial

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Lim, Hee Sung; Kim, You Lim; Lee, Suk Min

2016-01-01

[Purpose] The purpose of this study was to analyze the effects of Pilates exercise on static and dynamic balance in chronic stroke patients. [Subjects and Methods] Nineteen individuals with unilateral chronic hemiparetic stroke (age, 64.7 ± 6.9 years; height, 161.7 ± 7.9 cm; weight, 67.0 ± 11.1 kg) were randomly allocated to either a Pilates exercise group (PG, n=10) or a control group (CG, n=9). The PG attended 24 exercise sessions conducted over an 8-week period (3 sessions/week). Center of pressure (COP) sway and COP velocity were measured one week before and after the exercise program and compared to assess training effects. [Results] Pilates exercise positively affected both static and dynamic balance in patients with chronic stroke. For static balance, COP sway and velocity in the medial-lateral (M-L) and anterior-posterior (A-P) directions were significantly decreased in the PG after training while no significant differences were found in the CG. For dynamic balance, measured during treadmill walking, the PG showed significantly reduced COP sway and velocity in the M-L and A-P directions for both the paretic and non-paretic leg. [Conclusions] The findings provide initial evidence that Pilates exercise can enhance static and dynamic balance in patients with chronic stroke. PMID:27390424

EFFECTIVENESS OF A NEW BALANCE TRAINING PROGRAM ON ROCKER BOARD IN SITTING IN STROKE SUBJECTS A PILOT STUDY

Directory of Open Access Journals (Sweden)

Sandesh Rayamajhi

2014-06-01

Full Text Available Background: Stroke has been considered to be the most common cause of neurological disability with very high prevalence rate. The recovery of independence following stroke is a complex process requiring the reacquisition of many skills. Since controlling the body’s position in space is essential part of functional skills, restoration of balance is a critical part of the recovery of ability after stroke. Most of the work done regarding balance training in stroke subjects has focused on task-oriented activities and training under varied sensory input and found them to be effective. Studies have also compared the effect of stable and unstable surfaces on balance in stroke subjects and found that balance training on unstable surfaces is more effective in improving static and dynamic balance. There has not been any study till date investigating the effectiveness of balance training program on rocker board which is specific for stroke subjects who have difficulty in standing. Since balance training on rocker board in sitting has proved to be effective in improving balance in subjects with spinal cord injury who have difficulty in standing, there is a need to find out if similar balance training program on rocker board in sitting is also effective for improving balance of stroke subjects. Method: A Pilot study was performed on 10 stroke subjects selected through purposive sampling. Subjects were divided into two groups by randomization as control (CG and experimental group (EG. EG received balance training on a rocker board along with conventional physiotherapy program. The CG received only conventional physiotherapy program. Results: Post-intervention Berg balance scale score of EG and the CG was statistically significant (p < 0.05 in both the groups as compared to pre-treatment depicted through Wilcoxon signed rank analysis within the groups. Greater improvement was observed in the EG compared to the CG post-treatment, analysed through Mann

Motor rehabilitation after traumatic brain injury and stroke - Advances in assessment and therapy.

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Platz, Thomas; Hesse, S.; Mauritz, K.-H.

1999-01-01

A long-term goal in motor rehabilitation is that treatment is not selected on the basis of 'schools of thought', but rather, based on knowledge about efficacy and effectiveness of specific interventions for specific situations (e.g. functional syndromes). Motor dysfunction after stroke or TBI can be caused by many different functional syndromes such as paresis, ataxia, deafferentaion, visuo-perceptual deficits, or apraxia. Examples are provided showing that theory-based analysis of motor behavior makes it possible to describe 'syndrome-specific motor deficits'. Its potential implications for motor rehabilitation are that our understanding of altered motor behavior as well as specific therapeutic approaches might be promoted. A methodological prerequisite for clinical trials in rehabilitation is knowledge about test properties of assessment tools in follow-up situations such as test-retest reliability and responsiveness to change. Test-retest reliability assesses whether a test can produce stable measures with test repetition, while sensitivity to change reflects whether a test detects changes that occur over time. Exemplifying these considerations, a reliability and validity study of a kinematic arm movement analysis is summarized. In terms of new therapeutic developments, two examples of clinical therapeutic studies are provided assessing the efficacy of specific inter-ventions for specific situations in arm and gait rehabilitation: the Arm Ability Training for high functioning hemiparetic stroke and TBI patients, and the treadmill training for non-ambulatory hemiparetic patients. In addition, a new technical development, a machine-controlled gait trainer ist introduced.

Workspace location influences joint coordination during reaching in post-stroke hemiparesis

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Reisman, Darcy S.; Scholz, John P.

2006-01-01

The purpose of this study was to determine the influence of workspace location on joint coordination in persons with post-stroke hemiparesis when trunk motion was required to complete reaches beyond the arm’s functional reach length. Seven subjects with mild right hemiparesis following a stroke and seven age and gender matched control subjects participated. Joint motions and characteristics of hand and trunk movement were measured over multiple repetitions. The variance (across trials) of joint combinations was partitioned into two components at every point in the hand’s trajectory using the uncontrolled manifold approach; the first component is a measure of the extent to which equivalent joint combinations are used to control a given hand path, and reflects performance flexibility. The second component of joint variance reflects the use of non-equivalent joint combinations, which lead to hand path error. Compared to the control subjects, persons with hemiparesis demonstrated a significantly greater amount of non-equivalent joint variability related to control of the hand’s path and of the hand’s position relative to the trunk when reaching toward the hemiparetic side (ipsilaterally), but not when reaching to the less involved side. The relative timing of the hand and trunk was also altered when reaching ipsilaterally. The current findings support the idea that the previously proposed “arm compensatory synergy” may be deficient in subjects with hemiparesis. This deficiency may be due to one or a combination of factors: changes in central commands that are thought to set the gain of the arm compensatory synergy; a limited ability to combine shoulder abduction and elbow extension that limits the expression of an appropriately set arm compensatory synergy; or a reduction of the necessary degrees-of-freedom needed to adequately compensate for poor trunk control when reaching ipsilaterally. PMID:16328275

Modeling and simulation of normal and hemiparetic gait

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Luengas, Lely A.; Camargo, Esperanza; Sanchez, Giovanni

2015-09-01

Gait is the collective term for the two types of bipedal locomotion, walking and running. This paper is focused on walking. The analysis of human gait is of interest to many different disciplines, including biomechanics, human-movement science, rehabilitation and medicine in general. Here we present a new model that is capable of reproducing the properties of walking, normal and pathological. The aim of this paper is to establish the biomechanical principles that underlie human walking by using Lagrange method. The constraint forces of Rayleigh dissipation function, through which to consider the effect on the tissues in the gait, are included. Depending on the value of the factor present in the Rayleigh dissipation function, both normal and pathological gait can be simulated. First of all, we apply it in the normal gait and then in the permanent hemiparetic gait. Anthropometric data of adult person are used by simulation, and it is possible to use anthropometric data for children but is necessary to consider existing table of anthropometric data. Validation of these models includes simulations of passive dynamic gait that walk on level ground. The dynamic walking approach provides a new perspective of gait analysis, focusing on the kinematics and kinetics of gait. There have been studies and simulations to show normal human gait, but few of them have focused on abnormal, especially hemiparetic gait. Quantitative comparisons of the model predictions with gait measurements show that the model can reproduce the significant characteristics of normal gait.

Daily life activity routine discovery in hemiparetic rehabilitation patients using topic models.

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Seiter, J; Derungs, A; Schuster-Amft, C; Amft, O; Tröster, G

2015-01-01

Monitoring natural behavior and activity routines of hemiparetic rehabilitation patients across the day can provide valuable progress information for therapists and patients and contribute to an optimized rehabilitation process. In particular, continuous patient monitoring could add type, frequency and duration of daily life activity routines and hence complement standard clinical scores that are assessed for particular tasks only. Machine learning methods have been applied to infer activity routines from sensor data. However, supervised methods require activity annotations to build recognition models and thus require extensive patient supervision. Discovery methods, including topic models could provide patient routine information and deal with variability in activity and movement performance across patients. Topic models have been used to discover characteristic activity routine patterns of healthy individuals using activity primitives recognized from supervised sensor data. Yet, the applicability of topic models for hemiparetic rehabilitation patients and techniques to derive activity primitives without supervision needs to be addressed. We investigate, 1) whether a topic model-based activity routine discovery framework can infer activity routines of rehabilitation patients from wearable motion sensor data. 2) We compare the performance of our topic model-based activity routine discovery using rule-based and clustering-based activity vocabulary. We analyze the activity routine discovery in a dataset recorded with 11 hemiparetic rehabilitation patients during up to ten full recording days per individual in an ambulatory daycare rehabilitation center using wearable motion sensors attached to both wrists and the non-affected thigh. We introduce and compare rule-based and clustering-based activity vocabulary to process statistical and frequency acceleration features to activity words. Activity words were used for activity routine pattern discovery using topic models

Grip type and task goal modify reach-to-grasp performance in post-stroke hemiparesis.

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Schaefer, Sydney Y; DeJong, Stacey L; Cherry, Kendra M; Lang, Catherine E

2012-04-01

This study investigated whether grip type and/or task goal influenced reaching and grasping performance in poststroke hemiparesis. Sixteen adults with poststroke hemiparesis and twelve healthy adults reached to and grasped a cylindrical object using one of two grip types (3-finger or palmar) to achieve one of two task goals (hold or lift). Performance of the stroke group was characteristic of hemiparetic limb movement during reach-to-grasp, with more curved handpaths and slower velocities compared with the control group. These effects were present regardless of grip type or task goal. Other measures of reaching (reach time and reach velocity at object contact) and grasping (peak thumb-index finger aperture during the reach and peak grip force during the grasp) were differentially affected by grip type, task goal, or both, despite the presence of hemiparesis, providing new evidence that changes in motor patterns after stroke may occur to compensate for stroke-related motor impairment.

THE EFFECTIVENESS OF EMG BIOFEEDBACK ON HAND FUNCTION IN SUBJECTS WITH STROKE

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S. Sethana

2014-10-01

Full Text Available Introduction: Stroke is an event caused by the interruption of the blood supply to the brain, usually because a blood vessel bursts or blocked by a clot. Biofeedback can be defined as the technique of using equipment usually electronic to reveal to human beings about some of their internal physiological events normal and abnormal in form of auditory and visual signals. Method: The stroke patients diagnosed by neurologist were recruited from physiotherapy department and inpatients from neurology and general wards of SVIMS hospital, Tirupathi Andhra Pradesh. In the present study 30 subjects were randomly assigned to 15 experimental and 15 control groups. The subject was made to sit comfortably and the Surfaces electrodes were placed on Extensor carpi radialis, Extensor digitorum communis muscle belly and for 30minutes patient voluntarily contracts until signals displayed on screen for which visually and auditory cues are given. In control group placebo EMG where machine is turned away & has no cues. Both groups received CONVENTIONAL PHYSIOTHERAPY; for 30 minutes at a Frequency: 1 hour per day for 5days in a week, for 6weeks. Results: There was statistically significant (p<0.05 improvement in both variables from baseline to 6thweek in experimental group compared to control group. Conclusion: Our study demonstrates the potential benefits of EMG BF in improving hand function in subjects with stroke.

Resting-State Functional Connectivity and Cognitive Impairment in Children with Perinatal Stroke

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Nigul Ilves

2016-01-01

Full Text Available Perinatal stroke is a leading cause of congenital hemiparesis and neurocognitive deficits in children. Dysfunctions in the large-scale resting-state functional networks may underlie cognitive and behavioral disability in these children. We studied resting-state functional connectivity in patients with perinatal stroke collected from the Estonian Pediatric Stroke Database. Neurodevelopment of children was assessed by the Pediatric Stroke Outcome Measurement and the Kaufman Assessment Battery. The study included 36 children (age range 7.6–17.9 years: 10 with periventricular venous infarction (PVI, 7 with arterial ischemic stroke (AIS, and 19 controls. There were no differences in severity of hemiparesis between the PVI and AIS groups. A significant increase in default mode network connectivity (FDR 0.1 and lower cognitive functions (p<0.05 were found in children with AIS compared to the controls and the PVI group. The children with PVI had no significant differences in the resting-state networks compared to the controls and their cognitive functions were normal. Our findings demonstrate impairment in cognitive functions and neural network profile in hemiparetic children with AIS compared to children with PVI and controls. Changes in the resting-state networks found in children with AIS could possibly serve as the underlying derangements of cognitive brain functions in these children.

A soft robotic exosuit improves walking in patients after stroke.

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Awad, Louis N; Bae, Jaehyun; O'Donnell, Kathleen; De Rossi, Stefano M M; Hendron, Kathryn; Sloot, Lizeth H; Kudzia, Pawel; Allen, Stephen; Holt, Kenneth G; Ellis, Terry D; Walsh, Conor J

2017-07-26

Stroke-induced hemiparetic gait is characteristically slow and metabolically expensive. Passive assistive devices such as ankle-foot orthoses are often prescribed to increase function and independence after stroke; however, walking remains highly impaired despite-and perhaps because of-their use. We sought to determine whether a soft wearable robot (exosuit) designed to supplement the paretic limb's residual ability to generate both forward propulsion and ground clearance could facilitate more normal walking after stroke. Exosuits transmit mechanical power generated by actuators to a wearer through the interaction of garment-like, functional textile anchors and cable-based transmissions. We evaluated the immediate effects of an exosuit actively assisting the paretic limb of individuals in the chronic phase of stroke recovery during treadmill and overground walking. Using controlled, treadmill-based biomechanical investigation, we demonstrate that exosuits can function in synchrony with a wearer's paretic limb to facilitate an immediate 5.33 ± 0.91° increase in the paretic ankle's swing phase dorsiflexion and 11 ± 3% increase in the paretic limb's generation of forward propulsion ( P exosuit was sufficient to facilitate more normal walking in ambulatory individuals after stroke. Future work will focus on understanding how exosuit-induced improvements in walking performance may be leveraged to improve mobility after stroke. Copyright © 2017 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works.

The neural substrates of impaired finger tapping regularity after stroke.

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Calautti, Cinzia; Jones, P Simon; Guincestre, Jean-Yves; Naccarato, Marcello; Sharma, Nikhil; Day, Diana J; Carpenter, T Adrian; Warburton, Elizabeth A; Baron, Jean-Claude

2010-03-01

Not only finger tapping speed, but also tapping regularity can be impaired after stroke, contributing to reduced dexterity. The neural substrates of impaired tapping regularity after stroke are unknown. Previous work suggests damage to the dorsal premotor cortex (PMd) and prefrontal cortex (PFCx) affects externally-cued hand movement. We tested the hypothesis that these two areas are involved in impaired post-stroke tapping regularity. In 19 right-handed patients (15 men/4 women; age 45-80 years; purely subcortical in 16) partially to fully recovered from hemiparetic stroke, tri-axial accelerometric quantitative assessment of tapping regularity and BOLD fMRI were obtained during fixed-rate auditory-cued index-thumb tapping, in a single session 10-230 days after stroke. A strong random-effect correlation between tapping regularity index and fMRI signal was found in contralesional PMd such that the worse the regularity the stronger the activation. A significant correlation in the opposite direction was also present within contralesional PFCx. Both correlations were maintained if maximal index tapping speed, degree of paresis and time since stroke were added as potential confounds. Thus, the contralesional PMd and PFCx appear to be involved in the impaired ability of stroke patients to fingertap in pace with external cues. The findings for PMd are consistent with repetitive TMS investigations in stroke suggesting a role for this area in affected-hand movement timing. The inverse relationship with tapping regularity observed for the PFCx and the PMd suggests these two anatomically-connected areas negatively co-operate. These findings have implications for understanding the disruption and reorganization of the motor systems after stroke. Copyright (c) 2009 Elsevier Inc. All rights reserved.

Functional influence of botulinum neurotoxin type A treatment (Xeomin® of multifocal upper and lower limb spasticity on chronic hemiparetic gait

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Maurizio Falso

2012-05-01

Full Text Available This report describes the modification of hemiplegic shoulder pain and walking velocity through injections of Xeomin®, a new botulinum neurotoxin type A formulation, in a 67-year-old woman with chronic residual left hemiparesis and hemiparetic gait attributable to stroke. Clinical evaluation included upper and lower limb spasticity, upper and lower limb pain, trunk control, upper and lower limb motricity index, visual gait analysis, and gait velocity. Assessments were performed before, 1 week after, and 1 month after treatment. Improvement was observed in all clinical parameters assessed. Amelioration of spasticity of the upper and lower limbs and shoulder pain was observed after 1 month. Trunk postural attitude and paraxial muscle recruitment recovered. No adverse events were observed and the patient shows significant improvement of functional impairment derived from chronic spasticity after treatment with Xeomin®. We also provide a simple and useful protocol for clinical evaluation of the treatment.

A comparison of at-home walking and 10-meter walking test parameters of individuals with post-stroke hemiparesis.

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Nagano, Katsuhito; Hori, Hideaki; Muramatsu, Ken

2015-02-01

[Purpose] The purpose of this study was to clarify the difference in gait parameters of at-home walking and the 10-meter walking test results of individuals with hemiparesis. [Subjects] A total of 14 hemiparetic stroke recovery patients participated in this study. Inclusion criteria were: living at home, the ability to walk independently, and demonstrated low extremity on recovery stages III-V on the Brunnstrom Approach. The average age of the subjects was 66 years. [Methods] We used video surveillance and the inked footprint technique to record usual walking speed and maximum speed patterns both in subjects' homes and during the 10-meter walking test. From these methods, walking speed, stride length, and step rate were calculated. [Results] While both usual and maximum walking speeds of the 10-meter walking test correlated with stride length and step rate, at-home walking speeds only significantly correlated with stride length. [Conclusion] Walking patterns of the 10-meter walking test are quantifiably distinct from those demonstrated in patients' homes, and this difference is mainly characterized by stride length. In order to enhance in-home walking ability, exercises that improve length of stride rather than step rate should be recommended.

Unilateral Arm Crank Exercise Test for Assessing Cardiorespiratory Fitness in Individuals with Hemiparetic Stroke

DEFF Research Database (Denmark)

Oyake, Kazuaki; Yamaguchi, Tomofumi; Oda, Chihiro

2017-01-01

Cardiorespiratory fitness assessment with leg cycle exercise testing may be influenced by motor impairments in the paretic lower extremity. Hence, this study examined the usefulness of a unilateral arm crank exercise test to assess cardiorespiratory fitness in individuals with stroke, including s...

Alterações eletromiográficas dos músculos do tronco de pacientes com hemiparesia após acidente vascular encefálico Electromyographic alterations of trunk muscle of patients with post-stroke hemiparesis

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Fernando Cesar Iwamoto Marcucci

2007-09-01

Full Text Available O acidente vascular encefálico é a principal causa de incapacidade crônica em adultos, porém poucos estudos avaliaram a motricidade do tronco nestes indivíduos. OBJETIVO: Comparar a atividade mioelétrica do tronco entre indivíduos hemiparéticos e controle. MÉTODO: Foram avaliados oito indivíduos hemiparéticos e oito controles, por meio de eletromiografia de superfície (EMGs, durante atividades de flexão dos membros inferiores e rotação do tronco em supino; levantar e elevação dos membros superiores na posição sentada. RESULTADOS: O músculo reto abdominal parético apresentou maior ativação que o grupo controle (p=0,031 durante a flexão dos membros inferiores. Os músculos oblíquos apresentaram, bilateralmente, maior ativação na elevação dos membros inferiores do que na rotação (p=0,014 e p=0,002, respectivamente. Não houve diferenças entre músculos eretores durante as atividades. CONCLUSÃO: Os músculos flexores do tronco de indivíduos hemiparéticos apresentaram alterações motoras no reto abdominal do lado parético e realizam compensações por meio dos oblíquos externos.Stroke is the main cause of chronic disability in adults, but few studies evaluated the trunk motor activity in affected subjects. OBJECTIVE: To compare the myoelectrical activity of trunk muscle in hemiparetic and control subjects. METHOD: Eight hemiparetic and eight control subjects were assessed during lower extremities flexion and trunk rotation in supine position; stand up and rise up upper extremities in seated position. RESULTS: Paretic rectus abdominis presented a higher activation than control group (p=0.031 during lower extremities elevation. Obliquus externus abdominis showed a bilateral higher activation during lower extremities elevation than rotation activities (p=0.014 and p=0.002, respectively. There was no difference in extension activities comparison. CONCLUSION: Trunk flexor muscles of hemiparetic subjects demonstrated

Corticospinal tract integrity and motor function following neonatal stroke: a case study

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Gordon Anne L

2012-07-01

Full Text Available Abstract Background New MRI techniques enable visualisation of corticospinal tracts and cortical motor activity. The objective of this case study was to describe the magnetic resonance evidence of corticospinal pathway reorganisation following neonatal stroke. Case presentation An 11 year old boy with a neonatal right middle cerebral artery territory ischaemic stroke was studied. Functional MRI was undertaken with a whole hand squeezing task, comparing areas of cortical activation between hands. White matter tracts, seeded from the area of peak activation in the cortex, were visualised using a diffusion weighted imaging probabilistic tractography method. Standardised evaluations of unilateral and bilateral motor function were undertaken. Clinically, the child presented with a left hemiparesis. Functional MRI demonstrated that movement of the hemiparetic hand resulted in activation in the ipsi-lesional (right hemisphere only. Diffusion tractography revealed pathways in the right (lesioned hemisphere tracked perilesionally to the cortical area identified by functional MRI. Conclusion Our case demonstrates that neonatal stroke is associated with maintenance of organization of corticospinal pathways sufficient to maintain some degree of hand function in the affected hemisphere. Functional MRI and diffusion weighted imaging tractography may inform our understanding of recovery, organisation and reorganisation and have the potential to monitor responses to intervention following neonatal stroke.

Progressive Abduction Loading Therapy with Horizontal-Plane Viscous Resistance Targeting Weakness and Flexion Synergy to Treat Upper Limb Function in Chronic Hemiparetic Stroke: A Randomized Clinical Trial.

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Ellis, Michael D; Carmona, Carolina; Drogos, Justin; Dewald, Julius P A

2018-01-01

Progressive abduction loading therapy has emerged as a promising exercise therapy in stroke rehabilitation to systematically target the loss of independent joint control (flexion synergy) in individuals with chronic moderate/severe upper-extremity impairment. Preclinical investigations have identified abduction loading during reaching exercise as a key therapeutic factor to improve reaching function. An augmentative approach may be to additionally target weakness by incorporating resistance training to increase constitutive joint torques of reaching with the goal of improving reaching function by "overpowering" flexion synergy. The objective was, therefore, to determine the therapeutic effects of horizontal-plane viscous resistance in combination with progressive abduction loading therapy. 32 individuals with chronic hemiparetic stroke were randomly allocated to two groups. The two groups had equivalent baseline characteristics on all demographic and outcome metrics including age (59 ± 11 years), time poststroke (10.1 ± 7.6 years), and motor impairment (Fugl-Meyer, 26.7 ± 6.5 out of 66). Both groups received therapy three times/week for 8 weeks while the experimental group included additional horizontal-plane viscous resistance. Quantitative standardized progression of the intervention was achieved using a robotic device. The primary outcomes of reaching distance and velocity under maximum abduction loading and secondary outcomes of isometric strength and a clinical battery were measured at pre-, post-, and 3 months following therapy. There was no difference between groups on any outcome measure. However, for combined groups, there was a significant increase in reaching distance (13.2%, effect size; d  = 0.56) and velocity (13.6%, effect size; d  = 0.27) at posttesting that persisted for 3 months and also a significant increase in abduction, elbow extension, and external rotation strength at posttesting that did not persist 3�

Reducing Circumduction and Hip Hiking During Hemiparetic Walking Through Targeted Assistance of the Paretic Limb Using a Soft Robotic Exosuit.

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Awad, Louis N; Bae, Jaehyun; Kudzia, Pawel; Long, Andrew; Hendron, Kathryn; Holt, Kenneth G; OʼDonnell, Kathleen; Ellis, Terry D; Walsh, Conor J

2017-10-01

The aim of the study was to evaluate the effects on common poststroke gait compensations of a soft wearable robot (exosuit) designed to assist the paretic limb during hemiparetic walking. A single-session study of eight individuals in the chronic phase of stroke recovery was conducted. Two testing conditions were compared: walking with the exosuit powered versus walking with the exosuit unpowered. Each condition was 8 minutes in duration. Compared with walking with the exosuit unpowered, walking with the exosuit powered resulted in reductions in hip hiking (27 [6%], P = 0.004) and circumduction (20 [5%], P = 0.004). A relationship between changes in knee flexion and changes in hip hiking was observed (Pearson r = -0.913, P Exosuit assistance of the paretic limb during walking produces immediate changes in the kinematic strategy used to advance the paretic limb. Future work is necessary to determine how exosuit-induced reductions in paretic hip hiking and circumduction during gait training could be leveraged to facilitate more normal walking behavior during unassisted walking.

Prolonged corrected QT interval is predictive of future stroke events even in subjects without ECG-diagnosed left ventricular hypertrophy.

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Ishikawa, Joji; Ishikawa, Shizukiyo; Kario, Kazuomi

2015-03-01

We attempted to evaluate whether subjects who exhibit prolonged corrected QT (QTc) interval (≥440 ms in men and ≥460 ms in women) on ECG, with and without ECG-diagnosed left ventricular hypertrophy (ECG-LVH; Cornell product, ≥244 mV×ms), are at increased risk of stroke. Among the 10 643 subjects, there were a total of 375 stroke events during the follow-up period (128.7±28.1 months; 114 142 person-years). The subjects with prolonged QTc interval (hazard ratio, 2.13; 95% confidence interval, 1.22-3.73) had an increased risk of stroke even after adjustment for ECG-LVH (hazard ratio, 1.71; 95% confidence interval, 1.22-2.40). When we stratified the subjects into those with neither a prolonged QTc interval nor ECG-LVH, those with a prolonged QTc interval but without ECG-LVH, and those with ECG-LVH, multivariate-adjusted Cox proportional hazards analysis demonstrated that the subjects with prolonged QTc intervals but not ECG-LVH (1.2% of all subjects; incidence, 10.7%; hazard ratio, 2.70, 95% confidence interval, 1.48-4.94) and those with ECG-LVH (incidence, 7.9%; hazard ratio, 1.83; 95% confidence interval, 1.31-2.57) had an increased risk of stroke events, compared with those with neither a prolonged QTc interval nor ECG-LVH. In conclusion, prolonged QTc interval was associated with stroke risk even among patients without ECG-LVH in the general population. © 2014 American Heart Association, Inc.

Cortical reorganization associated lower extremity motor recovery as evidenced by functional MRI and diffusion tensor tractography in a stroke patient.

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Jang, Sung Ho; You, Sung H; Kwon, Yong-Hyun; Hallett, Mark; Lee, Mi Young; Ahn, Sang Ho

2005-01-01

Recovery mechanisms supporting upper extremity motor recovery following stroke are well established, but cortical mechanism associated with lower extremity motor recovery is unknown. The aim of this study was to assess cortical reorganization associated with lower extremity motor recovery in a hemiparetic patient. Six control subjects and a 17 year-old woman with left intracerebral hemorrhage due to an arterio-venous malformation rupture were evaluated. The motor function of the paretic (left) hip and knee had recovered slowly to the extent of her being able to overcome gravity for 10 months after the onset of stroke. However, her paretic upper extremity showed no significant motor recovery. Blood oxygenation level dependent (BOLD) functional MRI at 1.5 Tesla was used to determine the acutual location of cortical activation in the predefined regions of interest. Concurrently, Diffusion Tensor Imaging (DTI) in combination with a novel 3D-fiber reconstruction algorithm was utilized to investigate the pattern of the corticospinal pathway connectivity between the areas of the motor stream. All subjects' body parts were secured in the scanner and performed a sequential knee flexion-extension with a predetermined angle of 0-60 degrees at 0.5 Hz. Controls showed anticipated activation in the contralateral sensorimotor cortex (SM1) and the descending corticospinal fibers stemming from motor cortex. In contrast to control normal subjects, the stroke patient showed fMRI activation only in the unaffected (right) primary SM1 during either paretic or nonparetic knee movements. DTT fiber tracing data showed that the corticospinal tract fibers were found only in the unaffected hemisphere but not in the affected hemisphere. Our results indicate that an ipsilateral motor pathway from the unaffected (right) motor cortex to the paretic (right) leg was present in this patient. This study raises the potential that the contralesional (ipsilateral) SM1 is involved in cortical

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

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Fragoso Ana

2012-03-01

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

Robot-assisted reaching exercise promotes arm movement recovery in chronic hemiparetic stroke: a randomized controlled pilot study

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Rymer W Zev

2006-06-01

Full Text Available Abstract Background and purpose Providing active assistance to complete desired arm movements is a common technique in upper extremity rehabilitation after stroke. Such active assistance may improve recovery by affecting somatosensory input, motor planning, spasticity or soft tissue properties, but it is labor intensive and has not been validated in controlled trials. The purpose of this study was to investigate the effects of robotically administered active-assistive exercise and compare those with free reaching voluntary exercise in improving arm movement ability after chronic stroke. Methods Nineteen individuals at least one year post-stroke were randomized into one of two groups. One group performed 24 sessions of active-assistive reaching exercise with a simple robotic device, while a second group performed a task-matched amount of unassisted reaching. The main outcome measures were range and speed of supported arm movement, range, straightness and smoothness of unsupported reaching, and the Rancho Los Amigos Functional Test of Upper Extremity Function. Results and discussion There were significant improvements with training for range of motion and velocity of supported reaching, straightness of unsupported reaching, and functional movement ability. These improvements were not significantly different between the two training groups. The group that performed unassisted reaching exercise improved the smoothness of their reaching movements more than the robot-assisted group. Conclusion Improvements with both forms of exercise confirmed that repeated, task-related voluntary activation of the damaged motor system is a key stimulus to motor recovery following chronic stroke. Robotically assisting in reaching successfully improved arm movement ability, although it did not provide any detectable, additional value beyond the movement practice that occurred concurrently with it. The inability to detect any additional value of robot-assisted reaching

Measurement properties of the upright motor control test for adults with stroke: a systematic review.

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Gorgon, Edward James R; Lazaro, Rolando T

2016-01-01

The Upright Motor Control Test (UMCT) has been used in clinical practice and research to assess functional strength of the hemiparetic lower limb in adults with stroke. It is unclear if evidence is sufficient to warrant its use. The purpose of this systematic review was to synthesize available evidence on the measurement properties of the UMCT for stroke rehabilitation. Electronic databases that indexed biomedical literature were systematically searched from inception until October 2015 (week 4): Embase, PubMed, Web of Science, CINAHL, PEDro, Cochrane Library, Scopus, ScienceDirect, SPORTDiscus, LILACS, DOAJ, and Google Scholar. All studies that had used the UMCT in the time period covered underwent hand searching for any additional study. Observational studies involving adults with stroke that explored any measurement property of the UMCT were included. The COnsensus-based Standards for the selection of health Measurement INstruments was used to assess the methodological quality of included studies. The CanChild Outcome Measures Rating Form was used for extracting data on measurement properties and clinical utility. The search yielded three methodologic studies that addressed criterion-related validity and contruct validity. Two studies of fair methodological quality demonstrated moderate-level evidence that Knee Extension and Knee Flexion subtest scores were predictive of community-level and household-level ambulation. One study of fair methodological quality provided limited-level evidence for the correlation of Knee Extension subtest scores with a laboratory measure of ground reaction forces. No published studies formally assessed reliability, responsiveness, or clinical utility. Limited information on responsiveness and clinical utility dimensions could be inferred from the included studies. The UMCT is a practical assessment tool for voluntary control or functional strength of the hemiparetic lower limb in standing in adults with stroke. Although different

Generalization of improved step length symmetry from treadmill to overground walking in persons with stroke and hemiparesis†

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Savin, Douglas N.; Morton, Susanne M.; Whitall, Jill

2013-01-01

Objectives Determine whether adaptation to a swing phase perturbation during gait transferred from treadmill to overground walking, the rate of overground deadaptation, and whether overground aftereffects improved step length asymmetry in persons with hemiparetic stroke and gait asymmetry. Methods Ten participants with stroke and hemiparesis and 10 controls walked overground on an instrumented gait mat, adapted gait to a swing phase perturbation on a treadmill, then walked overground on the gait mat again. Outcome measures, primary: overground step length symmetry, rates of treadmill step length symmetry adaptation and overground step length symmetry deadaptation; secondary: overground gait velocity, stride length, and stride cycle duration. Results Step length symmetry aftereffects generalized to overground walking and adapted at a similar rate on the treadmill in both groups. Aftereffects decayed at a slower rate overground in participants with stroke and temporarily improved overground step length asymmetry. Both groups’ overground gait velocity increased post adaptation due to increased stride length and decreased stride duration. Conclusions Stroke and hemiparesis do not impair generalization of step length symmetry changes from adapted treadmill to overground walking, but prolong overground aftereffects. Significance Motor adaptation during treadmill walking may be an effective treatment for improving overground gait asymmetries post-stroke. PMID:24286858

Improved lower extremity pedaling mechanics in individuals with stroke under maximal workloads.

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Linder, Susan M; Rosenfeldt, Anson B; Bazyk, Andrew S; Koop, Mandy Miller; Ozinga, Sarah; Alberts, Jay L

2018-05-01

Background Individuals with stroke present with motor control deficits resulting in the abnormal activation and timing of agonist and antagonist muscles and inefficient movement patterns. The analysis of pedaling biomechanics provides a window into understanding motor control deficits, which vary as a function of workload. Understanding the relationship between workload and motor control is critical when considering exercise prescription during stroke rehabilitation. Objectives To characterize pedaling kinematics and motor control processes under conditions in which workload was systematically increased to an eventual patient-specific maximum. Methods A cohort study was conducted in which 18 individuals with chronic stroke underwent a maximal exertion cardiopulmonary exercise test on a stationary cycle ergometer, during which pedaling torque was continuously recorded. Measures of force production, pedaling symmetry, and pedaling smoothness were obtained. Results Mean Torque increased significantly (p pedaling action, improved from 0.37(0.29) to 0.29(0.35) during downstroke (p = 0.007), and worsened during the upstroke: -0.37(0.38) to -0.62(0.46) (p pedaling improved significantly from initial to terminal workloads (p pedaling kinematics at terminal workloads indicate that individuals with stroke demonstrate improved motor control with respect to the timing, sequencing, and activation of hemiparetic lower extremity musculature compared to lower workloads. Therapeutic prescription involving higher resistance may be necessary to sufficiently engage and activate the paretic lower extremity.

EFFECTIVENESS OF TRUNK TRAINING EXERCISES VERSUS SWISS BALL EXERCISES FOR IMPROVING SITTING BALANCE AND GAIT PARAMETERS IN ACUTE STROKE SUBJECTS

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Kothalanka Viswaja

2015-12-01

Full Text Available Background: The aim of this study is to evaluate the effectiveness of trunk training and Swiss ball exercises in acute stroke subjects. Trunk is often neglected part in the stroke rehabilitation, trunk training exercises and Swiss ball exercises result in better recruitment of trunk muscles thus improving sitting balance and gait parameters in acute stroke subjects. However literature evidences for trunk training exercises and Swiss ball exercises in improving sitting balance and gait are scarce in acute stroke population. Methods: A total of 60 subjects who met the inclusion criteria were recruited from department of physiotherapy, G.S.L general hospital and were randomly allocated into 2 groups with 30 subjects in each group. Initially all of them were screened for balance and gait using trunk impairment scale and by assessing gait parameters, after that they were given a 30min of trunk training and Swiss ball exercises for 5 days a week for 4 weeks. Both the groups received conventional physiotherapy for 4 weeks. Results: Post intervention there was no significant difference between the two groups. There was improvement post treatment in trunk training group (P0.5. Conclusion: The results had shown that both groups noted significant difference. But when comparing between these two groups there is no statistical significance noted. So this study concluded that there is no significant difference between trunk training exercises and Swiss ball exercises on sitting balance and gait parameters in subjects with stroke.

Life satisfaction in spouses of stroke survivors and control subjects: A 7-year follow-up of participants in the Sahlgrenska Academy study on ischaemic stroke

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Tamar Abzhandadze

2017-05-01

Full Text Available Objective: To investigate life satisfaction in spouses of middle-aged stroke survivors from the long-term perspective and to identify factors that explain their life satisfaction. Design: Cross-sectional, case-control study. Subjects: Cohabitant spouses of survivors of ischaemic stroke aged < 70 years at stroke onset (n = 248 and spouses of controls (n = 246. Methods: Assessments were made 7 years after inclusion to the study. Spouses’ life satisfaction was assessed with the Fugl-Meyer’s Life Satisfaction Check-List (LiSAT 11. Stroke-related factors were examined with the National Institutes of Health stroke scale, Mini-Mental State Examination, Barthel Index and modified Rankin Scale. Results: Spouses of stroke survivors had significantly lower satisfaction with general life, leisure, sexual life, partner relationship, family life, and poorer somatic and psychological health than spouses of controls. Caregiving spouses had significantly lower scores on all life domains except vocation and own activities of daily living than non-caregiving spouses. Spouses’ satisfaction on different life domains was explained mainly by their age, sex, support given to the partner, and the survivor’s level of global disability, to which both physical and cognitive impairments contributed. Conclusion: Seven years after stroke, spouses of stroke survivors reported lower life satisfaction compared with spouses of controls. Life satisfaction in stroke survivors’ spouses was associated with spouses’ age, sex, giving support, and the stroke survivors’ level of global disability.

Community-Based Adaptive Physical Activity Program for Chronic Stroke: Feasibility, Safety, and Efficacy of the Empoli Model

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Stuart, Mary; Benvenuti, Francesco; Macko, Richard; Taviani, Antonio; Segenni, Lucianna; Mayer, Federico; Sorkin, John D.; Stanhope, Steven J.; Macellari, Velio; Weinrich, Michael

2010-01-01

Objective To determine whether Adaptive Physical Activity (APA-stroke), a community-based exercise program for participants with hemiparetic stroke, improves function in the community. Methods Nonrandomized controlled study in Tuscany, Italy, of participants with mild to moderate hemiparesis at least 9 months after stroke. Forty-nine participants in a geographic health authority (Empoli) were offered APA-stroke (40 completed the study). Forty-four control participants in neighboring health authorities (Florence and Pisa) received usual care (38 completed the study). The APA intervention was a community-based progressive group exercise regimen that included walking, strength, and balance training for 1 hour, thrice a week, in local gyms, supervised by gym instructors. No serious adverse clinical events occurred during the exercise intervention. Outcome measures included the following: 6-month change in gait velocity (6-Minute Timed Walk), Short Physical Performance Battery (SPPB), Berg Balance Scale, Stroke Impact Scale (SIS), Barthel Index, Hamilton Rating Scale for Depression, and Index of Caregivers Strain. Results After 6 months, the intervention group improved whereas controls declined in gait velocity, balance, SPPB, and SIS social participation domains. These between-group comparisons were statistically significant at P glucose tolerance tests were performed on a subset of participants in the intervention group. For these individuals, insulin secretion declined 29% after 6 months (P = .01). Conclusion APA-stroke appears to be safe, feasible, and efficacious in a community setting. PMID:19318465

Sleep Duration, Sedentary Behavior, Physical Activity, and Quality of Life after Inpatient Stroke Rehabilitation.

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Ezeugwu, Victor E; Manns, Patricia J

2017-09-01

The aim of this study was to describe accelerometer-derived sleep duration, sedentary behavior, physical activity, and quality of life and their association with demographic and clinical factors within the first month after inpatient stroke rehabilitation. Thirty people with stroke (mean ± standard deviation, age: 63.8 ± 12.3 years, time since stroke: 3.6 ± 1.1 months) wore an activPAL3 Micro accelerometer (PAL Technologies, Glasgow, Scotland) continuously for 7 days to measure whole-day activity behavior. The Stroke Impact Scale and the Functional Independence Measure were used to assess quality of life and function, respectively. Sleep duration ranged from 6.6 to 11.6 hours/day. Fifteen participants engaged in long sleep greater than 9 hours/day. Participants spent 74.8% of waking hours in sedentary behavior, 17.9% standing, and 7.3% stepping. Of stepping time, only a median of 1.1 (interquartile range: .3-5.8) minutes were spent walking at a moderate-to-vigorous intensity (≥100 steps/minute). The time spent sedentary, the stepping time, and the number of steps differed significantly by the hemiparetic side (P stroke. There were moderate to strong correlations between the stepping time and the number of steps with gait speed (Spearman r = .49 and .61 respectively, P stroke, and cognition were not significant. People with stroke sleep for longer than the normal duration, spend about three quarters of their waking hours in sedentary behaviors, and engage in minimal walking following stroke rehabilitation. Our findings provide a rationale for the development of behavior change strategies after stroke. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Clinical evaluation of postural posture of patients with previous stroke subjected to early rehabilitation

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Anna Sagan

2018-02-01

Full Text Available Introduction: Impairment disorders are often found in patients with stroke and impairment of motor and cognitive functions. This is a very serious complication because, by imposing a motor impairment, it aggravates the condition of disability and makes it difficult to conduct physical rehabilitation.The resulting neurological deficits due to stroke determine functional disorders. The possibility of locomotion is usually compromised, therefore the risk of falls increases significantly. The aim of the work is to present Postural Assesment Scale for Strock PASS with the postural stroke assessment scale, the impact of early rehabilitation of patients staying in the neurology ward.Material and methods: Postural examination was carried out among 17 people, of which 8 were women, and 9 were male. The study was divided into two stages. The first stage occurred immediately after the stroke and the second one before the patient was discharged from the ward. Research was carried out at the Biegański Specialist Hospital in Grudziądz in the Department of Neurology and Clinical Neuroimmunology and Impact Department.Conclusions: The results of the postural studies carried out in people with previous stroke subjected to early physiotherapy have a beneficial effect of the conducted therapy. There are positive changes between the first and the final examination of the patients.

Effects of kinesthetic haptic feedback on standing stability of young healthy subjects and stroke patients.

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Afzal, Muhammad Raheel; Byun, Ha-Young; Oh, Min-Kyun; Yoon, Jungwon

2015-03-13

Haptic control is a useful therapeutic option in rehabilitation featuring virtual reality interaction. As with visual and vibrotactile biofeedback, kinesthetic haptic feedback may assist in postural control, and can achieve balance control. Kinesthetic haptic feedback in terms of body sway can be delivered via a commercially available haptic device and can enhance the balance stability of both young healthy subjects and stroke patients. Our system features a waist-attached smartphone, software running on a computer (PC), and a dedicated Phantom Omni® device. Young healthy participants performed balance tasks after assumption of each of four distinct postures for 30 s (one foot on the ground; the Tandem Romberg stance; one foot on foam; and the Tandem Romberg stance on foam) with eyes closed. Patient eyes were not closed and assumption of the Romberg stance (only) was tested during a balance task 25 s in duration. An Android application running continuously on the smartphone sent mediolateral (ML) and anteroposterior (AP) tilt angles to a PC, which generated kinesthetic haptic feedback via Phantom Omni®. A total of 16 subjects, 8 of whom were young healthy and 8 of whom had suffered stroke, participated in the study. Post-experiment data analysis was performed using MATLAB®. Mean Velocity Displacement (MVD), Planar Deviation (PD), Mediolateral Trajectory (MLT) and Anteroposterior Trajectory (APT) parameters were analyzed to measure reduction in body sway. Our kinesthetic haptic feedback system was effective to reduce postural sway in young healthy subjects regardless of posture and the condition of the substrate (the ground) and to improve MVD and PD in stroke patients who assumed the Romberg stance. Analysis of Variance (ANOVA) revealed that kinesthetic haptic feedback significantly reduced body sway in both categories of subjects. Kinesthetic haptic feedback can be implemented using a commercial haptic device and a smartphone. Intuitive balance cues were

Robot-assisted training of the kinesthetic sense: enhancing proprioception after stroke.

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De Santis, Dalia; Zenzeri, Jacopo; Casadio, Maura; Masia, Lorenzo; Riva, Assunta; Morasso, Pietro; Squeri, Valentina

2014-01-01

Proprioception has a crucial role in promoting or hindering motor learning. In particular, an intact position sense strongly correlates with the chances of recovery after stroke. A great majority of neurological patients present both motor dysfunctions and impairments in kinesthesia, but traditional robot and virtual reality training techniques focus either in recovering motor functions or in assessing proprioceptive deficits. An open challenge is to implement effective and reliable tests and training protocols for proprioception that go beyond the mere position sense evaluation and exploit the intrinsic bidirectionality of the kinesthetic sense, which refers to both sense of position and sense of movement. Modulated haptic interaction has a leading role in promoting sensorimotor integration, and it is a natural way to enhance volitional effort. Therefore, we designed a preliminary clinical study to test a new proprioception-based motor training technique for augmenting kinesthetic awareness via haptic feedback. The feedback was provided by a robotic manipulandum and the test involved seven chronic hemiparetic subjects over 3 weeks. The protocol included evaluation sessions that consisted of a psychometric estimate of the subject's kinesthetic sensation, and training sessions, in which the subject executed planar reaching movements in the absence of vision and under a minimally assistive haptic guidance made by sequences of graded force pulses. The bidirectional haptic interaction between the subject and the robot was optimally adapted to each participant in order to achieve a uniform task difficulty over the workspace. All the subjects consistently improved in the perceptual scores as a consequence of training. Moreover, they could minimize the level of haptic guidance in time. Results suggest that the proposed method is effective in enhancing kinesthetic acuity, but the level of impairment may affect the ability of subjects to retain their improvement in time.

Effect of visual distraction and auditory feedback on patient effort during robot-assisted movement training after stroke.

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Secoli, Riccardo; Milot, Marie-Helene; Rosati, Giulio; Reinkensmeyer, David J

2011-04-23

Practicing arm and gait movements with robotic assistance after neurologic injury can help patients improve their movement ability, but patients sometimes reduce their effort during training in response to the assistance. Reduced effort has been hypothesized to diminish clinical outcomes of robotic training. To better understand patient slacking, we studied the role of visual distraction and auditory feedback in modulating patient effort during a common robot-assisted tracking task. Fourteen participants with chronic left hemiparesis from stroke, five control participants with chronic right hemiparesis and fourteen non-impaired healthy control participants, tracked a visual target with their arms while receiving adaptive assistance from a robotic arm exoskeleton. We compared four practice conditions: the baseline tracking task alone; tracking while also performing a visual distracter task; tracking with the visual distracter and sound feedback; and tracking with sound feedback. For the distracter task, symbols were randomly displayed in the corners of the computer screen, and the participants were instructed to click a mouse button when a target symbol appeared. The sound feedback consisted of a repeating beep, with the frequency of repetition made to increase with increasing tracking error. Participants with stroke halved their effort and doubled their tracking error when performing the visual distracter task with their left hemiparetic arm. With sound feedback, however, these participants increased their effort and decreased their tracking error close to their baseline levels, while also performing the distracter task successfully. These effects were significantly smaller for the participants who used their non-paretic arm and for the participants without stroke. Visual distraction decreased participants effort during a standard robot-assisted movement training task. This effect was greater for the hemiparetic arm, suggesting that the increased demands associated

Mechanisms of Short-Term Training-Induced Reaching Improvement in Severely Hemiparetic Stroke Patients: A TMS Study

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Harris-Love, Michelle L.; Morton, Susanne M.; Perez, Monica A.; Cohen, Leonardo G.

2011-01-01

Background The neurophysiological mechanisms underlying improved upper-extremity motor skills have been partially investigated in patients with good motor recovery but are poorly understood in more impaired individuals, the majority of stroke survivors. Objective The authors studied changes in primary motor cortex (M1) excitability (motor evoked potentials [MEPs], contralateral and ipsilateral silent periods [CSPs and ISPs] using transcranial magnetic stimulation [TMS]) associated with training-induced reaching improvement in stroke patients with severe arm paresis (n = 11; Upper-Extremity Fugl-Meyer score (F-M) = 27 ± 6). Methods All patients underwent a single session of reaching training focused on moving the affected hand from a resting site to a target placed at 80% of maximum forward reaching amplitude in response to a visual “GO” cue. Triceps contribute primarily as agonist and biceps primarily as antagonist to the trained forward reaching movement. Response times were recorded for each reaching movement. Results Preceding training (baseline), greater interhemispheric inhibition (measured by ISP) in the affected triceps muscle, reflecting inhibition from the nonlesioned to the lesioned M1, was observed in patients with lower F-M scores (more severe motor impairment). Training-induced improvements in reaching were greater in patients with slower response times at baseline. Increased MEP amplitudes and decreased ISPs and CSPs were observed in the affected triceps but not in the biceps muscle after training. Conclusion These results indicate that along with training-induced motor improvements, training-specific modulation of intrahemispheric and interhemispheric mechanisms occurs after reaching practice in chronic stroke patients with substantial arm impairment. PMID:21343522

Upper limb stroke rehabilitation: the effectiveness of Stimulation Assistance through Iterative Learning (SAIL).

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Meadmore, Katie L; Cai, Zhonglun; Tong, Daisy; Hughes, Ann-Marie; Freeman, Chris T; Rogers, Eric; Burridge, Jane H

2011-01-01

A novel system has been developed which combines robotic therapy with electrical stimulation (ES) for upper limb stroke rehabilitation. This technology, termed SAIL: Stimulation Assistance through Iterative Learning, employs advanced model-based iterative learning control (ILC) algorithms to precisely assist participant's completion of 3D tracking tasks with their impaired arm. Data is reported from a preliminary study with unimpaired participants, and also from a single hemiparetic stroke participant with reduced upper limb function who has used the system in a clinical trial. All participants completed tasks which involved moving their (impaired) arm to follow an image of a slowing moving sphere along a trajectory. The participants' arm was supported by a robot and ES was applied to the triceps brachii and anterior deltoid muscles. During each task, the same tracking trajectory was repeated 6 times and ILC was used to compute the stimulation signals to be applied on the next iteration. Unimpaired participants took part in a single, one hour training session and the stroke participant undertook 18, 1 hour treatment sessions composed of tracking tasks varying in length, orientation and speed. The results reported describe changes in tracking ability and demonstrate feasibility of the SAIL system for upper limb rehabilitation. © 2011 IEEE

Therapeutic administration of atomoxetine combined with rTMS and occupational therapy for upper limb hemiparesis after stroke: a case series study of three patients.

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Kinoshita, Shoji; Kakuda, Wataru; Yamada, Naoki; Momosaki, Ryo; Okuma, Ryo; Watanabe, Shu; Abo, Masahiro

2016-03-01

Atomoxetine, a selective noradrenaline reuptake inhibitor, has been reported to enhance brain plasticity, but has not yet been used in stroke patients. We reported the feasibility and clinical benefits on motor functional recovery of the combination of repetitive transcranial magnetic stimulation (rTMS) and intensive occupational therapy (OT) in stroke patients. This pilot study was designed to evaluate the additive effects of oral atomoxetine to rTMS/OT in post-stroke hemiparetic patients. The study included three post-stroke patients with upper limb hemiparesis. Treatment with 40 mg/day atomoxetine commenced 2 weeks before admission. After confirming tolerance, the dose was increased to 120 mg/day. Low-frequency rTMS/OT was provided daily for 15 days during continued atomoxetine therapy. Motor function of the affected upper limb was evaluated with the Fugl-Meyer Assessment and Wolf Motor Function test. All patients completed the protocol and showed motor improvement up to 4 weeks after the treatment. No atomoxetine-related side effects were noted. Our protocol of triple therapy of atomoxetine, low-frequency rTMS, and OT is safe and feasible intervention for upper limb hemiparesis after stroke.

Constraints on grip selection in hemiparetic cerebral palsy: Effects of lesional side, end-point accuracy and context.

NARCIS (Netherlands)

Steenbergen, B.; Meulenbroek, R.G.J.; Rosenbaum, D.A.

2004-01-01

This study was concerned with the selection criteria used for grip planning in adolescents with left or right hemiparetic cerebral palsy. In the first experiment participants picked up a pencil and placed the tip in a pre-defined target region. We varied the size of the target to test the hypothesis

Robot-assisted training of the kinesthetic sense: enhancing proprioception after stroke

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Dalia eDe Santis

2015-01-01

Full Text Available Proprioception has a crucial role in promoting or hindering motor learning. In particular, an intact position sense strongly correlates with the chances of recovery after stroke. A great majority of neurological patients present both motor dysfunctions and impairments in kinesthesia, but traditional robot and virtual reality training techniques focus either in recovering motor functions or in assessing proprioceptive deficits. An open challenge is to implement effective and reliable tests and training protocols for proprioception that go beyond the mere position sense evaluation and exploit the intrinsic bidirectionality of the kinesthetic sense, which refers to both sense of position and sense of movement. Modulated haptic interaction has a leading role in promoting sensorimotor integration and it is a natural way to enhance volitional effort. Therefore, we designed a preliminary clinical study to test a new proprioception-based motor training technique for augmenting kinesthetic awareness via haptic feedback. The feedback was provided by a robotic manipulandum and the test involved 7 chronic hemiparetic subjects over three weeks. The protocol included evaluation sessions, that consisted of a psychometric estimate of the subject’s kinesthetic sensation, and training sessions, in which the subject executed planar reaching movements in the absence of vision and under a minimally assistive haptic guidance made by sequences of graded force pulses. The bidirectional haptic interaction between the subject and the robot was optimally adapted to each participant in order to achieve a uniform task difficulty over the workspace. All the subjects consistently improved in the perceptual scores as a consequence of training. Moreover, they could minimize the level of haptic guidance in time. Results suggest that the proposed method is effective in enhancing kinesthetic acuity, but the level of impairment may affect the ability of subjects to retain their

Innovative STRoke Interactive Virtual thErapy (STRIVE) online platform for community-dwelling stroke survivors: a randomised controlled trial protocol.

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Johnson, Liam; Bird, Marie-Louise; Muthalib, Makii; Teo, Wei-Peng

2018-01-09

The STRoke Interactive Virtual thErapy (STRIVE) intervention provides community-dwelling stroke survivors access to individualised, remotely supervised progressive exercise training via an online platform. This trial aims to determine the clinical efficacy of the STRIVE intervention and its effect on brain activity in community-dwelling stroke survivors. In a multisite, assessor-blinded randomised controlled trial, 60 stroke survivors >3 months poststroke with mild-to-moderate upper extremity impairment will be recruited and equally randomised by location (Melbourne, Victoria or Launceston, Tasmania) to receive 8 weeks of virtual therapy (VT) at a local exercise training facility or usual care. Participants allocated to VT will perform 3-5 upper limb exercises individualised to their impairment severity and preference, while participants allocated to usual care will be asked to maintain their usual daily activities. The primary outcome measures will be upper limb motor function and impairment, which will be assessed using the Action Research Arm Test and Upper Extremity Fugl-Meyer, respectively. Secondary outcome measures include upper extremity function and spasticity, as measured by the box and block test and Modified AshworthScale, respectively, and task-related changes in bilateral sensorimotor cortex haemodynamics during hand reaching and wrist extension movements as measured by functional near-infrared spectroscopy. Quality of life will be measured using the Euro-Quality of Life-5 Dimension-5 Level Scale, and the Motor Activity Log-28 will be used to measure use of the hemiparetic arm. All measures will be assessed at baseline and immediately postintervention. The study was approved by the Deakin University Human Research Ethics Committee in May 2017 (No. 2017-087). The results will be disseminated in peer-reviewed journals and presented at major international stroke meetings. ACTRN12617000745347; Pre-results. © Article author(s) (or their employer(s) unless

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

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Patten Carolynn

2013-01-01

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

Development of a Method to Determine Abnormal Joint Torque Coupling Patterns During Walking In Chronic Hemiparetic Stroke

NARCIS (Netherlands)

Fricke, S.S.; Dragunas, Andrew C.; Gordon, Keith E.; van der Kooij, H.; van Asseldonk, E.H.F.; Dewald, Julius P. A.

Motor impairments following stroke may lead to a reduced walking ability, however, no reliable assessments to quantify these impairments during walking are available [1]. For example, abnormal joint torque coupling between hip extension and hip adduction, previously reported under isometric

Stroke scale score and early prediction of outcome after stroke

International Nuclear Information System (INIS)

Ahmed, R.; Zuberi, F.Z.; Afsar, S.

2004-01-01

Objective: To evaluate the baseline National Institute of Health Stroke Scale (NIHSS) score as a predictor of functional outcome after ischemic stroke. Subjects and Methods: The study included 50 patients who presented to Civil Hospital, Karachi, during the study period with acute stroke and were evaluated with CT scan of brain. Only those patients were enrolled in the study that had acute ischemic stroke. The enrolled subjects were then evaluated for the neurological impairment using National Institute of Health Stroke Scale (NIHSS). The subjects were followed-up and their functional outcome was assessed using Barthel index (BI) on the 7th day of their admission. Results: Of the fifty patients enrolled in the study, 31 (62%) were males and 19 (38%) were females, with age ranging from 45 years to 95 years and a mean age of 59.9 years. Neurological impairment at presentation was assessed by NIHSS. The score ranged between 2 and 28. The functional outcome was evaluated on the 7th day using Barthel index (BI), which ranged from 0 to 80. NIHSS score was found to be a good predictor of functional outcome in patients with ischemic stroke (p<0.001). Other factors like gender, hypertension and heart disease did not affect the functional recovery in such patients. Various factors were found to be significant for early prediction of stroke recovery. The NIHSS score was the strongest predictor of outcome after ischemic stroke. Age at the time of the event was also found to be an important predictor for stroke recovery. Conclusion: The NIHSS score is a good predictor of patient's recovery after stroke. Assessing the patient's neurological impairment at first presentation of ischemic stroke can guide the physician regarding the prognosis and management plan. (author)

Study to assess the effectiveness of modified constraint-induced movement therapy in stroke subjects: A randomized controlled trial

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Priyanka Singh

2013-01-01

Full Text Available Background and Purpose: The purpose of this study was to assess the effectiveness of modified constraint induced movement therapy (m-CIMT in stroke subjects. Materials and Methods: A total of forty sub-acute stroke subjects were randomly assigned to either a m-CIMT (n = 20 or in a control group (n = 20. The m-CIMT group (14 men, 6 women; mean age = 55.2 years consisted of structured 2 h therapy sessions emphasizing affected arm use, occurring 5 times/week for 2 weeks. A mitt was used to restrain the unaffected arm for 10 h/day for 2 week. The control group (11 men, 9 women; mean age = 56.4 years consisted of conventional rehabilitation for time-matched exercise program. The outcome measures were evaluated at pre- and post-intervention by using the Wolf Motor Function Test (WMFT and Fugl-Meyer assessment (FMA of motor recovery after stroke. Results: After intervention significant effects were observed in m-CIMT group on WMFT (pre-test and post-test score was 28.04 ± 6.58, 13.59 ± 2.86; P =0.003. Similarly on FMA (pre- and post-test score was 31.15 ± 6.37, 55.7 ± 6.4; P = 0.00. Conclusion: There is a significant improvem ent in upper extremity function so it indicates that m-CIMT is effective in improving the motor function of the affected arm in stroke subjects. However, its long-term effect has not proved since there was no follow-up after intervention.

Effect of visual distraction and auditory feedback on patient effort during robot-assisted movement training after stroke

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Reinkensmeyer David J

2011-04-01

Full Text Available Abstract Background Practicing arm and gait movements with robotic assistance after neurologic injury can help patients improve their movement ability, but patients sometimes reduce their effort during training in response to the assistance. Reduced effort has been hypothesized to diminish clinical outcomes of robotic training. To better understand patient slacking, we studied the role of visual distraction and auditory feedback in modulating patient effort during a common robot-assisted tracking task. Methods Fourteen participants with chronic left hemiparesis from stroke, five control participants with chronic right hemiparesis and fourteen non-impaired healthy control participants, tracked a visual target with their arms while receiving adaptive assistance from a robotic arm exoskeleton. We compared four practice conditions: the baseline tracking task alone; tracking while also performing a visual distracter task; tracking with the visual distracter and sound feedback; and tracking with sound feedback. For the distracter task, symbols were randomly displayed in the corners of the computer screen, and the participants were instructed to click a mouse button when a target symbol appeared. The sound feedback consisted of a repeating beep, with the frequency of repetition made to increase with increasing tracking error. Results Participants with stroke halved their effort and doubled their tracking error when performing the visual distracter task with their left hemiparetic arm. With sound feedback, however, these participants increased their effort and decreased their tracking error close to their baseline levels, while also performing the distracter task successfully. These effects were significantly smaller for the participants who used their non-paretic arm and for the participants without stroke. Conclusions Visual distraction decreased participants effort during a standard robot-assisted movement training task. This effect was greater for

Effects of transcranial direct current stimulation over the supplementary motor area body weight-supported treadmill gait training in hemiparetic patients after stroke.

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Manji, Atsushi; Amimoto, Kazu; Matsuda, Tadamitsu; Wada, Yoshiaki; Inaba, Akira; Ko, Sangkyun

2018-01-01

Transcranial direct current stimulation (tDCS) is used in a variety of disorders after stroke including upper limb motor dysfunctions, hemispatial neglect, aphasia, and apraxia, and its effectiveness has been demonstrated. Although gait ability is important for daily living, there were few reports of the use of tDCS to improve balance and gait ability. The supplementary motor area (SMA) was reported to play a potentially important role in balance recovery after stroke. We aimed to investigate the effect of combined therapy body weight-supported treadmill training (BWSTT) and tDCS on gait function recovery of stroke patients. Thirty stroke inpatients participated in this study. The two BWSTT periods of 1weeks each, with real tDCS (anode: front of Cz, cathode: inion, 1mA, 20min) on SMA and sham stimulation, were randomized in a double-blind crossover design. We measured the time required for the 10m Walk Test (10MWT) and Timed Up and Go (TUG) test before and after each period. We found that the real tDCS with BWSTT significantly improved gait speed (10MWT) and applicative walking ability (TUG), compared with BWSTT+sham stimulation periods (ptraining after stroke. The facilitative effects of tDCS on SMA possibly improved postural control during BWSTT. The results indicated the implications for the use of tDCS in balance and gait training rehabilitation after stroke. Copyright © 2017 Elsevier B.V. All rights reserved.

Effects of 8 weeks of mat-based Pilates exercise on gait in chronic stroke patients.

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Roh, SuYeon; Gil, Ho Jong; Yoon, Sukhoon

2016-09-01

[Purpose] The purpose of this study was to investigate the effects of an 8-week program of Pilates exercise on gait in chronic hemiplegia patients and to determine whether or not it can be used for rehabilitation in postsrtoke patients. [Subjects and Methods] Twenty individuals with unilateral chronic hemiparetic stroke (age, 66.1 ± 4.4 yrs; height, 162.3 ± 8.3 cm; weight, 67.4 ± 12.3 kg) participated in this study and were randomly allocated equally to either a Pilates exercise group or a control group. To identify the effects of Pilates exercise, a 3-D motion analysis with 8 infrared cameras was performed. [Results] For the gait parameters, improvements were found in the Pilates exercise group for all variables, and statistical significance was observed for stride length, gait velocity, knee range of motion and hip range of motion. For the asymmetry indexes, insignificant improvements were found for all variables in the Pilates exercise group. [Conclusion] In conclusion, an 8-week program of Pilates exercise had a positive influence on improving the gait ability of poststroke patients, and the intervention could be applied to poststroke patients with various levels of physical disability by adjusting the intensity of training.

Effects of task-specific and impairment-based training compared with usual care on functional walking ability after inpatient stroke rehabilitation: LEAPS Trial.

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Nadeau, Stephen E; Wu, Samuel S; Dobkin, Bruce H; Azen, Stanley P; Rose, Dorian K; Tilson, Julie K; Cen, Steven Y; Duncan, Pamela W

2013-05-01

After inpatient stroke rehabilitation, many people still cannot participate in community activities because of limited walking ability. To compare the effectiveness of 2 conceptually different, early physical therapy (PT) interventions to usual care (UC) in improving walking 6 months after stroke. The locomotor experience applied post-stroke (LEAPS) study was a single-blind, randomized controlled trial conducted in 408 adults with disabling hemiparetic stroke. Participants were stratified at baseline (2 months) by impairment in walking speed: severe (exercise at home (home exercise program [HEP], n = 126). LTP participants were 18% more likely to transition to a higher functional walking level: severe to >0.4 m/s and moderate to >0.8 m/s than UC participants (95% confidence interval [CI] = 7%-29%), and HEP participants were 17% more likely to transition (95% CI = 5%-29%). Mean gain in walking speed in LTP participants was 0.13 m/s greater (95% CI = 0.09-0.18) and in HEP participants, 0.10 m/s greater (95% CI = 0.05-0.14) than in UC participants. Progressive PT, using either walking training on a treadmill and overground, conducted in a clinic, or strength and balance exercises conducted at home, was superior to UC in improving walking, regardless of severity of initial impairment.

Mediterranean Diet in patients with acute ischemic stroke: Relationships between Mediterranean Diet score, diagnostic subtype, and stroke severity index.

Science.gov (United States)

Tuttolomondo, Antonino; Casuccio, Alessandra; Buttà, Carmelo; Pecoraro, Rosaria; Di Raimondo, Domenico; Della Corte, Vittoriano; Arnao, Valentina; Clemente, Giuseppe; Maida, Carlo; Simonetta, Irene; Miceli, Giuseppe; Lucifora, Benedetto; Cirrincione, Anna; Di Bona, Danilo; Corpora, Francesca; Maugeri, Rosario; Iacopino, Domenico Gerardo; Pinto, Antonio

2015-11-01

Adherence to a Mediterranean Diet appears to reduce the risk of cardiovascular disease, cancer, Alzheimer's disease, and Parkinson's disease, as well as the risk of death due to cardiovascular disease. No study has addressed the association between diagnostic subtype of stroke and its severity and adherence to a Mediterranean Diet in subjects with acute ischemic stroke. To evaluate the association between Mediterranean Diet adherence, TOAST subtype, and stroke severity by means of a retrospective study. The type of acute ischemic stroke was classified according to the TOAST criteria. All patients admitted to our ward with acute ischemic stroke completed a 137-item validated food-frequency questionnaire adapted to the Sicilian population. A scale indicating the degree of adherence to the traditional Mediterranean Diet was used (Me-Di score: range 0-9). 198 subjects with acute ischemic stroke and 100 control subjects without stroke. Stroke subjects had a lower mean Mediterranean Diet score compared to 100 controls without stroke. We observed a significant positive correlation between Me-Di score and SSS score, whereas we observed a negative relationship between Me-Di score and NIHSS and Rankin scores. Subjects with atherosclerotic (LAAS) stroke subtype had a lower mean Me-Di score compared to subjects with other subtypes. Multinomial logistic regression analysis in a simple model showed a negative relationship between MeDi score and LAAS subtype vs. lacunar subtype (and LAAS vs. cardio-embolic subtype). Patients with lower adherence to a Mediterranean Diet are more likely to have an atherosclerotic (LAAS) stroke, a worse clinical presentation of ischemic stroke at admission and a higher Rankin score at discharge. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Changes of pelvis control with subacute stroke: A comparison of body-weight- support treadmill training coupled virtual reality system and over-ground training.

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Mao, Yurong; Chen, Peiming; Li, Lifang; Li, Le; Huang, Dongfeng

2015-01-01

Gait recovery is very important to stroke survivors to regain their independence in activity of daily life. This study aimed to investigate the effects of virtual reality (VR) coupled body weight support treadmill training (BWSTT) on pelvic control at the early stage of stroke. Kinematic and kinetic changes of pelvic motion were evaluated by a 3D gait analysis system and were compared to the results from over-ground walking training. Twenty-four patients having unilateral hemiplegia with subacute stroke were recruited to a VR coupled BWSTT group (n= 12) and a conventional therapy (CT) group (n= 12). Both of the groups received training of 20-40 min/day, 5 days/week, for 3 weeks. The results showed the tilt of pelvis in sagittal plane improved significantly (P= 0.038) after treatment in the BWSTT+VR group, in terms of decreased amplitude of anterior peak (mean, from 10.99° to 6.25°), while there were no significant differences in the control group. The findings suggested that VR coupled BWSTT gait training could decrease anterior tilt of pelvis in early hemiparetic persons following a modest intervention dose, and the training may have advantages over conventional over-ground gait training and can assist the therapists in correcting abnormal gait pattern of stroke survivors.

Flexion synergy overshadows flexor spasticity during reaching in chronic moderate to severe hemiparetic stroke.

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Ellis, Michael D; Schut, Ingrid; Dewald, Julius P A

2017-07-01

Pharmaceutical intervention targets arm flexor spasticity with an often-unsuccessful goal of improving function. Flexion synergy is a related motor impairment that may be inadvertently neglected. Here, flexor spasticity and flexion synergy are disentangled to determine their contributions to reaching dysfunction. Twenty-six individuals participated. A robotic device systematically modulated shoulder abduction loading during ballistic reaching. Elbow muscle electromyography data were partitioned into windows delineated by elbow joint velocity allowing for the separation of synergy- and spasticity-related activation. Reaching velocity decreased with abduction loading (psynergy increased with abduction loading (psynergy is the predominant contributor to reaching dysfunction while flexor spasticity appears only relevant during unnaturally occurring passively supported movement. Interventions targeting flexion synergy should be leveraged in future stroke recovery trials. Copyright © 2017 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.

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.

''Playstation eyetoy games'' improve upper extremity-related motor functioning in subacute stroke: a randomized controlled clinical trial.

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Yavuzer, G; Senel, A; Atay, M B; Stam, H J

2008-09-01

To evaluate the effects of ''Playstation EyeToy Games'' on upper extremity motor recovery and upper extremity-related motor functioning of patients with subacute stroke. The authors designed a randomized, controlled, assessor-blinded, 4-week trial, with follow-up at 3 months. A total of 20 hemiparetic inpatients (mean age 61.1 years), all within 12 months post-stroke, received 30 minutes of treatment with ''Playstation EyeToy Games'' per day, consisting of flexion and extension of the paretic shoulder, elbow and wrist as well as abduction of the paretic shoulder or placebo therapy (watching the games for the same duration without physical involvement into the games) in addition to conventional program, 5 days a week, 2-5 hours/day for 4 weeks. Brunnstrom's staging and self-care sub-items of the functional independence measure (FIM) were performed at 0 month (baseline), 4 weeks (post-treatment), and 3 months (follow-up) after the treatment. The mean change score (95% confidence interval) of the FIM self-care score (5.5 [2.9-8.0] vs 1.8 [0.1-3.7], P=0.018) showed significantly more improvement in the EyeToy group compared to the control group. No significant differences were found between the groups for the Brunnstrom stages for hand and upper extremity. ''Playstation EyeToy Games'' combined with a conventional stroke rehabilitation program have a potential to enhance upper extremity-related motor functioning in subacute stroke patients.

USING THE METHOD KINESIOTAPING IN REHABILITATION OF CHILDREN WITH HEMIPARETIC FORM OF CEREBRAL PALSY

Directory of Open Access Journals (Sweden)

Vladimir Evgenevich Tuchkov

2016-08-01

Full Text Available The study examines the impact of a new kind of impact in the rehabilitation of hemiparetic form of cerebral palsy – a method kinesiotaping «Concept 4 tapes». Within this framework, the receptor patient unit gradually turned on, resulting in a restructuring of the program abnormal movement, the conditions of use of other methods to increase the efficiency and depth of the order of their influence. The advantage of a technique kinesiotaping is the standard approach, allowing you to apply effects diagram method to all patients without loss of efficacy of therapeutic effects.

Results of the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial by stroke subtypes

DEFF Research Database (Denmark)

Amarenco, Pierre; Benavente, Oscar; Goldstein, Larry B

2009-01-01

BACKGROUND AND PURPOSE: The SPARCL trial showed that atorvastatin 80 mg/d reduces the risk of stroke and other cardiovascular events in patients with recent stroke or transient ischemic attack (TIA). We tested the hypothesis that the benefit of treatment varies according to index event stroke...... subtype. METHODS: Subjects with stroke or TIA without known coronary heart disease were randomized to atorvastatin 80 mg/d or placebo. The SPARCL primary end point was fatal or nonfatal stroke. Secondary end points included major cardiovascular events (MCVE; stroke plus major coronary events). Cox...... regression models testing for an interaction with treatment assignment were used to explore potential differences in efficacy based on stroke subtype. RESULTS: For subjects randomized to atorvastatin versus placebo, a primary end point occurred in 13.1% versus 18.6% of those classified as having large vessel...

Using commercial video games for upper limb stroke rehabilitation: is this the way of the future?

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Pietrzak, Eva; Cotea, Cristina; Pullman, Stephen

2014-01-01

The increasing number of people living with poststroke sequelae has stimulated the search for novel ways of providing poststroke rehabilitation without putting additional stress on overburdened health care systems. One of them is the use of commercially available technology and off-the-shelf video games for hemiparetic upper limb rehabilitation. The MEDLINE, EMBASE, and Cochrane Library databases were searched using key word synonyms for stroke, upper limb, and video games. Included studies investigated upper limb stroke rehabilitation using commercially available consoles and video games, reported outcomes that included measures of upper limb functionality, and were published in a peer-reviewed journal written in English. Thirteen studies were identified - 6 published as full articles and 7 as abstracts. Studies were generally small and only 3 were randomized. The gaming systems investigated were the Nintendo Wii (n = 10), EyeToy PlayStation (n = 2), and CyWee Z (n = 1). The Nintendo Wii appears to provide the greatest benefits to patients, with improvements seen in upper extremity function measures such as joint range of motion, hand motor function, grip strength, and dexterity. Three studies indicate that video therapy appears to be safe and that long-term improvements continue at follow-up. At present, the evidence that the use of commercial video games in rehabilitation improves upper limb functionality after stroke is very limited. However, this approach has the potential to provide easily available and affordable stroke rehabilitation therapy in settings where access to therapy is limited by geographical or financial constraints.

Hand Passive Mobilization Performed with Robotic Assistance: Acute Effects on Upper Limb Perfusion and Spasticity in Stroke Survivors

Directory of Open Access Journals (Sweden)

Massimiliano Gobbo

2017-01-01

Full Text Available This single arm pre-post study aimed at evaluating the acute effects induced by a single session of robot-assisted passive hand mobilization on local perfusion and upper limb (UL function in poststroke hemiparetic participants. Twenty-three patients with subacute or chronic stroke received 20 min passive mobilization of the paretic hand with robotic assistance. Near-infrared spectroscopy (NIRS was used to detect changes in forearm tissue perfusion. Muscle tone of the paretic UL was assessed by the Modified Ashworth Scale (MAS. Symptoms concerning UL heaviness, joint stiffness, and pain were evaluated as secondary outcomes by self-reporting. Significant (p=0.014 improvements were found in forearm perfusion when all fingers were mobilized simultaneously. After the intervention, MAS scores decreased globally, being the changes statistically significant for the wrist (from 1.6±1.0 to 1.1±1.0; p=0.001 and fingers (from 1.2±1.1 to 0.7±0.9; p=0.004. Subjects reported decreased UL heaviness and stiffness after treatment, especially for the hand, as well as diminished pain when present. This study supports novel evidence that hand robotic assistance promotes local UL circulation changes, may help in the management of spasticity, and acutely alleviates reported symptoms of heaviness, stiffness, and pain in subjects with poststroke hemiparesis. This opens new scenarios for the implications in everyday clinical practice. Clinical Trial Registration Number is NCT03243123.

Hand Passive Mobilization Performed with Robotic Assistance: Acute Effects on Upper Limb Perfusion and Spasticity in Stroke Survivors.

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Gobbo, Massimiliano; Gaffurini, Paolo; Vacchi, Laura; Lazzarini, Sara; Villafane, Jorge; Orizio, Claudio; Negrini, Stefano; Bissolotti, Luciano

2017-01-01

This single arm pre-post study aimed at evaluating the acute effects induced by a single session of robot-assisted passive hand mobilization on local perfusion and upper limb (UL) function in poststroke hemiparetic participants. Twenty-three patients with subacute or chronic stroke received 20 min passive mobilization of the paretic hand with robotic assistance. Near-infrared spectroscopy (NIRS) was used to detect changes in forearm tissue perfusion. Muscle tone of the paretic UL was assessed by the Modified Ashworth Scale (MAS). Symptoms concerning UL heaviness, joint stiffness, and pain were evaluated as secondary outcomes by self-reporting. Significant ( p = 0.014) improvements were found in forearm perfusion when all fingers were mobilized simultaneously. After the intervention, MAS scores decreased globally, being the changes statistically significant for the wrist (from 1.6 ± 1.0 to 1.1 ± 1.0; p = 0.001) and fingers (from 1.2 ± 1.1 to 0.7 ± 0.9; p = 0.004). Subjects reported decreased UL heaviness and stiffness after treatment, especially for the hand, as well as diminished pain when present. This study supports novel evidence that hand robotic assistance promotes local UL circulation changes, may help in the management of spasticity, and acutely alleviates reported symptoms of heaviness, stiffness, and pain in subjects with poststroke hemiparesis. This opens new scenarios for the implications in everyday clinical practice. Clinical Trial Registration Number is NCT03243123.

Modular Ankle Robotics Training in Early Sub-Acute Stroke: A Randomized Controlled Pilot Study

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Forrester, Larry W.; Roy, Anindo; Krywonis, Amanda; Kehs, Glenn; Krebs, Hermano Igo; Macko, Richard F.

2014-01-01

Background Modular lower extremity (LE) robotics may offer a valuable avenue for restoring neuromotor control after hemiparetic stroke. Prior studies show that visually-guided and visually-evoked practice with an ankle robot (anklebot) improves paretic ankle motor control that translates into improved overground walking. Objective Assess the feasibility and efficacy of daily anklebot training during early sub-acute hospitalization post-stroke. Methods Thirty-four inpatients from a stroke unit were randomly assigned to anklebot (N=18) or passive manual stretching (N=16) treatments. All suffered a first stroke with residual hemiparesis (ankle manual muscle test grade 1/5 to 4/5), and at least trace muscle activation in plantar- or dorsiflexion. Anklebot training employed an “assist-as-needed” approach during > 200 volitional targeted paretic ankle movements, with difficulty adjusted to active range of motion and success rate. Stretching included >200 daily mobilizations in these same ranges. All sessions lasted 1 hour and assessments were not blinded. Results Both groups walked faster at discharge, however the robot group improved more in percent change of temporal symmetry (p=0.032) and also of step length symmetry (p=0.038), with longer nonparetic step lengths in the robot (133%) vs. stretching (31%) groups. Paretic ankle control improved in the robot group, with increased peak (p≤ 0.001) and mean (p≤ 0.01) angular speeds, and increased movement smoothness (p≤ 0.01). There were no adverse events. Conclusion Though limited by small sample size and restricted entry criteria, our findings suggest that modular lower extremity robotics during early sub-acute hospitalization is well tolerated and improves ankle motor control and gait patterning. PMID:24515923

Upper extremity function in stroke subjects: relationships between the international classification of functioning, disability, and health domains.

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Faria-Fortini, Iza; Michaelsen, Stella Maris; Cassiano, Janine Gomes; Teixeira-Salmela, Luci Fuscaldi

2011-01-01

Upper limb (UL) impairments are the most common disabling deficits after stroke and have complex relationships with activity and participation domains. However, relatively few studies have applied the ICF model to identify the contributions of specific UL impairments, such as muscular weakness, pain, and sensory loss, as predictors of activity and participation. The purposes of this predictive study were to evaluate the relationships between UL variables related to body functions/structures, activity, and participation domains and to determine which would best explain activity and participation with 55 subjects with chronic stroke. Body functions/structures were assessed by measures of grip, pinch, and UL strength, finger tactile sensations, shoulder pain, and cognition (MMSE); activity domain by measures of observed performance (BBT, NHPT, and TEMPA); and participation by measures of quality of life (SSQOL). Upper-limb and grip strength were related to all activity measures (0.52 stroke subjects. 2c. Copyright © 2011 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

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

OpenAIRE

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 survivor...

The positive effect of mirror visual feedback on arm control in children with Spastic hemiparetic cerebral palsy is dependent on which arm is viewed

NARCIS (Netherlands)

Smorenburg, A; Ledebt, A.; Feltham, M.; Deconinck, F.; Savelsbergh, G.J.P.

2011-01-01

Mirror visual feedback has previously been found to reduce disproportionate interlimb variability and neuromuscular activity in the arm muscles in children with Spastic Hemiparetic Cerebral Palsy (SHCP). The aim of the current study was to determine whether these positive effects are generated by

Drivers of costs associated with reperfusion therapy in acute stroke: the Interventional Management of Stroke III Trial.

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Simpson, Kit N; Simpson, Annie N; Mauldin, Patrick D; Hill, Michael D; Yeatts, Sharon D; Spilker, Judith A; Foster, Lydia D; Khatri, Pooja; Martin, Renee; Jauch, Edward C; Kleindorfer, Dawn; Palesch, Yuko Y; Broderick, Joseph P

2014-06-01

The Interventional Management of Stroke (IMS) III study tested the effect of intravenous tissue-type plasminogen activator (tPA) alone when compared with intravenous tPA followed by endovascular therapy and collected cost data to assess the economic implications of the 2 therapies. This report describes the factors affecting the costs of the initial hospitalization for acute stroke subjects from the United States. Prospective cost analysis of the US subjects was treated with intravenous tPA alone or with intravenous tPA followed by endovascular therapy in the IMS III trial. Results were compared with expected Medicare payments. The adjusted cost of a stroke admission in the study was $35 130 for subjects treated with endovascular therapy after intravenous tPA treatment and $25 630 for subjects treated with intravenous tPA alone (P<0.0001). Significant factors related to costs included treatment group, baseline National Institutes of Health Stroke Scale, time from stroke onset to intravenous tPA, age, stroke location, and comorbid diabetes mellitus. The mean cost for subjects who had routine use of general anesthesia as part of endovascular therapy was $46 444 when compared with $30 350 for those who did not have general anesthesia. The costs of embolectomy for IMS III subjects and patients from the National Inpatient Sample cohort exceeded the Medicare diagnosis-related group payment in ≥75% of patients. Minimizing the time to start of intravenous tPA and decreasing the use of routine general anesthesia may improve the cost-effectiveness of medical and endovascular therapy for acute stroke. http://www.clinicaltrials.gov. Unique identifier: NCT00359424. © 2014 American Heart Association, Inc.

Increased reward in ankle robotics training enhances motor control and cortical efficiency in stroke.

Science.gov (United States)

Goodman, Ronald N; Rietschel, Jeremy C; Roy, Anindo; Jung, Brian C; Diaz, Jason; Macko, Richard F; Forrester, Larry W

2014-01-01

Robotics is rapidly emerging as a viable approach to enhance motor recovery after disabling stroke. Current principles of cognitive motor learning recognize a positive relationship between reward and motor learning. Yet no prior studies have established explicitly whether reward improves the rate or efficacy of robotics-assisted rehabilitation or produces neurophysiologic adaptations associated with motor learning. We conducted a 3 wk, 9-session clinical pilot with 10 people with chronic hemiparetic stroke, randomly assigned to train with an impedance-controlled ankle robot (anklebot) under either high reward (HR) or low reward conditions. The 1 h training sessions entailed playing a seated video game by moving the paretic ankle to hit moving onscreen targets with the anklebot only providing assistance as needed. Assessments included paretic ankle motor control, learning curves, electroencephalograpy (EEG) coherence and spectral power during unassisted trials, and gait function. While both groups exhibited changes in EEG, the HR group had faster learning curves (p = 0.05), smoother movements (p

Uric acid predicts mortality and ischaemic stroke in subjects with diastolic dysfunction: the Tromsø Study 1994-2013.

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Norvik, Jon V; Schirmer, Henrik; Ytrehus, Kirsti; Storhaug, Hilde M; Jenssen, Trond G; Eriksen, Bjørn O; Mathiesen, Ellisiv B; Løchen, Maja-Lisa; Wilsgaard, Tom; Solbu, Marit D

2017-05-01

To investigate whether serum uric acid predicts adverse outcomes in persons with indices of diastolic dysfunction in a general population. We performed a prospective cohort study among 1460 women and 1480 men from 1994 to 2013. Endpoints were all-cause mortality, incident myocardial infarction, and incident ischaemic stroke. We stratified the analyses by echocardiographic markers of diastolic dysfunction, and uric acid was the independent variable of interest. Hazard ratios (HR) were estimated per 59 μmol/L increase in baseline uric acid. Multivariable adjusted Cox proportional hazards models showed that uric acid predicted all-cause mortality in subjects with E/A ratio 1.5 (HR 1.51, 95% CI 1.09-2.09, P for interaction between E/A ratio category and uric acid = 0.02). Elevated uric acid increased mortality risk in persons with E-wave deceleration time 220 ms (HR 1.46, 95% CI 1.01-2.12 and HR 1.13, 95% CI 1.02-1.26, respectively; P for interaction = 0.04). Furthermore, in participants with isovolumetric relaxation time ≤60 ms, mortality risk was higher with increasing uric acid (HR 4.98, 95% CI 2.02-12.26, P for interaction = 0.004). Finally, elevated uric acid predicted ischaemic stroke in subjects with severely enlarged left atria (HR 1.62, 95% CI 1.03-2.53, P for interaction = 0.047). Increased uric acid was associated with higher all-cause mortality risk in subjects with echocardiographic indices of diastolic dysfunction, and with higher ischaemic stroke risk in persons with severely enlarged left atria.

Interprofessional stroke rehabilitation for stroke survivors using home care.

Science.gov (United States)

Markle-Reid, Maureen; Orridge, Camille; Weir, Robin; Browne, Gina; Gafni, Amiram; Lewis, Mary; Walsh, Marian; Levy, Charissa; Daub, Stacey; Brien, Heather; Roberts, Jacqueline; Thabane, Lehana

2011-03-01

To compare a specialized interprofessional team approach to community-based stroke rehabilitation with usual home care for stroke survivors using home care services. Randomized controlled trial of 101 community-living stroke survivors (stroke) using home care services. Subjects were randomized to intervention (n=52) or control (n=49) groups. The intervention was a 12-month specialized, evidence-based rehabilitation strategy involving an interprofessional team. The primary outcome was change in health-related quality of life and functioning (SF-36) from baseline to 12 months. Secondary outcomes were number of strokes during the 12-month follow-up, and changes in community reintegration (RNLI), perceived social support (PRQ85-Part 2), anxiety and depressive symptoms (Kessler-10), cognitive function (SPMSQ), and costs of use of health services from baseline to 12 months. A total of 82 subjects completed the 12-month follow-up. Compared with the usual care group, stroke survivors in the intervention group showed clinically important (although not statistically significant) greater improvements from baseline in mean SF-36 physical functioning score (5.87, 95% CI -3.98 to 15.7; p=0.24) and social functioning score (9.03, CI-7.50 to 25.6; p=0.28). The groups did not differ for any of the secondary effectiveness outcomes. There was a higher total per-person costs of use of health services in the intervention group compared to usual home care although the difference was not statistically significant (p=0.76). A 12-month specialized, interprofessional team is a feasible and acceptable approach to community-based stroke rehabilitation that produced greater improvements in quality of life compared to usual home care. Clinicaltrials.gov identifier: NCT00463229.

Task-Based Mirror Therapy Augmenting Motor Recovery in Poststroke Hemiparesis: A Randomized Controlled Trial.

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Arya, Kamal Narayan; Pandian, Shanta; Kumar, Dharmendra; Puri, Vinod

2015-08-01

To establish the effect of the task-based mirror therapy (TBMT) on the upper limb recovery in stroke. A pilot, randomized, controlled, assessor-blinded trial was conducted in a rehabilitation institute. A convenience sample of 33 poststroke (mean duration, 12.5 months) hemiparetic subjects was randomized into 2 groups (experimental, 17; control, 16). The subjects were allocated to receive either TBMT or standard motor rehabilitation-40 sessions (5/week) for a period of 8 weeks. The TBMT group received movements using various goal-directed tasks and a mirror box. The movements were performed by the less-affected side superimposed on the affected side. The main outcome measures were Brunnstrom recovery stage (BRS) and Fugl-Meyer assessment (FMA)-FMA of upper extremity (FMA-UE), including upper arm (FMA-UA) and wrist-hand (FMA-WH). The TBMT group exhibited highly significant improvement on mean scores of FMA-WH (P hemiparesis. MT using tasks may be used as an adjunct in stroke rehabilitation. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Can stroke patients use visual analogue scales?

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Price, C I; Curless, R H; Rodgers, H

1999-07-01

Visual analogue scales (VAS) have been used for the subjective measurement of mood, pain, and health status after stroke. In this study we investigated how stroke-related impairments could alter the ability of subjects to answer accurately. Consent was obtained from 96 subjects with a clinical stroke (mean age, 72.5 years; 50 men) and 48 control subjects without cerebrovascular disease (mean age, 71.5 years; 29 men). Patients with reduced conscious level or severe dysphasia were excluded. Subjects were asked to rate the tightness that they could feel on the (unaffected) upper arm after 3 low-pressure inflations with a standard sphygmomanometer cuff, which followed a predetermined sequence (20 mm Hg, 40 mm Hg, 0 mm Hg). Immediately after each change, they rated the perceived tightness on 5 scales presented in a random order: 4-point rating scale (none, mild, moderate, severe), 0 to 10 numerical rating scale, mechanical VAS, horizontal VAS, and vertical VAS. Standard tests recorded deficits in language, cognition, and visuospatial awareness. Inability to complete scales with the correct pattern was associated with any stroke (P<0.001). There was a significant association between success using scales and milder clinical stroke subtype (P<0.01). Within the stroke group, logistic regression analysis identified significant associations (P<0.05) between impairments (cognitive and visuospatial) and inability to complete individual scales correctly. Many patients after a stroke are unable to successfully complete self-report measurement scales, including VAS.

Sensorimotor control of tracking movements at various speeds for stroke patients as well as age-matched and young healthy subjects.

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Di Ao

Full Text Available There are aging- and stroke-induced changes on sensorimotor control in daily activities, but their mechanisms have not been well investigated. This study explored speed-, aging-, and stroke-induced changes on sensorimotor control. Eleven stroke patients (affected sides and unaffected sides and 20 control subjects (10 young and 10 age-matched individuals were enrolled to perform elbow tracking tasks using sinusoidal trajectories, which included 6 target speeds (15.7, 31.4, 47.1, 62.8, 78.5, and 94.2 deg/s. The actual elbow angle was recorded and displayed on a screen as visual feedback, and three indicators, the root mean square error (RMSE, normalized integrated jerk (NIJ and integral of the power spectrum density of normalized speed (IPNS, were used to investigate the strategy of sensorimotor control. Both NIJ and IPNS had significant differences among the four groups (P<0.01, and the values were ranked in the following order: young controls < age-matched controls stroke patients stroke patients, which could be explained by the stroke- and aging-induced increase in reliance on feedback control. The RMSE increased with the increase in the target speed and the NIJ and IPNS initially declined and then remained steady for all four groups, which indicated a shift from feedback to feedforward control as the target speed increased. The feedback-feedforward trade-off induced by stroke, aging and speed might be explained by a change in the transmission delay and neuromotor noise. The findings in this study improve our understanding of the mechanism underlying the sensorimotor control and neurological changes caused by stroke and aging.

Default Mode Network Connectivity in Stroke Patients.

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Tuladhar, Anil Man; Snaphaan, Liselore; Shumskaya, Elena; Rijpkema, Mark; Fernandez, Guillén; Norris, David G; de Leeuw, Frank-Erik

2013-01-01

The pathophysiology of episodic memory dysfunction after infarction is not completely understood. It has been suggested that infarctions located anywhere in the brain can induce widespread effects causing disruption of functional networks of the cortical regions. The default mode network, which includes the medial temporal lobe, is a functional network that is associated with episodic memory processing. We investigated whether the default mode network activity is reduced in stroke patients compared to healthy control subjects in the resting state condition. We assessed the whole brain network properties during resting state functional MRI in 21 control subjects and 20 'first-ever' stroke patients. Patients were scanned 9-12 weeks after stroke onset. Stroke lesions were located in various parts of the brain. Independent component analyses were conducted to identify the default mode network and to compare the group differences of the default mode network. Furthermore, region-of-interest based analysis was performed to explore the functional connectivity between the regions of the default mode network. Stroke patients performed significantly worse than control subjects on the delayed recall score on California verbal learning test. We found decreased functional connectivity in the left medial temporal lobe, posterior cingulate and medial prefrontal cortical areas within the default mode network and reduced functional connectivity between these regions in stroke patients compared with controls. There were no significant volumetric differences between the groups. These results demonstrate that connectivity within the default mode network is reduced in 'first-ever' stroke patients compared to control subjects. This phenomenon might explain the occurrence of post-stroke cognitive dysfunction in stroke patients.

Stroke risk perception among participants of a stroke awareness campaign

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Kraywinkel, Klaus; Heidrich, Jan; Heuschmann, Peter U; Wagner, Markus; Berger, Klaus

2007-01-01

Background Subjective risk factor perception is an important component of the motivation to change unhealthy life styles. While prior studies assessed cardiovascular risk factor knowledge, little is known about determinants of the individual perception of stroke risk. Methods Survey by mailed questionnaire among 1483 participants of a prior public stroke campaign in Germany. Participants had been informed about their individual stroke risk based on the Framingham stroke risk score. Stroke risk factor knowledge, perception of lifetime stroke risk and risk factor status were included in the questionnaire, and the determinants of good risk factor knowledge and high stroke risk perception were identified using logistic regression models. Results Overall stroke risk factor knowledge was good with 67–96% of the participants recognizing established risk factors. The two exceptions were diabetes (recognized by 49%) and myocardial infarction (57%). Knowledge of a specific factor was superior among those affected by it. 13% of all participants considered themselves of having a high stroke risk, 55% indicated a moderate risk. All major risk factors contributed significantly to the perception of being at high stroke risk, but the effects of age, sex and education were non-significant. Poor self-rated health was additionally associated with high individual stroke risk perception. Conclusion Stroke risk factor knowledge was high in this study. The self perception of an increased stroke risk was associated with established risk factors as well as low perception of general health. PMID:17371603

Effect of foot placements during sit to stand transition on timed up and go test in stroke subjects: A cross sectional study.

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Joshua, Abraham M; Karnad, Shreekanth D; Nayak, Akshatha; Suresh, B V; Mithra, Prasanna; Unnikrishnan, B

2017-01-01

Timed up and go (TUG) test is been used as a screening tool for the assessment of risk of falling in individuals following stroke. Though TUG test is a quick test, it has fair sensitivity compared to other tests. This study was carried out to obtain and compare test scores for different types of foot placements during sit to stand transition in stroke subjects. A Cross-sectional study with purposive sampling included 28 post stroke subjects who were able to walk 6 meter with or without assistance. Timed Up and Go test was carried out with four different types of foot placements and scores were recorded. The data were compared using Kruskal-Wallis One way analysis of variance and Wilcoxon signed ranks test. There were comparable differences between asymmetric 1 test strategy which involved affected extremity to be placed behind the unaffected and other test strategies (Z = -4.457,-3.848,-4.458; p = 0.000). The initial foot placements during sit to stand transition influenced the time taken to complete the test which was significantly higher in asymmetric 1 strategy, Incorporation of the initial foot placement mainly asymmetric 1 strategy into conventional TUG test would help in identifying accurately the subject's functional mobility and postural stability.

Modified sphygmomanometer test for the assessment of strength of the trunk, upper and lower limbs muscles in subjects with subacute stroke: reliability and validity.

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Aguiar, Larissa T; Lara, Eliza M; Martins, Julia C; Teixeira-Salmela, Luci F; Quintino, Ludmylla F; Christo, Paulo P; DE Morais Fairaa, Christina

2016-10-01

Limitations in activities have been related to weakness of the upper limbs (UL), lower limbs (LL) and trunk muscles after stroke. Therefore, the measurement of strength after stroke becomes essential. The Modified Sphygmomanometer Test (MST) is an alternative method for the measurement of strength, since it is cheap and provides objective values. However, no studies have investigated the measurement properties of the MST in sub-acute stroke. To investigate the test-retest and inter-rater reliabilities and criterion-related validity of the MST for the measurement of strength of the UL, LL, and trunk muscles in subjects with sub-acute stroke, and verify whether the number of trials would affect the results. Diagnostic accuracy. Local community, out-patient clinics, and university laboratory. Sixty- five subjects with sub-acute stroke (62±14 years) participated of the present study. The strength of 36 muscular groups was measured with the MST and dynamometers (criterion standard). To investigate whether the number of trials would affect the results, analysis of variance was applied. For the test-retest and inter-rater reliabilities and criterion-related validity of the MST, intra-class correlation coefficients (ICC), Pearson correlation coefficients, and coefficients of determination were calculated. Similar results were found for all muscular groups and number of trials (0.01≤F≤0.14; 0.87≤p≤0.99) with significant and adequate values of test-retest (0.57≤ICC≥0.98) (exception: first trial of the non-paretic ankle dorsiflexors) and inter-rater (0.50≤ICC≥0.99) (exception: non-paretic ankle plantar flexors) reliabilities and validity (0.70≤r≥0.95; p≤0.001). The values obtained with the MST were good predictors of those obtained with the dynamometers (0.54≤r2≤0.90). In general, the MST showed adequate reliabilities and criterion-related validity for measuring strength of subjects with sub-acute stroke, and only one trial, after familiarization

Task-specific ankle robotics gait training after stroke: a randomized pilot study.

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Forrester, Larry W; Roy, Anindo; Hafer-Macko, Charlene; Krebs, Hermano I; Macko, Richard F

2016-06-02

An unsettled question in the use of robotics for post-stroke gait rehabilitation is whether task-specific locomotor training is more effective than targeting individual joint impairments to improve walking function. The paretic ankle is implicated in gait instability and fall risk, but is difficult to therapeutically isolate and refractory to recovery. We hypothesize that in chronic stroke, treadmill-integrated ankle robotics training is more effective to improve gait function than robotics focused on paretic ankle impairments. Participants with chronic hemiparetic gait were randomized to either six weeks of treadmill-integrated ankle robotics (n = 14) or dose-matched seated ankle robotics (n = 12) videogame training. Selected gait measures were collected at baseline, post-training, and six-week retention. Friedman, and Wilcoxon Sign Rank and Fisher's exact tests evaluated within and between group differences across time, respectively. Six weeks post-training, treadmill robotics proved more effective than seated robotics to increase walking velocity, paretic single support, paretic push-off impulse, and active dorsiflexion range of motion. Treadmill robotics durably improved gait dorsiflexion swing angle leading 6/7 initially requiring ankle braces to self-discarded them, while their unassisted paretic heel-first contacts increased from 44 % to 99.6 %, versus no change in assistive device usage (0/9) following seated robotics. Treadmill-integrated, but not seated ankle robotics training, durably improves gait biomechanics, reversing foot drop, restoring walking propulsion, and establishing safer foot landing in chronic stroke that may reduce reliance on assistive devices. These findings support a task-specific approach integrating adaptive ankle robotics with locomotor training to optimize mobility recovery. NCT01337960. https://clinicaltrials.gov/ct2/show/NCT01337960?term=NCT01337960&rank=1.

Gait parameters associated with responsiveness to treadmill training with body-weight support after stroke: an exploratory study.

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Mulroy, Sara J; Klassen, Tara; Gronley, JoAnne K; Eberly, Valerie J; Brown, David A; Sullivan, Katherine J

2010-02-01

Task-specific training programs after stroke improve walking function, but it is not clear which biomechanical parameters of gait are most associated with improved walking speed. The purpose of this study was to identify gait parameters associated with improved walking speed after a locomotor training program that included body-weight-supported treadmill training (BWSTT). A prospective, between-subjects design was used. Fifteen people, ranging from approximately 9 months to 5 years after stroke, completed 1 of 3 different 6-week training regimens. These regimens consisted of 12 sessions of BWSTT alternated with 12 sessions of: lower-extremity resistive cycling; lower-extremity progressive, resistive strengthening; or a sham condition of arm ergometry. Gait analysis was conducted before and after the 6-week intervention program. Kinematics, kinetics, and electromyographic (EMG) activity were recorded from the hemiparetic lower extremity while participants walked at a self-selected pace. Changes in gait parameters were compared in participants who showed an increase in self-selected walking speed of greater than 0.08 m/s (high-response group) and in those with less improvement (low-response group). Compared with participants in the low-response group, those in the high-response group displayed greater increases in terminal stance hip extension angle and hip flexion power (product of net joint moment and angular velocity) after the intervention. The intensity of soleus muscle EMG activity during walking also was significantly higher in participants in the high-response group after the intervention. Only sagittal-plane parameters were assessed, and the sample size was small. Task-specific locomotor training alternated with strength training resulted in kinematic, kinetic, and muscle activation adaptations that were strongly associated with improved walking speed. Changes in both hip and ankle biomechanics during late stance were associated with greater increases in

Efficacy of gait trainer as an adjunct to traditional physical therapy on walking performance in hemiparetic cerebral palsied children: a randomized controlled trial.

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Gharib, Nevein Mm; El-Maksoud, Gehan M Abd; Rezk-Allah, Soheir S

2011-10-01

To assess the effects of additional gait trainer assisted walking exercises on walking performance in children with hemiparetic cerebral palsy. A randomized controlled study. Paediatric physical therapy outpatient clinic. Thirty spastic hemiparetic cerebral palsied children of both sexes (10-13 years - 19 girls and 11 boys). Children were randomly assigned into two equal groups; experimental and control groups. Participants in both groups received a traditional physical therapy exercise programme. Those in the experimental group received additional gait trainer based walking exercises which aimed to improve walking performance. Treatment was provided three times per week for three successive months. Children received baseline and post-treatment assessments using Biodex Gait Trainer 2 assessment device to evaluate gait parameters including: average step length, walking speed, time on each foot (% of gait cycle) and ambulation index. Children in the experimental group showed a significant improvement as compared with those in the control group. The ambulation index was 75.53±7.36 (11.93 ± 2.89 change score) for the experimental group and 66.06 ± 5.48 (2.13 ± 4.43 change score) for the control group (t = 3.99 and P = 0.0001). Time of support for the affected side was 42.4 ± 3.37 (7 ± 2.20 change score) for the experimental group and 38.06 ± 4.63 (3.33 ± 6.25 change score) for the control group (t = 2.92 and P = 0.007). Also, there was a significant improvement in step length and walking speed in both groups. Gait trainer combined with traditional physiotherapy increase the chance of improving gait performance in children with spastic hemiparetic cerebral palsy.

Impaired implicit learning and feedback processing after stroke.

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Lam, J M; Globas, C; Hosp, J A; Karnath, H-O; Wächter, T; Luft, A R

2016-02-09

The ability to learn is assumed to support successful recovery and rehabilitation therapy after stroke. Hence, learning impairments may reduce the recovery potential. Here, the hypothesis is tested that stroke survivors have deficits in feedback-driven implicit learning. Stroke survivors (n=30) and healthy age-matched control subjects (n=21) learned a probabilistic classification task with brain activation measured using functional magnetic resonance imaging in a subset of these individuals (17 stroke and 10 controls). Stroke subjects learned slower than controls to classify cues. After being rewarded with a smiley face, they were less likely to give the same response when the cue was repeated. Stroke subjects showed reduced brain activation in putamen, pallidum, thalamus, frontal and prefrontal cortices and cerebellum when compared with controls. Lesion analysis identified those stroke survivors as learning-impaired who had lesions in frontal areas, putamen, thalamus, caudate and insula. Lesion laterality had no effect on learning efficacy or brain activation. These findings suggest that stroke survivors have deficits in reinforcement learning that may be related to dysfunctional processing of feedback-based decision-making, reward signals and working memory. Copyright © 2015 IBRO. Published by Elsevier Ltd. All rights reserved.

Stroke And Substance Abuse

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A Chitsaz

2017-01-01

Introduction: stroke in recreational substance users can be an indirect complication, like endocarditis and cardio embolism in parenteral drug users. With some drug like cocaine, stroke appear to be the result of a direct effect. In young subjects without other risk factors provide persuasive evidence for causality . OPIATES: Heroine is the most abused opiate drug, which is administered by injection, by snorting or by smoking. Stroke affects heroin users by diverse mechanisms,. Injec...

A mechanized gait trainer for restoring gait in nonambulatory subjects.

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Hesse, S; Uhlenbrock, D; Werner, C; Bardeleben, A

2000-09-01

To construct an advanced mechanized gait trainer to enable patients the repetitive practice of a gaitlike movement without overstraining therapists. DEVICE: Prototype gait trainer that simulates the phases of gait (by generating a ratio of 40% to 60% between swing and stance phases), supports the subjects according to their ability (lifts the foot during swing phase), and controls the center of mass in the vertical and horizontal directions. Two nonambulatory, hemiparetic patients who regained their walking ability after 4 weeks of daily training on the gait trainer, a 55-year-old woman and a 62-year-old man, both of whom had a first-time ischemic stroke. Four weeks of training, five times a week, each session 20 minutes long. Functional ambulation category (FAC, levels 0-5) to assess gait ability and ground level walking velocity. Rivermead motor assessment score (RMAS, 0-13) to assess gross motor function. Patient 1: At the end of treatment, she was able to walk independently on level ground with use of a walking stick. Her walking velocity had improved from .29m/sec to .59m/sec. Her RMAS score increased from 4 to 10, meaning she could walk at least 40 meters outside, pick up objects from floor, and climb stairs independently. Patient 2: At end of 4-week training, he could walk independently on even surfaces (FAC level 4), using an ankle-foot orthosis and a walking stick. His walking velocity improved from .14m/sec to .63m/sec. His RMAS increased from 3 to 10. The gait trainer enabled severely affected patients the repetitive practice of a gaitlike movement. Future studies may elucidate its value in gait rehabilitation of nonambulatory subjects.

Closing the sensorimotor loop: haptic feedback facilitates decoding of motor imagery

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Gomez-Rodriguez, M.; Peters, J.; Hill, J.; Schölkopf, B.; Gharabaghi, A.; Grosse-Wentrup, M.

2011-06-01

The combination of brain-computer interfaces (BCIs) with robot-assisted physical therapy constitutes a promising approach to neurorehabilitation of patients with severe hemiparetic syndromes caused by cerebrovascular brain damage (e.g. stroke) and other neurological conditions. In such a scenario, a key aspect is how to reestablish the disrupted sensorimotor feedback loop. However, to date it is an open question how artificially closing the sensorimotor feedback loop influences the decoding performance of a BCI. In this paper, we answer this issue by studying six healthy subjects and two stroke patients. We present empirical evidence that haptic feedback, provided by a seven degrees of freedom robotic arm, facilitates online decoding of arm movement intention. The results support the feasibility of future rehabilitative treatments based on the combination of robot-assisted physical therapy with BCIs.

Modular ankle robotics training in early subacute stroke: a randomized controlled pilot study.

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Forrester, Larry W; Roy, Anindo; Krywonis, Amanda; Kehs, Glenn; Krebs, Hermano Igo; Macko, Richard F

2014-09-01

BACKGROUND. Modular lower extremity robotics may offer a valuable avenue for restoring neuromotor control after hemiparetic stroke. Prior studies show that visually guided and visually evoked practice with an ankle robot (anklebot) improves paretic ankle motor control that translates into improved overground walking. To assess the feasibility and efficacy of daily anklebot training during early subacute hospitalization poststroke. Thirty-four inpatients from a stroke unit were randomly assigned to anklebot (n = 18) or passive manual stretching (n = 16) treatments. All suffered a first stroke with residual hemiparesis (ankle manual muscle test grade 1/5 to 4/5), and at least trace muscle activation in plantar- or dorsiflexion. Anklebot training employed an "assist-as-needed" approach during >200 volitional targeted paretic ankle movements, with difficulty adjusted to active range of motion and success rate. Stretching included >200 daily mobilizations in these same ranges. All sessions lasted 1 hour and assessments were not blinded. Both groups walked faster at discharge; however, the robot group improved more in percentage change of temporal symmetry (P = .032) and also of step length symmetry (P = .038), with longer nonparetic step lengths in the robot (133%) versus stretching (31%) groups. Paretic ankle control improved in the robot group, with increased peak (P ≤ .001) and mean (P ≤ .01) angular speeds, and increased movement smoothness (P ≤ .01). There were no adverse events. Though limited by small sample size and restricted entry criteria, our findings suggest that modular lower extremity robotics during early subacute hospitalization is well tolerated and improves ankle motor control and gait patterning. © The Author(s) 2014.

Sensorimotor Control of Tracking Movements at Various Speeds for Stroke Patients as Well as Age-Matched and Young Healthy Subjects

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Ao, Di; Song, Rong; Tong, Kai-yu

2015-01-01

There are aging- and stroke-induced changes on sensorimotor control in daily activities, but their mechanisms have not been well investigated. This study explored speed-, aging-, and stroke-induced changes on sensorimotor control. Eleven stroke patients (affected sides and unaffected sides) and 20 control subjects (10 young and 10 age-matched individuals) were enrolled to perform elbow tracking tasks using sinusoidal trajectories, which included 6 target speeds (15.7, 31.4, 47.1, 62.8, 78.5, and 94.2 deg/s). The actual elbow angle was recorded and displayed on a screen as visual feedback, and three indicators, the root mean square error (RMSE), normalized integrated jerk (NIJ) and integral of the power spectrum density of normalized speed (IPNS), were used to investigate the strategy of sensorimotor control. Both NIJ and IPNS had significant differences among the four groups (Pcontrols controls control. The RMSE increased with the increase in the target speed and the NIJ and IPNS initially declined and then remained steady for all four groups, which indicated a shift from feedback to feedforward control as the target speed increased. The feedback-feedforward trade-off induced by stroke, aging and speed might be explained by a change in the transmission delay and neuromotor noise. The findings in this study improve our understanding of the mechanism underlying the sensorimotor control and neurological changes caused by stroke and aging. PMID:26030289

Functional electrical stimulation mediated by iterative learning control and 3D robotics reduces motor impairment in chronic stroke

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Meadmore Katie L

2012-06-01

Full Text Available Abstract Background Novel stroke rehabilitation techniques that employ electrical stimulation (ES and robotic technologies are effective in reducing upper limb impairments. ES is most effective when it is applied to support the patients’ voluntary effort; however, current systems fail to fully exploit this connection. This study builds on previous work using advanced ES controllers, and aims to investigate the feasibility of Stimulation Assistance through Iterative Learning (SAIL, a novel upper limb stroke rehabilitation system which utilises robotic support, ES, and voluntary effort. Methods Five hemiparetic, chronic stroke participants with impaired upper limb function attended 18, 1 hour intervention sessions. Participants completed virtual reality tracking tasks whereby they moved their impaired arm to follow a slowly moving sphere along a specified trajectory. To do this, the participants’ arm was supported by a robot. ES, mediated by advanced iterative learning control (ILC algorithms, was applied to the triceps and anterior deltoid muscles. Each movement was repeated 6 times and ILC adjusted the amount of stimulation applied on each trial to improve accuracy and maximise voluntary effort. Participants completed clinical assessments (Fugl-Meyer, Action Research Arm Test at baseline and post-intervention, as well as unassisted tracking tasks at the beginning and end of each intervention session. Data were analysed using t-tests and linear regression. Results From baseline to post-intervention, Fugl-Meyer scores improved, assisted and unassisted tracking performance improved, and the amount of ES required to assist tracking reduced. Conclusions The concept of minimising support from ES using ILC algorithms was demonstrated. The positive results are promising with respect to reducing upper limb impairments following stroke, however, a larger study is required to confirm this.

Hemiparetic cerebral palsy: clinical data compared with neuroimaging Paralisia cerebral hemiparética: dados clínicos comparados à neuroimagem

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RC Turolla de Souza

2006-01-01

Full Text Available OBJECTIVE: The present study correlated fine motor function (FMF and sensory function (SF performance with magnetic resonance imaging classification, in cases of hemiparetic cerebral palsy. METHOD: Specific protocols were used to evaluate FMF, SF and brain lesion extent and location in the hemisphere. Forty-six patients were assessed: 23 with hemiparetic cerebral palsy (group 1 and 23 normal individuals (group 2. Their ages ranged from 7 to 16 years, with a mean of 12 years and 8 months. RESULTS: FMF and SF performance in group 1 was significantly worse than in group 2. Hemiparetic cerebral palsy cases with lesions in only one brain structure presented better results than those with two or more damaged structures larger than 10 mm. Patients with unilateral or bilateral cortical and subcortical impairment presented worse performance than those with subcortical lesions. CONCLUSION: Motor and sensory dysfunctions need to be identified and understood in order to provide routine training and special care for such children.OBJETIVO: Este estudo correlacionou o desempenho da função motora fina (FMF e Sensorial (FS na paralisia cerebral hemiparética (PC-H à classificação da ressonância magnética (RM. MÉTODO: Utilizaram-se os protocolos específicos para avaliar FMF, FS e lesões encefálicas quanto à sua extensão e localização no hemisfério. Foram avaliados 46 sujeitos sendo 23 com PC-H, grupo 1, e 23 crianças normais, grupo 2. A idade variou entre 07 a 16 anos, idade média de 12 anos e 8 meses. RESULTADOS: O desempenho das FMF e FS demonstrou ser significantemente pior no grupo 1 quando comparado ao grupo controle. PC-H que apresentavam lesões atingindo uma única estrutura encefálica demonstraram melhores resultados que aqueles com comprometimento atingindo duas estruturas maiores que 10 mm. O desempenho dos sujeitos com comprometimento cortical e subcortical, uni ou bilateral, foi inferior quando comparados aos com les

Benefits of Repetitive Transcranial Magnetic Stimulation (rTMS for Spastic Subjects: Clinical, Functional, and Biomechanical Parameters for Lower Limb and Walking in Five Hemiparetic Patients

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Luc Terreaux

2014-01-01

Full Text Available Introduction. Spasticity is a disabling symptom resulting from reorganization of spinal reflexes no longer inhibited by supraspinal control. Several studies have demonstrated interest in repetitive transcranial magnetic stimulation in spastic patients. We conducted a prospective, randomized, double-blind crossover study on five spastic hemiparetic patients to determine whether this type of stimulation of the premotor cortex can provide a clinical benefit. Material and Methods. Two stimulation frequencies (1 Hz and 10 Hz were tested versus placebo. Patients were assessed clinically, by quantitative analysis of walking and measurement of neuromechanical parameters (H and T reflexes, musculoarticular stiffness of the ankle. Results. No change was observed after placebo and 10 Hz protocols. Clinical parameters were not significantly modified after 1 Hz stimulation, apart from a tendency towards improved recruitment of antagonist muscles on the Fügl-Meyer scale. Only cadence and recurvatum were significantly modified on quantitative analysis of walking. Neuromechanical parameters were modified with significant decreases in Hmax⁡ /Mmax⁡ and T/Mmax⁡ ratios and stiffness indices 9 days or 31 days after initiation of TMS. Conclusion. This preliminary study supports the efficacy of low-frequency TMS to reduce reflex excitability and stiffness of ankle plantar flexors, while clinical signs of spasticity were not significantly modified.

Benefits of repetitive transcranial magnetic stimulation (rTMS) for spastic subjects: clinical, functional, and biomechanical parameters for lower limb and walking in five hemiparetic patients.

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Terreaux, Luc; Gross, Raphael; Leboeuf, Fabien; Desal, Hubert; Hamel, Olivier; Nguyen, Jean Paul; Pérot, Chantal; Buffenoir, Kévin

2014-01-01

Introduction. Spasticity is a disabling symptom resulting from reorganization of spinal reflexes no longer inhibited by supraspinal control. Several studies have demonstrated interest in repetitive transcranial magnetic stimulation in spastic patients. We conducted a prospective, randomized, double-blind crossover study on five spastic hemiparetic patients to determine whether this type of stimulation of the premotor cortex can provide a clinical benefit. Material and Methods. Two stimulation frequencies (1 Hz and 10 Hz) were tested versus placebo. Patients were assessed clinically, by quantitative analysis of walking and measurement of neuromechanical parameters (H and T reflexes, musculoarticular stiffness of the ankle). Results. No change was observed after placebo and 10 Hz protocols. Clinical parameters were not significantly modified after 1 Hz stimulation, apart from a tendency towards improved recruitment of antagonist muscles on the Fügl-Meyer scale. Only cadence and recurvatum were significantly modified on quantitative analysis of walking. Neuromechanical parameters were modified with significant decreases in H max⁡ /M max⁡ and T/M max⁡ ratios and stiffness indices 9 days or 31 days after initiation of TMS. Conclusion. This preliminary study supports the efficacy of low-frequency TMS to reduce reflex excitability and stiffness of ankle plantar flexors, while clinical signs of spasticity were not significantly modified.

Functional versus Nonfunctional Rehabilitation in Chronic Ischemic Stroke: Evidences from a Randomized Functional MRI Study

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Maristela C. X. Pelicioni

2016-01-01

Full Text Available Motor rehabilitation of stroke survivors may include functional and/or nonfunctional strategy. The present study aimed to compare the effect of these two rehabilitation strategies by means of clinical scales and functional Magnetic Resonance Imaging (fMRI. Twelve hemiparetic chronic stroke patients were selected. Patients were randomly assigned a nonfunctional (NFS or functional (FS rehabilitation scheme. Clinical scales (Fugl-Meyer, ARA test, and modified Barthel and fMRI were applied at four moments: before rehabilitation (P1 and immediately after (P2, 1 month after (P3, and three months after (P4 the end of rehabilitation. The NFS group improved significantly and exclusively their Fugl-Meyer scores at P2, P3, and P4, when compared to P1. On the other hand, the FS group increased significantly in Fugl-Meyer at P2, when compared to P1, and also in their ARA and Barthel scores. fMRI inspection at the individual level revealed that both rehabilitation schemes most often led to decreased activation sparseness, decreased activity of contralesional M1, increased asymmetry of M1 activity to the ipsilesional side, decreased perilesional activity, and decreased SMA activity. Increased M1 asymmetry with rehabilitation was also confirmed by Lateralization Indexes. Our clinical analysis revealed subtle differences between FS and NFS.

Three-dimensional movement analysis of handwriting in subjects with mild hemiparesis.

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Harada, Takako; Okajima, Yasutomo; Takahashi, Hidetoshi

2010-08-01

To investigate the effects of hemiparesis on handwriting using a 3-dimensional movement analyzer. Comparative case study. Ambulatory care clinic. Right-handed patients (n=25; mean age +/- SD, 62.3+/-10y) with mild right hemiparesis secondary to subcortical stroke, and age-matched (n=10; 65.6+/-13y) and age-unmatched (n=15; 32.4+/-10y) control subjects. Not applicable. Time required to write a Japanese character of 2 different sizes and average speed of handwriting at the pen tip. Average radii of tracks of the moving pen tip, metacarpal head of the index finger, and distal end of the forearm during writing. Correlation coefficients of the instantaneous speed-time graph of the pen tip with that of the index finger and with that of the distal forearm during writing. Time for writing with the hemiparetic right hand was longer than that with the unaffected left hand (P=.05 approximately .03), while it was shorter in healthy control subjects (P=.07 approximately .05). In contrast with the left-hand writing, the track radius of the pen tip of the right-hand writing in patients with hemiparesis with normal joint position sense was significantly larger than that of the finger or distal forearm (P=.01). The finding was the same as in the young and elderly control subjects. This right-left difference disappeared in the patients with hemiparesis with position sense impairment. The correlation coefficient of speed between the pen tip and the finger was larger in right-hand than left-hand writing in the control and sensory-normative patients with hemiparesis even though the difference was significant only in the healthy elderly subjects (P=.03). Irrespective of the right or left hand use, the correlation coefficient between the pen tip and the finger or distal forearm significantly increased as the character size increased (P=.03 approximately 6 x10(-6)) in all subjects and patients. However, this size-related difference was less significant in the patients with sensory

The effects of onabotulinum toxin A injection into rectus femoris muscle in hemiplegic stroke patients with stiff-knee gait: a placebo-controlled, nonrandomized trial.

Science.gov (United States)

Tok, Fatih; Balaban, Birol; Yaşar, Evren; Alaca, Rdvan; Tan, Arif Kenan

2012-04-01

This study aimed to compare the efficacy of onabotulinum toxin A (onabot) injection into the rectus femoris muscle with that of placebo in the treatment of hemiplegic stroke patients presenting with stiff-knee gait. Twenty-five chronic hemiparetic stroke patients presenting with a stiff-knee gait were included in this study. Fifteen patients received 100-125 U of onabot, and 10 patients received placebo into the rectus femoris muscle. Three-dimensional gait analysis, energy expenditure, 10-m and 6-min walk tests, and spasticity level of the rectus femoris were evaluated at baseline and 2 mos posttreatment. The mean age of patients who received onabot was 53.86 ± 14.74 yrs and of those who received placebo was 59.00 ± 8.11 yrs. At study onset, groups were similar with respect to all parameters (P > 0.05). We observed significant improvement in knee flexion (7 degrees average) during swing and a reduction in energy cost of 0.8-J/kg per meter response to injection of 100-125 U of onabot into the rectus femoris muscle. Onabot treatment significantly reduced muscle tone and improved knee kinematics, energy expenditure during walking, and functional assessments at 2 mos (P application of onabot into the rectus femoris muscle in stroke patients who presented with stiff-knee gait may be a treatment option to provide independent, safe, and less tiring ambulation.

Predictive factors of subjective sleep quality and insomnia complaint in patients with stroke: implications for clinical practice

Directory of Open Access Journals (Sweden)

PATRICIA C. DA ROCHA

2013-09-01

Full Text Available The complaints regarding sleep problems have not been well identified after a stroke. The aim of this study was to investigate the predictive factors of sleep quality and insomnia complaints in patients with stroke. A total of 70 subjects, 40 patients (57 ± 7 years and 30 healthy controls (52 ± 6 years assessed by the Pittsburgh Sleep Quality Index (PSQI and the Sleep Habits Questionnaire took part in the study. The data were analyzed using the chi-square test, the Student's t-test and logistic regression analysis. On average, the patients showed poor sleep quality (patients: 6.3 ± 3.5; controls: 3.9 ± 2.2; p= 0.002 and insomnia complaint was the most prevalent (patients: 37.5%; controls: 6.7%; p= 0.007. The absence of insomnia complaint (OR= 0.120; 95%CI= 0.017-0.873; p= 0.036 and the decreased latency of sleep (OR= 0.120; 95%CI= 0.017-0.873; p= 0.036 were the protective factors of sleep quality. Female sex (OR= 11.098; 95%CI= 1.167-105.559; p= 0.036 and fragmented sleep (OR= 32.040; 95%CI= 3.236-317.261; p= 0.003 were the risk factors for insomnia complaint. We suggest that complaints of poor sleep quality and insomnia should be given priority assessment during clinical diagnosis of sleep disorders in stroke.

Life satisfaction in spouses of stroke survivors and control subjects: A 7-year follow-up of participants in the Sahlgrenska Academy study on ischaemic stroke.

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Abzhandadze, Tamar; Forsberg-Wärleby, Gunilla; Holmegaard, Lukas; Redfors, Petra; Jern, Christina; Blomstrand, Christian; Jood, Katarina

2017-07-07

To investigate life satisfaction in spouses of middle-aged stroke survivors from the long-term perspective and to identify factors that explain their life satisfaction. Cross-sectional, case-control study. Cohabitant spouses of survivors of ischaemic stroke aged life satisfaction was assessed with the Fugl-Meyer's Life Satisfaction Check-List (LiSAT 11). Stroke-related factors were examined with the National Institutes of Health stroke scale, Mini-Mental State Examination, Barthel Index and modified Rankin Scale. Spouses of stroke survivors had significantly lower satisfaction with general life, leisure, sexual life, partner relationship, family life, and poorer somatic and psychological health than spouses of controls. Caregiving spouses had significantly lower scores on all life domains except vocation and own activities of daily living than non-caregiving spouses. Spouses' satisfaction on different life domains was explained mainly by their age, sex, support given to the partner, and the survivor's level of global disability, to which both physical and cognitive impairments contributed. Seven years after stroke, spouses of stroke survivors reported lower life satisfaction compared with spouses of controls. Life satisfaction in stroke survivors' spouses was associated with spouses' age, sex, giving support, and the stroke survivors' level of global disability.

Stroke management: Informal caregivers' burdens and strians of caring for stroke survivors.

Science.gov (United States)

Gbiri, Caleb Ademola; Olawale, Olajide Ayinla; Isaac, Sarah Oghenekewe

2015-04-01

Stroke survivors live with varied degrees of disabilities and cares are provided largely by the informal caregivers. This study investigated informal caregivers' burden and strains of caring for stroke patients. This study involved 157 (81 males and 76 females) informal caregivers of stroke survivors receiving care in all secondary and tertiary health institutions with physiotherapy services in Lagos State, Nigeria. Information was collected through self-administered questionnaire during clinic-hours. Data was analyzed using Spearman's Rank Correlation Coefficient. The patients' age ranged between 20 and 79 (mean=59.6 ± 14.6 years). Sixty-one had haemorrhagic stroke while 96 had ischaemic stroke. The informal caregivers' age was 39.2 ± 12.8 years (range: 17-36 years). More (60.8%) participants reported moderate objective while 79.2% had mild subjective burdens. The following factors significantly increased (Pfinancial well-beings of the informal caregivers. Caring for stroke survivors put social, emotional, health and financial burdens and strains on the informal caregivers. These burdens and strains increase with duration of stroke, intimacy, smaller number of caregivers and length of daily caregiving. Therefore, informal caregivers should be involved in the rehabilitation plan for stroke patients and their well-being should also be given adequate attention. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Study of cerebral vascular diseases with radioisotopes in cerebral atherosclerotical subjects and/for subjects with sequelae of cerebral stroke, before and after use of the association piracetam-dihydroergotoxine

International Nuclear Information System (INIS)

Lara, P.F.; Ferreira, A.; Paulillo, L.F.; Cukierman, M.

1985-01-01

Twently subjects with cerebral sclerosis and/or sequelas of cerebral stroke were studied, before and after use of piracetam-dihydroergotoxine. We performed the complete hemispheric cerebral blood flow and cerebral scintigraphy, beyond clinical and neurological examination. Scintigraphies were unchanged. Cerebral circulation times, or both hemispheres, diminished. This occurred, probably, in relation with metabolic effects of both pharmaceutical drugs. The alpha sympatolytic and modulatory effects of dihydroergotoxine should be considered. (author) [pt

Knowledge of stroke among stroke patients and their relatives in Northwest India.

Science.gov (United States)

Pandian, Jeyaraj Durai; Kalra, Guneet; Jaison, Ashish; Deepak, Sukhbinder Singh; Shamsher, Shivali; Singh, Yashpal; Abraham, George

2006-06-01

The knowledge of warning symptoms and risk factors for stroke has not been studied among patients with stroke in developing countries. We aimed to assess the knowledge of stroke among patients with stroke and their relatives. Prospective tertiary referral hospital-based study in Northwest India. Trained nurses and medical interns interviewed patients with stroke and transient ischemic attack and their relatives about their knowledge of stroke symptoms and risk factors. Univariable and multivariable logistic regression were used. Of the 147 subjects interviewed, 102 (69%) were patients and 45 (31%) were relatives. There were 99 (67%) men and 48 (33%) women and the mean age was 59.7+/-14.1 years. Sixty-two percent of respondents recognized paralysis of one side as a warning symptom and 54% recognized hypertension as a risk factor for stroke. In the multivariable logistic regression analysis, higher education was associated with the knowledge of correct organ involvement in stroke (OR 2.6, CI 1.1- 6.1, P =0.02), whereas younger age (OR 2.7, CI 1.1-7.0, P =0.04) and higher education (OR 4.1, CI 1.5-10.9, P =0.005) correlated with a better knowledge regarding warning symptoms of stroke. In this study cohort, in general, there is lack of awareness of major warning symptoms, risk factors, organ involvement and self-recognition of stroke. However younger age and education status were associated with better knowledge. There is an urgent need for awareness programs about stroke in this study cohort.

Knowledge of stroke risk factors amongst black diabetic, hypertensive and stroke patients

Directory of Open Access Journals (Sweden)

G. Bogoshi

2003-01-01

knowledge of black patients diagnosed with hypertension, diabetes and stroke about the risk factors for stroke.  Four groups made up of 33 subjects (hypertensive, diabetic, stroke and control group were interviewed using open-ended questions and a structured questionnaire. Qualitative coding, frequencies and proportions were used to determine their knowledge.  Groups were compared with respect to percentage knowledge using the chi-square statistic at a 0.05 level of significance.  Stress was mentioned as the most important risk factor in all groups.  Although identification of stroke risk factors was  inadequate, the diabetic group was found to be significantly better in  identifying some of the risk factors (salt - p =0,05; sugar - p = 0,001; fat - p = 0,004; moderate smoking - p = 0,05; weight - p = 0,002

Localization of Impaired Kinesthetic Processing Post-stroke.

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Kenzie, Jeffrey M; Semrau, Jennifer A; Findlater, Sonja E; Yu, Amy Y; Desai, Jamsheed A; Herter, Troy M; Hill, Michael D; Scott, Stephen H; Dukelow, Sean P

2016-01-01

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 association with

Prediction of Major Vascular Events after Stroke

DEFF Research Database (Denmark)

Ovbiagele, Bruce; Goldstein, Larry B.; Amarenco, Pierre

2014-01-01

BACKGROUND: Identifying patients with recent stroke or transient ischemic attack (TIA) at high risk of major vascular events (MVEs; stroke, myocardial infarction, or vascular death) may help optimize the intensity of secondary preventive interventions. We evaluated the relationships between...... the baseline Framingham Coronary Risk Score (FCRS) and a novel risk prediction model and with the occurrence of MVEs after stroke or TIA in subjects enrolled in the Stroke Prevention by Aggressive Reduction in Cholesterol Level (SPARCL) trial. METHODS: Data from the 4731 subjects enrolled in the SPARCL study...... were analyzed. Hazard ratios (HRs) from Cox regression models were used to determine the risk of subsequent MVEs based on the FCRS predicting 20% or more 10-year coronary heart disease risk. The novel risk model was derived based on multivariable modeling with backward selection. Model discrimination...

Effect of auditory feedback differs according to side of hemiparesis: a comparative pilot study

OpenAIRE

Robertson, Johanna VG; Hoellinger, Thomas; Lindberg, P?vel; Bensmail, Djamel; Hanneton, Sylvain; Roby-Brami, Agn?s

2009-01-01

Abstract Background Following stroke, patients frequently demonstrate loss of motor control and function and altered kinematic parameters of reaching movements. Feedback is an essential component of rehabilitation and auditory feedback of kinematic parameters may be a useful tool for rehabilitation of reaching movements at the impairment level. The aim of this study was to investigate the effect of 2 types of auditory feedback on the kinematics of reaching movements in hemiparetic stroke pati...

The Immediate Effect of a Textured Insole in Nonparetic Lower Limb Symmetry of Weight Bearing and Gait Parameters in Patients with Chronic Stroke

Directory of Open Access Journals (Sweden)

Mehdi Hassan Abadi

2016-04-01

Conclusion The current study showed that obligatory use of affected limb side could improve symmetry of weight bearing in walking and standing position of patients with chronic stroke by overcoming the phenomenon of learned lack of using and correcting the failure of sending sensory signals to centers of movement controls. The results of this study showed that unilateral use of textured insole with shore A-80 in the unaffected side could immediately improve weight bearing symmetry and step length symmetry in patients with hemiparesis, but it has no effect on their walking speed and step length. Using insole with A-60 hardness did not significantly change any variables of tests. Considering the results of this study, these insoles can be used in balance exercises and walking of hemiparetic patients.

Effects of modified constraint-induced movement therapy on reach-to-grasp movements and functional performance after chronic stroke: a randomized controlled study.

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Lin, K-C; Wu, C-Y; Wei, T-H; Lee, C-Y; Liu, J-S

2007-12-01

To evaluate changes in (1) motor control characteristics of the hemiparetic hand during the performance of a functional reach-to-grasp task and (2) functional performance of daily activities in patients with stroke treated with modified constraint-induced movement therapy. Two-group randomized controlled trial with pretreatment and posttreatment measures. Rehabilitation clinics. Thirty-two chronic stroke patients (21 men, 11 women; mean age=57.9 years, range=43-81 years) 13-26 months (mean 16.3 months) after onset of a first-ever cerebrovascular accident. Thirty-two patients were randomized to receive modified constraint-induced movement therapy (restraint of the unaffected limb combined with intensive training of the affected limb) or traditional rehabilitation for three weeks. Kinematic analysis was used to assess motor control characteristics as patients reached to grasp a beverage can. Functional outcomes were evaluated using the Motor Activity Log and Functional Independence Measure. There were moderate and significant effects of modified constraint-induced movement therapy on some aspects of motor control of reach-to-grasp and on functional ability. The modified constraint-induced movement therapy group preplanned reaching and grasping (P=0.018) more efficiently and depended more on the feedforward control of reaching (P=0.046) than did the traditional rehabilitation group. The modified constraint-induced movement therapy group also showed significantly improved functional performance on the Motor Activity Log (Pcontrol strategy during goal-directed reaching, a possible mechanism for the improved movement performance of stroke patients undergoing this therapy.

tDCS and Robotics on Upper Limb Stroke Rehabilitation: Effect Modification by Stroke Duration and Type of Stroke.

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Straudi, Sofia; Fregni, Felipe; Martinuzzi, Carlotta; Pavarelli, Claudia; Salvioli, Stefano; Basaglia, Nino

2016-01-01

Objective. The aim of this exploratory pilot study is to test the effects of bilateral tDCS combined with upper extremity robot-assisted therapy (RAT) on stroke survivors. Methods. We enrolled 23 subjects who were allocated to 2 groups: RAT + real tDCS and RAT + sham-tDCS. Each patient underwent 10 sessions (5 sessions/week) over two weeks. Outcome measures were collected before and after treatment: (i) Fugl-Meyer Assessment-Upper Extremity (FMA-UE), (ii) Box and Block Test (BBT), and (iii) Motor Activity Log (MAL). Results. Both groups reported a significant improvement in FMA-UE score after treatment (p robotics on motor function. Patients with chronic and subcortical stroke benefited more from the treatments than patients with acute and cortical stroke, who presented very small changes. Conclusion. The additional use of bilateral tDCS to RAT seems to have a significant beneficial effect depending on the duration and type of stroke. These results should be verified by additional confirmatory studies.

Relationship between QT Interval Dispersion in acute stroke and stroke prognosis: A Systematic Review

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Lederman, Yitzchok S.; Balucani, Clotilde; Lazar, Jason; Steinberg, Leah; Gugger, James; Levine, Steven R.

2014-01-01

Background QT dispersion (QTd) has been proposed as an indirect ECG measure of heterogeneity of ventricular repolarization. The predictive value of QTd in acute stroke remains controversial. We aimed to clarify the relationship between QTd and acute stroke and stroke prognosis. Methods A systematic review of the literature was performed using pre-specified medical subjects heading (MeSH) terms, Boolean logic and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Eligible studies (a) included ischemic or hemorrhagic stroke and (b) provided QTd measurements. Results Two independent reviewers identified 553 publications. Sixteen articles were included in the final analysis. There were a total of 888 stroke patients: 59% ischemic and 41% hemorrhagic. There was considerable heterogeneity in study design, stroke subtypes, ECG assessment-time, control groups and comparison groups. Nine studies reported a significant association between acute stroke and baseline QTd. Two studies reported that QTd increases are specifically related to hemorrhagic strokes, involvement of the insular cortex, right-side lesions, larger strokes, and increases in 3, 4-dihydroxyphenylethylene glycol in hemorrhagic stroke. Three studies reported QTd to be an independent predictor of stroke mortality. One study each reported increases in QTd in stroke patients who developed ventricular arrhythmias and cardiorespiratory compromise. Conclusions There are few well-designed studies and considerable variability in study design in addressing the significance of QTd in acute stroke. Available data suggest that stroke is likely to be associated with increased QTd. While some evidence suggests a possible prognostic role of QTd in stroke, larger and well-designed studies need to confirm these findings. PMID:25282188

Constraints on grip selection in hemiparetic cerebral palsy: effects of lesional side, end-point accuracy, and context.

Science.gov (United States)

Steenbergen, Bert; Meulenbroek, Ruud G J; Rosenbaum, David A

2004-04-01

This study was concerned with selection criteria used for grip planning in adolescents with left or right hemiparetic cerebral palsy. In the first experiment, we asked participants to pick up a pencil and place the tip in a pre-defined target region. We varied the size of the target to test the hypothesis that increased end-point precision demands would favour the use of a grip that affords end-state comfort. In the second experiment, we studied grip planning in three task contexts that were chosen to let us test the hypothesis that a more functional task context would likewise promote the end-state comfort effect. When movements were performed with the impaired hand, we found that participants with right hemiparesis (i.e., left brain damage) aimed for postural comfort at the start rather than at the end of the object-manipulation phase in both experiments. By contrast, participants with left hemiparesis (i.e., right brain damage) did not favour a particular selection criterion with the impaired hand in the first experiment, but aimed for postural comfort at the start in the second experiment. When movements were performed with the unimpaired hand, grip selection criteria again differed for right and left hemiparetic participants. Participants with right hemiparesis did not favour a particular selection criterion with the unimpaired hand in the first experiment and only showed the end-state comfort effect in the most functional tasks of the second experiment. By contrast, participants with left hemiparesis showed the end-state comfort effect in all conditions of both experiments. These data suggest that the left hemisphere plays a special role in action planning, as has been recognized before, and that one of the deficits accompanying left brain damage is a deficit in forward movement planning, which has not been recognized before. Our findings have both theoretical and clinical implications.

Patent foramen ovale and the risk of ischemic stroke in a multiethnic population.

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Di Tullio, Marco R; Sacco, Ralph L; Sciacca, Robert R; Jin, Zhezhen; Homma, Shunichi

2007-02-20

We sought to assess the risk of ischemic stroke from a patent foramen ovale (PFO) in the multiethnic prospective cohort of northern Manhattan. Patent foramen ovale has been associated with increased risk of ischemic stroke, mainly in case-control studies. The actual PFO-related stroke risk in the general population is unclear. The presence of PFO was assessed at baseline by using transthoracic 2-dimensional echocardiography with contrast injection in 1,100 stroke-free subjects older than 39 years of age (mean age 68.7 +/- 10.0 years) from the Northern Manhattan Study (NOMAS). The presence of atrial septal aneurysm (ASA) also was recorded. Subjects were followed annually for outcomes. We assessed PFO/ASA-related stroke risk after adjusting for established stroke risk factors. We detected PFO in 164 subjects (14.9%); ASA was present in 27 subjects (2.5%) and associated with PFO in 19 subjects. During a mean follow-up of 79.7 +/- 28.0 months, an ischemic stroke occurred in 68 subjects (6.2%). After adjustment for demographics and risk factors, PFO was not found to be significantly associated with stroke (hazard ratio 1.64, 95% confidence interval [CI] 0.87 to 3.09). The same trend was observed in all age, gender, and race-ethnic subgroups. The coexistence of PFO and ASA did not increase the stroke risk (adjusted hazard ratio 1.25, 95% CI 0.17 to 9.24). Isolated ASA was associated with elevated stroke incidence (2 of 8, or 25%; adjusted hazard ratio 3.66, 95% CI 0.88 to 15.30). Patent foramen ovale, alone or together with ASA, was not associated with an increased stroke risk in this multiethnic cohort. The independent role of ASA needs further assessment in appositely designed and powered studies.

Risk of stroke and cardiovascular events after ischemic stroke or transient ischemic attack in patients with type 2 diabetes or metabolic syndrome: secondary analysis of the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial

DEFF Research Database (Denmark)

Callahan, Alfred; Amarenco, Pierre; Goldstein, Larry B

2011-01-01

To perform a secondary analysis of the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial, which tested the effect of treatment with atorvastatin in reducing stroke in subjects with a recent stroke or transient ischemic attack, to explore the effects of treatment...

The efficacy of problem solving therapy to reduce post stroke emotional distress in younger (18-65) stroke survivors.

Science.gov (United States)

Chalmers, Charlotte; Leathem, Janet; Bennett, Simon; McNaughton, Harry; Mahawish, Karim

2017-11-26

To investigate the efficacy of problem solving therapy for reducing the emotional distress experienced by younger stroke survivors. A non-randomized waitlist controlled design was used to compare outcome measures for the treatment group and a waitlist control group at baseline and post-waitlist/post-therapy. After the waitlist group received problem solving therapy an analysis was completed on the pooled outcome measures at baseline, post-treatment, and three-month follow-up. Changes on outcome measures between baseline and post-treatment (n = 13) were not significantly different between the two groups, treatment (n = 13), and the waitlist control group (n = 16) (between-subject design). The pooled data (n = 28) indicated that receiving problem solving therapy significantly reduced participants levels of depression and anxiety and increased quality of life levels from baseline to follow up (within-subject design), however, methodological limitations, such as the lack of a control group reduce the validity of this finding. The between-subject results suggest that there was no significant difference between those that received problem solving therapy and a waitlist control group between baseline and post-waitlist/post-therapy. The within-subject design suggests that problem solving therapy may be beneficial for younger stroke survivors when they are given some time to learn and implement the skills into their day to day life. However, additional research with a control group is required to investigate this further. This study provides limited evidence for the provision of support groups for younger stroke survivors post stroke, however, it remains unclear about what type of support this should be. Implications for Rehabilitation Problem solving therapy is no more effective for reducing post stroke distress than a wait-list control group. Problem solving therapy may be perceived as helpful and enjoyable by younger stroke survivors. Younger stroke

Genetics of ischemic stroke: future clinical applications.

Science.gov (United States)

Wang, Michael M

2006-11-01

Ischemic stroke has long been thought to have a genetic component that is independent of conventional vascular risk factors. It has been estimated that over one half of stroke risk is determined by inherited genes. However, until recently, strong evidence of genetic influence on ischemic stroke has been subject to criticism because the risk factors for stroke are also inherited and because previous studies suffered from limitations imposed by this highly heterogeneous neurological disorder. Recent advances in molecular genetics have led to the identification of specific genetic loci that impart susceptibility to ischemic stroke. We review the studies of these genes and discuss the future potential applications of genetic markers on the management of ischemic stroke patients.

Author Details

African Journals Online (AJOL)

Relative Therapeutic Efficacy of the Treadmill and Step Bench in Gait Rehabilitation of Hemiparetic Stroke Patients Abstract PDF · Vol 6, No 1-2 (2014) - Articles Active Commuting to School as a Source of Health Promotion Among Urban Day Secondary School Students in Ibadan, Nigeria: Barriers and facilitators

Constraint-induced movement therapy: some thoughts about theories and evidence

NARCIS (Netherlands)

van der Lee, Johanna H.

2003-01-01

Constraint-Induced Movement Therapy (CIMT) is a type of treatment for hemiparetic stroke patients in which the patient is strongly encouraged to use the affected arm. One way of doing this is to immobilise the unaffected arm. This treatment is meant to help patients overcome 'learned non-use'. The

Insight of Human Stroke from blood flow and blood pressure

Science.gov (United States)

Chen, Zhi; Ivanov, Plamen Ch.; Hu, Kun; Stanley, H. Eugene

2003-03-01

Stroke is is one of the leading cause of death and disability in the world. It is well believed that stroke is caused by the disturbance of cerebrovascular autoregulation. We investigate the blood flow on the left and right middle cerebral artery and beat-to-beat blood pressure simultaneously measured from the finger, for both subjects with stroke and healthy subjects. Synchronization technique is used to distinguish the difference between these two groups.

Statin treatment and stroke outcome in the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial

DEFF Research Database (Denmark)

Goldstein, L.B.; Amarenco, P.; Zivin, J.

2009-01-01

BACKGROUND AND PURPOSE: Laboratory experiments suggest statins reduce stroke severity and improve outcomes. The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial was a placebo-controlled, randomized trial designed to determine whether treatment with atorvastatin reduces...... or 4), moderate (modified Rankin Scale score 3 or 2), and mild (modified Rankin Scale score 1 or 0) outcome ischemic strokes and transient ischemic attacks and an increase in the proportion of event-free subjects randomized to atorvastatin (P

Optimizing a Treadmill Ramp Protocol to Evaluate Aerobic Capacity of Hemiparetic Poststroke Patients.

Science.gov (United States)

Bernardes, Wendell L; Montenegro, Rafael A; Monteiro, Walace D; de Almeida Freire, Raul; Massaferri, Renato; Farinatti, Paulo

2018-03-01

Bernardes, WL, Montenegro, RA, Monteiro, WD, de Almeida Freire, R, Massaferri, R, and Farinatti, P. Optimizing a treadmill ramp protocol to evaluate aerobic capacity of hemiparetic poststroke patients. J Strength Cond Res 32(3): 876-884, 2018-A correct assessment of cardiopulmonary capacity is important for aerobic training within motor rehabilitation of poststroke hemiparetic patients (PSHPs). However, specific cardiopulmonary exercise testing (CPET) for these patients are scarce. We proposed adaptations in a protocol originally developed for PSHPs by Ovando et al. (CPET1). We hypothesized that our adapted protocol (CPET2) would improve the original test, by preventing early fatigue and increasing patients' peak performance. Eleven PSHPs (52 ± 14 years, 10 men) performed both protocols. CPET2 integrated changes in final speed (100-120% vs. 140% maximal speed in 10-m walking test), treadmill inclination (final inclination of 5 vs. 10%), and estimated test duration (10 vs. 8 minutes) to smooth the rate of workload increment of CPET1. Peak oxygen uptake (V[Combining Dot Above]O2peak) (20.3 ± 6.1 vs. 18.6 ± 5.0 ml·kg·min; p = 0.04), V[Combining Dot Above]O2 at gas exchange transition (V[Combining Dot Above]O2-GET) (11.5 ± 2.9 vs. 9.8 ± 2.0 ml·kg·min; p = 0.04), and time to exhaustion (10 ± 3 vs. 6 ± 2 minutes; p higher in CPET2 than in CPET1. Slopes and intercepts of regressions describing relationships between V[Combining Dot Above]O2 vs. workload, heart rate vs. workload, and V[Combining Dot Above]O2 vs. heart rate were similar between CPETs. However, standard errors of estimates obtained for regressions between heart rate vs. workload (3.0 ± 1.3 vs. 3.8 ± 1.0 b·min; p = 0.004) and V[Combining Dot Above]O2 vs. heart rate (6.0 ± 2.1 vs. 4.8 ± 2.4 ml·kg·min; p = 0.05) were lower in CPET2 than in CPET1. In conclusion, the present adaptations in Ovando's CPET protocol increased exercise tolerance of PSHPs, eliciting higher V[Combining Dot Above]O2peak

Home-based Neurologic Music Therapy for Upper Limb Rehabilitation with Stroke Patients at Community Rehabilitation Stage - a Feasibility Study Protocol.

Directory of Open Access Journals (Sweden)

Alex J Street

2015-09-01

Full Text Available Background: Impairment of upper limb function following stroke is more common than lower limb impairment and is also more resistant to treatment. Several lab-based studies with stroke patients have produced statistically significant gains in upper limb function when using musical instrument playing and techniques where rhythm acts as an external time-keeper for the priming and timing of upper limb movements. Methods: For this feasibility study a small sample size of 14 participants (3 – 60 months post stroke has been determined through clinical discussion between the researcher and study host in order to test for management, feasibility and effects, before planning a larger trial determined through power analysis. A cross-over design with five repeated measures will be used, whereby participants will be randomized into either a treatment (n=7 or wait list control (n=7 group. Intervention will take place twice weekly over 6 weeks. The ARAT and 9HPT will be used to measure for quantitative gains in arm function and finger dexterity, pre/post treatment interviews will serve to investigate treatment compliance and tolerance. A lab based EEG case comparison study will be undertaken to explore audio-motor coupling, brain connectivity and neural reorganization with this intervention, as evidenced in similar studies. Discussion: Before evaluating the effectiveness of a home-based intervention in a larger scale study, it is important to assess whether implementation of the trial methodology is feasible. This study investigates the feasibility, efficacy and patient experience of a music therapy treatment protocol comprising a chart of 12 different instrumental exercises and variations, which aims at promoting measurable changes in upper limb function in hemiparetic stroke patients. The study proposes to examine several new aspects including home-based treatment and dosage, and will provide data on recruitment, adherence and variability of outcomes.

Home-based neurologic music therapy for upper limb rehabilitation with stroke patients at community rehabilitation stage-a feasibility study protocol.

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Street, Alexander J; Magee, Wendy L; Odell-Miller, Helen; Bateman, Andrew; Fachner, Jorg C

2015-01-01

Impairment of upper limb function following stroke is more common than lower limb impairment and is also more resistant to treatment. Several lab-based studies with stroke patients have produced statistically significant gains in upper limb function when using musical instrument playing and techniques where rhythm acts as an external time-keeper for the priming and timing of upper limb movements. For this feasibility study a small sample size of 14 participants (3-60 months post stroke) has been determined through clinical discussion between the researcher and study host in order to test for management, feasibility and effects, before planning a larger trial determined through power analysis. A cross-over design with five repeated measures will be used, whereby participants will be randomized into either a treatment (n = 7) or wait list control (n = 7) group. Intervention will take place twice weekly over 6 weeks. The ARAT and 9HPT will be used to measure for quantitative gains in arm function and finger dexterity, pre/post treatment interviews will serve to investigate treatment compliance and tolerance. A lab based EEG case comparison study will be undertaken to explore audio-motor coupling, brain connectivity and neural reorganization with this intervention, as evidenced in similar studies. Before evaluating the effectiveness of a home-based intervention in a larger scale study, it is important to assess whether implementation of the trial methodology is feasible. This study investigates the feasibility, efficacy and patient experience of a music therapy treatment protocol comprising a chart of 12 different instrumental exercises and variations, which aims at promoting measurable changes in upper limb function in hemiparetic stroke patients. The study proposes to examine several new aspects including home-based treatment and dosage, and will provide data on recruitment, adherence and variability of outcomes.

Treadmill training with partial body weight support and an electromechanical gait trainer for restoration of gait in subacute stroke patients: a randomized crossover study.

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Werner, C; Von Frankenberg, S; Treig, T; Konrad, M; Hesse, S

2002-12-01

The purpose of this study was to compare treadmill and electromechanical gait trainer therapy in subacute, nonambulatory stroke survivors. The gait trainer was designed to provide nonambulatory subjects the repetitive practice of a gait-like movement without overexerting therapists. This was a randomized, controlled study with a crossover design following an A-B-A versus a B-A-B pattern. A consisted of 2 weeks of gait trainer therapy, and B consisted of 2 weeks of treadmill therapy. Thirty nonambulatory hemiparetic patients, 4 to 12 weeks after stroke, were randomly assigned to 1 of the 2 groups receiving locomotor therapy every workday for 15 to 20 minutes for 6 weeks. Weekly gait ability (functional ambulation category [FAC]), gait velocity, and the required physical assistance during both kinds of locomotor therapy were the primary outcome measures, and other motor functions (Rivermead motor assessment score) and ankle spasticity (modified Ashworth score) were the secondary outcome measures. Follow-up occurred 6 months later. The groups did not differ at study onset with respect to the clinical characteristics and effector variables. During treatment, the FAC, gait velocity, and Rivermead scores improved in both groups, and ankle spasticity did not change. Median FAC level was 4 (3 to 4) in group A compared with 3 (2 to 3) in group B at the end of treatment (P=0.018), but the difference at 6-month follow up was not significant. The therapeutic effort was less on the gait trainer, with 1 instead of 2 therapists assisting the patient at study onset. All but seven patients preferred the gait trainer. The newly developed gait trainer was at least as effective as treadmill therapy with partial body weight support while requiring less input from the therapist. Further studies are warranted.

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Vol 5, No 1-2 (2013), Relative Therapeutic Efficacy of Phonophoresis and Cryotherapy as Combined Therapy in the Management of Musculoskeletal Injuries, Abstract PDF. HAK Onuwe, K Amadi. Vol 4, No 1-2 (2012), Relative Therapeutic Efficacy of the Treadmill and Step Bench in Gait Rehabilitation of Hemiparetic Stroke ...

Stroke liaison workers for stroke patients and carers: an individual patient data meta-analysis.

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Ellis, Graham; Mant, Jonathan; Langhorne, Peter; Dennis, Martin; Winner, Simon

2010-05-12

Many patients experience depression, social isolation and anxiety post stroke. These are associated with a poorer outcome. Ameliorating these problems may improve patient wellbeing. To evaluate the impact of a healthcare worker or volunteer whose multi-dimensional roles have been grouped under the title 'stroke liaison worker'. We searched the Cochrane Stroke Group Trials Register (searched February 2009), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2009), MEDLINE (1966 to 2009), EMBASE (1980 to 2009) and four other databases. We performed a cited reference search, searched conference proceedings and trials registers, checked reference lists and contacted authors and trial investigators. Randomised controlled trials investigating the impact of a stroke liaison worker versus usual care. We invited trialists to participate in a review of individual patient data. Primary outcomes for patients were subjective health status and extended activities of daily living. Primary outcomes for carers were subjective health status including measures of carer strain. We included 16 trials involving 4759 participants. Analysis did not show a significant overall difference for subjective health status (standardised mean difference (SMD) -0.03, 95% confidence interval (CI) -0.11 to 0.04, P = 0.34) or extended activities of daily living (SMD 0.04, 95% CI -0.03 to 0.11, P = 0.22). There was no overall significant effect for the outcome of carer subjective health status (SMD 0.04, 95% CI -0.05 to 0.14, P = 0.37). Patients with mild to moderate disability (Barthel 15 to 19) had a significant reduction in dependence (odds ratio (OR) 0.62, 95% CI 0.44 to 0.87, P = 0.006). This would equate to 10 fewer dependent patients (95% CI 17 fewer to 4 fewer) for every 100 patients seen by the stroke liaison worker. Similar results were seen for the outcome of death or dependence for the subgroup with Barthel 15 to 19 (OR 0.55, 95% CI 0.38 to 0.81, P

Neuromagnetic beta and gamma oscillations in the somatosensory cortex after music training in healthy older adults and a chronic stroke patient.

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Jamali, Shahab; Fujioka, Takako; Ross, Bernhard

2014-06-01

Extensive rehabilitation training can lead to functional improvement even years after a stroke. Although neuronal plasticity is considered as a main origin of such ameliorations, specific subtending mechanisms need further investigation. Our aim was to obtain objective neuromagnetic measures sensitive to brain reorganizations induced by a music-supported training. We applied 20-Hz vibrotactile stimuli to the index finger and the ring finger, recorded somatosensory steady-state responses with magnetoencephalography, and analyzed the cortical sources displaying oscillations synchronized with the external stimuli in two groups of healthy older adults before and after musical training or without training. In addition, we applied the same analysis for an anecdotic report of a single chronic stroke patient with hemiparetic arm and hand problems, who received music-supported therapy (MST). Healthy older adults showed significant finger separation within the primary somatotopic map. Beta dipole sources were more anterior located compared to gamma sources. An anterior shift of sources and increases in synchrony between the stimuli and beta and gamma oscillations were observed selectively after music training. In the stroke patient a normalization of somatotopic organization was observed after MST, with digit separation recovered after training and stimulus induced gamma synchrony increased. The proposed stimulation paradigm captures the integrity of primary somatosensory hand representation. Source position and synchronization between the stimuli and gamma activity are indices, sensitive to music-supported training. Responsiveness was also observed in a chronic stroke patient, encouraging for the music-supported therapy. Notably, changes in somatosensory responses were observed, even though the therapy did not involve specific sensory discrimination training. The proposed protocol can be used for monitoring changes in neuronal organization during training and will improve

Stroke And Substance Abuse

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A Chitsaz

2017-02-01

Full Text Available Introduction: stroke in recreational substance users can be an indirect complication, like endocarditis and cardio embolism in parenteral drug users. With some drug like cocaine, stroke appear to be the result of a direct effect. In young subjects without other risk factors provide persuasive evidence for causality . OPIATES: Heroine is the most abused opiate drug, which is administered by injection, by snorting or by smoking. Stroke affects heroin users by diverse mechanisms,. Injectors are at risk of infections endocarditis, which carries risk for both ischemic and hemorrhagic stroke. Cerebral or subarachnoid hemorrhage usually occurs after rupture of a septic (mycotic aneurysm. Heroine users can are also at risk for hemorrhagic stroke secondary to liver failure with deranged clotting and to heroin nephropathy with uremia or malignant hypertension. In some heroin users the drug it self is directly causal due to vasculitis, hypersensitivity and immunologic changes. Embolization of foreign material to brain due to mixed of heroine with quinine can cause cerebral embolism. AMPHETAMINE AND other psychostimulants: In abuser of amphetamine hemorrhagic stroke can occur, oral, intravenous, nasal, and inhalational routes of administration have been reported. Most were chronic user, but in several patients, stroke followed a first exposure. Some of amphetamine induced intracranial hemorrhages are secondary to acute hypertension, some to cerebral vacuities, and some to a combination of two. Decongestants and diet pills: Phenylpropanolamine (PPA, an amphetamine – like drug, in decongestants and diet pills, induce acute hypertension, sever headache, psychiatric symptoms, seizures and hemorrhagic stroke. Ephedrine and pseudo ephedrine are present in decongestants and bronchodilators and induce headache, tachyarrhythmia, hypertensive emergency, and hemorrhagic and occlusive stroke. Ecstasy, 3,4 Methylenedioxymethamphetamin (MDMA with amphetamine like can

A cognitive-balance control training paradigm using wii fit to reduce fall risk in chronic stroke survivors.

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Subramaniam, Savitha; Wan-Ying Hui-Chan, Christina; Bhatt, Tanvi

2014-10-01

The impaired ability to maintain balance while performing higher-level cognitive tasks (cognitive-motor interference) significantly predisposes stroke survivors to risk of falls. We investigated adherence and intervention-related effects of gaming to improve balance control and decrease cognitive-motor interference in stroke survivors. Community-dwelling individuals with hemiparetic stroke (N = 8) received balance control training using Wii Fit in conjunction with cognitive training for approximately 110 min/d for 5 consecutive days. Changes in balance and cognitive performance were evaluated by the limits of stability test performed under single-task (ST) and dual-task (DT) conditions. The outcome measures from the limits of stability test included reaction time and movement velocity of the center of pressure. The cognitive performance was quantified by the number of errors. The DT cost was computed for the balance and cognitive outcome measures using [(ST - DT)/ST × 100]. Adherence was assessed by change on the Intrinsic Motivation Inventory scores postintervention. No commercial party having a direct financial interest in the research findings reported here has conferred orwill confer. Posttraining, reaction time cost in the forward direction improved from 31 ± 8.02 to ±8.7 ± 6.6. Similarly, movement velocity cost improved from 33.7 ± 12.3 to 11 ± 1. Cognitive cost also decreased from 47.9 ± 13.9 to 20 ± 18.8. There were similar improvements in the backward direction for all the outcome measures. Scores on the Intrinsic Motivation Inventory improved from 16.6 ± 1.3 to 23.5 ± 1.5. The results demonstrate good adherence and evidence of clinical value of this high-intensity, short-duration protocol for reducing cognitive-motor interference and improving balance control in stroke survivors. Future studies should examine the dose-response effects and long-term changes of such DT training paradigm applied to improve fall efficacy.Video Abstract available

Robotic identification of kinesthetic deficits after stroke.

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Semrau, Jennifer A; Herter, Troy M; Scott, Stephen H; Dukelow, Sean P

2013-12-01

Kinesthesia, the sense of body motion, is essential to proper control and execution of movement. Despite its importance for activities of daily living, no current clinical measures can objectively measure kinesthetic deficits. The goal of this study was to use robotic technology to quantify prevalence and severity of kinesthetic deficits of the upper limb poststroke. Seventy-four neurologically intact subjects and 113 subjects with stroke (62 left-affected, 51 right-affected) performed a robot-based kinesthetic matching task with vision occluded. The robot moved the most affected arm at a preset speed, direction, and magnitude. Subjects were instructed to mirror-match the movement with their opposite arm (active arm). A large number of subjects with stroke were significantly impaired on measures of kinesthesia. We observed impairments in ability to match movement direction (69% and 49% impaired for left- and right-affected subjects, respectively) and movement magnitude (42% and 31%). We observed impairments to match movement speed (32% and 27%) and increased response latencies (48% and 20%). Movement direction errors and response latencies were related to clinical measures of function, motor recovery, and dexterity. Using a robotic approach, we found that 61% of acute stroke survivors (n=69) had kinesthetic deficits. Additionally, these deficits were highly related to existing clinical measures, suggesting the importance of kinesthesia in day-to-day function. Our methods allow for more sensitive, accurate, and objective identification of kinesthetic deficits after stroke. With this information, we can better inform clinical treatment strategies to improve poststroke rehabilitative care and outcomes.

Stroke risk factors among participants of a world stroke day ...

African Journals Online (AJOL)

2015-04-20

Apr 20, 2015 ... Materials and Methods: We screened 224 volunteers from Ile‑Ife during the ... Blood pressures (BP) were measured and body mass index (BMI) was ... Conclusion: Stroke risk factors such as hypertension and obesity were common among the .... an accoson mercury sphygmomanometer, with the subjects.

Strength deficit of knee flexors is dependent on hip position in adults with chronic hemiparesis.

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Michaelsen, Stella M; Ovando, Angélica C; Bortolotti, Adriano; Bandini, Bruno

2013-01-01

The extent to which muscle length affects force production in paretic lower limb muscles after stroke in comparison to controls has not been established. To investigate knee flexor strength deficits dependent on hip joint position in adults with hemiparesis and compare with healthy controls. a cross-sectional study with ten subjects with chronic (63±40 months) hemiparesis with mild to moderate lower limb paresis (Fugl-Meyer score 26±3) and 10 neurologically healthy controls. Isometric knee flexion strength with the hip positioned at 90° and 0° of flexion was assessed randomly on the paretic and non-paretic side of hemiparetic subjects and healthy controls. Subjects were asked to perform a maximal isometric contraction sustained for four seconds and measured by a dynamometer. The ratio of knee flexor strength between these two hip positions was calculated: Hip 0°/Hip 90°. Also, locomotor capacity was evaluated by the timed up and go test and by walking velocity over 10 meters. In subjects with hemiparesis, absolute knee flexion torque decreased (phemiparesis when compared to controls. More attention should be given to lower limb muscle strengthening exercises in individuals with stroke, with emphasis on the strengthening exercises in positions in which the muscle is shortened.

Cognitive performance after ischaemic stroke

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Maria Gabriela R. Ferreira

Full Text Available Cognitive impairment after stroke affects the patient recovery process. Therefore, the identification of factors associated with cognitive outcomes is important since it allows risk profiles of stroke survivors to be determined. OBJECTIVE: To assess cognitive outcome of stroke outpatients and investigate associations among clinical and demographic variables, vascular risk factors, depression symptoms and functional ability; and to describe the neuropsychological profile of these patients. METHODS: A cross-sectional design study was conducted. Subjects who suffered a first-ever ischaemic stroke 6 to 10 months prior to data collection underwent neuropsychological assessment and screening for depressive symptoms and functional ability. The outcome "cognitive performance" was analyzed considering two groups: "cognitive impairment" and "no cognitive impairment". RESULTS: There was a statistically significant association between cognitive impairment and female gender, age, stroke severity and functional ability. Regarding neuropsychological profile, the cognitive impairment group exhibited more generalized deficits in attention, visuospatial organization, verbal functions and verbal memory domains compared to the community control group. CONCLUSION: The occurrence of cognitive impairment among patients was high, especially in women, older participants, individuals with more severe stroke, and greater impairment in functional ability. Multiple cognitive domains are affected and this may hamper recovery and negatively impact independence and quality of life after stroke.

Neuroserpin polymorphisms and stroke risk in a biracial population: the stroke prevention in young women study

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Stern Barney J

2007-10-01

Full Text Available Abstract Background Neuroserpin, primarily localized to CNS neurons, inhibits the adverse effects of tissue-type plasminogen activator (tPA on the neurovascular unit and has neuroprotective effects in animal models of ischemic stroke. We sought to evaluate the association of neuroserpin polymorphisms with risk for ischemic stroke among young women. Methods A population-based case-control study of stroke among women aged 15–49 identified 224 cases of first ischemic stroke (47.3% African-American and 211 age-matched control subjects (43.1% African-American. Neuroserpin single nucleotide polymorphisms (SNPs chosen through HapMap were genotyped in the study population and assessed for association with stroke. Results Of the five SNPs analyzed, the A allele (frequency; Caucasian = 0.56, African-American = 0.42 of SNP rs6797312 located in intron 1 was associated with stroke in an age-adjusted dominant model (AA and AT vs. TT among Caucasians (OR = 2.05, p = 0.023 but not African-Americans (OR = 0.71, p = 0.387. Models adjusting for other risk factors strengthened the association. Race-specific haplotype analyses, inclusive of SNP rs6797312, again demonstrated significant associations with stroke among Caucasians only. Conclusion This study provides the first evidence that neuroserpin is associated with early-onset ischemic stroke among Caucasian women.

Periodontal Disease, Regular Dental Care Use, and Incident Ischemic Stroke.

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Sen, Souvik; Giamberardino, Lauren D; Moss, Kevin; Morelli, Thiago; Rosamond, Wayne D; Gottesman, Rebecca F; Beck, James; Offenbacher, Steven

2018-02-01

Periodontal disease is independently associated with cardiovascular disease. Identification of periodontal disease as a risk factor for incident ischemic stroke raises the possibility that regular dental care utilization may reduce the stroke risk. In the ARIC (Atherosclerosis Risk in Communities) study, pattern of dental visits were classified as regular or episodic dental care users. In the ancillary dental ARIC study, selected subjects from ARIC underwent fullmouth periodontal measurements collected at 6 sites per tooth and classified into 7 periodontal profile classes (PPCs). In the ARIC study 10 362 stroke-free participants, 584 participants had incident ischemic strokes over a 15-year period. In the dental ARIC study, 6736 dentate subjects were assessed for periodontal disease status using PPC with a total of 299 incident ischemic strokes over the 15-year period. The 7 levels of PPC showed a trend toward an increased stroke risk (χ 2 trend P periodontal disease). Periodontal disease was significantly associated with cardioembolic (hazard ratio, 2.6; 95% confidence interval, 1.2-5.6) and thrombotic (hazard ratio, 2.2; 95% confidence interval, 1.3-3.8) stroke subtypes. Regular dental care utilization was associated with lower adjusted stroke risk (hazard ratio, 0.77; 95% confidence interval, 0.63-0.94). We confirm an independent association between periodontal disease and incident stroke risk, particularly cardioembolic and thrombotic stroke subtype. Further, we report that regular dental care utilization may lower this risk for stroke. © 2018 American Heart Association, Inc.

Rhythmic auditory stimulation improves gait more than NDT/Bobath training in near-ambulatory patients early poststroke: a single-blind, randomized trial.

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Thaut, M H; Leins, A K; Rice, R R; Argstatter, H; Kenyon, G P; McIntosh, G C; Bolay, H V; Fetter, M

2007-01-01

The effectiveness of 2 different types of gait training in stroke rehabilitation, rhythmic auditory stimulation (RAS) versus neurodevelopmental therapy (NDT)/Bobath- based training, was compared in 2 groups of hemiparetic stroke patients over a 3-week period of daily training (RAS group, n = 43; NDT/Bobath group =35). Mean entry date into the study was 21.3 days poststroke for the RAS group and 22.3 days for the control group. Patients entered the study as soon as they were able to complete 5 stride cycles with handheld assistance. Patients were closely equated by age, gender, and lesion site. Motor function in both groups was pre-assessed by the Barthel Index and the Fugl-Meyer Scales. Pre- to posttest measures showed a significant improvement in the RAS group for velocity (P = .006), stride length (P = .0001), cadence (P = .0001) and symmetry (P = .0049) over the NDT/Bobath group. Effect sizes for RAS over NDT/Bobath training were 13.1 m/min for velocity, 0.18 m for stride length, and 19 steps/min for cadence. The data show that after 3 weeks of gait training, RAS is an effective therapeutic method to enhance gait training in hemiparetic stroke rehabilitation. Gains were significantly higher for RAS compared to NDT/Bobath training.

Cognitive alterations in motor imagery process after left hemispheric ischemic stroke.

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Jing Yan

Full Text Available BACKGROUND: Motor imagery training is a promising rehabilitation strategy for stroke patients. However, few studies had focused on the neural mechanisms in time course of its cognitive process. This study investigated the cognitive alterations after left hemispheric ischemic stroke during motor imagery task. METHODOLOGY/PRINCIPAL FINDINGS: Eleven patients with ischemic stroke in left hemisphere and eleven age-matched control subjects participated in mental rotation task (MRT of hand pictures. Behavior performance, event-related potential (ERP and event-related (desynchronization (ERD/ERS in beta band were analyzed to investigate the cortical activation. We found that: (1 The response time increased with orientation angles in both groups, called "angle effect", however, stoke patients' responses were impaired with significantly longer response time and lower accuracy rate; (2 In early visual perceptual cognitive process, stroke patients showed hypo-activations in frontal and central brain areas in aspects of both P200 and ERD; (3 During mental rotation process, P300 amplitude in control subjects decreased while angle increased, called "amplitude modulation effect", which was not observed in stroke patients. Spatially, patients showed significant lateralization of P300 with activation only in contralesional (right parietal cortex while control subjects showed P300 in both parietal lobes. Stroke patients also showed an overall cortical hypo-activation of ERD during this sub-stage; (4 In the response sub-stage, control subjects showed higher ERD values with more activated cortical areas particularly in the right hemisphere while angle increased, named "angle effect", which was not observed in stroke patients. In addition, stroke patients showed significant lower ERD for affected hand (right response than that for unaffected hand. CONCLUSIONS/SIGNIFICANCE: Cortical activation was altered differently in each cognitive sub-stage of motor imagery after

Use of computerized tomography in brain stroke

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Landmark, K.; Aursnes, I.; Eldvik, P.; Lilleaas, F.G.

1988-04-01

In a retrospective study in 115 patients consecutively admitted to a ''stroke unit'', 108 were found to have been subjected to one or more cerebral CT-scans, of which ten revealed cerebral haemorrhage, two tumor cerebri and one subdural haematoma. The latter patient was successfully operated upon. The clinical diagnosis of stroke in progression was made in seven patients, whereas embolic stroke was diagnosed in 22. After haemorrhage had been excluded by CT, anticoagulant therapy (warfarin/heparin) was started for various reasons in 35 patients altogether. It is concluded that CT, if available locally, should be performed routinely during the first days following acute stroke.

Use of computerized tomography in brain stroke

International Nuclear Information System (INIS)

Landmark, K.; Aursnes, I.; Eldvik, P.; Lilleaas, F.G.

1988-01-01

In a retrospective study in 115 patients consecutively admitted to a ''stroke unit'', 108 were found to have been subjected to one or more cerebral CT-scans, of which ten revealed cerebral haemorrhage, two tumor cerebri and one subdural haematoma. The latter patient was successfully operated upon. The clinical diagnosis of stroke in progression was made in seven patients, whereas embolic stroke was diagnosed in 22. After haemorrhage had been excluded by CT, anticoagulant therapy (warfarin/heparin) was started for various reasons in 35 patients altogether. It is concluded that CT, if available locally, should be performed routinely during the first days following acute stroke

Examining Differences in Patterns of Sensory and Motor Recovery After Stroke With Robotics.

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Semrau, Jennifer A; Herter, Troy M; Scott, Stephen H; Dukelow, Sean P

2015-12-01

Developing a better understanding of the trajectory and timing of stroke recovery is critical for developing patient-centered rehabilitation approaches. Here, we quantified proprioceptive and motor deficits using robotic technology during the first 6 months post stroke to characterize timing and patterns in recovery. We also make comparisons of robotic assessments to traditional clinical measures. One hundred sixteen subjects with unilateral stroke were studied at 4 time points: 1, 6, 12, and 26 weeks post stroke. Subjects performed robotic assessments of proprioceptive (position sense and kinesthesia) and motor function (unilateral reaching task and bimanual object hit task), as well as several clinical measures (Functional Independence Measure, Purdue Pegboard, and Chedoke-McMaster Stroke Assessment). One week post stroke, many subjects displayed proprioceptive (48% position sense and 68% kinesthesia) and motor impairments (80% unilateral reaching and 85% bilateral movement). Interindividual recovery on robotic measures was highly variable. However, we characterized recovery as early (normal by 6 weeks post stroke), late (normal by 26 weeks post stroke), or incomplete (impaired at 26 weeks post stroke). Proprioceptive and motor recovery often followed different timelines. Across all time points, robotic measures were correlated with clinical measures. These results highlight the need for more sensitive, targeted identification of sensory and motor deficits to optimize rehabilitation after stroke. Furthermore, the trajectory of recovery for some individuals with mild to moderate stroke may be much longer than previously considered. © 2015 American Heart Association, Inc.

Effects of robotic-aided rehabilitation on recovery of upper extremity function in chronic stroke: a single case study.

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Flinn, Nancy A; Smith, Jennifer L; Tripp, Christopher J; White, Matthew W

2009-01-01

The objective of the study was to examine the results of robotic therapy in a single client. A 48-year-old female client 15 months post-stroke, with right hemiparesis, received robotic therapy as an outpatient in a large Midwestern rehabilitation hospital. Robotic therapy was provided three times a week for 6 weeks. Robotic therapy consisted of goal-directed, robotic-aided reaching tasks to exercise the hemiparetic shoulder and elbow. No other therapeutic intervention for the affected upper extremity was provided during the study or 3 months follow-up period. The outcome measures included the Fugl-Meyer, graded Wolf motor function test (GWMFT), motor activity log, active range of motion and Canadian occupational performance measure. The participant made gains in active movement; performance; and satisfaction of functional tasks, GWMFT and functional use. Limitations involved in this study relate to the generalizability of the sample size, effect of medications, expense of robotic technologies and the impact of aphasia. Future research should incorporate functional use training along with robotic therapy.

Subjective changes in emotion, cognition and behaviour after stroke : Factors affecting the perception of patients and partners

NARCIS (Netherlands)

Visser-Keizer, AC; Meyboom-De Jong, B; Deelman, BG; Berg, IJ; Gerritsen, MJJ

2002-01-01

The presence and severity of changes in emotion and cognition experienced by left- and right-sided stroke patients and observed by their partners were compared at 3 months poststroke. The results showed that, regardless of the side of stroke, several changes were reported by half of the stroke

Relationships of Stroke Patients’ Gait Parameters with Fear of Falling

OpenAIRE

Park, Jin; Yoo, Ingyu

2014-01-01

[Purpose] The purpose of this study was to assess the correlation of gait parameters with fear of falling in stroke survivors. [Subjects] In total, 12 patients with stroke participated. [Methods] The subjects performed on a Biodex Gait Trainer 2 for 5 min to evaluate characteristic gait parameters. The kinematic gait parameters measured were gait speed, step cycle, step length, and time on each foot (step symmetry). All the subjects also completed a fall anxiety survey. [Results] Correlations...

Integrated analysis of ischemic stroke datasets revealed sex and age difference in anti-stroke targets

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Wen-Xing Li

2016-09-01

Full Text Available Ischemic stroke is a common neurological disorder and the burden in the world is growing. This study aims to explore the effect of sex and age difference on ischemic stroke using integrated microarray datasets. The results showed a dramatic difference in whole gene expression profiles and influenced pathways between males and females, and also in the old and young individuals. Furthermore, compared with old males, old female patients showed more serious biological function damage. However, females showed less affected pathways than males in young subjects. Functional interaction networks showed these differential expression genes were mostly related to immune and inflammation-related functions. In addition, we found ARG1 and MMP9 were up-regulated in total and all subgroups. Importantly, IL1A, ILAB, IL6 and TNF and other anti-stroke target genes were up-regulated in males. However, these anti-stroke target genes showed low expression in females. This study found huge sex and age differences in ischemic stroke especially the opposite expression of anti-stroke target genes. Future studies are needed to uncover these pathological mechanisms, and to take appropriate pre-prevention, treatment and rehabilitation measures.

[Hand fine motor skills and use of both hand and arm in subjects after a stroke: a systematic review].

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Ostolaza, M; Abudarham, J; Dilascio, S; Drault-Boedo, E; Gallo, S; Garcete, A; Kramer, M; Maiaru, M; Mendelevich, A; Modica, M; Peralta, F; Sanchez-Correa, C

2017-04-01

In clinical practice it is important to be able to assess the function of the upper limb of the patient who has suffered a stroke. There is currently no systemic review that could identify assessment tools for the 'fine use of the hand' and 'use of both hand and arm'. Primary, to identify observational tools which can assess the fine use of the hand and the use of both hand and arm in patients with stroke sequels. Secondary, to analyze the bias risk in the included articles, describing and categorizing the clinical utility, validity and reliability. A search was carried in Medline, LILACS, SciELO and Open Grey, which included articles published until October 2015. Studies that validate assessing tools of the upper limb in subjects with a stroke sequel which evaluate the fine use of the hand and the use of both hand and arm were included. Eleven tools in evaluate observational haven been selected, which assess the fine use of the hand and the use of hand and arm. In every case both validity and reliability have been reported, but clinical utility has been less considered for assessment. The studies that researched these tools showed a high risk of bias in their development. ARAT-19 showed a lower bias risk, but when it has to do with applicability and the reference trial is taken into account, the level of concern is high.

Is ankle contracture after stroke due to abnormal intermuscular force transmission?

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Diong, Joanna; Herbert, Robert D

2015-02-01

Contracture after stroke could be due to abnormal mechanical interactions between muscles. This study examined if ankle plantarflexor muscle contracture after stroke is due to abnormal force transmission between the gastrocnemius and soleus muscles. Muscle fascicle lengths were measured from ultrasound images of soleus muscles in five subjects with stroke and ankle contracture and six able-bodied subjects. Changes in soleus fascicle length or pennation during passive knee extension at fixed ankle angle were assumed to indicate intermuscular force transmission. Changes in soleus fascicle length or pennation were adjusted for changes in ankle motion. Subjects with stroke had significant ankle contracture. After adjustment for ankle motion, 9 of 11 subjects demonstrated small changes in soleus fascicle length with knee extension, suggestive of intermuscular force transmission. However, the small changes in fascicle length may have been artifacts caused by movement of the ultrasound transducers. There were no systematic differences in change in fascicle length (median between-group difference adjusting for ankle motion = -0.01, 95% CI -0.26-0.08 mm/degree of knee extension) or pennation (-0.05, 95% CI -0.15-0.07 degree/ degree of knee extension). This suggests ankle contractures after stroke were not due to abnormal (systematically increased or decreased) intermuscular force transmission between the gastrocnemius and soleus.

Changes in the Employment Status and Risk of Stroke and Stroke Types.

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Eshak, Ehab S; Honjo, Kaori; Iso, Hiroyasu; Ikeda, Ai; Inoue, Manami; Sawada, Norie; Tsugane, Shoichiro

2017-05-01

Because of limited evidence, we investigated a long-term impact of changes in employment status on risk of stroke. This was a prospective study of 21 902 Japanese men and 19 826 women aged 40 to 59 years from 9 public health centers across Japan. Participants were followed up from 1990 to 1993 to the end of 2009 to 2014. Cox proportional hazard ratio of stroke (incidence and mortality) and its types (hemorrhagic and ischemic) was calculated according to changes in the employment status within 5 years interval between 1990 to 1993 and 1995 to 1998 (continuously employed, job loss, reemployed, and continuously unemployed). During the follow-up period, 973 incident cases and 275 deaths from stroke in men and 460 cases and 131 deaths in women were documented. Experiencing 1 spell of unemployment was associated with higher risks of morbidity and mortality from total, hemorrhagic, and ischemic stroke in both men and women, even after propensity score matching. Compared with continuously employed subjects, the multivariable hazard ratio (95% confidence interval) for total stroke incidence in job lost men was 1.58 (1.18-2.13) and in job lost women was 1.51 (1.08-2.29), and those for total stroke mortality were 2.22 (1.34-3.68) in men and 2.48 (1.26-4.77) in women. The respective hazard ratio (95% confidence interval) in reemployed men was 2.96 (1.89-4.62) for total stroke incidence and 4.21 (1.97-8.97) for mortality, whereas those in reemployed women were 1.30 (0.98-1.69) for incidence and 1.28 (0.76-2.17) for mortality. Job lost men and women and reemployed men had increased risks for both hemorrhagic and ischemic stroke incidence and mortality. © 2017 American Heart Association, Inc.

Incidence of Stroke in Young Adults: A Review

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Carmine Marini

2011-01-01

Full Text Available Introduction. Stroke in the young may have a dramatic impact on the quality of life in survivors. This study was aimed to evaluate incidence of first-ever stroke in the young by means of a systematic review. Materials and Methods. All papers on incidence of stroke in the young published after 1980, were identified by electronic search of Medline and manual search of reference lists. Only studies recruiting subjects under 44 years of age and with a lower age limit not higher than 20 years were included. Incidence rates were standardized to the 2000 European population according to the direct method. Poisson regression analysis was used to compare studies. Results. 29 studies including 3548 participants were identified. Incidence rates, after excluding a few outliers, ranged between 8.63 and 19.12 for crude rates and between 8.70 and 21.02 for standardized rates. Heterogeneity among studies was statistically significant but improved after excluding 4 studies. Few studies reported the proportions of stroke subtypes. Conclusions. Stroke in subjects under 45 years of age is not such a rare disease and requires specific preventive programs.

Prevalence of Fabry disease in young patients with cryptogenic ischemic stroke.

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Dubuc, Véronique; Moore, David F; Gioia, Laura C; Saposnik, Gustavo; Selchen, Daniel; Lanthier, Sylvain

2013-11-01

A German study diagnosed 4% of young cryptogenic ischemic stroke patients with Fabry disease, an X-linked lysosomal storage disease caused by mutations in the alpha-galactosidase A (α-GAL-A) gene resulting in an accumulation of glycosphingolipids. A lower prevalence was found in other geographic regions. To determine the prevalence of Fabry disease in a Canadian population of young cryptogenic ischemic stroke patients. Patients with cryptogenic ischemic stroke at age 16-55 were retrospectively identified in our institutional stroke database and underwent a focused clinical evaluation. We sequenced the α-GAL-A gene and measured the levels of blood globotriaosylsphingosine in subjects with mutations of undetermined pathogenicity. Fabry disease was diagnosed in patients with pathogenic mutations or increased levels of blood globotriaosylsphingosine. Ninety-three of 100 study subjects had normal α-GAL-A gene polymorphisms. Seven had mutations of undetermined pathogenicity, including one with increased globotriaosylsphingosine (prevalence, 1%; 95% confidence interval, ischemic stroke presentation as the first clinical manifestation of Fabry disease. Both Fabry patients experienced recurrent ischemic stroke. Fabry disease accounts for a small proportion of young Canadians with cryptogenic ischemic stroke. Identification of Fabry biomarkers remains a research priority to delineate stroke patients disserving routine screening. Copyright © 2013 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Manual and oral apraxia in acute stroke, frequency and influence on functional outcome: The Copenhagen Stroke Study.

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Pedersen, P M; Jørgensen, H S; Kammersgaard, L P; Nakayama, H; Raaschou, H O; Olsen, T S

2001-09-01

To determine the frequency of manual and oral apraxia in acute stroke and to examine the influence of these symptoms on functional outcome. Seven hundred seventy six unselected, acute stroke patients who were admitted within seven days of stroke onset with unimpaired consciousness were included. If possible, the patients were assessed for manual and oral apraxia on acute admission. Neurologic stroke severity including aphasia was assessed with the Scandinavian Stroke Scale, and activities of daily living function was assessed with the Barthel Index. All patients completed their rehabilitation in the same large stroke unit. Six hundred eighteen patients could cooperate with the apraxia assessments. Manual apraxia was found in 7% of subjects (10% in left and 4% in right hemispheric stroke; chi2 = 9.0; P = 0.003). Oral apraxia was found in 6% (9% in left and 4% in right hemispheric stroke; chi2 = 5.4; P = 0.02). Both manual and oral apraxia were related to increasing stroke severity, and manual, but not oral, apraxia was associated with increasing age. There was no gender difference in frequency of apraxia. Patients with either type of apraxia had temporal lobe involvement more often than patients without. When analyzed with multiple linear and logistic regression analyses, neither manual nor oral apraxia had any independent influence on functional outcome. Apraxia is significantly less frequent in unselected patients with acute stroke than has previously been assumed and has no independent negative influence on functional outcome.

Vascular cognitive disorders and depression after first-ever stroke: the Fogarty-Mexico Stroke Cohort.

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Arauz, Antonio; Rodríguez-Agudelo, Yaneth; Sosa, Ana Luisa; Chávez, Mireya; Paz, Francisco; González, Margarita; Coral, Juliana; Díaz-Olavarrieta, Claudia; Román, Gustavo C

2014-01-01

memory in 49%, language in 38%, perception in 36%, and attention in 38%. Executive dysfunction occurred in 36% of non-demented subjects, 65% of them with mild-moderate deficits in daily living activities. Female gender (p ≤ 0.054), older age (mean age 65.6 years vs. 49.3, p Mexico cohort recruited relatively young acute stroke patients, compared with other Mexican stroke cohorts. PSD and VCI occurred frequently but prevalence of VaD (12%) was lower than expected. A high prevalence of treatable stroke risk factors suggests that preventive interventions are advisable. © 2014 S. Karger AG, Basel.

Intervention to enhance skilled arm and hand movements after stroke: A feasibility study using a new virtual reality system

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McLaughlin Margaret

2007-06-01

Full Text Available Abstract Background Rehabilitation programs designed to develop skill in upper extremity (UE function after stroke require progressive practice that engage and challenge the learner. Virtual realty (VR provides a unique environment where the presentation of stimuli can be controlled systematically for optimal challenge by adapting task difficulty as performance improves. We describe four VR tasks that were developed and tested to improve arm and hand movement skills for individuals with hemiparesis. Methods Two participants with chronic post-stroke paresis and different levels of motor severity attended 12 training sessions lasting 1 to 2 hours each over a 3-week period. Behavior measures and questionnaires were administered pre-, mid-, and post-training. Results Both participants improved VR task performance across sessions. The less impaired participant averaged more time on task, practiced a greater number of blocks per session, and progressed at a faster rate over sessions than the more impaired participant. Impairment level did not change but both participants improved functional ability after training. The less impaired participant increased the number of blocks moved on the Box & Blocks test while the more impaired participant achieved 4 more items on the Functional Test of the Hemiparetic UE. Conclusion Two participants with differing motor severity were able to engage in VR based practice and improve performance over 12 training sessions. We were able to successfully provide individualized, progressive practice based on each participant's level of movement ability and rate of performance improvement.

Possible Anandamide and Palmitoylethanolamide involvement in human stroke

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Pizzolato Gilberto

2010-05-01

Full Text Available Abstract Background Endocannabinoids (eCBs are ubiquitous lipid mediators that act on specific (CB1, CB2 and non-specific (TRPV1, PPAR receptors. Despite many experimental animal studies proved eCB involvement in the pathogenesis of stroke, such evidence is still lacking in human patients. Our aim was to determine eCB peripheral levels in acute stroke patients and evaluate their relationship with clinical disability and stroke volume. Methods A cohort of ten patients with a first acute (within six hours since symptoms onset ischemic stroke and a group of eight age- and sex-matched normal subjects were included. Groups were also matched for metabolic profile. All subjects underwent a blood sample collection for anandamide (AEA, 2-arachidonoylglycerol (2-AG and palmitoylethanolamide (PEA measurement; blood sampling was repeated in patients on admission (T0, at 6 (T1 and 18 hours (T2 thereafter. Patients neurological impairment was assessed using NIHSS and Fugl-Meyer Scale arm subitem (FMSa; stroke volume was determined on 48 h follow-up brain CT scans. Blood samples were analyzed by liquid chromatography-atmospheric pressure chemical ionization-mass spectrometry. Results 1T0 AEA levels were significantly higher in stroke patients compared to controls. 2A significant inverse correlation between T0 AEA levels and FMSa score was found. Moreover a positive correlation between T0 AEA levels and stroke volume were found in stroke patients. T0 PEA levels in stroke patients were not significantly different from the control group, but showed a significant correlation with the NIHSS scores. T0 2-AG levels were lower in stroke patients compared to controls, but such difference did not reach the significance threshold. Conclusions This is the first demonstration of elevated peripheral AEA levels in acute stroke patients. In agreement with previous murine studies, we found a significant relationship between AEA or PEA levels and neurological involvement, such

Microglial Cells Prevent Hemorrhage in Neonatal Focal Arterial Stroke

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Fernández-López, David; Faustino, Joel; Klibanov, Alexander L.; Derugin, Nikita; Blanchard, Elodie; Simon, Franziska; Leib, Stephen L.; Vexler, Zinaida S.

2016-01-01

Perinatal stroke leads to significant morbidity and long-term neurological and cognitive deficits. The pathophysiological mechanisms of brain damage depend on brain maturation at the time of stroke. To understand whether microglial cells limit injury after neonatal stroke by preserving neurovascular integrity, we subjected postnatal day 7 (P7) rats depleted of microglial cells, rats with inhibited microglial TGFbr2/ALK5 signaling, and corresponding controls, to transient middle cerebral arter...

Nonparetic knee extensor strength is the determinant of exercise capacity of community-dwelling stroke survivors.

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Wang, Wei-Te; Huang, Ling-Tzu; Chou, Ya-Hui; Wei, Ta-Sen; Lin, Chung-Che

2014-01-01

To investigate the relationship among walking speed, exercise capacity, and leg strength in community dwelling stroke subjects and to evaluate which one was the leading determinant factor of them. This is a descriptive, cross-sectional study. Thirty-five chronic stroke patients who were able to walk independently in their community were enrolled. Walking speed was evaluated by using the 12-meter walking test. A maximal exercise test was used to determine the stroke subjects' exercise capacity. Knee extensor strength, measured as isokinetic torque, was assessed by isokinetic dynamometer. The main walking speed of our subjects was 0.52 m/s. Peak oxygen uptake (VO₂ peak) was 1.21 ± 0.43 L/min. Knee extensor strength, no matter whether paretic or nonparetic side, was significantly correlated to 12-meter walking speed and exercise capacity. Linear regression also showed the strength of the affected knee extensor was the determinant of walking speed and that of the nonparetic knee extensor was the determinant of exercise capacity in community dwelling stroke subjects. Walking speed and peak oxygen uptake were markedly decreased after stroke. Knee extensor strength of nonparetic leg was the most important determinant of exercise capacity of the community-dwelling stroke subjects. Knee extensor strengthening should be emphasized to help stroke patient to achieve optimal community living.

Neural substrates underlying stimulation-enhanced motor skill learning after stroke.

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Lefebvre, Stéphanie; Dricot, Laurence; Laloux, Patrice; Gradkowski, Wojciech; Desfontaines, Philippe; Evrard, Frédéric; Peeters, André; Jamart, Jacques; Vandermeeren, Yves

2015-01-01

Motor skill learning is one of the key components of motor function recovery after stroke, especially recovery driven by neurorehabilitation. Transcranial direct current stimulation can enhance neurorehabilitation and motor skill learning in stroke patients. However, the neural mechanisms underlying the retention of stimulation-enhanced motor skill learning involving a paretic upper limb have not been resolved. These neural substrates were explored by means of functional magnetic resonance imaging. Nineteen chronic hemiparetic stroke patients participated in a double-blind, cross-over randomized, sham-controlled experiment with two series. Each series consisted of two sessions: (i) an intervention session during which dual transcranial direct current stimulation or sham was applied during motor skill learning with the paretic upper limb; and (ii) an imaging session 1 week later, during which the patients performed the learned motor skill. The motor skill learning task, called the 'circuit game', involves a speed/accuracy trade-off and consists of moving a pointer controlled by a computer mouse along a complex circuit as quickly and accurately as possible. Relative to the sham series, dual transcranial direct current stimulation applied bilaterally over the primary motor cortex during motor skill learning with the paretic upper limb resulted in (i) enhanced online motor skill learning; (ii) enhanced 1-week retention; and (iii) superior transfer of performance improvement to an untrained task. The 1-week retention's enhancement driven by the intervention was associated with a trend towards normalization of the brain activation pattern during performance of the learned motor skill relative to the sham series. A similar trend towards normalization relative to sham was observed during performance of a simple, untrained task without a speed/accuracy constraint, despite a lack of behavioural difference between the dual transcranial direct current stimulation and sham

Drivers of Costs Associated with Reperfusion Therapy in Acute Stroke: The IMS III Trial

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Simpson, Kit N.; Simpson, Annie N.; Mauldin, Patrick D.; Hill, Michael D; Yeatts, Sharon D.; Spilker, Judith A.; Foster, Lydia D.; Khatri, Pooja; Martin, Renee; Jauch, Edward C.; Kleindorfer, Dawn; Palesch, Yuko Y.; Broderick, Joseph P.

2014-01-01

Background and Purpose The IMS III study tested the effect of IV t-PA alone as compared to IV t-PA followed by endovascular therapy and collected cost data to assess the economic implications of the two therapies. This report describes the factors affecting the costs of the initial hospitalization for acute stroke subjects from the US. Methods Prospective cost analysis of US subjects treated with IV t-PA alone or IV t-PA followed by endovascular therapy in the IMS III trial. Results compared to expected Medicare payments. Results The adjusted cost of a stroke admission in the study was $35,130 for subjects treated with endovascular therapy following IV t-PA treatment and $25,630 for subjects treated with IV t-PA alone (p<0.0001). Significant factors related to costs included treatment group, baseline NIH Stroke Scale, time from stroke onset to IV t-PA, age, stroke location, and comorbid diabetes. The mean cost for subjects who had routine use of general anesthesia as part of endovascular therapy was $46,444 as compared to $30,350 for those who did not have general anesthesia. The costs of embolectomy for IMS III subjects and patients from the NIS cohort exceeded the Medicare DRG payment in more than 75% of patients. Conclusion Minimizing the time to start of IV t-PA and decreasing the use of routine general anesthesia, may improve the cost-effectiveness of medical and endovascular therapy for acute stroke. PMID:24876261

ACE Gene in Egyptian Ischemic Stroke Patients.

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Mostafa, Magdy A; El-Nabiel, Lobna M; Fahmy, Nagia Aly; Aref, Hany; Shreef, Edrees; Abd El-Tawab, Fathy; Abdulghany, Osama M

2016-09-01

Angiotensin-1-converting enzyme (ACE) is a crucial player in vascular homeostasis and in the pathogenesis of atherosclerosis and hypertension. The present study was conducted to determine whether there is an association between the ACE insertion/deletion (I/D) polymorphism and ischemic stroke in Egyptian population. Also, we analyzed the ACE gene I/D polymorphism as a risk factor for small-vessel (SV) versus large-vessel (LV) disease. Sixty patients with ischemic stroke were included: 30 with SV disease and 30 with LV disease. In addition, a control group of 30 apparent healthy subjects were studied. Clinical assessment, computed tomography, magnetic resonance imaging brain, and genetic study using the polymerase chain reaction of ACE gene were done for all subjects. We found that the distribution of ACE gene polymorphism frequency was significantly different between the 3 groups. The DD genotype was far more common in stroke patients compared to controls. It was also significantly more common in each of the patient groups compared to controls but rather similar in the 2 patient groups with SV and LV diseases. We found that the ACE gene deletion/deletion genotype is common in Egyptian patients with non-cardioembolic ischemic stroke but does not appear to be specific neither to SV nor to LV disease. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

[Elements of system semiotics of the brain and head with cranial vessels of patients with stroke and with risk of stroke development].

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Makomela, N M

2007-01-01

By means of a multispiral computer and magnetic resonance tomography 211 patients with an ischemic stroke, 109 patients with hemorrhagic stroke, 41 patients with an arterial hypertensia, 43 patients with aneurism, 58 patients with discirculation encephalopathy, 125 patients with ischemic illness of heart, practically healthy 62 have been observed. The author found high frequency of pathological deformations of carotid and vertebral arteries of not closed arterial circle, calcification of the pineal body and vascular plexus of lateral ventricles. cysts of maxillary sinuses of patients with stroke in comparison with patients at risk of the development of stroke and practically healthy subjects.

Case Report: Impact of Botulinum Toxin Injection on Function of Affected Upper Extremity in A Patient, 16 Years after Stroke

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Malek Amini

2012-10-01

Full Text Available Objective: Case report Impact of Botulinum Toxin injection on function of affected upper extremity in a patient after 16 years since stroke (CVA. Botulinum toxin injection is one the treatments in spasticity reduction and consequently in recovery of upper limb function in stroke patients. The purpose of this case study is to report the effect of Botulinum toxin injection on upper extremity function after 16 years of stroke. Materials & Methods: The patient was a 63-year-old man who has had a cerebrovascular accident that happened in the left hemisphere about 16 years ago, and as a result, a paresis in dominant hand and arm. Although the patient was able to perform simple movements but he was complaining about the slowness and stiffness in the movements. To treat spasticity the Botulinum toxin type A was used. Injection into selected muscles of hemiparetic upper limb was done by a specialist physician and was between 50-150IU based on specific volume of each muscle. After injection, the patient was monitored for 3 months and at the end of each month, the assessments were reevaluated. During this period, although research team suggested the patient to continue the rehabilitation but for personal reasons he didn’t participate in any treatment and didn`t receive any other antispasmodic medications. Results: An increase in range of motion was seen in all joints but this improvement was not significant. The greatest improvement in passive and active range of motion was seen in Metacarpophalengeal joints. At the end of each month, compared to the first month the recovery of function in upper extremity was significant. Maximum recovery of upper extremity function was related to the hand section of fugl-meyer assessment. At the end of the first month, spasticity significantly decreased so that the patient was able to extend all his joints more easily than before injection. Although spasticity never reached zero. Conclusion: Botulinum toxin injection

Physiotherapy based on the Bobath concept for adults with post-stroke hemiplegia: a review of effectiveness studies.

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Paci, Matteo

2003-01-01

The Bobath concept, also known as neurodevelopmental treatment, is a widely used approach in the rehabilitation of hemiparetic subjects in many countries. Despite 50 years of clinical use its effectiveness is questionable. This paper aims to examine whether there is evidence to accept neurodevelopmental treatment as an effective approach. A systematic literature search was undertaken. Fifteen trials have been selected and classified according to a 5-level hierarchic scale of evidence for clinical interventions. Results show no evidence proving the effectiveness of neurodevelopmental treatment or supporting neurodevelopmental treatment as the optimal type of treatment, but neither do methodological limitations allow for conclusions of non-efficacy. Methodological aspects of selected studies are discussed and requirements for further research are suggested.

Discriminating poststroke depression from stroke by nuclear magnetic resonance spectroscopy-based metabonomic analysis

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Xiao J

2016-08-01

Full Text Available Jianqi Xiao,1,* Jie Zhang,2,* Dan Sun,3,* Lin Wang,4,* Lijun Yu,5 Hongjing Wu,5 Dan Wang,5 Xuerong Qiu5 1Department of Neurosurgery, The First Hospital of Qiqihar City, Qiqihar, 2Department of Internal Medicine, Central Hospital of Jiamusi City, Jiamusi, 3Department of Geriatrics, General Hospital of Daqing Oil Field, Daqing, 4Department of Nursing, 5Department of Neurology, The First Hospital of Qiqihar City, Qiqihar, Heilongjiang, People’s Republic of China *These authors contributed equally to this work Abstract: Poststroke depression (PSD, the most common psychiatric disease that stroke survivors face, is estimated to affect ~30% of poststroke patients. However, there are still no objective methods to diagnose PSD. In this study, to explore the differential metabolites in the urine of PSD subjects and to identify a potential biomarker panel for PSD diagnosis, the nuclear magnetic resonance-based metabonomic method was applied. Ten differential metabolites responsible for discriminating PSD subjects from healthy control (HC and stroke subjects were found, and five of these metabolites were identified as potential biomarkers (lactate, α-hydroxybutyrate, phenylalanine, formate, and arabinitol. The panel consisting of these five metabolites provided excellent performance in discriminating PSD subjects from HC and stroke subjects, achieving an area under the receiver operating characteristic curve of 0.946 in the training set (43 HC, 45 stroke, and 62 PSD subjects. Moreover, this panel could classify the blinded samples from the test set (31 HC, 33 stroke, and 32 PSD subjects with an area under the curve of 0.946. These results laid a foundation for the future development of urine-based objective methods for PSD diagnosis and investigation of PSD pathogenesis. Keywords: poststroke depression, PSD, stroke, nuclear magnetic resonance, NMR, metabonomic

Alexia for Braille following bilateral occipital stroke in an early blind woman.

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Hamilton, R; Keenan, J P; Catala, M; Pascual-Leone, A

2000-02-07

Recent functional imaging and neurophysiologic studies indicate that the occipital cortex may play a role in Braille reading in congenitally and early blind subjects. We report on a woman blind from birth who sustained bilateral occipital damage following an ischemic stroke. Prior to the stroke, the patient was a proficient Braille reader. Following the stroke, she was no longer able to read Braille yet her somatosensory perception appeared otherwise to be unchanged. This case supports the emerging evidence for the recruitment of striate and prestriate cortex for Braille reading in early blind subjects.

Delayed-onset dementia after stroke or transient ischemic attack.

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Mok, Vincent C T; Lam, Bonnie Y K; Wang, Zhaolu; Liu, Wenyan; Au, Lisa; Leung, Eric Y L; Chen, Sirong; Yang, Jie; Chu, Winnie C W; Lau, Alexander Y L; Chan, Anne Y Y; Shi, Lin; Fan, Florence; Ma, Sze H; Ip, Vincent; Soo, Yannie O Y; Leung, Thomas W H; Kwok, Timothy C Y; Ho, Chi L; Wong, Lawrence K S; Wong, Adrian

2016-11-01

Patients surviving stroke without immediate dementia are at high risk of delayed-onset dementia. Mechanisms underlying delayed-onset dementia are complex and may involve vascular and/or neurodegenerative diseases. Dementia-free patients with stroke and/or transient ischemic attack (TIA; n = 919) were studied for 3 years prospectively, excluding those who developed dementia 3 to 6 months after stroke and/or TIA. Forty subjects (4.4%) developed dementia during the study period. Imaging markers of severe small vessel disease (SVD), namely presence of ≥3 lacunes and confluent white matter changes; history of hypertension and diabetes mellitus independently predicted delayed-onset dementia after adjustment for age, gender, and education. Only 6 of 31 (19.4%) subjects with delayed cognitive decline harbored Alzheimer's disease-like Pittsburg compound B (PiB) retention. Most PiB cases (16/25, 64%) had evidence of severe SVD. Severe SVD contributes importantly to delayed-onset dementia after stroke and/or TIA. Future clinical trials aiming to prevent delayed-onset dementia after stroke and/or TIA should target this high-risk group. Copyright © 2016 The Alzheimer's Association. Published by Elsevier Inc. All rights reserved.

Trends in stroke incidence. The Copenhagen City Heart Study

DEFF Research Database (Denmark)

Truelsen, T; Prescott, E; Grønbaek, M

1997-01-01

at least one of the two first examinations as well as the total cohort including nonresponders. Subjects between 45 and 84 years of age were followed from March 1, 1976 until March 1, 1993. Changes in age-specific stroke incidence were calculated by means of Poisson regression analysis. RESULTS......: For subjects aged 45 to 64 years, no significant trends were observed, with an annual incidence rate ratio of 1.00 (95% confidence interval [CI], 0.97 to 1.03) and 1.04 (95% CI, 0.99 to 1.08) for men and women, respectively. In subjects aged 65 to 84 years a significant decrease in stroke incidence was found...... in men, whose annual rate ratio was 0.97 (95% CI, 0.95 to 0.99), but not in women, whose annual rate ratio was 0.98 (95% CI, 0.95 to 1.00). Throughout four observed periods the stroke incidence among men remained significantly higher than that for women. CONCLUSIONS: During the period from 1976 to 1993...

Synthetic Oligodeoxynucleotides Containing Multiple Telemeric TTAGGG Motifs Suppress Inflammasome Activity in Macrophages Subjected to Oxygen and Glucose Deprivation and Reduce Ischemic Brain Injury in Stroke-Prone Spontaneously Hypertensive Rats.

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Jing Zhao

Full Text Available The immune system plays a fundamental role in both the development and pathobiology of stroke. Inflammasomes are multiprotein complexes that have come to be recognized as critical players in the inflammation that ultimately contributes to stroke severity. Inflammasomes recognize microbial and host-derived danger signals and activate caspase-1, which in turn controls the production of the pro-inflammatory cytokine IL-1β. We have shown that A151, a synthetic oligodeoxynucleotide containing multiple telemeric TTAGGG motifs, reduces IL-1β production by activated bone marrow derived macrophages that have been subjected to oxygen-glucose deprivation and LPS stimulation. Further, we demonstrate that A151 reduces the maturation of caspase-1 and IL-1β, the levels of both the iNOS and NLRP3 proteins, and the depolarization of mitochondrial membrane potential within such cells. In addition, we have demonstrated that A151 reduces ischemic brain damage and NLRP3 mRNA levels in SHR-SP rats that have undergone permanent middle cerebral artery occlusion. These findings clearly suggest that the modulation of inflammasome activity via A151 may contribute to a reduction in pro-inflammatory cytokine production by macrophages subjected to conditions that model brain ischemia and modulate ischemic brain damage in an animal model of stroke. Therefore, modulation of ischemic pathobiology by A151 may have a role in the development of novel stroke prevention and therapeutic strategies.

Upper-limb kinematic reconstruction during stroke robot-aided therapy.

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Papaleo, E; Zollo, L; Garcia-Aracil, N; Badesa, F J; Morales, R; Mazzoleni, S; Sterzi, S; Guglielmelli, E

2015-09-01

The paper proposes a novel method for an accurate and unobtrusive reconstruction of the upper-limb kinematics of stroke patients during robot-aided rehabilitation tasks with end-effector machines. The method is based on a robust analytic procedure for inverse kinematics that simply uses, in addition to hand pose data provided by the robot, upper arm acceleration measurements for computing a constraint on elbow position; it is exploited for task space augmentation. The proposed method can enable in-depth comprehension of planning strategy of stroke patients in the joint space and, consequently, allow developing therapies tailored for their residual motor capabilities. The experimental validation has a twofold purpose: (1) a comparative analysis with an optoelectronic motion capturing system is used to assess the method capability to reconstruct joint motion; (2) the application of the method to healthy and stroke subjects during circle-drawing tasks with InMotion2 robot is used to evaluate its efficacy in discriminating stroke from healthy behavior. The experimental results have shown that arm angles are reconstructed with a RMSE of 8.3 × 10(-3) rad. Moreover, the comparison between healthy and stroke subjects has revealed different features in the joint space in terms of mean values and standard deviations, which also allow assessing inter- and intra-subject variability. The findings of this study contribute to the investigation of motor performance in the joint space and Cartesian space of stroke patients undergoing robot-aided therapy, thus allowing: (1) evaluating the outcomes of the therapeutic approach, (2) re-planning the robotic treatment based on patient needs, and (3) understanding pathology-related motor strategies.

Localization of impaired kinesthetic processing post-stroke

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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

Clinicoanatomical correlation in stroke related aphasia

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Vikram Bohra

2015-01-01

Full Text Available Context: With advances in neuroimaging, traditional views regarding the clinicoanatomic correlation in stroke patients with aphasia are being challenged and it has been observed that lesions at a given cortical or subcortical site may manifest with different aphasia profiles. Aims: To study as to whether there is a strict clinicoanatomical correlation between the type of aphasia and lesion site in patients with first ever stroke. Settings and Design: Observational study, based in a tertiary care center. Materials and Methods: Stroke patient′s ≥18 years of age were screened and those with first ever stroke and aphasia were subjected to a detailed stroke workup and language assessment using the Hindi version of Western Aphasia Battery (WAB. Statistical analysis was done with χ2 test with Yates correction and Kruskal-Wallis test. The level of significance was set at P < 0.05. Results: Overall aphasia was detected in 27.9% of the 260 screened cases with stroke. Amongst 60 cases with first ever stroke and aphasia, the aphasia type was: Global (33.33%, Broca′s (28.3%, transcortical motor (13.33%, transcortical sensory (10%, Wernicke′s (8.33%, anomic (5%, and conduction (1.67% aphasia. A definite correlation between the lesion site and the type of aphasia as per the traditional classification was observed in 35% cases only. Conclusions: No absolute correlation exists between the lesion site and the type of clinical aphasia syndrome in majority of the patients with cortical and subcortical stroke.

Nonparetic Knee Extensor Strength Is the Determinant of Exercise Capacity of Community-Dwelling Stroke Survivors

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Wei-Te Wang

2014-01-01

Full Text Available Objective. To investigate the relationship among walking speed, exercise capacity, and leg strength in community dwelling stroke subjects and to evaluate which one was the leading determinant factor of them. Design. This is a descriptive, cross-sectional study. Thirty-five chronic stroke patients who were able to walk independently in their community were enrolled. Walking speed was evaluated by using the 12-meter walking test. A maximal exercise test was used to determine the stroke subjects’ exercise capacity. Knee extensor strength, measured as isokinetic torque, was assessed by isokinetic dynamometer. Results. The main walking speed of our subjects was 0.52 m/s. Peak oxygen uptake (VO2 peak was 1.21±0.43 L/min. Knee extensor strength, no matter whether paretic or nonparetic side, was significantly correlated to 12-meter walking speed and exercise capacity. Linear regression also showed the strength of the affected knee extensor was the determinant of walking speed and that of the nonparetic knee extensor was the determinant of exercise capacity in community dwelling stroke subjects. Conclusions. Walking speed and peak oxygen uptake were markedly decreased after stroke. Knee extensor strength of nonparetic leg was the most important determinant of exercise capacity of the community-dwelling stroke subjects. Knee extensor strengthening should be emphasized to help stroke patient to achieve optimal community living.

Influence of dance therapy on the functional mobility of children with spastic hemiparetic cerebral palsy

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D.C. Garção

2011-01-01

Full Text Available The aim of this study was to investigate the influence of dance therapy on the functional mobility of children with spastic hemiparetic cerebral palsy. Ten female children (mean age 7.2 ± 1.2 years diagnosed with cerebral palsy were included. In order to evaluate their functional mobility, standing (D and walking, running and jumping (E dimensions from GMFM were applied, and measurements were carried out in two phases: 1 control, six weeks without any motor intervention, and 2 activity, 18 sessions of dancing. Children were assessed three times: first, before the control phase, second, after the control phase, and third, at the end of the dancing phase. Kruskal-Wallis (p < .05 and Dunn tests (p < .05 were used. There were no changes in performance between the two first phases of evaluation (p = 1.00, however, at the end of the dancing phase a significant increase was measured in relation to D (p < .01 and E dimensions (p < .01. Results showed that dance therapy influences children's functional mobility.

Influence of dance therapy on the functional mobility of children with spastic hemiparetic cerebral palsy

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Diogo Costa Garção

2011-09-01

Full Text Available The aim of this study was to investigate the influence of dance therapy on the functional mobility of children with spastic hemiparetic cerebral palsy. Ten female children (mean age 7.2 ± 1.2 years diagnosed with cerebral palsy were included. In order to evaluate their functional mobility, standing (D and walking, running and jumping (E dimensions from GMFM were applied, and measurements were carried out in two phases: 1 control, six weeks without any motor intervention, and 2 activity, 18 sessions of dancing. Children were assessed three times: first, before the control phase, second, after the control phase, and third, at the end of the dancing phase. Kruskal-Wallis (p < .05 and Dunn tests (p < .05 were used. There were no changes in performance between the two first phases of evaluation (p = 1.00, however, at the end of the dancing phase a significant increase was measured in relation to D (p < .01 and E dimensions (p < .01. Results showed that dance therapy influences children's functional mobility.

Improved nutritional status in elderly patients 6 months after stroke

DEFF Research Database (Denmark)

Brynningsen, Peter Krogh; Husted, Steen; Damsgaard, Else Marie Skjøde

2007-01-01

focused on the late rehabilitation phase after stroke in the patients own home, where the attention on nutrition may be reduced. AIMS: To determine the prevalence of malnutrition during 6 months of stroke rehabilitation, and to investigate the association between nutritional status, functional recovery......INTRODUCTION: Nutritional status among stroke patients has received limited attention despite the fact, that it may have an influence on clinical outcome. Previous studies have estimated that 15-20 % of patients suffer from malnutrition in the acute phase of stroke, but so far no studies have......, length of stay in hospital and infectious complications. SUBJECTS AND METHODS: 89 patients with ischemic stroke consecutively admitted to a geriatric stroke rehabilitation unit had their nutritional status evaluated in the hospital at 1 week and 5 weeks after stroke, and in their own home at 3 months...

The Effects of Core Stabilization Exercise on Dynamic Balance and Gait Function in Stroke Patients

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Chung, Eun-Jung; Kim, Jung-Hee; Lee, Byoung-Hee

2013-01-01

[Purpose] The purpose of this study was to determine the effects of core stabilization exercise on dynamic balance and gait function in stroke patients. [Subjects] The subjects were 16 stroke patients, who were randomly divided into two groups: a core stabilization exercise group of eight subjects and control group of eight subjects. [Methods] Subjects in both groups received general training five times per week. Subjects in the core stabilization exercise group practiced an additional core s...

mStroke: "Mobile Stroke"-Improving Acute Stroke Care with Smartphone Technology.

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Andrew, Benjamin Y; Stack, Colleen M; Yang, Julian P; Dodds, Jodi A

2017-07-01

This study aimed to evaluate the effect of method and time of system activation on clinical metrics in cases utilizing the Stop Stroke (Pulsara, Inc.) mobile acute stroke care coordination application. A retrospective cohort analysis of stroke codes at 12 medical centers using Stop Stroke from March 2013 to May 2016 was performed. Comparison of metrics (door-to-needle time [DTN] and door-to-CT time [DTC], and rate of DTN ≤ 60 minutes [goal DTN]) was performed between subgroups based on method (emergency medical service [EMS] versus emergency department [ED]) and time of activation. Effects were adjusted for confounders (age, sex, National Institutes of Health Stroke Scale [NIHSS] score) using multiple linear and logistic regression. The final dataset included 2589 cases. Cases activated by EMS were more severe (median NIHSS score 8 versus 4, P technology provides unique insight into acute stroke codes. Activation of mobile electronic stroke coordination in the field appears to promote a more expedited and successful care process. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Modulation of walking speed by changing optic flow in persons with stroke

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Lamontagne Anouk

2007-06-01

Full Text Available Abstract Background Walking speed, which is often reduced after stroke, can be influenced by the perception of optic flow (OF speed. The present study aims to: 1 compare the modulation of walking speed in response to OF speed changes between persons with stroke and healthy controls and 2 investigate whether virtual environments (VE manipulating OF speed can be used to promote volitional changes in walking speed post stroke. Methods Twelve persons with stroke and 12 healthy individuals walked on a self-paced treadmill while viewing a virtual corridor in a helmet-mounted display. Two experiments were carried out on the same day. In experiment 1, the speed of an expanding OF was varied sinusoidally at 0.017 Hz (sine duration = 60 s, from 0 to 2 times the subject's comfortable walking speed, for a total duration of 5 minutes. In experiment 2, subjects were exposed to expanding OFs at discrete speeds that ranged from 0.25 to 2 times their comfortable speed. Each test trial was paired with a control trial performed at comfortable speed with matching OF. For each of the test trials, subjects were instructed to walk the distance within the same time as during the immediately preceding control trial. VEs were controlled by the CAREN-2 system (Motek. Instantaneous changes in gait speed (experiment 1 and the ratio of speed changes in the test trial over the control trial (experiment 2 were contrasted between the two groups of subjects. Results When OF speed was changing continuously (experiment 1, an out-of-phase modulation was observed in the gait speed of healthy subjects, such that slower OFs induced faster walking speeds, and vice versa. Persons with stroke displayed weaker (p 0.05, T-test. Conclusion Stroke affects the modulation of gait speed in response to changes in the perception of movement through different OF speeds. Nevertheless, the preservation of even a modest modulation enabled the persons with stroke to increase walking speed when

Interception of moving objects while walking in children with spastic hemiparetic cerebral palsy.

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Ricken, Annieck X C; Savelsbergh, G J P; Bennett, S J

2007-01-15

The purpose of the study was to examine the coordination of reaching and walking behaviour when children with Spastic Hemiparetic Cerebral Palsy (SHCP) intercept an approaching and hence externally-timed object. Using either the impaired or non-impaired arm, children intercepted a ball approaching from a fixed distance with one of three velocities. Each participant's initial starting position was scaled to their maximum walking velocity determined prior to testing; for the medium ball velocity, participants would arrive at the point of interception at the correct time if they walked with their maximum velocity. Children with SHCP adapted their reaching and walking behaviour to the different ball approach velocities. These adaptations were exhibited when using the impaired and non-impaired arm, and resulted in similar outcome performance irrespective of which arm was used. Still, children with SHCP found it necessary to increase trunk movement to compensate for the decreased elbow excursion and a decreased peak velocity of the impaired arm. Children with SHCP exhibited specific adaptations to their altered movement capabilities when performing a behaviourally-realistic task. The provision of an external timing constraint appeared to facilitate both reaching and walking movements and hence could represent a useful technique in rehabilitation.

Increased risk of stroke in contact dermatitis patients

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Chang, Wei-Lun; Hsu, Min-Hsien; Lin, Cheng-Li; Chan, Po-Chi; Chang, Ko-Shih; Lee, Ching-Hsiao; Hsu, Chung-Yi; Tsai, Min-Tein; Yeh, Chung-Hsin; Sung, Fung-Chang

2017-01-01

Abstract Dermatologic diseases are not traditional risk factors of stroke, but recent studies show atopic dermatitis, psoriasis, and bullous skin disease may increase the risk of stroke and other cardiovascular diseases. No previous studies have focused on the association between contact dermatitis and stroke. We established a cohort comprised of 48,169 contact dermatitis patients newly diagnosed in 2000–2003 and 96,338 randomly selected subjects without the disorder, frequency matched by sex, age, and diagnosis year, as the comparison cohort. None of them had a history of stroke. Stroke incidence was assessed by the end of 2011 for both cohorts. The incidence stroke was 1.1-fold higher in the contact dermatitis cohort than in the comparison cohort (5.93 vs 5.37 per 1000 person-years, P contact dermatitis cohort increased with age, from 1.14 (95% CI, 1.03–1.27) for 65 to 74 years; to 1.27 (95% CI, 1.15–1.42) for 75 years and older. The aHR of stroke were 1.16 (95% CI, 1.07–1.27) and 1.09 (95% CI, 1.00–1.18) for men and women, respectively. This study suggests that patients with contact dermatitis were at a modestly increased risk of stroke, significant for ischemic stroke but not for hemorrhagic stroke. Comorbidity, particularly hypertension, increased the hazard of stroke further. PMID:28272195

Subclinical Hypothyroidism and the Risk of Stroke Events and Fatal Stroke: An Individual Participant Data Analysis.

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Chaker, Layal; Baumgartner, Christine; den Elzen, Wendy P J; Ikram, M Arfan; Blum, Manuel R; Collet, Tinh-Hai; Bakker, Stephan J L; Dehghan, Abbas; Drechsler, Christiane; Luben, Robert N; Hofman, Albert; Portegies, Marileen L P; Medici, Marco; Iervasi, Giorgio; Stott, David J; Ford, Ian; Bremner, Alexandra; Wanner, Christoph; Ferrucci, Luigi; Newman, Anne B; Dullaart, Robin P; Sgarbi, José A; Ceresini, Graziano; Maciel, Rui M B; Westendorp, Rudi G; Jukema, J Wouter; Imaizumi, Misa; Franklyn, Jayne A; Bauer, Douglas C; Walsh, John P; Razvi, Salman; Khaw, Kay-Tee; Cappola, Anne R; Völzke, Henry; Franco, Oscar H; Gussekloo, Jacobijn; Rodondi, Nicolas; Peeters, Robin P

2015-06-01

The objective was to determine the risk of stroke associated with subclinical hypothyroidism. Published prospective cohort studies were identified through a systematic search through November 2013 without restrictions in several databases. Unpublished studies were identified through the Thyroid Studies Collaboration. We collected individual participant data on thyroid function and stroke outcome. Euthyroidism was defined as TSH levels of 0.45-4.49 mIU/L, and subclinical hypothyroidism was defined as TSH levels of 4.5-19.9 mIU/L with normal T4 levels. We collected individual participant data on 47 573 adults (3451 subclinical hypothyroidism) from 17 cohorts and followed up from 1972-2014 (489 192 person-years). Age- and sex-adjusted pooled hazard ratios (HRs) for participants with subclinical hypothyroidism compared to euthyroidism were 1.05 (95% confidence interval [CI], 0.91-1.21) for stroke events (combined fatal and nonfatal stroke) and 1.07 (95% CI, 0.80-1.42) for fatal stroke. Stratified by age, the HR for stroke events was 3.32 (95% CI, 1.25-8.80) for individuals aged 18-49 years. There was an increased risk of fatal stroke in the age groups 18-49 and 50-64 years, with a HR of 4.22 (95% CI, 1.08-16.55) and 2.86 (95% CI, 1.31-6.26), respectively (p trend 0.04). We found no increased risk for those 65-79 years old (HR, 1.00; 95% CI, 0.86-1.18) or ≥ 80 years old (HR, 1.31; 95% CI, 0.79-2.18). There was a pattern of increased risk of fatal stroke with higher TSH concentrations. Although no overall effect of subclinical hypothyroidism on stroke could be demonstrated, an increased risk in subjects younger than 65 years and those with higher TSH concentrations was observed.

Pediatric Stroke

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... and Patient Resources Home » Patients & Families » About Stroke » Pediatric Stroke » Introduction Introduction What is a Stroke? Ischemic Stroke Intracerebral Hemorrhage Subarachnoid Hemorrhage Pediatric Stroke Introduction Types of Stroke Diagnosis and Treatment ...

Development and pilot testing of HEXORR: Hand EXOskeleton Rehabilitation Robot

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Godfrey Sasha B

2010-07-01

Full Text Available Abstract Background Following acute therapeutic interventions, the majority of stroke survivors are left with a poorly functioning hemiparetic hand. Rehabilitation robotics has shown promise in providing patients with intensive therapy leading to functional gains. Because of the hand's crucial role in performing activities of daily living, attention to hand therapy has recently increased. Methods This paper introduces a newly developed Hand Exoskeleton Rehabilitation Robot (HEXORR. This device has been designed to provide full range of motion (ROM for all of the hand's digits. The thumb actuator allows for variable thumb plane of motion to incorporate different degrees of extension/flexion and abduction/adduction. Compensation algorithms have been developed to improve the exoskeleton's backdrivability by counteracting gravity, stiction and kinetic friction. We have also designed a force assistance mode that provides extension assistance based on each individual's needs. A pilot study was conducted on 9 unimpaired and 5 chronic stroke subjects to investigate the device's ability to allow physiologically accurate hand movements throughout the full ROM. The study also tested the efficacy of the force assistance mode with the goal of increasing stroke subjects' active ROM while still requiring active extension torque on the part of the subject. Results For 12 of the hand digits'15 joints in neurologically normal subjects, there were no significant ROM differences (P > 0.05 between active movements performed inside and outside of HEXORR. Interjoint coordination was examined in the 1st and 3rd digits, and no differences were found between inside and outside of the device (P > 0.05. Stroke subjects were capable of performing free hand movements inside of the exoskeleton and the force assistance mode was successful in increasing active ROM by 43 ± 5% (P Conclusions Our pilot study shows that this device is capable of moving the hand's digits through

Development and pilot testing of HEXORR: Hand EXOskeleton Rehabilitation Robot

Science.gov (United States)

2010-01-01

Background Following acute therapeutic interventions, the majority of stroke survivors are left with a poorly functioning hemiparetic hand. Rehabilitation robotics has shown promise in providing patients with intensive therapy leading to functional gains. Because of the hand's crucial role in performing activities of daily living, attention to hand therapy has recently increased. Methods This paper introduces a newly developed Hand Exoskeleton Rehabilitation Robot (HEXORR). This device has been designed to provide full range of motion (ROM) for all of the hand's digits. The thumb actuator allows for variable thumb plane of motion to incorporate different degrees of extension/flexion and abduction/adduction. Compensation algorithms have been developed to improve the exoskeleton's backdrivability by counteracting gravity, stiction and kinetic friction. We have also designed a force assistance mode that provides extension assistance based on each individual's needs. A pilot study was conducted on 9 unimpaired and 5 chronic stroke subjects to investigate the device's ability to allow physiologically accurate hand movements throughout the full ROM. The study also tested the efficacy of the force assistance mode with the goal of increasing stroke subjects' active ROM while still requiring active extension torque on the part of the subject. Results For 12 of the hand digits'15 joints in neurologically normal subjects, there were no significant ROM differences (P > 0.05) between active movements performed inside and outside of HEXORR. Interjoint coordination was examined in the 1st and 3rd digits, and no differences were found between inside and outside of the device (P > 0.05). Stroke subjects were capable of performing free hand movements inside of the exoskeleton and the force assistance mode was successful in increasing active ROM by 43 ± 5% (P < 0.001) and 24 ± 6% (P = 0.041) for the fingers and thumb, respectively. Conclusions Our pilot study shows that this device

Minor Electrocardiographic ST-T Change and Risk of Stroke in the General Japanese Population.

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Ishikawa, Joji; Hirose, Hideo; Schwartz, Joseph E; Ishikawa, Shizukiyo

2018-06-25

Minor ST-T changes are frequently observed on the electrocardiogram (ECG), but the risk of stroke associated with such changes is unclear.Methods and Results:In 10,642 subjects from the Japanese general population, we evaluated minor and major ST-T changes (major ST depression ≥0.1 mV) on ECGs obtained at annual health examinations. At baseline, minor ST-T changes were found in 10.7% of the subjects and 0.5% had major ST-T changes. Minor ST-T changes were associated with older age, female gender, higher systolic blood pressure, presence of hyperlipidemia, and use of antihypertensive medication. There were 375 stroke events during the follow-up period (128.7±28.1 months). In all subjects, minor ST-T changes (HR, 2.10; 95% CI: 1.57-2.81) and major ST-T changes (HR, 8.64; 95% CI: 4.44-16.82) were associated with an increased risk of stroke, but the stroke risk associated with minor ST-T changes had borderline significance after adjustment for conventional risk factors (P=0.055). In subgroup analysis, the risk of stroke was significantly associated with minor ST-T changes in subjects who had hyperlipidemia (HR, 1.75; 95% CI: 1.15-2.67) compared to those without hyperlipidemia (HR, 1.01; 95% CI: 0.64-1.59; P for interaction=0.016), even after adjustment for ECG-diagnosed left ventricular hypertrophy. Minor ST-T changes were particularly associated with a higher risk of stroke in subjects with hyperlipidemia and this association was independent of electrocardiographic left ventricular hypertrophy.

Apolipoprotein E genotypes associated with Alzheimer disease and concomitant stroke.

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Fekih-Mrissa, Najiba; Klai, Sarra; Mrad, Meriem; Mansour, Malek; Zaouali, Jamel; Gritli, Nasreddine; Mrissa, Ridha

2014-04-01

The ɛ4 allele of the apolipoprotein E (APOE) gene is a well-characterized genetic risk factor for Alzheimer disease (AD). The association between stroke and a higher risk for AD has also been reported. Our study sought to determine the relationship between the APOE gene and AD and the comorbid risk of stroke. The subjects of this study consisted of 48 patients with AD and 48 members of a control group. All subjects were genotyped for APOE. The results clearly show a significant increased risk of AD in carriers of the APOE ε3/ε4 genotype (P = .003, odds ratio [OR] = 4.1) or ε4 allele (P = .001, OR = 4.2). The risk for stroke in AD patients was also increased for carriers of the APOE ε3/ε4 genotype (P = .02, OR = 9.0) and for carriers of the APOE ε4 allele (P = .004, OR = 5.5). The present study is the first to establish a relationship between APOE ε4 and concomitant AD and stroke in the Tunisian population. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Gingival Inflammation Associates with Stroke--A Role for Oral Health Personnel in Prevention: A Database Study.

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Birgitta Söder

Full Text Available Gingival inflammation is the physiological response to poor oral hygiene. If gingivitis is not resolved the response will become an established lesion.We studied whether gingivitis associates with elevated risk for stroke. The hypothesis was based on the periodontitis-atherosclerosis paradigm.In our prospective cohort study from Sweden 1676 randomly selected subjects were followed up from 1985 to 2012. All subjects underwent clinical oral examination and answered a questionnaire assessing background variables such as socio-economic status and pack-years of smoking. Cases with stroke were recorded from the Center of Epidemiology, Swedish National Board of Health and Welfare, Sweden, and classified according to the WHO International Classification of Diseases. Unpaired t-test, chi-square tests, and multiple logistic regression analyses were used.Of the 1676 participants, 39 subjects (2.3% had been diagnosed with stroke. There were significant differences between the patients with stroke and subjects without in pack-years of smoking (p = 0.01, prevalence of gingival inflammation (GI (p = 0.03, and dental calculus (p = 0.017. In a multiple regression analysis the association between GI, confounders and stroke, GI showed odds ratio 2.20 (95% confidence interval 1.02-4.74 for stroke.Our present findings showed that gingival inflammation clearly associated with stroke in this 26-year cohort study. The results emphasize the role of oral health personnel in prevention.

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.

Nonparetic Knee Extensor Strength Is the Determinant of Exercise Capacity of Community-Dwelling Stroke Survivors

OpenAIRE

Wang, Wei-Te; Huang, Ling-Tzu; Chou, Ya-Hui; Wei, Ta-Sen; Lin, Chung-Che

2014-01-01

Objective. To investigate the relationship among walking speed, exercise capacity, and leg strength in community dwelling stroke subjects and to evaluate which one was the leading determinant factor of them. Design. This is a descriptive, cross-sectional study. Thirty-five chronic stroke patients who were able to walk independently in their community were enrolled. Walking speed was evaluated by using the 12-meter walking test. A maximal exercise test was used to determine the stroke subjects...

Development of network-based multichannel neuromuscular electrical stimulation system for stroke rehabilitation.

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Qu, Hongen; Xie, Yongji; Liu, Xiaoxuan; He, Xin; Hao, Manzhao; Bao, Yong; Xie, Qing; Lan, Ning

2016-01-01

Neuromuscular electrical stimulation (NMES) is a promising assistive technology for stroke rehabilitation. Here we present the design and development of a multimuscle stimulation system as an emerging therapy for people with paretic stroke. A network-based multichannel NMES system was integrated based on dual bus architecture of communication and an H-bridge current regulator with a power booster. The structure of the system was a body area network embedded with multiple stimulators and a communication protocol of controlled area network to transmit muscle stimulation parameter information to individual stimulators. A graphical user interface was designed to allow clinicians to specify temporal patterns and muscle stimulation parameters. We completed and tested a prototype of the hardware and communication software modules of the multichannel NMES system. The prototype system was first verified in nondisabled subjects for safety, and then tested in subjects with stroke for feasibility with assisting multijoint movements. Results showed that synergistic stimulation of multiple muscles in subjects with stroke improved performance of multijoint movements with more natural velocity profiles at elbow and shoulder and reduced acromion excursion due to compensatory trunk rotation. The network-based NMES system may provide an innovative solution that allows more physiological activation of multiple muscles in multijoint task training for patients with stroke.

Khat and stroke

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Sanjay V Kulkarni

2012-01-01

Full Text Available Khat chewing, though a tradition followed majorly in African countries, has of late spread widely across the globe due to faster transport systems and advanced preservation techniques. Many complications such as psychosis, arterial hypertension, angina pectoris, and myocardial infarction have been reported in connection to khat abuse. We present a case of a young man who presented with acute onset left-sided weakness. He was a known khat addict for over three decades. A diagnosis of left hemiplegia due to right middle cerebral artery infarction was established. Detailed evaluation revealed no significant underlying cause for stroke. Since the main central nervous system effects of khat are comparable with those of amphetamines and there are established reports of stroke in amphetamine abuse, the former was assumed to be the etiological factor. The patient was discontinued from taking khat and was managed conservatively. The subject showed significant recovery with no further complications or similar episodes during follow-up. To the best of our knowledge, this is the second case of stroke associated with khat. Since the management is essentially conservative, a vigilant history eliciting of khat abuse in prevalent countries would cut down unnecessary healthcare costs.

Stroke mimic diagnoses presenting to a hyperacute stroke unit.

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Dawson, Ang; Cloud, Geoffrey C; Pereira, Anthony C; Moynihan, Barry J

2016-10-01

Stroke services have been centralised in several countries in recent years. Diagnosing acute stroke is challenging and a high proportion of patients admitted to stroke units are diagnosed as a non-stroke condition (stroke mimics). This study aims to describe the stroke mimic patient group, including their impact on stroke services. We analysed routine clinical data from 2,305 consecutive admissions to a stroke unit at St George's Hospital, London. Mimic groupings were derived from 335 individual codes into 17 groupings. From 2,305 admissions, 555 stroke mimic diagnoses were identified (24.2%) and 72% of stroke mimics had at least one stroke risk factor. Common mimic diagnoses were headache, seizure and syncope. Medically unexplained symptoms and decompensation of underlying conditions were also common. Median length of stay was 1 day; a diagnosis of dementia (p=0.028) or needing MRI (p=0.006) was associated with a longer stay. Despite emergency department assessment by specialist clinicians and computed tomography brain, one in four suspected stroke patients admitted to hospital had a non-stroke diagnosis. Stroke mimics represent a heterogeneous patient group with significant impacts on stroke services. Co-location of stroke and acute neurology services may offer advantages where service reorganisation is being considered. © Royal College of Physicians 2016. All rights reserved.

Automatic detection of ischemic stroke based on scaling exponent electroencephalogram using extreme learning machine

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Adhi, H. A.; Wijaya, S. K.; Prawito; Badri, C.; Rezal, M.

2017-03-01

Stroke is one of cerebrovascular diseases caused by the obstruction of blood flow to the brain. Stroke becomes the leading cause of death in Indonesia and the second in the world. Stroke also causes of the disability. Ischemic stroke accounts for most of all stroke cases. Obstruction of blood flow can cause tissue damage which results the electrical changes in the brain that can be observed through the electroencephalogram (EEG). In this study, we presented the results of automatic detection of ischemic stroke and normal subjects based on the scaling exponent EEG obtained through detrended fluctuation analysis (DFA) using extreme learning machine (ELM) as the classifier. The signal processing was performed with 18 channels of EEG in the range of 0-30 Hz. Scaling exponents of the subjects were used as the input for ELM to classify the ischemic stroke. The performance of detection was observed by the value of accuracy, sensitivity and specificity. The result showed, performance of the proposed method to classify the ischemic stroke was 84 % for accuracy, 82 % for sensitivity and 87 % for specificity with 120 hidden neurons and sine as the activation function of ELM.

Predictors and brain connectivity changes associated with arm motor function improvement from intensive practice in chronic stroke [version 2; referees: 1 approved, 2 approved with reservations

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George F. Wittenberg

2017-02-01

Full Text Available Background and Purpose: The brain changes that underlie therapy-induced improvement in motor function after stroke remain obscure. This study sought to demonstrate the feasibility and utility of measuring motor system physiology in a clinical trial of intensive upper extremity rehabilitation in chronic stroke-related hemiparesis. Methods: This was a substudy of two multi-center clinical trials of intensive robotic and intensive conventional therapy arm therapy in chronic, significantly hemiparetic, stroke patients. Transcranial magnetic stimulation was used to measure motor cortical output to the biceps and extensor digitorum communus muscles. Magnetic resonance imaging (MRI was used to determine the cortical anatomy, as well as to measure fractional anisotropy, and blood oxygenation (BOLD during an eyes-closed rest state. Region-of-interest time-series correlation analysis was performed on the BOLD signal to determine interregional connectivity. Functional status was measured with the upper extremity Fugl-Meyer and Wolf Motor Function Test. Results: Motor evoked potential (MEP presence was associated with better functional outcomes, but the effect was not significant when considering baseline impairment. Affected side internal capsule fractional anisotropy was associated with better function at baseline. Affected side primary motor cortex (M1 activity became more correlated with other frontal motor regions after treatment. Resting state connectivity between affected hemisphere M1 and dorsal premotor area (PMAd predicted recovery. Conclusions: Presence of motor evoked potentials in the affected motor cortex and its functional connectivity with PMAd may be useful in predicting recovery. Functional connectivity in the motor network shows a trends towards increasing after intensive robotic or non-robotic arm therapy. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifiers: NCT00372411 \\& NCT00333983.

Ischemic strokes and migraine

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Bousser, M.G.; Baron, J.C.; Chiras, J.

1985-11-01

Lasting neurological deficits, though most infrequent, do occur in migrainous subjects and are well documented by clinical angiographic computed tomographic (CT scan) and even pathological studies. However the mechanism of cerebral ischemia in migraine remains widely unknown and the precise role of migraine in the pathogenesis of ischemic strokes is still debated. (orig./MG).

Power frequency spectrum analysis of surface EMG signals of upper limb muscles during elbow flexion - A comparison between healthy subjects and stroke survivors.

Science.gov (United States)

Angelova, Silvija; Ribagin, Simeon; Raikova, Rositsa; Veneva, Ivanka

2018-02-01

After a stroke, motor units stop working properly and large, fast-twitch units are more frequently affected. Their impaired functions can be investigated during dynamic tasks using electromyographic (EMG) signal analysis. The aim of this paper is to investigate changes in the parameters of the power/frequency function during elbow flexion between affected, non-affected, and healthy muscles. Fifteen healthy subjects and ten stroke survivors participated in the experiments. Electromyographic data from 6 muscles of the upper limbs during elbow flexion were filtered and normalized to the amplitudes of EMG signals during maximal isometric tasks. The moments when motion started and when the flexion angle reached its maximal value were found. Equal intervals of 0.3407 s were defined between these two moments and one additional interval before the start of the flexion (first one) was supplemented. For each of these intervals the power/frequency function of EMG signals was calculated. The mean (MNF) and median frequencies (MDF), the maximal power (MPw) and the area under the power function (APw) were calculated. MNF was always higher than MDF. A significant decrease in these frequencies was found in only three post-stroke survivors. The frequencies in the first time interval were nearly always the highest among all intervals. The maximal power was nearly zero during first time interval and increased during the next ones. The largest values of MPw and APw were found for the flexor muscles and they increased for the muscles of the affected arm compared to the non-affected one of stroke survivors. Copyright © 2017 Elsevier Ltd. All rights reserved.

Relationship between Estradiol and Antioxidant Enzymes Activity of Ischemic Stroke

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Nasrin Sheikh

2009-01-01

Full Text Available Some evidence suggests the neuroprotection of estrogen provided by the antioxidant activity of this compound. The main objective of this study was to determine the level of estradiol and its correlation with the activity of antioxidant enzymes, total antioxidant status and ferritin from ischemic stroke subjects. The study population consisted of 30 patients with acute ischemic stroke and 30 controls. There was no significant difference between estradiol in stroke and control group. The activity of superoxide dismutase and level of ferritin was higher in stroke compared with control group (<.05, <.001, resp.. There was no significant correlation between estradiol and glutathione peroxidase, glutathione reductase, catalase, total antioxidant status, and ferritin in stroke and control groups. We observed inverse correlation between estradiol with superoxide dismutase in males of stroke patients (=−0.54, =.029. Our results supported that endogenous estradiol of elderly men and women of stroke or control group has no antioxidant activity.

The L-arginine Pathway in Acute Ischemic Stroke and Severe Carotid Stenosis

DEFF Research Database (Denmark)

Molnar, Tihamer; Pusch, Gabriella; Papp, Viktoria

2014-01-01

BACKGROUND: Endothelial dysfunction is associated with increased levels of asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA) resulting in a decreased production of nitric oxide, which regulates the vascular tone. METHODS: Patients with acute ischemic stroke (AIS, n = 55......) and asymptomatic significant carotid stenosis (AsCS, n = 44) were prospectively investigated. L-arginine, ADMA, SDMA, S100 B, and high-sensitivity C-reactive protein (hsCRP) were serially measured within 6 hours after the onset of stroke, at 24 and 72 poststroke hours. All markers were compared with healthy...... subjects (n = 45). The severity of AIS was daily assessed by National Institute of Health Stroke Scale scoring. RESULTS: Even within 6 hours after the onset of stroke, L-arginine, ADMA, and SDMA were significantly higher in patients with AIS compared with both AsCS and healthy subjects. S100 B reflecting...

Brain-computer interface training combined with transcranial direct current stimulation in patients with chronic severe hemiparesis: Proof of concept study.

Science.gov (United States)

Kasashima-Shindo, Yuko; Fujiwara, Toshiyuki; Ushiba, Junichi; Matsushika, Yayoi; Kamatani, Daiki; Oto, Misa; Ono, Takashi; Nishimoto, Atsuko; Shindo, Keiichiro; Kawakami, Michiyuki; Tsuji, Tetsuya; Liu, Meigen

2015-04-01

Brain-computer interface technology has been applied to stroke patients to improve their motor function. Event-related desynchronization during motor imagery, which is used as a brain-computer interface trigger, is sometimes difficult to detect in stroke patients. Anodal transcranial direct current stimulation (tDCS) is known to increase event-related desynchronization. This study investigated the adjunctive effect of anodal tDCS for brain-computer interface training in patients with severe hemiparesis. Eighteen patients with chronic stroke. A non-randomized controlled study. Subjects were divided between a brain-computer interface group and a tDCS- brain-computer interface group and participated in a 10-day brain-computer interface training. Event-related desynchronization was detected in the affected hemisphere during motor imagery of the affected fingers. The tDCS-brain-computer interface group received anodal tDCS before brain-computer interface training. Event-related desynchronization was evaluated before and after the intervention. The Fugl-Meyer Assessment upper extremity motor score (FM-U) was assessed before, immediately after, and 3 months after, the intervention. Event-related desynchronization was significantly increased in the tDCS- brain-computer interface group. The FM-U was significantly increased in both groups. The FM-U improvement was maintained at 3 months in the tDCS-brain-computer interface group. Anodal tDCS can be a conditioning tool for brain-computer interface training in patients with severe hemiparetic stroke.

Intake of antioxidants and B vitamins is inversely associated with ischemic stroke and cerebral atherosclerosis

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Choe, Hansaem; Hwang, Ji-Yun; Yun, Jin A; Kim, Ji-Myung; Song, Tae-Jin; Chang, Namsoo; Kim, Yong-Jae

2016-01-01

BACKGROUND/OBJECTIVES This study was conducted to examine relationships between dietary habits and intakes of antioxidants and B vitamins and the risk of ischemic stroke, and to compare dietary factors according to the presence of cerebral artery atherosclerosis and stroke subtypes. SUBJECTS/METHODS A total of 147 patients and 144 control subjects were recruited consecutively in the metropolitan area of Seoul, Korea. Sixty participants each in the case and control groups were included in analyses after 1:1 frequency matching. In addition, 117 acute ischemic stroke patients were classified into subtypes according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) guidelines. Dietary intake was measured using a semi-quantitative food frequency questionnaire composed of 111 food items and plasma lipid and homocysteine levels were analyzed. RESULTS When compared with control subjects, stroke patients had unfavorable dietary behaviors and lower intakes of fruits (73.1 ± 83.2 g vs. 230.9 ± 202.1 g, P < 0.001), vegetables (221.1 ± 209.0 g vs. 561.7 ± 306.6 g, P < 0.001), and antioxidants, including vitamins C, E, B6, β-carotene, and folate. The intakes of fruits, vegetables, vitamin C, and folate were inversely associated with the risk of ischemic stroke after adjusting for confounding factors. Intakes of vegetables, vitamins C, B6, B12, and folate per 1,000 kcal were lower in ischemic stroke with cerebral atherosclerosis than in those without. Overall vitamin B12 intake per 1,000 kcal differed according to the TOAST classification (P = 0.004), but no differences among groups existed based on the post-hoc test. CONCLUSIONS When compared with control subjects, ischemic stroke patients, particularly those with cerebral atherosclerosis, had unfavorable dietary intake, which may have contributed to the development of ischemic stroke. These results indicate that proper dietary recommendations are important for the prevention of ischemic stroke. PMID:27698959

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

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

2016-01-01

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

The effects of core stabilization exercise on dynamic balance and gait function in stroke patients.

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Chung, Eun-Jung; Kim, Jung-Hee; Lee, Byoung-Hee

2013-07-01

[Purpose] The purpose of this study was to determine the effects of core stabilization exercise on dynamic balance and gait function in stroke patients. [Subjects] The subjects were 16 stroke patients, who were randomly divided into two groups: a core stabilization exercise group of eight subjects and control group of eight subjects. [Methods] Subjects in both groups received general training five times per week. Subjects in the core stabilization exercise group practiced an additional core stabilization exercise program, which was performed for 30 minutes, three times per week, during a period of four weeks. All subjects were evaluated for dynamic balance (Timed Up and Go test, TUG) and gait parameters (velocity, cadence, step length, and stride length). [Results] Following intervention, the core exercise group showed a significant change in TUG, velocity, and cadence. The only significant difference observed between the core group and control group was in velocity. [Conclusion] The results of this study suggest the feasibility and suitability of core stabilization exercise for stroke patients.

Rehabilitating the Stroke Collection

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Mary Grimmond

2006-06-01

Full Text Available Objective The aim of this project was to complete an analysis of monograph and audiovisual items held in the Central Coast Health Service (CCHS Libraries and containing information relevant to the treatment of acute stroke. Acute stroke is treated by multidisciplinary teams of clinicians based at two hospitals within the CCHS. The adequacy of the library collection was measured by subject coverage and age. Methods The methodology used consisted of three main steps: a literature review; design, administration, and analysis of a questionnaire to members of the CCHS Acute Stroke Team; and an analysis of the libraries’ collections. The research project utilised project management methodology and an evidence based librarianship framework. Results The questionnaire revealed that electronic resources were by far the most frequently used by participants, followed in order by print journals, books, interlibrary loan articles, and audiovisual items. Collection analysis demonstrated that the monograph and audiovisual collections were adequate in both scope and currency to support the information needs of Acute Stroke Team members, with the exception of resources to support patient education. Conclusion The researchers developed recommendations for future collection development in the area of acute stroke resources. Conducting this project within the evidence based librarianship framework helped to develop library staff members’ confidence in their ability to make future collection development decisions, informed by the target group’s information needs and preferences. The collection analysis methodology was designed to be replicated, and new specialist groups within the client base of the library will be targeted to repeat the collection analysis process.

Changes in serum growth factors in stroke rehabilitation patients and their relation to hemiparesis improvement.

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Okazaki, Hideto; Beppu, Hidehiko; Mizutani, Kenmei; Okamoto, Sayaka; Sonoda, Shigeru

2014-07-01

Predicting recovery from hemiparesis after stroke is important for rehabilitation. A few recent studies reported that the levels of some growth factors shortly after stroke were positively correlated with the clinical outcomes during the chronic phase. The aim of this study was to examine the relationships between the serum levels of growth factors (vascular endothelial growth factor [VEGF], insulin-like growth factor-I [IGF-I], and hepatocyte growth factor [HGF]) and improvement in hemiparesis in stroke patients who received rehabilitation in a postacute rehabilitation hospital. Subjects were 32 stroke patients (cerebral infarction: 21 and intracerebral hemorrhage [ICH]: 11). We measured serum levels of VEGF, IGF-I, and HGF and 5 items of the Stroke Impairment Assessment Set (SIAS) for hemiparesis on admission and at discharge. Age-matched healthy subjects (n=15) served as controls. Serum levels of VEGF and HGF in cerebral infarct patients on admission were higher than those in control subjects, and the serum levels of IGF-I in stroke patients were lower than those in controls. The level of HGF in ICH patients on admission was negatively correlated with gains in SIAS, and higher outliers in HGF concentration were correlated with lower gains in SIAS. Focusing on the extremely high levels of these factors may be a predictor of the low recovery from hemiparesis after stroke. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Determinations of vertical stroke V{sub cb} vertical stroke and vertical stroke V{sub ub} vertical stroke from baryonic Λ{sub b} decays

Energy Technology Data Exchange (ETDEWEB)

Hsiao, Y.K. [Shanxi Normal University, School of Physics and Information Engineering, Linfen (China); National Tsing Hua University, Department of Physics, Hsinchu (China); Geng, C.Q. [Shanxi Normal University, School of Physics and Information Engineering, Linfen (China); National Tsing Hua University, Department of Physics, Hsinchu (China); Hunan Normal University, Synergetic Innovation Center for Quantum Effects and Applications (SICQEA), Changsha (China)

2017-10-15

We present the first attempt to extract vertical stroke V{sub cb} vertical stroke from the Λ{sub b} → Λ{sub c}{sup +}l anti ν{sub l} decay without relying on vertical stroke V{sub ub} vertical stroke inputs from the B meson decays. Meanwhile, the hadronic Λ{sub b} → Λ{sub c}M{sub (c)} decays with M = (π{sup -},K{sup -}) and M{sub c} =(D{sup -},D{sup -}{sub s}) measured with high precisions are involved in the extraction. Explicitly, we find that vertical stroke V{sub cb} vertical stroke =(44.6 ± 3.2) x 10{sup -3}, agreeing with the value of (42.11 ± 0.74) x 10{sup -3} from the inclusive B → X{sub c}l anti ν{sub l} decays. Furthermore, based on the most recent ratio of vertical stroke V{sub ub} vertical stroke / vertical stroke V{sub cb} vertical stroke from the exclusive modes, we obtain vertical stroke V{sub ub} vertical stroke = (4.3 ± 0.4) x 10{sup -3}, which is close to the value of (4.49 ± 0.24) x 10{sup -3} from the inclusive B → X{sub u}l anti ν{sub l} decays. We conclude that our determinations of vertical stroke V{sub cb} vertical stroke and vertical stroke V{sub ub} vertical stroke favor the corresponding inclusive extractions in the B decays. (orig.)

Intrarater reliabilities of shoulder joint horizontal adductor muscle strength measurements using a handheld dynamometer for geriatric and stroke patients

OpenAIRE

Hirano, Masahiro; Katoh, Munenori; Kawaguchi, Saori; Uemura, Tomomi

2016-01-01

[Purpose] This study aimed to verify the appropriate number of measurements and the intrarater reliabilities of shoulder joint horizontal adductor muscle strength measurements using a handheld dynamometer (HHD) for geriatric and stroke patients. [Subjects and Methods] The subjects were 40 inpatients, who were divided into two groups: 20 stroke patients in the stroke group (SG), and 20 geriatric patients in the no-stroke group (N-SG). Measurements were performed three times using an HHD with a...

Cryptogenic Stroke

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Mohammad Saadatnia

2017-02-01

Full Text Available Cryptogenic stroke is defined as brain infarction that is not attributable to a source of definite embolism, large artery atherosclerosis, or small artery disease despite a thorough vascular, cardiac, and serologic evaluation. Despite many advances in our understanding of ischemic stroke, cryptogenic strokes remain a diagnostic and therapeutic challenge. The pathophysiology of cryptogenic stroke is likely various. Probable mechanisms include cardiac embolism secondary to occult paroxysmal atrial fibrillation, aortic atheromatous disease or other cardiac sources, paradoxical embolism from atrial septal abnormalities such as patent foramen ovale, hypercoagulable states, and preclinical or subclinical cerebrovascular disease.  Cryptogenic stroke is one-fourth among cerebral infarction, but most of them could be ascribed to embolic stroke. A significant proportion of cryptogenic strokes adhere to embolic infarct topography on brain imaging and improvement in our ability to detect paroxysmal atrial fibrillation in patients with cryptogenic stroke has strengthened the idea that these strokes are embolic in nature. a significant proportion of cryptogenic strokes adhere to embolic infarct topography on brain imaging.embolic stroke of undetermined sources(ESUS was planned for unifying embolic stroke of undetermined source.  The etiologies underlying ESUS included minor-risk potential cardioembolic sources, covert paroxysmal atrial fibrillation, cancer-associated coagulopathy and embolism, arteriogenic emboli, and paroxysmal embolism. Extensive evaluation including transesophageal echocardiography and cardiac monitoring for long time could identify the etiology of these patients. Therefore cryptogenic stroke is a diagnosis of exclusion. Compared with other stroke subtypes, cryptogenic stroke tends to have a better prognosis and lower long-term risk of recurrence.

Late night activity regarding stroke codes: LuNAR strokes.

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Tafreshi, Gilda; Raman, Rema; Ernstrom, Karin; Rapp, Karen; Meyer, Brett C

2012-08-01

There is diurnal variation for cardiac arrest and sudden cardiac death. Stroke may show a similar pattern. We assessed whether strokes presenting during a particular time of day or night are more likely of vascular etiology. To compare emergency department stroke codes arriving between 22:00 and 8:00 hours (LuNAR strokes) vs. others (n-LuNAR strokes). The purpose was to determine if late night strokes are more likely to be true strokes or warrant acute tissue plasminogen activator evaluations. We reviewed prospectively collected cases in the University of California, San Diego Stroke Team database gathered over a four-year period. Stroke codes at six emergency departments were classified based on arrival time. Those arriving between 22:00 and 8:00 hours were classified as LuNAR stroke codes, the remainder were classified as 'n-LuNAR'. Patients were further classified as intracerebral hemorrhage, acute ischemic stroke not receiving tissue plasminogen activator, acute ischemic stroke receiving tissue plasminogen activator, transient ischemic attack, and nonstroke. Categorical outcomes were compared using Fisher's Exact test. Continuous outcomes were compared using Wilcoxon's Rank-sum test. A total of 1607 patients were included in our study, of which, 299 (19%) were LuNAR code strokes. The overall median NIHSS was five, higher in the LuNAR group (n-LuNAR 5, LuNAR 7; P=0·022). There was no overall differences in patient diagnoses between LuNAR and n-LuNAR strokes (P=0·169) or diagnosis of acute ischemic stroke receiving tissue plasminogen activator (n-LuNAR 191 (14·6%), LuNAR 42 (14·0%); P=0·86). Mean arrival to computed tomography scan time was longer during LuNAR hours (n-LuNAR 54·9±76·3 min, LuNAR 62·5±87·7 min; P=0·027). There was no significant difference in 90-day mortality (n-LuNAR 15·0%, LuNAR 13·2%; P=0·45). Our stroke center experience showed no difference in diagnosis of acute ischemic stroke between day and night stroke codes. This

The neuroanatomy of pure apraxia of speech in stroke.

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Graff-Radford, Jonathan; Jones, David T; Strand, Edythe A; Rabinstein, Alejandro A; Duffy, Joseph R; Josephs, Keith A

2014-02-01

The left insula or Broca's area have been proposed as the neuroanatomical correlate for apraxia of speech (AOS) based on studies of patients with both AOS and aphasia due to stroke. Studies of neurodegenerative AOS suggest the premotor area and the supplementary motor areas as the anatomical correlates. The study objective was to determine the common infarction area in patients with pure AOS due to stroke. Patients with AOS and no or equivocal aphasia due to ischemic stroke were identified through a pre-existing database. Seven subjects were identified. Five had pure AOS, and two had equivocal aphasia. MRI lesion analysis revealed maximal overlap spanning the left premotor and motor cortices. While both neurodegenerative AOS and stroke induced pure AOS involve the premotor cortex, further studies are needed to establish whether stroke-induced AOS and neurodegenerative AOS share a common anatomic substrate. Copyright © 2014 Elsevier Inc. All rights reserved.

A quasi-experimental study on a community-based stroke prevention programme for clients with minor stroke.

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Sit, Janet W H; Yip, Vera Y B; Ko, Stanley K K; Gun, Amy P C; Lee, Judy S H

2007-02-01

The aim of this study was to determine the effectiveness of a community-based stroke prevention programme in (1) improving knowledge about stroke; (2) improving self-health-monitoring practice; (3) maintaining behavioural changes when adopting a healthy lifestyle for stroke prevention. People with minor stroke (or transient ischaemic attack) tend to under-estimate the long-term impact of this on their health. The challenge for nurses is to prevent subsequent strokes by finding ways to promote and sustain appropriate behaviours. Educational intervention is of paramount importance in equipping those at risk with relevant knowledge and self-care strategies for secondary stroke prevention. This study adopted a quasi-experimental design. One hundred and ninety subjects were recruited, of whom 147 (77 in the intervention group and 70 in the control group) completed the study. Data were obtained at three time points: baseline (T0); one week after (T1) and three months after (T2) the intervention. The intervention programme consisted of eight weekly two-hour sessions, with the aims of improving the participants' awareness of their own health signals and of actively involving them in self-care management of their own health for secondary stroke prevention. Significant positive changes were found among participants of the intervention group in the knowledge on stroke warning signs (P lifestyle modification of dietary habits (reduction in salted food intake, P = 0.004). No significant improvement was found in walking exercise participation in the intervention group, yet a significant decrease was detected among the control group. This study found a three-month-sustained effect of positive changes in knowledge and skill from participants who undertook a nurse-led community-based stroke prevention programme. Effective educational intervention by professional nurses helped clients integrate their learned knowledge into their real-life practice. This empowering, that is, the

Physical Activity Level of Ambulatory Stroke Patients: Is it Related to Neuropsychological Factors?

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Ersöz Hüseyinsinoğlu, Burcu; Kuran Aslan, Gökşen; Tarakci, Devrim; Razak Özdinçler, Arzu; Küçükoğlu, Hayriye; Baybaş, Sevim

2017-06-01

Physical inactivity is an important risk factor for stroke and stroke recurrence. There is insufficient knowledge about the physical activity (PA) level in stroke patients who are ambulatory in the subacute phase. Our aim was to compare the PA level between ambulatory stroke patients and a population of the same age and to investigate neuropsychological factors that could affect the PA level in the same stroke group. Eighty-five subacute stroke patients and 58 healthy subjects were included. Patients' demographic features, disease-related features, and comorbidities were recorded. The PA level was assessed by the International Physical Activity Questionnaire-Short Version and a pedometer (OMRON Walking style II). The Apathy Rating Scale was applied to determine the apathy level. Depression level was investigated by the Geriatric Depression Scale. The standardized Mini-mental State Examination was performed to assess the cognitive status. The PA level was significantly higher in the healthy group than in the stroke group (plevel of men was significantly higher than that of women (p=0.03). Participants who were classified as level 4 had a lower PA level than those who were classified as level 5 according to the Functional Ambulation Category. There was no relationship between the PA level and the apathy, cognitive, and depression levels in the stroke patients (p>0.05). Subacute stroke patients have a lower PA level than healthy subjects. This is not related to neuropsychological factors. The reasons for minor deficits related to ambulation should be researched further while developing strategies for increasing the PA level of subacute stroke patients.

Rates and correlates of suicidal ideation among stroke survivors: a meta-analysis.

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Bartoli, Francesco; Pompili, Maurizio; Lillia, Nicoletta; Crocamo, Cristina; Salemi, Giuseppe; Clerici, Massimo; Carrà, Giuseppe

2017-06-01

A better understanding of the epidemiological impact of suicidal ideation after stroke is required to identify subjects needing personalised interventions. The aim of this meta-analysis was to estimate rates and correlates of suicidal ideation among stroke survivors. We searched via Ovid, Medline, Embase and PsycInfo from database inception until August 2016. Predefined outcomes were (1) rates of suicidal ideation based on random-effects pooled proportion and (2) relevant sociodemographic and clinical correlates, using random-effects odds ratio (OR) or standardised mean difference (SMD) for categorical and continuous variables, respectively. Fifteen studies and 13 independent samples, accounting for 10 400 subjects, were included in meta-analyses. The pooled proportion of suicidal ideation among stroke survivors was 11.8% (7.4% to 16.2%), with high heterogeneity across studies (I 2 =97.3%). Current (OR=11.50; psuicidal ideation. Moreover, suicidal ideation was less likely in stroke survivors who were married (OR=0.63; psuicidal ideation. Thus, there is enough evidence to support the use of routine screening and early interventions to prevent and treat suicidal ideation after stroke, especially among subjects carrying specific correlates. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Child-Mediated Stroke Communication: findings from Hip Hop Stroke.

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Williams, Olajide; DeSorbo, Alexandra; Noble, James; Gerin, William

2012-01-01

Low thrombolysis rates for acute ischemic stroke are linked to delays in seeking immediate treatment due to low public stroke awareness. We aimed to assess whether "Child-Mediated Stroke Communication" could improve stroke literacy of parents of children enrolled in a school-based stroke literacy program called Hip Hop Stroke. Parents of children aged 9 to 12 years from 2 public schools in Harlem, New York City, were recruited to participate in stroke literacy questionnaires before and after their child's participation in Hip Hop Stroke, a novel Child-Mediated Stroke Communication intervention delivered in school auditoriums. Parental recall of stroke information communicated through their child was assessed 1-week after the intervention. Fifth and sixth grade students (n=182) were enrolled into Hip Hop Stroke. One hundred two parents were approached in person to participate; 75 opted to participate and 71 completed both the pretest and post-test (74% response rate and 95% retention rate). Parental stroke literacy improved after the program; before the program, 3 parents of 75 (3.9%) were able to identify the 5 cardinal stroke symptoms, distracting symptom (chest pains), and had an urgent action plan (calling 911) compared with 21 of 71 parents (29.6%) postintervention (P<0.001). The FAST mnemonic was known by 2 (2.7%) of participants before the program versus 29 (41%) after program completion (P<0.001). Knowledge of stroke signs and symptoms remains low among residents of this high-risk population. The use of Child-Mediated Stroke Communication suggests that school children aged 9 to 12 years may be effective conduits of critical stroke knowledge to their parents.

Stroke subtyping for genetic association studies? A comparison of the CCS and TOAST classifications.

Science.gov (United States)

Lanfranconi, Silvia; Markus, Hugh S

2013-12-01

A reliable and reproducible classification system of stroke subtype is essential for epidemiological and genetic studies. The Causative Classification of Stroke system is an evidence-based computerized algorithm with excellent inter-rater reliability. It has been suggested that, compared to the Trial of ORG 10172 in Acute Stroke Treatment classification, it increases the proportion of cases with defined subtype that may increase power in genetic association studies. We compared Trial of ORG 10172 in Acute Stroke Treatment and Causative Classification of Stroke system classifications in a large cohort of well-phenotyped stroke patients. Six hundred ninety consecutively recruited patients with first-ever ischemic stroke were classified, using review of clinical data and original imaging, according to the Trial of ORG 10172 in Acute Stroke Treatment and Causative Classification of Stroke system classifications. There was excellent agreement subtype assigned by between Trial of ORG 10172 in Acute Stroke Treatment and Causative Classification of Stroke system (kappa = 0·85). The agreement was excellent for the major individual subtypes: large artery atherosclerosis kappa = 0·888, small-artery occlusion kappa = 0·869, cardiac embolism kappa = 0·89, and undetermined category kappa = 0·884. There was only moderate agreement (kappa = 0·41) for the subjects with at least two competing underlying mechanism. Thirty-five (5·8%) patients classified as undetermined by Trial of ORG 10172 in Acute Stroke Treatment were assigned to a definite subtype by Causative Classification of Stroke system. Thirty-two subjects assigned to a definite subtype by Trial of ORG 10172 in Acute Stroke Treatment were classified as undetermined by Causative Classification of Stroke system. There is excellent agreement between classification using Trial of ORG 10172 in Acute Stroke Treatment and Causative Classification of Stroke systems but no evidence that Causative

Effects of electric stimulation-assisted cycling training in people with chronic stroke

NARCIS (Netherlands)

Janssen, T.W.J.; Beltman, J.M.; Elich, P.; Koppe, P.A.; Konijnenbelt, H.; de Haan, A.; Gerrits, K.H.L.

2008-01-01

Janssen TW, Beltman JM, Elich P, Koppe PA, Konijnenbelt H, de Haan A, Gerrits KH. Effects of electric stimulation-assisted cycling training in people with chronic stroke. Objective: To evaluate whether leg cycling training in subjects with chronic stroke can improve cycling performance, aerobic

Compensatory stepping responses in individuals with stroke: a pilot study.

Science.gov (United States)

Lakhani, Bimal; Mansfield, Avril; Inness, Elizabeth L; McIlroy, William E

2011-05-01

Impaired postural control and a high incidence of falls are commonly observed following stroke. Compensatory stepping responses are critical to reactive balance control. We hypothesize that, following a stroke, individuals with unilateral limb dyscontrol will be faced with the unique challenge of controlling such rapid stepping reactions that may eventually be linked to the high rate of falling. The objectives of this exploratory pilot study were to investigate compensatory stepping in individuals poststroke with regard to: (1) choice of initial stepping limb (paretic or non-paretic); (2) step characteristics; and (3) differences in step characteristics when the initial step is taken with the paretic vs. the non-paretic limb. Four subjects following stroke (38-165 days post) and 11 healthy young adults were recruited. Anterior and posterior perturbations were delivered by using a weight drop system. Force plates recorded centre-of-pressure excursion prior to the onset of stepping and step timing. Of the four subjects, three only attempted to step with their non-paretic limb and one stepped with either limb. Time to foot-off was generally slow, whereas step onset time and swing time were comparable to healthy controls. Two of the four subjects executed multistep responses in every trial, and attempts to force stepping with the paretic limb were unsuccessful in three of the four subjects. Despite high clinical balance scores, these individuals with stroke demonstrated impaired compensatory stepping responses, suggesting that current clinical evaluations might not accurately reflect reactive balance control in this population.

Neural correlates supporting sensory discrimination after left hemisphere stroke

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Borstad, Alexandra; Schmalbrock, Petra; Choi, Seongjin; Nichols-Larsen, Deborah S.

2012-01-01

Background Nearly half of stroke patients have impaired sensory discrimination, however, the neural structures that support post-stroke sensory function have not been described. Objectives 1) To evaluate the role of the primary somatosensory (S1) cortex in post-stroke sensory discrimination and 2) To determine the relationship between post-stroke sensory discrimination and structural integrity of the sensory component of the superior thalamic radiation (sSTR). Methods 10 healthy adults and 10 individuals with left hemisphere stroke participated. Stroke participants completed sensory discrimination testing. An fMRI was conducted during right, impaired hand sensory discrimination. Fractional anisotropy and volume of the sSTR were quantified using diffusion tensor tractography. Results Sensory discrimination was impaired in 60% of participants with left stroke. Peak activation in the left (S1) did not correlate with sensory discrimination ability, rather a more distributed pattern of activation was evident in post-stroke subjects with a positive correlation between peak activation in the parietal cortex and discrimination ability (r=.70, p=.023). The only brain region in which stroke participants had significantly different cortical activation than control participants was the precuneus. Region of interest analysis of the precuneus across stroke participants revealed a positive correlation between peak activation and sensory discrimination ability (r=.77, p=.008). The L/R ratio of sSTR fractional anisotropy also correlated with right hand sensory discrimination (r=.69, p=.027). Conclusions Precuneus cortex, distributed parietal lobe activity, and microstructure of the sSTR support sensory discrimination after left hemisphere stroke. PMID:22592076

Stroke Treatments

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... Stroke Association.org Professionals for Stroke Association.org Shop for Stroke Association.org Support for Stroke Association. ... works by dissolving the clot and improving blood flow to the part of the brain being deprived ...

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 ...

Acute Predictors of Social Integration Following Mild Stroke.

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Wise, Frances M; Harris, Darren W; Olver, John H; Davis, Stephen M; Disler, Peter B

2018-04-01

Despite an acknowledged need to accurately predict stroke outcome, there is little empirical evidence regarding acute predictors of participation restriction post stroke. The current study examines prediction of social integration following mild stroke, using combinations of acute poststroke factors. In a prospective, longitudinal study, a cohort of 60 stroke survivors was followed up at 6 months post stroke. Hierarchical multiple regression analyses were employed to evaluate the value of acute poststroke variables in predicting social integration at 6 months post stroke. A combination of age, number of comorbidities, stroke severity, social support factors, and general self-efficacy in the acute poststroke period accounted for 42% of the variance in 6-month social integration. The largest amount of variance (20%) was explained by inclusion of social support factors, including number and types of support. Post hoc analysis was conducted to establish whether marital status was the mediating variable through which early poststroke social support factors exerted influence upon subsequent social integration. The new combination of acute variables accounted for 48% of the variance in 6-month social integration. Results suggested that subjects with partners perceived higher levels of functional social support and lower levels of participation restriction. Stroke survivors with partners may receive greater amounts of companionship and encouragement from their partners, which enhances self-esteem and confidence. Such individuals are possibly more able to participate in and maintain relationships, thus improving social integration. Social support factors, mediated via marital status, are the strongest predictors of subsequent social integration following mild stroke. Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Epidemiology of stroke in a rural community in Southeastern Nigeria

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Enwereji KO

2014-06-01

Full Text Available Kelechi O Enwereji,1 Maduaburochukwu C Nwosu,1 Adesola Ogunniyi,2 Paul O Nwani,1 Azuoma L Asomugha,1 Ezinna E Enwereji3 1Neurology Unit, Department of Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria; 2Neurology Unit, Department of Medicine, University College Hospital Ibadan, Oyo State, Nigeria; 3Department of Community Medicine/Nursing Sciences, College of Medicine, Abia State University, Uturu, Abia State, Nigeria Background: The prevalence and incidence of stroke vary from community to community worldwide. Nonetheless, not much is known about the current epidemiology of stroke in rural Nigeria and indeed Africa. Methods: We carried out a two-phase door-to-door survey in a rural, predominantly low-income, community in Anambra, Southeastern Nigeria. We used a modified World Health Organization (WHO protocol for detecting neurological diseases in the first phase, and a stroke-specific questionnaire and neurological examination in the second phase. An equal number of sex- and age-matched stroke-negative subjects were examined. Results: We identified ten stroke subjects in the study. The crude prevalence of stroke in rural Nigeria was 1.63 (95% confidence interval [CI] 0.78–3.00 per 1,000 population. The crude prevalence of stroke in males was 1.99 (95% CI 0.73–4.33 per 1,000, while that for females was 1.28 (95% CI 0.35–3.28 per 1,000 population. The peak age-specific prevalence of stroke was 12.08 (95% CI 3.92–28.19 per 1,000, while after adjustment to WHO world population, the peak was 1.0 (95% CI 0.33–2.33 per 1,000. Conclusion: The prevalence of stroke was found to be higher than previously documented in rural Nigeria, with a slightly higher prevalence in males than females. This is, however, comparable to data from rural Africa. Keywords: Africa, developing country, prevalence

Lack of association between a functional variant of the BRCA-1 related associated protein (BRAP) gene and ischemic stroke.

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Liao, Yi-Chu; Lin, Hsiu-Fen; Guo, Yuh-Cherng; Chen, Chung-Hung; Huang, Zhi-Zhang; Juo, Suh-Hang Hank; Lin, Ruey-Tay

2013-01-28

Atherosclerosis shares common pathogenic features with myocardial infarction (MI) and ischemic stroke. BRCA-1 associated protein (BRAP), a newly identified risk gene for MI, aggravates the inflammatory response in atherosclerosis. The aim of this study was to test the association between the BRAP gene and stroke in a Taiwanese population. A total of 1,074 stroke patients and 1,936 controls were genotyped for the functional SNP rs11066001. In our previous studies, the rare allele of this SNP has been repeatedly shown to exert a recessive effect. Therefore, in the current study, we tested for the same recessive model. First, the genotype distributions between all the controls and all the stroke cases were compared. Then to reduce heterogeneity, we explored several population subsets by selecting young stroke subjects (using 45 years of age as the cutoff point), age- and sex-comparable controls, plaque-free controls, and stroke subtypes. We did not find any significant association for the entire data set (OR = 0.94, p = 0.74) or for the subset analyses using age- and sex-comparable controls (p = 0.70) and plaque-free controls (p = 0.91). Analyses of the four stroke subtypes also failed to show any significant associations (p = 0.42 - 0.98). For both young and old subjects, the GG genotype of rs11066001 was similar in the stroke cases and unmatched controls (8.1% vs. 9.4% in young subjects and 8.0% vs. 7.8% in old subjects). Comparing stroke cases with plaque-free controls also failed to find any significant association. The BRAP polymorphism may not play an important role in ischemic stroke in the studied population.

Red cell distribution width and neurological scoring systems in acute stroke patients

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Kara H

2015-03-01

Full Text Available Hasan Kara,1 Selim Degirmenci,1 Aysegul Bayir,1 Ahmet Ak,1 Murat Akinci,1 Ali Dogru,1 Fikret Akyurek,2 Seyit Ali Kayis3 1Department of Emergency Medicine, Faculty of Medicine, Selcuk University, Konya, Turkey; 2Department of Biochemistry, Faculty of Medicine, Selcuk University, Konya, Turkey; 3Department of Biostatistics, Faculty of Medicine, Karabuk University, Karabuk, Turkey Objectives: The purpose of the present study was to evaluate the association between the red blood cell distribution width (RDW and the Glasgow Coma Scale (GCS, Canadian Neurological Scale (CNS, and National Institutes of Health Stroke Scale (NIHSS scores in patients who had acute ischemic stroke. Methods: This prospective observational cohort study included 88 patients who have had acute ischemic stroke and a control group of 40 patients who were evaluated in the Emergency Department for disorders other than acute ischemic stroke. All subjects had RDW determined, and stroke patients had scoring with the GCS, CNS, and NIHSS scores. The GCS, CNS, and NIHSS scores of the patients were rated as mild, moderate, or severe and compared with RDW. Results: Stroke patients had significantly higher median RDW than control subjects. The median RDW values were significantly elevated in patients who had more severe rather than milder strokes rated with all three scoring systems (GCS, CNS, and NIHSS. The median RDW values were significantly elevated for patients who had moderate rather than mild strokes rated by GCS and CNS and for patients who had severe rather than mild strokes rated by NIHSS. The area under the receiver operating characteristic curve was 0.760 (95% confidence interval, 0.676–0.844. Separation of stroke patients and control groups was optimal with RDW 14% (sensitivity, 71.6%; specificity, 67.5%; accuracy, 70.3%. Conclusion: In stroke patients who have symptoms <24 hours, the RDW may be useful in predicting the severity and functional outcomes of the stroke

New developments in secondary stroke prevention: impact of the European/Australasian Stroke Prevention in Reversible Ischemia Trial (ESPRIT) on clinical management.

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Lutsep, Helmi L

2007-01-01

Secondary stroke prevention is an important goal of poststroke patient treatment. Various pharmacologic approaches have been advocated, but the relative efficacy and safety of these regimens has remained the subject of much debate. Recently released data from the European/Australasian Stroke Prevention in Reversible Ischemia Trial (ESPRIT) indicated that combination therapy with aspirin and extended-release dipyridamole was more effective than aspirin monotherapy, and probably more effective than anticoagulants, for the prevention of cerebrovascular events after a stroke or transient ischemic attack. When viewed in light of results of earlier trials, these findings confirmed that combination aspirin plus extended-release dipyridamole therapy improved outcomes in these patients and is a recommended option for poststroke patient treatment.

Relationships of stroke patients' gait parameters with fear of falling.

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Park, Jin; Yoo, Ingyu

2014-12-01

[Purpose] The purpose of this study was to assess the correlation of gait parameters with fear of falling in stroke survivors. [Subjects] In total, 12 patients with stroke participated. [Methods] The subjects performed on a Biodex Gait Trainer 2 for 5 min to evaluate characteristic gait parameters. The kinematic gait parameters measured were gait speed, step cycle, step length, and time on each foot (step symmetry). All the subjects also completed a fall anxiety survey. [Results] Correlations between gait parameters and fear of falling scores were calculated. There was a moderate degree of correlation between fear of falling scores and the step cycle item of gait parameters. [Conclusions] According to our results, the step cycle gait parameter may be related to increased fall anxiety.

Balancing the playing field: collaborative gaming for physical training.

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Mace, Michael; Kinany, Nawal; Rinne, Paul; Rayner, Anthony; Bentley, Paul; Burdet, Etienne

2017-11-20

Multiplayer video games promoting exercise-based rehabilitation may facilitate motor learning, by increasing motivation through social interaction. However, a major design challenge is to enable meaningful inter-subject interaction, whilst allowing for significant skill differences between players. We present a novel motor-training paradigm that allows real-time collaboration and performance enhancement, across a wide range of inter-subject skill mismatches, including disabled vs. able-bodied partnerships. A virtual task consisting of a dynamic ball on a beam, is controlled at each end using independent digital force-sensing handgrips. Interaction is mediated through simulated physical coupling and locally-redundant control. Game performance was measured in 16 healthy-healthy and 16 patient-expert dyads, where patients were hemiparetic stroke survivors using their impaired arm. Dual-player was compared to single-player performance, in terms of score, target tracking, stability, effort and smoothness; and questionnaires probing user-experience and engagement. Performance of less-able subjects (as ranked from single-player ability) was enhanced by dual-player mode, by an amount proportionate to the partnership's mismatch. The more abled partners' performances decreased by a similar amount. Such zero-sum interactions were observed for both healthy-healthy and patient-expert interactions. Dual-player was preferred by the majority of players independent of baseline ability and subject group; healthy subjects also felt more challenged, and patients more skilled. This is the first demonstration of implicit skill balancing in a truly collaborative virtual training task leading to heightened engagement, across both healthy subjects and stroke patients.

Prevalence of stroke/cardiovascular risk factors in Hungary

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Bodo, M.; Sipos, K.; Thuroczy, G.; Panczel, G.; Ilias, L.; Szonyi, P.; Bodo, M., Jr.; Nebella, T.; Banyasz, A.; Nagy, Z.

2010-04-01

A cross-sectional survey was conducted in Hungary using the Cerberus system which includes: 1) a questionnaire addressing the risk factors for stroke/cardiovascular disease; 2) amplifiers to record the pulse waves of cerebral arteries (rheoencephalography) and peripheral arteries, electrocardiogram and electroencephalogram. Additionally, subjects were measured for carotid stenosis by Doppler ultrasound and 12-lead electrocardiogram; subjects were also screened for blood cholesterol, glucose, and triglyceride levels. Prevalence of the following stroke risk factors was identified: overweight, 63.25%; sclerotic brain arteries (by rheoencephalogram), 54.29%; heart disease, 37.92%; pathologic carotid flow, 34.24%; smoking, 30.55%; high blood cholesterol, 28.70%; hypertension, 27.83%; high triglyceride, 24.35%; abnormality in electrocardiogram, 20%; high glucose, 15.95%; symptoms of transient ischemic attack, 16.07%; alcohol abuse, 6.74%; and diabetes, 4.53%. The study demonstrates a possible model for primary cardiovascular disease/stroke prevention. This method offers a standardizable, cost effective, practical technique for mass screenings by identifying the population at high risk for cardiovascular disturbances, especially cerebrovascular disease (primary prevention). In this model, the rheoencephalogram can detect cerebrovascular arteriosclerosis in the susceptibility/presymptomatic phase, earlier than the Doppler ultrasound technique. The method also provides a model for storing analog physiological signals in a computer-based medical record and is a first step in applying an expert system to stroke prevention.

Feasibility study into self-administered training at home using an arm and hand device with motivational gaming environment in chronic stroke.

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Nijenhuis, Sharon M; Prange, Gerdienke B; Amirabdollahian, Farshid; Sale, Patrizio; Infarinato, Francesco; Nasr, Nasrin; Mountain, Gail; Hermens, Hermie J; Stienen, Arno H A; Buurke, Jaap H; Rietman, Johan S

2015-10-09

Assistive and robotic training devices are increasingly used for rehabilitation of the hemiparetic arm after stroke, although applications for the wrist and hand are trailing behind. Furthermore, applying a training device in domestic settings may enable an increased training dose of functional arm and hand training. The objective of this study was to assess the feasibility and potential clinical changes associated with a technology-supported arm and hand training system at home for patients with chronic stroke. A dynamic wrist and hand orthosis was combined with a remotely monitored user interface with motivational gaming environment for self-administered training at home. Twenty-four chronic stroke patients with impaired arm/hand function were recruited to use the training system at home for six weeks. Evaluation of feasibility involved training duration, usability and motivation. Clinical outcomes on arm/hand function, activity and participation were assessed before and after six weeks of training and at two-month follow-up. Mean System Usability Scale score was 69 % (SD 17 %), mean Intrinsic Motivation Inventory score was 5.2 (SD 0.9) points, and mean training duration per week was 105 (SD 66) minutes. Median Fugl-Meyer score improved from 37 (IQR 30) pre-training to 41 (IQR 32) post-training and was sustained at two-month follow-up (40 (IQR 32)). The Stroke Impact Scale improved from 56.3 (SD 13.2) pre-training to 60.0 (SD 13.9) post-training, with a trend at follow-up (59.8 (SD 15.2)). No significant improvements were found on the Action Research Arm Test and Motor Activity Log. Remotely monitored post-stroke training at home applying gaming exercises while physically supporting the wrist and hand showed to be feasible: participants were able and motivated to use the training system independently at home. Usability shows potential, although several usability issues need further attention. Upper extremity function and quality of life improved after training

Stroke care challenges in rural India: Awareness of causes, preventive measures and treatment options of stroke among the rural communities

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Kanaga Lakshmi

2014-12-01

Full Text Available Introduction: Management of stroke in the remote rural areas in India faces major challenges because of lack of awareness. Stroke care services can be optimally implemented only if the communities have an understanding of the disease. Method: A population based, cross sectional survey of an adult general population sample between the ages of 31-60 years in a rural block in Tamil Nadu, India was carried out to study their knowledge, attitude, beliefs about cause, signs and symptoms, preventive measures and treatment options of stroke. Results: Of the 174 subjects studied only 69% were aware of the term stroke and 63% were able to list the symptoms. Only a little more than half the participants (58% were aware that diabetes, smoking and hypertension are risk factors for stroke. None of the participants were aware of the endovascular thrombolysis injection for better recovery from stroke. About quarter (23% of the participants did not think that the stroke is an emergency condition and they need to take the patient urgently to the hospital. Only 56% of the participants had checked their blood pressure and 49% for diabetes. A history of having either hypertension or diabetes and stroke in the family was the only factor that was significantly associated with better awareness (p=<0.001 independent of other potential facilitating factors including age, occupation, education and gender. Conclusion: There is a need to educate the rural communities about the risk factors, how to recognize the onset, the preventive measures and optimum care of stroke to reduce the burden.

Risk Factors and Stroke Characteristic in Patients with Postoperative Strokes.

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Dong, Yi; Cao, Wenjie; Cheng, Xin; Fang, Kun; Zhang, Xiaolong; Gu, Yuxiang; Leng, Bing; Dong, Qiang

2017-07-01

Intravenous thrombolysis and intra-arterial thrombectomy are now the standard therapies for patients with acute ischemic stroke. In-house strokes have often been overlooked even at stroke centers and there is no consensus on how they should be managed. Perioperative stroke happens rather frequently but treatment protocol is lacking, In China, the issue of in-house strokes has not been explored. The aim of this study is to explore the current management of in-house stroke and identify the common risk factors associated with perioperative strokes. Altogether, 51,841 patients were admitted to a tertiary hospital in Shanghai and the records of those who had a neurological consult for stroke were reviewed. Their demographics, clinical characteristics, in-hospital complications and operations, and management plans were prospectively studied. Routine laboratory test results and risk factors of these patients were analyzed by multiple logistic regression model. From January 1, 2015, to December 31, 2015, over 1800 patients had neurological consultations. Among these patients, 37 had an in-house stroke and 20 had more severe stroke during the postoperative period. Compared to in-house stroke patients without a procedure or operation, leukocytosis and elevated fasting glucose levels were more common in perioperative strokes. In multiple logistic regression model, perioperative strokes were more likely related to large vessel occlusion. Patients with perioperative strokes had different risk factors and severity from other in-house strokes. For these patients, obtaining a neurological consultation prior to surgery may be appropriate in order to evaluate the risk of perioperative stroke. Copyright © 2017. Published by Elsevier Inc.

The effect of operant-conditioning balance training on the down-regulation of spinal H-reflexes in a spastic patient.

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Hoseini, Najmeh; Koceja, David M; Riley, Zachary A

2011-10-24

Spasticity in chronic hemiparetic stroke patients has primarily been treated pharmacologically. However, there is increasing evidence that physical rehabilitation can help manage hyper-excitability of reflexes (hyperreflexia), which is a primary contributor to spasticity. In the present study, one chronic hemiparetic stroke patient operantly conditioned the soleus H-reflex while training on a balance board for two weeks. The results showed a minimal decrease in the Hmax-Mmax ratio for both the affected and unaffected limb, indicating that the H-reflex was not significantly altered with training. Alternatively, paired-reflex depression (PRD), a measure of history-dependent changes in reflex excitability, could be conditioned. This was evident by the rightward shift and decreased slope of reflex excitability in the affected limb. The non-affected limb decreased as well, although the non-affected limb was very sensitive to PRD initially, whereas the affected limb was not. Based on these results, it was concluded that PRD is a better index of hyperreflexia, and this measurement could be more informative of synapse function than simple H-reflexes. This study presents a novel and non-pharmacological means of managing spasticity that warrants further investigation with the potential of being translated to the clinic. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Prevalence of self-reported stroke and disability in the French adult population: a transversal study.

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Schnitzler, Alexis; Woimant, France; Tuppin, Philippe; de Peretti, Christine

2014-01-01

In France, the prevalence of stroke and the level of disability of stroke survivors are little known. The aim of this study was to evaluate functional limitations in adults at home and in institutions, with and without self-reported stroke. A survey named "the Disability Health survey" was carried out in people's homes (DHH) and in institutions (DHI). Medical history and functional level (activities-of-daily-living, ADL and instrumented-activities-of-daily-living IADL) were collected through interviews. The modified Rankin score (mRS) and the level of dependence and disability were compared between participants with and without stroke. 33896 subjects responded. The overall prevalence of stroke was 1.6% (CI95% [1.4%-1.7%]). The mRS was over 2 for 34.4% of participants with stroke (28.7% of participants at home and 87.8% of participants in institutions) versus respectively 3.9%, 3.1% and 71.6% without stroke. Difficulty washing was the most frequently reported ADL for those with stroke (30.6% versus 3% for those without stroke). Difficulty with ADL and IADL increased with age but the relative risk was higher below the age of 60 (17 to 25) than over 85 years (1.5 to 2.2), depending on the ADL. In the overall population, 22.6% of those confined to bed or chair reported a history of stroke. These results thus demonstrate a high national prevalence of stroke. Older people are highly dependent, irrespective of stroke history and the relative risk of dependence in young subjects with a history of stroke is high compared with those without.

Effect of Ankle-foot Orthosis on Lower Limb Muscle Activities and Static Balance of Stroke Patients Authors’ Names

OpenAIRE

Lee, Youngmin; Her, Jin Gang; Choi, Youngeun; Kim, Heesoo

2014-01-01

[Purpose] This study examined the effects of an ankle-foot orthosis worn during balance training on lower limb muscle activity and static balance of chronic stroke patients. [Subjects] The subjects were twenty-five inpatients receiving physical therapy for chronic stroke. [Methods] The chronic stroke patients were divided into two groups: thirteen patients were assigned to the ankle-foot orthosis group, while the remaining twelve patients wore only their shoes. Each group performed balance tr...

Encouragement-Induced Real-World Upper Limb Use after Stroke by a Tracking and Feedback Device: A Study Protocol for a Multi-Center, Assessor-Blinded, Randomized Controlled Trial

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Jeremia P. O. Held

2018-01-01

Full Text Available IntroductionRetraining the paretic upper limb after stroke should be intense and specific to be effective. Hence, the best training is daily life use, which is often limited by motivation and effort. Tracking and feedback technology have the potential to encourage self-administered, context-specific training of upper limb use in the patients’ home environment. The aim of this study is to investigate post-intervention and long-term effects of a wrist-worn activity tracking device providing multimodal feedback on daily arm use in hemiparetic subjects beyond 3 months post-stroke.Methods and analysisA prospective, multi-center, assessor-blinded, Phase 2 randomized controlled trial with a superiority framework. Sixty-two stroke patients will be randomized in two groups with a 1:1 allocation ratio, stratified based on arm paresis severity (Fugl-Meyer Assessment—Upper Extremity subscale <32 and ≥32. The experimental group receives a wrist-worn activity tracking device providing multimodal feedback on daily arm use for 6 weeks. Controls wear an identical device providing no feedback. Sample size: 31 participants per group, based on a difference of 0.75±1.00 points on the Motor Activity Log—14 Item Version, Amount of Use subscale (MAL—14 AOU, 80% power, two-sided alpha of 0.05, and a 10% attrition rate. Outcomes: primary outcome is the change in patient-reported amount of daily life upper limb use (MAL—14 AOU from baseline to post-intervention. Secondary outcomes are change in upper limb motor function, upper limb capacity, global disability, patient-reported quality of daily life upper limb use, and quality of life from baseline to post-intervention and 6-week follow-up, as well as compliance, activity counts, and safety.DiscussionThe results of this study will show the possible efficacy of a wrist-worn tracking and feedback device on patient-reported amount of daily life upper limb use.Ethics and disseminationThe study is approved by

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

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Jinkwon Kim

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

Changes in Electroencephalography Complexity using a Brain Computer Interface-Motor Observation Training in Chronic Stroke Patients: A Fuzzy Approximate Entropy Analysis

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Rui Sun

2017-09-01

Full Text Available Entropy-based algorithms have been suggested as robust estimators of electroencephalography (EEG predictability or regularity. This study aimed to examine possible disturbances in EEG complexity as a means to elucidate the pathophysiological mechanisms in chronic stroke, before and after a brain computer interface (BCI-motor observation intervention. Eleven chronic stroke subjects and nine unimpaired subjects were recruited to examine the differences in their EEG complexity. The BCI-motor observation intervention was designed to promote functional recovery of the hand in stroke subjects. Fuzzy approximate entropy (fApEn, a novel entropy-based algorithm designed to evaluate complexity in physiological systems, was applied to assess the EEG signals acquired from unimpaired subjects and stroke subjects, both before and after training. The results showed that stroke subjects had significantly lower EEG fApEn than unimpaired subjects (p < 0.05 in the motor cortex area of the brain (C3, C4, FC3, FC4, CP3, and CP4 in both hemispheres before training. After training, motor function of the paretic upper limb, assessed by the Fugl-Meyer Assessment-Upper Limb (FMA-UL, Action Research Arm Test (ARAT, and Wolf Motor Function Test (WMFT improved significantly (p < 0.05. Furthermore, the EEG fApEn in stroke subjects increased considerably in the central area of the contralesional hemisphere after training (p < 0.05. A significant correlation was noted between clinical scales (FMA-UL, ARAT, and WMFT and EEG fApEn in C3/C4 in the contralesional hemisphere (p < 0.05. This finding suggests that the increase in EEG fApEn could be an estimator of the variance in upper limb motor function improvement. In summary, fApEn can be used to identify abnormal EEG complexity in chronic stroke, when used with BCI-motor observation training. Moreover, these findings based on the fApEn of EEG signals also expand the existing interpretation of training-induced functional

Lack of association between a functional variant of the BRCA-1 related associated protein (BRAP gene and ischemic stroke

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Liao Yi-Chu

2013-01-01

Full Text Available Abstract Background Atherosclerosis shares common pathogenic features with myocardial infarction (MI and ischemic stroke. BRCA-1 associated protein (BRAP, a newly identified risk gene for MI, aggravates the inflammatory response in atherosclerosis. The aim of this study was to test the association between the BRAP gene and stroke in a Taiwanese population. Methods A total of 1,074 stroke patients and 1,936 controls were genotyped for the functional SNP rs11066001. In our previous studies, the rare allele of this SNP has been repeatedly shown to exert a recessive effect. Therefore, in the current study, we tested for the same recessive model. First, the genotype distributions between all the controls and all the stroke cases were compared. Then to reduce heterogeneity, we explored several population subsets by selecting young stroke subjects (using 45 years of age as the cutoff point, age- and sex-comparable controls, plaque-free controls, and stroke subtypes. Results We did not find any significant association for the entire data set (OR = 0.94, p = 0.74 or for the subset analyses using age- and sex-comparable controls (p = 0.70 and plaque-free controls (p = 0.91. Analyses of the four stroke subtypes also failed to show any significant associations (p = 0.42 – 0.98. For both young and old subjects, the GG genotype of rs11066001 was similar in the stroke cases and unmatched controls (8.1% vs. 9.4% in young subjects and 8.0% vs. 7.8% in old subjects. Comparing stroke cases with plaque-free controls also failed to find any significant association. Conclusions The BRAP polymorphism may not play an important role in ischemic stroke in the studied population.

Development of the Italian version of the trunk impairment scale in subjects with acute and chronic stroke. Cross-cultural adaptation, reliability, validity and responsiveness.

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Monticone, Marco; Ambrosini, Emilia; Verheyden, Geert; Brivio, Flavia; Brunati, Roberto; Longoni, Luca; Mauri, Gaia; Molteni, Alessandro; Nava, Claudia; Rocca, Barbara; Ferrante, Simona

2017-09-10

To cross-culturally adapt and psychometrically analyse the Italian version of the Trunk Impairment Scale on acute (cohort 1) and chronic stroke patients (cohort 2). The Trunk Impairment Scale was culturally adapted in accordance with international standards. The psychometric testing included: internal consistency (Cronbach's alpha), inter- and intra-rater reliability (intraclass correlation coefficient; standard error of measurement and minimal detectable change), construct validity by comparing Trunk Impairment Scale score with Barthel Index, motor subscale of Functional Independence Measure, and Trunk Control Test (Pearson's correlation), and responsiveness (Effect Size, Effect Size with Guyatt approach, standardized response mean, and Receiver Operating Characteristics curves). The Trunk Impairment Scale was administered to 125 and 116 acute and chronic stroke patients, respectively. Internal consistency was acceptable (α > 0.7), inter- and intra-rater reliability (ICC > 0.9, Minimal Detectable Change for total score  0.4) with all scales but the motor Functional Independence Measure in cohort 2. Distribution-based methods showed large effects in cohort 1 and moderate to large effects in cohort 2. The Minimal Important Difference was 3.5 both from patient's and therapist's perspective in cohort 1 and 2.5 and 1.5 from patient's and therapist's perspective, respectively, in cohort 2. The Trunk Impairment Scale was successfully translated into Italian and proved to be reliable, valid, and responsive. Its use is recommended for clinical and research purposes. Implications for Rehabilitation Trunk control is an essential part of balance and postural control, constituting an important prerequisite for daily activities and function. The TIS administered in subjects with subacute and chronic stroke was reliable, valid and responsive. The TIS is expected to help clinicians and researchers by identifying key functional processes related to disability in people

Ischemic stroke destabilizes circadian rhythms

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Borjigin Jimo

2008-10-01

Full Text Available Abstract Background The central circadian pacemaker is a remarkably robust regulator of daily rhythmic variations of cardiovascular, endocrine, and neural physiology. Environmental lighting conditions are powerful modulators of circadian rhythms, but regulation of circadian rhythms by disease states is less clear. Here, we examine the effect of ischemic stroke on circadian rhythms in rats using high-resolution pineal microdialysis. Methods Rats were housed in LD 12:12 h conditions and monitored by pineal microdialysis to determine baseline melatonin timing profiles. After demonstration that the circadian expression of melatonin was at steady state, rats were subjected to experimental stroke using two-hour intralumenal filament occlusion of the middle cerebral artery. The animals were returned to their cages, and melatonin monitoring was resumed. The timing of onset, offset, and duration of melatonin secretion were calculated before and after stroke to determine changes in circadian rhythms of melatonin secretion. At the end of the monitoring period, brains were analyzed to determine infarct volume. Results Rats demonstrated immediate shifts in melatonin timing after stroke. We observed a broad range of perturbations in melatonin timing in subsequent days, with rats exhibiting onset/offset patterns which included: advance/advance, advance/delay, delay/advance, and delay/delay. Melatonin rhythms displayed prolonged instability several days after stroke, with a majority of rats showing a day-to-day alternation between advance and delay in melatonin onset and duration. Duration of melatonin secretion changed in response to stroke, and this change was strongly determined by the shift in melatonin onset time. There was no correlation between infarct size and the direction or amplitude of melatonin phase shifting. Conclusion This is the first demonstration that stroke induces immediate changes in the timing of pineal melatonin secretion, indicating

Predictors of early infection in cerebral ischemic stroke.

Science.gov (United States)

Ashour, Wmr; Al-Anwar, A D; Kamel, A E; Aidaros, M A

2016-01-01

Infection is the most common complication of stroke. To determine the risk factors and predictors of post-stroke infection (PSI), which developed within 7 days from the onset of acute ischemic stroke. The study included 60 ischemic stroke patients admitted in the Neurology Department of Zagazig University, Egypt, who were subdivided into: [Non Stroke Associated Infection group (nSAI); 30 patients having stroke without any criteria of infection within 7 days from the onset and Stroke Associated Infection group (SAI); 30 patients having stroke with respiratory tract infection (RTI) or urinary tract infection within 7 days], in addition to 30 healthy sex and age-matching subjects as control. All the patients had a detailed history taking, thorough clinical general and neurological examination, laboratory tests (Urine analysis & urine culture, blood sugar, lipid profile and serum tumor necrosis factor-alpha (TNF-α) and interleukin (IL)-10), a chest radiography to assess RTI and brain computed tomography (CT) to exclude the hemorrhagic stroke and to confirm the ischemic stroke. SAI patients were found to be significantly older with higher baseline blood glucose level. Also the number of patients with tube feeding, lower conscious level, more stroke severity and more large size infarcts were significantly higher in SAI patients. There was a significant elevation in the IL-10, a significant decrease in the TNF-α and a significant decrease in the TNF-α/ IL-10 ratio, in the SAI group. The baseline serum level of IL-10 ≥ 14.5 pg/ ml and size of infarct area > 3.5 cm3 were found to be the independent predictors of PSI. Patients with older age, tube feeding, lower conscious level, worse baseline stroke severity, large cerebral infarcts in CT scan, and increased IL-10 serum level were more susceptible to infection. The baseline serum level of IL-10 ≥ 14.5 pg/ ml and the size of infarct area > 3.5 cm3 were the independent predictors of PSI.

Functional connectivity metrics during stroke recovery

DEFF Research Database (Denmark)

Yourganov, Grigori; Schmah, Tanya; Small, Steven L.

2010-01-01

We explore functional connectivity in nine subjects measured with 1 5T fMRI-BOLD in a longitudinal study of recovery from unilateral stroke affecting the motor area (Small et al, 2002) We found that several measures of complexity of covariance matrices show strong correlations with behavioral mea...

Prediction of Post-stroke Falls by Quantitative Assessment of Balance.

Science.gov (United States)

Lee, Hyun Haeng; Jung, Se Hee

2017-06-01

To evaluate characteristics of the postural instability in patients with stroke and to present a prediction model of post-stroke falls. Patients with a first-ever stroke who had been evaluated by the Balance Master (BM) at post-stroke 3 months (±1 month) between August 2011 and December 2015 were enrolled. Parameters for the postural instability, such as the weight bearing asymmetry (WBA) and postural sway velocity (PSV), were obtained. The fall events in daily lives were assessed via structured telephone interview with a fall related questionnaire. A total of 71 patients (45 men; 45 with ischemic stroke) were enrolled in this study. All subjects underwent BM evaluation at 3.03±0.40 months after stroke. The mean WBA was 17.18%±13.10% and mean PSV (measured as °/s) were noted as 0.66±0.37 (eyes-open on firm surface), 0.89±0.75 (eyes-closed on firm surface), 1.45±1.09 (eyes-open on soft surface), and 3.10±1.76 (eyes-closed on soft surface). A prediction model of post-stroke falls was drawn by multiple logistic regression analysis as follows: Risk of post-stroke falls = -2.848 + 1.878 x (PSV ECSS ) + 0.154 x (age=1 if age≥65; age=0 if agerisk of post-stroke falls.

Impairment on theory of mind and empathy in patients with stroke.

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Yeh, Zai-Ting; Tsai, Chung-Fen

2014-08-01

Impaired social function has been described in patients following stroke. The present study was designed to explore the degree of impairment in the ability to infer mental states in others, or cognitive and affective theory of mind, and empathy, in patients with stroke. A total of 34 patients with stroke were compared to 40 control subjects on tasks testing verbal and non-verbal theory of mind and empathy. Results indicated that patients with stroke were significantly impaired in both cognitive and affective theory of mind, even controlling for basic cognitive function and emotional processing. The patients with right stroke had poorer performance than those with left stroke on the cognitive component of non-verbal theory of mind. On the subscale of cognitive empathy, the right stroke group had poorer performance on perspective-taking than the control group. The right hemisphere may play an important role in decoding non-verbal cues to infer others' minds as well as the processing of empathy, especially the ability of perspective-taking. © 2014 The Authors. Psychiatry and Clinical Neurosciences © 2014 Japanese Society of Psychiatry and Neurology.

Knowledge of Stroke Risk Factors among Stroke Survivors in Nigeria

OpenAIRE

Grace Vincent-Onabajo; Taritei Moses

2016-01-01

Background. Knowledge of stroke risk factors is expected to reduce the incidence of stroke?whether first-ever or recurrent. This study examined knowledge of stroke risk factors and its determinants among stroke survivors. Methods. A cross-sectional survey of consenting stroke survivors at two physiotherapy facilities in Nigeria was carried out. Sociodemographic and clinical data were obtained and knowledge of stroke risk factors (defined as the ability to mention at least one correct risk fac...

Identification of stroke mimics among clinically diagnosed acute strokes.

Science.gov (United States)

Tuntiyatorn, Lojana; Saksornchai, Pichaya; Tunlayadechanont, Supoch

2013-09-01

Stroke is a clinically syndrome of a sudden onset of neurological deficit in a vascular cause. Stroke mimics is the non-vascular disorders with stroke-like clinical symptoms. It is important to distinguish true stroke from mimics since treatment plan may differ To determine the incidence of the stroke mimics and identify their etiologies. All non-contrast head CT of the patients with clinically diagnosed stroke who immediately received imaging upon arrival at the emergency department of the university hospital were retrospectively reviewed in 12-month period between January 1 and December 31, 2008. Medical records, laboratory results, MRI, and 6-month clinical follow-up records were reviewed for final diagnosis. Seven hundred four patients were included in this study, including 363 (51.5%) men and 341 (48.5%) women with range in age from 24 to 108 years. Amongst those, 417 (59.2%) were ischemic stroke, 80 (11.40%) were hemorrhagic stroke, 186 (26.4%) were stroke-mimics, and 21 (3%) were inconclusive. The etiologies among stroke-mimics were metabolic/intoxication (35, 18.8%), sepsis (28, 15.0%), seizure (21, 11.3%), syncope (20, 10.8%), subdural hemorrhage (14, 7.5%), vertigo (11, 6.0%), brain tumor (10, 5.30%), central nervous system infection (5, 2.7%), others (26, 14.0%), and unspecified (16, 8.6%). Incidence rates and etiologies of the stroke mimics were similar to the western reports. However the frequency of each mimic was not.

Prevention Of Stroke

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Nagaraja D

2005-01-01

Full Text Available Stroke is an important cause for neurological morbidity and mortality. Prevention of ischemic stroke involves identification and prevention of risk factors and optimal use of pharmacotherapy. Risk factors have been classified as modifiable and non-modifiable; control of modifiable factors should prevent stroke occurrence. Stroke prevention has been described at three levels: primary, secondary and tertiary. Prolonged hypertension increases an individual′s risk for developing fatal or nonfatal stroke by three times and its control has been shown to prevent stroke. Diabetes mellitus is an important cause for microangiopathy and predisposes to stroke. Statin trials have shown significant reduction in stroke in those who were treated with statins. Stroke risk can be reduced by avoiding tobacco use, control of obesity and avoiding sedentary life style. Anti platelet medications are effective for secondary prevention of stroke. Educating society regarding modifiable risk factors and optimal use of pharmacotherapy form the cornerstone for the prevention of stroke.

Does Virtual Reality-based Kinect Dance Training Paradigm Improve Autonomic Nervous System Modulation in Individuals with Chronic Stroke?

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Sampaio, Luciana Maria Malosá; Subramaniam, Savitha; Arena, Ross; Bhatt, Tanvi

2016-10-01

Physical inactivity and low resting heart rate variability (HRV) are associated with an increased cardiovascular deconditioning, risk of secondary stroke and mortality. Aerobic dance is a multidimensional physical activity and recent research supports its application as a valid alternative cardiovascular training. Furthermore, technological advances have facilitated the emergence of new approaches for exercise training holding promise, especially those methods that integrate rehabilitation with virtual gaming. The purpose of this study was to evaluate cardiac autonomic modulation in individuals with chronic stroke post-training using a virtual reality - based aerobic dance training paradigm. Eleven community-dwelling individuals with hemiparetic stroke [61.7( ± 4.3) years] received a virtual reality-based dance paradigm for 6 weeks using the commercially available Kinect dance video game "Just Dance 3." The training was delivered in a high-intensity tapering method with the first two weeks consisting of 5 sessions/week, next two weeks of 3 sessions/week and last two weeks of 2 sessions/week, with a total of 20 sessions. Data obtained for HRV analysis pre- and post-intervention consists of HRV for ten minutes in (1) supine resting position; (2) quiet standing. High-frequency (HF) power measures as indicators of cardiac parasympathetic activity, low-frequency (LF) power of parasympathetic-sympathetic balance and LF/HF of sympatho-vagal balance were calculated. YMCA submaximal cycle Ergometer test was used to acquire VO 2 max pre- and post-intervention. Changes in physical activity during dance training were assessed using Omran HJ-321 Tri-Axis Pedometer. After training, participants demonstrated a significant improvement in autonomic modulation in the supine position, indicating an improvement in LF=48.4 ( ± 20.1) to 40.3 ( ± 8.0), p =0.03; HF=51.5 ( ± 19) to 59.7 ( ± 8), p = 0.02 and LF/HF=1.6 ( ± 1.9) to 0.8 ( ± 0.26), p =0.05]. Post-training the

Blood Pressure Control: Stroke and Stroke Prevention

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Hans-Christoph Diener

2005-03-01

Full Text Available Hypertension is the most important modifiable risk factor for primary and secondary stroke prevention.All antihypertensive drugs are effective in primary prevention: the risk reduction for stroke is 30—42%. However, not all classes of drugs have the same effects: there is some indication that angiotensin receptor blockers may be superior to other classes of antihypertensive drugs in stroke prevention.Seventy-five percent of patients who present to hospital with acute stroke have elevated blood pressure within the first 24—48 hours. Extremes of systolic blood pressure (SBP increase the risk of death or dependency. The aim of treatment should be to achieve and maintain the SBP in the range 140—160 mmHg. However, fast and drastic blood pressure lowering can have adverse consequences.The PROGRESS trial of secondary prevention with perindopril + indapamide versus placebo + placebo showed a decrease in numbers of stroke recurrences in patients given both active antihypertensive agents, more impressive for cerebral haemorrhage.There were also indications that active treatment might decrease the development of post-stroke dementia.

Hemorrhagic and ischemic strokes compared: stroke severity, mortality, and risk factors.

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Andersen, Klaus Kaae; Olsen, Tom Skyhøj; Dehlendorff, Christian; Kammersgaard, Lars Peter

2009-06-01

Stroke patients with hemorrhagic (HS) and ischemic strokes were compared with regard to stroke severity, mortality, and cardiovascular risk factors. A registry started in 2001, with the aim of registering all hospitalized stroke patients in Denmark, now holds information for 39,484 patients. The patients underwent an evaluation including stroke severity (Scandinavian Stroke Scale), CT, and cardiovascular risk factors. They were followed-up from admission until death or censoring in 2007. Independent predictors of death were identified by means of a survival model based on 25,123 individuals with a complete data set. Of the patients 3993 (10.1%) had HS. Stroke severity was almost linearly related to the probability of having HS (2% in patients with the mildest stroke and 30% in those with the most severe strokes). Factors favoring ischemic strokes vs HS were diabetes, atrial fibrillation, previous myocardial infarction, previous stroke, and intermittent arterial claudication. Smoking and alcohol consumption favored HS, whereas age, sex, and hypertension did not herald stroke type. Compared with ischemic strokes, HS was associated with an overall higher mortality risk (HR, 1.564; 95% CI, 1.441-1.696). The increased risk was, however, time-dependent; initially, risk was 4-fold, after 1 week it was 2.5-fold, and after 3 weeks it was 1.5-fold. After 3 months stroke type did not correlate to mortality. Strokes are generally more severe in patients with HS. Within the first 3 months after stroke, HS is associated with a considerable increase of mortality, which is specifically associated with the hemorrhagic nature of the lesion.

Stroke Care 2: Stroke rehabilitation

NARCIS (Netherlands)

Langhorne, P.; Bernhardt, J.; Kwakkel, G.

2011-01-01

Stroke is a common, serious, and disabling global health-care problem, and rehabilitation is a major part of patient care. There is evidence to support rehabilitation in well coordinated multidisciplinary stroke units or through provision of early supported provision of discharge teams. Potentially

Airplane stroke syndrome.

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Humaidan, Hani; Yassi, Nawaf; Weir, Louise; Davis, Stephen M; Meretoja, Atte

2016-07-01

Only 37 cases of stroke during or soon after long-haul flights have been published to our knowledge. In this retrospective observational study, we searched the Royal Melbourne Hospital prospective stroke database and all discharge summaries from 1 September 2003 to 30 September 2014 for flight-related strokes, defined as patients presenting with stroke within 14days of air travel. We hypothesised that a patent foramen ovale (PFO) is an important, but not the only mechanism, of flight-related stroke. We describe the patient, stroke, and flight characteristics. Over the study period, 131 million passengers arrived at Melbourne airport. Our centre admitted 5727 stroke patients, of whom 42 (0.73%) had flight-related strokes. Flight-related stroke patients were younger (median age 65 versus 73, p<0.001), had similar stroke severity, and received intravenous thrombolysis more often than non-flight-related stroke patients. Seven patients had flight-related intracerebral haemorrhage. The aetiology of the ischaemic strokes was cardioembolic in 14/35 (40%), including seven patients with confirmed PFO, one with atrial septal defect, four with atrial fibrillation, one with endocarditis, and one with aortic arch atheroma. Paradoxical embolism was confirmed in six patients. Stroke related to air travel is a rare occurrence, less than one in a million. Although 20% of patients had a PFO, distribution of stroke aetiologies was diverse and was not limited to PFO and paradoxical embolism. Copyright © 2016 Elsevier Ltd. All rights reserved.

Stroke admissions in Kubwa General Hospital: A 30-month review

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Osaze Ojo

2017-01-01

Full Text Available >Background: Stroke is a common neurological disorder that contributes significantly to the morbidity and mortality of medical admissions.Objectives: To review the types, risk factors, hemispheric involvement, and outcomes of admitted stroke patients in Kubwa General Hospital, Abuja, Nigeria.Subjects and Methods: We carried out a retrospective study of patients who had a clinical diagnosis of stroke in Kubwa General Hospital, Abuja, Nigeria, between January 2013 and June 2015.Results: A total of 60 patients who had stroke were admitted during this period, accounting for 4.25% of medical admissions. Men and women accounted for 68.3% and 31.7%, respectively, with a male-to-female ratio of 2:1. Their mean age was 54.9 ± 13.5 years while the median age was 52.5 years. The mean hospital stay for these patients was 8.4 ± 5.5 days. Ischemic stroke occurred more frequently (65% compared with hemorrhagic stroke (35%. Hypertension (65%, alcohol (25%, previous stroke (18.3%, diabetes mellitus, and hypercholesterolemia (18.3% were the common identifiable risk factors for stroke. Ten patients (16.7% had two risk factors for stroke, whereas 8 patients (13.3% had three risk factors for stroke. The mean systolic and diastolic blood pressures on admission were 171.5 ± 41.6 mmHg and 103.3 ± 24.0 mmHg, respectively. The left hemisphere (53.3% was more often affected than the right hemisphere in these patients. Majority of the patients (48.3% were discharged following improvement while the case fatality was 11.7%.Conclusion: Stroke is not uncommon as a cause of medical admission in Kubwa General Hospital. Ischemic stroke occurred more commonly and the left hemisphere was more often involved compared with the right hemisphere. Hypertension was the most common risk factor for stroke in these patients.

Knowledge, attitude, and practice of stroke among high school students in Nepal.

Science.gov (United States)

Thapa, Lekhjung; Sharma, Nooma; Poudel, Ramesh Sharma; Bhandari, Tirtha Raj; Bhagat, Riwaz; Shrestha, Ashis; Shrestha, Shakti; Khatiwada, Dipendra; Caplan, Louis R

2016-01-01

Baseline stroke knowledge in a targeted population is indispensable to promote the effective stroke education. We report the baseline knowledge, attitude, and practice (KAP) of high school students with respect to stroke from Nepal. A self-structured questionnaire survey regarding KAP about stroke was conducted in high school students of 33 schools of Bharatpur, Nepal. Descriptive statistics including Chi-square test was used, and the significant variables were subjected to binary logistic regression. Among 1360 participants, 71.1% had heard or read about stroke; 30.2% knew someone with stroke. 39.3% identified brain as the organ affected. Sudden onset limb/s weakness/numbness (72%) and hypertension (74%) were common warning symptom and risk factor identified. 88.9% would take stroke patients to a hospital. Almost half participants (55.5%) felt ayurvedic treatment be effective. 44.8% felt stroke as a hindrance to a happy life and 86.3% believed that family care was helpful for early recovery. Students who identified at least one risk factor were 3.924 times ( P school Nepalese students regarding stroke was satisfactory, and the students having knowledge about the risk factors and warning symptoms were more likely to take stroke patients to a hospital. However, a few misconceptions persisted.

'The adventure': Charles-Ferdinand Ramuz's extraordinary stroke diary.

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Bogousslavsky, J

2010-01-01

The famous Swiss writer Charles-Ferdinand Ramuz suffered a stroke at 65 years, which he called 'the adventure' or 'the accident'. He developed language disturbances suggesting crossed aphasia in a right hander with left hemiparesis. This uncommon pattern allowed him to continue to write his diary and to report his disturbances, with a unique depth and precision, especially for cognitive-emotional changes. Language and motor dysfunction recovered within a few weeks, but Ramuz complained of persisting emotional flattening alternating with irritability, fatigue, depression, anxiety, and concentration difficulty, which gave him the feeling to have become another person and to be inhabited by a stranger, whom he compared with devils. Ramuz fought several months to resume his literary activity, having the impression to have lost inspiration and creativity. However, the novels he wrote less than 6 months after stroke show no stylistic changes and have been found to be of the same quality as his previous production. Ramuz even 'used' his stroke experience in his work, in particular in a novel depicting an old man who has a stroke and dies of it. Ramuz's diary, with his own daily description of stroke features and consequences during acute and recovery phases, is a unique document in a writer of his importance, and provides invaluable information on subjective emotional and cognitive experience of stroke. Copyright (c) 2010 S. Karger AG, Basel.

The value of serum mean platelet volume in ischaemic stroke patient

International Nuclear Information System (INIS)

Tamer, F.; Fevzi, Y.; Deniz, A.E.; Cemil, K.; Cihat, Y.; Muhittin, Y.; Serkan, Y.M.; Ali, C.M.; Faith, B.

2013-01-01

Objective: To investigate the value of serum Mean Platelet Volume in acute ischaemic stroke patients. Method: The retrospective case-control study was conducted at Ankara Numune Training and Research Hospital in Turkey and comprised record of patients of acute ischaemic stroke admitted to the Emergency Department between June 2010 and January 2012. The two groups were statistically compared using SPSS 18.0. Result: Overall, there were 482 stroke patients (Group 1) and 315 subjects as controls (Group 2). The median value in Group 1 was 9.0 (2.1) (fL), while in Group 2 it was 8.80 (2.4) (fL). The difference was statistically significant (Z=-2.80; p<0.05). Conclusion: Mean Platelet Volume increased in the stroke patients. (author)

Stroke Rehabilitation.

Science.gov (United States)

Belagaje, Samir R

2017-02-01

Rehabilitation is an important aspect of the continuum of care in stroke. With advances in the acute treatment of stroke, more patients will survive stroke with varying degrees of disability. Research in the past decade has expanded our understanding of the mechanisms underlying stroke recovery and has led to the development of new treatment modalities. This article reviews and summarizes the key concepts related to poststroke recovery. Good data now exist by which one can predict recovery, especially motor recovery, very soon after stroke onset. Recent trials have not demonstrated a clear benefit associated with very early initiation of rehabilitative therapy after stroke in terms of improvement in poststroke outcomes. However, growing evidence suggests that shorter and more frequent sessions of therapy can be safely started in the first 24 to 48 hours after a stroke. The optimal amount or dose of therapy for stroke remains undetermined, as more intensive treatments have not been associated with better outcomes compared to standard intensities of therapy. Poststroke depression adversely affects recovery across a variety of measures and is an important target for therapy. Additionally, the use of selective serotonin reuptake inhibitors (SSRIs) appears to benefit motor recovery through pleiotropic mechanisms beyond their antidepressant effect. Other pharmacologic approaches also appear to have a benefit in stroke rehabilitation. A comprehensive rehabilitation program is essential to optimize poststroke outcomes. Rehabilitation is a process that uses three major principles of recovery: adaptation, restitution, and neuroplasticity. Based on these principles, multiple different approaches, both pharmacologic and nonpharmacologic, exist to enhance rehabilitation. In addition to neurologists, a variety of health care professionals are involved in stroke rehabilitation. Successful rehabilitation involves understanding the natural history of stroke recovery and a

Prevalence of apraxia among patients with a first left hemisphere stroke in rehabilitation centres and nursing homes.

OpenAIRE

Donkervoort, M.; Dekker, J.; Ende, E. van den; Stehmann-Saris, J.C.; Deelman, B.G.

2000-01-01

OBJECTIVE: To investigate the prevalence of apraxia in patients with a first left hemisphere stroke. SUBJECTS: Left hemisphere stroke patients staying at an inpatient care unit of a rehabilitation centre or nursing home and receiving occupational therapy (n = 600). MEASURES: A short questionnaire on general patient characteristics and stroke-related aspects was completed by occupational therapists for every left hemisphere stroke patient they treated. A diagnosis of apraxia or nonapraxia was ...

Patent foramen ovale closure with GORE HELEX or CARDIOFORM Septal Occluder vs. antiplatelet therapy for reduction of recurrent stroke or new brain infarct in patients with prior cryptogenic stroke: Design of the randomized Gore REDUCE Clinical Study.

Science.gov (United States)

Kasner, Scott E; Thomassen, Lars; Søndergaard, Lars; Rhodes, John F; Larsen, Coby C; Jacobson, Joth

2017-12-01

Rationale The utility of patent foramen ovale (PFO) closure for secondary prevention in patients with prior cryptogenic stroke is uncertain despite multiple randomized trials completed to date. Aims The Gore REDUCE Clinical Study (REDUCE) aims to establish superiority of patent foramen ovale closure in conjunction with antiplatelet therapy over antiplatelet therapy alone in reducing the risk of recurrent clinical ischemic stroke or new silent brain infarct in patients who have had a cryptogenic stroke. Methods and design This controlled, open-label trial randomized 664 subjects with cryptogenic stroke at 63 multinational sites in a 2:1 ratio to either antiplatelet therapy plus patent foramen ovale closure (with GORE® HELEX® Septal Occluder or GORE® CARDIOFORM Septal Occluder) or antiplatelet therapy alone. Subjects will be prospectively followed for up to five years. Neuroimaging is required for all subjects at baseline and at two years or study exit. Study outcomes The two co-primary endpoints for the study are freedom from recurrent clinical ischemic stroke through at least 24 months post-randomization and incidence of new brain infarct (defined as clinical ischemic stroke or silent brain infarct) through 24 months. The primary analyses are an unadjusted log-rank test and a binomial test of subject-based proportions, respectively, both on the intent-to-treat population, with adjustment for testing multiplicity. Discussion The REDUCE trial aims to target a patient population with truly cryptogenic strokes. Medical therapy is limited to antiplatelet agents in both arms thereby reducing confounding. The trial should determine whether patent foramen ovale closure with the Gore septal occluders is safe and more effective than medical therapy alone for the prevention of recurrent clinical ischemic stroke or new silent brain infarct; the neuroimaging data will provide an opportunity to further support the proof of concept. The main results are anticipated in 2017

Risk Factors for Stroke-associated Pneumonia: A Prospective Cohort Study

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Alexis Suárez Quesada

2015-12-01

Full Text Available Background: stroke-associated pneumonia prolongs hospital stay and is an important risk factor for morbidity and mortality. Objective: to determine risk factors for stroke-associated pneumonia. Methods: a prospective single-cohort study was conducted involving 390 patients aged 16-93 years who met clinical and neuroimaging criteria for acute stroke treated at the Carlos Manuel de Céspedes Hospital from January 2012 through March 2015. Univariate comparison of qualitative variables was performed by using the Kaplan-Meier method. The Cox regression model was applied for multivariate analysis of risk factors for pneumonia. The area under the ROC curve was used to determine the discriminatory power of the model. Results: two hundred thirteen patients (54.6 % with ischemic stroke and 177 (45.4 % with hemorrhagic stroke were studied. Cases of nosocomial pneumonia after acute stroke accounted for 25.4 %. Subjects who developed pneumonia had lower scores on the Glasgow scale and higher scores on the modified Rankin scale. The following risk factors were identified using the Cox regression model: Glasgow coma score (Exp (B: 0.687; 95 % CI 0.630 to 0.750 and stroke subtype (Exp (B: 1.723; 95 % CI 1.137 to 2.610. The area under the ROC curve was 0.88. Conclusions: the risk factors for the development of nosocomial pneumonia after acute stroke found were the level of consciousness and suffering a hemorrhagic stroke. Other influencing variables are chronic obstructive pulmonary disease and heart disease as a comorbid condition.

Changes of resting cerebral activities in subacute ischemic stroke patients

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Ping Wu

2015-01-01

Full Text Available This study aimed to detect the difference in resting cerebral activities between ischemic stroke patients and healthy participants, define the abnormal site, and provide new evidence for pathological mechanisms, clinical diagnosis, prognosis prediction and efficacy evaluation of ischemic stroke. At present, the majority of functional magnetic resonance imaging studies focus on the motor dysfunction and the acute stage of ischemic stroke. This study recruited 15 right-handed ischemic stroke patients at subacute stage (15 days to 11.5 weeks and 15 age-matched healthy participants. A resting-state functional magnetic resonance imaging scan was performed on each subject to detect cerebral activity. Regional homogeneity analysis was used to investigate the difference in cerebral activities between ischemic stroke patients and healthy participants. The results showed that the ischemic stroke patients had lower regional homogeneity in anterior cingulate and left cerebrum and higher regional homogeneity in cerebellum, left precuneus and left frontal lobe, compared with healthy participants. The experimental findings demonstrate that the areas in which regional homogeneity was different between ischemic stroke patients and healthy participants are in the cerebellum, left precuneus, left triangle inferior frontal gyrus, left inferior temporal gyrus and anterior cingulate. These locations, related to the motor, sensory and emotion areas, are likely potential targets for the neural regeneration of subacute ischemic stroke patients.

Ethnic differences in ischemic stroke subtypes in young-onset stroke: the Stroke Prevention in Young Adults Study.

Science.gov (United States)

Trivedi, Megh M; Ryan, Kathleen A; Cole, John W

2015-10-29

Prior studies indicate that young African-Americans (AA) have a greater frequency of ischemic stroke than similarly aged European-Americans (EA). We hypothesized that differences in stroke subtype frequency mediated through sex and differing risk factor profiles may play a role in ethnicity-specific stroke. Utilizing our biracial young-onset stroke population, we explored these relationships. Fifty nine hospitals in the Baltimore-Washington area participated in a population-based study of young-onset stroke in men (218-AA, 291-EA) and women (219-AA, 222-EA) aged 16-49. Data on age, sex, ethnicity and stroke risk factors (hypertension (HTN) and smoking) were gathered through standardized interview. A pair of vascular neurologists adjudicated each case to determine TOAST subtype. Logistic regression analyses evaluating for differences in stroke risk factors by TOAST subtype were performed. Analyses controlling for age and sex demonstrated that AA were more likely to have a lacunar stroke than EA (OR = 1.61; 95% CI = 1.12-2.32; p = 0.011) when utilizing the other TOAST subtypes as the reference group. This effect was mediated by HTN, which increases the risk of lacunar stroke (OR = 2.03; 95% CI = 1.38-2.98; p = 0.0003) and large artery stroke (OR = 1.70; 95% CI = 1.01-2.88; p = 0.048) when controlling for sex, ethnicity, and age. Cases below age 40 were more likely to have a cardioembolic stroke than those above age 40 (OR = 1.62; 95% CI = 1.15-2.27; p = 0.006), controlling for sex and ethnicity. Lastly, current smokers were more likely to have a large artery stroke than non-smokers (OR = 1.79; 95% CI = 1.08-2.98; p = 0.024). Our population-based data demonstrate ethnic differences in ischemic stroke subtypes. These findings may help clarify mechanisms of stroke in young adults which may in part be driven by ethnic-specific differences in early-onset traditional risk factors, thereby indicating differing emphasis on workup and prevention.

Association Between the 20210G>A Prothrombin Gene Polymorphism and Arterial Ischemic Stroke in Children and Young Adults-Two Meta-analyses of 3586 Cases and 6440 Control Subjects in Total.

Science.gov (United States)

Sarecka-Hujar, Beata; Kopyta, Ilona; Skrzypek, Michal; Sordyl, Joanna

2017-04-01

Previous data have shown that the 20210G>A polymorphism of the Factor II gene is related to an increased prothrombin level, which may in turn lead to a procoagulant state. The heterogeneous and multifactorial character of arterial ischemic stroke often results in contradictory reports describing the association between the 20210G>A polymorphism and arterial ischemic stroke in different populations. We performed a meta-analysis of available data addressing the relation between the FII 20210G>A polymorphism and arterial ischemic stroke, both in young adults and children. We searched PubMed using appropriate keywords. The inclusion criteria for the study were as follows: case-control study, study population consisting of children, study population consisting of young adults, arterial ischemic stroke confirmed by magnetic resonance imaging or computed tomography, and English language. The exclusion criteria included lack of genotype or allele frequencies, study design other than a case-control study, outcome definition other than arterial ischemic stroke, and previously overlapped patient groups. Finally, 30 case-control studies (14 in children and 16 in young adults) were included. Statistical analyses were conducted using R software. Heterogeneity between the studies was evaluated using the Dersimonian and Laird's Q test. In the case of significant between-studies heterogeneity, the pooled odds ratio was estimated with a random-effects model, otherwise a fixed-effects model was used. The pooled analysis showed that carriers of 20210A allele (GA+AA genotypes) of the prothrombin gene are more common in arterial ischemic stroke patients, both in children and young adults, than in control subjects (P = 0.006; odds ratio, 1.83; 95% confidence interval, 1.19 to 2.80 and P = 0.001; odds ratio, 1.69; 95% confidence interval, 1.25 to 2.28, respectively). The results of the present meta-analysis have proven that the FII 20210G>A polymorphism is associated with arterial

Atorvastatin in stroke: a review of SPARCL and subgroup analysis

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Branko N Huisa

2010-03-01

Full Text Available Branko N Huisa, Andrew B Stemer, Justin A ZivinDepartment of Neuroscience University of California, San Diego, CA, USAAbstract: Statin therapy in patients with cardiovascular disease is associated with reduced incidence of stroke. The Stroke Prevention by Aggressive Reduction of Cholesterol Levels (SPARCL trial showed daily treatment with 80 mg of atorvastatin in patients with a recent stroke or transient ischemic attack (TIA reduced the incidence of fatal or nonfatal stroke by 16%. Several post hoc analyses of different subgroups followed the SPARCL study. They have not revealed any significant differences when patients were sorted by age, sex, presence of carotid disease or type of stroke, with the exception of intracranial hemorrhage as the entry event. Lower low-density lipoprotein cholesterol levels in addition to possible neuroprotective mechanisms due to atorvastatin treatment correlate with improved risk reduction. Although not predefined subgroups and subject to an insufficient power, these post hoc studies have generated new clinical questions. However, clinicians should avoid denying therapy based on such subgroup analysis. At this point, the best evidence powerfully demonstrates stroke and TIA patients should be prescribed high dose statin therapy for secondary stroke prevention.Keywords: statins, intracranial hemorrhage, neuroprotection, outcome, prevention, carotid stenosis, transient ischemic attack

Outcome Determinants of Stroke in a Brazilian Primary Stroke Center

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Gustavo W. Kuster

2014-01-01

Full Text Available Background. Stroke mortality in Brazil is one of the highest among Western countries. Nonetheless, stroke outcome determinants are still poorly known in this country. In this study we evaluate outcome determinants of stroke in a primary stroke center in São Paulo, Brazil. Methods. We evaluated demographic, clinical, and outcome data of patients with ischemic stroke (IS, transient ischemic attack (TIA, and intracerebral hemorrhage (ICH admitted at “Hospital Paulistano,” São Paulo, Brazil. In-hospital mortality and functional outcome determinants were assessed. Univariate and binary logistic regression analysis were performed. Results. Three hundred forty-one patients were included in the study, 52.2% being male with 66.8±15.7 years. The stroke type distribution was IS: 59.2%, TIA: 29.6%, and ICH: 11.1%. ICH was associated with greater severity and poorer functional outcome. The determinants of poorer functional outcome were higher NIHSS, lower Glasgow score, and lower oxygen saturation level. The most important mortality determinant was the presence of visual symptoms. Conclusions. The stroke mortality and stroke outcome determinants found in the present study do not remarkably differ from studies carried out in developed countries. Stroke prognosis studies are crucial to better understand the high burden of stroke in Brazil.

Early sitting, standing, and walking in conjunction with contemporary Bobath approach for stroke patients with severe motor deficit.

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Tang, Qingping; Tan, Lihong; Li, Baojun; Huang, Xiaosong; Ouyang, Chunhong; Zhan, Hailan; Pu, Qinqin; Wu, Lixiang

2014-01-01

The commonly used therapeutic approach, the contemporary Bobath approach (CBA), is not sufficient to restore independent locomotion for individuals with severe motor deficit (SMD) after stroke. Therefore, we propose that the early sitting, standing, and walking in conjunction with the CBA (ECBA) be used to treat individuals with SMD after stroke. To investigate whether ECBA may enhance mobility and balance in subjects with SMD after stroke. Thirty-three men and 15 women, aged 60 to 74 years, with SMD after stroke were recruited for the study. CBA or ECBA was performed with the subjects 5 times per week in 50-minute sessions for 8 weeks. The Stroke Rehabilitation Assessment of Movement (STREAM) and the Berg Balance Scale were implemented before treatment and at 4 and 8 weeks after treatment, respectively. The STREAM scores indicated that ECBA was more efficient than the CBA intervention for lower extremity mobility, F(1, 46) = 24.0, P < .001, and basic mobility, F(1, 46) = 102.6, P < .001. Overall STREAM scores were higher in the ECBA group, F(1, 46) =24.1, P < .001, after 8 weeks of therapy. Balance scores of the ECBA subjects were higher than those of the CBA subjects after 8 weeks of therapy, F(1, 46) = 73.1, P < .001. However, there was no difference in upper extremity mobility between the 2 groups. ECBA is a valuable intervention to improve lower extremity mobility, basic mobility, and balance ability for individuals with SMD after stroke.

Role of Acute Lesion Topography in Initial Ischemic Stroke Severity and Long-Term Functional Outcomes.

Science.gov (United States)

Wu, Ona; Cloonan, Lisa; Mocking, Steven J T; Bouts, Mark J R J; Copen, William A; Cougo-Pinto, Pedro T; Fitzpatrick, Kaitlin; Kanakis, Allison; Schaefer, Pamela W; Rosand, Jonathan; Furie, Karen L; Rost, Natalia S

2015-09-01

Acute infarct volume, often proposed as a biomarker for evaluating novel interventions for acute ischemic stroke, correlates only moderately with traditional clinical end points, such as the modified Rankin Scale. We hypothesized that the topography of acute stroke lesions on diffusion-weighted magnetic resonance imaging may provide further information with regard to presenting stroke severity and long-term functional outcomes. Data from a prospective stroke repository were limited to acute ischemic stroke subjects with magnetic resonance imaging completed within 48 hours from last known well, admission NIH Stroke Scale (NIHSS), and 3-to-6 months modified Rankin Scale scores. Using voxel-based lesion symptom mapping techniques, including age, sex, and diffusion-weighted magnetic resonance imaging lesion volume as covariates, statistical maps were calculated to determine the significance of lesion location for clinical outcome and admission stroke severity. Four hundred ninety subjects were analyzed. Acute stroke lesions in the left hemisphere were associated with more severe NIHSS at admission and poor modified Rankin Scale at 3 to 6 months. Specifically, injury to white matter (corona radiata, internal and external capsules, superior longitudinal fasciculus, and uncinate fasciculus), postcentral gyrus, putamen, and operculum were implicated in poor modified Rankin Scale. More severe NIHSS involved these regions, as well as the amygdala, caudate, pallidum, inferior frontal gyrus, insula, and precentral gyrus. Acute lesion topography provides important insights into anatomic correlates of admission stroke severity and poststroke outcomes. Future models that account for infarct location in addition to diffusion-weighted magnetic resonance imaging volume may improve stroke outcome prediction and identify patients likely to benefit from aggressive acute intervention and personalized rehabilitation strategies. © 2015 American Heart Association, Inc.

Atherosclerosis and Stroke

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... Stroke Association.org Professionals for Stroke Association.org Shop for Stroke Association.org Support for Stroke Association. ... endothelium significantly. The artery’s diameter shrinks and blood flow decreases, reducing oxygen supply. How atherosclerotic plaque causes ...

Normative NeuroFlexor data for detection of spasticity after stroke: a cross-sectional study

OpenAIRE

Pennati, Gaia Valentina; Plantin, Jeanette; Borg, J?rgen; Lindberg, P?vel G

2016-01-01

Background and Objective The NeuroFlexor is a novel instrument for quantification of neural, viscous and elastic components of passive movement resistance. The aim of this study was to provide normative data and cut-off values from healthy subjects and to use these to explore signs of spasticity at the wrist and fingers in patients recovering from stroke. Methods 107 healthy subjects (age range 28?68 years; 51?% females) and 39 stroke patients (age range 33?69 years; 33?% females), 2?4 weeks ...

Hemorrhagic and Ischemic Strokes Compared Stroke Severity, Mortality, and Risk Factors

DEFF Research Database (Denmark)

Andersen, Klaus Kaae; Olsen, T. S.; Dehlendorff, Christian

2009-01-01

were diabetes, atrial fibrillation, previous myocardial infarction, previous stroke, and intermittent arterial claudication. Smoking and alcohol consumption favored HS, whereas age, sex, and hypertension did not herald stroke type. Compared with ischemic strokes, HS was associated with an overall...... higher mortality risk (HR, 1.564; 95% CI, 1.441-1.696). The increased risk was, however, time-dependent; initially, risk was 4-fold, after 1 week it was 2.5-fold, and after 3 weeks it was 1.5-fold. After 3 months stroke type did not correlate to mortality. Conclusion-Strokes are generally more severe...... based on 25 123 individuals with a complete data set. Results-Of the patients 3993 (10.1%) had HS. Stroke severity was almost linearly related to the probability of having HS (2% in patients with the mildest stroke and 30% in those with the most severe strokes). Factors favoring ischemic strokes vs HS...

Serum Insulin-Like Growth Factor 1 and the Risk of Ischemic Stroke: The Framingham Study.

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Saber, Hamidreza; Himali, Jayandra J; Beiser, Alexa S; Shoamanesh, Ashkan; Pikula, Aleksandra; Roubenoff, Ronenn; Romero, Jose R; Kase, Carlos S; Vasan, Ramachandran S; Seshadri, Sudha

2017-07-01

Low insulin-like growth factor 1 (IGF-1) has been associated with increased risk of atherosclerosis and atrial fibrillation in cross-sectional studies. Yet, prospective data linking IGF-1 levels to the development of ischemic stroke remain inconclusive. We examined prospectively the association between serum IGF-1 levels and incident ischemic stroke. We measured serum IGF-1 levels in 757 elderly individuals (mean age 79±5, 62% women), free of prevalent stroke, from the Framingham original cohort participants at the 22nd examination cycle (1990-1994) and were followed up for the development of ischemic stroke. Cox models were used to relate IGF-1 levels to the risk for incident ischemic stroke, adjusted for potential confounders. During a mean follow-up of 10.2 years, 99 individuals developed ischemic stroke. After adjustment for age, sex, and potential confounders, higher IGF-1 levels were associated with a lower risk of incident ischemic stroke, with subjects in the lowest quintile of IGF-1 levels having a 2.3-fold higher risk of incident ischemic stroke (95% confidence interval, 1.09-5.06; P =0.03) as compared with those in the top quintile. We observed an effect modification by diabetes mellitus and waist-hip ratio for the association between IGF-1 and ischemic stroke ( P <0.1). In subgroup analyses, the effects were restricted to subjects with diabetics and those in top waist-hip ratio quartile, in whom each standard deviation increase in IGF-1 was associated with a 61% (hazard ratio, 0.39; 95% confidence interval, 0.20-0.78; P =0.007) and 41% (hazard ratio, 0.59; 95% confidence interval, 0.37-0.95; P =0.031) lower risk of incident ischemic stroke, respectively. IGF-1 levels were inversely associated with ischemic stroke, especially among persons with insulin resistance. © 2017 American Heart Association, Inc.

Stroke etiology and collaterals: atheroembolic strokes have greater collateral recruitment than cardioembolic strokes.

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Rebello, L C; Bouslama, M; Haussen, D C; Grossberg, J A; Dehkharghani, S; Anderson, A; Belagaje, S R; Bianchi, N A; Grigoryan, M; Frankel, M R; Nogueira, R G

2017-06-01

Chronic hypoperfusion from athero-stenotic lesions is thought to lead to better collateral recruitment compared to cardioembolic strokes. It was sought to compare collateral flow in stroke patients with atrial fibrillation (AF) versus stroke patients with cervical atherosclerotic steno-occlusive disease (CASOD). This was a retrospective review of a prospectively collected endovascular database. Patients with (i) anterior circulation large vessel occlusion stroke, (ii) pre-treatment computed tomography angiography (CTA) and (iii) intracranial embolism from AF or CASOD were included. CTA collateral patterns were evaluated and categorized into two groups: absent/poor collaterals (CTA collateral score 0-1) versus moderate/good collaterals (CTA collateral score 2-4). CT perfusion was also utilized for baseline core volume and evaluation of infarct growth. A total of 122 patients fitted the inclusion criteria, of whom 88 (72%) had AF and 34 (27%) CASOD. Patients with AF were older (P Collateral scores were lower in the AF group (P = 0.01) with patients having poor collaterals in 28% of cases versus 9% in the CASOD group (P = 0.03). Mortality rates (20% vs. 0%; P = 0.02) were higher in the AF patients whilst rates of any parenchymal hemorrhage (6% vs. 26%; P collaterals (odds ratio 4.70; 95% confidence interval 1.17-18.79; P = 0.03). Atheroembolic strokes seem to be associated with better collateral flow compared to cardioembolic strokes. This may in part explain the worse outcomes of AF-related stroke. © 2017 EAN.

Cumulative keyboard strokes: a possible risk factor for carpal tunnel syndrome

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Eleftheriou Andreas

2012-08-01

Full Text Available Abstract Background Contradictory reports have been published regarding the association of Carpal Tunnel Syndrome (CTS and the use of computer keyboard. Previous studies did not take into account the cumulative exposure to keyboard strokes among computer workers. The aim of the present study was to investigate the association between cumulative keyboard use (keyboard strokes and CTS. Methods Employees (461 from a Governmental data entry & processing unit agreed to participate (response rate: 84.1 % in a cross-sectional study. Α questionnaire was distributed to the participants to obtain information on socio-demographics and risk factors for CTS. The participants were examined for signs and symptoms related to CTS and were asked if they had previous history or surgery for CTS. The cumulative amount of the keyboard strokes per worker per year was calculated by the use of payroll’s registry. Two case definitions for CTS were used. The first included subjects with personal history/surgery for CTS while the second included subjects that belonged to the first case definition plus those participants were identified through clinical examination. Results Multivariate analysis used for both case definitions, indicated that those employees with high cumulative exposure to keyboard strokes were at increased risk of CTS (case definition A: OR = 2.23;95 % CI = 1.09-4.52 and case definition B: OR = 2.41; 95%CI = 1.36-4.25. A dose response pattern between cumulative exposure to keyboard strokes and CTS has been revealed (p  Conclusions The present study indicated a possible association between cumulative exposure to keyboard strokes and development of CTS. Cumulative exposure to key-board strokes would be taken into account as an exposure indicator regarding exposure assessment of computer workers. Further research is needed in order to test the results of the current study and assess causality between cumulative keyboard strokes and

Stroke treatment outcomes in hospitals with and without Stroke Units.

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Masjuan, J; Gállego Culleré, J; Ignacio García, E; Mira Solves, J J; Ollero Ortiz, A; Vidal de Francisco, D; López-Mesonero, L; Bestué, M; Albertí, O; Acebrón, F; Navarro Soler, I M

2017-10-23

Organisational capacity in terms of resources and care circuits to shorten response times in new stroke cases is key to obtaining positive outcomes. This study compares therapeutic approaches and treatment outcomes between traditional care centres (with stroke teams and no stroke unit) and centres with stroke units. We conducted a prospective, quasi-experimental study (without randomisation of the units analysed) to draw comparisons between 2 centres with stroke units and 4 centres providing traditional care through the neurology department, analysing a selection of agreed indicators for monitoring quality of stroke care. A total of 225 patients participated in the study. In addition, self-administered questionnaires were used to collect patients' evaluations of the service and healthcare received. Centres with stroke units showed shorter response times after symptom onset, both in the time taken to arrive at the centre and in the time elapsed from patient's arrival at the hospital to diagnostic imaging. Hospitals with stroke units had greater capacity to respond through the application of intravenous thrombolysis than centres delivering traditional neurological care. Centres with stroke units showed a better fit to the reference standards for stroke response time, as calculated in the Quick study, than centres providing traditional care through the neurology department. Copyright © 2017 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

Utility of electronic patient records in primary care for stroke secondary prevention trials

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Ashworth Mark

2011-02-01

Full Text Available Abstract Background This study aimed to inform the design of a pragmatic trial of stroke prevention in primary care by evaluating data recorded in electronic patient records (EPRs as potential outcome measures. The study also evaluated achievement of recommended standards of care; variation between family practices; and changes in risk factor values from before to after stroke. Methods Data from the UK General Practice Research Database (GPRD were analysed for 22,730 participants with an index first stroke between 2003 and 2006 from 414 family practices. For each subject, the EPR was evaluated for the 12 months before and after stroke. Measures relevant to stroke secondary prevention were analysed including blood pressure (BP, cholesterol, smoking, alcohol use, body mass index (BMI, atrial fibrillation, utilisation of antihypertensive, antiplatelet and cholesterol lowering drugs. Intraclass correlation coefficients (ICC were estimated by family practice. Random effects models were fitted to evaluate changes in risk factor values over time. Results In the 12 months following stroke, BP was recorded for 90%, cholesterol for 70% and body mass index (BMI for 47%. ICCs by family practice ranged from 0.02 for BP and BMI to 0.05 for LDL and HDL cholesterol. For subjects with records available both before and after stroke, the mean reductions from before to after stroke were: mean systolic BP, 6.02 mm Hg; diastolic BP, 2.78 mm Hg; total cholesterol, 0.60 mmol/l; BMI, 0.34 Kg/m2. There was an absolute reduction in smokers of 5% and heavy drinkers of 4%. The proportion of stroke patients within the recommended guidelines varied from less than a third (29% for systolic BP, just over half for BMI (54%, and over 90% (92% on alcohol consumption. Conclusions Electronic patient records have potential for evaluation of outcomes in pragmatic trials of stroke secondary prevention. Stroke prevention interventions in primary care remain suboptimal but important

Stroke knowledge in an Irish semi-rural community-dwelling cohort and impact of a brief education session.

LENUS (Irish Health Repository)

O'Callaghan, Geraldine

2012-11-01

Poor knowledge of stroke risk factors and failure to recognize and act on acute symptoms hinders efforts to prevent stroke and improve clinical outcomes. Levels of stroke knowledge are poorly established within Ireland. This study was conducted to establish levels of knowledge among men and women aged >40 years in an Irish community, and also to determine the impact of a single education session on stroke knowledge. Subjects from 2 separate geographical locations were allocated to an intervention group (n = 200), who received stroke information over a 90-minute session, or a control group (n = 200). Both groups completed a stroke knowledge questionnaire at baseline and at 4 weeks after the educational session. Overall, the initial response rate was 70% (280\\/400); 52% of the respondents knew that the brain is affected by stroke, 58% could list 2 or more risk factors but only 27% could list 2 or more warning signs, 50% would call 999 (emergency number in Ireland) in response to stroke, 17% had heard of thrombolytic therapy, but only 1% knew the time frame for receiving thrombolytics. The response rate to the resurvey following the educational session was 57%, with 47 of 117 subjects in the intervention group (40%) attending the session. Stroke knowledge scores improved by 50% in the intervention group (P < .001). Overall, the knowledge of stroke risk factors, warning signs, and thrombolytic therapy was poor in this Irish community-dwelling cohort. Our study demonstrates that a single educational session can improve short-term knowledge of stroke symptoms and thrombolytic therapy.

Stroke: advances in medical therapy and acute stroke intervention.

Science.gov (United States)

Barrett, Kevin M; Lal, Brajesh K; Meschia, James F

2015-10-01

Evidence-based therapeutic options for stroke continue to emerge based on results from well-designed clinical studies. Ischemic stroke far exceeds hemorrhagic stroke in terms of prevalence and incidence, both in the USA and worldwide. The public health effect of reducing death and disability related to ischemic stroke justifies the resources that have been invested in identifying safe and effective treatments. The emergence of novel oral anticoagulants for ischemic stroke prevention in atrial fibrillation has introduced complexity to clinical decision making for patients with this common cardiac arrhythmia. Some accepted ischemic stroke preventative strategies, such as carotid revascularization for asymptomatic carotid stenosis, require reassessment, given advances in risk factor management, antithrombotic therapy, and surgical techniques. Intra-arterial therapy, particularly with stent retrievers after intravenous tissue plasminogen activator, has recently been demonstrated to improve functional outcomes and will require investment in system-based care models to ensure that effective treatments are received by patients in a timely fashion. The purpose of this review is to describe recent advances in medical and surgical approaches to ischemic stroke prevention and acute treatment. Results from recently published clinical trials will be highlighted along with ongoing clinical trials addressing key questions in ischemic stroke management and prevention where equipoise remains.

Neural basis of acquired amusia and its recovery after stroke

OpenAIRE

Sihvonen, A.J.; Ripollés, P.; Leo, V.; Rodríguez-Fornells, Antoni; Soinila, S.; Särkämö, T.

2016-01-01

Although acquired amusia is a relatively common disorder after stroke, its precise neuroanatomical basis is still unknown. To evaluate which brain regions form the neural substrate for acquired amusia and its recovery, we performed a voxel-based lesion-symptom mapping (VLSM) and morphometry (VBM) study with 77 human stroke subjects. Structural MRIs were acquired at acute and 6 month poststroke stages. Amusia and aphasia were behaviorally assessed at acute and 3 month poststroke stages using t...

Discontinuation of antiplatelet treatment and risk of recurrent stroke and all-cause death

DEFF Research Database (Denmark)

Ostergaard, Kamilla; Pottegård, Anton; Hallas, Jesper

2014-01-01

use and followed them up for stroke recurrence, or all-cause death. Person-time was classified by antiplatelet drug use into current use, recent use (≤150 days after last use), and non-use (>150 days after last use). Lipid-lowering drug (LLD) use was classified by the same rules. We used Cox......BACKGROUND: We wished to examine the impact of antiplatelet drug discontinuation on recurrent stroke and all-cause mortality. METHODS: We identified a cohort of incident ischaemic stroke patients in a Danish stroke registry, 2007-2011. Using population-based registries we assessed subjects' drug...... proportional hazard models to calculate the adjusted hazard ratio (HR) and corresponding 95% confidence intervals (CIs) for the risk of recurrent stroke or death associated with discontinuation of antiplatelet or LLD drugs. RESULTS: Among 4,670 stroke patients followed up for up a median of 1.5 years, 237...

Patent Foramen Ovale: Is Stroke Due to Paradoxical Embolism?

Science.gov (United States)

Ranoux, D.; Cohen, A.; Cabanes, L.; Amarenco, P.; Bousser, M. G.; Mas, J. L.

1993-01-01

Background and Purpose: A patent foramen ovale has been reported to be significantly more frequent in young stroke patients than in matched control subjects, and paradoxical embolism has been suggested as the main mechanism of stroke in-this situation. The present study was designed to test this hypothesis. Methods: Sixty-eight consecutive patients under 55 years of age presenting with an ischemic stroke had an extensive workup, including transesophageal echocardiography with contrast. We compared the prevalence of criteria for the diagnosis of paradoxical embolism in patients with and without a patent foramen ovale. Results: A patent foramen ovale was found in 32 patients (47%). A Valsalva-provoking activity was present at stroke onset in six patients with a patent foramen ovale and in eight patients with no patent foramen ovale (X(sup 2)=0.1, nonsignificant). Clinical/radiological features suggestive of an embolic mechanism were not more frequent in patients with a patent foramen ovale. Clinical evidence of deep vein thrombosis was present in one patient with a patent foramen ovale and in none of the others. No occult venous thrombosis was found in a subgroup of patients with a patent foramen ovale and no definite cause for stroke who underwent venography (n=13). Conclusions. Our results do not support the hypothesis that paradoxical embolism is the primary mechanism of stroke in patients with a patent foramen ovale. (Stroke 1993;24:31-34) KEY WORDS e cerebral ischemia e embolism foramen ovale, patent

Stroking and tapping the skin: behavioral and electrodermal effects.

Science.gov (United States)

Etzi, Roberta; Carta, Carlotta; Gallace, Alberto

2018-02-01

Being caressed represents one of the most typical expressions of affection conveyed by touch. Converging evidence suggests that the pleasant perception of gentle and slow stroking delivered to the hairy skin is mediated by C-Tactile afferents (CTs). While behavioral and neural responses to CT-optimal touch have been moderately explored so far, less is known about the autonomic reaction to different kinds of touch (both CT-optimal and not). Here, we investigated whether physiological arousal varies as a function of the specific tactile stimulation provided. Stroking (slow: 3 cm/s 'CT-optimal'; or fast: 30 cm/s) and tapping (random or fixed spatial order) stimulations were delivered to the participants' forearm with a brush, for durations of 9 or 60 s. Participants' skin conductance response (SCR) and level (SCL), as well as subjective evaluations, were recorded. The results revealed that being stroked (at both the velocities) induced higher SCR and SCL than being tapped. Moreover, while higher SCR was elicited by CT-suboptimal stroking compared to CT-optimal stroking, SCL was not affected differently by CT-optimal touch. No differences were found between the effects of 9 and 60 s stimulations. Slow stroking was evaluated as the most pleasant, relaxing and 'social' type of touch compared to the other tactile stimulations. Taken together, these findings shed light on the psychophysiological responses to stroking (including CT-optimal touch) and tapping, and contribute to elucidate the mechanisms underlying hedonic tactile perception.

Relationship between the Berg Balance Scale and Static Balance Test in Hemiplegic Patients with Stroke

OpenAIRE

Suzuki, Makoto; Fujisawa, Hiroyuki; Machida, Yooichiro; Minakata, Shin

2013-01-01

[Purpose] The purpose of this study was to analyze the relationship between results of the Berg Balance Scale (BBS) and Static Balance Test (SBT) in hemiplegic patients with stroke. [Subjects] The subjects were 39 hemiplegic patients (25 men, 14 women; mean age, 69.4 ? 11.0?years) with stroke that had occurred within the preceding 6 months and who had good understanding of verbal instructions. [Methods] The SBT consists of five posture-holding tasks (sitting, stride standing, close standing, ...

The effect of modified trampoline training on balance, gait, and falls efficacy of stroke patients

OpenAIRE

Hahn, Joohee; Shin, Seonhae; Lee, Wanhee

2015-01-01

[Purpose] This research was conducted to investigate the effects of modified trampoline training on the balance, gait, and falls efficacy of stroke patients. [Subjects] Twenty-four stroke patients participated in this study. The subjects were randomly allocated to one of two groups: the trampoline group (n=12) or the control group (n=12). [Methods] Both groups participated in conventional physical therapy for thirty minutes per day, three times a week for six weeks. The trampoline group also ...

Levels of acute phase proteins remain stable after ischemic stroke

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Paik Myunghee C

2006-10-01

Full Text Available Abstract Background Inflammation and inflammatory biomarkers play an important role in atherosclerosis and cardiovascular disease. Little information is available, however, on time course of serum markers of inflammation after stroke. Methods First ischemic stroke patients ≥40 years old had levels of high-sensitivity C-reactive protein (hsCRP, serum amyloid A (SAA, and fibrinogen measured in plasma samples drawn at 1, 2, 3, 7, 14, 21 and 28 days after stroke. Levels were log-transformed as needed, and parametric and non-parametric statistical tests were used to test for evidence of a trend in levels over time. Levels of hsCRP and SAA were also compared with levels in a comparable population of stroke-free participants. Results Mean age of participants with repeated measures (n = 21 was 65.6 ± 11.6 years, and 13 (61.9% were men, and 15 (71.4% were Hispanic. Approximately 75% of patients (n = 15 had mild strokes (NIH Stroke Scale score 0–5. There was no evidence of a time trend in levels of hsCRP, SAA, or fibrinogen for any of the markers during the 28 days of follow-up. Mean log(hsCRP was 1.67 ± 1.07 mg/L (median hsCRP 6.48 mg/L among stroke participants and 1.00 ± 1.18 mg/L (median 2.82 mg/L in a group of 1176 randomly selected stroke-free participants from the same community (p = 0.0252. Conclusion Levels of hsCRP are higher in stroke patients than in stroke-free subjects. Levels of inflammatory biomarkers associated with atherosclerosis, including hsCRP, appear to be stable for at least 28 days after first ischemic stroke.

Effect of B-vitamin supplementation on stroke: a meta-analysis of randomized controlled trials.

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Chi Zhang

Full Text Available BACKGROUND: B vitamins have been extensively used to reduce homocysteine levels; however, it remains uncertain whether B vitamins are associated with a reduced risk of stroke. Our aim was to evaluate the effects of B vitamins on stroke. METHODOLOGY AND PRINCIPAL FINDINGS: We systematically searched PubMed, EmBase, and the Cochrane Central Register of Controlled Trials to identify studies for our analysis. Relative risk (RR was used to measure the effect of B-vitamin supplementation on the risk of stroke. The analysis was further stratified based on factors that could affect the treatment effects. Of the 13,124 identified articles, we included 18 trials reporting data on 57,143 individuals and 2,555 stroke events. B-vitamin supplementation was not associated with a significant reduction in the risk of stroke (RR, 0.91, 95%CI: 0.82-1.01, P = 0.075; RD, -0.003, 95%CI: -0.007-0.001, P = 0.134. Subgroup analyses suggested that B-vitamin supplementation might reduce the risk of stroke if included trials had a man/woman ratio of more than 2 or subjects received dose of folic acid less than 1 mg. Furthermore, in a cumulative meta-analysis for stroke, the originally proposed nonsignificant B-vitamin effect was refuted by the evidence accumulated up to 2006. There is a small effect with borderline statistical significance based on data gathered since 2007. CONCLUSIONS/SIGNIFICANCE: Our study indicates that B-vitamin supplementation is not associated with a lower risk of stroke based on relative and absolute measures of association. Subgroup analyses suggested that B-vitamin supplementation can effectively reduce the risk of stroke if included trials had a man/woman ratio of more than 2 or subjects received dose of folic acid less than 1 mg.

Cerebral and extracerebral vasoreactivity in symptomatic lacunar stroke patients: a case-control study.

Science.gov (United States)

Deplanque, Dominique; Lavallee, Philippa C; Labreuche, Julien; Gongora-Rivera, Fernando; Jaramillo, Arturo; Brenner, David; Abboud, Halim; Klein, Isabelle F; Touboul, Pierre-Jean; Vicaut, Eric; Amarenco, Pierre

2013-08-01

Whether cerebral artery endothelial dysfunction is a key factor of symptomatic lacunar stroke and cerebral small vessel disease remains unclear. Cerebral and extracerebral vasoreactivity were measured in 81 patients with recent symptomatic lacunar stroke and in 81 control subjects matched for main vascular risk factors. Cerebral vasoreactivity and carotid endothelial-dependent vasodilation were measured after five-minutes of carbon dioxide-induced hypercapnia. Brachial endothelial-dependent vasodilation was assessed after hyperemia induced by deflating a cuff around the forearm previously inflated to 200 mmHg for four-minutes. Carotid and brachial endothelial-independent vasodilation were measured five-minutes after administration of sublingual nitroglycerin 300 μg. Brain magnetic resonance imaging were analyzed in lacunar stroke patients. One-month after stroke onset, patients had more severely impaired cerebral vasoreactivitys than matched controls (mean ± standard deviation, 14·4 ± 12·1% vs. 19·4 ± 17·4%; P = 0·049). Severe alterations of both carotid and brachial endothelial-dependent and at a lesser degree of carotid and brachial endothelial-independent vasodilation were observed in both groups. After adjustment for confounders, subjects with a cerebral vasoreactivity value in the two lower tertiles (≤19·6%) were more likely to have had a symptomatic lacunar stroke (adjusted odds ratio, 3·78; 95% confidence interval, 1·42 to 10·08; P = 0·008). Only alteration of brachial endothelial-independent vasodilation correlated with parenchymal abnormalities, namely microbleeds and leukoaraiosis. While abnormalities in extracerebral vasoreactivity seem related to vascular risk factors, the severity of endothelial dysfunction in cerebral arteries may be determinant in the occurrence of symptomatic lacunar stroke in patients with small vessel disease. © 2012 The Authors. International Journal of Stroke © 2012 World Stroke

Acute stroke unit improves stroke management-four years on from INASC.

Science.gov (United States)

Shanahan, E; Keenan, R; Cunningham, N; O'Malley, G; O'Connor, M; Lyons, D; Peters, C

2015-02-01

The Irish Heart Foundation carried out the Irish National Audit of Stroke Care (INASC) in 2008. Management practices were significantly poorer than those in the UK Sentinel audits. Since then an acute stroke unit has been established in University Hospital Limerick. A stroke database was established. 12 key indicators of stroke management audited by INASC were identified. Results were compared to those in INASC. 89 stroke patients were admitted. 8 of the 12 key indicators scored significantly better than in INASC. 92.5% had a brain scan within 24hrs (INASC-40%, p = strokes received anti-thrombotics (INASC-85%, p = 0.001). 94% had rehab goals agreed by MDT (22% in INASC p = 0.0000). 55% were treated in stroke unit (2% in INASC, p = 0.0000). MDT input improved with regard to physiotherapy (87% vs 43% in INASC, p = Stroke management has significantly improved from 2008, however some deficiencies remain.

Standardization of Connor-Davidson Resilience Scale in Iranian subjects with Cerebrovascular Accident

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Seyed Alireza Derakhshanrad1

2014-12-01

Full Text Available Background: Resilience is a personal trait that can influence the stroke subjects’ attitudes toward future opportunities and facilitate the transitional process and adaptation in them. Assessment of this trait in stroke subjects with a standardized tool would promote the rehabilitation protocols and occupational therapy interventions. Therefore, the objective of this study was to standardize the Connor-Davidson Resilience Scale (CD-RISC for Persian Iranian people who have had strokes. Methods: A descriptive observational study was adopted in order to standardize the CD-RISC in stroke population. The population was comprised of 34 female and 29 male subjects with a mean age of 51.4±10.6 years and the history of ischemic or hemorrhagic cerebrovascular accidents. Subjects were recruited based on inclusion criteria within the period of two months between May and July of 2014. Descriptive statistics were calculated along with the Cronbach’s alpha to determine reliability. Standard multiple regression analyses searched for any correlation between variables and resilience. Results: Statistical parameters revealed a mean of 58.4±15.5 for CD-RISC raw scores. Percentile ranks were also calculated from raw data. Cronbach’s alpha of 0.892 revealed that the CD-RISC had high reliability for the population of this study. Multiple regression analyses showed that the functional status was the only variable that uniquely predicted subjects’ resilience (ß=0.41; P<0.01. Conclusion: The findings of this research confirmed applicability of CDRISC in Iranian people who have had strokes. The standardized CD-RISC was determined to be suitable for use in the clinic and for utilization in research studies in Iranian people status post-stroke.

Migraine as a risk factor for young patients with ischemic stroke: a case-control study.

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Abanoz, Yasin; Gülen Abanoz, Yeşim; Gündüz, Ayşegül; Uludüz, Derya; İnce, Birsen; Yavuz, Burcu; Göksan, Baki

2017-04-01

Studies have suggested a possible association of migraine and increased risk of ischemic stroke in young adults, particularly in smokers and in women who use oral contraceptive drugs. We aimed to analyze the association between migraine and ischemic stroke in young population in a hospital-based cohort. We included 202 consecutive patients with the diagnosis of ischemic stroke who were between 15 and 50 years and age- and gender-matched 250 volunteers with no history of stroke. All participants were interviewed using a questionnaire for migraine. Localization of ischemic lesion was classified as anterior and posterior circulation according to neuroimaging findings. The cause of ischemic lesion and all risk factors were recorded. Undetermined etiology was the most frequent (43.1%) and the most common determined cause was cardioembolism (22.3%) in young stroke patients. Frequency of migraine was 30.2% among patients with stroke whereas 16.8% of healthy subjects had migraine (p = 0.001). Migraine with aura was significantly more common among patients with stroke compared to healthy subjects (18.3 vs 4.4%; p = 0.000) whereas the frequency of migraine without aura was similar in both groups (11.9 vs 12.4%). Using logistic regression, migraine with aura was shown to be an independent risk factor for ischemic stroke in young population (p = 0.000) and separate analysis for gender demonstrated that it was only a risk factor for women (p = 0.009) but not for men (p = 0.107). Migraine with aura was found to be more common in ischemic stroke in young patients. It was an independent risk factor in women.

Serum Potassium Is Positively Associated With Stroke and Mortality in the Large, Population-Based Malmö Preventive Project Cohort

DEFF Research Database (Denmark)

Johnson, Linda S; Mattsson, Nick; Sajadieh, Ahmad

2017-01-01

analyses. There were 2061 incident stroke events and 8709 deaths. Cox regression analyses adjusted for multiple stroke risk factors (age, sex, height, weight, systolic blood pressure, fasting blood glucose, serum sodium, current smoking, prevalent diabetes mellitus, prevalent coronary artery disease.......0001). This was significant in subjects both older and younger than the median age (46.5 years), and there was evidence of an interaction with serum sodium. The association was positive and significant for both ischemic stroke and intracerebral hemorrhage and in both hypertensive and normotensive subjects. CONCLUSIONS: Serum...

Correlation between Nerve Growth Factor (NGF with Brain Derived Neurotropic Factor (BDNF in Ischemic Stroke Patient

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Joko Widodo

2016-05-01

Full Text Available Background: The neurotrophins nerve growth factor (NGF and brain-derived neurotrophic factor (BDNF is a family of polypeptides that play critical role during neuronal development, appear to mediate protective role on neurorepair in ischemic stroke. Naturally in adult brain neurorepair process consist of: angiogenesis, neurogenesis, and neuronal plasticity, it can also be stimulated by endogenous neurorepair. In this study we observed correlation between NGF and BDNF ischemic stroke patient’s onset: 7-30 and over 30 days. Methods: This is cross sectional study on 46 subjects aged 38 – 74 years old with ischemic stroke from The Indonesian Central Hospital of Army Gatot Subroto Jakarta. Diagnosis of ischemic stroke was made using clinical examination and magnetic resonance imaging (MRI by neurologist. Subjects were divided into 2 groups based on stroke onset: 7 – 30 days (Group A: 19 subjects and > 30 days (Group B: 27 Subjects. Serum NGF levels were measured with ELISA method and BDNF levels were measured using multiplex method with Luminex Magpix. Results: Levels of NGF and BDNF were significantly different between onset group A and B (NGF p= 0.022, and BDNF p=0.008, with mean levels NGF in group A higher than group B, indicating that BDNF levels is lower in group A than group B. There was no significant correlation between NGF and BDNF levels in all groups. Conclusion: The variations in neurotrophic factor levels reflect an endogenous attempt at neuroprotection against biochemical and molecular changes after ischemic stroke. NGF represents an early marker of brain injury while BDNF recovery is most prominent during the first 14 days after onsite but continuous for more than 30 days. There is no significant correlation between NGF and BDNF in each group.  

Measuring of vertical stroke Vub vertical stroke in the forthcoming decade

International Nuclear Information System (INIS)

Kim, C.S.

1997-01-01

I first introduce the importance of measuring V ub precisely. Then, from a theoretician's point of view, I review (a) past history, (b) present trials, and (c) possible future alternatives on measuring vertical stroke V ub vertical stroke and/or vertical stroke V ub /V cb vertical stroke. As of my main topic, I introduce a model-independent method, which predicts Γ(B→X u lν)/Γ(B→X c lν)≡(γ u /γ c ) x vertical stroke V ub /V cb vertical stroke 2 ≅(1.83±0.28) x vertical stroke V ub /V cb vertical stroke 2 and vertical stroke V ub /V cb vertical stroke ≡(γ c /γ u ) 1/2 x [B(B→X u lν)/B(B→ X c lν]) 1/2 ≅(0.74±0.06) x [B(B→X u lν/)B(B→X c lν)] 1/2 , based on the heavy quark effective theory I also explore the possible experimental options to separate B→X u lν from the dominant B→X c lν: the measurement of inclusive hadronic invariant mass distributions, and the 'D-π' (and 'K-π') separation conditions I also clarify the relevant experimental backgrounds. (orig.)

Stroke

Science.gov (United States)

... doctor Preventing falls Stroke - discharge Swallowing problems Images Brain Carotid stenosis, x-ray of the left artery Carotid stenosis, x-ray of the right artery Stroke Brainstem function Cerebellum - function Circle of Willis Left cerebral hemisphere - ...

Stroke prevention in atrial fibrillation: findings from Tuscan FADOI Stroke Registry

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Luca Masotti

2014-06-01

Full Text Available Despite vitamin K antagonists (VKAs are considered the first choice treatment for stroke prevention in atrial fibrillation (AF, literature shows their underuse in this context. Since data about VKAs use prior and after acute stroke lack, the aim of this study was to focus on management of anticoagulation with VKAs in this context. Data were retrieved from Tuscan FADOI Stroke Registry, an online data bank aimed to report on characteristics of stroke patients consecutively admitted in Internal Medicine wards in 2010 and 2011. In this period 819 patients with mean age 76.5±12.3 years were enrolled. Data on etiology were available for 715 of them (88.1%, 87% being ischemic and 13% hemorrhagic strokes. AF was present in 238 patients (33%, 165 (69.3% having a known AF before hospitalization, whereas 73 patients (31.7% received a new diagnosis of AF. A percentage of 89% of strokes in patients with known AF were ischemic and 11% hemorrhagic. A percentage of 86.7% of patients with known AF had a CHADS2 ≥2, but only 28.3% were on VKAs before hospitalization. A percentage of 78.8% of patients treated with VKAs before stroke had an international normalized ratio (INR ≤2.0; 68.7% of patients with VKAs-related hemorrhagic strokes had INR ≤3.0. Combined endpoint mortality or severe disability in patients with ischemic stroke associated with AF was present in 47%, while it was present in 19.30% and 19.20% of atherothrombotic and lacunar strokes, respectively. At hospital discharge, VKAs were prescribed in 25.9% of AF related ischemic stroke patients. AF related strokes are burdened by severe outcome but VKAs are dramatically underused in patients with AF, even in higher risk patients. Efforts to improve anticoagulation in this stroke subtype are warranted.

Ischemic Stroke in Young Adults: Profile of SARAH Hospital Brasília From 2008 to 2012.

Science.gov (United States)

Montanaro, Vinícius V A; Freitas, Denise D S; Ruiz, Miguel C M; Cavalcanti, Eduardo B U; Marinho, Patricia B C; Freitas, Maria C D N B; Oliveira, Eleonora M J D

2017-03-01

The societal and economic impact of ischemic stroke in young adults is considerable. The etiological investigation of ischemic stroke in this population is also challenging. To describe the characteristics of young patients with ischemic stroke admitted to a neurological rehabilitation program in Brazil. This transversal retrospective study analyzed data from the electronic health records of 134 patients aged 18 to 45 years with ischemic stroke admitted from 2008 to 2012. The average patient age at the time of ictus was 33 years; 56% of the subjects were female, and 29.3% had undetermined etiologies of stroke, on the basis of both TOAST and SSS TOAST criteria. Further, 48.7% of the subjects had a known vascular risk factor, which was arterial hypertension in most cases. The results of thrombophilia testing were positive in 13.7% of patients, but in only 3.7% of patients, thrombophilia was determined to be the causal mechanism of the stroke. There was a significant association between thrombophilia and patent foramen ovale, but no significant association was found between thrombophilia and arterial dissection. Among the patients with artery dissections, 46% had a history of trauma, which was statistically significant. Etiological diagnosis of stroke in the young is challenging for clinicians. Hence, a more effective classification scheme, better investigative mechanisms, and correct determination of causal associations in ischemic stroke are needed. Thrombophilia screening should be performed in the presence of relevant clinical signs and/or family history.

Acute stroke unit improves stroke management-four years on from INASC.

LENUS (Irish Health Repository)

Shanahan, E

2015-02-01

The Irish Heart Foundation carried out the Irish National Audit of Stroke Care (INASC) in 2008. Management practices were significantly poorer than those in the UK Sentinel audits. Since then an acute stroke unit has been established in University Hospital Limerick. A stroke database was established. 12 key indicators of stroke management audited by INASC were identified. Results were compared to those in INASC. 89 stroke patients were admitted. 8 of the 12 key indicators scored significantly better than in INASC. 92.5% had a brain scan within 24hrs (INASC-40%, p = < 0.001). 100% of ischaemic strokes received anti-thrombotics (INASC-85%, p = 0.001). 94% had rehab goals agreed by MDT (22% in INASC p = 0.0000). 55% were treated in stroke unit (2% in INASC, p = 0.0000). MDT input improved with regard to physiotherapy (87% vs 43% in INASC, p = < 0.02) and SALT (74% vs 26%, p = < 0.02). Stroke management has significantly improved from 2008, however some deficiencies remain.

Neurophysiologic Correlates of Post-Stroke Mood and Emotional Control

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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.

Does use of the recognition of stroke in the emergency room stroke assessment tool enhance stroke recognition by ambulance clinicians?

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Fothergill, Rachael T; Williams, Julia; Edwards, Melanie J; Russell, Ian T; Gompertz, Patrick

2013-11-01

U.K ambulance services assess patients with suspected stroke using the Face Arm Speech Test (FAST). The Recognition Of Stroke In the Emergency Room (ROSIER) tool has been shown superior to the FAST in identifying strokes in emergency departments but has not previously been tested in the ambulance setting. We investigated whether ROSIER use by ambulance clinicians can improve stroke recognition. Ambulance clinicians used the ROSIER in place of the FAST to assess patients with suspected stroke. As the ROSIER includes all FAST elements, we calculated a FAST score from the ROSIER to enable comparisons between the two tools. Ambulance clinicians' provisional stroke diagnoses using the ROSIER and calculated FAST were compared with stroke consultants' diagnosis. We used stepwise logistic regression to compare the contribution of individual ROSIER and FAST items and patient demographics to the prediction of consultants' diagnoses. Sixty-four percent of strokes and 78% of nonstrokes identified by ambulance clinicians using the ROSIER were subsequently confirmed by a stroke consultant. There was no difference in the proportion of strokes correctly detected by the ROSIER or FAST with both displaying excellent levels of sensitivity. The ROSIER detected marginally more nonstroke cases than the FAST, but both demonstrated poor specificity. Facial weakness, arm weakness, seizure activity, age, and sex predicted consultants' diagnosis of stroke. The ROSIER was not better than the FAST for prehospital recognition of stroke. A revised version of the FAST incorporating assessment of seizure activity may improve stroke identification and decision making by ambulance clinicians.

Patent foramen ovale is not associated with an increased risk of stroke recurrence.

Science.gov (United States)

Feurer, R; Sadikovic, S; Sepp, D; Esposito, L; Schleef, M; Bockelbrink, A; Schwarze, J; Hemmer, B; Sander, D; Poppert, H

2010-11-01

Despite numerous studies suggesting a relationship between paradoxical embolism from a patent foramen ovale (PFO) and stroke, the role of PFO as a risk factor for cerebral ischaemia remains controversial. We therefore sought to determine the association between a RLS detected by contrast-enhanced transcranial Doppler ultrasonography (c-TCD) and recurrent stroke in an unselected population sample. We analyzed the records of 763 patients with diagnosis of cerebral ischaemia at our institution. All patients had undergone TCD-based detection of RLS. Embolic signals have been measured both under resting conditions and after performing a Valsalva maneuver. For follow-up, all patients were contacted by mail, which included a standardized questionnaire. Endpoints of follow-up were defined as recurrence of cerebral ischaemia, occurrence of myocardial infarction or death from any cause. Follow-up data were available in 639 patients (83.7%). At baseline, a RLS was detected in 140 (28%) men and in 114 (42%) women. Ten shunt-carriers (1.6%) and 32 patients (5.0%) without RLS had suffered a recurrent stroke. After adjustment for age, sex, and atrial fibrillation, the hazard ratio of RLS for stroke recurrence was 0.86 (95% CI 0.41-1.79). The condition of RLS at rest adjusted for age, sex, stroke subtype, and cardiovascular risk factors was not found to increase the risk of stroke substantially (HR 1.16 [95% CI 0.41-3.29]) Our data suggest that the risk of recurrent stroke in subjects with PFO is not significantly increased in comparison with subject without it. © 2010 The Author(s). Journal compilation © 2010 EFNS.

The effect of an intensive exercise programme on leg function in chronic stroke patients: a pilot study with one-year follow-up.

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Stock, Roland; Mork, Paul Jarle

2009-09-01

To investigate the effect of two weeks of intensive exercise on leg function in chronic stroke patients and to evaluate the feasibility of an intensive exercise programme in a group setting. Pilot study with one-group pre-test post-test design with two pre-tests and one-year follow-up. Inpatient rehabilitation hospital. Twelve hemiparetic patients completed the intervention. Ten patients participated at one-year follow-up. Six hours of daily intensive exercise for two weeks with focus on weight-shifting towards the affected side and increased use of the affected extremity during functional activities. An insole with nubs in the shoe of the non-paretic limb was used to reinforce weight-shift toward the affected side. Timed Up and Go, Four Square Step Test, gait velocity, gait symmetry and muscle strength in knee and ankle muscles. Maximal gait velocity (P = 0.002) and performance time (seconds) on Timed Up and Go (mean, SD; 12.2, 3.8 vs. 9.4, 3.2) and Four Square Step Test improved from pre- to post-test (P = 0.005). Improvements remained significant at follow-up. Preferred gait velocity and gait symmetry remained unchanged. Knee extensor (Pstroke patients. Most improvements persisted at the one-year follow-up.

Increased Vascular Disease Mortality Risk in Prediabetic Korean Adults Is Mainly Attributable to Ischemic Stroke.

Science.gov (United States)

Kim, Nam Hoon; Kwon, Tae Yeon; Yu, Sungwook; Kim, Nan Hee; Choi, Kyung Mook; Baik, Sei Hyun; Park, Yousung; Kim, Sin Gon

2017-04-01

Prediabetes is a known risk factor for vascular diseases; however, its differential contribution to mortality risk from various vascular disease subtypes is not known. The subjects of the National Health Insurance Service in Korea (2002-2013) nationwide cohort were stratified into normal glucose tolerance (fasting glucose mortality risk for vascular disease and its subtypes-ischemic heart disease, ischemic stroke, and hemorrhagic stroke. When adjusted for age, sex, and body mass index, IFG stage 2, but not stage 1, was associated with significantly higher all-cause mortality (hazard ratio [HR], 1.26; 95% confidence interval [CI], 1.18-1.34) and vascular disease mortality (HR, 1.27; 95% CI, 1.08-1.49) compared with normal glucose tolerance. Among the vascular disease subtypes, mortality from ischemic stroke was significantly higher (HR, 1.60; 95% CI, 1.18-2.18) in subjects with IFG stage 2 but not from ischemic heart disease and hemorrhagic stroke. The ischemic stroke mortality associated with IFG stage 2 remained significantly high when adjusted other modifiable vascular disease risk factors (HR, 1.51; 95% CI: 1.10-2.09) and medical treatments (HR, 1.75; 95% CI, 1.19-2.57). Higher IFG degree (fasting glucose, 110-125 mg/dL) was associated with increased all-cause and vascular disease mortality. The increased vascular disease mortality in IFG stage 2 was attributable to ischemic stroke, but not ischemic heart disease or hemorrhagic stroke in Korean adults. © 2017 American Heart Association, Inc.

Stroke-induced immunodepression and dysphagia independently predict stroke-associated pneumonia - The PREDICT study.

Science.gov (United States)

Hoffmann, Sarah; Harms, Hendrik; Ulm, Lena; Nabavi, Darius G; Mackert, Bruno-Marcel; Schmehl, Ingo; Jungehulsing, Gerhard J; Montaner, Joan; Bustamante, Alejandro; Hermans, Marcella; Hamilton, Frank; Göhler, Jos; Malzahn, Uwe; Malsch, Carolin; Heuschmann, Peter U; Meisel, Christian; Meisel, Andreas

2017-12-01

Stroke-associated pneumonia is a frequent complication after stroke associated with poor outcome. Dysphagia is a known risk factor for stroke-associated pneumonia but accumulating evidence suggests that stroke induces an immunodepressive state increasing susceptibility for stroke-associated pneumonia. We aimed to confirm that stroke-induced immunodepression syndrome is associated with stroke-associated pneumonia independently from dysphagia by investigating the predictive properties of monocytic HLA-DR expression as a marker of immunodepression as well as biomarkers for inflammation (interleukin-6) and infection (lipopolysaccharide-binding protein). This was a prospective, multicenter study with 11 study sites in Germany and Spain, including 486 patients with acute ischemic stroke. Daily screening for stroke-associated pneumonia, dysphagia and biomarkers was performed. Frequency of stroke-associated pneumonia was 5.2%. Dysphagia and decreased monocytic HLA-DR were independent predictors for stroke-associated pneumonia in multivariable regression analysis. Proportion of pneumonia ranged between 0.9% in the higher monocytic HLA-DR quartile (≥21,876 mAb/cell) and 8.5% in the lower quartile (≤12,369 mAb/cell). In the presence of dysphagia, proportion of pneumonia increased to 5.9% and 18.8%, respectively. Patients without dysphagia and normal monocytic HLA-DR expression had no stroke-associated pneumonia risk. We demonstrate that dysphagia and stroke-induced immunodepression syndrome are independent risk factors for stroke-associated pneumonia. Screening for immunodepression and dysphagia might be useful for identifying patients at high risk for stroke-associated pneumonia.

The effects of a Korean computer-based cognitive rehabilitation program on cognitive function and visual perception ability of patients with acute stroke

OpenAIRE

Park, Jin-Hyuck; Park, Ji-Hyuk

2015-01-01

[Purpose] The purpose of this study is to investigate the effects of a Korean computer-based cognitive rehabilitation program (CBCR) on the cognitive function and visual perception ability of patients with acute stroke. [Subjects] The subjects were 30 patients with acute stroke. [Methods] The subjects were randomly assigned to either the experimental group (EG) or the control group (CG). The EG subjects received CBCR with the CoTras program. The CG subjects received conventional cognitive reh...

Posturography using the Wii Balance Board™: A feasibility study with healthy adults and adults post-stroke.

Science.gov (United States)

Llorens, Roberto; Latorre, Jorge; Noé, Enrique; Keshner, Emily A

2016-01-01

Posturography systems that incorporate force platforms are considered to assess balance and postural control with greater sensitivity and objectivity than conventional clinical tests. The Wii Balance Board (WBB) system has been shown to have similar performance characteristics as other force platforms, but with lower cost and size. To determine the validity and reliability of a freely available WBB-based posturography system that combined the WBB with several traditional balance assessments, and to assess the performance of a cohort of stroke individuals with respect to healthy individuals. Healthy subjects and individuals with stroke were recruited. Both groups were assessed using the WBB-based posturography system. Individuals with stroke were also assessed using a laboratory grade posturography system and a battery of clinical tests to determine the concurrent validity of the system. A group of subjects were assessed twice with the WBB-based system to determine its reliability. A total of 144 healthy individuals and 53 individuals with stroke participated in the study. Concurrent validity with another posturography system was moderate to high. Correlations with clinical scales were consistent with previous research. The reliability of the system was excellent in almost all measures. In addition, the system successfully characterized individuals with stroke with respect to the healthy population. The WBB-based posturography system exhibited excellent psychometric properties and sensitivity for identifying balance performance of individuals with stroke in comparison with healthy subjects, which supports feasibility of the system as a clinical tool. Copyright © 2015 Elsevier B.V. All rights reserved.

Polymorphisms of the lipoprotein lipase gene as genetic markers for stroke in colombian population: a case control study.

Science.gov (United States)

Velásquez Pereira, Leydi Carolina; Vargas Castellanos, Clara Inés; Silva Sieger, Federico Arturo

2016-12-30

To analyze if there is an association between the presence of polymorphisms in the LPL gene (rs320, rs285 and rs328) with development of acute ischemic stroke in Colombian population. In a case control design, 133 acute ischemic stroke patients (clinical diagnosis and x-ray CT) and 269 subjects without stroke as controls were studied. PCR -RFLP technique was used to detect rs320, rs285 and rs328 polymorphisms in the LPL gene. In the present research was not found any association between any of the LPL gene polymorphism and acute ischemic stroke in the population studied; the allele and genotypic frequencies of the studied polymorphisms were similar in cases and controls and followed the Hardy-Weinberg equilibrium. The study was approved by the IRB and each subject signed the informed consent. LPL gene polymorphisms are not genetic markers for the development of stroke in the Colombian sample used.

Pomegranate supplementation improves cognitive and functional recovery following ischemic stroke: A randomized trial.

Science.gov (United States)

Bellone, John A; Murray, Jeffrey R; Jorge, Paolo; Fogel, Travis G; Kim, Mary; Wallace, Desiree R; Hartman, Richard E

2018-02-13

We tested whether supplementing with pomegranate polyphenols can enhance cognitive/functional recovery after stroke. In this parallel, block-randomized clinical trial, we administered commercially-available pomegranate polyphenol or placebo pills twice per day for one week to adult inpatients in a comprehensive rehabilitation setting starting approximately 2 weeks after stroke. Pills contained 1 g of polyphenols derived from whole pomegranate, equivalent to levels in approximately 8 oz of juice. Placebo pills were similar to the pomegranate pills except that they contained only lactose. Of the 163 patients that were screened, 22 were eligible and 16 were randomized (8 per group). We excluded one subject per group from the neuropsychological analyses since they were lost to follow-up, but we included all subjects in the analysis of functional data since outcome data were available. Clinicians and subjects were blinded to group assignment. Neuropsychological testing (primary outcome: Repeatable Battery for the Assessment of Neuropsychological Status) and functional independence scores were used to determine changes in cognitive and functional ability. Pomegranate-treated subjects demonstrated more neuropsychological and functional improvement and spent less time in the hospital than placebo controls. Pomegranate polyphenols enhanced cognitive and functional recovery after stroke, justifying pursuing larger clinical trials.

Excessive Atrial Ectopy and Short Atrial Runs Increase the Risk of Stroke Beyond Incident Atrial Fibrillation

DEFF Research Database (Denmark)

Larsen, Bjørn Strøier; Kumarathurai, Preman; Falkenberg, Julie

2015-01-01

.3% had diagnosed AF before their stroke. The incidence of stroke in subjects with ESVEA and a CHA2DS2-VASc (congestive heart failure, hypertension, age 75 years or older, diabetes mellitus, previous stroke or transient ischemic attack, vascular disease, age 65 to 74 years, female) score of ≥2 was 2...

Genetics of Atrial Fibrillation and Possible Implications for Ischemic Stroke

Directory of Open Access Journals (Sweden)

Robin Lemmens

2011-01-01

Full Text Available Atrial fibrillation is the most common cardiac arrhythmia mainly caused by valvular, ischemic, hypertensive, and myopathic heart disease. Atrial fibrillation can occur in families suggesting a genetic background especially in younger subjects. Additionally recent studies have identified common genetic variants to be associated with atrial fibrillation in the general population. This cardiac arrhythmia has important public health implications because of its main complications: congestive heart failure and ischemic stroke. Since atrial fibrillation can result in ischemic stroke, one might assume that genetic determinants of this cardiac arrhythmia are also implicated in cerebrovascular disease. Ischemic stroke is a multifactorial, complex disease where multiple environmental and genetic factors interact. Whether genetic variants associated with a risk factor for ischemic stroke also increase the risk of a particular vascular endpoint still needs to be confirmed in many cases. Here we review the current knowledge on the genetic background of atrial fibrillation and the consequences for cerebrovascular disease.

Long-term functional outcome of pediatric stroke survivors.

Science.gov (United States)

Hurvitz, Edward; Warschausky, Seth; Berg, Michelle; Tsai, Shane

2004-01-01

To examine the long-term functional, psychosocial, and medical outcome of pediatric stroke survivors. This was a descriptive survey performed on patients with childhood stroke who participated in an earlier study. Measures included the Vineland Adaptive Behavior Scales (VABS) and the Diener Satisfaction with Life Scale. Current information on living situation, school placement, employment, and medical outcome were obtained. Twenty-nine (58%) patients participated. The mean age was 19.3 years (SD = 6.6), mean age of onset of stroke was 7.0 years (SD = 5.4), and mean follow-up time was 11.9 years (SD = 3.9). Diagnoses included hemorrhagic (31%) and ischemic (69%) stroke. All but one adult had finished high school, and the majority of participants had gone to college. 60% of patients over age 16 were employed. The average VABS levels for communication, daily living skills, socialization, and adaptive behavior fell into the moderately low range. Use of seizure medications and ADL dependence were the predictors for lower VABS levels (p life satisfaction. Patients who scored below adequate on VABS tended toward lower life satisfaction. Pediatric stroke survivors had good educational and mobility outcomes, but communication, ADL, and socialization fell into the low-moderate range. The different predictors of functional and subjective quality of life outcomes suggest that functional outcomes may mediate the relations between medical factors and satisfaction with life.

Blood markers of coagulation, fibrinolysis, endothelial dysfunction and inflammation in lacunar stroke versus non-lacunar stroke and non-stroke: systematic review and meta-analysis.

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Wiseman, Stewart; Marlborough, Fergal; Doubal, Fergus; Webb, David J; Wardlaw, Joanna

2014-01-01

The cause of cerebral small vessel disease is not fully understood, yet it is important, accounting for about 25% of all strokes. It also increases the risk of having another stroke and contributes to about 40% of dementias. Various processes have been implicated, including microatheroma, endothelial dysfunction and inflammation. A previous review investigated endothelial dysfunction in lacunar stroke versus mostly non-stroke controls while another looked at markers of inflammation and endothelial damage in ischaemic stroke in general. We have focused on blood markers between clinically evident lacunar stroke and other subtypes of ischaemic stroke, thereby controlling for stroke in general. We systematically assessed the literature for studies comparing blood markers of coagulation, fibrinolysis, endothelial dysfunction and inflammation in lacunar stroke versus non-stroke controls or other ischaemic stroke subtypes. We assessed the quality of included papers and meta-analysed results. We split the analysis on time of blood draw in relation to the stroke. We identified 1,468 full papers of which 42 were eligible for inclusion, including 4,816 ischaemic strokes, of which 2,196 were lacunar and 2,500 non-stroke controls. Most studies subtyped stroke using TOAST. The definition of lacunar stroke varied between studies. Markers of coagulation/fibrinolysis (tissue plasminogen activator (tPA), plasminogen activator inhibitor (PAI), fibrinogen, D-dimer) were higher in lacunar stroke versus non-stroke although fibrinogen was no different to non-stroke in the acute phase. tPA and PAI were no different between lacunar and non-lacunar stroke. Fibrinogen and D-dimer were significantly lower in lacunar stroke compared to other ischaemic strokes, both acutely and chronically. Markers of endothelial dysfunction (homocysteine, von Willebrand Factor (vWF), E-selectin, P-selectin, intercellular adhesion molecule-1 (ICAM), vascular cellular adhesion molecule-1 (VCAM)) were higher or

Diabetes, fasting glucose levels, and risk of ischemic stroke and vascular events: findings from the Northern Manhattan Study (NOMAS).

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Boden-Albala, Bernadette; Cammack, Sam; Chong, Ji; Wang, Culing; Wright, Clinton; Rundek, Tatjana; Elkind, Mitchell S V; Paik, Myunghee C; Sacco, Ralph L

2008-06-01

There is insufficient randomized trial data to support evidence-based recommendations for tight control of fasting blood glucose (FBG) among diabetic subjects in primary stroke prevention. We explored the relationship between FBG among diabetic subjects and risk of ischemic stroke in a multiethnic prospective cohort. Medical and social data and FBG values were collected for 3,298 stroke-free community residents: mean age +/- SD was 69 +/-10 years; 63% were women, 21% were white, 24% were black, and 53% were Hispanic; and follow-up was 6.5 years. Baseline FBG levels were categorized: 1) elevated FBG: history of diabetes and FBG >or=126 mg/dl (7.0 mmol/l); 2) target FBG: history of diabetes and FBG benefits of tighter glucose control for primary stroke prevention.

Accuracy and reliability of observational gait analysis data: judgments of push-off in gait after stroke.

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McGinley, Jennifer L; Goldie, Patricia A; Greenwood, Kenneth M; Olney, Sandra J

2003-02-01

Physical therapists routinely observe gait in clinical practice. The purpose of this study was to determine the accuracy and reliability of observational assessments of push-off in gait after stroke. Eighteen physical therapists and 11 subjects with hemiplegia following a stroke participated in the study. Measurements of ankle power generation were obtained from subjects following stroke using a gait analysis system. Concurrent videotaped gait performances were observed by the physical therapists on 2 occasions. Ankle power generation at push-off was scored as either normal or abnormal using two 11-point rating scales. These observational ratings were correlated with the measurements of peak ankle power generation. A high correlation was obtained between the observational ratings and the measurements of ankle power generation (mean Pearson r=.84). Interobserver reliability was moderately high (mean intraclass correlation coefficient [ICC (2,1)]=.76). Intraobserver reliability also was high, with a mean ICC (2,1) of.89 obtained. Physical therapists were able to make accurate and reliable judgments of push-off in videotaped gait of subjects following stroke using observational assessment. Further research is indicated to explore the accuracy and reliability of data obtained with observational gait analysis as it occurs in clinical practice.

Knowledge, attitude, and practice of stroke among high school students in Nepal

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Lekhjung Thapa

2016-01-01

Full Text Available Background: Baseline stroke knowledge in a targeted population is indispensable to promote the effective stroke education. We report the baseline knowledge, attitude, and practice (KAP of high school students with respect to stroke from Nepal. Materials and Methods: A self-structured questionnaire survey regarding KAP about stroke was conducted in high school students of 33 schools of Bharatpur, Nepal. Descriptive statistics including Chi-square test was used, and the significant variables were subjected to binary logistic regression. Results: Among 1360 participants, 71.1% had heard or read about stroke; 30.2% knew someone with stroke. 39.3% identified brain as the organ affected. Sudden onset limb/s weakness/numbness (72% and hypertension (74% were common warning symptom and risk factor identified. 88.9% would take stroke patients to a hospital. Almost half participants (55.5% felt ayurvedic treatment be effective. 44.8% felt stroke as a hindrance to a happy life and 86.3% believed that family care was helpful for early recovery. Students who identified at least one risk factor were 3.924 times (P < 0.001, confidence interval [CI] = 1.867–8.247 or those who identified at least one warning symptom were 2.833 times (P ≤ 0.023, CI = 1.156–6.944 more likely to take stroke patients to a hospital. Conclusion: KAP of high school Nepalese students regarding stroke was satisfactory, and the students having knowledge about the risk factors and warning symptoms were more likely to take stroke patients to a hospital. However, a few misconceptions persisted.

Effect of position feedback during task-oriented upper-limb training after stroke: Five-case pilot study

NARCIS (Netherlands)

Molier, B.I.; Prange, Grada Berendina; Krabben, T.; Stienen, Arno; van der Kooij, Herman; Buurke, Jaap; Jannink, M.J.A.; Hermens, Hermanus J.

2011-01-01

Feedback is an important element in motor learning during rehabilitation therapy following stroke. The objective of this pilot study was to better understand the effect of position feedback during task-oriented reach training of the upper limb in people with chronic stroke. Five subjects

Organizational issues in stroke treatment: The Swiss paradigm - Stroke units

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Georgios K Matis

2013-01-01

Full Text Available Stroke represents the leading cause of acquired disability in adults and poses a tremendous socioeconomic burden both on patients and the society. In this sense, prompt diagnosis and urgent treatment are needed in order to radically reduce the devastating consequences of this disease. Herein the authors present the new guidelines recently adopted by the Swiss Stroke Society concerning the establishment of stroke units. Standardized treatment and allocation protocols along with an acute rehabilitation concept seem to be the core of the Swiss stroke management system. Coordinated multidisciplinary care provided by specialized medical, nursing and therapy staff is of utmost importance for achieving a significant dependency and death reduction. It is believed that the implementation of these guidelines in the stroke care system would be beneficial not only for the stroke patients, but also for the health system.

Effect of Graded Unilateral Sanding Exercise on Metabolic and Cardiopulmonary Function in the Healthy and the Hemiparetic Elderly Subjects

OpenAIRE

Muraki, Toshiaki

1997-01-01

The purpose of this study was to investigate how 18 elderly subjects with cerebral vascular accident (CVA) (14 men and 4 women) and 19 healthy elderly subjects (6 men and 13 women) would respond to a five-step graded unilateral sanding activity. Three indicators of pulmonary function such as expiratory tidal volume, respiratory rate, and expiratory volume and four indicators of cardiometabolic function such as metabolic equivalents (METS), systolic blood pressure, heart rate, and pressure rat...

Prior antiplatelet drug use and short-term mortality in older patients with acute ischemic stroke (AIS).

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Zuliani, Giovanni; Galvani, Matteo; Bonetti, Francesco; Prandini, Stefano; Magon, Stefania; Gasperini, Beatrice; Ruggiero, Carmelinda; Cherubini, Antonio

2012-01-01

Some studies suggest that previous treatment with antiplatelet agents (AA) might reduce ischemic stroke severity and improve outcomes in terms of clinical deficits or mortality. We evaluated the effect of the prior chronic use of AA on short-term (30 days) mortality in a sample of consecutive patients with AIS. Four hundred thirty-nine older patients (>65 years) with "major" AIS (modified Rankin scale ≥ 3) consecutively admitted to the University ward of Internal Medicine or Geriatrics were enrolled. Stroke was classified according to Oxfordshire Community Stroke Project (OCSP). Data recorded included: (1) clinical features; (2) medical history including home therapies, and vascular risk factors; (3) routine clinical chemistry analyzes (verb)/analyses (noun). Short-term (30 days) mortality was 27.6%. One hundred fifteen subjects (26.2%) were taking AA before admission. Compared with subjects not treated, subjects taking AA were characterized by higher prevalence of recurrent stroke (35% vs. 22%). In this group, a trend toward a higher prevalence of congestive heart failure (CHF), smoking, and altered levels of consciousness (ALC) was noted. Stroke type and short-term mortality (33% vs. 26.2%; odds ratio=OR=1.25; 95% confidence interval=CI=0.75-2.10, age and gender adjusted) were not different between the two groups. Adjustment for glucose, CHF, previous stroke, smoking, and ALC did not change mortality risk (OR=0.83; 95%CI=0.40-1.72). We conclude that in older patients hospitalized for "major" AIS, prior use of AA was not associated with any benefit in terms of short-term mortality both in patients with first, as well as in those with recurrent ischemic stroke. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Impact of age on the importance of systolic and diastolic blood pressures for stroke risk

DEFF Research Database (Denmark)

Vishram, Julie K K; Borglykke, Anders Rething; Andreasen, Anne H

2012-01-01

, and Monograph (MORGAM) Project with baseline between 1982 and 1997, 68 551 subjects aged 19 to 78 years, without cardiovascular disease and not receiving antihypertensive treatment, were included. During a mean of 13.2 years of follow-up, stroke incidence was 2.8%. Stroke risk was analyzed using hazard ratios...

Urinary tract infection after acute stroke: Impact of indwelling urinary catheterization and assessment of catheter-use practices in French stroke centers.

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Net, P; Karnycheff, F; Vasse, M; Bourdain, F; Bonan, B; Lapergue, B

2018-03-01

Urinary catheterization and acute urinary retention increase the risk of urinary tract infection (UTI). Our study aimed to investigate the incidence of UTI following acute stroke at our stroke center (SC) and to assess urinary catheter-care practices among French SCs. Stroke patients hospitalized within 24h of stroke onset were prospectively enrolled between May and September 2013. Neurological deficit level was assessed on admission using the US National Institutes of Health Stroke Scale (NIHSS). Patients were followed-up until discharge. Indwelling urinary catheterization (IUC) was the only technique authorized during the study. An electronic survey was also conducted among French SCs to assess their practices regarding urinary catheterization in acute stroke patients. A total of 212 patients were included, with 45 (21.2%) receiving indwelling urinary catheters. The overall estimated incidence of UTI was 14.2%, and 18% among patients receiving IUC. On univariate analysis, IUC was significantly associated with older age, longer hospital stays and higher NIHSS scores. Of the 30 SCs that responded to our survey, 19 (63.3%) declared using IUC when urinary catheterization was needed. The main argument given to justify its use was that it was departmental policy to adopt this technique. Also, 27 participants (90%) stated that conducting a study to assess the impact of urinary catheterization techniques on UTI rates in acute stroke patients would be relevant. Our results are in accord with previously reported data and confirm the high burden of UTI among acute stroke subjects. However, no association was found between IUC and UTI on univariate analysis due to a lack of statistical power. Also, our survey showed high heterogeneity in catheter-use practices among French SCs, but offered no data to help determine the best urinary catheterization technique. Urinary catheterization is common after acute stroke and a well-known risk factor of UTI. However, as high

Patent foramen ovale closure with GORE HELEX or CARDIOFORM Septal Occluder vs. antiplatelet therapy for reduction of recurrent stroke or new brain infarct in patients with prior cryptogenic stroke

DEFF Research Database (Denmark)

Kasner, Scott E; Thomassen, Lars; Søndergaard, Lars

2017-01-01

Rationale The utility of patent foramen ovale (PFO) closure for secondary prevention in patients with prior cryptogenic stroke is uncertain despite multiple randomized trials completed to date. Aims The Gore REDUCE Clinical Study (REDUCE) aims to establish superiority of patent foramen ovale...... with truly cryptogenic strokes. Medical therapy is limited to antiplatelet agents in both arms thereby reducing confounding. The trial should determine whether patent foramen ovale closure with the Gore septal occluders is safe and more effective than medical therapy alone for the prevention of recurrent...... closure in conjunction with antiplatelet therapy over antiplatelet therapy alone in reducing the risk of recurrent clinical ischemic stroke or new silent brain infarct in patients who have had a cryptogenic stroke. Methods and design This controlled, open-label trial randomized 664 subjects...

A measure of early physical functioning (EPF) post-stroke.

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Finch, Lois E; Higgins, Johanne; Wood-Dauphinee, Sharon; Mayo, Nancy E

2008-07-01

To develop a comprehensive measure of Early Physical Functioning (EPF) post-stroke quantified through Rasch analysis and conceptualized using the International Classification of Functioning Disability and Health (ICF). An observational cohort study. A cohort of 262 subjects (mean age 71.6 (standard deviation 12.5) years) hospitalized post-acute stroke. Functional assessments were made within 3 days of stroke with items from valid and reliable indices commonly utilized to evaluate stroke survivors. Information on important variables was also collected. Principal component and Rasch analysis confirmed the factor structure, and dimensionality of the measure. Rasch analysis combined items across ICF components to develop the measure. Items were deleted iteratively, those retained fit the model and were related to the construct; reliability and validity were assessed. A 38-item unidimensional measure of the EPF met all Rasch model requirements. The item difficulty matched the person ability (mean person measure: -0.31; standard error 0.37 logits), reliability of the person-item-hierarchy was excellent at 0.97. Initial validity was adequate. The 38-item EPF measure was developed. It expands the range of assessment post acute stroke; it covers a broad spectrum of difficulty with good initial psychometric properties that, once revalidated, can assist in planning and evaluating early interventions.

Stroke survivors' endorsement of a "stress belief model" of stroke prevention predicts control of risk factors for recurrent stroke.

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Phillips, L Alison; Tuhrim, Stanley; Kronish, Ian M; Horowitz, Carol R

2014-01-01

Perceptions that stress causes and stress-reduction controls hypertension have been associated with poorer blood pressure (BP) control in hypertension populations. The current study investigated these "stress-model perceptions" in stroke survivors regarding prevention of recurrent stroke and the influence of these perceptions on patients' stroke risk factor control. Stroke and transient ischemic attack survivors (N=600) participated in an in-person interview in which they were asked about their beliefs regarding control of future stroke; BP and cholesterol were measured directly after the interview. Counter to expectations, patients who endorsed a "stress-model" but not a "medication-model" of stroke prevention were in better control of their stroke risk factors (BP and cholesterol) than those who endorsed a medication-model but not a stress-model of stroke prevention (OR for poor control=.54, Wald statistic=6.07, p=.01). This result was not explained by between group differences in patients' reported medication adherence. The results have implications for theory and practice, regarding the role of stress belief models and acute cardiac events, compared to chronic hypertension.

Effects of a sexual rehabilitation intervention program on stroke patients and their spouses.

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Song, HoSook; Oh, HyunSoo; Kim, HwaSoon; Seo, WhaSook

2011-01-01

The present study was conducted to examine whether a sexual rehabilitation intervention program, which was developed during the present study and designed for stroke patients and their spouses, was effective in terms of sexual knowledge and satisfaction and frequency of sexual activity at 1 month after intervention. The study subjects were conveniently selected from stroke patients admitted to the neurology department at a university hospital located in Incheon, South Korea. A total of 46 subjects (12 couples for the experimental group and 11 couples for the control group) were included. Sexual knowledge, sexual satisfaction, frequency of sexual activity, level of cognitive function, and performance with respect to daily living activities were measured. The results obtained demonstrated that the devised sexual rehabilitation intervention program significantly increased sexual satisfaction and frequency of sexual activity, but that it did not promote sexual knowledge. The present study has meaning because the intervention program could be used as a practical guideline for post-stroke sexual rehabilitation. In addition, the findings of this study provide evidence regarding the usefulness of sexual education and counseling on the sexual health of post-stroke patients and their spouses.

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

The Characterization of Deqi during Moxibustion in Stroke Rats

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Zhimai Lv

2013-01-01

Full Text Available The efficacy of acupuncture and moxibustion is closely related to Deqi phenomenons, which are some subjective feelings. However, no one has reported the objective characterization of Deqi. Our preliminary research has found a phenomenon of tail temperature increasing (TTI obviously in some stroke rats by suspended moxibustion at the acupoint dà zhuī (DU 14, which is similar to one characterization of Deqi during moxibustion that moxibustion heat is transferred from the original moxibustion acupoint to the other areas of the body. We wonder whether TTI is the objective indicator of Deqi characterization in animals. The present study showed that the stroke rat’s recovery was also associated with TTI phenomenon. This suggests that TTI phenomenon is one objective characterization of the Deqi in stroke rats. Application of the TTI phenomenon contributes to explore the physiological mechanism of Deqi.

Effect of sibutramine on cardiovascular outcomes in overweight and obese subjects.

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James, W Philip T; Caterson, Ian D; Coutinho, Walmir; Finer, Nick; Van Gaal, Luc F; Maggioni, Aldo P; Torp-Pedersen, Christian; Sharma, Arya M; Shepherd, Gillian M; Rode, Richard A; Renz, Cheryl L

2010-09-02

The long-term effects of sibutramine treatment on the rates of cardiovascular events and cardiovascular death among subjects at high cardiovascular risk have not been established. We enrolled in our study 10,744 overweight or obese subjects, 55 years of age or older, with preexisting cardiovascular disease, type 2 diabetes mellitus, or both to assess the cardiovascular consequences of weight management with and without sibutramine in subjects at high risk for cardiovascular events. All the subjects received sibutramine in addition to participating in a weight-management program during a 6-week, single-blind, lead-in period, after which 9804 subjects underwent random assignment in a double-blind fashion to sibutramine (4906 subjects) or placebo (4898 subjects). The primary end point was the time from randomization to the first occurrence of a primary outcome event (nonfatal myocardial infarction, nonfatal stroke, resuscitation after cardiac arrest, or cardiovascular death). The mean duration of treatment was 3.4 years. The mean weight loss during the lead-in period was 2.6 kg; after randomization, the subjects in the sibutramine group achieved and maintained further weight reduction (mean, 1.7 kg). The mean blood pressure decreased in both groups, with greater reductions in the placebo group than in the sibutramine group (mean difference, 1.2/1.4 mm Hg). The risk of a primary outcome event was 11.4% in the sibutramine group as compared with 10.0% in the placebo group (hazard ratio, 1.16; 95% confidence interval [CI], 1.03 to 1.31; P=0.02). The rates of nonfatal myocardial infarction and nonfatal stroke were 4.1% and 2.6% in the sibutramine group and 3.2% and 1.9% in the placebo group, respectively (hazard ratio for nonfatal myocardial infarction, 1.28; 95% CI, 1.04 to 1.57; P=0.02; hazard ratio for nonfatal stroke, 1.36; 95% CI, 1.04 to 1.77; P=0.03). The rates of cardiovascular death and death from any cause were not increased. Subjects with preexisting

Female caregivers and stroke severity determines caregiver stress in stroke patients

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Bindu Menon

2017-01-01

Full Text Available Background: Stroke is among the major causes of short- and long-term disability. This study aimed to understand the caregivers (CGs stress in stroke survivors. Materials and Methods: A 22-item questionnaire was administered to 201 CGs of stroke survivors. The variables tested were physical and mental health, social support, financial, and personal problems. CGs were divided into Group A (Barthel index [BI] 75 according to patient's BI, according to gender (male and female CG and relation; spouses (wife, husband, daughters, sons, daughter-in-law, grandchildren, and rest (father, mother, brother, sister, and in-laws. Data were analyzed using SPSS software version–21. Data were analyzed to determine which variables of the patient effects the CG stress. Results: Majority of the CGs (74.62% were females. 65% of CGs graded their burden as moderate to severe. 81% of CGs had left their work for caregiving. More than half of the CGs felt sleep disturbance and physical strain. Psychological instability and financial burdens were reported in 3/4th of CGs. Group A CGs faced more sleep, financial, health, and social life disturbance. Patient's bladder and bowel problems, shoulder pain, patients noncooperative attitude for medication administration, and physiotherapy were more upsetting for Group A CGs. Female CGs were subjected to more sleep disturbance, physical and psychological stress, faced more difficulty regarding the patient's bladder, bowel, personal hygiene needs, and physiotherapy. Female CGs felt less motivated in caregiving than male CGs. Wives and daughters-in-law experienced more burden. Time spent and burden perceived was more by female CGs (χ2 = 15.199, P = 0.002 than males (χ2 = 11.931, P = 0.018; wives and daughters than other relations (χ2 = 32.184, P = 0.000, (χ2 = 35.162, P = 0.019. Conclusion: Our study showed that caregiving burden was predominantly shouldered by females CGs. CGs faced physical, psychological, and socioeconomic

A thematic framework of illness narratives produced by stroke patients.

Science.gov (United States)

Pluta, A; Ulatowska, H; Gawron, N; Sobanska, M; Lojek, E

2015-01-01

The present study aims at elucidating the impact of stroke on psychosocial functioning of stroke survivors. Data were investigated using interpretative thematic analysis of illness stories produced by 29 patients. Eight themes emerged from the data: Medical Information; Interpersonal Changes; Cognitive, Physical and Emotional Functioning; Strategies of Coping; Social Support; and Information Irrelevant to the Question. The most frequent organization of the themes followed the course of medical intervention and rehabilitation. Narrations of individual patients varied in terms of the presence of particular themes, the amount of information on each topic and organization. The results suggest that the analysis of non-guided illness narratives can be effectively used to identify the thematic areas important to individual stroke patients. The thematic content analysis of stroke stories can allow health professionals to better understand the patient's state of knowledge related to illness as well as his or her socio-psychological functioning which may be useful in the course of planning further assessment and rehabilitation of patients with stroke. Implications for Rehabilitation Experience of illness and life changes following stroke should be recognized as central to the provision of targeted rehabilitation. To understand the subjective perspective a content analysis of the content narrative is recommended. Our study highlights seven general thematic categories that may be regarded as key. The categories may be useful for clinicians to help individuals to clarify their main concerns following a stroke.

The prevalence and magnitude of impaired cutaneous sensation across the hand in the chronic period post-stroke.

Science.gov (United States)

Bowden, Jocelyn L; Lin, Gaven G; McNulty, Penelope A

2014-01-01

Sensation is commonly impaired immediately post-stroke but little is known about the long-term changes in cutaneous sensation that have the capacity to adversely impact independence and motor-function. We investigated cutaneous sensory thresholds across the hand in the chronic post-stroke period. Cutaneous sensation was assessed in 42 community-dwelling stroke patients and compared to 36 healthy subjects. Sensation was tested with calibrated monofilaments at 6 sites on the hand that covered the median, ulnar and radial innervation territories and included both glabrous (hairless) and hairy skin. The motor-function of stroke patients was assessed with the Wolf Motor Function Test and the upper-limb motor Fugl-Meyer Assessment. Impaired cutaneous sensation was defined as monofilament thresholds >3 SD above the mean of healthy subjects and good sensation was ≤ 3 SD. Cutaneous sensation was impaired for 33% of patients and was 40-84% worse on the more-affected side compared to healthy subjects depending on the site (psensation fell within the healthy range, although ∼ 1/3 of patients were classified with impaired sensation. Classification by motor-function revealed low levels of impaired sensation. The magnitude of sensory loss was only apparent when the sensory-function of stroke patients was classified as good or impaired. Sensation was most impaired on the dorsum of the hand where age-related changes in monofilament thresholds are minimal in healthy subjects. Although patients with both high and low motor-function had poor cutaneous sensation, overall patients with low motor-function had poorer cutaneous sensation than those with higher motor-function, and relationships were found between motor impairments and sensation at the fingertip and palm. These results emphasize the importance of identifying the presence and magnitude of cutaneous sensory impairments in the chronic period after stroke.

Associations between serum uric acid levels and the incidence of nonfatal stroke: a nationwide community-based cohort study.

Science.gov (United States)

Kamei, Keita; Konta, Tsuneo; Hirayama, Atsushi; Ichikawa, Kazunobu; Kubota, Isao; Fujimoto, Shouichi; Iseki, Kunitoshi; Moriyama, Toshiki; Yamagata, Kunihiro; Tsuruya, Kazuhiko; Narita, Ichiei; Kondo, Masahide; Shibagaki, Yugo; Kasahara, Masato; Asahi, Koichi; Watanabe, Tsuyoshi

2017-06-01

Hyperuricemia is an established risk factor for cardiovascular events and mortality. This study investigated the association between serum uric acid and the incidence of nonfatal stroke in a Japanese community-based population. We used a nationwide database of 155,322 subjects (aged 40-73, male 39 %) who participated in the annual "Specific Health Check and Guidance in Japan" checkup from 2008 to 2010. We examined the relationship between the quintiles of serum uric acid levels at baseline and the incidence of nonfatal stroke during a 2-year study period using self-reported data. The crude incidence of nonfatal stroke was significantly associated with serum uric acid levels at baseline, showing the lowest values in subjects with the 3rd quintile (Q3: men, 5.0-5.6; women, 3.8-4.3) of uric acid levels (mg/dL) and the highest values in subjects with the highest quintile (Q5: men ≥7.1, women ≥5.5) both in men and women (P uric acid levels for incident stroke was high, irrespective of characteristics such as age, sex, and renal function. This study has shown that serum uric acid is independently associated with the incidence of nonfatal stroke in the general Japanese population.

Fast Recognition of BCI-Inefficient Users Using Physiological Features from EEG Signals: A Screening Study of Stroke Patients.

Science.gov (United States)

Shu, Xiaokang; Chen, Shugeng; Yao, Lin; Sheng, Xinjun; Zhang, Dingguo; Jiang, Ning; Jia, Jie; Zhu, Xiangyang

2018-01-01

Motor imagery (MI) based brain-computer interface (BCI) has been developed as an alternative therapy for stroke rehabilitation. However, experimental evidence demonstrates that a significant portion (10-50%) of subjects are BCI-inefficient users (accuracy less than 70%). Thus, predicting BCI performance prior to clinical BCI usage would facilitate the selection of suitable end-users and improve the efficiency of stroke rehabilitation. In the current study, we proposed two physiological variables, i.e., laterality index (LI) and cortical activation strength (CAS), to predict MI-BCI performance. Twenty-four stroke patients and 10 healthy subjects were recruited for this study. Each subject was required to perform two blocks of left- and right-hand MI tasks. Linear regression analyses were performed between the BCI accuracies and two physiological predictors. Here, the predictors were calculated from the electroencephalography (EEG) signals during paretic hand MI tasks (5 trials; approximately 1 min). LI values exhibited a statistically significant correlation with two-class BCI (left vs. right) performance (r = -0.732, p discrimination of BCI-inefficient users. These results demonstrated that the proposed BCI predictors were promising to promote the BCI usage in stroke rehabilitation and contribute to a better understanding of the BCI-inefficiency phenomenon in stroke patients.

Fast Recognition of BCI-Inefficient Users Using Physiological Features from EEG Signals: A Screening Study of Stroke Patients

Science.gov (United States)

Shu, Xiaokang; Chen, Shugeng; Yao, Lin; Sheng, Xinjun; Zhang, Dingguo; Jiang, Ning; Jia, Jie; Zhu, Xiangyang

2018-01-01

Motor imagery (MI) based brain-computer interface (BCI) has been developed as an alternative therapy for stroke rehabilitation. However, experimental evidence demonstrates that a significant portion (10–50%) of subjects are BCI-inefficient users (accuracy less than 70%). Thus, predicting BCI performance prior to clinical BCI usage would facilitate the selection of suitable end-users and improve the efficiency of stroke rehabilitation. In the current study, we proposed two physiological variables, i.e., laterality index (LI) and cortical activation strength (CAS), to predict MI-BCI performance. Twenty-four stroke patients and 10 healthy subjects were recruited for this study. Each subject was required to perform two blocks of left- and right-hand MI tasks. Linear regression analyses were performed between the BCI accuracies and two physiological predictors. Here, the predictors were calculated from the electroencephalography (EEG) signals during paretic hand MI tasks (5 trials; approximately 1 min). LI values exhibited a statistically significant correlation with two-class BCI (left vs. right) performance (r = −0.732, p discrimination of BCI-inefficient users. These results demonstrated that the proposed BCI predictors were promising to promote the BCI usage in stroke rehabilitation and contribute to a better understanding of the BCI-inefficiency phenomenon in stroke patients. PMID:29515363

Impact of Dual Task on Parkinson's Disease, Stroke and Ataxia Patients' Gait: A Comparative Analysis

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Michelly Arjona Maciel

2014-01-01

Full Text Available Introduction: Performing dual task for neurological patients is complex and it can be influenced by the localization of the neurological lesion. Objective: Comparing the impact of dual task on gait in patients with Parkinson's disease, stroke and ataxia. Method: Subjects with Parkinson's disease (PD in initial phase, stroke and ataxia, with independent gait, were evaluated while doing simple gait, with cognitive, motor and cognitive-motor gait demand, assessing average speed and number of steps. Results: Ataxia and stroke patients, compared with PD, showed an increase in the number of steps and decrease the average speed on the march with cognitive demand. Subjects with PD performed better on tasks when compared to others. Conclusion: In this study the impact of dual task was lower in Parkinson's disease patients.

Mild Hypokalemia and Supraventricular Ectopy Increases the Risk of Stroke in Community-Dwelling Subjects

DEFF Research Database (Denmark)

Mattsson, Nick; Kumarathurai, Preman; Larsen, Bjørn Strøier

2017-01-01

.0±6.94 versus 64.0±6.66 years; Pconfidence interval, 1.04-3.28) after...... covariate adjustments, as well as in a competing risk analysis with death (hazard ratio, 1.51; 95% confidence interval, 1.12-2.04). Excessive supraventricular ectopic activity was also associated with stroke (hazard ratio, 2.23; 95% confidence interval, 1.33-3.76). The combination of hypokalemia...

The Reliability and Validity of the Rosenberg Self-Esteem Scale with Japanese Patients After Stroke

OpenAIRE

篠原, 純子; 児玉, 和紀; 迫田, 勝則; 金久, 重子; 百本, 文子

2002-01-01

The reliability and validity of the Rosenberg Self-Esteem Scale with Japanese patients after stroke was examined. Subjects were outpatients between 6 months and 3 years post stroke of cerebral infarction. Two kinds of Self-Esteem were examined. One was that of the present time. The other was that of the past time (Respondents recalled their Self-Esteem before having a stroke). The respondents were 38 people who consisted of 26 males and 12 females. Twenty-eight of thirty-eight respondents ans...

Upper-limb sensory impairments after stroke: Self-reported experiences of daily life and rehabilitation

Directory of Open Access Journals (Sweden)

Håkan Carlsson

2017-10-01

Full Text Available Objective: To describe stroke survivors’ experiences of sensory impairment in the upper limb, the influence of such impairment on daily life, coping strategies used, and sensory training for the affected hand. Design: A qualitative study with a content analysis approach. Subjects: Fifteen post-stroke patients interviewed individually. Results: Five categories emerged from the data: “Changed and varied perception of the sensation”; “Affected movement control”; “Problems using the hand in daily life”; “Various strategies to cope with upper limb disability”; and “Lack of sensory training”. Numbness and tingling, changes in temperature sensitivity, and increased sensitivity to touch and pain were reported. Many subjects had difficulty adjusting their grip force and performing movements with precision. It was problematic and mentally fatiguing managing personal care and carrying out household and leisure activities. Practical adaptations, compensation with vision, increased concentration, and use of the less affected hand were strategies used to overcome difficulties. Despite their problems very few subjects had received any specific sensory training for the hand. Conclusion: Stroke survivors perceive that sensory impairment of the upper limb has a highly negative impact on daily life, but specific rehabilitation for the upper limb is lacking. These findings imply that the clinical management of upper limb sensory impairment after stroke requires more attention.

Texture analysis of computed tomography images of acute ischemic stroke patients

International Nuclear Information System (INIS)

Oliveira, M.S.; Castellano, G.; Fernandes, P.T.; Avelar, W.M.; Santos, S.L.M.; Li, L.M.

2009-01-01

Computed tomography (CT) images are routinely used to assess ischemic brain stroke in the acute phase. They can provide important clues about whether to treat the patient by thrombolysis with tissue plasminogen activator. However, in the acute phase, the lesions may be difficult to detect in the images using standard visual analysis. The objective of the present study was to determine if texture analysis techniques applied to CT images of stroke patients could differentiate between normal tissue and affected areas that usually go unperceived under visual analysis. We performed a pilot study in which texture analysis, based on the gray level co-occurrence matrix, was applied to the CT brain images of 5 patients and of 5 control subjects and the results were compared by discriminant analysis. Thirteen regions of interest, regarding areas that may be potentially affected by ischemic stroke, were selected for calculation of texture parameters. All regions of interest for all subjects were classified as lesional or non-lesional tissue by an expert neuroradiologist. Visual assessment of the discriminant analysis graphs showed differences in the values of texture parameters between patients and controls, and also between texture parameters for lesional and non-lesional tissue of the patients. This suggests that texture analysis can indeed be a useful tool to help neurologists in the early assessment of ischemic stroke and quantification of the extent of the affected areas. (author)

Multilingual Validation of the Questionnaire for Verifying Stroke-Free Status in West Africa.

Science.gov (United States)

Sarfo, Fred; Gebregziabher, Mulugeta; Ovbiagele, Bruce; Akinyemi, Rufus; Owolabi, Lukman; Obiako, Reginald; Akpa, Onoja; Armstrong, Kevin; Akpalu, Albert; Adamu, Sheila; Obese, Vida; Boa-Antwi, Nana; Appiah, Lambert; Arulogun, Oyedunni; Mensah, Yaw; Adeoye, Abiodun; Tosin, Aridegbe; Adeleye, Osimhiarherhuo; Tabi-Ajayi, Eric; Phillip, Ibinaiye; Sani, Abubakar; Isah, Suleiman; Tabari, Nasir; Mande, Aliyu; Agunloye, Atinuke; Ogbole, Godwin; Akinyemi, Joshua; Laryea, Ruth; Melikam, Sylvia; Uvere, Ezinne; Adekunle, Gregory; Kehinde, Salaam; Azuh, Paschal; Dambatta, Abdul; Ishaq, Naser; Saulson, Raelle; Arnett, Donna; Tiwari, Hemnant; Jenkins, Carolyn; Lackland, Dan; Owolabi, Mayowa

2016-01-01

The Questionnaire for Verifying Stroke-Free Status (QVSFS), a method for verifying stroke-free status in participants of clinical, epidemiological, and genetic studies, has not been validated in low-income settings where populations have limited knowledge of stroke symptoms. We aimed to validate QVSFS in 3 languages, Yoruba, Hausa and Akan, for ascertainment of stroke-free status of control subjects enrolled in an on-going stroke epidemiological study in West Africa. Data were collected using a cross-sectional study design where 384 participants were consecutively recruited from neurology and general medicine clinics of 5 tertiary referral hospitals in Nigeria and Ghana. Ascertainment of stroke status was by neurologists using structured neurological examination, review of case records, and neuroimaging (gold standard). Relative performance of QVSFS without and with pictures of stroke symptoms (pictograms) was assessed using sensitivity, specificity, positive predictive value, and negative predictive value. The overall median age of the study participants was 54 years and 48.4% were males. Of 165 stroke cases identified by gold standard, 98% were determined to have had stroke, whereas of 219 without stroke 87% were determined to be stroke-free by QVSFS. Negative predictive value of the QVSFS across the 3 languages was 0.97 (range, 0.93-1.00), sensitivity, specificity, and positive predictive value were 0.98, 0.82, and 0.80, respectively. Agreement between the questionnaire with and without the pictogram was excellent/strong with Cohen k=0.92. QVSFS is a valid tool for verifying stroke-free status across culturally diverse populations in West Africa. © 2015 American Heart Association, Inc.